我院医院信息系统的现状和今后发展方向

医院信息系统（Hospital Information System,HIS)是指利用电子计算机和通讯设备，为医院所属各部门提供病人诊疗信息和行政管理信息的收集、存储、处理、提取和数据交换的能力，并满足所有授权用户的功能需求。我院的医院信息系统属于较完整的、集成的医院信息系统阶段，各系统之间信息高度共享。随着医疗技术和信息技术的飞速发展，医院信息系统也在不断发展、完善，我院医院信息系统将向以下四方面发展：（1）建立电子病历系统；（2）建立医学影像存档和通信系统（PACS）；（3）建立远程医疗系统；（4）与医保系统相结合；可以预见，医院信息系统在医院中应用的范围、水平将对医院的改革和现代化进程产生越来越重要的影响。     

远程心电监护系统

介绍了一种远程心电监护系统。系统由远程移动终端和医院监护中心两部分组成，远程移动终端由患者携带在身上，包括监测装置、应急治疗装置和GPS三部分，医院监护中心作为整个远程实时监护系统的中枢，其主要功能是实现远程各移动监护终端用户ECG信号的远程集中监护、存储、分析和早期诊断，以及回放、打印功能，并对各终端参数、状态的远程监控；结合GIS平台的强大空间位置分析功能实现对移动用户的地理位置跟踪、定位、显示。远程心电监护系统可以帮助医生实时监测病人的心电情况，一旦发现病发先兆，可以及时地进行有效的治疗。     

远程急救救治与指导系统设计

介绍了远程急救救治与指导系统的整体规划、具体内容、需要集成的信息及设备、涉及到的主要技术、硬件配置。强调在远程急救救治与指导系统的设计中，软硬件平台、系统功能以及同医院信息系统的集成是重点。     

边疆医院远程医疗系统开发与应用

对边疆医院远程医疗开发应用中的投资与效益、医院自身建设、人才培养、组织与管理、再开发等问题进行了分析探讨。认为；边疆医院要从实际出发来选择投资远程医疗的开发应用．要加强医院自身建设．强化复合型人才的培养．成立远程医疗管理委员会，完善管理规章制度．加强质量管理．并注重做好远程医疗的再开发工作。     

建立医院绩效评价系统的理论与实践

在医院开展绩效评价工作，对于完善医院评价系统和提高医院管理效率具有重要意义。作者提出要借鉴企业绩效评价经验和绩效管理理论，在建立医院绩效评价系统的过程中，首先，应避免片面追求经济效益，注意将医院外部评价和医院内部评价系统建设相结合，以及注重绩效评价在绩效管理中的整体作用。其次，结合医院具体管理实践，提出了构建医院、科室、岗位三级绩效评价体系；注重综合评价方法的选择；注重持续的绩效沟通和适时调整等工作方法。     

一种适合中国国情的远程专家会诊系统

介绍一种利用低成本视频会议系统和低消耗通讯费用构成的远程专家会诊系统。该系统具有病人预约信息登录、传送，图文资料获取、校正、传送，两地动态图像实时显示、白板等功能，基本满足远程会诊的要求。     

远程医学的发展与思考

根据目前远程医学发展的现状，提出了发展远程医学要坚持信息化建设与管理并举，逐步克服“异构现象”，实现与全军医院信息系统之间的无缝链接；坚持外包与自研相结合，开发远程医学专业应用软件，强调远程医学资源的共享利用。     

社区远程查房系统设计与应用

远程查房作为远程医疗的重要组成部分对于提高基层医疗卫生机构的医疗水平和质量具有重要的意义。本文以某高校医院(社区卫生服务中心)为例,对远程查房的业务流程、系统架构、系统功能和软硬件配置等进行了分析和设计,并对远程查房系统的应用效果进行了介绍。     

某省各级医院医疗设备购置管理现况分析

为了了解各级医院在医疗设备购置方面的管理现况，调查了某省10家医院的设备购置管理现况。基于调查结果和分析，提出了几点建议：(1)加强设备的购置论证；(2)加大卫生行政部门对大型医疗设备的管理力度；(3)开展设备的成本效益分析；(4)注意基础设备的配置。     

内镜图文工作站网络信息系统的设计与实现

目的：建立一种内镜图文工作站网络信息网络系统,集中管理医院内镜图文信息,帮助医生实现远程查询、远程诊断等功能。方法：利用局域网将医院所有内镜图文工作站与服务器链接,服务器负责收集所有工作站的信息,医生利用服务器完成远程查询、远程诊断等功能。结果：医院实现了内镜图文信息的统一管理,医生利用系统实现了远程病例查询和远程诊断。结论：该系统可视为医院信息系统重要组成部分。     

