Tamino在电子病案中的应用

在对基于XML文档的EMR进行有效存储的解决方案中，Tamino作为第一个纯XML数据库系统的信息服务器因其优良的系统架构可以高效对XML文档进行存储和获得各类型数据，是今后构建EMR系统结构中存储层的首要选择对象。随着更多专门针对XML的象Tamino一样的开发利器出现，BMR的发展前景将更为看好。     

可扩展型医院专科电子病历体系——新一代专科电子病历解决方案

电子病历包含越来越多的临床知识是必然的趋势,将全院电子病历搭建于一个技术平台之上,并将各科室的专科知识整合到一个临床电子病历系统之上,是解决专科临床知识整合的可行方法.该文介绍了基于相同技术框架之上,可根据临床需求自由扩展的专科电子病历体系的解决方案及部分功能演示.     

XML在病历信息电子化中的应用

随着时代的进步 ,人类已步入信息化、网络化社会 ,不断发展的时代背景、技术背景给医疗信息管理带来了前所未有的机遇和挑战。病历管理是医疗信息管理的基础 ,其电子化必将成为一种发展趋势。电子病历系统用计算机来代替人工实现病历信息的采集、存储、传递、表现和加工利用 ,改变了保管条件 ,为网络医疗奠定基础 ,更利于其在医疗、教学、科研中广泛应用。当前 ,病历电子化工作处于纸张型与电子型并存的开拓研究与试运行阶段 ,其有关法律效力问题正在研究并逐步与国际接轨中 ,目前可率先应用于科研、统计、教学等领域。由于患者信息类型的多…     

XML压缩技术在医用嵌入式系统数据传输中的应用

随着网络和嵌入式系统的发展,医用嵌入式计算机设备走进了医务工统、编程语言等优势,被广泛的应用到医学信息领域.Web Service最具争议的方面是使用的SOAP消息格式XML冗长,对于嵌入式Internet信息系统存储空间小、网络传输慢的特点似乎不太适应.根据平台的差异性分析、采用合适的压缩算法来改善Web Service的传输性能,可以大大提高医用嵌入式系统的性能.     

XML数据库技术及其在医院信息系统中的应用

本文分析了医疗信息的特点和传统关系型数据库的局限性,在介绍XML和XML数据库技术基础上,以实际例子描述混合型XML数据库在医院信息系统中的应用.     

EMR新方法：在粘膜下层注射纤维蛋白原混合物

据Lee SH G astrointestEndosc,2004592220-224报道在粘膜下层注射纤维蛋白原混合物是一种新EM R 方法。 Lee SH 及其同事选取35例早期食管病变患者采用新的粘膜下注射纤维蛋白原混合物的EM R 方法切除病变组织,评价其临床效果。为了完成手术操作,不要求所有的35处病变均行辅助     

手机电磁辐射对小鼠自由基影响的研究

目的 :研究经手机电磁辐射后的小鼠血清中SOD、MDA含量的变化 ,推断手机电磁辐射可能对人体造成的早期损害。方法 :应用分光光度比色法检测手机辐射后血清SOD、MDA含量 ,并与对照组进行统计学比较 ,同时电镜下观察大脑皮层、海马、小脑超微结构的变化。结果 :实验组小鼠血清SOD低于对照组 ,有显著性差异 (P <0 .0 5 ) ,而实验组MDA含量明显高于对照组 (P <0 .0 1) ;电镜下 ,实验组大脑皮层、海马、小脑超微结构与对照组相比较没有明显改变。结论 :手机辐射使小鼠体内自由基生成增多 ,对机体细胞造成早期损伤。     

我院电子病历系统功能与应用体会

电子病历是数字化医院建设的核心。本文论述了XML在电子病历中的基础地位,并以长征医院的电子病历为例,论述了其主要功能特点、使用效果,最后进行了讨论。     

元数据家族中的新成员-MODS和METS

针对图书馆的数字化对象,LC推出了新的元数据标准--MODS和METS。新标准的出现利用了XML模式的发展,更适应图书馆的需要。     

双向电泳在疾病研究中的应用

生命的表现形式最终是由蛋白质决定的。因此,对蛋白质组的研究具有很现实的意义。双向电泳(2-DE)技术作为蛋白质组学研究的一项核心技术,主要用于细胞、组织以及其他样本蛋白质提取物的分析。近年来,2-DE结合质谱(MS)技术被广泛用于差异蛋白的鉴定、疾病标志物的筛选、药物靶标的确定等,目前已经成为蛋白质组学研究的支撑技术,以其高通量、高分辨率和重复性被广泛应用到各个领域,特别是生物医学的研究中。本文就近年2-DE技术的应用进展,尤其在生物医学方面的贡献做一综述。     

Comparative domain modeling of human EGF-like module EMR2 and study of interaction of the fourth domain of EGF with chondroitin 4-sulphate

