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。     

基于健康档案的区域卫生平台标准符合性改造的初探

为了提高卫生信息标准符合性测评效率,探索基于健康档案的区域卫生信息平台开展标准符合性改造的技术方案。方案提出在数据标准改造、共享文档标准改造和平台功能改造三个层次的具体策略。     

区域电子健康档案信息共享标准及方案选择探讨

目的：卫生健康信息电子化（eHealth）对促进医疗安全、提高医疗效率及医疗质量的作用逐渐为人们所认识，医疗信息系统之间共享电子健康档案（Electronic Health Records，EHR）需要相关标准的研究。方法：对EHR结构和内容的共享标准进行了广泛调研，评价了这些标准对开发我国EHR共享的作用和影响。结果：对国内区域化电子健康档案共享标准的选择提出了建议。结论：通过区域电子健康档案（EHR）共享将使个体医疗保健更加方便。     

电子健康档案的标准体系框架研究

电子健康档案（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。电子健康档案标准化体系的研究与建立，对于避免管理模式混乱、低水平重复建设和信息孤岛现象的出现具有巨大的潜在应用价值。从医疗保健系统过程及其特点出发，依据标准和标准化的基本理论，分析了电子健康档案标准体系研究的现状和发展趋势，提出了以健康领域为对象、数字技术为内容、标准层次为级别的三维结构模型，并据此探讨了我国电子健康档案标准体系框架的建设方法。     

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.     

军队人员电子化健康档案标准系研究

本研究借鉴国家居民健康档案信息标准基本内容,围绕军队人员电子健康档案的内容需求,概括出军队人员健康管理的生命周期、主要健康问题和相关干预活动,建立了军队人员电子健康档案三维框架和信息主题域模型,基于军队各级医疗机构卫生服务特点,梳理出了5个主题域和28个子域;抽象出8个基本医疗卫生服务活动类型;并对基本活动类型进行了实例提取,将每个实例对应到HL7（V3）具体信息模型（R—MIM）,得到基本数据集的数据元集合,构建了军队人员健康档案信息标准体系。     

全球电子健康档案的发展及对我们的启示

全球正在兴起以电子健康档案为目标的卫生信息化建设热潮,我们看到民众广泛参与的驱动力,在线、互动化应用门槛的降低,ICT技术与Healthcare加速融合下的丰富技术实现,标准开放与互操作的良性生态系统的建立等趋势特性,可以预见,电子健康档案将成为影响深远的Internet在线应用——健康信息银行,将形成基于信息技术和通信技术的健康服务新业态。在由此引发的医疗卫生服务的巨大变革下,我国的电子健康档案建设将面临前所未有的挑战和发展机遇。     

军队保健对象电子健康档案数据库框架设计

基于管理者对军队保健对象信息化需求,依托现有数据资源,构建了面向网络的电子健康档案数据库框架,提供了查询、统计、报表等综合应用服务。加强在信息化条件下对军队保健对象情况的实时监测、过程控制和科学研究,步入以循证管理信息为支撑的干部保健信息化管理．有的放矢地分析问题、解决问题,提高管理效率和质量,提升干部保健的竞争力和服务水平。     

电子健康档案标准——CDA与openEHR

电子健康档案记录个人终生完整、准确的健康信息。针对目前常见的医疗档案标准,本文针对HL7CDA与openEHR进行了详细阐述,并针对两者在适用范围、模型结构与安全性方面的不同进行比较。并针对中国电子健康档案发展的前景进行展望,并指出了可能存在的障碍。     

电子健康档案的标准、规范与应用

2008年,新津县开始探索区域一体的医疗卫生信息化建设。经过一年的努力,初步建立起了覆盖全县的区域卫生信息化网络体系,县内19家医疗卫生机构,12所农村新型社区卫生服务站被纳入体系统一管理。基本实现了辖区内医疗卫生信息互联互通,区域共享,为建立全民健康档案奠定了基础。     

