Dareway DRG/DIP One-Stop Solution Gains Recognition by Leveraging Electronic Medical Records Across Public and Private Hospitals
On December 28, 2020, the National Health Commission (hereinafter referred to as the NHC) issued the Accreditation Standards for Tertiary Hospitals (2020 Edition) (hereinafter referred to as the 2020 Standards). Compared with the 2011 edition, the 2020 Standards place significant emphasis on Diagnosis-Related Groups (DRGs). In particular, DRG-based indicators are integrated throughout Part II, which accounts for no less than 60% of the overall accreditation score, serving as one of its core themes. It is no exaggeration to state that hospitals must be familiar with and effectively utilize DRGs as a management tool to successfully pass the accreditation.
Prior to this, the National Healthcare Security Administration (NHSA) had already been vigorously promoting the application of Diagnosis-Related Groups (DRG) in medical insurance settlements. In May 2019, the NHSA announced pilot programs for DRG-based payment in 30 cities and released the Technical Specifications for China Healthcare Security DRG (CHS-DRG) and the A-DRG grouping scheme in October of the same year. On June 18, 2020, the NHSA further issued Version 1.0 of the CHS-DRG Subgrouping Scheme, completing the preparatory work on grouping schemes prior to the full implementation of CHS-DRG.
On November 4, 2020, the National Healthcare Security Administration announced the pilot implementation of DIP payment (global budgeting based on regional points and case-mix index-based payment) in medical insurance settlements across 71 pilot cities. On November 20, it issued the technical specifications for DIP and the disease category database. Although DIP differs from DRG in grouping methodology, they are identical in essence and principle, as both classify cases according to specific principles; thus, DIP can be regarded as a variant of DRG.
Through this series of measures, DRG has firmly established its core role in both performance evaluation and health insurance settlement. From any perspective, the momentum behind DRG adoption is unstoppable. It will become an essential tool that hospitals must understand, master, and leverage effectively in the future. Addressing key pain points faced by hospitals, Beijing Darui Jisi Technology Co., Ltd. (hereinafter referred to as “Darui Jisi”) has developed a one-stop, closed-loop DRG solution, which has been successfully implemented in multiple hospitals with favorable outcomes.
From the perspective of corporate registration, Darui Jisi, established in June 2016, is undoubtedly a young company. However, the story is quite different when viewed from the team’s standpoint. “Our founding team has over 20 years of experience in healthcare informatization, previously focusing primarily on the development of software such as electronic medical records (EMR) and clinical pathways,” said Tan Xiaogang, Founder and CEO of Darui Jisi.
Tan Xiaogang, Founder and CEO of Darui Jisi (Image from Darui Jisi)
“In the second half of 2015, we identified DRG as a field with immense potential. From that point on, we began preparing to establish a company dedicated to addressing DRG-related challenges, with the official incorporation taking place in 2016,” added Tan Xiaogang. The founding team chose a resonant name for the new venture: “Da Rui Ji Si.” “Da Rui Ji Si” is a homophone for DRGs in Chinese, while “Ji Si” conveys the meaning of “pooling wisdom to create value in healthcare management.”
A prerequisite for implementing Diagnosis-Related Groups (DRG) is high-quality data collection, which is closely tied to electronic medical records (EMR) and the front page of medical records. Leveraging years of accumulated expertise in EMR and medical record front pages, the core team of Darui Jisi enabled the newly established company to become one of the first four enterprises authorized by the National Health Commission to use the CN-DRG grouper (the other three being well-known listed companies in the healthcare informatics sector).
In January 2017, Beijing Tiantan Hospital, as a pilot hospital for Drgs under the Darui Jisi initiative, became an in-house model for DRG application and presented its experience at the National Healthcare Reform Research Conference. Subsequently, in 2018, the DRG quality control system at Beijing Friendship Hospital and the intelligent coding system at Beijing Hospital were launched one after another. In 2019, the DRG platforms for provincial and municipal Health Commissions, as well as the DRG platform for the Beijing Children’s Hospital Medical Consortium, were implemented. This newly established company quickly secured its industry standing, demonstrating convincing professionalism.
In the subsequent upgrades and iterations of its products, Darui Jisi has also responded with remarkable speed. In June 2020, the National Healthcare Security Administration released the CHS-DRG subgrouping scheme, and the company launched its CHS-DRG solution in July. On November 20, 2020, the National Healthcare Security Administration issued the DIP grouping specifications; within less than ten days, Darui Jisi rolled out its DIP solution.
