计算机网络系统在护理工作中的应用

我院于１９９６年自行开发了医院信息系统,实现了全部病人系统的微机网络化管理。该系统包括１３个子系统,其中护理管理办公子系统（以下简称系统）共设护士工作站８个,运行２年来,提高了工作质量和工作效率,改善了办公环境,有效地加强了护理文书的管理,使复杂、耗时的护理工作变得快捷、简单,推动了护理管理现代化进程。１　系统软件应用１．１　软件程序特点１．１．１　适用性、通用性强,人机界面好,声色并茂,易学易用。１．１．２　信息传输、处理速度快,效率高,便于全院工作协调运行,实现了护理办公自动化。１．１．３　…     

眼眶病数据库系统的设计与开发

 目的 设计开发有眼眶病专科特色的数据库系统,改善病例资料管理状况,提高科研能力.方法 使用浏览器/服务器数据库结构,采用PostgreSQL8.3搭建数据库平台,Ruby1.8.6作为数据库系统的开发工具.实现患者资料的数据录入、浏览、检索、短信随访、预约挂号、权限管理等6个功能模块.结果 该系统可全面地收集眼眶病患者的病例资料,并在局域网内共享数据,各功能模块运行良好,数据保存安全可靠.结论 该系统稳定性、安全性和兼容性可靠,专科特色明显,实现了临床资料的信息化管理,有利于临床、教学和科研工作.     

医院办公自动化系统建设中应注意的几个要素

随着信息化建设的深入发展,医院对现代化管理要求不断提高,医院办公正逐步走向无纸化和流程自动化阶段,并以全面实现文件管理制度化、标准化、规范化和网络化为目标[1].2010 -09我院正式建成办公自动化系统,它简化了医院管理部门和业务科室之间信息传达的流程,使医院的公文管理、信息发布、日常办公等辅助办公功能模块得到普及,加快了医院内部的信息交流,大大提高了工作效率.医院在系统建设投入人力物力的同时,应注意以下几个要素.     

计算机辅助检测系统在低剂量CT早期肺癌筛查中的应用研究

目的:评价计算机辅助检测(computed aided detection,CAD)系统在低剂量CT肺癌筛查中的应用价值。方法:120例受检者的胸部低剂量CT图像纳入本研究。采用CAD肺结节自动分析软件(方法 A)、横断面薄层图像结合MIP图像(方法 B)、方法 C(方法 A+B)。方法 B和C由低年资和中年资影像诊断科医师各1名独立完成。以2名高年资影像诊断医师应用方法 C检出的肺结节的一致意见为真结节参照标准。记录检出肺结节的大小、位置和密度,所得数据应用SPSS 16.0软件进行统计学分析。结果:2位高年资医师确定了178个真结节。方法 A检出真结节121个,敏感性为67.98%;低年资和中年资医师应用方法 B检出的真结节数及敏感性分别为97个(54.49%)、142个(79.78%);2位医师应用方法 C检出真结节数及敏感性分别为138个(77.53%)、170个(95.50%)。低年资和中年资医师应用方法 C检出肺结节的敏感性均高于方法B,且差异有统计学意义(P0.001)。低年资和中年资医师应用方法C检出的结节数与参照标准均具有较高的一致性(Kappa=0.718、0.930,P0.001),2位医师之间具有较高的一致性(Kappa=0.784,P0.001)。结论:CAD系统明显提高了影像诊断医师对肺结节的检出能力,具有较高的应用价值。由于CAD系统相对较高的假阴性,在实际工作中尚不能独立应用。     

"军字一号"系统在医院管理中的改进应用

医院信息系统（Hospital information system,HIS）是计算机技术和管理科学在医院信息管理中的应用,是计算机技术对医院管理、临床医学、信息管理长期影响、渗透以及相互结合的产物。随着医院信息化管理的逐步开展和深化,计算机信息技术实现了医疗信息的统一化,并在提高医疗工作质量和效率方面发挥了巨大的潜力,使医院的管理模式发生了前所未有的变化。我院于1998年开始运行“军字一号”工程的HIS及医师工作站,7年来,系统运行逐渐稳定,有力地促进了医院人、财、物的优化管理,推动了我院管理的科学化、现代化、正规化进程。但是随着医院的发展,病员量及医师工作量的逐年增高,在医院、科室、个人年终和每月进行工作量统计评比时,原有的HIS没有支持医师工作量统计的功能,医务处及医师需要花费大量的时间进行统计。     

