通过对门诊电子病历书写时间短、计算机操作水平参差不齐和书写习惯改变等推广难点进行分析,从门诊电子病历系统设计理念、功能设计、推广经验等方面对门诊电子病历系统升级改造实践进行总结,并展望人工智能、区域互联互通等在门诊电子病历中的发展应用.

根据新型冠状病毒的流行病学特点,探讨新型冠状病毒肺炎患者病案无纸化模式下病案管理流程、电子签名的法律地位及可靠电子签名需具备的条件、临床数据中心建设对无纸化下保证信息获取全面的意义、电子归档的必要性和归档的步骤.纸质病案管理模式下污染区和清洁区纸质病案的种类、实行新冠患者住院病案一人一袋管理方法中污染区纸质病案送往清洁区和直接送往病案室污染区流程、清洁区病案送往污染区的流程,并根据新冠病毒的特点及纸质病案的特性提出采用 56℃30 分钟进行纸质病案消毒和75%酒精或过氧乙酸进行密封袋表面消毒方法和流程;病案科分为污染通道和清洁通道管理、每个通道的功能和消毒方法,病案科清洁区和污染区人员防护等级和方法.

从人口老龄化的视角对三级医院预约挂号的实践现状进行了分析,介绍了北京医院在老年患者预约挂号便利服务方面的举措,从加强宣传引导、推动创新和个性化服务、提高资源整合等方面提出了进一步改进预约挂号服务的建议.

为了研究医疗机构病案资料无纸化应用中信息安全问题.本研究通过SWOT分析找出病案无纸化应用后医疗机构面临的机遇与挑战,建立医、患双方博弈模型,寻找纳什均衡策略,找出病案资料无纸化过程中患者最为关注的问题即是诊疗信息泄露的问题.根据医患博弈纳什均衡策略变化能够看出,在病案资料无纸化初期,信息系统安全性差,信息泄露风险较高,存在两组纳什均衡侧率,其一是对医疗信息泄露风险担忧程度高的部分患者会选择去不实施病案无纸化的医疗机构就诊.其二是对医疗信息泄露风险担忧程度低的部分患者会选择去实施病案无纸化的医疗机构就诊.在信息系统不断完善后,信息泄露风险逐渐降低,所有患者选择前往实施病案无纸化策略的医疗机构将成为唯一的纳什均衡.通过医患双方博弈纳什均衡变化研究,医疗机构实施病案无纸化进程中解决医疗信息安全问题是决定该项工作成功与否的重中之重.

目的 通过应用DRGs识别费用异常病组并进行合理控费.方法 以北京市某三甲医院2017年1月-2019年1月-4月份上报的住院病案首页信息为基础,北京地区住院医疗服务绩效评价平台返回的分组数据为研究资料,研究运用DRGs进行合理控费.结果 运用DRGs控费系统,实现费用异常DRGs病组的识别及控费.以费用超额最高的病组IB13-脊柱融合手术,伴合并症与伴随病为例分析,例均总费用由2018年3月的164921.8元,2019年3月降至98731.59元,例均耗材费用由141346.03元降至77436.38元,通过SPSS软件单样本T检验及配对样本T检验的方法,显示上述数据变化均具有统计学意义.结论 基于DRGs的合理控费是有效的,该模式能够切实帮助临床科室找出费用异常点,并且控费责任落实到人,是一项科学有效的合理控费模式.

Objective Based on the key clinical evaluation program of former Ministry of Public Health,to establish an evaluation framework of cardiovascular clinical specialty,which is based on the first page of inpatient record.Methods Under the three evaluation dimensions,selecting evaluation indicators for cardiovascular clinical specialty according to the Medical Quality Management and Control Indicators of General Hospitals (2011) published by former Ministry of Public Health and clinical indicators used by main international organizations,and combining with the characteristics of cardiovascular clinical specialty and data elements of the first page of inpatient record,and establishing an evaluation framework by the Nominal Group Technique.Results The spectrum of diseases of cardiovascular clinical specialty is determined.The spectrum of surgeries and procedures of cardiovascular clinical specialty are confirmed.An evaluation framework of cardiovascular clinical specialty,including 3 first class indicators,10 second class indicators and 20 third class indicators,are established.Conclusion Establishing an evaluation framework of cardiovascular clinical specialty by the hospitalization summary reports is viable and objective.

