Yisheng Intelligence Shines at National Healthcare Security Administration Awards with Smart Medical Records Solution Powering DRG/DIP Reform

September 24DayThe Award Ceremony for the Smart Medical Insurance Solutions Competition, hosted by the National Healthcare Security Administration, was held in Beijing., Hu Jinglin, Secretary of the Party Leadership Group and Director of the National Healthcare Security Administration; Shi Zihai, Yan Qinghui, Members of the Party Leadership Group and Deputy Directors of the National Healthcare Security Administration;Shen Jiangying, Member of the Party Committee, Director, and Vice President of Xinhua NetLeaders attended the award ceremony. The Smart Healthcare Security Solutions Competition is the first major national competition focused on smart healthcare security, organized by the National Healthcare Security Administration since its establishment. The competition focuses on exploring and addressing bottlenecks, pain points, and challenging issues in healthcare security work. Guided by the mindset of smart healthcare security, it solicits solutions from across China that leverage technologies such as big data, cloud computing, the internet, and artificial intelligence. It aims to attract enterprise teams with deep industry expertise to actively identify practical problems in the healthcare security field, offering insights and contributing wisdom to advance the development of healthcare security.

In November 2021, the National Healthcare Security Administration issued the Three-Year Action Plan for DRG/DIP Payment Method Reform, marking the commencement of comprehensive nationwide coverage of DRG/DIP payment methods. As DRG/DIP reimbursement under medical insurance relies entirely on medical record data, the quality of such data has become a critical foundation determining the success or failure of the DRG/DIP payment reform. However, hospital medical records face numerous persistent practical challenges, and inaccurate medical record data can significantly impact the interests of both medical insurance authorities and hospitals.

Hu Jinglin, Secretary of the Party Leadership Group and Director of the National Healthcare Security Administration (NHSA), stated that the NHSA attaches great importance to the development of smart healthcare security. Since its establishment in 2018, the administration has regarded the construction of a nationally unified healthcare security information system as a crucial measure to advance the implementation of healthcare security reforms. In 2021, the State Council issued the 14th Five-Year Plan for National Healthcare Security, which proposed the concept of “smart healthcare security” at the national level for the first time and designated it as one of the strategic goals under the “Five Healthcare Securities” framework. With effective government guidance and active participation from all sectors, smart healthcare security is injecting robust vitality and boundless energy into China’s healthcare security sector. Currently, China has preliminarily established a healthcare security information system characterized by nationwide uniformity, high efficiency and compatibility, as well as convenience and security, laying a solid foundation for the in-depth application of smart healthcare security.

Hu Jinglin stated that, moving forward, healthcare security authorities at all levels across China must fully leverage the role of the national unified healthcare security information platform, continuously advance the standardization of healthcare security informatization, strive to create an open and inclusive environment, and promote the implementation and application of various outstanding smart healthcare security solutions.

Beijing Yisheng Intelligent Technology Co., Ltd. (hereinafter referred to as “Yisheng Intelligence”) has developed a smart medical record solution based on cutting-edge global artificial intelligence technologies, leveraging five years of accumulated expertise and integrated with real-world clinical practices. This solution provides robust support for the accuracy of baseline data in medical records under the DRG/DIP payment systems of China’s national healthcare insurance program. Owing to these strengths, Yisheng Intelligence advanced through rigorous preliminary, semi-final, and final rounds, impressing the judging panel with its practical and implementable product philosophy, leading-edge technical solutions, and outstanding real-world application metrics, thereby securing first place in the Medical Record Quality Control track. Among the 18 teams nationwide that reached the finals, Yisheng Intelligence ranked fourth overall and was awarded the Second Prize of the competition, emerging as the most prominent startup team amidst industry giants such as Tencent, Ping An, Taikang, and Baidu.

Yisheng Intelligent’s Smart Medical Record Solution adheres to national clinical quality standard systems, benchmarks against feedback from clinicians at top-tier hospitals, and leverages proprietary intelligent technologies to fundamentally address the practical challenge of significant DRG/DIP settlement deviations caused by inaccurate data. This solution delivers three key values for the reform of medical insurance DRG/DIP payment methods:

First, ensure that complete medical record data authentically and accurately reflects the diagnosis and treatment process as well as resource consumption, thereby guaranteeing the accuracy of DRG/DIP settlements. This approach not only enhances the efficiency of health insurance fund utilization but also safeguards the reasonable revenue of healthcare institutions, achieving a win-win outcome for both health insurance payers and hospitals.

Second, aggregated analysis based on high-quality medical record data provides more accurate data support for healthcare insurance decision-making and regulation, and drives the calculation and continuous optimization of DRG/DIP payment systems.

Third, it provides intelligent quality control and verification tools for the supervision of medical insurance funds and internal hospital management, making efficient and intelligent large-scale full medical record audits possible.

Currently, Yisheng Intelligent’s solutions have gained widespread recognition and acclaim from users. Validated by numerous clients, including top-tier Grade A tertiary hospitals across China, the clinical adoption rate has exceeded 98% (i.e., 98% of the medical record defects identified by Yisheng AI are recognized and adopted by clinicians). The system’s high accuracy and clinical adoption rate are attributed to Yisheng Intelligent’s specialized reinforcement learning algorithm for medical record quality control, which has been meticulously refined and accumulated over time. This algorithm enables machines to deeply understand the medical logical connotations within medical records through self-learning and iterative improvement, thereby addressing the long-standing challenge of significantly enhancing the intrinsic quality of medical records.

With the comprehensive coverage of the national healthcare insurance DRG/DIP payment reform, refined hospital management and high-quality development have become an inevitable trend. High-quality medical data, centered on medical record data, will serve as the infrastructure supporting medical management, operations, decision-making, and regulation. In the future, Yisheng Intelligent, leveraging its leading technology and truly implementable products, will focus on improving foundational data quality and medical care quality, thereby unlocking broader application scenarios and greater potential for innovation.