浅析电子健康档案的建设

电子健康档案是协调医疗保健专业人员工作的必备工具,可以最大限度地实现健康信息的共享。本文探讨了电子健康档案的作用,并且分析了我国电子健康档案的发展现状,结合电子健康档案发展中面临的问题和挑战,对电子健康档案的建设提出了几点建议。     

电子健康档案的发展与现状综述

通过分析电子健康档案在国内外发展历程和在我国的现状,从标准、体制、实施、应用等方面总结了中国电子档案当前所面临的问题。参考成功的中国电子档案建设实施经验,总结并得出中国电子档案建设实施工作的建设重点。     

军人电子健康档案设计与功能

本文通过界定军人电子健康档案概念,从国际信息化发展、国家信息化建设和官兵健康需求变化三个方面,系统分析建设军人电子健康档案的勤务需求,提出军人电子健康档案的设计思路、设计原则、系统架构和勤务功能,为我军卫勤信息化建设提供参考.     

基于云计算的电子健康档案系统建设理念与实践

电子健康档案(Electronic Health Records,EHR)是人们在健康相关活动中直接形成的具有保存备查价值的电子化历史纪录,是医疗卫生管理和临床诊疗决策的重要依据。借助云计算的理念和技术建设标准化的电子健康档案体系和系统,对于节约建设经费、降低维护成本、推进数据标准化、提高资源利用率具有巨大的应用价值。笔者从云计算的网络特点和基础架构出发,依据电子健康档案系统的应用目标和发展方向,提出了以居民健康为对象,在传送健康信息的同时,传送健康服务、传送计算能力的电子健康档案系统建设新理念,并据此探讨了标准化电子健康档案系统的建设方法和区域实践。     

国外电子健康档案应用进展分析

通过回顾国外建设电子健康档案的发展历程、数据标准和关键技术,比较发达国家电子健康档案应用现状,总结影响健康档案成功应用的5项关键因素,为推进电子健康档案与结核病人管理信息系统的融合提供一定的借鉴.     

“以人为本”视角下居民电子健康档案建设的问题探讨

该文主要阐述了电子健康档案建设中＂以人为本＂的意义;以及在电子健康档案建设的整个过程中＂以人为本＂的体现和还需完善的方面。最后提出电子健康档案的建设,站在其他群体的立场上,多角度、全方面地思考,将＂以人为本＂的理念贯穿于电子健康档案建设的整个过程中。     

电子健康档案符合性测试的提出与设计

卫生信息化建设已然成为世界各国推进卫生服务可及性过程中重要的关注点。在审视我国以电子健康档案和电子病历为核心的卫生信息化建设理论研究和实践探索的基础上,阐述了电子健康档案符合性测试的内涵和基本特征,深入探讨电子健康档案符合性测试点要求和用例设计,并提出电子健康档案符合性测试的基本思路、技术路线和测试管理流程。     

居民电子健康档案管理的研究进展

新时期的卫生事业对于推动医疗改革更为重视,信息技术不断应用到医疗卫生事业中,因此,居民电子健康档案被逐渐提及,并应用到实际医疗卫生事业工作中。早在2009年,居民电子健康档案的整体建设与规划方案就已经形成较为系统性的模型,时至今日,我国的居民电子健康档案的建档率已经达到了比较高的水平,无论居民身处何地、年龄或者职业,都可以通过互联网平台完成电子健康档案的使用。居民健康档案是我国公共卫生服务体系中的核心内容,面对新形势下的公共医疗卫生服务环境,必须要全面推进居民电子健康档案的建设与发展,从而提升医疗卫生事业管理工作的信息化水平,进而在节约医疗卫生服务成本的同时,提高管理工作质量和效率,并提高居民的满意度,给居民带来更为便民的医疗卫生服务。基于此,本文在简要分析了居民电子健康档案重要价值的基础上,综述了居民电子健康档案管理思路,为居民电子健康档案的管理提供帮助。     

美国区域卫生信息化及有效使用电子健康档案的启示

通过介绍美国区域卫生信息化发展、有效使用EHR计划、区域卫生信息化组织等,探讨推进区域卫生信息化和电子健康档案应用过程中的问题和挑战,包括公共医学术语和技术标准、电子健康档案及区域卫生信息化潜在经济效益、电子健康档案应用保障机制、区域卫生信息化水平评价及区域卫生信息化组织可持续运营等,以提供借鉴。     

