重视医院信息化建设

我们正处在一个日新月异、飞速发展的信息化时代。2003年突发的SARS,更加快了我国各行各业,尤其是卫生领域的信息化建设和发展的步伐。各级领导都十分重视信息化。2003年底,卫生部制定了《国家公共卫生信息系统建设方案(草案)》,计划在三年内建成四个大型信息系统,包括:疫情和突发公共卫生事件监测系统;医疗救治信息系统;卫生监督执法信息系统和突发公共卫生事件应急指挥中心与决策系统。     

融合12320卫生热线数据构建突发传染病事件早期症状监测预警平台

通过分析和挖掘广州市12320卫生热线电话数据信息,结合原有传染病疫情监测体系,建立基于热线数据的突发公共卫生事件监测预警系统,介绍预警方法和流程.该系统能利用12320咨询信息进行数据分析处理,可作为公共卫生信息聚合和舆情监测的工具.     

医院突发公共卫生事件应急能力提升的策略

目的:研究提高医院应对突发公共卫生事件能力的对策。方法:查阅文献资料,掌握医院应急能力建设的研究成果。通过实地调研,剖析医院应急能力建设现状。结果:基于文献分析和实地调研,结合应急管理理论,提出完善医院应对突发公共卫生事件能力的对策。结论:为提高医院应对突发公共卫生事件的能力,医院应完善危机管理组织结构;树立危机意识,塑造危机氛围;制定科学合理的应急预案,强化模拟训练;建立危机预警信息系统;提高医院公关能力,构建信息沟通渠道;建立医院的危机反馈系统。     

医院应对突发公共卫生事件的五个误区

目的:通过研究医院应对突发公共卫生事件中存在的误区,来提高医院应对突发公共卫生事件的能力.方法:查阅文献资料,掌握医院应急能力建设的研究成果.通过实地调研,总结分析医院应对突发公共卫生事件中存在的误区.结果:发现各医院在不同程度上对突发公共卫生事件的概念、危机管理过程、危机事件的发展阶段以及应对能力提高方面存在误区.结论:医院应该普及应对突发公共卫生事件的相关知识,在应对突发公共卫生事件中形成一种危机文化,切实提高医院应对突发公共卫生事件的能力.     

国家公共健康与安全信息系统建设研究

国家公共健康与安全信息系统一般由急救、公共卫生监测、药品监督管理、毒物中毒、核应急管理等部分组成，是国家公共卫生危机管理体系建设的重要组成部分。增强国家公共健康与安全信息系统的安全性，建立快捷、畅通、准确、及时系统运行机制是提高处理突发公共卫生事件应急反应能力重要的基础。     

我国医院信息系统面临的挑战与任务

本文将美国医院信息系统的发展趋势概括为临床信息系统的实现和深入应用,企业级信息系统应用集成。提出我国医院信息系统面临的七大任务与挑战:一体化医院管理信息系统的建设;系统的安全性;管理信息系统对决策的支持,成本核算;医疗保险;突发公共卫生事件与医疗救助;临床信息系统和电子病历     

广西二级医院突发公共卫生事件救治能力的调查

目的:了解广西二级医院突发公共卫生事件的救治能力现状.方法:应用量表法对广西136家二级医院进行调查,调查内容包括:二级医院发生突发公共卫生事件时卫生人力资源调配、病床及相关设施、应急资源储备、应急设备获得、医疗救治预案.结果:126家二级医院按要求填写量表,占92.6%.调查反映出在突发公共卫生事件时广西二级医院在人力资源调配方面有一定能力,在病床及相关设施扩充方面的能力有限,对应急资源具有一定储备,多数医院不能从其他部门获得应急资源,突发公共卫生事件医疗救治预案不够完善.结论:广西二级医院对突发公共卫生事件的救治能力十分有限,需要加强建设,系统化管理.     

