中美电子病历应用评价的比较研究

发布时间：2018-06-01 22:41

本文选题：电子病历 + 应用评价　；参考：《东南大学》2017年硕士论文

【摘要】：研究背景和目的:近年中央和地方各级政府大力加强对医疗信息化的政策支持力度和财政投入,形成医疗卫生信息化建设前所未有的良好局面,大型医院已基本建立HIS、PACS、LIS、EHR以及医院集成平台、区域卫生信息平台、远程医疗平台等各种信息系统,卫生行业正在进入全面信息化的发展期,电子病历系统成为建设核心,如何评价电子病历要求正在成为重要问题。中美两国分别在2010年和2009年提出电子病历应用评价标准,本研究旨在从标准内容和标准推广两个方面进行比较研究,一是对比中美两个评价标准内容有多少差异,二是历经数年发展,两个标准在实践中推广效果表现如何,存在哪些影响因素,哪些政策可以相互借鉴,对中国电子病历应用评价提出改进建议。研究方法:本文以文献研究、比较研究和专家访谈为主要研究方法。文献研究上以2006年1月1日到2016年2月28日为时间界限,从ELsevier、Springer-link、Pubmed、EBSCO、中国知网、万方数据库、维普科技文献六个文献库采用主题词检索方式进行文献检索,在文献阅读基础上手工补充文献。在文献研究基础上,对美国《Electronic Health Record Incentive Program》(电子病历激励计划中的"有效使用"标准)和中国《电子病历系统功能应用水平分级评价方法和标准》的评价标准、评价方法、评价程序进行横向比较法研究,分析对比美国和中国两国在电子病历评价方面的差异,归纳和总结相关问题和解决办法进行专家访谈,评估美国标准与中国标准的等级对应关系,并用肯德尔和谐系数进行一致性检验。最后借鉴结构-过程-结果模型,分组织体系、过程管理、政策效果三个部分对中美两国电子病历应用标准的政策推广进行系统性比较研究,通过两国医院对评价标准的采用率来对比评价标准在政策实践中的推广效果,从组织体系、过程管理分别分析效果差异的影响因素,结合我国电子病历发展现状,为我国电子病历推广提供政策参考意见。结果:1、美国电子病历"有效使用"中针对医院的评价项目在阶段1有24个、阶段2有22个,分别与中国电子病历应用水平分级的37个评价项目横向对比,阶段1和阶段2中分别有15项和12项与中国标准的评价项目不同级别相对应,中国标准中有17项是关注医院内部流程的评价项目,美国标准中没有对应项。2、通过专家访谈和调查反馈显示,美国标准阶段1和阶段2的评价要求与中国电子病历应用水平分级的第4级最为相近,专家评价肯德尔协调系数分别为0.870 和 0.888(P0.05)。3、从政策产出效果对比分析,在相同的五年时间中,参与美国电子病历"有效使用"标准的医院采用率为85%,远高于中国电子病历应用分级评价标准39%的参与采用率(P0.01)。4、从组织体系对比分析,美国通过ONC、CMS、HITSP三家机构分别从战略方面、准入机制、标准协同、评价核定等方面共同推进电子病历应用评价工作,同时提供人员培训、示范社区、区域支持等诸多措施配套推进,可以看出美国电子病历应用评价的组织体系更为成熟;中国目前仅有电子病历试点办公室负责评价核定工作,缺乏进行顶层设计的组织保障、也缺少标准协同机构,整体组织体系相对薄弱,配套措施较少。5、从过程管理对比分析,美国标准已经进行三次更新,并提供电子病历激励计划,通过经济刺激进行鼓励使用,为标准推广提供更持久动力;中国标准自2010年颁布之后至今尚未进行过更新,也缺乏相关激励反馈机制。结论:1、中国电子病历应用评价标准覆盖面远低于美国类似标准的原因可能有:1)组织机构不完善;2)缺少系统性配套措施;3)缺少经济激励措施。2、中国的政策制定要充分认识电子病历推广的复杂性和长期性。美国在强力的政策支持、完善的组织机构、诸多配套行动的支持下,其推广计划仍多次受挫,被迫延期,在中国医疗机构尚且不具备诸多有利条件的情况下,制定电子病历以及健康大数据推广政策更需要对此有清晰的认识。3、要充分关注电子病历推广的顶层战略设计,不能仅仅关注标准内容,更需明确电子病历应用目的,制定长期计划进行引导,重视绩效产出表现,在推动大型医疗机构有效使用电子病历同时,更需要促进中小医院和诊所对电子病历应用的关注。4、评价标准需要关注整个体系的建设,形成循证决策,不断调整,促进标准能根据不同利益方需求和时代发展不断进化更新,保持标准的有效性和前瞻性。5、可借鉴美国经验,利用医保资金补偿作为经济激励措施,促进利益相关各方的协同,提升效率使社会整体能获得更好收益,也为评价标准发展提供更持久的发展动力。
[Abstract]:Research background and purpose: in recent years, the central and local governments at all levels have strengthened the policy support and financial input to medical information, and formed an unprecedented good situation in the construction of medical and health information. The large hospitals have basically established HIS, PACS, LIS, EHR and the platform of hospital collection, regional health information platform, telemedicine platform, etc. All kinds of information systems, the health industry is entering the development period of comprehensive information. The electronic medical record system has become the core of the construction. How to evaluate the requirements of the electronic medical record is becoming an important problem. China and the United States put forward the evaluation standard of the application of electronic medical records in 2010 and 2009 respectively. This study aims to promote two aspects from the standard content and standard. Comparison study, one is to compare the differences between the two evaluation standards of China and the United States, two is the development of the past several years, the two standards in practice how to promote the effectiveness of the performance, which factors, which policies can learn from each other, and put forward suggestions for the evaluation of the application of electronic medical records in China. Research and expert interview are the main research methods. In the literature study, from January 1, 2006 to February 28, 2016, ELsevier, Springer-link, Pubmed, EBSCO, Chinese knowledge network, Wanfang database, and VP science and technology literature are retrieved by subject words retrieval methods, and the manual supplement on the basis of literature reading. On the basis of literature research, the (the "effective use" standard in the electronic medical record incentive plan) and the evaluation criteria for the evaluation method and standard of the functional application level of the electronic medical records system, the evaluation method and the evaluation procedure were studied laterally, and the analysis and comparison of the United States and the United States were made. The differences in the evaluation of electronic medical records in China, induction and summary of related problems and solutions are interviewed by experts, and the corresponding relationship between the United States and China standards is evaluated, and the consistency test is carried out with the Kendall harmony coefficient. Finally, the structure process result model, the organization system, the process management, and the policy effect are three. A systematic comparative study of the policy promotion of the standard for the application of electronic medical records in China and the United States is systematically compared. Through the comparison of the adoption rate of the evaluation standards of the two hospitals in the two countries, the effectiveness of the evaluation standards in the policy practice is compared, and the impact factors of the difference in the effect are analyzed from the organizational system and process management respectively, and the status of the development of the electronic medical records in China is combined. China's electronic medical record promotion provides policy reference. Results: 1, the United States electronic medical records "effective use" of the hospital evaluation projects in stage 1 have 24, stage 2, 22, respectively, and the Chinese electronic medical record application level of the 37 evaluation items in the horizontal comparison, stage 1 and stage 2, 15 and 12 items with China standard evaluation respectively. 