平煤总医院门诊医生站的建设

门诊医生工作站是门急诊医生借助计算机网络，实现患者信息采集、处理、存储、传输和服务，实现对门急诊患者信息管理的计算机软件系统。可以实现医疗管理信息和数字化，从而提高医院的管理水平、医生的工作效率和服务质量。本文介绍了实施门诊医生工作站流程及重点讨论了利用门诊医生工作站对提高门诊服务质量的几点体会。     

医院门诊管理（网络）系统应用体会

一、《医院门诊管理(网络)系统》产生的条件一所较大的综合性医院,日门诊人次一般都在千人以上,甚至更多。采用手工操作的计价、收费不仅差错率大、耗时费力,而且给统计工作造成很大困难。针对这些情况,我院与某公司合作共同研制了《医院门诊管理(网络)系统》软件并投入门诊使用,收到良好的效果,使我院开通了“门诊收费——药库”电脑网络,实现了划价、收费一条龙,以每一笔有效的划价收费记录作为一     

门诊候诊叫号方案及其适用性分析

介绍了本院采用的门诊叫号方案。从硬件、操作、成本、内容扩展等方面,与目前其他医院所应用的叫号分诊系统作出对比,认为该方案具有性价比高,灵活方便的特点,适合于本院业务流程特点,但同时亦存在维护成本高的缺点。     

军队患者门诊信息的分析与利用

目的：了解军队人员门诊概况，探讨门诊用药、门诊质量的评价方法，辅助门诊管理。方法：借助统计分析方法和计算机软机系统，实现门诊信息分析系统，及时总结门诊用药、费用消耗、体系单位就医状况。结果：通过对某些身份人员一年门诊就诊情况分析发现，各体系单位保障水平较高；高消耗药品较集中，消耗前10位药品占总消耗的30％。结论：非治疗性用药和常规用药可分流到体系单位的门诊部，减轻医院门诊压力；门诊诊断信息缺失使门诊治疗质量和效果难以评价。     

实施门诊医生工作站与优化门诊流程的思考

医院门诊拥挤出现“三长一短”现象是每个综合性医院面临的问题。我院以实施计算机门诊医生工作站为契机 ,改革门诊服务流程 ,减少患者等待时间 ,提高门诊服务水平 ,取得了满意的成效。一、门诊诊疗流程改革(一 )挂号流程改革 :门诊医生工作站实施后 ,挂号工作由高年资护士承担 ,实施预检、注册、挂号、分诊一体化服务 ,患者的基本信息由挂号处工作人员直接录入计算机 ,并在病历卡上粘贴已经注册的识别标记———条形码 ,高速热敏打印机打印挂号单 ,患者凭挂号单到指定诊室就诊。对于已注册的患者可以不通过挂号直接找医生就诊 ,挂号费用在…     

安徽省繁昌,铜陵两县门诊服务分析

在为期6天的门诊病人调查中,共访问了2532人。92％的门诊病人是由于疾病来就诊。内科病人占一半,病种主要集中在呼吸系统与消化系统。用量最多的药品是抗感染药物与解热镇痛药,两者要占门诊用药的68.8％。平均每次门诊费用与药费分别为25.41元与14.52元,平均每次门诊用药数为2.03种,与国外报道及国内贫困县研究结果相比,都偏高。单因素与多因素分析都表示医疗保健制度对每次门诊费用有影响,公费医疗对门诊费用有负向作用,显示近期的公费医疗改革已初显成效。同时还表示医疗机构对每次门诊费用作用很大,在多因素分析中,与乡卫生院及村卫生室相比,县医院的偏回归系数最大。     

大型综合性医院开设“365无假日门诊”的实践

随着国家医疗体制改革工作的深入推进,为解决民众＂看病难＂问题,很多医院推行了＂365无假日门诊＂的新举措,为患者提供多渠道、多样化、便捷的医疗服务,有效缓解患者＂看病难＂的问题。本文从实际出发,阐述开设＂365无假日门诊＂的具体做法和体会。     

门诊电子病历的应用

目的：通过对门诊医生工作站系统的改造,实现要素提醒、强制完成、费用预警、处方量控制、电子化记录、病历本打印等智能化功能,解决传统门诊病历书写存在的问题,提高门诊病历规范化水平。方法通过信息化手段实现结构化病历电子书写。结果提高门诊病历书写质量,减少医疗纠纷,加大门诊就诊效率。结论利用信息化手段,提高门诊病历书写规范化水平。     

浅谈门诊医疗一卡通

门诊信息管理系统是医院信息系统一个重要的组成部分,也是医院数字化建设过程中的一个重要步骤。从4个方面浅析门诊信息管理系统的主要内容和功能,并从病历、检查/检验、处方等方面详述重要的子系统——门诊医生工作站的作用和意义。阐明了一旦完善地实施了计算机管理的门诊信息管理系统,则门诊医疗一卡通将随之建立,长期困扰医院门诊的“三长一短”问题将从根本上得到消除。     

