我院医疗信息服务平台建设的实践探索

医院搭建并应用12582120医疗信息服务平台,对于健康咨询、就医指导、疑难病会诊及预约挂号管理都具有重要意义。主要介绍搭建12582120医疗信息服务平台,包括12582120医疗服务热线平台、易农宝手机APP预约挂号系统、远程医疗服务平台、农村平价医药平台和易复诊医患信息管理APP系统平台为会员服务情况,并针对平台运用中存在的问题提出整改措施,使平台功能最大化,以利于推进分级诊疗体系建设,从而达到方便患者就医的目的。     

远程医学在北京大学肿瘤医院的实践与思考

远程会诊和远程教育是对医疗卫生工作的重要拓展和补充。通过分析北京大学肿瘤医院675例远程会诊案例,阐述了医院运用远程医学平台开展远程会诊和远程教育工作的方法、流程和特点,探索医院促进远程医疗工作的方法。     

安徽省县级公立医院参与远程会诊情况调查分析

目的 分析安徽省县级公立医院信息化基本建设情况、医务人员参加远程会诊的意愿及其影响因素,为推进远程会诊持续发展提供意见。方法 通过文献复习,初步设计了远程会诊调查表,以无记名方式对安徽省8家开展远程会诊的县级公立医院进行调查。结果 （1）8家县级医院的信息化建设各不相同。（2）8家县级医院医务人员对远程会诊知晓率为76.2%。（3）对远程会诊相关问题理解不同,使用远程会诊意愿也不用。结论 从提高县级医院信息化平台建设,加强远程会诊宣传工作,以点带面,推进远程会诊发展,创新远程会诊服务模式等方面入手,提高县级公立医院和医务人员的参与度。     

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。     

我院远程医疗会诊情况分析与思考

目的 总结和回顾多年来远程会诊工作开展情况,探索提高远程医疗效率的方法。方法 对完成的139例远程会诊的相关资料统计分析。结果 目前远程会诊主要承担的是偏远地区、不方便外出就诊的患者,近90%是为病情急危患者组织的急诊会诊,60%是常见病、多发病中的复杂难治病例。结论 提高远程会诊质量和效率,有利于节约医疗资源,使更多基层患者得到救治,开展远程疑难病例、死亡病例讨论及远程查房等方式,开辟远程会诊的新领域。     

单日远程会诊突破102例简析与思考

通过对医院单日102例远程会诊病例从地域分布、临床分类和会诊目的3个方面的简单统计分析,讨论远程医学的应用需求、应用方式,探索远程医学在区域医疗协作中的应用模式。     

远程会诊系统诊断皮肤真菌病

远程医疗会诊作为一种新的医学服务模式,与传统的医疗手段相比较,发展迅速,在医学领域中已充分显示出优越性.我国地域辽阔,医疗资源分布非常不平均,边远地区极其缺乏高端医疗人才和器材.皮肤病有发病率高、直观性强等特点,非常适合开展远程会诊.现通过医院在建设皮肤病远程会诊系统过程中产生的问题,对皮肤病远程会诊进行一些讨论.     

国内医院预约挂号的现状和建议

随着国家医疗改革的不断深入,卫生部针对国内大部分综合性医院门诊挂号拥挤的现象和因此导致的众多问题,推出了预约挂号的新政。预约挂号实行以来减轻了门诊拥挤,提高了诊疗效率,方便了患者就诊,但在实际推广仍有不足,因此需要推广实名制挂号、构建统一预约挂号平台、加强信用建设、完善医院管理创新、试行社区预约转诊等,实现预约挂号的"人性化、精细化、信息化、社会化"。     

北京某三甲医院预约挂号对患者候诊时间的影响分析

目的 分析预约挂号是否缩短门诊患者的等候时间。方法抽取医院某一周全部患者挂号记录49 147条,通过秩和检验方法,分析预约挂号与非预约挂号患者的候诊时间的差异,比较不同预约方式对患者候诊时间是否存在影响。结果 预约挂号平均候诊时间为50分钟,非预约挂号患者平均候诊时间为111分钟,不同预约方式的患者候诊时间存在统计学上的差异。结论 预约挂号能够有效缩短门诊患者的候诊时间,其中复诊预约患者候诊时间最短,应鼓励患者预约就诊,复诊患者应鼓励进行复诊预约。     

基于医疗联合体的区域医疗信息平台建设

以医疗联合体为依托,建立区域医疗信息平台。其平台系统集成并共享各医疗机构的诊疗信息,对居民在各医疗机构的诊疗信息进行系统、连贯的有机整合;系统制定规范的分级诊疗流程、上转诊间预约、下转自动推送机制;在区域医疗联合体内部层级医疗机构内,提供远程会诊、在线医学教育、病患健康宣教、区域临床统一知识库、居民电子健康档案、诊疗预约、信息共享服务。     

Telemedicine: a cautious welcome.

Telemedicine is a major new development. Having become technically and economically feasible, it deserves proper investigation. Rushing into equipment purchase, however, is almost certain to prove counterproductive. Face to face contact is fundamental to health care and enthusiasts of telemedicine should recognise that it is not as good as the real thing (and unlikely ever to be). However, constraints on time and resources will make face to face consultation increasingly expensive, and telemedicine has the potential to produce major efficiencies in the diagnostic process. The goal of current research is therefore to marry medicine with technology, capitalising on the advantages of telemedicine and producing a robust system that delivers an acceptable service at an appropriate price.     