17 of the Chinese standards are concerned with the evaluation of the internal process of the hospital. There is no corresponding item.2 in the United States standard. Through expert interview and feedback, the evaluation of the standard 1 and stage 2 in the United States is the most similar to the level of the level of the application level of the Chinese electronic medical record. The expert evaluation of the Kendall Association The adjustment coefficients are 0.870 and 0.888 (P0.05).3 respectively. From the comparison and analysis of the effect of policy output, in the same five years, the adoption rate of the "effective use" standard of the American electronic medical record is 85%, far higher than the participation rate (P0.01).4 of the Chinese Electronic medical record application grading evaluation standard 39%, from the organizational system comparison and analysis, the United States passes the ONC The three institutions of CMS and HITSP, respectively, promote the application and evaluation of electronic medical records from the aspects of strategy, access mechanism, standard synergy, evaluation and verification, and provide personnel training, demonstration community, regional support and many other measures. It can be seen that the organization system of the evaluation of the application of electronic medical records in the United States is more mature; at present, China is only the only one. The pilot office of the electronic medical record is responsible for the evaluation of the work, the lack of organizational guarantee for the top level design, the lack of standard coordination institutions, the relatively weak overall organization system and the less supporting measures.5. The United States standards have been updated three times from the process management comparison and analysis, and the electronic medical record incentive plan is provided through the economic stimulus. Encourage use, provide more lasting power for standard extension; China standard has not been updated since its promulgation in 2010 and lack of relevant incentive feedback mechanism. Conclusion: 1, the reason that the coverage of the evaluation standard of the application of Chinese electronic medical records is far below the similar standards in the United States may be: 1) the organization is not perfect; 2) lack of systematic supporting measures. 3) the lack of economic incentives.2, China's policy formulation should fully recognize the complexity and long term of the promotion of electronic medical records. With the support of strong policy support, perfect organization, and many supporting actions, the promotion plan of the United States is still frustrated and delayed, and there are still no favorable conditions in Chinese medical institutions. In the case of an electronic medical record and a large health data promotion policy, we need to have a clear understanding of the.3. We should pay full attention to the top-level strategic design of the electronic medical record promotion. We should not only pay attention to the standard content, but also need to clarify the purpose of the application of the electronic medical record, make the long-term plan guidance, pay attention to the performance output and promote the large medical machine. The effective use of electronic medical records should also promote the attention of small and medium hospitals and clinics to the application of electronic medical records (.4). The evaluation standards need to pay attention to the construction of the whole system, form evidence-based decision-making, constantly adjust, and promote the continuous evolution of standards according to the needs of different interests and the development of the times, and maintain the validity and forward-looking.5 of the standard. Using the experience of the United States for reference, using the medical insurance fund compensation as an economic incentive measure, promote the synergy of the stakeholders, improve the efficiency to make the whole society gain better income, and provide a more lasting impetus for the development of the evaluation standard.
【学位授予单位】：东南大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R197.323

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