浦东新区构建新型中西医结合公共卫生服务体系研究

浦东新区作为“国家中医药发展综合改革试验区”及全国首批“治未病预防保健服务试点地区”之一,两年来积极探索新型中西医结合公共卫生服务体系。本文从探究新型中西医结合公共卫生服务体系的工作方法,分别就如何构建完善组织架构、规范运行机制体制、明确工作职责与内容、强化非中医人员培训、实施信息化同步配套等5个方面所开展的工作．总结了构建新型中西医结合公共卫生服务体系之后中医预防保健项目所取得的工作成效。通过剖析在创建新型中西医结合公共卫生服务体系中存在的共性问题,笔者认为,构建中西医结合公共卫生服务体系势在必行,应注重中西医结合公共卫生服务服务模式创新,加强人才队伍建设,完善政策保障制度体系．继续加大对公共卫生事业的资金投入,做好宣传和推广。     

The impact on a private group practice of converting to an automated medical information system

As hardware and software developments make medical information systems increasingly available to physician office practices and outpatients facilities, there is a need to focus on systems installation and conversion issues. In addition to the detailed step-by-step implementation plan, the overall impact of the new system should be anticipated. The purchasers should consider such issues as new information flow and user communication patterns between patient care and ancillary and support departments; restructuring of fundamental approaches to work allocation for either batch or real-time systems; and new emphasis on any departments vital to problem-spotting and solving. At California Primary Physicians (CPP), an awareness of these changes did not develop until well after the official “live” date had passed and the staff had been successfully using the system for several months. This paper explains how the above issues have emerged and the impact they have had on CPP, and provides a framework for anticipating such matters in any system installation.     

Information and Communications Technologies Health Projects in Panama: A Systematic Review and their Relation with Public Policies

This paper presents a review about Information and Communications Technologies (ICTs) health projects in Panama. The main contribution is to provide a vision of the situation in Panama, allowing an understanding of the dynamics of health policies and how they have affected the implementation of ICT’s Projects to improve the health of Panamanians. We analyze the projects found with ICT’s in health of Panama, which allow us to see a perspective of projects information is obtained from 2000 to 2016, however it is important to highlight that there may be other projects that we do not know because we did not find enough information or evidence of the same. That is why this review has interviews with key personnel, who have guided us with the search for information. 56% of technology projects are concentrated in the capital city and only 16% in the province of Chiriquí. 64% of these projects are focused on the development of information systems, mainly focused on electronic patient registration. And 60% refers to projects related to primary health care. The MINSA and CSS both with a 20% participation in ICT project, in addition we can notice the dispersion of projects for hospitals, where each one is developing programs per their needs or priorities. The national information about ICT projects of Health, it has been notorious the state of dispersion and segmented of public health information. We consider that it is a natural consequence of Policy in Panamanian Health System. This situation limits the information retrieval and knowledge of ICT in Health of Panama. To stakeholders, this information is directed so that health policies are designed towards a more effective and integral management, administering the ICT’s as tools for the well-being of most the Panamanian population, including indigenous group.     

Effects of pruning of a decision-tree for the ear,nose, and throat realm in primary health care based on case-notes

In the primary health care center of Mjölby a sample of case notes in the ear-nose-and-throat realm (N=425) was computer processed using an inductive rule-based decision-tree generating program. As a result of incomplete information in the case-files, the decision trees were “noisy,” e.g., had branches and leaves without meaning. This led to a need for “pruning.” Various methods were tried. The effects of different methods of decision-tree generating and pruning are discussed. The choice of root argument and branching of the decision-trees suggested by the software was the most clinically applicable. The “statistic” approach to pruning gave the most compact and still most clinically relevant decision-tree. The pruned and edited decision trees are compared with a previously published preliminary essential data set for the ear-nose-and-throat realm in primary health care and then discussed as a possible decision support system for various primary health care groups in a practice setting.     

