浅谈医院病案信息管理的问题与对策  

Discussion on the Problems and Countermeasures of Information Management of Hospital Medical Records

作　　者：蔡文娟 林苏[1] 张丽彬[1] CAI Wenjuan;LIN Su;ZHANG Libin(Medical-record Department,Fujian Cancer Hospital/Fujian Medical University Cancer Hospital,Fuzhou Fujian 350014,China)

机构地区：[1]福建省肿瘤医院/福建医科大学附属肿瘤医院病案室,福建福州350014

出　　处：《中国卫生标准管理》2020年第22期4-6,共3页China Health Standard Management

摘　　要：病案信息是医院运营过程中最为重要的信息,其重要程度要超过财务信息、物流信息等信息。病案信息管理贯穿着医院管理的方方面面,其管理效率、管理质量影响着医院管理水平。新形势下的医疗体制改革对病案信息管理提出了更高的要求,病案信息的有效利用不再局限于临床和科研,而是渗透到了医疗体制改革的方方面面。文章分析了医院病案信息管理中存在的问题,通过提高医务人员,特别是医院管理层、医师、护士等对病案质量的重视程度,加强病案管理人员的业务能力建设,加强对病案信息化的投入等方面提出建议,改善医院病案信息管理质量,完善病案信息管理体系,以适应新形势下的医疗体制改革的需要。Medical record information is the most important information in the operation of the hospital,and its importance is more than financial information,logistics information and other information.Medical record information management runs through all aspects of hospital management,and affects the efficiency and quality of hospital management.The medical system reform puts forward higher requirements for medical record information management.The effective use of medical record information is no longer limited to clinical and scientific research,but permeates all aspects of medical system reform.The article analyzes the problems in hospital medical record information management.In order to improve the quality of hospital medical record information management,we should pay more attention to the management of medical record information,strengthen the professional capacity of the medical record management personnel,and strengthen the investment in medical record information,so as to meet the needs of medical system reform.

关 键 词：医院 病案 信息管理 数字化病案 医改 医院管理 

分 类 号：R197[医药卫生—卫生事业管理]