数字卫生:助推医改 服务健康——中国数字医疗的现状与展望

数字卫生通过构建统一标准的居民电子健康档案(EHR)、电子病历(EMR)、交互式卫生信息平台、城乡社区与医院双向转诊、远程诊疗、远程教育和健康咨询等系统达到提高医疗卫生服务质量、改善服务可及性,推进医药卫生体制改革发展,服务老百姓的健康的目标。依托"十一五"国家科技支撑计划重点项目"国家数字卫生关键技术与区域应用示范研究"项目的实施应用,浙江省已经开始数字医疗卫生探索,建立了一整套的数字医疗卫生系统,真正起到了助推医改、服务健康的技术支撑作用,对推进中国卫生事业发展意义重大。     

基于PEST分析法基层卫生信息化的发展研究进展

背景我国医疗卫生资源配置不均衡,“看病贵、看病难”得不到有效解决,作为医疗卫生体系网底功能的基层医疗卫生机构,需要借助信息化的手段提高基层医疗卫生机构的服务能力、转变服务方式,将慢性病等患者留在基层,缓解医疗卫生的供需矛盾。目的分析我国基层卫生信息化建设与发展的宏观环境,并针对目前基层卫生信息化建设所面临的问题提出建议。方法检索中国知网(CNKI)、万方数据知识服务平台、PubMed等数据库,以及国家卫生健康委员会、国家发展和改革委员会等部委官方网站中关于基层卫生信息化相关研究的期刊论文、学位论文、图书、研究报告、政策文件等。检索关键词:“基层卫生信息化”“信息化建设”“primary health informatization”“informatization construction”等;检索时间:2000—2019年。运用PEST分析法分别从政治、经济、社会和技术4个方面整体把握我国基层卫生信息化建设的宏观环境。结果我国基层卫生信息化建设的环境因素归纳为—政治(顶层设计完善、重视规范标准)、经济(缺乏持续性建设资金)、社会(人口老龄加剧、医疗资源配置失衡、信息化人才缺失)、技术(信息技术、新兴技术共同发展)。结论为使我国基层卫生信息化稳定高速发展,需要各地区政府机关统筹规划基层卫生信息化的建设模式、采取多渠道筹资支持信息化建设、打造信息化人才队伍以及探索新技术的应用。     

国外“医养结合”照护模式介绍及经验启示

<正>"医养结合"是我国学者提出的为实现健康老龄化的新型的养老照护模式,2013年国家正式下发的《国务院关于加快发展养老服务业的若干意见》~([1]),该意见明确了积极推进医疗卫生与养老服务相结合,推动医养融合发展。2015年国务院转发的《关于推进医疗卫生与养老服务相结合的指导意见》~([2])更是对医疗卫生与养老服务结合提出了更明确的指导意见,鼓励通过建设医疗养老联合体等多种方式,整合医疗、康复、养老和护理资源,为老年人提供治疗期住院、康复期护理、稳定     

山东大学附属山东省耳鼻喉医院山东省立医院西院

正卫生部国家临床重点专科|山东省重点学科|山东大学博士和硕士学位授予点山东省"泰山学者"岗位单位|一流设施一流技术一流服务一流管理山东省耳鼻喉医院(山东省立医院西院)是山东省卫生健康委直属医疗机构,是山东大学附属医院、山东省首批重点专科医院,是一所以耳鼻喉学科为引领、综合学科为支撑、各专业全面发展的省属大型三级甲等公立医疗机构。     

山东大学附属山东省耳鼻喉医院 山东省立医院西院

正卫生部国家临床重点专科|山东省重点学科|山东大学博士和硕士学位授予点山东省"泰山学者"岗位单位|一流设施一流技术一流服务一流管理山东省耳鼻喉医院(山东省立医院西院)是山东省卫生健康委直属医疗机构,是山东大学附属医院、山东省首批重点专科医院,是一所以耳鼻喉学科为引领、综合学科为支撑、各专业全面发展的省属大型三级甲等公立医疗机构。     