Design and Development of a Sharable Clinical Decision Support System Based on a Semantic Web Service Framework

Clinical decision support (CDS) systems provide clinicians and other health care stakeholders with patient-specific assessments or recommendations to aid in the clinical decision-making process. Despite their demonstrated potential for improving health care quality, the widespread availability of CDS systems has been limited mainly by the difficulty and cost of sharing CDS knowledge among heterogeneous healthcare information systems. The purpose of this study was to design and develop a sharable clinical decision support (S-CDS) system that meets this challenge. The fundamental knowledge base consists of independent and reusable knowledge modules (KMs) to meet core CDS needs, wherein each KM is semantically well defined based on the standard information model, terminologies, and representation formalisms. A semantic web service framework was developed to identify, access, and leverage these KMs across diverse CDS applications and care settings. The S-CDS system has been validated in two distinct client CDS applications. Model-level evaluation results confirmed coherent knowledge representation. Application-level evaluation results reached an overall accuracy of 98.66 % and a completeness of 96.98 %. The evaluation results demonstrated the technical feasibility and application prospect of our approach. Compared with other CDS engineering efforts, our approach facilitates system development and implementation and improves system maintainability, scalability and efficiency, which contribute to the widespread adoption of effective CDS within the healthcare domain.     

ComputerR/: More harm than good?

Clinical information systems (CIS) are health care technologies that can assist clinicians and clinical managers to improve the performance of health care organizations. However, failure to consider scientific evidence of efficacy, effectiveness, and efficiency when selecting CISs is one factor explaining the adoption of systems that do not improve either the quality or efficiency of patient care. This paper discusses a technology assessment framework that can assist decision-makers to evaluate alternative CISs. Existing methodologies developed to evaluate diagnostic and therapeutic technologies can be used by researchers to provide evidence needed by decision-makers at each step of the framework. The rigorous evaluation of CISs prior to their implementation can help decision-makers to avoid adopting “white elephants.”     

The diffusion of computer-based information technology into health institutions of Republic of Serbia (FR Yugoslavia)

The basic purpose of this study was to analyze the diffusion of computer-based information technology into the health care institutions of the Republic of Serbia in the year 1994, and to compare the results with a similar investigation in 1992 in order to determine the state and progress of its development. The instrument of investigation was a questionnaire with 24 questions, distributed to all the independent health institutions in Serbia (total 238). The overall response rate was 40.8%. Of the number of responding health institutions, 92.8% own computers which are in use, six PCs on average, and on average use two application softwares, obligatory one for accounting and billing. In conclusion, health care institutions in the Republic of Serbia are unsatisfactorily equipped with information technology and without the developed institutional information system, except on the level of the project. So, careful planning, selection, implementation and management with national coordination will be needed to ensure the appropriate use of technology and information systems in health care.     

Challenges in ethics, safety, best practices, and oversight regarding HIT vendors, their customers, and patients: a report of an AMIA special task force

The current commercial health information technology (HIT) arena encompasses a number of competing firms that provide electronic health applications to hospitals, clinical practices, and other healthcare-related entities. Such applications collect, store, and analyze patient information. Some vendors incorporate contract language whereby purchasers of HIT systems, such as hospitals and clinics, must indemnify vendors for malpractice or personal injury claims, even if those events are not caused or fostered by the purchasers. Some vendors require contract clauses that force HIT system purchasers to adopt vendor-defined policies that prevent the disclosure of errors, bugs, design flaws, and other HIT-software-related hazards. To address this issue, the AMIA Board of Directors appointed a Task Force to provide an analysis and insights. Task Force findings and recommendations include: patient safety should trump all other values; corporate concerns about liability and intellectual property ownership may be valid but should not over-ride all other considerations; transparency and a commitment to patient safety should govern vendor contracts; institutions are duty-bound to provide ethics education to purchasers and users, and should commit publicly to standards of corporate conduct; and vendors, system purchasers, and users should encourage and assist in each others'' efforts to adopt best practices. Finally, the HIT community should re-examine whether and how regulation of electronic health applications could foster improved care, public health, and patient safety.     

基于Web Services的区域卫生信息平台的研究与实现

区域内各级医疗机构存在许多异构的信息系统,这就造成系统信息交流不顺畅,系统之间产生大量的“信息孤岛”,无法充分利用有限的医疗资源。提出建立基于WebServices的区域卫生信息平台,分析了平台的总体架构和信息交换的过程。通过该平台的成功实施,使区域内各医疗卫生机构的信息系统在该平台上实现无缝集成,从而消除了“信息孤岛”,使这些系统能够协同工作,更进一步提高区域卫生信息化建设的效率。     

Introducing a Module for Laboratory Test Order Entry and Reporting of Results at a Hospital Ward: An Evaluation Study Using a Multi-Method Approach

The medical record system DocuLive EPR was installed at a “typical” ward at the Central Hospital of Akershus. Modules for laboratory order entry and reporting of results were evaluated prospectively using several information sources (hospital information systems, telephone records, user survey, semi-structured interviews with key informants). The main findings are discussed, and the lessons learned from the evaluation project are presented.     

