IMPAX PACS在黑龙江省区域化医疗远程会诊中的初步应用

目的:研究黑龙江省不同医疗机构之间新型协同服务模式,加强垦区各级医疗机构的信息化基础建设,建立基于医学影像存档与通信传输系统(Picture Archiving and Communications System,PACS)的数字化医疗区域。方法:将哈尔滨医科大学附属第四医院现有的影像数据归档,集成到IMPAX PACS数据中心(Internet Data Center,IDC),作为整个区域医疗的影像中心。通过IDC交换平台的延伸覆盖,以及医院信息系统(Hospital Information System,HIS)与XERO集成,可经网络调阅IDC中的影像,实现远程影像会诊。结果:建立基于IMPAX PACS的区域医疗;工程覆盖1家省会大医院和垦区2家综合性医院、5家二级医院、11家农场医院,实现联网医院间的影像学远程会诊。结论:PACS区域远程医疗系统的建立为基层百姓就医提供方便,影像学远程会诊可有效避免影像学重复检查,双向转诊、信息共享给患者带来更多的便利和实惠,具有巨大的社会效益。     

Administrative and organization impact of PACS and its effect on the quality of care

PACS integrated to RIS and HIS will have a significant impact on the hospital operation. This paper describes the current radiological process and indicates at what points PACS may prove to be important, in order to guarantee its successful implementation with the objective to improve patient care by better management of personnel, equipment and information.     

Evaluation of PACS-induced organizational change

Filmless digital imaging with a PACS will affect health care institutions by changing the handling of clinically relevant information, altering needed staffing levels, and possibly affecting both the quality and cost of care. Economic evaluation of PACS compares the costs and/or benefits of PACS with those of all other relevant alternatives. Other evaluations may focus on narrower research questions. This paper discusses methodological considerations in economic evaluation, methods of time measurement, and the methods and results of several applied assessments of PACS effects on the medical imaging department or the hospital.     

Overview of capacity data

This paper presents an overview of the data from 15 cases collected with the CAPACITY software for cost analysis of PACS. The data suggest that both hospital wide and partial PACS implementations do not pay back yet. Only Nuclear Medicine PACS systems may be introduced cost-neutral in the near future. Because of the assumed price drop of hardware components of 5–25% per year, hospital wide and partial PACS may allow cost savings within the next 10–20 years. There are major differences in viewpoints concerning the required PACS configurations and their costs. The experiences with the CAPACITY software suggest the need for the establishment of key rules, for designing a PACS configuration and for estimating PACS costs.     

Workshop aims,outline of the program

This workshop on the Technology Assessment of PACS has been organized as a rounding off of the Technology Assessment Activities which were initiated within the Dutch PACS Project (1986–1989). It is made possible by a funding from the Dutch Ministry of Health Care (WVC). We hope it will be not only a rounding off, but will contribute to more intensive cooperations in this area. In the scope of the Dutch PACS project, the software package CAPACITY for cost analyses of PACS has been developed, to stimulate the dialogue and exchange of data. During the workshop, the data which were collected with CAPACITY are used as a framework for discussions. This paper presents the outline of the workshop, its background, its aims and the program.     

PACS在口腔根管治疗中的应用

医学影像存储与传输系统（PACS）的建设改变了原有的摄片和看片模式,对提高医院的医疗质量的到了很大的推进作用。该文论述了我院PACS系统的特点以及在口腔根管治疗中的应用。并与原来的胶片流程做了对比,研究了PACS系统在根管治疗中的应用的优势以及今后的发展前景。     

基于PACS的影像学检查流程优化研究

为了推行惠民便民措施,优化就医流程、降低候诊时间,切实解决“看病难”问题,提出了优化整合PACS（医学影像存储和传输系统）,整合以放射线科、磁共振室、CT室为主要科室,以信息流代替患者流为主要改进方式,以预约登记、检查诊断、数字传输、信息存储为主要功能的一体化综合诊断管理平台。基于PACS的影像学检查流程优化对于提升临床诊断水平、降低患者候诊时间、降低科室运营成本、缓解“看病难、看病贵”有着重大意义。     

Experience with an operational nuclear medicine PACS in the Utrecht University Hospital

At the department of nuclear medicine of the University Hospital Utrecht a single modality PACS has been operational since mid 1990. After 1 year of operation the functionality, the organizational and economical consequences and the acceptability of the PACS are evaluated. The functional aspects reviewed are: viewing facilities, patient data management, connectivity, reporting facilities, archiving, privacy and security. It is concluded that the improved quality of diagnostic viewing and the potential integration with diagnosis, reporting and archiving are highly appreciated. The many problems that have occurred during the transition period, however, greatly influence the appreciation and acceptability of the PACS. Overall, we feel that on the long term there will be a positive effect on the quality and efficiency of the work done in our department.     