The organization of the medical practice and implications for delivering quality care

The attention devoted to quality in health care has focused primarily on hospitals. With the shift in care from hospitals to outpatient clinics and physicians' offices, there has emerged a need to consider how quality should be approached in these settings. This article explores the structural barriers in the typical medical practice that must be removed in order to improve the many dimensions of quality. The typical practice must concentrate on enhancing clinical outcomes, patient satisfaction, and practice productivity. One effective strategy is to form teams of physicians and other staff to work on relevant issues. Another is to focus on how the practice can be defined to better meet the needs of patients.     

The potential of telemedicine: barriers, incentives and possibilities in the implementation phase

Between 1998 and 1999, the Swedish Institute for Health Services Development (Spri) evaluated three applications in which specialist competence was being accessed via telemedicine. The results indicated that these kinds of application can be cost-effective in an organization well adapted to new technology and that telemedicine can improve continuity of care for patients. However, the new technology was seldom supported by the old organization and better education and technical support are needed. In a study called 'Incentives and Implementation', the Federation of Swedish County Councils interviewed people in Swedish health-care with a lot of experience of telemedicine. The interviewees agreed that telemedicine was likely to affect the whole structure of health-care. Peripheral competence was expected to increase and referral patterns to change, as well as the functions of the personnel and the hospitals. New working conditions and methods of work were expected to be made possible by telemedicine and health-care was expected to become more process oriented, partly because patients are likely to be more demanding and better informed. To be able to utilize this potential, health-care managers will have to show more interest in and commitment to telemedicine. Old organizational patterns must be called into question and be developed along with information technology and telemedicine. It is also important to give priority to training in telemedicine for physicians and nurses.     

中国军队远程医疗网络的建设与应用

目的：为加速军队信息化建设,增强平战时期部队卫勤保障力量,根据总后勤部卫生部计划布署,2年建成采用普通电话线通讯方式的全军远程医疗会诊网络。方法：由全军远程医学研究开发基地全面负责网络建设任务;对全军各大单位实施远程医疗专业技术集中培训,统一配置远程医疗软硬件设备,各单位自行装配建站的方法,完成互交式远程医疗网络建设。结果：全军设立大小网络站点221个;共实施远程医疗活动1500余例次,舆医学图片资料1700余张,业务范围涉及21个临床专科;应用单位满意率达92.8%。结论：军队远程医疗网络建设与应用,缓解了基层医疗单位专业技术力量不足的问题,有效地救治了大批危重疑难伤病员。通过医学专家网上医技传授,带动了我军基层医院及医务人员整体医技水平的提高,也暴露了诊疗工作中存在和急等改进的问题。     

Differences in readiness between rural hospitals and primary care providers for telemedicine adoption and implementation: findings from a statewide telemedicine survey

Purpose: Published advantages of and challenges with telemedicine led us to examine the scope of telemedicine adoption, implementation readiness, and barriers in a southern state where adoption has been historically low. We hypothesized that rural hospitals and primary care providers (RPCPs) differ on adoption, readiness, and implementation barriers. We examined the degree to which they differ on (a) telemedicine adoption or readiness; (b) telemedicine training needs; (c) current use of technology for patient care; and (d) environmental concerns in facilities for telemedicine. Methods: Paper surveys were sent to rural hospitals and RPCPs with response rates of 50% (n = 38) and 25.9% (n = 339), respectively. Three of 4 hospitals were represented. Chi‐square analyses were used to test for differences between rural hospitals and RPCPs. Findings: Compared to RPCPs, rural hospitals were significantly more likely to report higher rates of telemedicine knowledge (P= .0007); planning for or implementing telemedicine (P < .0001); and reporting their disaster recovery data systems (P= .0002) and availability and location of outlets and connections (P= .03) as adequate for telemedicine. Rural hospitals were less likely to report having no telemedicine education needs (P= .04). Conclusions: Telemedicine continues to be a viable solution for bridging geographic access gaps to a variety of specialty care. Users need assistance in understanding legal implications, care coordination, billing for services, and disaster data recovery. In rural areas, hospitals appear to best embody characteristics of facilities that successfully implement telemedicine and have the greatest degree of readiness.     