EMR2 is an EGF-like module containing mucin-like hormone receptor-2 precursor,a G-protein coupled receptor (G-PCR).Mutation in EMR2 causes complicated disorders like polycystic kidney disease (PKD).The structure of EMR2 shows that the fifth domain is comprised of EGF-TM7 helices.Functional assignment of EMR2 by support vector machine (SVM) revealed that along with transporter activity,several novel functions are predicted.A twenty amino acid sequence MGGRVFLVFLAFCVWLTLPG acts as the signal peptide responsible for posttranslational transport.Eight amino acids are involved in N-glycosylation sites and two cleavage sites are Leu517 and Ser518 in EMR2.The residue Arg241 is responsible for interaction with glycosaminoglycan and chondroitin sulfate.On the basis of structure,function and ligand binding sites,competitive EMR2 inhibitors designed may decrease the rate of human diseases like Usher’s syndrome,bilateral frontoparietal polymicrogyria and PKD.     

Inactivation of the EGF-TM7 receptor EMR4 after the Pan-Homo divergence

We here report on the identification of a novel human EGF-TM7 receptor, designated EMR4. Like most EGF-TM7 receptor genes, EMR4 is localized on the short arm of chromosome 19, in close proximity to EMR1. Remarkably, due to a one-nucleotide deletion in exon 8, translation of human EMR4 would result in a truncated 232-amino acid protein lacking the entire seven-span transmembrane region. This deletion is not present in nonhuman primates, including chimpanzees, suggesting that EMR4 became nonfunctional only after human speciation, about five million years ago. Thus, EMR4 surprisingly accounts for a genetic difference between humans and primates related to immunity.     

Evaluation and selection of open-source EMR software packages based on integrated AHP and TOPSIS

Evaluating and selecting software packages that meet the requirements of an organization are difficult aspects of software engineering process. Selecting the wrong open-source EMR software package can be costly and may adversely affect business processes and functioning of the organization. This study aims to evaluate and select open-source EMR software packages based on multi-criteria decision-making. A hands-on study was performed and a set of open-source EMR software packages were implemented locally on separate virtual machines to examine the systems more closely. Several measures as evaluation basis were specified, and the systems were selected based a set of metric outcomes using Integrated Analytic Hierarchy Process (AHP) and TOPSIS. The experimental results showed that GNUmed and OpenEMR software can provide better basis on ranking score records than other open-source EMR software packages.     

The impact of residents’ training in Electronic Medical Record (EMR) use on their competence: Report of a pragmatic trial

Objectives

Even though Electronic Medical Records (EMRs) are increasingly used in healthcare organizations there is surprisingly little theoretical work or educational programs in this field. This study is aimed at comparing two training programs for doctor–patient–computer communication (DPCC).

Methods

36 Family Medicine Residents (FMRs) participated in this study. All FMRs went through twelve identical simulated encounters, six pre and six post training. The experiment group received simulation based training (SBT) while the control group received traditional lecture based training.

Results

Performance, attitude and sense of competence of all FMRs improved, but no difference was found between the experiment and control groups. FMRs from the experiment group evaluated the contribution of the training phase higher than control group, and showed higher satisfaction.

Conclusion

We assume that the mere exposure to simulation served as a learning experience and enabled deliberate practice that was more powerful than training. Because DPCC is a new field, all participants in such studies, including instructors and raters, should receive basic training of DPCC skills.

Practice implication

Simulation enhances DPCC skills. Future studies of this kind should control the exposure to simulation prior to the training phase. Training and assessment of clinical communication should include EMR related skills.     

无线移动查房系统的安全方案

目的无线移动多媒体查房系统的安全策略实施。方法在鼻科无线查房系统范围建立足够的无线路由器,在数据安全方面采用IEEE802.11标准定义的WEP协议,建立一套完整的用户身份认证系统,。医疗数据实行定时备份。结果手持TabletPC在鼻科移动工作范围内工作没有信号盲区,每一用户均有对应的帐号和密码进入系统,系统避免外界的干扰、侵袭。系统定时的备份,保证了数据的完整。讨论由于建筑群内存在多种无线信号屏蔽障碍物,通过增加无线路由器的方法能杜绝信号盲区,增加信号的强度。由于WEP协议存在一定的缺陷,容易受到黑客的入侵而危害系统数据和系统动作,密钥认证系统保证无线网络免遭外界的侵袭,数据的安全得到保障。医疗病历要求医疗数据的完整和真实,系统医疗数据定时备份方案,保证数据完整。     