中华消化病与影像杂志(电子版)

正中华消化病与影像杂志(电子版)是新闻出版广电总局"十二五"国家重点出版规划立项的连续型电子出版物之一(新出音【2010】660号),是由中华人民共和国国家卫生健康委员会主管,中华医学会主办,中华医学电子音像出版社有限责任公司出版的     

中华消化病与影像杂志(电子版)

正中华消化病与影像杂志(电子版)是新闻出版广电总局"十二五"国家重点出版规划立项的连续型电子出版物之一(新出音【2010】660号),是由中华人民共和国国家卫生健康委员会主管,中华医学会主办,中华医学电子音像出版社有限责任公司出版的     

山东大学附属山东省耳鼻喉医院 山东省立医院西院

正卫生部国家临床重点专科|山东省重点学科|山东大学博士和硕士学位授予点山东省"泰山学者"岗位单位|一流设施一流技术一流服务一流管理山东省耳鼻喉医院(山东省立医院西院)是山东省卫生健康委直属医疗机构,是山东大学附属医院、山东省首批重点专科医院,是一所以耳鼻喉学科为引领、综合学科为支撑、各专业全面发展的省属大型三级甲等公立医疗机构。医院位于济南西部城区,开放床位1200余张,设有临床     

中国人口老龄化背景下应用型全科医学人才实践能力培养模式改革与创新

<正>随着中国人口老龄化进程的不断加快和基层医疗卫生服务人员严重匮乏,新时期卫生与健康工作提出了建设健康中国的卫生健康新策略[1]。因此,培养全科医学人才、健全基层卫生服务、积极应对人口老龄化,成为中国新医改和实现健康中国目标最关键和最紧迫的问题[2]。全科医学是一门综合的集临床、预防、康复及健康管理为一体的医疗专业学科,以"人的健康"为中心,面向社区与家庭,提供长期的、连续的、负责式的照护服务[3～5]。中国自20 世纪80 年代后期引进全     

中国家庭医生制度研究进展

<正>社区卫生服务作为人们享受基本医疗卫生服务、提高人们健康水平的重要举措,有利于缓解居民"看病难、看病贵"的难题。而家庭医生作为社区卫生服务工作开展的主体,发挥着居民健康和控制医疗费用支出"守门人"的作用~([1])。因此,建立家庭医生制度成为改善社区居民健康,优化社区卫生服务体系的关键之举。1997年1月《中共中央、国务院关于卫生改革与发展的决定》中提出全科医学发展和全科医生培养的重要性,这是政府首次提出培养专业化的全科医生是社区卫生服务体系的     

Allied health in residential aged care: Using routinely collected data to improve funding opportunities

Consumers and providers have long been advocating for increased access to and delivery of allied health services in Australian residential aged care (RAC). There is significant evidence that allied health interventions are effective; however, there is limited evidence on the benefit of routine day-to-day allied health service delivery in RAC. This information is critical to effectively inform funders and policy advisors of the necessity of allied health in RAC. To improve arguments for future funding opportunities, providers, facilities and consumers need to partner together to use routinely collected, yet disparate, data, in electronic health and billing records, to improve data collection practices and evidence generation on allied health in aged care.     

Personal health records for people living with HIV: a review

Personal health records have the potential to improve patient outcomes, but the state of the literature on personal health record usage by people living with the human immunodeficiency virus (HIV) is unclear. The purpose of this review is to examine the impact of personal health records on HIV-related health beliefs and behaviors. We used the Health Belief Model to guide a review of studies examining the impact of electronic personal health records on the health beliefs and behaviors among people living with HIV. The search yielded 434 results. Following abstract review, 19 papers were selected for full-text review, and 12 were included in the review. A limited number of studies in this review found a positive impact of personal health records on HIV-related beliefs and behaviors. Additional research is needed to identify which personal health record features are most influential in changing health behaviors and why adoption rates remain low, particularly for groups at greatest risk for poor HIV outcomes. Theory-informed interventions are needed to identify which patients are likely to benefit from using personal health records and how to reduce barriers to personal health record adoption for people living with HIV.     

