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上海:信息化成深化医改新引擎

2017-08-11 佚名 健康报

信息化不仅能让百姓便捷就医,引发健康服务模式的变革,更能成为引领医改深化的新引擎。沿着这样的思路一路走来,上海市的健康信息化建设让患者、医务人员、医疗机构乃至行业管理者都尝到了甜头。在“线上”创造获得感在业务量快速增长的上海市儿童医院,优化服务流程、改善就医体验,解决就医过程中的“急、难、愁”问题,成为建设智慧医院的初衷。“智慧医院就是要用信息化技术改造医院,最终让患儿就医更方便。”该院副院长

信息化不仅能让百姓便捷就医,引发健康服务模式的变革,更能成为引领医改深化的新引擎。沿着这样的思路一路走来,上海市的健康信息化建设让患者、医务人员、医疗机构乃至行业管理者都尝到了甜头。

在“线上”创造获得感

在业务量快速增长的上海市儿童医院,优化服务流程、改善就医体验,解决就医过程中的“急、难、愁”问题,成为建设智慧医院的初衷。

“智慧医院就是要用信息化技术改造医院,最终让患儿就医更方便。”该院副院长高春辉说,医院尽可能地把诊断和治疗之外的环节搬到“线上”,减少患者在医院的等待时间。如今,预约、挂号、付费、就医指导、满意度测评等,患者都可以在指尖上完成。医院还于2016年11月启动上海儿童互联网医院,在线为患者提供预检服务,并根据预检信息将患者精确导流给相应的专家团队或医生。自互联网医院上线以来,已提供预检分诊、精准预约超1.4万人次。

上海市儿童医院的实践,正是该市医疗卫生机构应用信息化技术的一个缩影。该市卫生计生委主任邬惊雷说,上海已经构建起全市统一的健康管理云平台,并通过让“上海健康云”App在市民、家庭医生、临床医生和公共卫生从业人员等人群的手机上安家,力求打造一个全新的健康管理模式。

在静安区南京西路街道社区卫生服务中心,记者见到了患有糖尿病多年的签约居民戚大妈。她告诉记者,通过手机,可以清楚地知道自己的家庭医生是谁,并随时咨询。在慢病管理一栏,她能看到血糖控制目标、每次血糖测量结果,以及医生的治疗建议。更方便的是,家人也可通过亲情账户功能,看到她的健康档案和就诊记录。

记者了解到,“上海健康云”市民端应用可以在线提供慢病风险评估、健康档案调阅、在线问诊、在线签约、预约挂号和转诊、免疫规划、亲情账户等功能,引导市民开展慢病自主管理。截至目前,服务已覆盖122个社区,实现9万余名社区居民线上注册,有7000余名家庭医生提供线上服务,120余万名社区居民在社区卫生服务中心使用物联网监测设备测量体征。

邬惊雷表示,上海市已经基于市、区两级平台建立了覆盖全市的疾病防控系统,涵盖高血压管理、糖尿病管理、脑卒中管理、死亡登记、结核病登记管理、肿瘤登记管理6个业务系统,二期还增补了免疫规划管理、传染病控制应急免疫管理、儿童青少年健康管理、伤害事件监测、出生登记以及精神卫生信息管理系统,正逐步构建起全程管理的疾病综合防治服务体系。

信息化助力分级诊疗

要让分级诊疗、双向转诊政策落地,离不开信息化的有力支撑。上海市通过建成“1+17”市、区两级交换平台,实现了对该市400多家公立医疗卫生机构的数据共享,达成了“两个任何”的目标:在全市任何一台医生工作站上可以调阅患者任何一次的医疗卫生服务记录。

上海市儿童医院是建设儿科医联体的先行者。高春辉说,上海对儿科医联体的定义并不局限于传统意义上的医疗资源联合,更是信息的联合、规范的联合、标准的联合。该院在5年实践中,从输出技术、派出专家、开展规范化培训、搭建远程网络协作平台,走向开设区级医院示范门诊,力求以信息化的互联互通带动区级医院与母院在就诊流程、诊疗规范、就医感受直至医疗质量上的同质化,让合作医院真正成为儿童医院的“连锁机构”。

高春辉表示,将通过建立医生信息、床位信息、患者信息共享系统,做好区级医院和社区卫生服务中心的后盾,同时把该院的专科门诊做大、普通内科做小。眼下,该院已经和嘉定区卫生计生委信息中心搭建了“儿童—嘉定儿联体云”,探索联合体内的医疗信息共享和资源共享,推进互联网儿童健康服务。

在南京西路街道社区卫生服务中心主任叶涛看来,信息化对把居民留在社区就医帮助很大。他说,上海市三级医院包括知名专家在内的门诊预约号源的50%优先向家庭医生开放,基层医生通过家庭医生工作站可以帮助签约居民预约专家号、向上级医院转诊。居民转诊回社区后,家庭医生可为患者开具上级医院药品,并有专人配送到家。患者在上级医院的就诊记录基层也能看到,有利于家庭医生为患者提供连续、规范的治疗,最大限度地减少重复检查。而区域内影像、心电、检验、超声等会诊中心的建立,也扩大了市级优势医疗资源的辐射作用,为社区医疗提供了有效支撑。这些都让签约居民对家庭医生的依从性更强,对社区卫生服务中心的黏性更强。