Tan Xiaogang stated that, based on his previous experience specializing in electronic medical records (EMRs), the quality of medical records in Chinese hospitals is uneven. While major cities fare relatively better, the quality of EMRs in some remote areas remains unsatisfactory. However, relevant authorities have gradually taken note of this issue and initiated measures to address it, including the establishment of the HQMS data quality monitoring system for medical record face sheets.
In 2011, China established the Direct Reporting System for Medical Service Supervision and Information Network and launched pilot programs for direct reporting via this network. In 2012, the system was transformed into the Hospital Quality Monitoring System (HQMS), managed by the HQMS Research Center, and achieved automatic data acquisition from all tertiary hospitals nationwide starting December 31, 2012.
This platform primarily leverages medical record face sheets and extended data to audit various medical process information generated within hospitals, with a particular focus on healthcare quality data, ensuring compliance with reporting standards and enabling hospitals to submit real-time data on a daily basis. Furthermore, the National Health Commission has successively established the National Medical Record Management Quality Control Center and the DRG Quality Control Center, which are responsible for quality control of medical record face sheet data and DRG-related quality control, respectively.
“Although various provinces made revisions to the standards during this process, the overarching principle of these revisions has been toward increasing granularity, with ever-higher requirements for data quality. Therefore, while data quality was not particularly good at that time, we believe the trajectory is inevitably positive. Data quality is invariably driven to improve through practical application.” Tan Xiaogang believes that with the implementation of DRG-based payment, data quality can be significantly enhanced in the short term.
Addressing the pain points associated with the deployment and application of historical electronic medical records (EMRs) and medical record face sheets, Darui Jisi has adopted multiple measures to enhance medical record quality control. These measures primarily include comprehensive coverage across the entire workflow—pre-event planning, in-process monitoring, and post-event analysis—as well as functionalities such as pre- and in-process grouping prediction, intelligent coding assistance during the process, data quality control both during and after the process, clinical decision support, and clinical pathway management.
Comprehensive coverage of the entire process—pre-admission planning, in-process monitoring, and post-discharge analysis—enables optimized triage recommendations and treatment planning for admitted patients by integrating admission diagnoses with the hospital’s leading disciplines, departments, and disease groups. For inpatients, it provides comprehensive in-process management capabilities for physicians, departments, and the entire hospital, offering regulatory analysis and decision-support tools for quality control, real-time grouping, intelligent coding assistance, optimization of clinical treatment protocols, and cost structure. The post-event analysis function delivers holistic analysis and decision support across various organizational levels—including the entire hospital, departments, wards, and primary care teams—as well as for individual physicians, while also evaluating the hospital’s disciplinary strengths and disease group profiles.
Pre- and intra-event group prediction can provide auxiliary tools for departments and physicians to optimize treatment plans and control costs reasonably; it can also be integrated into physician workstations with management authorization, thereby seamlessly embedding into hospital workflow processes.
Building on years of expertise in electronic medical records (EMR), Darui Jisi’s DRG solution comprehensively supports intelligent coding assistance for medical record front pages and clinical progress notes. Leveraging the latest AI, machine learning, and natural language processing (NLP) technologies, it provides an integrated intelligent coding API that can be seamlessly embedded into hospital HIS/EMR physician workstations and other clinical workflows. This enhances coding accuracy and efficiency, thereby alleviating the coding workload for hospitals.
“The application of artificial intelligence in medical record front pages and clinical course documentation is, in my view, highly targeted and valuable. Through big data training, AI can directly codify clinical rules, providing targeted and effective support for hospitals in conducting quality control during and after care delivery. Our related solutions have been successfully implemented at benchmark institutions such as Beijing Hospital and Jinhua Central Hospital,” added Tan Xiaogang.
In-process and post-event data quality control enables analysis of in-process quality control and post-event quality control statistics for medical record front pages and health insurance settlement lists. The solution embeds a vast library of quality control rules and supports hospital-based experts in independently defining and extending rules. Furthermore, the solution supports custom quality control rules and automatically calculates scores in accordance with the rules established by the National Health Commission.