PACS的高级预防维护技术

目的 通过讨论PACS高级预防维护技术,供同他人在日常维护过程中有一定地借鉴作用.方法 从PACS数据库性能检测与优化,存储设备检测及PACS各应用软件模块三方面进行阐述.结果 经过医院一线安装维护人员和PACS厂家多年实践的总结,拥有一定的可参考依据.结论 PACS的高级预防维护是一个复杂的系统工程,包括一般维护和高级维护在内的实践理论才刚刚起步,科学的、规范化的预防维护需要不断地完善和发展.     

PACS辅助教学在医学影像学实习教学中的应用探讨

尝试应用影像存储及传输系统(Picture Archiving and Communication System,PACS),对我院临床本科生进行影像学实习教学。首先应用PACS建立电子影像学图片库,学生在PACS联网的计算机上学习教学内容,通过定期随堂测验、期末考试和课后问卷调查评估PACS辅助教学的教学效果,对PACS辅助教学在医学影像学实习教学中的应用价值进行探讨。与以往传统医学影像学实习教学方法相比,PACS辅助教学在医学影像学实习教学中具有激发学生学习主动性、提高学习效率和学生读片能力的优越性,显著提高教学效果和教学质量,对促进医学影像学教学改革具有重要意义。     

Development of an anesthesia data warehouse: Preliminary results

Hospital information system manages patient's hospitalization information across different applications and databases. As statistics are performed with difficulties on these different databases, the university hospital of Lille developed an anesthesia data warehouse. This common structure stores data related to anesthesia procedures and patient hospital stay. In that way, the joint analysis on intervention's events and patient's outcome is possible. However, data quality remains one of the main issues in this kind of project. Indeed, errors in patient identifier result in difficulties to link data between the different sources. This problem will be approached in the next phase of the project.     

Joint use of epidemiological and hospital medico-administrative data to estimate prevalence. Application to French data on breast cancer

Background Estimate complete, limited-duration, and hospital prevalence of breast cancer in a French Département covered by a population-based cancer registry and in whole France using complementary information sources. Methods: Incidence data from a cancer registry, national incidence estimations for France, mortality data, and hospital medico-administrative data were used to estimate the three prevalence indices. The methods included a modelling of epidemiological data and a specific process of data extraction from medico-administrative databases. Results: Limited-duration prevalence at 33 years was a proxy for complete prevalence only in patients aged less than 70 years. In 2007 and in women older than 15 years, the limited-duration prevalence at 33 years rate per 100,000 women was estimated at 2372 for Département Isère and 2354 for whole France. The latter rate corresponded to 613,000 women. The highest rate corresponded to women aged 65–74 years (6161 per 100,000 in whole France). About one third of the 33-year limited-duration prevalence cases were diagnosed five years before and about one fourth were hospitalized for breast-cancer-related care (i.e., hospital prevalence). In 2007, the rate of hospitalized women was 557 per 100,000 in whole France. Among the 120,310 women hospitalized for breast-cancer-related care in 2007, about 13% were diagnosed before 2004. Conclusion: Limited-duration prevalence (long- and short-term), and hospital prevalence are complementary indices of cancer prevalence. Their efficient direct or indirect estimations are essential to reflect the burden of the disease and forecast median- and long-term medical, economic, and social patient needs, especially after the initial treatment.     

郑州市第五人民医院PACS医学影像系统设计

本文介绍了郑州市第五人民医院PACS医学影像系统,描述了系统的目标,构架,功能和特点,采用了功能化的模块设计。可满足后续设备联入系统,已应用于医院的医疗过程中,解决了医学图像的获取,显示,存储,传输和管理等问题。符合DICOM3.0国际信息交换标准,实现了数字化,网络化和无胶片化的现代化医学影像诊断与管理,显著提高了诊疗质量和工作效率,降低了医疗成本,增加了经济收入和社会效益,对其它医院实现数字化进程也具有一定的借鉴意义。     

PACS服务器硬盘阵列故障处理及其预防对策

介绍了我院PACS服务器的磁盘故障及其处理方法,并提出对医院PACS服务器配置和管理上的一些建议。     

The impact of PACS on research and education

Picture Archiving and Communication Systems (PACS) are rapidly evolving and the total digital radiology department may be a reality within the next decade. PACS can have a major impact on the educational and research responsibilities of a medical institution. The possibility of correlating real patient data with existing radiological teaching files opens up numerous possibilities. Multi-institutional research can be strengthened by employing the PACS as the means to the end. This paper discusses the representative examples of how teaching and research can be enhanced with PACS and the technical requirements to achieve the inter-connectivity.     