构建军人电子健康档案平台存在的难点及解决方案

介绍了建立军人健康档案对于实时掌控官兵身心健康和提高官兵健康水平具有重大意义,指出了当前军队在建设军队人员电子健康档案平台时存在的问题和难点,并针对相应的不足,提出了新的思路和解决方案。根据实施电子健康档案流程,着重从理论研究、系统规范、平台建设、安全体系和共享机制等方面进行了深入分析研究,为构建军队人员电子健康档案提供了理论基础和实践经验。     

Progress along developmental tracks for electronic health records implementation in the United States

The development and implementation of electronic health records (EHR) have occurred slowly in the United States. To date, these approaches have, for the most part, followed four developmental tracks: (a) Enhancement of immunization registries and linkage with other health records to produce Child Health Profiles (CHP), (b) Regional Health Information Organization (RHIO) demonstration projects to link together patient medical records, (c) Insurance company projects linked to ICD-9 codes and patient records for cost-benefit assessments, and (d) Consortia of EHR developers collaborating to model systems requirements and standards for data linkage. Until recently, these separate efforts have been conducted in the very silos that they had intended to eliminate, and there is still considerable debate concerning health professionals access to as well as commitment to using EHR if these systems are provided. This paper will describe these four developmental tracks, patient rights and the legal environment for EHR, international comparisons, and future projections for EHR expansion across health networks in the United States.     

我国电子病历的发展与展望

本文主要介绍了美国和日本电子病历的建设现状,分析了我国医院卫生信息化建设现状与发达国家的差距,最后提出了我国电子病历的发展方向。     

Using electronic health records to help coordinate care

The use of electronic health records that can securely transmit patient data among physicians will help coordinate the care of 60 million Americans with multiple chronic conditions. This article summarizes the different organizations in the United States that are developing this technology. It discusses some of the problems encountered and the current initiatives to resolve them. The article concludes with three recommendations for enhancing care coordination: (1) a common health record, such as the Continuity of Care Record, to facilitate the exchange of clinical information among health providers; (2) regional governance structures to encourage the exchange of clinical data; and (3) payment by purchasers of care, both public and private, to physicians for using electronic health records.     

Immunization information systems use during a public health emergency in the United States.

Use of the Louisiana Immunization Network for Kids Statewide (LINKS) during the aftermath of Hurricane Katrina saved parents and immunization providers' time, money, and the inconvenience of having to unnecessarily revaccinate children displaced both inside and outside Louisiana. This immunization information system remained online via a backup system following the hurricane, thereby making immunization history data available to queries from healthcare providers caring for displaced persons both within Louisiana and throughout the United States. LINKS contained immunization records for approximately 1.5 million people of all ages at the time of the hurricane. Assessment of more than 21 000 successful electronic immunization queries of children and adolescents displaced outside Louisiana state boundaries from virtually all states estimates that more than $4.6 million was saved in revaccination expenses. The impact of recovered records for these children within Louisiana is certainly as critical. Our review illustrates the value of an immunization information system as a tool to support not only individuals, healthcare providers, and public health authorities but also the presidential vision to develop Electronic Health Records in the United States over the next 10 years.     

Documentation of body mass index and control of associated risk factors in a large primary care network

Background  

Body mass index (BMI) will be a reportable health measure in the United States (US) through implementation of Healthcare Effectiveness Data and Information Set (HEDIS) guidelines. We evaluated current documentation of BMI, and documentation and control of associated risk factors by BMI category, based on electronic health records from a 12-clinic primary care network.     

The American Recovery and Reinvestment Act: lessons learned from physicians who have gone electronic

The recently passed American Recovery and Reinvestment Act (the Act) is a landmark piece of legislation that will shape health care informatics in the United States for the foreseeable future. The Act provides financial incentives to hospitals and physicians who upgrade their medical record systems by implementing electronic versions. This article defines health care informatics, outlines the provisions of the Act and associated incentives that are available to hospitals and physicians, discusses the advantages and barriers related to upgrading to an electronic medical records system that have been identified in the literature, and details several case studies where small physician group practices put electronic medical records systems into operation. The analysis of these cases shows that the challenges faced by the physicians and practice administrators reinforce the key challenges identified in the literature. Given these seemingly common impediments, suggestions for overcoming such challenges are summarized. These key lessons should be of interest to any practice looking to upgrade their medical records system.     

