|
|
The value and application of electronic medical records in the construction of disease-oriented outpatient clinic |
ZHANG Dongxiao1 JIA Nan2 MA Hongyu2 SUN Yujian1 FU Na1 DONG Hao1 ZHAO Wenjie1 HUANG Qiao1 |
1.Department of Galactophore, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing 100010, China;
2.Department of Galactophore, Xingtai Hospital of Traditional Chinese Medicine, Hebei Province, Xingtai 054001, China |
|
|
Abstract Disease-oriented outpatient clinic is a rapidly developing outpatient service mode in recent years. Electronic medical record has many advantages, such as large sample size, more in line with clinical practice and so on. The combination of the model electronic medical record and the disease-oriented outpatient clinic can be used to collect a specific disease case, which is of great significance to the improvement of the special disease efficacy and development of new drugs. This paper discusses the value and application of electronic medical record in the construction of disease-oriented outpatient clinic, taking the plasma cell mastitis of galactophore department of Beijing Traditional Chinese Medicine Hospital, Capital Medical University as an example. From the two aspects of the template design, operation process and application effect of the electronic medical record in the disease-oriented outpatient clinic. It is found that the electronic medical record in the disease-oriented outpatient clinic can effectively form a high-quality clinical data set of specific diseases. To improve the level of disease awareness, prevent diseases before they occur; form clinical decision-making; optimize the clinical pathway; enrich materials for teaching and improve the teaching level. The accumulation of electronic medical records plays an important role in the construction of disease-oriented outpatient clinic and is an important way to enhance the strength of the discipline.
|
|
|
|
|
[1] 吴非,田丹,张晓青,等.实现医学整合,满足门诊患者新需求——“一站式”多学科综合门诊[J].医学与哲学:人文社会医学版,2010,31(4):11-13.
[2] 应争先.医院精细化管理的实践[J].中国医院,2011,15(1):53-55.
[3] 孟菲,王晓丹.中药饮片处方合理用药评价模式探索[J].中国合理用药探索,2018,15(4):71-73.
[4] 张董晓,孙宇建,付娜,等.浆细胞性乳腺炎专病门诊的建设经验[J].中医药管理杂志,2015,23(24):128-129.
[5] 刘宝延,周雪忠,张润顺,等.“医疗与临床科研信息共享系统”中医电子病历系统信息基本要求[J].中国数字医学,2012,7(10):57-60.
[6] 夏川江.电子病历在随访及科研中的应用[J].中国数字医学,2008,3(3):35-36.
[7] 李昱熙,周国鹏,蒋捷,等.我国心血管专科临床科研数据中心的建设与思考[J].中国医院管理,2017,37(5):51-53.
[8] 李翠荣,王燕,王希凯,等.电子病历助力临床医学教学的形式探讨[J].医学信息,2011,24(8):5221-5222.
[9] 梁兆晖,杨小波,印鉴,等.中医专科专病临床科研一体化电子病历的构建[J].中国中医药信息杂志,2007,14(8):101-102.
[10] 游广彦.医院信息系统中电子病历的实现与应用研究[J].信息化建设,2016(6):254.
[11] 付娜,张董晓,孙宇建,等.穿刺抽脓联合垫棉绑缚法治疗乳腺脓肿45例[J].河南中医,2016,36(7):1183-1184.
[12] 赵文洁,张董晓,付娜,等.垫棉绑缚法渊源考[J].北京中医药,2016,35(4):353-355.
[13] 谢芳,汤苏阳,张董晓,等.肌骨超声引导下穿刺抽脓治疗乳腺脓肿67例[J].武警医学,2016,27(11):1136-1137.
[14] 吴风浪,周铭,耿鹏.医院电子病历的多维数据分析研究[J].中国医学装备,2019,16(9):132-135.
[15] 颜剑峰.临床路径结合电子病历在医院管理中的作用[J].中国管理信息化,2013,16(2):83-84.
[16] 张燕,高非,游伟程.电子病历——基于病人全集的循证医学临床证据[J].循证医学,2010,10(5):286-289.
[17] 张董晓,赵文洁,付娜,等.改良消化膏湿热敷法治疗中重度乳痛症[J].北京中医药,2019,38(1):43-44.
[18] 梁欢,张董晓,孙宇建,等.从中医“痰邪致病”理论看肉芽肿性小叶性乳腺炎发病[J].北京中医药大学学报,2018,41(10):808-811.
[19] 谢芳,孙宇建,张董晓,等.乳痈方结合外治法治疗非哺乳期乳腺炎100例临床观察[J].世界中西医结合杂志,2017,12(3):372-373,421.
[20] 张董晓,黄巧,赵相坤,等.乳管冲洗配合中药治疗乳腺导管炎32例[J].中医外治杂志,2014,23(3):15-16.
[21] 谭玉培,张董晓,孙宇建,等.纤维乳管镜对乳管内病变的诊疗价值[J].世界中西医结合杂志,2018,13(12):1687-1691. |
|
|
|