医疗安全预警体系构建与信息化实现

医疗质量与患者安全已成为医院管理的首要重点,介绍了“以医疗信息化的发展为基础,应用医疗数据仓库和数据挖掘技术,构建医疗安全预警体系”的全过程和应用效果。信息化的医疗安全预警体系,为医院提供了新的管理依据,避免了医疗安全事件的发生,为现代医疗安全管理提供创新思路。

     

医院图书馆建立学科馆员制度的制约因素探讨

目的：探讨在医院图书馆建立学科馆员制度和开展学科化服务的必要性与可行性。方法：通过上海市三级医院图书馆的人员、信息服务基础、数字化资源建设及学科馆员设置比例等的调研数据,分析其影响医院图书馆开展学科化服务的制约因素。结果：目前医院图书馆开展学科化服务存在：大环境、制度、评估指标、人员素质、和数字化资源建设六方面的主要制约因素。结论：学科馆员制度设置和学科化服务的开展是医院图书馆发展的方向和主流。通过对制约因素的揭示,在现有的条件和状态下,可通过制度保证、完善评估机制和标准、人员的继续教育和资源共建共享等措施,逐步提高医院图书馆学科馆员设置比例,以提升医院图书馆服务水平。     

医院行政值班系统设计与应用

医院行政总值班是医院管理中重要的组成部分,这一观点在医院管理实践中已形成共识。文中首次提出如何运用信息化手段,借助医院现有行政值班制度,建立一个行政值班信息管理系统,并将行政值班工作借助信息化技术和手段进行管理和积累,实现自动排班、行政值班人员短信提醒、实时签到、事务记录、数据分析等功能,既方便行政值班人员实时、应急处理紧急情况,又能对行政值班情况进行及时监控分析,以更好地保障医院行政管理工作的正常运行。     

基于数据挖掘的门诊信息资源分析

目的：随着各级医院信息化建设的不断加强,医院的信息化水平也日益提高。目前各医院都有自己完善的信息化系统,在日常的门诊中,信息化系统积累了大量的门诊就诊数据,但长久以来这部分数据只是处于低层次的应用。对数据的深层次分析、加工以及对医院管理层的决策支持能力较弱。面对着这些宝贵的数据,医院迫切需要数据挖掘和分析工具从积累的就诊数据中分析出更深层次的、高价值的信息,从而为医院的管理决策提供高价值的决策信息。方法：以聚类算法进行数据挖掘建模,对某院门诊信息资源中有用字段进行挖掘分析。结果：根据数据挖掘模型进行挖掘分析,对有价值字段进行聚类分析,得到相关字段数据挖掘结果。结论：将得到相关字段数据挖掘结果进行分析,并将所分析的结果在医院管理决策和医疗质量管理等方面的应用进行探讨。     

Understanding hospital referral rates: a user's guide.

Detailed referral information from one practice was used to investigate the effect of calculating referral rates in several different ways. Referral rates for individual general practitioners should be related to the number of consultations carried out and not to the number of registered patients; for whole practices list size may be used as the denominator. Most doctors will not need to control for age and sex of patients when comparing referral rates but may need to control for case mix when comparing referral rates to individual specialties. In addition, a method is described for distinguishing systematic variation between the referral rates of individual doctors from the random variation that may arise from data based on fairly small numbers of referrals. The method indicates whether systematic variation is greater than would be expected by chance, and it can be extended to indicate whether variability in referral rates is greater in one specialty than another. Because of random variation with time a year''s data may not be sufficient to allow reliable interpretation of referral rates to individual specialties, except for the largest. At present there is no known relation between high or low referral rates and quality of care. Nevertheless, if doctors are to interpret their own rates of referral they need those rates to be reliable and valid. Use of the 10 guidelines described in this paper will help to prevent unwarranted conclusions being drawn from information on general practitioners'' rates of referral to hospital.