与此同时,上海也在对社区卫生服务综合改革推出的“1+1+1”签约服务组合试点情况进行实时监测,并实现了与全市239家社区卫生服务中心系统及分级诊疗系统的对接。该市卫生计生信息中心主任谢桦介绍,全市试点社区目前共签约居民200余万人,77.06%的门诊发生在“1+1+1”组合内,签约社区就诊率达到57.7%;194家社区开展了延伸处方服务,金额超过8500万元。上海市也将把签约居民就诊流向、就诊依从度作为对家庭医生和社区绩效的考核指标,进一步推动就诊下沉。

用大数据给医院“画像”

从医疗大数据的众多应用可能中,上海市找到了一条监管公立医院的有效路径。凭借积累的近10亿份门急诊数据和1000多万份住院病案,上海建立了评价考核医院绩效的统一标准,利用“标化工具”实现不同医院医疗服务产出的可比性。

“建立良好的医院系统生态,需要形成公立医院医疗服务产出评价的‘度量衡’。”谢桦说,上海市为此引入公立医院病种组合指数、病种总例数、指数单价等指标,实时汇集全市公立医疗机构诊疗数据,反映每家医院收治病种和开展诊疗技术的难易程度、总体服务量、收费是否规范以及费用结构是否合理。大数据犹如一面镜子,照出了每家医院的真实状况和在全市医疗机构中所处的位置,让所有院长都心服口服。

邬惊雷说,上海市公立医院管理平台通过对大数据的抓取,可以给医院和科室“画像”。“这个‘画像’可以精确反映出你增加的服务量是不是和你的医院定位相匹配;精确反映出对于同一种疾病的治疗,你消耗的药品和耗材是不是合理。每位院长都可以看到兄弟医院的情况,分管区长、分管市长也可以看到各家医院的情况。”这样的管理手段,真正让院长坐不住了。

复旦大学附属华山医院信息中心主任黄虹告诉记者,身为三级医院,如果住院综合指数低,就意味着医院救治疑难杂症的能力不够,和医院应有的定位不符。院长对这个指标体系显示出了很大兴趣,这必将会对未来的公立医院发展产生很强的导向作用。

“就医院内部管理来说,之前也缺乏一个精细化的管理工具,现在则可以把病种指数的办法套用过来管理各个科室。”黄虹进一步举例,该院神经外科有9个临床小组,手外科和普外科各有8个临床小组,也可以按这样的思路比较各个小组收治病患的复杂程度、治疗例数和费用结构,进而作为内部绩效考核的依据。这样的管理手段,也有利于医院把强势科室做得更强。

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    2017-08-13 tidiq
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  4. [GetPortalCommentsPageByObjectIdResponse(id=1775847, encodeId=ee921e758474d, content=<a href='/topic/show?id=7864660e9be' target=_blank style='color:#2F92EE;'>#深化医改#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=66079, encryptionId=7864660e9be, topicName=深化医改)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c1e138833678, createdName=lsndxfj, createdTime=Mon Nov 06 21:59:00 CST 2017, time=2017-11-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1286780, encodeId=47bb1286e8074, content=<a href='/topic/show?id=ebac3442063' target=_blank style='color:#2F92EE;'>#医改#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=34420, encryptionId=ebac3442063, topicName=医改)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b3e9205, createdName=tidiq, createdTime=Sun Aug 13 06:59:00 CST 2017, time=2017-08-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1411083, encodeId=d6da1411083bd, content=<a href='/topic/show?id=ad7b2e332cd' target=_blank style='color:#2F92EE;'>#信息化#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=27332, encryptionId=ad7b2e332cd, topicName=信息化)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=36df2798267, createdName=chenhongpeng, createdTime=Sun Aug 13 06:59:00 CST 2017, time=2017-08-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=232606, encodeId=a3b523260686, content=好东西学习了!, beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=92191944782, createdName=thlabcde, createdTime=Fri Aug 11 23:15:01 CST 2017, time=2017-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=232529, encodeId=22a9232529f3, content=学习了受益匪浅。, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLDicHg2ldsSNmib46PmdzpO7CQEmPjuULp1v45zPWwMYhrnXgvl3OtmUCZSQfgITWn96X9moL94nUGA/0, createdBy=28072041016, createdName=131****1460, createdTime=Fri Aug 11 19:45:38 CST 2017, time=2017-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=232509, encodeId=ed23232509bd, content=学习了受益匪浅, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib06iaV3D9Tg5Kzuf9u71gZhPYMiajRtENwicoAABeQtfXOlic8ibhYSy6DvJZWUDVtjRvTfqBffr1XJ6JLtFB5kHicthl/0, createdBy=08bb2061153, createdName=189****7206, createdTime=Fri Aug 11 19:06:00 CST 2017, time=2017-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=232491, encodeId=52f323249104, content=学习谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/05/25/aee510ed68ce4736e9fe4ec7d03c01b1.jpg, createdBy=ce892064652, createdName=楠博One, createdTime=Fri Aug 11 16:14:53 CST 2017, time=2017-08-11, status=1, ipAttribution=)]
    2017-08-11 thlabcde

    好东西学习了!

