电子病历中复合元素实现方法研究

Research on the Realization Method of Compound Elements in Electronic Medical Records

目的:探讨结构化电子病历复合元素概念,研究复合元素实现方法及意义。方法:通过提纲录入式和引导输入式两种方式,分别在结构化电子病历模板和医学专用输入引擎系统中实现复合元素录入。结果:复合元素为结构化电子病历逻辑质控提供了新思路,医学专用输入引擎系统为实现复合元素开辟了新途径。结论:复合元素对于完善结构化电子病历标准规范、实现数据交换与共享、开展数据挖掘与分析、加强病历质量控制等具有重要意义。

Objective： Discuss on the concept of structured electronic medical records composite element, research on the Realization and significance of composite element. Methods： By the ways of Outline-style entry and guided-style input, respectively achieve the composite element entry in structured EMR templates and in the medicine dedicated input engine system. Results：The composite elements provides a new idea for structured EHR logic quality control, at the same time medical dedicated input engine system opens up a new avenue for the realization of the composite elements. Conclusion： The composite element has important significance in improving structured electronic medical records standard specification, realizing data exchange and data sharing, conductig data mining and data analysis, Strengthening EMR quality control and so on.