整合医学资源 提高医院信息化水平

结合实践,介绍了180医院信息资源整合实践,包括对现有数字信息进行结构化处理和排序,为信息资源标引建立索引,按照定义好的标准格式进行存储;将多个分散的网站资源和办公应用系统库进行集中整合管理。指出整合后的局域网办公自动化功能更完备,医学数字资源更丰富、实用,具有知识关联功能性强和自动化程度高的特点。     

SaaS模式在新农合信息系统中的应用实践

与所有IT系统一样，新农合信息系统建设和运营的目的是为了符合业务应用的需要，期间牵涉到许多环节，如何使合管办专注于新农合业务应用，降低新农合信息系统建设和运营的成本和风险，是一个值得探讨的问题。从信息系统建设和运营的角度对传统模式和SaaS模式进行了分析，发现新农合信息系统采用SaaS模式可以使合管办不需要关心IT系统的建设和维护。专注于系统的业务应用方面的工作。在项目风险、建设费用、维护能力等方面具有比较明显的优势。随后介绍了中国电信采用SaaS模式提供新农合信息系统的具体应用实践。并介绍了具体的系统架构、运作模式和特点。最后对下一步的发展方向进行了展望。     

Laboratory test analysis near the patient. Opportunities for improved clinical diagnosis and management

New developments in laboratory technology have produced complex analytic systems that are simple to operate, relatively reliable, and inexpensive. These systems allow the office practitioner to perform test analyses in an office laboratory and can provide timely information useful for diagnostic and clinical management decisions. This article reviews the clinical applications and analytic systems available for use in urine analysis, blood cell analysis, determination of the sedimentation rate, coagulation testing, biochemical analysis, and bacteriologic and virologic testing. Although these analytic systems are generally designed to be used by nonprofessional laboratory staff, there is only limited information available about their reliability when used in this manner. Physicians, in bringing this technology into their office laboratories, must be cognizant of a new area of medical practice because they will now be the professionals responsible for the laboratory's function. It will be important that they develop new skills as the office laboratory directors and develop consultative relationships with laboratory professionals to ensure that the information used in patient care is both timely and reliable.     

数字化医院中央集成工作平台的研究与应用

针对解放军总医院数字化医院建设中面临的问题和特点,对医院所有信息系统进行中央集成,形成全院统一的数字化管理工作平台。介绍系统的结构以及公用办公、业务管理、数据监控等系统的功能,指出该系统具有集成多种异构数据源、兼容其它医院信息系统等特点。     

动物实验管理系统的特点分析

随着现代办公方式的改变,信息化,无纸化办公成为一种趋势,相应的管理平台、管理系统也随之应运而生。本文主要通过对中国食品药品检定研究院的动物实验管理系统具体功能的叙述,讨论网络化,平台化办公方式的特点。     

A proposed expert system for nursing practice

The knowledge on which nursing practice is based comes largely from traditional sources, expert nurses passing on the wisdom of their experience to novices. Nursing research, although increasing, is usually parallel to nursing practice, and its findings, at best, are implemented only after long delays. Consequently, the most effective nursing responses to a particular client problem may be undiscovered or unknown. Nursing information systems reflect the nature and usage of nursing knowledge. They offer standard care plans, but the knowledge and decision structures for individualizing care remain exclusively in the mind of the nurse. Nurses may have great freedom to enter information into the information system, but the information is rarely retrievable in a form suitable for evaluation or research. Nursing practice, and the knowledge on which it is based, could be enhanced through the use of a novel expert system. This paper describes how such a system could be developed, with examples from the authors' prototype programs. Taxonomies of data, diagnoses, objectives, and interventions would make it possible to compare patients and to determine the relative effectiveness of nursing interventions. A built-in evaluation component would provide feedback and correction. Everyday nursing practice would become a field for research, and the knowledge gained from research would immediately be fed back into practice. In its development and in its implementation, this kind of system would help to build nursing science.     

The impact on a private group practice of converting to an automated medical information system

As hardware and software developments make medical information systems increasingly available to physician office practices and outpatients facilities, there is a need to focus on systems installation and conversion issues. In addition to the detailed step-by-step implementation plan, the overall impact of the new system should be anticipated. The purchasers should consider such issues as new information flow and user communication patterns between patient care and ancillary and support departments; restructuring of fundamental approaches to work allocation for either batch or real-time systems; and new emphasis on any departments vital to problem-spotting and solving. At California Primary Physicians (CPP), an awareness of these changes did not develop until well after the official “live” date had passed and the staff had been successfully using the system for several months. This paper explains how the above issues have emerged and the impact they have had on CPP, and provides a framework for anticipating such matters in any system installation.     

