三级医院图书馆构建多元化信息服务模式实践与思考

论述网络环境下医院图书馆信息服务多元化的必要性及其核心内容,从构建多元化的医学信息资源体系、信息服务模式的多元化、提供有价值的决策情报等方面对三级医院图书馆如何构建符合医疗卫生事业改革和医院学科发展需求的信息服务模式进行探讨。     

基于“签、约、服”三环节的医防融合式家庭医生工作室构建研究

提高基层医疗卫生服务能力,为居民提供优质、高效的家庭医生签约服务,是目前基层医疗卫生机构需要解决的重点问题之一。家庭医生工作室是推进家庭医生服务的重要形式与载体,可以有效整合区域内医疗资源,更好地促进分级诊疗,同时提高居民的获得感和满意度。重庆市渝中区大溪沟街道社区卫生服务中心自2016年开始积极探索家庭医生工作室建设,紧扣签约服务的“签、约、服”三环节构建医防融合式家庭医生工作室,建立了“三定”（定岗、定任务、定分配）、“三优”（优化服务内容、服务流程、服务渠道）、“两衔接”（全科医生与市级专家、社区卫生与市级医院资源整合衔接）的有效签约服务模式。本文介绍了医防融合式家庭医生工作室的团队建设、服务内容及服务方式,并对其构建策略进行汇总分析,以期为其他地区的家庭医生工作室建设提供参考。     

县级医院融入社区卫生服务的探索与尝试

社区卫生建设是世界卫生组织倡导的服务模式,是我国新医改的重要组成部分。本文通过介绍诸城市人民医院在融人社区卫生服务中的做法和效果,阐述了县级医院融入社区卫生建设,是发展和完善社区卫生服务网络的有效形式;县级医院与社区医院建立集团化的协调机制,是解决三级医疗网内服务功能冲突的有效途径;县级医院的最大舞台在社区卫生服务,最大市场在农村。     

基于即时通信工具的远程医疗系统架构

目的：探索常态化、市场化的远程医疗服务模式,推广远程医疗应用、提高远程医疗资源利用率。方法：引入即时通信工具,跨越医院间的系统架构差异,结合远程医疗多媒体模块,整合专线网和宽带网,实现医院间远程医疗业务随时随地交互。结果：实现全互通互联、随时随地信息获取、常态化运营的全开放远程医疗系统。结论：全开放远程医疗系统将对传统的医疗业务产生重大影响,并产生巨大的经济、社会和管理效益。     

现代社区卫生管理与服务的探讨

目的:探讨现代社区卫生管理与服务的发展方向。方法:回顾我国近二十余年来在社区卫生管理与服务方面的改革路程,分析社区卫生管理与服务改革面临的瓶颈。结果:现代社区卫生管理与服务应着力于完善三级社区卫生服务网络,完善双向转诊制度,丰富公共卫生服务,倡导中医"治未病"理念,以满足居民日益增长的多样化的健康需求。结论:积极推进医疗资源的纵向整合,加强基础公共卫生服务,是现代社区卫生管理与服务的中心任务。     

科创承载型功能社区家庭医生服务需求及其影响因素研究

背景　上海市作为国家科技创新中心重要承载区，除了满足创新创业的政策支持、创业环境、资金投入等需求外，满足各类人才在健康保健等方面的延伸需求对于促进“产城融合”至关重要。发展功能社区卫生服务是完善功能配套、促进“产城融合”的关键环节，但当前功能社区服务存在短板，无法为“产城融合”提供支撑，亟须突破。目的　分析科创承载型功能社区人群多样化的健康服务需求，并为家庭医生健康服务在功能社区的拓展提供建议。方法　2019年3-11月，通过对上海市科创承载型功能社区进行分层随机抽样调查，共发放1 500份问卷，获得功能社区人群基本情况及生活方式、心理健康状况、卫生服务需求与利用等相关数据，了解功能社区人群的健康状况、卫生服务需求与利用情况，并分析功能社区家庭医生服务需求的影响因素；并参考文献研究结果，对比与其他类型功能社区人群的主要健康问题与卫生服务需求的差异。结果　共回收有效问卷1 487份（99.13%），其中调查对象两周患病率〔5.92%（88/1 487）〕、慢性病患病率〔5.98%（89/1 487）〕较低；功能社区人群健康服务主观需求主要是常见疾病处理（1 251人，84.13%）、健康管理（858人，57.70%）、健康体检（699人，47.01%）、健康咨询（586人，39.41%）、心理咨询（470人，31.61%）。功能社区人群家庭医生签约服务知晓率为57.03%（848/1 487），45.73%（680/1 487）有签约意愿，且性别、年龄、文化程度、自我感觉健康状况、慢性病患病情况对家庭医生签约意愿产生影响（P<0.05）；就诊意愿调查中，患病后想去的卫生机构前3位分别是市级医院（620人，41.69%）、区级医院（404人，27.17%）、门诊部（所）/卫生室/卫生服务站（153人，10.29%），其中质量（734人，25.41%）、距离（732人，25.34%）和有可信赖的医生（391人，13.48%）是主要影响因素；卫生服务实际利用情况与就诊意愿基本一致。结论　在科创承载型功能社区中开展健康保健服务具现实意义和可操作性。不同类型功能社区卫生服务需求可能存在差异，应针对不同需求提供差异化的健康服务方案，并吸取其他类型功能社区健康服务发展的优秀经验。建议从明确覆盖人群与服务内容、丰富供给方式、优化筹资来源、加强统筹协调等角度完善功能社区家庭医生服务的推进工作。     