Technology for Diabetes Care and Evaluation in the Veterans Health Administration: Harnessing Information Technologies to Improve the Delivery of Diabetes Care to Veterans: The Future Is Today

Background

Although momentum is now building nationally for improved informatics, progress has been incremental in most cases. One notable exception is the Veterans Health Administration, which utilizes one of the most widely used electronic medical record systems in the world.

Objectives

The articles in this symposium demonstrate the implementation of technology to move beyond the electronic medical record at the time of the medical encounter to improve timeliness and outcomes of care delivery for veterans with diabetes.

Results

We report on the use of electronic registries and nurse practitioner-based programs across multiple sites to improve glycemic control; the implementation of a digital retinal imaging system in primary care clinics; the use of health information technology to improve patient self-care; and the development of a research database to move beyond performance measurement to evaluate longitudinal outcomes.

Conclusions

While these articles demonstrate the ability of a single national system of care to harness the power of technology to novel strategies for the delivery of care and its evaluation, the technology is scalable from small group practices to regional health care systems.     

传染病医院CA电子签名系统的技术与实施

为推进医院无纸化进程,保证电子病历的法律效力、减少院内感染,本文论述了传染病医院电子签名基本概念与相关技术原理,通过部署数字证书管理、数字签名验证、电子签章和时间戳系统,将电子签名服务与医院各个系统进行安全集成,实现可靠的电子签名。建立医院统一的电子认证服务体系和业务应用安全支撑体系,保证电子病历的真实性、合法性,减少各业务环节医护人员易受感染的环节,对加强医疗管理、提高医疗效率具有重要意义。     

From Papyrus to the Electronic Tablet: A Brief History of the Clinical Medical Record with Lessons for the Digital Age

A major transition is underway in documentation of patient-related data in clinical settings with rapidly accelerating adoption of the electronic health record and electronic medical record. This article examines the history of the development of medical records in the West in order to suggest lessons applicable to the current transition. The first documented major transition in the evolution of the clinical medical record occurred in antiquity, with the development of written case history reports for didactic purposes. Benefiting from Classical and Hellenistic models earlier than physicians in the West, medieval Islamic physicians continued the development of case histories for didactic use. A forerunner of modern medical records first appeared in Paris and Berlin by the early 19th century. Development of the clinical record in America was pioneered in the 19th century in major teaching hospitals. However, a clinical medical record useful for direct patient care in hospital and ambulatory settings was not developed until the 20th century. Several lessons are drawn from the 4000-year history of the medical record that may help physicians improve patient care in the digital age.     

Development and clinical application of an electronic health record quality control system for pulmonary aspergillosis based on guidelines and natural language processing technology

BackgroundThere are considerable differences in the diagnosis and treatment of pulmonary aspergillosis (PA) between specialized hospitals and primary hospitals or developed areas and underdeveloped areas in China. There is a lack of electronic systems that assist respiratory physicians in standardizing the diagnosis and treatment of PA.MethodsWe extracted 26 quality control points from the latest guidelines related to PA, and developed a PA quality control system of electronic health record (EHR) based on natural language processing (NLP) techniques. We obtained PA patient records in the Department of Respiratory Medicine of the First Affiliated Hospital of Guangzhou Medical University to verify the effectiveness of the system comparing with manually evaluation of respiratory experts.ResultsWe successfully developed quality control system of PA; 699 PA medical records from EHR of the First Affiliated Hospital of Guangzhou Medical University between January 2015 and March 2020 were obtained and assessed by the system; 162 defects were found, which included 19 medical records with diagnostic defects, 76 medical records with examination defects, and 80 medical records with treatment defects; 200 medical records were sampled for validation, and found that the sensitivity and accuracy of quality control system for pulmonary aspergillosis (QCSA) were 0.99 and 0.96, F1 value was 0.85, and the recall rate was 0.77 compared with experts’ evaluation.ConclusionsOur system successfully uses medical guidelines and NLP technology to detect defects in the diagnosis and treatment of PA, which helps to improve the management quality of PA patients.     