Harnessing Electronic Health Records for Public Health Surveillance

Electronic medical record (EMR) systems are a rich potential source for detailed, timely, and efficient surveillance of large populations. We created the Electronic medical record Support for Public Health (ESP) system to facilitate and demonstrate the potential advantages of harnessing EMRs for public health surveillance. ESP organizes and analyzes EMR data for events of public health interest and transmits electronic case reports or aggregate population summaries to public health agencies as appropriate. It is designed to be compatible with any EMR system and can be customized to different states’ messaging requirements. All ESP code is open source and freely available. ESP currently has modules for notifiable disease, influenza-like illness syndrome, and diabetes surveillance.An intelligent presentation system for ESP called the RiskScape is under development. The RiskScape displays surveillance data in an accessible and intelligible format by automatically mapping results by zip code, stratifying outcomes by demographic and clinical parameters, and enabling users to specify custom queries and stratifications. The goal of RiskScape is to provide public health practitioners with rich, up-to-date views of health measures that facilitate timely identification of health disparities and opportunities for targeted interventions. ESP installations are currently operational in Massachusetts and Ohio, providing live, automated surveillance on over 1 million patients. Additional installations are underway at two more large practices in Massachusetts.     

Electronic Health Records Access During a Disaster

As has been demonstrated previously, medical care providers that employ an electronic health records (EHR) system provide more appropriate, cost effective care. Those providers are also better positioned than those who rely on paper records to recover if their facility is damaged as a result of severe storms, fires, or other events. The events surrounding Superstorm Sandy in 2012 made it apparent that, with relatively little additional effort and investment, health care providers with EHR systems may be able to use those systems for patient care purposes even during disasters that result in damage to buildings and facilities, widespread power outages, or both.     

农村居民电子健康档案建立

目的探索农村居民电子健康档案数据的采集及应用,分析农村地区建立电子健康档案的方法及困难。方法以四川省偏远农村为试点,采用集中筛查与补充检查相结合的方式,创建农村居民电子健康档案。结果在布拖县完成10 067名农村居民完成体检及健康相关调查,并建立居民电子健康档案。结论创建农村居民电子健康档案对建立健全医疗卫生网络,提高医疗卫生服务质量,整合卫生资源等方面有积极作用,并对创建农村居民电子档案存在问题提出对策。     

Use of Electronic Health Records to Improve Maternal Vaccination

IntroductionAccurate electronic health record (EHR) documentation of maternal vaccination is an essential component of evidence-based strategies to increase vaccination uptake. Within a larger intervention trial, this study assessed the impact of tailored protocols and immunization champions on obstetrics-gynecology practices' EHR documentation of maternal vaccines—including administration, history, and refusals—and sought to understand clinical staff's experience of the barriers and solutions to documentation in the EHR.MethodsIn 2012 and 2014, random samples of obstetric patient charts (N = 275) were reviewed during the preintervention and postintervention periods to assess changes in vaccination documentation. In-depth interviews with clinic staff were conducted during and after the intervention to evaluate the experience of clinical providers and staff in using the EHR to document maternal vaccine activities (N = 34 interviews). Analyses were conducted in 2015 and 2016.ResultsDocumentation of any vaccination activities in the EHR for influenza vaccine improved from 27% to 60% (p < .001) and from 13% to 87% (p < .001) for tetanus-diphtheria-acellular-pertussis vaccine. Documentation improvements were largely located in unsearchable notes rather than in searchable fields (52% for influenza, 59% for tetanus-diphtheria-acellular-pertussis). Barriers to EHR documentation reported by clinic staff included perceptions that inputting vaccine information into searchable fields was time consuming and that searchable fields were difficult to use.ConclusionsExisting EHR structured fields do not meet the needs of obstetric providers, posing challenges for maternal immunization. We recommend obstetrics-gynecology practices collaborate with staff to develop effective maternal vaccination documentation protocols, test usability when selecting an EHR, and customize alerts to balance effectively reminding clinical staff against alert fatigue. Further, we recommend that future work address the need for improved maternal vaccination documentation to facilitate quality improvement in obstetrics-gynecology settings.     

基于电子健康档案的妇幼医疗保健区域信息平台

本文聚焦基于电子健康档案的妇幼医疗保健区域信息平台作为整个区域医疗卫生信息平台建设,实现载体平台,对保障妇女、儿童健康,提高出生人12素质,促进妇幼卫生事业发展的重要作用.基于电子健康档案的妇幼医疗保健区域信息平台建设,将有助于强化政府与社会对妇幼医疗保健卫生服务的监管,改善该体系的运行状态,提高妇幼医疗保健服务的质量和效率,对妇幼医疗保健卫生服务具有重要意义.探讨基于电子健康档案的妇幼医疗保健区域信息平台构建工作的难点与重点及今后为整合到国家综合卫生管理信息平台中的前提基础,为今后具体实现此平台奠定理论基础.     