中医药在康复医学中的循证实践

Chinese medicine is among other traditional medical systems practiced either as a coadjutant intervention to Greek medicine or as the unique therapeutic intervention for illness prevention,treatment or rehabilitation.The complete spectrum from that traditional system includes acupuncture and moxibustion,herbal and food therapy,massage therapy(tuina),physical exercises(taijiquan),and breathing exercises(qigong).In this article,it is presented several randomized controlled trials and systematic reviews on the application of all therapeutic modalities from Chinese medicine in the physical rehabilitation scenario.The discussed studies encompasses both "positive" and "negative" results of Chinese medicine intervention for disabilities due to illnesses of the nervous,musculoskeletal or cardiovascular systems.Additionally,the importance of the personalized approach for Chinese medicineand rehabilitation is emphasized together with the need for reproducible methods for pattern differentiation and intervention selection.Chinese medicine resources are recognized as promising methods for therapeutic rehabilitation and can be incorporated into the rehabilitation science.The wide variety of therapeutic resources explains why Chinese medicine is currently a multidisciplinary practice for health protection and promotion,early diagnosis and treatment as well as rehabilitation with roles in the public health care system.     

Health IT Success and Failure: Recommendations from Literature and an AMIA Workshop

With the United States joining other countries in national efforts to reap the many benefits that use of health information technology can bring for health care quality and savings, sobering reports recall the complexity and difficulties of implementing even smaller-scale systems. Despite best practice research that identified success factors for health information technology projects, a majority, in some sense, still fail. Similar problems plague a variety of different kinds of applications, and have done so for many years. Ten AMIA working groups sponsored a workshop at the AMIA Fall 2006 Symposium. It was entitled “Avoiding The F-Word: IT Project Morbidity, Mortality, and Immortality” and focused on this under-addressed problem. Participants discussed communication, workflow, and quality; the complexity of information technology undertakings; the need to integrate all aspects of projects, work environments, and regulatory and policy requirements; and the difficulty of getting all the parts and participants in harmony. While recognizing that there still are technical issues related to functionality and interoperability, discussion affirmed the emerging consensus that problems are due to sociological, cultural, and financial issues, and hence are more managerial than technical. Participants drew on lessons from experience and research in identifying important issues, action items, and recommendations to address the following: what “success” and “failure” mean, what contributes to making successful or unsuccessful systems, how to use failure as an enhanced learning opportunity for continued improvement, how system successes or failures should be studied, and what AMIA should do to enhance opportunities for successes. The workshop laid out a research agenda and recommended action items, reflecting the conviction that AMIA members and AMIA as an organization can take a leadership role to make projects more practical and likely to succeed in health care settings.     

Care for Canada''s frail elderly population: Fragmentation or integration?

Budget constraints, technological advances and a growing elderly population have resulted in major reforms in health care systems across Canada. This has led to fewer and smaller acute care hospitals and increasing pressure on the primary care and continuing care networks. The present system of care for the frail elderly, who are particularly vulnerable, is characterized by fragmentation of services, negative incentives and the absence of accountability. This is turn leads to the inappropriate and costly use of health and social services, particularly in acute care hospitals and long-term care institutions. Canada needs to develop a publicly managed community-based system of primary care to provide integrated care for the frail elderly. The authors describe such a model, which would have clinical and financial responsibility for the full range of health and social services required by this population. This model would represent a major challenge and change for the existing system. Demonstration projects are needed to evaluate its cost-effectiveness and address issues raised by its introduction.     

