成都市社区卫生信息化建设及评估研究
摘要
在信息技术快速发展的大背景下,医疗信息化建设的进程不断推进。本研究结合中国当前“新医改”的热门话题和实际发展情况,选定成都市社区卫生机构作为特定研究对象,通过对社区医疗信息化建设现状的调查及分析,构建成都市社区卫生信息化建设评估指标体系理论模型,并以成都高新区合作社区卫生服务中心为个案分析对成都社区卫生服务的信息化发展提出了一系列的政策建议。
论文首先对社区卫生信息化建设的国内外研究情况进行了评述,为后面的研究提供了一个理论和方法背景；然后对成都市社区卫生信息化建设内容及现状进行客观描述,接着根据社区卫生信息化建设的理论和实践要求,通过采用客观性、导向性、整体性、可操作性以及稳定性和动态性相结合等原则,设计出成都市社区卫生信息化建设的评估指标体系理论模型。
本研究在德尔菲方法、访谈法及适合定性定量相结合研究的AHP层次分析法原理的支撑下分析并计算出各指标的权重。为了保证此次实证分析的可行性、真实性和有效性,通过前期查阅大量资料和充分地实地调查,结合现有研究成果,自主设计三种调查问卷(确定指标权重的专家调查问卷与评分定级的社区卫生信息化建设访谈提纲、调查问卷)。同时为了验证该模型的适用性和合理性,采用个案分析的方法对成都高新区合作社区卫生服务中心进行访谈并运用本指标体系进行评估。在综合评估的基础上,结合成都市社区卫生信息化建设的进程,对成都市社区卫生信息化建设提出了若干对策和建议。
The course of medical information proceeds in the context of rapid information technology development. The study here combines the current hot topic of "new medical reform" with the actual situation, and chooses Chengdu's community healthcare institutions as the subjects to try to develop the city's community healthcare information and build an evaluation system through carefully investigating and analyzing the current situations of communities' information development. Moreover, the author proposes a range of suggestions about the policy regarding the city's community healthcare service information.
The paper, above all, gives an statement of the studies conducted at home and abroad on community healthcare service information, and provides some theories and methodologies for the followed research. After that, the paper offers an objective description of Chengdu's current development of community healthcare service information, and finally based on the theoretical and practical requirement of developing communities'healthcare information and according to the principles of combined objectivity, guidance, completeness, operability, stability and dynamics, the author designs the city's evaluation system of developing community healthcare information.
Besides, with the support of AHP hierarchic analytic principle, which combines Delphi Method, interviewing method and Qualitative and quantitative analysis, the paper analyzes and calculate the respective weight of all the indicators. In order to give a better evaluation of the city of community healthcare information development, and confirm the applicability the AHP method, the author employs case analysis and interviews a cooperative healthcare service center in Gaoxin District and gives an evaluation using the system.
Ultimately, based on the comprehensive evaluation, and with the city's development of communities'healthcare service information combined, the papers proposes several suggestions and solutions to respond to the current situation.
论文首先对社区卫生信息化建设的国内外研究情况进行了评述,为后面的研究提供了一个理论和方法背景；然后对成都市社区卫生信息化建设内容及现状进行客观描述,接着根据社区卫生信息化建设的理论和实践要求,通过采用客观性、导向性、整体性、可操作性以及稳定性和动态性相结合等原则,设计出成都市社区卫生信息化建设的评估指标体系理论模型。
本研究在德尔菲方法、访谈法及适合定性定量相结合研究的AHP层次分析法原理的支撑下分析并计算出各指标的权重。为了保证此次实证分析的可行性、真实性和有效性,通过前期查阅大量资料和充分地实地调查,结合现有研究成果,自主设计三种调查问卷(确定指标权重的专家调查问卷与评分定级的社区卫生信息化建设访谈提纲、调查问卷)。同时为了验证该模型的适用性和合理性,采用个案分析的方法对成都高新区合作社区卫生服务中心进行访谈并运用本指标体系进行评估。在综合评估的基础上,结合成都市社区卫生信息化建设的进程,对成都市社区卫生信息化建设提出了若干对策和建议。
The course of medical information proceeds in the context of rapid information technology development. The study here combines the current hot topic of "new medical reform" with the actual situation, and chooses Chengdu's community healthcare institutions as the subjects to try to develop the city's community healthcare information and build an evaluation system through carefully investigating and analyzing the current situations of communities' information development. Moreover, the author proposes a range of suggestions about the policy regarding the city's community healthcare service information.