Objectives:To investigate status quo of radiation workers' personal doses surveillance in a tertiary general hospital in Beijing during January 2013 to December 2016.Methods:LiF(Mg,Cu,P) thermos luminescent dosimeters(TLDs) were used in the regular data collection.The data were analyzed according to the laws and regulations and technical standards.Results:It shows that the average external exposure doses were 0.18 mSv/a,0.20mSv/a,0.22 mSv/a,0.22mSv/a from 2013 to 2016.X-ray imaging diagnosis,interventional radiology,nuclear medicine and radiation therapy work average doses were 0.16 mSv/a,0.18mSv/a,0.47mSv/a,0.19mSv/a.Conclusion:The majority doses level of the radiation workers in the hospital are lower than standard and their working environment is safe.Indeed,both strengthening on personal doses monitoring and individual protection should be emphasized in regular working practice.

Medical quality is the basis of survival and development of a hospital.Long-term management mechanism needs to be established to improve the quality of medical care.This paper explores the approach to a comprehensive evaluation model based on medical safety and quality in multiple departments,with a view to promote continuous improvement of medical quality in general hospital.

Objective To analyze the implementation and improvement effect of PDCA cycle in the management of medical records collection in a comprehensive 3A grade hospital, so as to improve the recovery rate of medical records. Methods Using PDCA cycle management method, summarizes the management measures in the management system, recycling process, related personnel and information technology and other measures to improve the management of medical records recycling. Analyzing medical record recycling effect before the implementation of the first quarter and the second quarter of 2016, and the implementation of the improvement measures in the first quarter and the second quarter of 2017. Results After the implementation of PDCA cycle management, the recovery rate of medical records has been significantly improved. The first quarter and the second quarter of 2016, 7 days, 3 days and 2 days of timely filing rates were 90.9% and 93.2%, 73.8% and 71.2%, and 46.1% and 41.7%respectively. The first quarter and the second quarter of 2017, 7 days, 3 days and 2 days of timely filing rates were 95.5% and 95.8%, 79.2% and 80.2%, and 52.0% and 49.9% respectively. The recovery rate of the two groups was significantly different, and the quality of recycling management was improved continuously. Conclusion PDCA cycle management can promote the management of medical records recycling, and can be used as a reference tool for scientific management of medical records recycling in medical institutions.

Objective To explore the implementation and effect assessment in continuous quality improvement of radiological protection management by PDCA circulation method in a general hospital. Methods According to existing problems,we use PDCA cycle to promote radiation management orderly,including completing organizational structure, revising rules and regulations, setting up the equipment account, establishing database of radiation workers, and so on. Situation of equipment licensing rate, equipment filing rate, radiation workplace protection publicity column coverage, radiology staff training rate before and after the special rectification of radiation protection of December 2014 and March 2015 was compared. Results Equipment licensing rate increases from 80.0% to 100.0%. Archives rate ranges from 14.0% to 100.0%. Poster rate goes from 26.7% to 80.0%. Training rate achieves at 97.4%. The number of protective equipment configuration increases by 84.4%. Conclusion The experience from PDCA cycle mode involving in radiology management can be regard as a scientific reference tool in general hospital management.

Objective To analyze the distribution characters and influencing factors of patients with over-long hospitalization days and to discuss the measures of shortening the average hospitalization days, providing reference for medical institutions to improve economic benefit and social benefit. Methods 37337 cases of medical record information in 2014 from a hospital in Beijing were collected, and the materials of 381 cases of patients with hospitalization days more than 42 days were selected.Then the gender composition, distribution of age, hospitalization days, hospital departments and the diseases were analyzed. Finally, through the Logistic regression analysis to determine the influencing factors of over-long hospitalization days. Results The proportion of male patients was more than female ones among the 381 cases of patients with hospitalization days. The average age of the cases is 65.53 years old. The average hospitalization days of the cases are 72.19 days. The top five hospital departments were respectively Neurology Department,General Surgery Department,V.I.P Medical Section, Emergency Department, Neurosurgery Department. The top five diseases were circulatory system diseases, tumor, nervous system diseases,respiratory system disease, actors influencing health status and contact with health institutions.Through Logistic regression analysis found that age,whether to change department during hospitalization, discharging way, whether the V.I.P Medical Section, whether to surgery and disease is one of the influencing factors of over-long hospitalization days(P<0.05). Conclusion The health administrative department and medical institutions should strengthen the construction of health alliance, making the mutual referral between medical institutions more smoothly,and implement the clinical pathway actively, accelerating the implementation of DRGs Prospective Payment System. Moreover, medical institutions should do the following work to shorten the average hospitalization days: strengthening the management of patients stay over 30 days, setting up the early warning mechanism, reinforcing the supervision for key departments and diseases.