A Scalable Healthcare Information System Based on a Service-oriented Architecture

Many existing healthcare information systems are composed of a number of heterogeneous systems and face the important issue of system scalability. This paper first describes the comprehensive healthcare information systems used in National Taiwan University Hospital (NTUH) and then presents a service-oriented architecture (SOA)-based healthcare information system (HIS) based on the service standard HL7. The proposed architecture focuses on system scalability, in terms of both hardware and software. Moreover, we describe how scalability is implemented in rightsizing, service groups, databases, and hardware scalability. Although SOA-based systems sometimes display poor performance, through a performance evaluation of our HIS based on SOA, the average response time for outpatient, inpatient, and emergency HL7Central systems are 0.035, 0.04, and 0.036 s, respectively. The outpatient, inpatient, and emergency WebUI average response times are 0.79, 1.25, and 0.82 s. The scalability of the rightsizing project and our evaluation results show that the SOA HIS we propose provides evidence that SOA can provide system scalability and sustainability in a highly demanding healthcare information system.     

A problem-oriented approach to medical information systems

A relatively simple computer-based information system developed for a primary care group practice at the San Francisco Veterans Administration Hospital contributes to the management of the practice, to improvement of medical care for patients within the group, and to research studies on resource utilization in the management of chronic diseases and the evaluation of care of chronically ill patients. Preliminary results from the use of the information system are encouraging and demonstrate that much may be achieved by information systems that do not attempt to computerize the entire medical record.     

全科医疗慢性病管理质量评价研究进展

慢性病已成为影响我国乃至全球居民健康的重大问题，全科医疗服务质量的改进对提升基层医疗慢性病管理水平有重要意义。通过对全科医疗慢性病管理质量进行评价，进而发现目前存在的问题，是实现持续质量改进的重要途径。综述国内外研究现状，部分国家已建立较为完善的全科医疗慢性病管理质量评价体系，与国外相比，我国的全科医疗慢性病管理质量评价与改进实践仍处于探索阶段，虽然取得了一定进展，但也存在一些挑战：第一，慢性病管理质量评价主要集中在高血压和糖尿病两种疾病，对于其他慢性病的临床管理质量关注不足，且在临床指标细化程度上与国外相比仍须进一步加强；第二，在评价全科医疗慢性病管理实践过程方面存在局限，多数研究仅关注服务规范框架内的绩效考核指标，可借鉴国外经验，细化以循证为基础的质量评价和质量改进体系，具体化监测指标；第三，基层医疗信息系统建设仍存在很大改进空间，信息“碎片化”和信息缺失严重阻碍了慢性病管理质量的有效评价，应尽快完善信息系统建设；第四，质量评价结果侧重于在行政体系内反馈，卫生服务提供者缺乏对自身服务质量的认知，应探索更为公平、有效的评价与反馈机制，促进慢性病管理质量的持续改进。     

医院集成化信息平台建设探析

运用“米歇模型”对医院信息系统的集成化现状做出分析。指出医院面向临床的信息系统已经初步实现了集成化,但面向管理的信息系统还处于分散建立状态．提出医院当前需借鉴企业资源计划（ERP,Enterprise Resource Planning）的先进管理思想和理念,大力推进面向管理的信息系统——医院资源计划（HRP,Hospital Resource Planning）的集成化建设,并最终与面向临床的信息系统融合,形成高度集成的信息系统。     

医院检验系统建设研究

随着侧重经济核算的管理信息系统逐渐成熟,包括检验系统在内的临床信息系统日益受到重视.本文以北医三院检验系统的实施为例,着重讨论了检验系统的系统构成、操作流程、与管理信息系统的集成以及实施中的相关问题.     

办公自动化系统应用于病案管理的探讨

办公自动化是一种新型的数字化办公模式,具有科学、高效、环保的特点,满足医院现代化管理的要求。对于多系统而难兼容的医疗机构,本文探讨应用办公自动化加强病案管理的方法。通过访问权限设置,解决病案统计信息的保密性问题;通过问题的及时反馈,加强与临床沟通,改善病案书写质量;通过疑难特殊病例的实时讨论,提高分类编码准确性;通过示踪管理,提高病案信息使用的安全性,为信息传递和共享提供便捷服务。     

Evaluating medicines: let's use all the evidence

The current drug regulatory system is outdated and relies primarily on a process of premarketing evaluation, followed by periodic reviews of reported adverse events. While long-term medicine use for chronic conditions is now commonplace, current drug evaluation systems do not incorporate the comprehensive evidence accruing over time in clinical practice. Good quality, routinely collected data on medicines use are now available in some countries. Consistent with international opinion, we propose an expanded and integrated system of medicines regulation for Australia, based on a surveillance system that improves safety monitoring by complementing existing systems, making best use of routinely collected data, and leveraging the power of information technology. Australia is well placed to pilot such a model system.     

