无线一键通:一种基于决策现场的移动临床决策支持方案的研究  

作　　者：雷健波[1] 王飞[1] 胡建平[2] 

机构地区：[1]北京大学医学信息学中心,北京市100191 [2]中华人民共和国卫生部统计信息中心,北京市100044

出　　处：《中国卫生信息管理杂志》2011年第3期61-64,共4页Chinese Journal of Health Informatics and Management

基　　金：国家自然科学基金"81171426"支持

摘　　要：新医改为医疗信息化的发展提供了强大的动力,电子病历和电子健康档案的建设成为医院和区域信息化的重中之重。研究人员逐渐达成共识,临床信息系统尤其电子病历的核心价值在于是否有临床决策支持[1],原因是临床决策支持能够降低医疗差错和提高医疗质量。而临床决策支持的关键是要研究临床医生的信息需求、决策方式以及提供决策支持的方法。临床医生信息需求,作为一个研究领域,已经有很多研究者系统地从如何了解、识别、以及解决临床医生信息需求等方面做了研究。研究表明:不能充分及时获得病人相关信息能导致临床差错。研究人员提出"Infobutton"(一键通)[2],这种连接了病人特有数据和在线信息资源的技术,能够改善医务人员获取临床信息的能力,同时满足医务人员在决策现场的信息需求。哥伦比亚大学医学中心率先开发并应用了基于Web网络和无线技术的一键通技术。这篇文章回顾了最近吸引了研究者兴趣的临床医生信息需求的研究,同时分享了在无线环境下开发一键通技术,一种基于决策现场的移动临床决策支持解决方案的经历。The new health reform policy has become one of the most powerful driving forces for development of health informatics.Electronic Medical Record and Electronic Health Record systems stay at the core of digitalization of Hospitals and regional health information networks.It has been established that the core of EMR is clinical decision support which aims to reduce medical errors and improve quality of care.To identify clinicians information needs and understand the process of decision support are the keys for clinical decision support strategy.Systematic researches have been done to understand,identify and resolve clinical information needs.It has been further established that inadequate access to patient related information could be potential of medical errors.Research has shown that infobuttons,links between patient-specific data and online information resources,may improve clinicians' access to clinical information system and meet clinicians' information needs at the point of care.Both web-based and wireless based infobuttons have been initially developed and employed at Columbia University Medical Center.This paper reviews the research of clinicians' information needs that recently caught researchers' attention and shares experiences on developing infobuttons,a solution to meet clinicians' information needs as a point of care decision support strategy.

关 键 词：一键通 临床医生信息需求 无线 移动 决策现场 临床决策支持 

分 类 号：R197.324[医药卫生—卫生事业管理]