The paper, above all, gives an statement of the studies conducted at home and abroad on community healthcare service information, and provides some theories and methodologies for the followed research. After that, the paper offers an objective description of Chengdu's current development of community healthcare service information, and finally based on the theoretical and practical requirement of developing communities'healthcare information and according to the principles of combined objectivity, guidance, completeness, operability, stability and dynamics, the author designs the city's evaluation system of developing community healthcare information.
Besides, with the support of AHP hierarchic analytic principle, which combines Delphi Method, interviewing method and Qualitative and quantitative analysis, the paper analyzes and calculate the respective weight of all the indicators. In order to give a better evaluation of the city of community healthcare information development, and confirm the applicability the AHP method, the author employs case analysis and interviews a cooperative healthcare service center in Gaoxin District and gives an evaluation using the system.
Ultimately, based on the comprehensive evaluation, and with the city's development of communities'healthcare service information combined, the papers proposes several suggestions and solutions to respond to the current situation.
引文
[1]孙艳香.城镇社区卫生服务信息化建设的主要障碍探析[J].医院管理论坛,2010,27(1),20-22.
[2]顾剑芳.城市社区卫生服务中心信息化构建模式探索一以上海市浦东新区为例[D].复旦大学,2009,4：1-3.
[3]李伟,张华伟,徐勇勇.社区卫生服务信息化建设的瓶颈问卷及发展对策[J].中国全科医学,2007,10(7),522-253.
[4]张昊.关于社区医疗管理信息系统的思考[D].吉林大学,2008,4.
[5]成都市区域卫生信息化建设总体方案.2009,http://wenku.baidu.com/view/a49a2f 84bceb19e8b8f6ba4b.html.
[6]范启勇,刘青,沈佳妮.上海市社区卫生信息化建设评估指标体系及其应用研究[J].课题论著,2009,5(5)：23-26.
[7]朱妍.医院信息化能力成熟度等级测评实证分析[D].首都经济贸易大学,2010,3：8-11.
[8]DeRenzi,Brian etal. A framework for case-based community health information systems[J]. Proceedings-2011 IEEE Global Humanitarian Technology Conference, Seattle, WA,USA,GHTC 2011,377-382.
[9]刘红昊.社区卫生服务政策体系建设研究[D].天津大学管理学院.2008.8：9-10.
[10]De Lusignan S,Chan T. The development of primary care information technology in the United Kindom[J].The Journal of Ambulatory Care Management2008.31(3):201-210.
[11]De Phillips Ⅲ H. Initiatives and barriers to adopting health Information technology [J].DisManageHealthOuteomes2007,15(1):1-6.
[12]Ann Scheck, McAlearney. Perceived efficiency impacts following electronic health record implementation:An exploratory study of an urban community health center network[J]. International Journal of Medical Informatics.2010:807-816.
[13]Zhenfeng Shao, Haicong Yu,Qing Ye.Construction of the community health management and service system based on spatial information grid[C].2007 3rd International Conference on Wireless Communications, Networking, and Mobile Computing-WiCOM '07,2007,1:6228-31.
[14]GongShu,LianWei etal. Medical information education platform and its application in community health management [J]. ITME 2011-Proceedings:2011 IEEE International Symposium on IT in Medicine and Education,2011,1:196-200.
[15]18th Annual HIMSS Leadership Survey Final Report:Healthcare CIO[EB/OL]. (2007-04-10).http://www.himss.org/2007survey.
[16]Steven E. Labkoff, William A. Yasnofl.A framework for systematic evaluation of health information infrastructure progress in communities [J]. Journal of Biomedical Informatics,2006:100-105.
[17]MatthewScotch, Bambang Parmanto. Development of SOVAT:A numerical-spatial decision support system for community health assessment research [J]. International Journal of Medical Informatics.2006:771-784.
[18]吕彩霞.基于SaaS的社区医疗信息化管理模式研究[D].太原理工大学,2010,5.
[19]陆维嘉.社区卫生服务的综合信息系统建设探讨[J].医学信息,2010,09(23)9：78-80.
