【作者】 黄勇；

【导师】 惠孛； 李雄华；

【作者基本信息】 电子科技大学 ， 软件工程（专业学位）， 2014， 硕士

【摘要】 按照“信息广州、智慧广州”提出的深入推进社会保障信息化的相关指导思想,为进一步健全广州市医疗保险体系,增进医疗保险基金对抗风险及互济能力,提升医保待遇和服务管理水平,需要完成广州市医疗保险信息系统的重新架构开发,实现市级统筹和城乡医保一体化相关工作。更新架构后的系统包含全部医疗保险业务,适合人社局医疗保险政策扩充的需求,为各经办机构、医疗机构、保险对象提供完备的服务,达到社会服务平等均一化、推进实现“和谐广州”目标。针对本项目,作者所在团队对广州市医疗保险业务深入分析后,通过对医保政策的研究,提出了以险种为基础,以保险要素(参保人、保险费、待遇、支付)为特征的方法库思想,采用面向对象、构件化的设计方法和多层软件体系结构等先进的设计思想,遵循软件工程的要求,采用架构重构和功能继承相结合的原则进行系统开发,以现有医疗保险管理信息系统为基础,按照“七统一”方式(即统一技术和应用标准、统一网络平台、统一数据库平台、统一应用平台、统一办公自动化平台、统一信息安全设施、统一资源管理平台),结合SOA、云计算等先进技术,根据“金保工程”(二期)、社会保险核心系统三版平台的建设要求,对系统架构进行重构,及对业务功能补充、完善,保障了开发出来的系统具备可扩充性、可维护性、先进性和安全性。并将原有系统中存在的巨量历史业务数据准确、无缝割接到新系统,从根本上解决之前广州市多个医保统筹区各自使用不同的医保系统,无法进行医保业务市级统筹的问题、由政策变化引起的系统重复开发问题,和原有系统功能不全、性能低下、维护不易等一系列问题。新系统业务特点:实现多险合一业务;支持一个数据中心、多个统筹区;设计上突破系统现有险种、可比较方便地扩充险种;实现可灵活配置的多级业务经办;实现多种服务终端便捷高效延伸;完善内控稽核,确保基金安全;提升绩效考核管理水平;实现异地就医联网即时结算;实现医保关系联网转移接续;建立统一基本信息库,实现信息共享;并对多种城乡业务实现灵活网络接入方式、多种缴费方式、移动业务经办、身份信息自动采集等新功能。新系统技术特点:医疗待遇计算模型基于云计算,以方法库思想适应政策变化,采用三层体系技术支持业务的多样性及其扩充,全面的医院接口方案,对C/S/S结构与B/S/S结构的双兼容,采用服务构件热装载管理引擎提供了全天侯服务,纯业务接口,隐式传参使程序架构更清晰,更稳定。目前,该系统已经服务于广州市800余万医保参保人群、定点医疗机构670余家、定点药店1000余家,取得了良好的社会经济效益。系统从启动到实施上线经历两年,本文作者作为广州市医疗保险信息系统的项目部核心成员,负责系统部分功能模块,如医疗机构管理、个人综合查询、药品目录维护模块的设计与实现,参与了该系统的前期需求调研、软件架构确定、系统设计分析等大部分建设流程。本文对项目采用的关键技术、项目需求、设计依据、开发流程及作者负责模块的实现方法做了简要阐述。更多还原

【Abstract】 According to the guiding ideology " Information Guangzhou, wisdom Guangzhou" related to further promote the social security information,in order to improve the system of Guangzhou medical insurance system, enhancing the ability against medical insurance fund risks and helping each other in all aid, improving the management level of the medical insurance benefits and services, we need to complete re-architecture the Guangzhou medical insurance system, achieve co-ordination and integration of municipal and rural health care related work.Reconstructed system covers all Medicare services, can meet the needs of the development of Guangzhou health insurance policy. The system provide more and better services for health insurance agencies, medical institutions, and the majority of the insured people, to achieve the target equalization of public services, and build a harmonious Guangzhou.For this project, the author team put forward on the basis of danger to plant, to insurance elements(ginseng, insurance premium, treatment, payment) of method library thoughts for Guangzhou medical insurance business in-depth analysis of the health insurance policy through research, characterized by adopting object-oriented, component-based design method and multi-layer software architecture, such as advanced design idea, and use the architecture refactoring and the principle of combining inheritance function in terms of system development. On the basis of the existing medical insurance management information system, according to the way of "seven"(that is, the technology and application of standard, unified network platform, unified database platform, unified application platform and office automation platform, unified information security facilities and resources management platform), combining with the advanced technology such as SOA(Service-Oriented Architecture), cloud computing, according to The Golden Social Security Project(phase ii), 3 edition platform for the construction of the core of social insurance system, we reconstruction this system architecture, supplement and complete business function. The original system of huge amounts of historical business data are accurated and seamless cutted over to the new system, security system has developed the scalability and maintainability, sophistication, and security. The project is fundamentally solves the multiple health care as a whole which the area respectively use different health care system in Guangzhou before, solves the problem of municipal health business as a whole, iterative development problems caused by changes in policy system, and a series of problems such as the original system function is not complete, poor performance, maintenance and so on.The new system has the following business characteristics: multi-in-one insurance business; support a data center, a number of co-ordination zone; breakthrough in the design of the existing insurance system which can be relatively easy to expand insurance; achieve flexible configuration of multi-level business managers; achieve a variety of convenient and efficient service terminal extension; improve internal control audits, ensure their security; enhance the performance appraisal management level; realize remote medical networked real-time settlement; achieve the transfer of insurance relationship networking connection; establish a unified basic information database, information sharing. And for a variety of urban and rural business, add some new features such as variety of urban and rural services network access flexible, mobile business manager, a variety of payment methods, identity information collected automatically, etc.The new system technical characteristics:The calculation model of medical treatment based on Cloud Computing, using the method base thought to adapt to changes in policy, adopting the three layer system technology to support business diversity and its extension, comprehensive hospital interface scheme, the double compatible of the C/S/S structure and B/S/S structure. Service components heat load management engine provides service 24 hours a day Pure business interface, and concealed passing parameters make the program structure more clearly, more stable.Now, the system has been in the service of more than 800 insurance ginseng protect people in Guangzhou, more than 670 medical establishment that decide a dot, more than 1000 drugstore that decide a dot, achieved good economic and social benefits.It took two years for the system from start to implement on-line. The author is a core member of the project department of Guangzhou City medical insurance information system, mainly in charge of the overall system function modules,such as the design and implementation for the modules of the management of medical institutions, comprehensive query, drug directory maintenance. The author took part in most of the construction processes, include the system needs of the preliminary investigation, the determination of the software architecture, the analysis of the system design,etc.In this paper, the author briefly described the key technologies, the project requirements, the design basis, the development process, and the implementation methods of the modules which the author in charged of.更多还原