新版电子病历的病案质量控制系统设计  

Quality Control System of New Type Electronic Medical Record

作　　者：陈大鹏[1] 陈金雄[1] 郭志旭[1] 

机构地区：[1]南京军区福州总医院计算机应用与管理科,福州350025

出　　处：《解放军医院管理杂志》2013年第7期637-639,共3页Hospital Administration Journal of Chinese People's Liberation Army

基　　金：南京军区卫生部联卫〈2009〉560号课题:电子病历质量控制系统(09MA102)

摘　　要：电子病历是医院临床信息系统中的核心组成部分,其质量管理的状况标志着医院管理的水平。实现质量监控的全过程、全流程管理,是医院病历质量管理的一个瓶颈。为了更好实现患者电子病历的质量控制,实现质量监控的全过程、全流程管理,本研究首先构建完整的电子病历质量控制标准规范,通过提取与此标准规范不相符合的存储内容,达到事前、事中、事后全流程的电子病历质量监管。Electronic medical record is a core component of hospital clinical information system.Its quality management level marks the level of hospital management.How to achieve the quality monitoring process,management of the whole process,is still a bottleneck of the hospital medical record quality management.In order to achieve better patient electronic medical records quality control and the whole process management,the article introduced the construction of complete quality control standards for electronic medical records.The incompatible memory contents with this standard will be extracted,so as to achieve the whole monitoring of the electronic medical record quality.

关 键 词：电子病历 质量控制 

分 类 号：R197.32[医药卫生—卫生事业管理]