基层医疗机构电子病历数据标准符合性测评研究  

Study of Electronic Medical Record Data Standards Compliance Evaluation

作　　者：李朋[1] 蹇奕苹 余中心[1] 肖兵[1] 吴开贵[2] 

机构地区：[1]重庆市卫生信息中心,重庆市401147 [2]重庆大学计算机学院,重庆市400030

出　　处：《中国卫生信息管理杂志》2016年第1期61-64,98,共5页Chinese Journal of Health Informatics and Management

基　　金：重庆市社会民生科技创新专项重庆市基层医疗卫生机构信息标准研究及应用(项目编号:cstc2015shmszx120036)

摘　　要：为了提高重庆市基层医疗卫生机构电子病历的建设水平,重庆市卫生信息中心以国家卫生计生委电子病历数据集标准为依据,结合重庆市本次需求,制定本地电子病历标准;以数据集标准为依据,组织专家对当前市内正在使用的几家电子病历产品开展了实验室环境下的数据标准符合性测评,对电子病历的数据集完整性、准确性、结构化等进行了科学、严谨的审查工作,通过测评工作,将有效推动重庆市基层医疗卫生机构电子病历的升级、改造等建设工作。To improve the Electronic Medical Record（EMR） of basic medical and health institutions in Chongqing, Chongqing Health Information Center establishes Chongqing local EMR standards by combining with actual demand, based on EMR data set standards of National Health and Family Planning Commission; Based on the EMR data set standards, Chongqing organizes relevant experts to proceed standard compliance evaluation under the laboratory environment for some Electronic Medical Records products which are in use in the city currently, in order to examine the completeness, accuracy and structuring of the EMR data set scientifi cally and rigorously. Through the assessments, it will effectively promote the EMR of primary medical and health institutions in Chongqing to upgrade, reform and so on and so forth.

关 键 词：基层医疗卫生机构 电子病历 标准符合性测评 数据标准 

分 类 号：R-34[医药卫生] R197.6