北京市电子病历区域共享数据质量评价指标体系构建及应用研究  

Research on the Construction and Application of Quality Evaluation Index System for Regional sharing Data of Electronic Health Record in Beijing

作　　者：高摘星 路凤 刘晶 郭默宁 GAO Zhaixing;LU Feng;LIU Jing;GUO Moning(Beijing Municipal Health Big Data and Policy Research Center(Beijing Institute of Hospital Management),Beijing 101117,China)

机构地区：[1]北京市卫生健康大数据与政策研究中心(北京市医院管理研究所),北京市101117 [2]北京市医疗管理数据质量控制和改进中心,北京市101117

出　　处：《中国卫生信息管理杂志》2024年第6期791-797,共7页Chinese Journal of Health Informatics and Management

基　　金：北京市卫生健康委首都卫生发展科研专项“基于健康医疗大数据的脑血管病患者长期健康状况监测模式探索研究”(首发2022-2G-2049)。

摘　　要：目的探索构建电子病历区域共享数据质量评价指标体系,提升区域电子病历共享数据质量。方法通过梳理文献资料,应用历史数据开展实证分析,以及开展三轮专家咨询,确定评价维度、评价指标数据项、评分方法及权重。结果形成电子病历区域共享数据质量评价指标体系,并应用于30家试点医院开展月度监测分析,2023年1月至6月数据质量总体平均分由90.53分提升至93.83分。结论应用本研究建立的电子病历区域共享数据质量评价指标体系开展质控工作已取得良好效果,试点医院数据质量持续提升,可为我国其他省市研制电子病历区域共享数据质控方案提供参考。Objective Exploring the establishment of data quality evaluation index system to improve the data quality of regional sharing data of electronic health record.Methods Literature review,empirical analysis and three rounds of expert consultation were conducted to determine the evaluation dimension,evaluation indicators,scoring methods and weights.Results A regional sharing data quality evaluation index system for electronic health record was formed and applied to 30 pilot hospitals for monthly analysis and monitoring.From January to June 2023,the overall average score of data quality increased from 90.53 to 93.83.Conclusion Through applying the regional sharing data quality evaluation index system of electronic health record established in this study to conduct quality control,the quality of the data from pilot hospitals was improved continuously,which could provide reference for other provinces and cities in China to develop the regional sharing data quality evaluation index system of electronic health record.

关 键 词：电子病历 数据质控 评价指标体系 

分 类 号：R-34[医药卫生] R319