军队远程医疗会诊环节规范化管理研究 |
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引用本文: | 连平,崇抗美,翟新海,宁义. 军队远程医疗会诊环节规范化管理研究[J]. 解放军医院管理杂志, 2003, 10(4): 353-355 |
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作者姓名: | 连平 崇抗美 翟新海 宁义 |
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作者单位: | 1. 全军远程医学研究开发基地,中国上海,200052 2. 总后卫生部信息中心,中国北京,100842 |
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摘 要: | 目的:探讨军队远程医疗会诊规范化管理。方法:收集和检查了上海85医院远程会诊中心执行会诊的病历质量,并建立病案系统。结果:会诊中心4年共执行远程医疗会诊658例;其中传送会诊病历599例(91%),影像图像392例(60%),会诊意见单595例(90%),采集了会诊实况录像203例(31%)。病历质量分析显示,58%的远程病历能被认可,1794幅放射影像图像中只有80%的影像图像被认为可阅读。结论:远程医疗会诊的最佳操作是远程病历应该预先传送,传输的病史应该完整,图像应该可阅读;为确保远程医学网络数据传递安全性和保密性,应采用专网专用的会诊软件;会诊资料收集多媒体化,病案标识和分类标准化,以及会诊病例管理信息化是远程医疗会诊规范操作的三个基本环节。
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关 键 词: | 规范化管理 军队医院 信息化 远程医疗会诊 病历质量 病案标识 |
文章编号: | 1008-9985(2003)04-0353-0355-03 |
修稿时间: | 2003-05-08 |
Standardization Management in Military Teleconsultation Process |
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Abstract: | Objective: To discuss links of standardization management in military teleconsultation. Methods: The author collected the medical records from telemedicine cases dealt with by the telemedicine center in No.85 military hospital and examined their quality. Results: There were 658 telemedicine cases in total. The medical records included the patient record in 599 cases (90.03%), transmitted images in 392 cases (59.57%), the consultant's opinion in 595 cases (90.43%) and video recording of the teleconsultation in 203 cases (30.85%). The quality of patient records was reviewed and found to be acceptable in 57.76% of cases. In total, 1794 radiology images (85% of all images) were transmitted via the telemedicine Network. The consultant considered 352 of them (20%) to be unreadable on the screen (i.e. 80% of radiology images were consider to be acceptable). Conclusion: For optimum performance of telemedicine, the patient record and associated images should be delivered in advance and the relevant parts of the record should be available during a teleconsultation. It is necessary to use the special software for telemedicine network and three aspects of the management of the medical records for teleconsultation: multimedia collection, standardization of patient' record identification and classification, and informational management. |
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Keywords: | teleconsultation standardization management |
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