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日本医疗企业从财务型管理向综合管理的转变:战略与架构

Migration of the Japanese healthcare enterprise from a financial to integrated management: strategy and architecture.

作者信息

Akiyama M

机构信息

Department of Medical Informatics, International Medical Center of Japan, Tokyo, 162-8655, Japan.

出版信息

Stud Health Technol Inform. 2001;84(Pt 1):715-8.

Abstract

The Hospital Information System (HIS) has been positioned as the hub of the healthcare information management architecture. In Japan, the billing system assigns an "insurance disease names" to performed exams based on the diagnosis type. Departmental systems provide localized, departmental services, such as order receipt and diagnostic reporting, but do not provide patient demographic information. The system above has many problems. The departmental system's terminals and the HIS's terminals are not integrated. Duplicate data entry introduces errors and increases workloads. Order and exam data managed by the HIS can be sent to the billing system, but departmental data cannot usually be entered. Additionally, billing systems usually keep departmental data for only a short time before it is deleted. The billing system provides payment based on what is entered. The billing system is oriented towards diagnoses. Most importantly, the system is geared towards generating billing reports rather than at providing high-quality patient care. The role of the application server is that of a mediator between system components. Data and events generated by system components are sent to the application server that routes them to appropriate destinations. It also records all system events, including state changes to clinical data, access of clinical data and so on. Finally, the Resource Management System identifies all system resources available to the enterprise. The departmental systems are responsible for managing data and clinical processes at a departmental level. The client interacts with the system via the application server, which provides a general set of system-level functions. The system is implemented using current technologies CORBA and HTTP. System data is collected by the application server and assembled into XML documents for delivery to clients. Clients can access these URLs using standard HTTP clients, since each department provides an HTTP compliant web-server. We have implemented an integrated system communicating via CORBA middleware, consisting of an application server, endoscopy departmental server, pathology departmental server and wrappered legacy HIS. We have found this new approach solves the problems outlined earlier. It provides the services needed to ensure that data is never lost and is always available, that events that occur in the hospital are always captured, and that resources are managed and tracked effectively. Finally, it reduces costs, raises efficiency, increases the quality of patient care, and ultimately saves lives. Now, we are going to integrate all remaining hospital departments, and ultimately, all hospital functions.

摘要

医院信息系统(HIS)已被定位为医疗信息管理架构的核心。在日本,计费系统根据诊断类型为所进行的检查分配“保险疾病名称”。科室系统提供本地化的科室服务,如医嘱接收和诊断报告,但不提供患者人口统计学信息。上述系统存在诸多问题。科室系统的终端与HIS的终端未集成。重复的数据录入会引入错误并增加工作量。HIS管理的医嘱和检查数据可发送到计费系统,但科室数据通常无法录入。此外,计费系统通常在短时间内保留科室数据,之后便将其删除。计费系统根据录入的内容进行支付。计费系统以诊断为导向。最重要的是,该系统旨在生成计费报告,而非提供高质量的患者护理。应用服务器的作用是充当系统组件之间的中介。系统组件生成的数据和事件被发送到应用服务器,由应用服务器将它们路由到适当的目的地。它还记录所有系统事件,包括临床数据的状态变化、临床数据的访问等。最后,资源管理系统识别企业可用的所有系统资源。科室系统负责在科室层面管理数据和临床流程。客户端通过应用服务器与系统交互,应用服务器提供一组通用的系统级功能。该系统使用当前技术CORBA和HTTP实现。系统数据由应用服务器收集,并组装成XML文档以交付给客户端。由于每个科室都提供符合HTTP的网络服务器,客户端可以使用标准HTTP客户端访问这些URL。我们已经实现了一个通过CORBA中间件进行通信的集成系统,该系统由一个应用服务器、内镜科室服务器、病理科室服务器和包装后的遗留HIS组成。我们发现这种新方法解决了前面所述的问题。它提供了所需的服务,以确保数据永不丢失且始终可用,确保医院发生的事件始终被捕获,确保资源得到有效管理和跟踪。最后,它降低了成本,提高了效率,提升了患者护理质量,并最终挽救了生命。现在,我们将整合所有剩余的医院科室,并最终整合所有医院功能。

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