摘要
随着医院规模的扩大和现有医疗水平的提升,病案在数量上和所蕴含的大量临床数据的使用需求也在与日俱增,传统的纸质病案由于其固有的载体属性,严重制约了病案的深度使用和医院现代化的发展。而随着医疗信息技术水平的提高,病案无纸化即电子病案已经成为病案发展的新趋势,如何实现病案的无纸化成为现代医院管理面临的新挑战。该文就病案无纸化面临的问题和实现的措施进行了探究。
With the expansion of the scale of hospitals and the improvement of existing medical standards,the number of medical records and the use of large amounts of clinical data contained in them are also increasing.Traditional paper medical records have severely restricted medical records due to their inherent carrier properties.In-depth use and the modern development of hospitals were severely inhibited.With the improvement of medical information technology,paperless medical records,that is,electronic medical records,has become a new trend in the development of medical records.How to achieve paperless medical records has become a new challenge for modern hospital management.This article explores the problems and implementation measures of paperless medical records.
作者
刘蕾
葛会香
刘彤晖
安佰悦
董富国
罗文强
LIU Lei;GE Hui-xiang;LIU Tong-hui;AN Bai-yue;DONG Fu-guo;LUO Wen-qiang(Affiliated Hospital of Qingdao University,Qingdao,Shandong Province,266500 China)
出处
《中国卫生产业》
2020年第32期65-67,共3页
China Health Industry
关键词
病案无纸化
电子病案
病案管理
Medical record paperless
Electronic medical record
Medical record management
