广东省医院国际疾病分类扩展码规范字典库研制报告

目的建立作为现行ICD-10编码补充的《广东省医院国际疾病分类扩展码规范字典库》,满足省内医疗机构对疾病分类一病一码及疾病分类编码规范化的需求;方法收集广东省多间协作医院疾病编码手册和/或编码字典库,了解省内主要医院扩展码编目情况并在此基础上建立《广东省医院国际疾病分类扩展码规范字典库》;结果通过《广东省医院国际疾病分类扩展码规范字典库》,统一广东省医疗单位所使用的疾病名称及其分类代码;结论规范化《广东省医院国际疾病分类扩展码规范字典库》的建立,既满足了现代医学对疾病分类一病一码的需求,又提高了广东省各级医疗机构的疾病分类编码水平。本研究成果已经在省内所有二级以上医院推广,对广东省医学信息管理规范化起到良好作用。

A Report on the Storage of the Extend Codes Standard Dictionary of International Classification of Diseases for the Hospitals in Guangdong Province

Objective To Establish the Storage of the Extend Codes Standard Dictionary of International Classification of Diseases for the Hospitals in Guangdong Province as a supplement of ICD-10 Codes, and to meet the clinical demand of classification of diseases-one disease matches one code, and satisfy the demand of standardization of the classification and code of diseases. Methods We collected the handbooks on diseases coding and/or coding dictionary storage from several coordinated hospitals in Guangdong Province, and investigated the catalogue situation of extend codes in main hospitals beyond Guangdong Province, and established the Storage of the Extend Codes Standard Dictionary of International Classification of Diseases for the Hospitals in Guangdong Province. Results By the Storage of the Extend Codes Standard Dictionary of International classification of Diseases for the Hospitals in Guangdong Province, the names of diseases and their classified codes that were using at present are united in Guangdong Province. Conclusion The establishment of the Storage of the Extend Codes Standard Dictionary of International of diseases for the Hospitals in Guangdong Province not only meet the modern hospital's demands of classification of diseases that one disease matches one code, but also improved the disease classification and code quality and the standard of information management in the hospitals at different levels, and it took positive effect.