[20]鲍勇.加强社区卫生服务信息化建设实施健康管理可持续发展[J].实用全科医学,2007,5(11)：941-94.
[21]范方志.社区医疗模式的探讨[J].医学理论与实践,2003,16(9)：1106.
[22]任晓晖,李宁秀等.四川省社区卫生服务机构建设评价指标筛选[J].四川大学学报(医学版)2008,39(3)：471-473.
[23]郭清,王小合等.中国城市2005年社区卫生服务评价指标及操作方法研究[J].中国全科医学,2002,12(5)：973-975.
[24]黄文财,程伟强.广州市社区卫生服务信息化建设现状评估及发展策略[J].医学信息,2010,05：64-66.
[25]蹇洁,盛或湛.基于项目全生命周期的社区信息化建设评估研究[J].科技管理研究,2009,12：230-231.
[26]赵志静,徐怀伏.社区医疗信息化建设初探[J].上海医药,2007,28(7)：316-318.
[27]秦月华.城市社区卫生服务运行现状评估与发展研究[D].江西财经大学,2006,10.
[28]Payton, Fay Cobb etal. How a community health information network is really used[J]. Communications of the ACM,1999,42 (12):85-89.
[29]Sockolow,PS,Bowles,KH etal. Community-Based, Interdisciplinary Geriatric Care Team Satisfaction With an Electronic Health Record A Multimethod Study [J]. CIN-COMPUTERS INFORMATICS NURSING.2012,6.30(6):300-311.
[30]龚怀宇,郭剑锋等.成都市区域卫生信息平台建设探讨[J].中国信息界(e医疗),2010,4.
[31]金新政.现代医院信息系统[M].北京市：人民卫生出版社,2009,09.
[32]王小合等.构建社区卫生信息系统,实现社区卫生事业管理现代化[J].中国初级卫生保健,2002,16(10)：6.
[33]Liwei;Zhanghuawei;Xuyongyong. Process and Techniques for Establishment of Information Technology Standard for Community Health Services [J]. Chinese General Practice.2007; (10):519-521.
[34]Zhaojunping, Zhang zhenjiang etal. E-health-oriented community health information system in China:Our challenges, solution, and experience [J]. Telemedicine and e-Health, v 17, n 7,2011,9:584-588.
[35]HuHongpu;LEI Xingyun;CHEN Quan etal. Construction of Automated Community Health Service Supervision and Management System [J]. Chinese General Practice.2011(14): 2847-2850.
[36]朱蔚.社区卫生信息化建设的实践与思考[J].管理实践,2010,29(12),268.
[37]成都市区域卫生信息化建设总体方案2009,http://wenku.baidu.com/view/a49a2 f84bceb 19e8b8f6ba4b.html.
[38]计虹.医疗卫生领域医院信息化的应用现状及展望[J].中国预防医学杂志,2008,9(5)：437-439.
[39]章长生,周永生,赵德森.基于SWOT分析模型的中小企业发展战略[J].中国集体经济,2007,6：17-17.
[40]Lujianyu;Ruan,Huanli etal. Construction and implementation outcomes evaluation of community health management information system [J]. TITME 2011-Proceedings:2011 IEEE International Symposium on IT in Medicine and Education, v 2, p 82-86.2011.
[41]于长海,郭继志等.潍坊市城区社区卫生服务机构的SWOT分析[J].中国初级卫生保健,2011,9(25),15-16.
[42]薛焕美,胡守忠等.上海市松江区社区卫生服务机构的SWOT分析及对策建议[J].卫生软科学,2009,12(23),683-685.
[43]Chiu;Yueh-Hsia etal. Health information system for community-based multiple screening in Keelung, Taiwan (Keelung Community-based Integrated Screening No.3) [J]. International Journal of Medical Informatics,2006,5:369-383.
[44]徐秋红等.医疗信息化建设的践行者——专访北医三院信息管理中心主任沈韬[J].科学中国人,2010,3.
[45]中国医院信息化发展报研究告(白皮书)[R].中国医院协会信息管理专业委员会(CHIMA)、埃森哲咨询公司.2008,5.
[46]杜方冬.我国医院信息化水平评价指标体系及综合评价模型研究[D].中南大学,2007,11.