区块链技术在居民电子健康档案中的应用

授权医疗服务人员随时、随地及时获取全面的居民电子健康档案信息,公共卫生工作人员能及时掌握居民健康信息,对于疾病防治、跟踪及诊疗意义重大;助力居民方便、安全掌握自己的健康资料,参与健康管理,在不同地域都能使医疗卫生服务持续,影响深远;区块链由于高冗余、无法篡改、低成本和能进行多签名及复杂权限的管理等特性,可能实现居民对个人健康隐私信息的保密及授权的数据共享,使这个数据真正的掌握在居民自己手中,同时无需第三方授权,即可将个人健康信息提供给居民选定的医疗卫生机构进行服务。     

Strengthening Public Health and Primary Care Collaboration Through Electronic Health Records

Electronic health records (EHRs) have great potential to serve as a catalyst for more effective coordination between public health departments and primary care providers (PCP) in maintaining healthy communities.As a system for documenting patient health data, EHRs can be harnessed to improve public health surveillance for communicable and chronic illnesses. EHRs facilitate clinical alerts informed by public health goals that guide primary care physicians in real time in their diagnosis and treatment of patients.As health departments reassess their public health agendas, the use of EHRs to facilitate this agenda in primary care settings should be considered. PCPs and EHR vendors, in turn, will need to configure their EHR systems and practice workflows to align with public health priorities as these agendas include increased involvement of primary care providers in addressing public health concerns.Electronic health records (EHRs) have great potential to serve as a catalyst for more effective coordination between public health departments and primary care providers in maintaining healthy communities. As prominent health risks to the community continue their shift from contagious diseases to chronic illnesses, public health departments are increasingly focused on conditions such as diabetes and obesity. At the same time, serious threats persist from traditional public health concerns, such as communicable disease outbreaks.Primary care providers, and particularly community health centers (CHCs), that provide care for low-income populations are on the front lines in treating and containing both communicable diseases and chronic illnesses that are more prevalent in these communities. Traditional models of primary care are also evolving, with increased focus on community-based approaches in response to changing financial incentives and formal recognition programs, such as the Patient-Centered Medical Home certification offered by the National Committee for Quality Assurance and the Joint Commission.1,2 Use of these models is facilitated by the parallel increase in adoption of EHRs.Federal incentive programs have been a proponent of EHR implementation and “meaningful use” of EHRs among primary care providers, with targeted funding to support their adoption among CHCs.3 The promotion of health information technology to improve the public’s health is 1 of 5 focus areas for meaningful use of EHRs. Finally, 1 of the 3-part aims of the Centers for Medicare and Medicaid Services (CMMS) is the improvement of population health—a goal that will only be met through improved coordination of primary care and public health.4,5In 2003, the potential for addressing community health needs with the aid of EHR data exchange initiated a partnership between The New York City Department of Health and Mental Hygiene (NYC DOHMH) and The Institute for Family Health. Together, these organizations have developed, tested, implemented, and monitored the use of an EHR in meeting public health and primary care goals. NYC DOHMH is one of the world’s largest public health agencies, operating programs in disease control, environmental health, epidemiology, health care access, health promotion and disease prevention, and mental hygiene. It also makes public health-enabled EHRs available to over 2500 primary care providers throughout New York City as part of its Primary Care Information Project (PCIP).The Institute for Family Health is a nonprofit organization that provides care to more than 80 000 patients in 26 federally qualified health center sites in New York City and New York State’s Mid-Hudson Valley. The Institute’s goal in establishing an EHR system was not only to enhance the quality of patient care in its own practices, but also to improve the health of the communities it serves. Recognizing that the 2 organizations had parallel missions to maintain healthy communities, the Institute and NYC DOHMH partnered in EHR data exchange initiatives to meet the shared goals of improving the surveillance and management of both communicable disease and chronic disease. Projects addressing these goals are described below.