贯彻《执业医师法》加强医师执业管理

《中华人民共和国执业医师法》（简称《医师法》）于1999年5月1日起正式实施，这是解放后我国第一部以医师为对象的法律。医师法共6章48条，全面总结了我国建国50年特别是改革开放以来医师队伍管理的经验教训，并借鉴国外发达国家医师队伍管理的成功经验，对医师的准入、权利和义务等方面进行了全面的规定，为依法行医、依法管医提供了法律保障，是我国医师队伍管理走向规范化、法制化新的里程碑。     

基于深度学习的乳腺X线摄影肿块检测系统的应用

目的 探讨基于深度学习(DL)的乳腺X线摄影肿块检测系统的临床应用价值。资料与方法 回顾性分析2019年4—12月深圳市人民医院1 755例接受乳腺X线摄影检查的患者资料。由DL系统和2名初级职称医师采用盲法独立阅片，比较DL系统与2名医师对肿块病灶检出的敏感度，并分析患者年龄、乳腺密度分类、乳腺影像报告和数据系统分类、肿块形态、边缘、密度、大小对于DL系统及2名初级职称医师肿块检出准确度的影响。结果 共检出肿块324例(618个肿块)，2名医师及DL系统分别检出肿块277例(519个肿块)、268例(482个肿块)、284例(533个肿块)。DL系统及2名医师对于肿块检出的敏感度分别为86.25%、83.98%、77.99%,DL系统对于不同乳腺密度分类的肿块检出差异无统计学意义(χ²=3.04,P>0.05)，而2名医师的差异有统计学意义(χ²=9.39、8.96,P<0.05)。DL系统对于不同患者年龄、肿块形态、边缘、密度、大小及乳腺影像报告和数据系统分类的肿块检出差异均有统计学意义(χ²=15.28...     

在CT上鉴别亚实性及实性肺结节:经验丰富的胸部放射学医师的观察者内及观察者间的一致性

正摘要目的对经验丰富的胸部放射学医师在CT上鉴别亚实性及实性肺结节的重复性及准确度进行量化。材料与方法Beth Israel Deaconess医学中心的机构伦理委员会批准了这项多中心研究。选择6名在胸部放射学方面平均有21年(17~22年)经验的放射科医师;选择有10个实性和10个亚实性的结节影像以创建一个120个结节的数据;以该集合为     

基于乳腺X线摄影的深度学习技术鉴别乳腺影像报告和数据系统3类与4类疾病的价值

目的探讨基于乳腺X线摄影的深度学习技术鉴别乳腺影像报告和数据系统(BI-RADS)3类与4类疾病的价值。方法回顾性分析2020年1至12月在深圳市人民医院及深圳市罗湖区人民医院乳腺X线摄影评估为BI-RADS 3类及4类305例患者的临床及影像资料。305例患者共314个病灶, 均为女性, 年龄21～83(47±12)岁。按1∶1比例交叉、简单随机分配给2名工作经验分别为5年及6年普通影像诊断医师(普通医师A、普通医师B)和2名工作经验均为21年且经过专业乳腺影像培训的乳腺影像诊断医师(专业医师A、专业医师B)单独阅片, 之后分别结合深度学习系统再次阅片, 最终将乳腺病变重新分为BI-RADS 3类或4类。采用受试者操作特征曲线及曲线下面积(AUC)评价诊断效能, 以DeLong法比较AUC的差异。结果普通医师A结合深度学习系统重新分类BI-RADS 3类与4类乳腺病灶的AUC较普通医师A单独诊断明显提高(AUC分别为0.79、0.63, Z=2.82、P=0.005);普通医师B结合深度学习系统重新分类BI-RADS 3类与4类乳腺病灶的AUC较普通医师B明显提高(AUC分别为0.8...     