Heeding humanity in an age of electronic health records: Heidegger,Levinas, and Healthcare

The American Recovery and Reinvestment Act of 2009 (ARRA) required healthcare providers in the United States to adopt and demonstrate meaningful use of electronic health records (EHRs) by January 1, 2014. In many ways, EHRs mark a notable improvement over paper medical records as they are more easily accessible and allow for electronic searching and sharing of medical history. However, as EHRs have become mandated by ARRA, many nurses now rely upon computers far more heavily during nurse–patient interactions, thereby decreasing the level of direct interpersonal communication between the two. There is evidence that eye contact between nurses and patients positively affects patient satisfaction. Above and beyond the issue of patient satisfaction is the more basic ethical issue of respecting the patient as a person. The author argues that the templates used in electronic health systems have the possibility of eroding the respect for humanity that is the hallmark of nurse–patient relationships, as signalled by the American Nurses Association’s first principle in their Code of Ethics. Using concepts from philosophers Martin Heidegger and Emmanuel Levinas, the author provides guidance as to what an ethical interaction between nurse and patient should look like in an age of EHRs.     

Electronic health records to support obesity-related patient care: Results from a survey of United States physicians

ObjectiveObesity-related electronic health record functions increase the rates of measuring Body Mass Index, diagnosing obesity, and providing obesity services. This study describes the prevalence of obesity-related electronic health record functions in clinical practice and analyzes characteristics associated with increased obesity-related electronic health record sophistication.MethodsData were analyzed from DocStyles, a web-based panel survey administered to 1507 primary care providers practicing in the United States in June, 2013. Physicians were asked if their electronic health record has specific obesity-related functions. Logistical regression analyses identified characteristics associated with improved obesity-related electronic health record sophistication.ResultsOf the 88% of providers with an electronic health record, 83% of electronic health records calculate Body Mass Index, 52% calculate pediatric Body Mass Index percentile, and 32% flag patients with abnormal Body Mass Index values. Only 36% provide obesity-related decision support and 17% suggest additional resources for obesity-related care. Characteristics associated with having a more sophisticated electronic health record include age ≤ 45 years old, being a pediatrician or family practitioner, and practicing in a larger, outpatient practice.ConclusionsFew electronic health records optimally supported physician's obesity-related clinical care. The low rates of obesity-related electronic health record functions currently in practice highlight areas to improve the clinical health information technology in primary care practice.More work can be done to develop, implement, and promote the effective utilization of obesity-related electronic health record functions to improve obesity treatment and prevention efforts.     

Anthrax vaccination in the Millennium Cohort: validation and measures of health

BACKGROUND: In 1998, the United States Department of Defense initiated the Anthrax Vaccine Immunization Program. Concerns about vaccine-related adverse health effects followed, prompting several studies. Although some studies used self-reported vaccination data, the reliability of such data has not been established. The purpose of this study was to compare self-reported anthrax vaccination to electronic vaccine records among a large military cohort and to evaluate the relationship between vaccine history and health outcome data. METHODS: Between September 2005 and February 2006 self-reported anthrax vaccination was compared to electronic records for 67,018 participants enrolled in the Millennium Cohort Study between 2001 and 2003 using kappa statistics. Multivariable modeling investigated vaccination concordance as it pertains to subjective health (functional status) and objective health (hospitalization) metrics. RESULTS: Greater than substantial agreement (kappa=0.80) was found between self-report and electronic recording of anthrax vaccination. Of all participants with electronic documentation of anthrax vaccination, 98% self-reported being vaccinated; and of all participants with no electronic record of vaccination, 90% self-reported not receiving a vaccination. There were no differences between vaccinated and unvaccinated participants in overall measures of health. Only the subset of participants who self-reported anthrax vaccination, but had no electronic confirmation, differed from others in the cohort, with consistently lower measures of health as indicated by Medical Outcomes Study 36-Item Short Form Health Survey for Veterans (SF-36V) scores. CONCLUSIONS: These results indicate that military members accurately recall their anthrax vaccinations. Results also suggest that anthrax vaccination among Millennium Cohort participants is not associated with self-reported health problems or broad measures of health problems severe enough to require hospitalization. Service members who self-report vaccination with no electronic documentation of vaccination, however, report lower measures of physical and mental health and deserve further research.     

Social work in health settings in the U.S.A.

The review of the literature on social work focuses on the development of the profession in the United States, its involvement in health areas, and some of the recent directions with which writers in the profession are concerned. The diversity of the literature, as well as the culturally defined practice nature of the profession, make cross-national comparison of patterns of development of less value. The relationship between social work in health and mental health settings is mentioned, but the literature in psychiatric social work is large enough to be the subject of a separate survey. The profession is now represented in most primary-care-giving agencies in the United States, and in public health settings as well. Practitioners meet standards of training and education in common with nationally defined norms. Future concerns of social work in health include the effects of advancing medical technology on the patient care system, the increasing life expectancy with emphasis on old age, and controlling the increase in population.