Tan Xiaogang stated that this quality control approach can effectively enhance the quality of medical records: “The system enables decentralized management during its application. In other words, various clinical departments, including physicians themselves, have corresponding accounts to access relevant information. We provide quality control alerts for medical records with substandard data quality, specifying which fields are non-compliant. Moreover, these alerts are increasingly shifting toward real-time intervention, providing immediate feedback during the documentation process. This is highly beneficial for improving the quality of medical records.”
“We have seen cases where the initial case enrollment rate was only in the mid-60s percentile, but rapidly increased to over 90% within one to two months. Currently, during the implementation of DRG systems in many large hospitals, we are able to significantly improve the data quality of medical record front sheets within 1–3 months,” he added.
Finally, there is clinical decision support and pathway management. This function can embed comprehensive prompt tools in the pre-event and during-event stages to achieve integrated process control and decision support. Meanwhile, it can also implement phased optimization management by combining with the disease course, conducting process supervision according to hospitalization procedures (such as admission examination and diagnosis, preoperative preparation, postoperative days 1-3, nursing rehabilitation, and other diagnostic and treatment steps) or daily medical orders, thereby achieving process optimization and process control.
In terms of system architecture, Darui Jisi’s fully closed-loop DRG/DIP solution adopts a pure B/S architecture and leverages the cloud-based SaaS model to integrate clinical pathways, EMR, management and operations, performance evaluation, quality control, and health insurance cost containment. This design not only accommodates public hospitals but is also highly suitable for a wide range of private hospitals.
“DRG is a systemic issue. Regardless of whether they are public or private, any hospital with inpatient beds that is connected to the medical insurance system must address the challenges posed by DRG. Relatively speaking, I believe private hospitals will face a greater impact. Therefore, private hospitals with strong management awareness attach great importance to this. For example, iKang Healthcare Group owns an outstanding private Grade-A tertiary hospital, Huangshi iKang Hospital. They have placed significant emphasis on DRG and partnered with us last year to implement an in-hospital DRG system. Currently, the application of this system at the hospital is deepening, including integration with local disease-based point value methods.”
In terms of coverage, Darui Jisi’s DRG/DIP platform encompasses three major categories: the Healthcare Security Administration platform, the National Health Commission platform, and the Medical Consortium platform. The hospital-side platforms include the Specialty DRG/DIP Platform, the Hospital DRG/DIP Platform, and the Commercial Insurance DRG/DIP Intelligent Underwriting Platform.
In the latest DIP solution, Darui Jisi’s DIP grouping algorithm fully supports and complies with the DIP Grouping Technical Specifications issued by the National Healthcare Security Administration (NHSA), as well as the DIP grouping catalog derived from calculations based on tens of millions of medical records. It provides recommended DIP payment point values validated through real-world application scenarios. Furthermore, the solution can be integrated with the MDC and ADRG components of the CHS-DRG Grouping Technical Specifications, facilitating the establishment of management indicators by healthcare security platforms and enabling unified supervision. Related products have been successfully implemented in Guangdong, Sichuan, Hebei, and other regions.
“We are actually among the first companies in China to launch a DIP solution—we introduced our DIP solution as early as November 2020 and presented it to relevant leaders. It has now been implemented both at the National Healthcare Security Administration and in hospitals. We generally believe that the promotion of DIP facilitates the reform of the medical insurance payment system, which is a very positive development.” When discussing DIP, Tan Xiaogang shared his views: “At present, DRG and DIP each have their own focuses, advantages, and disadvantages. I believe that in practice, the two may coexist for a period, learning from and integrating with each other, ultimately forming a comprehensive system for medical insurance payment reform with Chinese characteristics.”
Currently, Dairui Jisi’s CHS-DRG/DIP solutions have been successfully implemented in over one hundred Grade 3A hospitals across China. Leading institutions such as Beijing Tiantan Hospital (National Center for Neurological Disorders), Beijing Children’s Hospital (National Center for Children’s Health), Beijing Hospital (National Center for Gerontology), Qilu Hospital of Shandong University, Fujian Medical University Union Hospital, Zhejiang Cancer Hospital, Jinhua Central Hospital, and Siping Central Hospital have all adopted the system and provided favorable evaluations.
“To summarize in one sentence, Darui Jisi is a professional, focused, and innovative provider of integrated DRG and DIP solutions. By ‘integrated,’ we mean that we offer a comprehensive, closed-loop solution covering pre-event, intra-event, and post-event stages.” This is how Tan Xiaogang describes the positioning and vision of Darui Jisi.
Currently, Darui Jisi has launched a new round of financing.