创新并改进医院图书馆读者服务工作探讨

分析网络环境下医院读者服务需求的特点,以大连医科大学附属第一医院为例,探讨创新、改进读者服务工作的措施,包括持续更新馆藏资源、整合文献信息资源、开展培训、实时参考咨询、学科化服务、定题服务、推送服务、远程访问等方面。     

医院图书馆开展以学科为导向的个性化信息服务探讨

分析医院图书馆开展多层次、个性化信息服务的必要性和可行性并提出相应策略,包括搭建个性化学科导航服务平台、网络数字参考咨询与传统咨询相结合、嵌入式定题服务、提高医务人员信息素养、创建个人数字图书馆、利用微博丰富信息服务内容、强化网络环境下的图书馆导读等,最后强调应注重提高图书馆员的综合素质。     

医院与社区互动的卫生服务综合信息系统的建立与研究

阐述了充分利用信息技术和网络通信技术手段,建立首都医科大学附属复兴医院与月坛社区卫生服务信息共享网络平台、双向转诊信息平台及与居民家庭互动信息平台,并依托三个平台实现医院与社区双向转诊、健康信息咨询、居民电子健康档案信息、家庭信息互动等医院与社区的新型卫生协同服务模式。     

新型冠状病毒肺炎疫情下的基层医疗卫生发展策略

基层医疗卫生机构是新型冠状病毒肺炎疫情防控的“网底”,加强基层新型冠状病毒感染防控工作,提升基层医疗卫生机构服务提供和疫情应对能力,对全国疫情控制工作至关重要。本文通过实地调研,检索国家及各地卫生健康委官方网站疫情防控相关信息,梳理了基层医疗卫生机构在疫情时期发挥的重要作用,并提出疫情平战结合时期基层卫生工作重点,以及今后基层医疗卫生发展策略。针对疫情的复杂形势,目前基层医疗卫生机构应重点做好社区疫情防控、协助开展医疗救治服务、做好常规诊疗服务和公共卫生服务、做好医疗安全和院感防控、充分发挥好县域医共体作用五方面工作。同时,针对疫情应对和基层“短板”,提出今后基层医疗卫生发展策略：加强全科医生制度和分级诊疗制度建设;增强基层医务人员对重大疫情的预警灵敏性、报告及时性和应急处置能力;充分利用人工智能、信息技术工具等手段,持续加强基层信息化建设和应用;推进医联体、医共体建设,探索医防融合的有效模式;大力开展爱国卫生运动,强化群防群控机制,做好健康社区健康乡村建设。     

网络环境下医院科研信息服务的思考

网络环境下信息服务的特点是服务体系网络化,它实现了信息资源的共享性;服务特色集成化,确保了信息来源的系统性;服务层次立体化,促成了信息服务的多样性。医院科研信息服务的措施包括依托医院局域网络,实现科研信息共享;整合科研信息资源,提供全面系统服务;推行综合服务方式,满足不同用户需求。     

A Provably Secure RFID Authentication Protocol Based on Elliptic Curve for Healthcare Environments

To enhance the quality of healthcare in the management of chronic disease, telecare medical information systems have increasingly been used. Very recently, Zhang and Qi (J. Med. Syst. 38(5):47, 32), and Zhao (J. Med. Syst. 38(5):46, 33) separately proposed two authentication schemes for telecare medical information systems using radio frequency identification (RFID) technology. They claimed that their protocols achieve all security requirements including forward secrecy. However, this paper demonstrates that both Zhang and Qi’s scheme, and Zhao’s scheme could not provide forward secrecy. To augment the security, we propose an efficient RFID authentication scheme using elliptic curves for healthcare environments. The proposed RFID scheme is secure under common random oracle model.     

Why common carrier and network neutrality principles apply to the Nationwide Health Information Network (NWHIN)

The Office of the National Coordinator will be defining the architecture of the Nationwide Health Information Network (NWHIN) together with the proposed HealtheWay public/private partnership as a development and funding strategy. There are a number of open questions—for example, what is the best way to realize the benefits of health information exchange? How valuable are regional health information organizations in comparison with a more direct approach? What is the role of the carriers in delivering this service? The NWHIN is to exist for the public good, and thus shares many traits of the common law notion of ‘common carriage’ or ‘public calling,’ the modern term for which is network neutrality. Recent policy debates in Congress and resulting potential regulation have implications for key stakeholders within healthcare that use or provide services, and for those who exchange information. To date, there has been little policy debate or discussion about the implications of a neutral NWHIN. This paper frames the discussion for future policy debate in healthcare by providing a brief education and summary of the modern version of common carriage, of the key stakeholder positions in healthcare, and of the potential implications of the network neutrality debate within healthcare.     

