How can Deep Learning Retrieve the Write-Missing Additional Diagnosis from Chinese Electronic Medical Record For DRG
This addresses a common and serious issue in healthcare under DRG systems, where missing diagnoses can lead to incorrect medical insurance payments, but it is incremental as it applies existing NLP methods to a new domain.
The paper tackles the problem of detecting write-missing diagnoses in Chinese electronic medical records, which are diseases documented in records but omitted in discharge diagnoses, affecting DRG grouping accuracy. They propose a framework with three modules, achieving interpretable results and verifying its value in a hospital setting.
The purpose of write-missing diagnosis detection is to find diseases that have been clearly diagnosed from medical records but are missed in the discharge diagnosis. Unlike the definition of missed diagnosis, the write-missing diagnosis is clearly manifested in the medical record without further reasoning. The write-missing diagnosis is a common problem, often caused by physician negligence. The write-missing diagnosis will result in an incomplete diagnosis of medical records. While under DRG grouping, the write-missing diagnoses will miss important additional diagnoses (CC, MCC), thus affecting the correct rate of DRG enrollment. Under the circumstance that countries generally start to adopt DRG enrollment and payment, the problem of write-missing diagnosis is a common and serious problem. The current manual-based method is expensive due to the complex content of the full medical record. We think this problem is suitable to be solved as natural language processing. But to the best of our knowledge, no researchers have conducted research on this problem based on natural language processing methods. We propose a framework for solving the problem of write-missing diagnosis, which mainly includes three modules: disease recall module, disease context logic judgment module, and disease relationship comparison module. Through this framework, we verify that the problem of write-missing diagnosis can be solved well, and the results are interpretable. At the same time, we propose advanced solutions for the disease context logic judgment module and disease relationship comparison module, which have obvious advantages compared with the mainstream methods of the same type of problems. Finally, we verified the value of our proposed framework under DRG medical insurance payment in a tertiary hospital.