医院应对突发公共卫生危机事件应急医疗救治体系建设

总结我国以往突发公共卫生事件的经验教训、特别是5．12汶川特大地震灾害的经验教训,在贯彻执行《中华人民共和国突发公共卫生事件应急条例》中。我们必须作好医院应对突发公共卫生危机事件应急医疗救治体系建设工作。在平时,医院应该对突发公共卫生危机事件有关准备工作计划和预案以及具体执行情况进行评价和评估。建立特别是包括预案监测和应急救治体系在内的应急管理体系,评价的各项指标设定是否科学规范、合法合理,应急救治设施和设备等救援物资是否符合有关规定等。     

广东省医疗机构突发公共卫生事件监测与预警能力的初步评估

目的 了解广东省医疗机构对突发公共卫生事件的监测与预警能力.方法 以目的抽样方法对广东省209家医院进行问卷调查.结果 80%以上医院对发热、不明原因肺炎、不明原因的死亡、流感样疾病和急诊入院人数实行了监测并能及时上报异常情况;对败血症/感染性休克监测和报告的比例分别仅为51.3%和63.7%;对病原生物和中毒的检测能力较低;对各类突发公共卫生事件没有预警能力.结论 广东省医疗机构突发公共卫生事件监测能力尚有待提高,应尽早开展预警研究.     

我国突发公共卫生事件预警体系的实现条件

目的 探讨我国突发公共卫生事件预警体系的实现条件.方法 针对突发公共卫生预警体系建设对预防和应对突发公共卫生事件的重要性,提出突发公共卫生事件预警体系的实现条件.结果 必须建立起快速、健全的预警体系,预防和减少疾病的发生和流行,一旦出现危机,就能迅速做出反应,使损失降到最低.结论 只有通过加强法律体系建设、组织体系建设、人才建设等方法,才能实现突发公共卫生事件预警体系的建设.     

基于J2EE的基层公共卫生应急综合指挥平台设计

在突发公共卫生应急事件日益频繁和加快卫生信息共享需求的背景下,结合卫生行业监管的实际要求,提出了一套基于J2EE技术MVC模式的系统设计方案,实现日常公共卫生系统各项信息的采集、分析、预警等。同时,结合GIS系统,能够实时监测整个城市的公共卫生情况,及早发现异常现象并做出应急处理,在遇到突发事件时能够结合防治预案、专家系统和人为决策,及时准确地进行处理,从而提高城市管理和公共安全水平。     

Violence in health care: the contribution of the Australian Patient Safety Foundation to incident monitoring and analysis

Because of growing concern about violence in health care in Australia, we reviewed the relevant data on incidents involving violence collected using the Australian Incident Monitoring System (AIMS). Among 42 338 incidents reported from 1 July 2000 to 30 June 2002, 3621 (9% of all incidents) involved patients and physical violence or violent verbal exchange; staff injury was reported in 5% of cases. The proportion was higher in emergency departments (16%, with frequent involvement of mental health problems or alcohol or drug intoxication) and mental health units (28%). Contributing factors include changes in our society and in mental health service provision. With the closure of public psychiatric hospitals in the past decade, more patients with mental illness are seeking care in public hospital emergency departments. AIMS analysis highlights the importance of understanding the contributing and precipitating factors in violent incidents, and supports a variety of preventive initiatives, including de-escalation training for staff; violence management plans; improved building design to protect staff and patients; and fast-tracking of patients with mental health problems as well as improved waiting times in public hospital emergency services. We recommend that a national system be developed to share and compare incident monitoring data, to monitor trends, and to facilitate learning and thinking at all levels - ward, department, hospital, state and national.     

2003年医疗卫生领域信息化进展

介绍了国际国内医疗卫生领域信息化的进展情况:SARS刺激了医院信息系统的发展,医学信息标准化2003年开始有了实质性进展;卫生部制定了国家公共卫生信息系统建设现阶段的主要任务;美国国家疾病控制中心传染病监控系统的建设;我国区域卫生信息系统及其需进一步研究的难点是标准化问题、医院信息系统、门诊信息系统、医学图象处理系统以及医院信息系统中间件研究.     