Organizational and environmental factors affecting the utilization of telemedicine in rural home healthcare

In the last five years, home health agencies have become increasingly interested in telemedicine as a potential means to meet the future healthcare needs of their aged and chronically ill clientele. This case study examines the organizational and environmental conditions that affected the implementation of a telemedicine program in one rural home healthcare organization. Several factors restricted the utilization of telemedicine, including Medicare's Prospective Payment System and corresponding documentation (Outcome Assessment and Information Set), the organization controlling grant funding for the program, and several environmental factors. Findings suggest that in rural communities, older homecare patients may have less opportunity to benefit from telemedicine. The study demonstrates the importance of environmental and organizational factors when implementing a telemedicine program. Recommendations are offered for home healthcare organizations considering development of telemedicine programs.     

谈影响县医院医疗服务能力提升现存问题及对策

目的进一步了解影响县医院医疗服务能力提升现存问题,并针对问题提出对策。方法制定了《辽宁省县级医院医疗服务能力评价标准(试行)》,对我省43家县中心医院进行了县级医院的服务能力评价。结果43家县级医院基本可以满足居民常见病、多发病诊疗,目前存在的主要问题是现代医院的管理制度欠缺,医疗质量控制和安全风险制度不完善,医务人员短缺,科室人才梯队断档,缺乏远程教育与诊治能力,信息技术人员不足,缺少信息化培训等。结论提高县级医院的服务能力需要加强政策扶植,人才引进,增加资金投入,改善医疗设备和环境,推进对口支援。同时要建立现代医院的管理制度,强化医疗质量控制,完善医疗安全风险制度,提升医院管理,加强医院信息化建设,提升远程医疗水平。     

Defining the needs of a telemedicine service

While telemedicine programme objectives, technologies and even philosophies will differ, certain common factors that enhance programme success can be identified. For example, a programme design which is driven by technological imperatives is likely to fail. It must also be recognized that telemedicine programmes cannot force remote sites to use their services. Thus developers must assess the needs for the proposed telemedicine service from a clinical, economic and technical perspective. From a clinical perspective, it is important to remember that certain clinical services can be provided via telemedicine while others cannot. Programme developers must recognize the significant role of the remote team in sustaining services; the on-site presenter is essential for the successful practice of telemedicine. Evaluating a telemedicine programme should be viewed as an integral step in its design and implementation. One site may define effectiveness in terms of access to services while another may measure success by cost savings. The success of future telemedicine programmes will be strongly related to their ability to recognize that they should be used to enhance current health-care delivery rather than to replace it.     

Successfully developing a telemedicine system

Successfully developing telemedicine systems is primarily about effective change management. The literature suggests that certain principles are likely to increase the chances of success in developing a telemedicine system. These are: (1) telemedicine applications and sites should be selected pragmatically, rather than philosophically; (2) clinician drivers and telemedicine users must own the systems; (3) telemedicine management and support should follow best-practice business principles; (4) the technology should be as user-friendly as possible; (5) telemedicine users must be well trained and supported, both technically and professionally; (6) telemedicine applications should be evaluated and sustained in a clinically appropriate and user-friendly manner; (7) information about the development of telemedicine must be shared. If telemedicine is to realize its full potential, it must be properly evaluated and the results of any evaluations published, whether the results are positive or negative. Since telemedicine is about communication with colleagues and patients across large distances, it should be possible for those involved in it to do the same with their experiences.     

中国情境下医院社会责任的概念及内涵解析

要保证我国医院的公益性,就必须正确地理解医院社会责任的概念和内涵。医院社会责任的本质是从事能产生社会效益的活动。我国医院社会责任的活动内容和西方相比是有差异的。医院社会责任是指医院在维持自身生存和发展的基础上,为满足特定的社会需求,在维护公共卫生、保证医疗服务质量和可及性、完成政府指令性任务及其他提高社会效益方面所承担的责任。     

Telemedicine,COVID-19, and disparities: Policy implications

While the rapid expansion of telemedicine in response to the COVID-19 pandemic highlights the impressive ability of health systems to adapt quickly to new complexities, it also raises important concerns about how to implement these novel modalities equitably. As the healthcare system becomes increasingly virtual, it risks widening disparities among marginalized populations who have worse health outcomes at baseline and limited access to the resources necessary for the effective use of telemedicine. In this article, we review recent policy changes and outline important recommendations that governments and health care systems can adopt to improve access to telemedicine and to tailor the use of these technologies to best meet the needs of underserved patients. We suggest that by making health equity integral to the implementation of telemedicine now, it will help to ensure that all can benefit from its use going forward and that this will be increasingly integral to care delivery.