Integrated specialty service readiness in health reform: connections in haemophilia comprehensive care

Summary.  The World Health Organization (WHO) has identified primary healthcare reform as a global priority whereby innovative practice changes are directed at improving health. This transformation to health reform in haemophilia service requires clarification of comprehensive care to reflect the WHO definition of health and key elements of primary healthcare reform. While comprehensive care supports effective healthcare delivery, comprehensive care must also be regarded beyond immediate patient management to reflect the broader system purpose in the care continuum with institutions, community agencies and government. Furthermore, health reform may be facilitated through integrated service delivery (ISD). ISD in specialty haemophilia care has the potential to reduce repetition of assessments, enhance care plan communication between providers and families, provide 24-h access to care, improve information availability regarding care quality and outcomes, consolidate access for multiple healthcare encounters and facilitate family self-efficacy and autonomy [ 1 ]. Three core aspects of ISD have been distinguished: clinical integration, information management and technology and vertical integration in local communities [ 2 ]. Selected examples taken from Canadian haemophilia comprehensive care illustrate how practice innovations are bridged with a broader system level approach and may support initiatives in other contexts. These innovations are thought to indicate readiness regarding ISD. Reflecting on the existing capacity of haemophilia comprehensive care teams will assist providers to connect and direct their existing strengths towards ISD and health reform.     

绩效考核在城市社区公共卫生服务管理中的应用效果分析

目的观察实施绩效考核在城市社区公共卫生服务管理中的效果。方法以辖区内7个社区卫生服务中心为研究对象,把健康档案、预防接种、儿童保健、妇女保健、老年保健、高血压、糖尿病、重性精神病患者管理等作为观察指标,通过查阅资料和现场调查,对比实施绩效考核办法前及实施3年后基本公共卫生服务项目组织管理、资金筹集、服务实施等方面的差异。结果上述社区卫生服务中心实施绩效考核办法3年后基本公共卫生服务组织管理项目健全,监督指导进一步加强;在资金筹集情况、健康档案建立率和电子建档率、高血压和糖尿病管理率、重性精神病患者管理率等方面与实施绩效考核办法前比较,管理水平和效果有了显著的提高。结论城市实施基本公共卫生服务项目绩效考核,应用于公共卫生项目的管理可取得较大的成效。     

Electronic health records: new opportunities for clinical research

Clinical research is on the threshold of a new era in which electronic health records (EHRs) are gaining an important novel supporting role. Whilst EHRs used for routine clinical care have some limitations at present, as discussed in this review, new improved systems and emerging research infrastructures are being developed to ensure that EHRs can be used for secondary purposes such as clinical research, including the design and execution of clinical trials for new medicines. EHR systems should be able to exchange information through the use of recently published international standards for their interoperability and clinically validated information structures (such as archetypes and international health terminologies), to ensure consistent and more complete recording and sharing of data for various patient groups. Such systems will counteract the obstacles of differing clinical languages and styles of documentation as well as the recognized incompleteness of routine records. Here, we discuss some of the legal and ethical concerns of clinical research data reuse and technical security measures that can enable such research while protecting privacy. In the emerging research landscape, cooperation infrastructures are being built where research projects can utilize the availability of patient data from federated EHR systems from many different sites, as well as in international multilingual settings. Amongst several initiatives described, the EHR4CR project offers a promising method for clinical research. One of the first achievements of this project was the development of a protocol feasibility prototype which is used for finding patients eligible for clinical trials from multiple sources.