MRI计算机辅助诊断系统对不同经验医师鉴别乳腺小肿块良恶性的价值

目的：探讨应用乳腺磁共振计算机辅助系统（MRI-CAD）对于不同经验的医师鉴别乳腺小肿块良恶性的价值。方法：回顾性分析行 MRI 检查的肿块型乳腺病灶235个（≤2．0 cm）,均经病理证实或随诊2年以上。比较4名医师（2名经验缺乏者和2名经验丰富者）使用 CAD 系统前后的诊断敏感度、特异度。采用 ROC 曲线评价并比较4名医师使用 CAD 系统前后的诊断符合率。采用 Kappa 检验评价使用 CAD 系统前后医师间的一致性。结果：235个病灶中,155个良性病灶,80个恶性病灶。4位医师均检出了所有病灶。应用 CAD 系统前,4名医师诊断乳腺癌的特异度分别为55．5％、58．1％、72．3％、74．8％,使用 CAD 后分别为72．3％、76．1％、75．5％、70．3％;医师一、医师二（两名低年资医师）的诊断特异度前后差异具有统计学意义（P ＜0．001）,医师三及医师四差异无统计学意义（P 3＝0．404,P 4＝0．265）。四位医师在使用 CAD 系统后诊断敏感度均略有提高,但差异均无统计学意义（P 1＝1．000,P 2＝1．000,P 3＝1．000,P 4＝0．480）。医师一、医师二及医师三在应用 CAD 系统后,总体诊断符合率均有明显提高,ROC 曲线下面积分别由0．899（95％CI：0．853～0．934）、0．839（95％CI：0．785～0．883）、0．929（95％CI：0．888～0．958）提高至0．947（95％CI：0．910～0．972）、0．987（95％CI：0．962～0．997）、0．971（95％CI：0．940～0．988）,且差异具有统计学意义（P 1＝0．002,P 2＜0．001,P 3＜0．001）。医师四尽管在使用 CAD 系统后总体诊断符合率亦有提高,ROC 曲线下面积由0．940（95％CI：0．901～0．966）提高至0．960（95％CI：0．927～0．981）,但差异无统计学意义（P ＝0．11）。四位医师在应用 CAD 系统后诊断一致性提高（P ＝0．004）。结论：MRI-CAD 系统的应用有助于提高医师诊断乳腺小肿块的准确度及特异度,使得不同经验程度医师的诊断一致性提高,减少了不必要的活检,可作为提高缺乏经验医师诊断符合率的有力工具。     

Access control for electronic patient records

The transition from hardcopy records to electronic records is in the forefront for healthcare today. For healthcare facilities, a major issue is determining who can access patients' medical information and how access to this information can be controlled. There are three components to access control: identification, authentication and authorization. Checking proof of identity is a means of authenticating someone--through a driver's license, passport or their fingerprints. Similar processes are needed in a computer environment, through the use of passwords, one-time passwords or smartcards, encryption and kerberos, and call-back procedures. New in the area of access control are biometric devices, which are hardware/software combinations that digitize a physical characteristic and compare the sample with previously stored samples. Fingerprints, voiceprints and facial features are examples. Their cost is currently prohibitive, but in time, they may become more common. Digital certificates and certification authorities are other means used to authenticate identify. When a system challenges a user's identity at log on, the user provides a certification that tells the system to go to the issuing certification authority and find proof the user's claim is valid. Low-level certifications offer little value for sensitive data, but high-level certification is now being introduced. It requires more specific, detailed information on the applicant. Authorization, the final component of access control, establishes what a specific user can and cannot access. To have effective access control, transaction logging and system monitoring are needed to ensure the various techniques are being used and performing properly.     