Objectives To study the effect of the application of clinical pathway system on the entry rate and the completion rate and to explore the countermeasures of the problems encountered in the process of the application of the clinical pathway system. Methods Sixteen clinical pathways were selected,the completed number of which during January 2014 to June 2015 more than 60. The entry rate and the completion rate of each quarter during January 2014 to June 2015 were collected. Chi-square test was adopted to analyze the entry rate and the completion rate of six quarters before and after the application of clinical pathway system. Results After the application of clinical pathway system, the entry rate and the completion rate reduced from 70.3% and 96.3% to the minimum of 51.5% and 66.6%, respectively. Through the implementation of intervention measures, the entry rate rose to 68.4%, the completion rate rose to 77.5%, chi-square test showed a statistically significant difference(P<0.05). Conclusion Hospitals should establish appropriate clinical pathway system according to the actual situation; improve the compliance of medical staff at the same time, in order to make the clinical pathway system to give full play to the role of management.

Objectives To explore how to use Eviews 6.0 software's time series forecasting method to construct a model to predict the number of discharged patients and its significance, and how to choose an accurate method for predicting discharge patients.Methods To use Eviews 6.0 software to transform the time series data by logarithm and first-order difference method, to eliminate the data trend and seasonal changes, ensure the time series turn into stationary series, and then estimate time series model. At last, discuss the purpose of accurate prediction of the number of discharged patients.ResultsIn this study, we found the application of ARIMA seasonal model could predict the discharged numbers more accurately compared with other models. The comparison of actual discharged patients number with predicted numbers in 2014 confirmed that with average prediction error was 11.3%. ConclusionsThrough the comprehensive comparison of several prediction methods, we agreed that the ARIMA (p,d,q)(P,D,Q)S model was more accurate in the prediction of discharge patients numbers, and also helpful for the realization to transform the hospital management from during and after the event to pre-event management.

Objective To investigate the characteristics and influencing factors of medical complications cases through analyzing the occurrence of medical complications.Methods To collect complication data based on the front pages of medical records from January to December in 2015, and conduct analysis on the characteristics and influencing factors of medical complications cases with the application of logistic regression analysis of binary variable.Results The incidence rates of medical complications in plastic surgery,cardiovascular surgery, neurosurgery departments were higher. The cases with medical complications in general surgery, neurosurgery and thoracic surgery were more than others. The types of medical complications mainly included pulmonary infection, postoperative incision infection, postoperative fat liquefaction of incision, postoperative anastomotic fistula and postoperative bleeding. The risk factors of the medical complications included gender, age, length of stay and whether or not operating departments. The regression equation was LogitP=-7.994+-0.558 X1+0.024 X2+0.034 X3+1.58 X4. Conclusions It has the characteristics of accurate, timely and convenient to monitor the occurrence of medical complications based on hospitalization summary reports.Focusing on elderly patients, implementing infection control measures and strengthening the perioperative management were the effective methods to prevent and reduce the medical complications during the hospitalization.

The paper describes the concept and history of clinical pathway as well as its application at home and abroad, summarizes the problems of implementation of the clinical pathway in China. such as: narrow scope of application, lack of enthusiasm of medical staff, non-applicable Medicare Payment System, revising clinical pathway no timely, absence of evaluation method and backward situation of information system. The author proposes some strategies as follows: concentrating on revising clinical pathway, reforming the Medicare Payment System, establishing and improving the performance appraisal system and incentive mechanism, making scientific evaluation method of clinical pathway, accelerating information system construction and setting standard, in order to expand the coverage of clinical pathway and to promote the development of clinical pathway.

Establishing a suitable and feasible management pattern for the clinical application of medical technologies under the new circumstance that the National Health and Family Planning Commission can celled the admission approval for the clinical practice of the third and second class medical technologies and that medical institutions are supposed to take major responsibilities for the application and management of the medical technologies in July, 2015. Through material research as well as expert interviews, we basically established the medical technology management model as well as operating measures that are suitable for hospitals to operate, and then the clinical implementations was evaluated and improved through practice. We eventually established a suitable and feasible management pattern for the clinical application of medical technologies under the new policy background which is of great significance to the management of medical quality of the hospital.