网络医疗中医患关系的建立与认定

医患关系的建立与认定在网络医疗中关乎医患双方合法权益的维护,对网络医疗的规范与发展有重要意义。通过文献分析、专家咨询等方法,分析网络医疗医患关系建立与认定上存在的障碍,借鉴美国实践经验,提出基于我国国情的建议。网络医疗带来了医患关系主体、建立条件、认定方式的变化,对通过挂号建立与认定医患关系的传统模式带来了挑战。应在承认线上医患关系及医疗行为的基础上,制定符合我国法律法规、严于线下诊疗标准的网络医疗医患关系建立标准。同时,应从法律手段与技术手段两方面加强网络医疗医患关系的认定,保障网络医疗中医患双方的合法权益。     

统一通信模式下的医疗服务创新探索

作为一种成熟的通信技术,统一通信正逐步被国内大型医院所采用。在医院这个特殊的应用场景里,统一通信在方便医护人员沟通的同时,也能在咨询预约、医疗会诊、远程医疗、护士紧急呼叫、病房探视等面为病患提供帮助。     

Development of a telemedicine program: a review of 1,000 videoconferencing consultations

Objective To examine the financial and organizational characteristics, demand for services, and satisfaction outcomes of a growing telemedicine program serving both urban or suburban and rural populations. Design Retrospective review of 1,000 consecutive telemedicine consultations in the University of California (UC) Davis Telemedicine Program. Setting Telemedicine videoconferencing units, used to integrate care in the UC Davis Health System among the UC Davis Medical Center and several urban or suburban primary care clinics, rural hospitals, and clinic affiliates. Subjects A total of 657 consecutive patients who consented to a telemedicine consultation. Main outcome measures Demographic information about the patient population, the rural and urban or suburban clinics, the types of specialty consultations, and telemedicine equipment used in the UC Davis Health System. Patient and physician satisfaction were measured on a 5-point Likert scale. Results Patients and primary care physicians reported high levels of satisfaction. Rural clinics requested more and a greater variety of specialist consultations than urban or suburban clinics. Conclusion Although referring physicians and patients indicate a high level of satisfaction with telemedicine services and insurers are negotiating reimbursement policies, additional research must investigate the reasons why some payers, patients, and providers resist participation in these services.     

An overview of telemedicine: the virtual gaze of health care in the next century

This article considers the role of telemedicine in the production of biomedical health care using three specific theoretical constructs as lenses through which to examine this phenomenon: (1) Foucault's medical "gaze"; (2) the political economy of health; and (3) deterritorialization and multisite ethnography. This examination focuses first on the changing corporate structure of health care and changing political attitudes toward telemedicine. Second, it documents the current use of telemedicine in prisons, the military, and in cross-cultural settings. Third, it discusses responses to telemedicine of individual physicians, health care staff, and patients, finding that these responses are broadly conditioned by an individual's mode of articulation with biomedical institutions and that they are mediated by personal experience.     

Multi-purpose HealthCare Telemedicine Systems with mobile communication link support

The provision of effective emergency telemedicine and home monitoring solutions are the major fields of interest discussed in this study. Ambulances, Rural Health Centers (RHC) or other remote health location such as Ships navigating in wide seas are common examples of possible emergency sites, while critical care telemetry and telemedicine home follow-ups are important issues of telemonitoring. In order to support the above different growing application fields we created a combined real-time and store and forward facility that consists of a base unit and a telemedicine (mobile) unit. This integrated system: can be used when handling emergency cases in ambulances, RHC or ships by using a mobile telemedicine unit at the emergency site and a base unit at the hospital-expert's site, enhances intensive health care provision by giving a mobile base unit to the ICU doctor while the telemedicine unit remains at the ICU patient site and enables home telemonitoring, by installing the telemedicine unit at the patient's home while the base unit remains at the physician's office or hospital. The system allows the transmission of vital biosignals (3–12 lead ECG, SPO2, NIBP, IBP, Temp) and still images of the patient. The transmission is performed through GSM mobile telecommunication network, through satellite links (where GSM is not available) or through Plain Old Telephony Systems (POTS) where available. Using this device a specialist doctor can telematically "move" to the patient's site and instruct unspecialized personnel when handling an emergency or telemonitoring case. Due to the need of storing and archiving of all data interchanged during the telemedicine sessions, we have equipped the consultation site with a multimedia database able to store and manage the data collected by the system. The performance of the system has been technically tested over several telecommunication means; in addition the system has been clinically validated in three different countries using a standardized medical protocol.     

计算机仿真技术在优化就医序列中的应用研究

积极推进预约诊疗服务、方便群众看病就医、缩短病人无效等候之间,是公立医院改革的重要课题,优化就医序列是解决上述课题的有效方法。通过计算机仿真技术充分挖掘现有医疗资源,可以优化调度资源,提高医院服务能力和质量。在分析了国内外计算机仿真技术在医院管理优化就医序列中的应用,初步研究了存在问题,并提出了相应的发展对策。