CSER and eMERGE: current and potential state of the display of genetic information in the electronic health record

Objective Clinicians’ ability to use and interpret genetic information depends upon how those data are displayed in electronic health records (EHRs). There is a critical need to develop systems to effectively display genetic information in EHRs and augment clinical decision support (CDS).Materials and Methods The National Institutes of Health (NIH)-sponsored Clinical Sequencing Exploratory Research and Electronic Medical Records & Genomics EHR Working Groups conducted a multiphase, iterative process involving working group discussions and 2 surveys in order to determine how genetic and genomic information are currently displayed in EHRs, envision optimal uses for different types of genetic or genomic information, and prioritize areas for EHR improvement.Results There is substantial heterogeneity in how genetic information enters and is documented in EHR systems. Most institutions indicated that genetic information was displayed in multiple locations in their EHRs. Among surveyed institutions, genetic information enters the EHR through multiple laboratory sources and through clinician notes. For laboratory-based data, the source laboratory was the main determinant of the location of genetic information in the EHR. The highest priority recommendation was to address the need to implement CDS mechanisms and content for decision support for medically actionable genetic information.Conclusion Heterogeneity of genetic information flow and importance of source laboratory, rather than clinical content, as a determinant of information representation are major barriers to using genetic information optimally in patient care. Greater effort to develop interoperable systems to receive and consistently display genetic and/or genomic information and alert clinicians to genomic-dependent improvements to clinical care is recommended.     

新型冠状病毒肺炎疫情期间“互联网+医疗健康”服务体系建设思考

通过对新型冠状病毒肺炎疫情防控期间的工作回顾和总结,结合国家“互联网+医疗健康”的政策指导,对疫情期间的“互联网+医疗健康”服务体系建设进行了梳理和探讨。提出了应对疫情的智能预约挂号平台、互联网门诊平台、5G区域协同救治转运信息平台的具体建设方案,分析了“互联网+”医院的运用模式,为未来应对突发性公共卫生事件,以及互联网医院建设提供了参考依据。     

多管齐下，杜绝医院非法统方行为的实践

伴随着药品购销领域以商业目的进行统方事件的贿赂犯罪事件频频曝光，全国各地纪检和监察机关也逐步加大了对非法统方事件的查处和预防力度。文章从网络信息安全、管理制度和思想教育三个方面阐述了医疗机构如何防范非法统方事件的做法，从而遏制非法统方行为的滋生蔓延。     

商业保险统一支付平台在三级甲等医院场景中的应用设计与实践

目前,商业保险有着巨大的发展空间,相关政策大力支持商业保险公司与医疗机构合作。随着“互联网+”技术的快速发展,大力推广在线医疗卫生新模式,发展基于互联网的医疗卫生服务,将健康保险与健康管理相结合将会成为趋势。山东省立第三医院在省内搭建首家商业保险统一支付平台,实现多家保险公司快速医疗赔付,具有标杆意义,是推动医疗改革的有效探索,扩大了医院在行业及相关管理部门的影响力。     

Current Issues in Health Care Informatics

Health care informatics has emerged as a diverse and important new field of study. The field can be very broadly defined as the science that addresses how best to use information to improve health care. The field includes the four areas of bioinformatics, medical informatics, public health informatics, and consumer health informatics. Health care informatics applications can be used to improve the quality of patient care, to increase productivity, and to provide access to knowledge. After providing an overview of the field, the 10 articles contained in this special issue are briefly discussed. The first six articles address a diverse set of topics such as the use of health care informatics to conduct research, clinical information systems used by the U.S. Air Force, electronic medical records and physician satisfaction in Oman, and a point of care documentation system used by hospice care providers. The last four articles discuss the complex issues raised by the implementation of the Health Insurance Portability and Accountability Act of 1996 (HIPAA).     

A consensus action agenda for achieving the national health information infrastructure

BackgroundImproving the safety, quality, and efficiency of health care will require immediate and ubiquitous access to complete patient information and decision support provided through a National Health Information Infrastructure (NHII).MethodsTo help define the action steps needed to achieve an NHII, the U.S. Department of Health and Human Services sponsored a national consensus conference in July 2003.ResultsAttendees favored a public–private coordination group to guide NHII activities, provide education, share resources, and monitor relevant metrics to mark progress. They identified financial incentives, health information standards, and overcoming a few important legal obstacles as key NHII enablers. Community and regional implementation projects, including consumer access to a personal health record, were seen as necessary to demonstrate comprehensive functional systems that can serve as models for the entire nation. Finally, the participants identified the need for increased funding for research on the impact of health information technology on patient safety and quality of care. Individuals, organizations, and federal agencies are using these consensus recommendations to guide NHII efforts.