Effect of an imaging-based streamlined electronic healthcare process on quality and costs

RATIONALE AND OBJECTIVES: A streamlined process of care supported by technology and imaging may be effective in managing the overall healthcare process and costs. This study examined the effect of an imaging-based electronic process of care on costs and rates of hospitalization, emergency room (ER) visits, specialist diagnostic referrals, and patient satisfaction. MATERIALS AND METHODS: A healthcare process was implemented for an employer group, highlighting improved patient access to primary care plus routine use of imaging and teleconsultation with diagnostic specialists. An electronic infrastructure supported patient access to physicians and communication among healthcare providers. The employer group, a self-insured company, manages a healthcare plan for its employees and their dependents: 4,072 employees were enrolled in the test group, and 7,639 in the control group. Outcome measures for expenses and frequency of hospitalizations, ER visits, traditional specialist referrals, primary care visits, and imaging utilization rates were measured using claims data over 1 year. Homogeneity tests of proportions were performed with a chi-square statistic, mean differences were tested by two-sample t-tests. Patient satisfaction with access to healthcare was gauged using results from an independent firm. RESULTS: Overall per member/per month costs post-implementation were lower in the enrolled population (126 dollars vs 160 dollars), even though occurrence of chronic/expensive diseases was higher in the enrolled group (18.8% vs 12.2%). Lower per member/per month costs were seen for inpatient (33.29 dollars vs 35.59 dollars); specialist referrals (21.36 dollars vs 26.84 dollars); and ER visits (3.68 dollars vs 5.22 dollars). Moreover, the utilization rate for hospital admissions, ER visits, and traditional specialist referrals were significantly lower in the enrolled group, although primary care and imaging utilization were higher. Comparison to similar employer groups showed that the company's costs were lower than national averages (119.24 dollars vs 146.32 dollars), indicating that the observed result was not attributable to normalization effects. Patient satisfaction with access to healthcare ranked in the top 21st percentile. CONCLUSION: A streamlined healthcare process supported by technology resulted in higher patient satisfaction and cost savings despite improved access to primary care and higher utilization of imaging.     

Nuclear medicine information management systems

There are good arguments for considering a computer system to improve timeliness and quality of patient care, enhance the format of clinical reports, and strengthen management controls for the containment of health care costs. A nuclear medicine information management system serves to fill these needs. Receptionists access the system to schedule patient studies, log patient data, and generate examination records. Secretaries transcribe and print clinical reports. Film library staff locate patient films and keep track of borrowed studies. Technologists produce study work sheets, record quality assurance information, and process the examination results. Staff preparing radiopharmaceuticals use the system to receive and inventory tracer stocks, track preparation and dispensing activities, and to keep records for external review. Clinicians use it to look up old study results and record their study impressions. Managers access statistical reports, billing information, and resource utilization data. This review describes an information management system as implemented in a nuclear medicine clinic. Software applications for patient scheduling, radiopharmacy, film management, report generation, quality assurance, and inventory control are described as implemented on a variety of academic and commercial systems. Hardware architectures and the issues surrounding system specification and installation are explored.     

Beefing up your storage networks: a solution for disaster recovery

Redundancy of all technologies involved in securing, accounting, transporting, authenticating and authorizing access to patient record data is vital to ensuring against practices and procedures that might be construed as HIPAA violations or threats to patient well-being. This is particularly notable in data storage technologies, where it is critical to store multiple, redundant, synchronized copies of the electronic patient record, including all radiological imagery in all modalities, to prevent a HIPAA-related compliance issue from being raised. This involves constructing storage networks that are simple to maintain, yet have sufficient flexibility and resiliency of design to ensure future growth and increasing disaster tolerance without affecting radiological operations or patient record data access at any time, i.e., a zero-disruption storage architecture. In terms of time, the optimal set of technologies to create a zero-time recovery window involve geographically dispersed computing and storage facilities, interconnected by several redundant but logically and physically separate networks. In this architecture, patient record data is kept in multiple locations via synchronous mirroring or replication techniques, assuring realtime updating of all instances of the patient record. In addition, zero-time recovery mandates the use of online magnetic disk technologies in all locations to hold enough patient record data to perform all necessary and sufficient examinations and consultations. Hospitals are finding that using networked storage technology from vendors who have pre-qualified their technology with existing healthcare imaging applications creates secure, highly available access to data. Other facets to consider for selecting an optimal solution for radiology data storage and disaster recovery include choosing a solution that is standards-based, easy to implement and operate, and requires minimal full-time-equivalent (FTE) staff hours. For radiology applications, look for a system that removes complexity from storage management. The current need to meet HIPAA regulations actually creates a positive opportunity for hospitals to re-examine and upgrade their data management procedures to ensure less interaction by FTE staff. Electronic data can be made more secure than paper data, is much faster to retrieve, and can be viewed in multiple locations at the same time. However, these benefits are lost if a healthcare organization implements a cumbersome system that integrates poorly with existing applications and networks, and requires intensive administration.     