对《突发公共卫生事件预防控制》教学的思考

在现代社会中，突发公共卫生事件的预防和控制非常重要，但现行公共卫生专业教学计划中尚欠缺这方面的内容，存在以下倾向：侧重疾病预防，欠缺伤害预防；侧重院内技术，欠缺现场技术；侧重实验技术，欠缺信息技术；侧重平常预防，欠缺突发预防；侧重技术能力，欠缺组织能力等。建议今后将关于突发公共卫生事件预防和控制的教学内容纳入公共卫生专业学生的培养计划之中。     

新疆2007－2010年学校突发公共卫生事件流行病学调查分析

目的：探讨新疆2007－2010年学校突发公共卫生事件流行特点,以便提出针对性控制策略。方法采用描述性流行病学方法,对新疆2007－2010年通过突发公共卫生事件管理信息系统上报的学校突发公共卫生事件进行分析。结果新疆2007-2010年学校突发公共卫生事件呈下降趋势,有明显的季节性高峰,3－6月和9－12月全疆报告事件各占学校突发公共卫生事件的48．66％和43．62％;报告事件以小学（62．75％）和中学（27．52％）为主;报告事件以传染病为主,占学校突发事件的96．31％,其中以呼吸道传染病为主,占学校突发传染病事件的93．73％。报告事件排名前5位的依次为水痘（38．59％）、流行性腮腺炎（29．53％）、甲型 H1N1流感（9．40％）、风疹（5．37％）和手足口病（4．03％）。结论水痘、流行性腮腺炎和甲型 H1N1流感为南北疆学校突发公共卫生事件防范的重点传染病,同时北疆需加强对手足口病和食物中毒的防控,南疆需加强对流行性感冒的防控。建议完善学校缺课监测预警,加强通风,让学生积极参加户外活动等综合性措施以减少学校突发公共卫生事件的危害。     

AMIA Advocates National Health Information System in Fight Against National Health Threats

To protect public health and national safety, AMIA recommends that the federal government dedicate technologic resources and medical informatics expertise to create a national health information infrastructure (NHII). An NHII provides the underlying information utility that connects local health providers and health officials through high-speed networks to national data systems necessary to detect and track global threats to public health. AMIA strongly recommends the accelerated development and wide-scale deployment of electronic public health surveillance systems, computer-based patient records, and disaster-response information technologies. Such efforts hold the greatest potential to protect our citizens from disaster and to deliver the best health care if disaster strikes.To protect public health and national safety, AMIA recommends that the federal government dedicate technologic resources and medical informatics expertise to create a national health information infrastructure (NHII). An NHII provides the underlying information utility that connects local health providers and health officials through high-speed networks to national data systems (e.g., Centers for Disease Control and Prevention) necessary to detect and track global threats to public health.In the short term, this means adapting existing information systems to facilitate public health surveillance and emergency response. To establish a permanent infrastructure, AMIA strongly recommends the accelerated development and wide-scale deployment of electronic public health surveillance systems, computer-based patient records, and disaster-response information technologies. Such efforts hold the greatest potential to protect our citizens from disaster, and to deliver the best health care if disaster strikes.While meeting the acute needs of today, this initiative will begin laying the groundwork for a NHII that will continue to serve the health needs of the nation—a lasting endowment for future generations. Establishing an NHII requires thoughtful strategic planning and strong inter-agency leadership. Work on key components of the NHII must begin immediately. These key components include:

• Strategic planning and coordination. There must be a central coordinating entity that can quickly inventory existing public- and personal-health initiatives and develop a strategy to fashion a national system to protect Americans against health threats of various types, including biological, chemical, nuclear, and physical. The short-term strategy must be part of a framework for a permanent infrastructure that serves public health, patient care, and research.
• Connectivity and communications. Local, regional, and national coordination cannot exist without efficient, instantaneous communication. Public health services must be linked using secure connections to the Internet as an immediate top priority. AMIA recommends federal government funding to guarantee high-speed, dedicated access to the Internet for all public and private health care facilities and related organizations. Minimum-level workstations should be required, and adequate tools and training should be provided.
• Standards. Effective communication among local, community, state, and federal facilities require the use of standards. Health care messaging standards should be used for data interchange. A common vocabulary standard and required data elements for public health surveillance databases are required to enable effective sharing of data. Without a common vocabulary, data from local systems cannot be analyzed to detect emerging health threats. Government coordination and support for consensus standardization and low-cost distribution of common vocabularies for health event detection, prevention, and intervention are a fundamental aspect of an NHII.
• Resource databases. An up-to-date, central, Internet-based health resources directory containing information about available resources—knowledge, physical, and human—is vital to providing the timely information needed to manage any public health crisis. The national health resource directory would include information about physical resources, such as health care organizations, safety facilities, and environmental agencies; human resources, including physicians, nurses, and public health and support personnel; organizational resources, such as emergency medical services, county and city law enforcement agencies, and other emergency-response groups; and knowledge resources ranging from clinical guidelines to extensive clinical decision support algorithms related to threat vectors. Local health authorities must be trained in use of the directory to effectively derive maximal benefit when responding to national health threats.
• Public health surveillance systems. Effective public health practice and decision making depend on timely information, much of which is not readily available. Information about patients with clinical conditions of public health importance, symptoms compatible with prodromes of serious infection or exposure, health behaviors, and environmental risk factors must be collected, transmitted, aggregated, analyzed, and utilized for prompt decision making. Whether the health threat is biological, chemical, or nuclear, early detection and rapid response are essential. Existing public health systems in place and under development should be adapted to meet the current needs. Implementation of public health system initiatives such as the National Electronic Disease Surveillance System and Health Alert Network must be accelerated to meet the acute threat posed by bioterrorism.
• National identifiers. National identifiers for providers, insurers, businesses, and individuals are required by the Health Insurance Portability and Accountability Act (HIPAA) of 1996. The privacy provision of HIPAA that protects confidential health information has been finalized. In the face of the acute crisis, the work on identifiers should be accelerated so that effective epidemiologic data can be gathered and analyzed and appropriate health care services delivered where needed.

AMIA is an organization of professionals who operate at the interface between health care and computer and information science. Our leadership and members are capable and willing to contribute to solving the acute situation while laying the foundation for a lasting infrastructure to manage health information for the benefit of patients and the public.TANG, National Health Information System Proposal     

公立医院高质量发展下公益性补偿机制探讨

公立医院受取消药品耗材加成、医保付费制度改革及疫情防控等影响,医疗业务收入下降,运营成本增加.为推进公立医院以人民健康为中心、保障基本医疗卫生事业公益性、防范化解重大疫情和突发公共卫生风险等公益性职能的履行,应逐步提高对公立医院的财政补偿,并持续调整医疗服务收费结构,促进医院内部经营管理模式转型.建立与完善对公立医院的...     

从抗击"非典"的斗争看应变意识和能力

通过回顾北京急救中心抗击"非典"斗争的历程,论述了在处理突发公共卫生事件中急救中心管理者强化应变意识,提高应变能力的工作体会.指出紧急事件中的应变意识,首先就是要迅速启用应急机制并运用超常规的方式相对集中应急工作的指挥权,以随时准备完成最艰巨任务的意识.在紧急事件中的应变意识,也是方位意识、超前意识以及决断和协调意识的综合体.应急状态中,要重视相关信息的追踪,力争工作的前瞻性.     

美国急性传染病的预防控制体系

急性传染病是美国死亡率最高的疾病之一.(Center for Disease Control and Prevention CDC)与联邦政府部门和其他机构合作,提供健康监视和预防体系,落实疾病预防计划和措施,管理全国健康统计数据,提供检疫指导、工作场地安全和环境疾病预防等服务,形成了较为有效和完善的急性传染病预防和控制体系.本文介绍了CDC在预防和控制急性传染病方面的主要做法,包括制定全面控制规划,建立监测体系,提高监测能力.开展应用研究,提高实验室检测能力.及时发布信息,开展全面指导.注重专业人员的培训,推广预防控制传染病的新技术、新方法.推行疫苗接种计划,改善医疗机构防治策略.加强国际合作,提供国际疾病传播监管服务.对医疗和生物恐怖紧急情况的快速反映是预防和控制体系的一个组成部分,包括制订医疗和生物恐怖紧急情况的全国反应计划,制定快速反应程序和规范,及时发布预警信息,协调快速反应力量及时反应,储备医疗物资,健全快速反应机制.CDC成功的预防措施和实践显示了其预防和控制体系的优势.