Regulation of physicians' office laboratories. The Idaho experience

Timely availability of reliable test results enhances the office practitioner's ability to provide high-quality care that is personally satisfying to patients. Modern technology allows physicians to have such timely information available through test analyses performed in an office laboratory. Studies of physicians' office laboratories in Idaho found the performance, initially, to be unacceptably variable for many hematology, urinalysis, clinical chemistry, and microbiology tests. State regulation, requiring each office laboratory to comply with quality assurance guidelines and to participate in a proficiency testing program, resulted in a marked improvement in the proficiency level of office laboratory testing in Idaho. With the increasing dispersion of clinical laboratory technology, it is essential that standards of practice for the office laboratory be developed that ensure, within reasonable limits, the reliability of test information used in patient care. If widespread acceptance of such standards cannot be developed with a voluntary approach, states should consider regulation of office laboratories within their jurisdiction. Compliance with standards of practice, voluntarily or as a result of regulation, should promote quality performance in the office laboratory and allow the physician to use confidently the timely test information in dealing with diagnostic and management problems in patient care.     

Computer support for clinical and ancillary support areas

Military medicine is aggressively meeting the need for enhanced information flow and improved efficiency in the delivery of health care by implementing automated systems. A Department of Defense (DOD) Agency, the Tri-Service Medical Information Systems (TRIMIS) Program office, is centrally procuring automated data processing to support clinical and patient appointment activities within the DOD health care system of 165 hospitals and 287 clinics. The procured systems are then implemented with the assistance of the military departments. Systems are now supporting cardiology, pharmacy, radiology, clinical laboratory, and patient appointment and scheduling. Capabilities of all these systems are detailed in the paper. To date, the TRIMIS efforts have contributed significantly to more efficient information processing, thus ensuring continued quality health care through the DOD.     

基于GB/T 20274的信息系统安全技术保障评估及计算机实现

国家标准GB/T 20274定义了信息系统的安全技术保障要素集,并建议以能力成熟度等级的形式度量信息系统的安全技术保障性。本文首先对安全技术保障度量的能力成熟度等级进行量化处理;其次将信息系统组件的安全技术保障性表示成向量的形式,在向量和向量∞范数的基础上重新阐述了信息系统的安全技术保障模型;最后,给出了信息系统的安全技术保障的计算机实现算法。仿真实验结果验证了本文算法能有效地实现信息系统的安全技术保障的评估。     

Clinical Computing in General Dentistry

ObjectiveMeasure the adoption and utilization of, opinions about, and attitudes toward clinical computing among general dentists in the United States.DesignTelephone survey of a random sample of 256 general dentists in active practice in the United States.MeasurementsA 39-item telephone interview measuring practice characteristics and information technology infrastructure; clinical information storage; data entry and access; attitudes toward and opinions about clinical computing (features of practice management systems, barriers, advantages, disadvantages, and potential improvements); clinical Internet use; and attitudes toward the National Health Information Infrastructure.ResultsThe authors successfully screened 1,039 of 1,159 randomly sampled U.S. general dentists in active practice (89.6% response rate). Two hundred fifty-six (24.6%) respondents had computers at chairside and thus were eligible for this study. The authors successfully interviewed 102 respondents (39.8%). Clinical information associated with administration and billing, such as appointments and treatment plans, was stored predominantly on the computer; other information, such as the medical history and progress notes, primarily resided on paper. Nineteen respondents, or 1.8% of all general dentists, were completely paperless. Auxiliary personnel, such as dental assistants and hygienists, entered most data. Respondents adopted clinical computing to improve office efficiency and operations, support diagnosis and treatment, and enhance patient communication and perception. Barriers included insufficient operational reliability, program limitations, a steep learning curve, cost, and infection control issues.ConclusionClinical computing is being increasingly adopted in general dentistry. However, future research must address usefulness and ease of use, workflow support, infection control, integration, and implementation issues.     

医学信息工程专业KAQ人才培养模式研究

介绍了医学信息工程专业从加强师资结构、课程设置、实践教学和评价体系等方面进行改革,以强化学生知识、能力和素质教育的一些设想和做法。指出KAQ模式顺应了医学信息工程专业人才培养需求,对培养高质量的复合型医学信息人才具有借鉴意义。     

基于异构系统融合的医疗事务审批机制研究

目提出将医院异构系统融合,实现医疗事务审批机制在临床信息系统和oA系统中无缝衔接。分析比较了三种融合方法,并从医院实际情况出发,详细阐述了基于WebService融合的审批方案设计。该审批机制方便了医务人员,优化了事务审批流程,并为管理者提供了可追溯、可监管的审批平台。