HIPAA compliant auditing system for medical images.

As an official regulation for healthcare privacy and security, Health Insurance Portability and Accountability Act (HIPAA) mandates health institutions to protect health information against unauthorized use or disclosure. One such method proposed by HIPAA Security Standards is audit trail, which records and examines health information access activities. HIPAA mandates healthcare providers to have the ability to generate audit trails on data access activities for any specific patient. Although current medical imaging systems generate activity logs, there is a lack of formal methodology to interpret these large volumes of log data and generate HIPAA compliant auditing trails. This paper outlines the design of a HIPAA compliant auditing system (HCAS) for medical images in imaging systems such as PACS and discusses the development of a security monitoring (SM) toolkit based on some of the partial components in HCAS.     

基于OA协同办公系统实现院内跨专科联合会诊的全流程闭环管理实践

 目的 梳理院内科室间的协作工作流程,保障临床医疗质量,提高医疗安全水平。方法 基于OA协同办公系统的设计实践,将跨专科联合会诊流程,融入项目管理的思路,从前期跨专科科室沟通,到协作诊疗的方案讨论,再回溯跟踪进行质量评估,形成整体标准化的院内跨专科联合会诊工作流程。结果 实现了全流程的闭环管理和质量监控。结论 该系统完善了院内跨专科的联合会诊业务流程和监管手段,有效提高了临床医疗质量,也为管理者提供了数字化管理依据。     

Benefits of cloud computing for PACS and archiving

The goal of cloud-based services is to provide easy, scalable access to computing resources and IT services. The healthcare industry requires a private cloud that adheres to government mandates designed to ensure privacy and security of patient data while enabling access by authorized users. Cloud-based computing in the imaging market has evolved from a service that provided cost effective disaster recovery for archived data to fully featured PACS and vendor neutral archiving services that can address the needs of healthcare providers of all sizes. Healthcare providers worldwide are now using the cloud to distribute images to remote radiologists while supporting advanced reading tools, deliver radiology reports and imaging studies to referring physicians, and provide redundant data storage. Vendor managed cloud services eliminate large capital investments in equipment and maintenance, as well as staffing for the data center--creating a reduction in total cost of ownership for the healthcare provider.     

Individuals with mild-to-moderate hip osteoarthritis exhibit altered pelvis and hip kinematics during sit-to-stand

BackgroundPerformance of the sit-to-stand (STS) task is compromised in individuals with advanced hip osteoarthritis (OA). Understanding how STS performance is altered in individuals with mild-to-moderate hip OA may inform interventions to improve function and slow disease progression.Research questionDo trunk, pelvis, and hip biomechanics differ during a STS task between individuals with mild-to-moderate hip OA and a healthy, age-matched control group?MethodsThirteen individuals with mild-to-moderate symptomatic and radiographic hip OA and seventeen healthy, age-matched controls performed a standardized STS task. Data were acquired using a three-dimensional motion capture system. The primary outcome measures were task duration, sagittal and frontal plane trunk, pelvis, and hip joint angles, and sagittal and frontal plane trunk and hip joint moments. Comparisons of lower-limb measures were between the most affected side in the hip OA group and a randomly chosen limb for the control group, termed the index limb, prior to and following lift-off from the chair.ResultsParticipants with mild-to-moderate hip OA took longer to perform the STS task compared to controls. Prior to lift-off, the hip OA group exhibited greater posterior pelvic tilt, greater pelvic rise on the index side and less hip joint flexion relative to controls. Following lift-off, the hip OA group exhibited greater pelvic rise on the index side compared to controls.SignificanceIndividuals with mild-to-moderate hip OA exhibit subtle alterations in movement strategy compared to healthy controls when completing a STS task similar, to a small extent, to adaptations reported in advanced stages of the disease. Interventions to target these features and prevent further decline in physical function may be warranted in the management of mild-to-moderate hip OA while the opportunity remains.