Nobel J J
Harvard School of Public Health, Boston, MA 02115.
Int J Biomed Comput. 1994 Jan;34(1-4):21-8. doi: 10.1016/0020-7101(94)90007-8.
The environment of health care delivery is changing dramatically, matched by design trends in the organizations that are responsible for care delivery, whether at the hospital or the national level. However, the emerging goals of these organizations have a certain amount of uniformity independent of background, cultural assumptions or organizational size: they are all committed to the delivery of services that maximize satisfaction of system beneficiaries at a minimum of expense. Achievement of these goals will in part require the development of a management and delivery coordination infrastructure that links the key resource utilizers and administrative operators at the point of production. Merged computer and telecommunications systems connecting at user interface nodes called workstations represent a critical enabling technology for meeting the organizational goals described above. Future delivery systems will need to provide compassionate care, retaining the most highly regarded traditions of medical practice without ignoring considerations of cost, clinical outcome and financial sustainability. This paper describes some of the limitations of the current delivery system, and attempts to identify key design concepts and paradigms that might serve to guide future system development.
医疗服务提供环境正在发生巨大变化，负责医疗服务提供的组织（无论是在医院层面还是国家层面）的设计趋势与之相匹配。然而，这些组织新出现的目标在一定程度上具有一致性，不受背景、文化假设或组织规模的影响：它们都致力于提供服务，以最低的成本实现系统受益人的满意度最大化。实现这些目标部分需要开发一种管理和交付协调基础设施，该基础设施在生产点将关键资源使用者和行政运营者联系起来。连接称为工作站的用户界面节点的合并计算机和电信系统是实现上述组织目标的关键支持技术。未来的医疗服务系统需要提供富有同情心的护理，保留备受推崇的医疗实践传统，同时不忽视成本、临床结果和财务可持续性等因素。本文描述了当前医疗服务系统的一些局限性，并试图确定可能有助于指导未来系统开发的关键设计概念和范式。