建设双向转诊、信息共享的网络体系

目的建立城市医院与社区卫生服务机构双向转诊、信息共享网络体系。方法根据项目计划,在卫生行政管理部门组织下,由医院、社区卫生服务机构和相关IT公司分工协作为南京市鼓楼区构建双向转诊、信息共享的网络体系。结果开发了双向转诊信息管理系统,实现了包括HIS与CHSS之间的信息“有限”共享、医院合理用药系统的共享、心电远程传输、医院检验报告共享和双向转诊等服务功能。结论网络体系的建设,使双向转诊工作得到顺利实施,信息共享有效地提高了社区卫生服务的水平。     

基于电子认证服务的军队医院信息安全解决方案

分析军队医院现有信息系统的安全现状与需求,提出基于电子认证服务应用的整体安全解决方案.具体介绍系统组成、体系架构、建设组网情况,指出该系统可提供身份认证、数字签名、时间戳、数据加密、电子签章和证书管理等服务.     

Implementation of Online Veterinary Hospital on Cloud Platform

Pet markets involve in great commercial possibilities, which boost thriving development of veterinary hospital businesses. The service tends to intensive competition and diversified channel environment. Information technology is integrated for developing the veterinary hospital cloud service platform. The platform contains not only pet medical services but veterinary hospital management and services. In the study, QR Code andcloud technology are applied to establish the veterinary hospital cloud service platform for pet search by labeling a pet’s identification with QR Code. This technology can break the restriction on veterinary hospital inspection in different areas and allows veterinary hospitals receiving the medical records and information through the exclusive QR Code for more effective inspection. As an interactive platform, the veterinary hospital cloud service platform allows pet owners gaining the knowledge of pet diseases and healthcare. Moreover, pet owners can enquire and communicate with veterinarians through the platform. Also, veterinary hospitals can periodically send reminders of relevant points and introduce exclusive marketing information with the platform for promoting the service items and establishing individualized marketing. Consequently, veterinary hospitals can increase the profits by information share and create the best solution in such a competitive veterinary market with industry alliance.     

A Secure and Efficient Authentication and Key Agreement Scheme Based on ECC for Telecare Medicine Information Systems

In the field of the Telecare Medicine Information System, recent researches have focused on consummating more convenient and secure healthcare delivery services for patients. In order to protect the sensitive information, various attempts such as access control have been proposed to safeguard patients’ privacy in this system. However, these schemes suffered from some certain security defects and had costly consumption, which were not suitable for the telecare medicine information system. In this paper, based on the elliptic curve cryptography, we propose a secure and efficient two-factor mutual authentication and key agreement scheme to reduce the computational cost. Such a scheme enables to provide the patient anonymity by employing the dynamic identity. Compared with other related protocols, the security analysis and performance evaluation show that our scheme overcomes some well-known attacks and has a better performance in the telecare medicine information system.     

A Secure Authentication Scheme for Telecare Medicine Information Systems

The telecare medicine information system enables or supports health-care delivery services. In recent years, the increased availability of lower-cost telecommunications systems and custom made physiological monitoring devices for patients have made it possible to bring the advantages of telemedicine directly into the patient’s home. These systems are moving towards an environment where automated patient medical records and electronically interconnected telecare facilities are prevalent. A secure authentication scheme will thus be needed to safeguard data integrity, confidentiality, and availability. Many schemes based on cryptography have been proposed for the goals. However, much of the schemes are vulnerable to various attacks, and are neither efficient, nor user friendly. Specially, in terms of efficiency, some schemes need the exponential computation resulting in high time cost. Therefore, we propose a novel authentication scheme that is added the pre-computing idea within the communication process to avoid the time-consuming exponential computations. Finally, it is shown to be more secure and practical for telecare medicine environments.     

Visual Sharing Protection Method for Medical Images

The telecare medical information system (TMIS) aims to establish telecare services and enable the public to access medical services or medical information at remote sites. Authentication and key agreement is essential to ensure data integrity, confidentiality, and availability for TMIS. Most recently, Chen et al. proposed an efficient and secure dynamic ID-based authentication scheme for TMIS, and claimed that their scheme achieves user anonymity. However, we observe that Chen et al.’s scheme achieves neither anonymity nor untraceability, and is subject to the identity guessing attack and tracking attack. In order to protect user privacy, we propose an enhanced authentication scheme which achieves user anonymity and untraceablity. It is a secure and efficient authentication scheme with user privacy preservation which is practical for TMIS.     

网络环境下医院图书馆核心价值的体现——知识服务

阐述现代图书馆的核心价值以及医院图书馆以用户为中心所提供知识服务的措施,包括一站式信息服务、整合信息资源、个性化知识服务以及多元化信息服务.通过服务模式的改变,拓展用户获取信息的途径,充分发挥图书馆在医疗、教学、科研中的作用.