The trends in EMR and CPOE adoption in Japan under the national strategy

PurposeWe evaluate the status of health information system (HIS) adoption (In this paper, “HIS” means electronic medical record system (EMR) and computerized provider order entry system (CPOE)). We also evaluate the affect of the policies of Japanese government.MethodsThe status of HIS adoption in Japan from 2002 to 2011 was investigated using reports from complete surveys of all medical institutions conducted by the Ministry of Health, Labour and Welfare (MHLW). HIS-related budgets invested by the Japanese government from 2000 to 2008 were surveyed mainly using literatures and administrative documents of the Japanese government (MHLW and Ministry of Economy, Trade and Industry).ResultsThe rates of HIS adoption in Japan in 2011 were: 20.9% for the rate of EMR adoption in clinics, 20.1% for the rate of EMR adoption and 36.6% for the rate of CPOE adoption in hospitals. In hospitals, the rate of EMR and CPOE adoption were 51.5% and 78.6% in 822 large hospitals (400 or more beds), 27.3% and 52.1% in 1832 medium hospitals (200–399 beds), and 13.5% and 26.0% in 5951 small hospitals (less than 200 beds), respectively. Japan has a large number of medical institutions (99,547 clinics and 8605 hospitals) with a low rate of EMR adoption in clinics and a high rate of HIS adoption in hospitals. The national budget to expand HIS use was implemented for medium and large hospitals mainly. The policy target of New IT Reform Strategy was not achieved.ConclusionThe rate of HIS adoption in Japanese medium and large hospitals is high compared to small hospitals and clinics, and this is attributable to the fact that the Japanese government placed the target for HIS adoption on key hospitals with a large number of beds and concentrated budget investment in those hospitals. Besides, legal approval of EMR and the introduction of Diagnostic Procedure Combination system facilitated EMR adoption. There is less financial support for small hospitals than medium and large hospitals. The low rate of EMR adoption in clinics stems from the facts that there was little subsidies or incentives in the national remuneration for medical services, lack of cooperation from medical associations, and a failed attempt to mandate computerization of medical accounting (medical billing). Giving financial incentives is an effective means of raising EMR adoption rate. For wide usage of HIS, more financial support and incentive may be necessary for small hospitals and clinics.     

To test or not: A registry-based observational study of an online decision support for prostate-specific antigen tests

BackgroundWatchful waiting is an essential part in the handling of patients with prostate cancer (PC). More effective disease management may be achieved by this strategy. Correct use of prostate-specific antigen (PSA) test is crucial and the general practitioner (GP) may therefore benefit from access to a clinical decision support system (CDSS) that focuses on this challenge. There are many barriers to the use of CDSSs. The aim of the present paper is to study if such barriers may be overcome by granting GPs easier access to a web-based CDSS via a hyperlink in the GPs’ electronic medical record system (EMR).MethodsIn the present population-based observational registry study with an intervention and control group, we created a web-based CDSS that was made accessible to GPs via hyperlink inserted into the EMR medical chart contents. The intervention was introduced 1 January 2011. Our outcome measure was the number of age-standardised PSA test rates per 1000 men per practice during three equally sized periods of 6 months within the study period from 1 January 2010 to 30 June 2011.ResultsWe found that none of the differences between intervention and control groups were statistically significant.ConclusionsProviding GPs with access to a CDSS to aid their decision to use the PSA, had no measurable effect on the GPs’ PSA testing behaviour.     

The effects of EMR deployment on doctors' work practices: a qualitative study in the emergency department of a teaching hospital

ObjectiveThe goal of this study was to examine the effects of medical notes (MD) in an electronic medical records (EMR) system on doctors’ work practices at an Emergency Department (ED).MethodsWe conducted a six-month qualitative study, including in situ field observations and semi-structured interviews, in an ED affiliated with a large teaching hospital during the time periods of before, after, and during the paper-to-electronic transition of the rollout of an EMR system. Data were analyzed using open coding method and various visual representations of workflow diagrams.ResultsThe use of the EMR in the ED resulted in both direct and indirect effects on ED doctors’ work practices. It directly influenced the ED doctors’ documentation process: (i) increasing documentation time four to five fold, which in turn significantly increased the number of incomplete charts, (ii) obscuring the distinction between residents’ charting inputs and those of attendings, shifting more documentation responsibilities to the residents, and (iii) leading to the use of paper notes as documentation aids to transfer information from the patient bedside to the charting room. EMR use also had indirect consequences: it increased the cognitive burden of doctors, since they had to remember multiple patients’ data; it aggravated doctors’ multi-tasking due to flexibility in the system use allowing more interruptions; and it caused ED doctors’ work to become largely stationary in the charting room, which further contributed to reducing doctors’ time with patients and their interaction with nurses.DiscussionWe suggest three guidelines for designing future EMR systems to be used in teaching hospitals. First, the design of documentation tools in EMR needs to take into account what we called “note-intensive tasks” to support the collaborative nature of medical work. Second, it should clearly define roles and responsibilities. Lastly, the system should provide a balance between flexibility and interruption to better manage the complex nature of medical work and to facilitate necessary interactions among ED staff and patients in the work environment.