基于微信平台的信息化病案管理在胃肠外科患者中的应用效果

Application effects of information-based medical record management based on WeChat platform in patients of gastrointestinal surgery

目的:观察基于微信平台的信息化病案管理在胃肠外科患者中的应用效果。方法:选取2021年7月至2022年6月采用常规病案管理的270例胃肠外科患者的病案资料设为对照组,选取2022年7月至2023年6月采用基于微信平台的信息化病案管理的270例胃肠外科患者的病案资料设为观察组。比较两组病案归档错误率、病案调取时间、复印时间、管理人员病案管理掌握程度评分和管理满意度评分。结果:观察组病案错误率、病案丢失率、内容损坏率、内容缺失率、顺序错乱率等病案归档错误率均低于对照组,差异有统计学意义(P<0.05);观察组病案调取时间和复印时间均短于对照组,差异有统计学意义(P<0.05);观察组病案信息学知识、病案管理学知识和信息化病案管理操作规范等管理人员病案管理掌握程度评分均高于对照组,差异有统计学意义(P<0.05);观察组病案资料管理质量、病案资料调阅速度、病案资料复印时间等管理满意度评分均高于对照组,差异有统计学意义(P<0.05)。结论:基于微信平台的信息化病案管理应用于胃肠外科患者可降低病案归档错误率,缩短病案调取时间与复印时间,以及提高管理人员病案管理掌握程度评分和病案资料管理质量满意度评分的效果优于常规病案管理。

Objective:To observe application effects of information-based medical record management based on WeChat platform in patients of gastrointestinal surgery.Methods:The medical records of 270 patients of gastrointestinal surgery who were managed by routine medical record management from July 2021 to June 2022 were selected as the control group,and the medical records of 270 patients of gastrointestinal surgery who were managed by information-based medical record management based on WeChat platform from July 2022 to June 2023 were selected as the observation group.The error rate of medical record archiving,the time of medical record retrieval,the copying time,the score of medical record management mastery of management personnel,and the score of management satisfaction were compared between the two groups.Results:The error rate of medical records,the loss rate of medical records,the damage rate of contents,the loss rate of contents and the sequence disorder rate in the observation group were lower than those in the control group,and the differences were statistically significant(P<0.05).The time of medical record retrieval and copying in the observation group were shorter than those in the control group,and the differences were statistically significant(P<0.05).The scores of medical record management mastery of management personnel such as medical record informatics knowledge,medical record management knowledge and information-based medical record management operation norms in the observation group were higher than those in the control group,and the differences were statistically significant(P<0.05).Further,the satisfaction scores of management quality,retrieval speed,and copying time of medical records in the observation group were higher than those in the control group,and the differences were statistically significant(P<0.05).Conclusions:The information-based medical record management based on WeChat platform in the patients of gastrointestinal surgery can reduce the error rate of medical record archiving,shorten the time of medical record retrieval and the copying time,and improve the mastery score of medical record management and the satisfaction score of medical record data management quality.Moreover,it is superior to the routine medical record management.