2018年国家门诊专业质控中心工作报告

目的调查全国门诊专业医疗质量现状,为加强全国门诊质量管理提供依据。方法收集并分析了2018年全国4 450家综合医院门诊相关的人力资源、空间资源、门诊服务、门诊病历、门诊诊断等质控指标情况。结果调查医院中,71.82%的医院施行实名制预约挂号,平均预约途径数为4.45个,医院MDT门诊开展率22.00%,医院门诊电子病历使用率为49.96%;医院门诊标准诊断库使用率为56.27%。委属委管医院、三级医院、二级医院的门诊诊断与出院诊断的亚目符合率分别为69.4%、62.9%、71.1%。结论医院应当加强预约挂号管理,提供多种预约挂号管理,提供多种预约挂号方式;积极开展多学科（MDT）门诊,为肿瘤等疾病患者提供个性化的诊疗方案;加快推进门诊电子病历使用;提高门诊诊断与出院诊断符合率。调查医院对门诊质量指标的理解存在差异,应当制定统一的门诊质控指标及标准,推行统一的门诊诊断编码库。     

门诊初诊患者基本信息登记流程重组

门诊初诊患者基本信息是医院重要的信息资源，信息录入的及时、准确和完整极其重要。作者分析了初复诊患者挂号的服务内容和流程，设计了挂号流程重组方案，在仿真技术的支持下，模拟寻找流程重组最佳方案，取得了良好的应用效果。     

电子病历在HIS中的应用与分析

本文针对新版电子病历在我院信息系统中的应用进行了分析和展望。     

Do patients’ information requirements for choice in health care vary with their socio‐demographic characteristics?

Objectives

This study examines whether the information used to inform hospital choice, and the sources of that information, varies with patients’ socio‐demographic characteristics. It also examines whether information used by patients to inform choice is associated with attending their local hospital.

Methods

A survey of 1033 patients who were offered a choice of hospital provider for elective treatment in England. Logistic regression was used to examine associations between patient characteristics and information used to inform choice of a hospital provider and sources of information used.

Results

Factors most important to patients in choosing a hospital were quality of care, cleanliness, standard of facilities and reputation. While quality of care and related factors are important to the majority of patients, those with lower levels of education were more likely to report that location and appointment times were important. Those who thought quality important were more likely to attend their local hospital provider. The main sources of information used to inform choice of hospital were own experience, family and friends and the general practitioner (GP). Patients who sought advice from their GP or booking advisors were less likely to attend their local hospitals.

Conclusions

Differences among patients as to what factors are important when choosing a hospital provider and what information and support they access suggest there needs to be a variety of information sources and support available to promote choice. Greater shared decision making through active involvement and support by GPs or booking advisors may be required if they are to make choices in line with their preferences.     

数字化医院中电子病历应用研究

医院信息系统是数字化医院的象征 ,电子病历则是医院信息系统的重要组成部分之一.本文主要介绍了电子病历与 HIS之间的关系和电子病历在医院信息化过程中的作用,并总结了电子病历在发展过程中存在的问题.     

Towards patient-centered health services in India--a scale to measure patient perceptions of quality.

OBJECTIVE: . (i) To develop a reliable and valid scale to measure in-patient and outpatient perceptions of quality in India and (ii) to identify aspects of perceived quality which have large effects on patient satisfaction. DESIGN: Cross-sectional survey of health facilities and patients at clinics. SETTING: Primary health centers, community health centers, district hospitals, and female district hospitals in the state of Uttar Pradesh in north India. MAIN OUTCOME MEASURES: Internal consistency, validity, and factor structure of the scale are evaluated. The association between patient satisfaction and perceived quality dimensions is examined. RESULTS: A 16-item scale having good reliability and validity is developed. Five dimensions of perceived quality are identified-medicine availability, medical information, staff behavior, doctor behavior, and hospital infrastructure. Patient perceptions of quality at public health facilities are slightly better than neutral. Multivariate regression analysis results indicate that for outpatients, doctor behavior has the largest effect on general patient satisfaction followed by medicine availability, hospital infrastructure, staff behavior, and medical information. For in-patients, staff behavior has the largest effect followed by doctor behavior, medicine availability, medical information, and hospital infrastructure. CONCLUSIONS: The scale developed can be used to measure perceived quality at a range of facility types for outpatients and in-patients. Perceived quality at public facilities is only marginally favorable, leaving much scope for improvement. Better staff and physician interpersonal skills, facility infrastructure, and availability of drugs have the largest effect in improving patient satisfaction at public health facilities.     

