Friedman B A
University of Michigan Medical School, Ann Arbor 48109-0602, USA.
Am J Clin Pathol. 1996 Apr;105(4 Suppl 1):S3-9.
This article considers some of the major changes that are occurring in pathology and pathology informatics in response to the shift to managed care in the United States. To better understand the relationship between information management in clinical laboratories and managed care, a typology of integrated delivery systems is presented. Following this is a discussion of the evolutionary trajectory for the computer networks that serve these large consolidated healthcare delivery organizations. The most complex of these computer networks is a community health information network. Participation in the planning and deployment of community health information networks will be important for pathologists because information management within pathology will be inexorably integrated into the larger effort by integrated delivery systems to share clinical, financial, and administrative data on a regional basis. Finally, four laboratory information management challenges under managed care are discussed, accompanied by possible approaches to each of them. The challenges presented are (1) organizational integration of departmental information systems such as the laboratory information system; (2) weakening of the best-of-breed approach to laboratory information system selection; (3) the shift away from the centralized laboratory paradigm; and (4) the development of rule-based systems to monitor and control laboratory utilization.
本文探讨了美国病理学和病理信息学领域因向管理式医疗转变而正在发生的一些重大变化。为了更好地理解临床实验室信息管理与管理式医疗之间的关系，本文提出了一种综合交付系统的类型学。接下来讨论了服务于这些大型综合医疗服务组织的计算机网络的发展轨迹。其中最复杂的计算机网络是社区健康信息网络。病理学家参与社区健康信息网络的规划和部署非常重要，因为病理信息管理将不可避免地融入综合交付系统在区域层面共享临床、财务和行政数据的更大努力中。最后，讨论了管理式医疗下实验室信息管理面临的四个挑战，并针对每个挑战提出了可能的应对方法。提出的挑战包括：（1）部门信息系统（如实验室信息系统）的组织整合；（2）在选择实验室信息系统时弱化“最佳选择”方法；（3）从集中式实验室模式转变；（4）开发基于规则的系统来监测和控制实验室的使用。