[47]刘国.成都市可持续发展指标体系与综合评估的研究[D].成都理工大学,2005,5：30-31.
[48]鲁珍珍.基于层次分析法的企业文化建设效果测评体系研究[D].兰州大学,2009,5.
[49]朱成全等.我国物质文明指标体系构建、测量与提升对策[J].财经问题研究,2009,7.
[50]陈淑琼.基于AHP的客户知识管理能力测评体系研究[J].兰州大学,2010,5
[51]王瑜.我国社区卫生服务建设中的政府职能[D].天津师范大学,2008,3.
[52]王首珏.新型农村合作医疗信息化管理研究[D].上海交通大学,2007,6.
[2]顾剑芳.城市社区卫生服务中心信息化构建模式探索一以上海市浦东新区为例[D].复旦大学,2009,4：1-3.
[3]李伟,张华伟,徐勇勇.社区卫生服务信息化建设的瓶颈问卷及发展对策[J].中国全科医学,2007,10(7),522-253.
[4]张昊.关于社区医疗管理信息系统的思考[D].吉林大学,2008,4.
[5]成都市区域卫生信息化建设总体方案.2009,http://wenku.baidu.com/view/a49a2f 84bceb19e8b8f6ba4b.html.
[6]范启勇,刘青,沈佳妮.上海市社区卫生信息化建设评估指标体系及其应用研究[J].课题论著,2009,5(5)：23-26.
[7]朱妍.医院信息化能力成熟度等级测评实证分析[D].首都经济贸易大学,2010,3：8-11.
[8]DeRenzi,Brian etal. A framework for case-based community health information systems[J]. Proceedings-2011 IEEE Global Humanitarian Technology Conference, Seattle, WA,USA,GHTC 2011,377-382.
[9]刘红昊.社区卫生服务政策体系建设研究[D].天津大学管理学院.2008.8：9-10.
[10]De Lusignan S,Chan T. The development of primary care information technology in the United Kindom[J].The Journal of Ambulatory Care Management2008.31(3):201-210.
[11]De Phillips Ⅲ H. Initiatives and barriers to adopting health Information technology [J].DisManageHealthOuteomes2007,15(1):1-6.
[12]Ann Scheck, McAlearney. Perceived efficiency impacts following electronic health record implementation:An exploratory study of an urban community health center network[J]. International Journal of Medical Informatics.2010:807-816.
[13]Zhenfeng Shao, Haicong Yu,Qing Ye.Construction of the community health management and service system based on spatial information grid[C].2007 3rd International Conference on Wireless Communications, Networking, and Mobile Computing-WiCOM '07,2007,1:6228-31.
[14]GongShu,LianWei etal. Medical information education platform and its application in community health management [J]. ITME 2011-Proceedings:2011 IEEE International Symposium on IT in Medicine and Education,2011,1:196-200.
[15]18th Annual HIMSS Leadership Survey Final Report:Healthcare CIO[EB/OL]. (2007-04-10).http://www.himss.org/2007survey.
[16]Steven E. Labkoff, William A. Yasnofl.A framework for systematic evaluation of health information infrastructure progress in communities [J]. Journal of Biomedical Informatics,2006:100-105.
[17]MatthewScotch, Bambang Parmanto. Development of SOVAT:A numerical-spatial decision support system for community health assessment research [J]. International Journal of Medical Informatics.2006:771-784.
[18]吕彩霞.基于SaaS的社区医疗信息化管理模式研究[D].太原理工大学,2010,5.
[19]陆维嘉.社区卫生服务的综合信息系统建设探讨[J].医学信息,2010,09(23)9：78-80.
[20]鲍勇.加强社区卫生服务信息化建设实施健康管理可持续发展[J].实用全科医学,2007,5(11)：941-94.
[21]范方志.社区医疗模式的探讨[J].医学理论与实践,2003,16(9)：1106.
[22]任晓晖,李宁秀等.四川省社区卫生服务机构建设评价指标筛选[J].四川大学学报(医学版)2008,39(3)：471-473.
[23]郭清,王小合等.中国城市2005年社区卫生服务评价指标及操作方法研究[J].中国全科医学,2002,12(5)：973-975.
[24]黄文财,程伟强.广州市社区卫生服务信息化建设现状评估及发展策略[J].医学信息,2010,05：64-66.
