Verna C, Moncelli G, Monaco A, Gastaldi L
Divisione di Chirurgia Generale, USL n.5- Ospedale di Giaveno Torino.
Minerva Chir. 1997 Jan-Feb;52(1-2):161-6.
In recent years, the necessity for a surgical department to obtain a wide range of clinical data in a short period is greatly increased. This necessity has been almost satisfied with widespread use of information systems in medicine using database programs and the integration of these database with other programs has allowed graphic representation of data. Anyhow, some difficulties are still present, such as low knowledge in using personal computers and lacking of a common program for all surgical departments. In the article the authors present a computerized program for the filing of medical records in a surgical department. Starting from January 1992, clinical data of all patients admitted in our department have been recorded in the described program. After three years of use, the system has shown to be easy to use, and able to give useful information for data analysis regarding the population observed, the clinical activity performed and the level of quality obtained. For these reasons, it can represent an attempt to diffuse and uniform computerized data recording in surgical departments.
近年来，外科部门在短时间内获取广泛临床数据的必要性大幅增加。随着医学领域信息系统通过数据库程序的广泛应用，这一需求几乎得到了满足，并且这些数据库与其他程序的整合实现了数据的图形化展示。无论如何，仍然存在一些困难，比如使用个人电脑的知识不足以及缺乏适用于所有外科科室的通用程序。在本文中，作者介绍了一种用于外科科室病历归档的计算机化程序。自1992年1月起，我们科室收治的所有患者的临床数据都记录在该程序中。经过三年的使用，该系统已证明易于使用，并且能够为所观察人群、所开展的临床活动以及所获得的质量水平的数据分析提供有用信息。基于这些原因，它可被视为在外科科室推广和统一计算机化数据记录的一次尝试。