What can artefact analysis tell us about patient transitions between the hospital and primary care? Lessons from the HANDOVER project

Abstract

Background: Hospital discharge often faces breakdowns in information, communication, and coordination. The European Union FP7 Health Research Programme commissioned the European HANDOVER Project in 2008, a three year, 3.5 million Euro programme to examine transitions of patient care from the hospital to the community care settings. Six European countries—Italy, the Netherlands, Poland, United Kingdom, Spain, and Sweden—participated in this collaborative study.

Objectives: This paper highlights a multi-centre, multi-national research programme. We describe how HANDOVER participants conducted an ‘artefact analysis’ as one element of the mixed methods study to inform opportunities to make patient handovers between hospital and community care more effective.

Methods: The artefact analysis consisted of a four-step process to assess different tools used in communication and treatment and their effects on the communication processes between the hospital and general practice settings.

Results: Four themes emerged from our analysis: (a) The inpatient care of a patient is ‘hospital centric’ whereby the hospital ‘pulls’ information regarding a patient's family physician (b) There are rich cognitive artefacts that support the patient clinician encounter; c) The use of information technology does not necessarily improve the communication process; and (d) There is a role for the patient, albeit not particularly well-defined or explicit, as a conduit for essential information communication.

Conclusion: Cognitive artefact analysis is an innovative method to provide insights into transitions of patient care. It may be most useful to think about interventions at both the individual patient and the system levels that more fully address and overcome the system issues at work.     

Virtual Medical Care: How Are Our Patients Using Online Health Information?

An increasing percentage of Internet users are seeking health information online. The purpose of our study was to determine the extent of Internet access and online health-seeking and the feasibility of implementing Internet services for our urban, residency-based practice. Using a self-administered survey, we obtained information on use of the Internet, demographics and socioeconomic profile, presence of a chronic medical condition and self-rated health from 300 consecutive patients. Complete surveys were obtained by 203 (68 percent). Responses were compared based on demographic, socioeconomic, and medical variables using Chi-square analysis. Results showed that our sample population tended to be under age 50, female, non-Hispanic Black, low income, and healthy. Seventy-seven percent of respondents had accessed the Internet at least once, 79 percent had used the Internet to find health-related information, 73 percent used the online information to make a health-related decision, 50 percent shared the information with their provider. In conclusion, we confirmed a high rate of Internet usage in our specific patient population, characterized by low socioeconomic status, low education level, and high minority percentages. Our patients not only access online health information, but also make changes based on this information, with only about half of all patients sharing this information with their physicians. It is unclear how this system of ‘virtual medical care’ influences overall patient health.Heather A. Liszka and Terrence E. Steyer are Assistant Professors of Family Medicine, William J. Hueston is Professor and Department Chair of Family Medicine, all at the Medical University of South Carolina, Charleston, SC.     

Ensuring Quality Information for Patients: development and preliminary validation of a new instrument to improve the quality of written health care information

BACKGROUND: Despite the recent focus on improving the quality of patient information, there is no rigorous method of assessing quality of written patient information that is applicable to all information types and that prescribes the action that is required following evaluation. OBJECTIVE: The aims of this project were to develop a practical measure of the presentation quality for all types of written health care information and to provide preliminary validity and reliability of the measure in a paediatric setting. METHODS: The Ensuring Quality Information for Patients (EQIP) tool was developed through a process of item generation, testing for concurrent validity, inter-rater reliability and utility. Patient information managers and health care professionals tested EQIP in three annual audits of health care leaflets produced by a children's hospital. RESULTS: The final tool comprised 20 items. Kendall's tau B rank correlation between EQIP and DISCERN was 0.56 (P = 0.001). There was strong agreement between intuitive rating and the EQIP score (Kendall's tau B = 0.78, P = 0.009). Internal consistency using Cronbach's alpha was 0.80. There was good agreement between pairs of raters (mean kappa = 0.60; SD = 0.18) with no differences based on types of leaflets. Audits showed significant improvement in the number of leaflets achieving a higher quality EQIP rating over a 3-year period. CONCLUSIONS: EQIP demonstrated good preliminary validity, reliability and utility when used by patient information managers and healthcare professionals for a wide variety of written health care information. EQIP uniquely identifies actions to be taken as a result of the quality assessment. Use of EQIP improved the quality of written health care information in a children's hospital. Wider evaluation of EQIP with written information for other populations and settings is recommended.     

105例老年患者非手术治疗抗菌药物应用分析

目的 了解本院抗菌药物应用情况，倡导合理用药。方法 对2001年6月份出院的1464份病历随机调查786份登记，重点分析老年非手术治疗患者抗菌药物应用情况。结果 老年组使用抗菌药物者占50．97％，用于治疗者占76．19％，有效率73．33％。结论 老年患者应用抗菌药物存在把握指征不够严格、配伍不当、品种更换过频及品种趋向高档化、病原送检率低等问题。