Objectives To investigate the reasons and influencing factors of the unplanned readmission within 31 days of discharged patients for the same or related diseases.Methods The data was from the electronic medical records of discharged patients in surgical departments from January to June in 2015. We investigated the reason of the unplanned readmission patients within 31 days by the root-cause analysis, we analyzed age, gender, discharged means, payment type, length of stay, the weight of disease and whether or not operation patients through logistic regression, then explored the influencing factors.Results The reasons of unplanned readmission were postoperative infection, recrudescence, postoperative bleeding,postoperative discomfort, postoperative edema and effusion, postoperative edema or fistula of anastomotic, postoperative fat liquefaction of incision and so on. The risk factors of the unplanned readmission included hospitalization days,disease weight and whether operation patients. The regression equation was Logit P=-5.379+0.019 X1+0.241 X2+0.909 X3.Conclusions By strengthening the perioperative management and physician skill training, strictly implementation of qualification, paying attention to postoperative infection control and encourage the development of new technology and new technology, and carrying out health education and follow up measures actively, thus could we reduce the occurrence of unplanned readmission for the same or related diseases and improve the quality and efficiency of medical treatment.

Objectives To study the application effects of medical records writing quality improvement measures in operation departments of a hospital. Method To conduct analysis on the defects existing in the medical records of eight operation departments which had more than 180 discharged patients in the first quarter of 2014. To monitor the rate of the defect rate in medical records of the eight operation departments from the second quarter of 2014 to the second quarter of 2015. Chi-square test was adopted to analyze the changes in the rate of disfigurement in medical records after the implementation of improvement measures.Results After the following implementation of improvement measures, such as taking part in the morning shift of operation departments, strengthening the information feedback by the Internet, organizing training in the departments and some of the doctors, as well as establishing the reward and punishment mechanism of hospitals and departments, the rate of defect rate in medical records was dropped from 20.9% in the first quarter of 2014 to 13.9% in the second quarter,then rose slightly, and then in the second quarter of 2015 to achieve a minimum of 12.4%. Chi-square test showed a statistically significant difference(P<0.05).Conclusions The medical quality management department should put forward simple and effective improvement measures suited for each of the department according to the characteristics of medical work mode of operation departments, so as to improve the quality of medical record of operation departments continuously as well as ensure the safety of medical treatment.

Objective To analyze the coding of the medical record front pages from the special supervision in 2014 and 2015. To compare the medical record coding quality before and after the improvement measures, and evaluate the efficacy of the improvement. Methods Review the coding of 200 (2014) and 150 (2015) medical record front pages, and check the medical record with medical record front page and fill in check lists. Compare the medical record front page coding quality. Results The hospital adopted five measures to strengthen medical record coding quality, including check the medical records when coding, the major surgery coding is consistent with the main diagnosis, Coders daily choose and check 20% medical record, Collective discussion weekly, coders communicate with physicians to determine codes. Analysis showed that the quality of medical record front page has a significant increase in 2015. Conclusion The medical record department needs to improve management of the quality of coding, and coding quality control procedure. The communication between physician and coders is the key to improve the quality of medical record front page coding.

Objective: To study the application of cluster analysis in comprehensive evaluate and analysis of medical records'quality.Meth-ods:4238 medical records have been checked by EMR system in 2013, and their 4011 medical records'defects were classified by cluster analy-sis.Results: According to the similarity of medical records'defects and the number of medical record's defects to cluster classify three classifica-tion in both internal medicine group and surgical group clinical departments, and refer to general medical record defects'rate per class to compre-hensive evaluate the clinical departments'medical records'quality and the common defects'type, to help the medical department provide personal-ize training to different doctors.Furthermore, compared with cluster analysis method and traditional method, the former is more precise and scien-tific and can provide more accurate information for hospital management to make decision.Conclusion:Cluster analysis not only can comprehen-sive evaluate the quality of medical records, but also can be used to classify the departments by the similarity of the medical records'defects and help the clinical departments identify their commonly made mistake in medical records'writing at the same time.Furthermore, this method can make the continuous quality improvement of medical records faster and better, and it also can be applied in many other fields of hospital management.