[25]蹇洁,盛或湛.基于项目全生命周期的社区信息化建设评估研究[J].科技管理研究,2009,12：230-231.
[26]赵志静,徐怀伏.社区医疗信息化建设初探[J].上海医药,2007,28(7)：316-318.
[27]秦月华.城市社区卫生服务运行现状评估与发展研究[D].江西财经大学,2006,10.
[28]Payton, Fay Cobb etal. How a community health information network is really used[J]. Communications of the ACM,1999,42 (12):85-89.
[29]Sockolow,PS,Bowles,KH etal. Community-Based, Interdisciplinary Geriatric Care Team Satisfaction With an Electronic Health Record A Multimethod Study [J]. CIN-COMPUTERS INFORMATICS NURSING.2012,6.30(6):300-311.
[30]龚怀宇,郭剑锋等.成都市区域卫生信息平台建设探讨[J].中国信息界(e医疗),2010,4.
[31]金新政.现代医院信息系统[M].北京市：人民卫生出版社,2009,09.
[32]王小合等.构建社区卫生信息系统,实现社区卫生事业管理现代化[J].中国初级卫生保健,2002,16(10)：6.
[33]Liwei;Zhanghuawei;Xuyongyong. Process and Techniques for Establishment of Information Technology Standard for Community Health Services [J]. Chinese General Practice.2007; (10):519-521.
[34]Zhaojunping, Zhang zhenjiang etal. E-health-oriented community health information system in China:Our challenges, solution, and experience [J]. Telemedicine and e-Health, v 17, n 7,2011,9:584-588.
[35]HuHongpu;LEI Xingyun;CHEN Quan etal. Construction of Automated Community Health Service Supervision and Management System [J]. Chinese General Practice.2011(14): 2847-2850.
[36]朱蔚.社区卫生信息化建设的实践与思考[J].管理实践,2010,29(12),268.
[37]成都市区域卫生信息化建设总体方案2009,http://wenku.baidu.com/view/a49a2 f84bceb 19e8b8f6ba4b.html.
[38]计虹.医疗卫生领域医院信息化的应用现状及展望[J].中国预防医学杂志,2008,9(5)：437-439.
[39]章长生,周永生,赵德森.基于SWOT分析模型的中小企业发展战略[J].中国集体经济,2007,6：17-17.
[40]Lujianyu;Ruan,Huanli etal. Construction and implementation outcomes evaluation of community health management information system [J]. TITME 2011-Proceedings:2011 IEEE International Symposium on IT in Medicine and Education, v 2, p 82-86.2011.
[41]于长海,郭继志等.潍坊市城区社区卫生服务机构的SWOT分析[J].中国初级卫生保健,2011,9(25),15-16.
[42]薛焕美,胡守忠等.上海市松江区社区卫生服务机构的SWOT分析及对策建议[J].卫生软科学,2009,12(23),683-685.
[43]Chiu;Yueh-Hsia etal. Health information system for community-based multiple screening in Keelung, Taiwan (Keelung Community-based Integrated Screening No.3) [J]. International Journal of Medical Informatics,2006,5:369-383.
[44]徐秋红等.医疗信息化建设的践行者——专访北医三院信息管理中心主任沈韬[J].科学中国人,2010,3.
[45]中国医院信息化发展报研究告(白皮书)[R].中国医院协会信息管理专业委员会(CHIMA)、埃森哲咨询公司.2008,5.
[46]杜方冬.我国医院信息化水平评价指标体系及综合评价模型研究[D].中南大学,2007,11.
[47]刘国.成都市可持续发展指标体系与综合评估的研究[D].成都理工大学,2005,5：30-31.
[48]鲁珍珍.基于层次分析法的企业文化建设效果测评体系研究[D].兰州大学,2009,5.
[49]朱成全等.我国物质文明指标体系构建、测量与提升对策[J].财经问题研究,2009,7.
[50]陈淑琼.基于AHP的客户知识管理能力测评体系研究[J].兰州大学,2010,5
[51]王瑜.我国社区卫生服务建设中的政府职能[D].天津师范大学,2008,3.
[52]王首珏.新型农村合作医疗信息化管理研究[D].上海交通大学,2007,6.