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1775847, encodeId=ee921e758474d, content=<a href='/topic/show?id=7864660e9be' target=_blank style='color:#2F92EE;'>#深化医改#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=66079, encryptionId=7864660e9be, topicName=深化医改)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c1e138833678, createdName=lsndxfj, createdTime=Mon Nov 06 21:59:00 CST 2017, time=2017-11-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1286780, encodeId=47bb1286e8074, content=<a href='/topic/show?id=ebac3442063' target=_blank style='color:#2F92EE;'>#医改#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=34420, encryptionId=ebac3442063, topicName=医改)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b3e9205, createdName=tidiq, createdTime=Sun Aug 13 06:59:00 CST 2017, time=2017-08-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1411083, encodeId=d6da1411083bd, content=<a href='/topic/show?id=ad7b2e332cd' target=_blank style='color:#2F92EE;'>#信息化#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=27332, encryptionId=ad7b2e332cd, topicName=信息化)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=36df2798267, createdName=chenhongpeng, createdTime=Sun Aug 13 06:59:00 CST 2017, time=2017-08-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=232606, encodeId=a3b523260686, content=好东西学习了!, beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=92191944782, createdName=thlabcde, createdTime=Fri Aug 11 23:15:01 CST 2017, time=2017-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=232529, encodeId=22a9232529f3, content=学习了受益匪浅。, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLDicHg2ldsSNmib46PmdzpO7CQEmPjuULp1v45zPWwMYhrnXgvl3OtmUCZSQfgITWn96X9moL94nUGA/0, createdBy=28072041016, createdName=131****1460, createdTime=Fri Aug 11 19:45:38 CST 2017, time=2017-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=232509, encodeId=ed23232509bd, content=学习了受益匪浅, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib06iaV3D9Tg5Kzuf9u71gZhPYMiajRtENwicoAABeQtfXOlic8ibhYSy6DvJZWUDVtjRvTfqBffr1XJ6JLtFB5kHicthl/0, createdBy=08bb2061153, createdName=189****7206, createdTime=Fri Aug 11 19:06:00 CST 2017, time=2017-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=232491, encodeId=52f323249104, content=学习谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/05/25/aee510ed68ce4736e9fe4ec7d03c01b1.jpg, createdBy=ce892064652, createdName=楠博One, createdTime=Fri Aug 11 16:14:53 CST 2017, time=2017-08-11, status=1, ipAttribution=)]
    2017-08-11 131****1460

    学习了受益匪浅。

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1775847, encodeId=ee921e758474d, content=<a href='/topic/show?id=7864660e9be' target=_blank style='color:#2F92EE;'>#深化医改#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=66079, encryptionId=7864660e9be, topicName=深化医改)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c1e138833678, createdName=lsndxfj, createdTime=Mon Nov 06 21:59:00 CST 2017, time=2017-11-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1286780, encodeId=47bb1286e8074, content=<a href='/topic/show?id=ebac3442063' target=_blank style='color:#2F92EE;'>#医改#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=34420, encryptionId=ebac3442063, topicName=医改)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b3e9205, createdName=tidiq, createdTime=Sun Aug 13 06:59:00 CST 2017, time=2017-08-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1411083, encodeId=d6da1411083bd, content=<a href='/topic/show?id=ad7b2e332cd' target=_blank style='color:#2F92EE;'>#信息化#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=27332, encryptionId=ad7b2e332cd, topicName=信息化)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=36df2798267, createdName=chenhongpeng, createdTime=Sun Aug 13 06:59:00 CST 2017, time=2017-08-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=232606, encodeId=a3b523260686, content=好东西学习了!, beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=92191944782, createdName=thlabcde, createdTime=Fri Aug 11 23:15:01 CST 2017, time=2017-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=232529, encodeId=22a9232529f3, content=学习了受益匪浅。, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLDicHg2ldsSNmib46PmdzpO7CQEmPjuULp1v45zPWwMYhrnXgvl3OtmUCZSQfgITWn96X9moL94nUGA/0, createdBy=28072041016, createdName=131****1460, createdTime=Fri Aug 11 19:45:38 CST 2017, time=2017-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=232509, encodeId=ed23232509bd, content=学习了受益匪浅, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib06iaV3D9Tg5Kzuf9u71gZhPYMiajRtENwicoAABeQtfXOlic8ibhYSy6DvJZWUDVtjRvTfqBffr1XJ6JLtFB5kHicthl/0, createdBy=08bb2061153, createdName=189****7206, createdTime=Fri Aug 11 19:06:00 CST 2017, time=2017-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=232491, encodeId=52f323249104, content=学习谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/05/25/aee510ed68ce4736e9fe4ec7d03c01b1.jpg, createdBy=ce892064652, createdName=楠博One, createdTime=Fri Aug 11 16:14:53 CST 2017, time=2017-08-11, status=1, ipAttribution=)]
    2017-08-11 189****7206

    学习了受益匪浅

    0

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    2017-08-11 楠博One

    学习谢谢分享

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