【作者】 马明；

【导师】 吴乐山；

【作者基本信息】 中国人民解放军军事医学科学院 ， 军事预防医学， 2010， 博士

【摘要】 研究目的在全面把握远程医学的发展历程、研究热点与发展趋势的基础上,紧密结合武警部队远程医学存在的问题与发展需求,形成创新发展武警远程医学的总体思路,找准实现创新发展的突破口,提出能够具体落实的创新发展保障措施。研究内容研究内容主要分为三个部分：(1)远程医学的发展历程、研究热点与发展趋势；(2)武警远程医学发展现状、问题与思考；(3)武警远程医学创新发展策略。研究方法根据研究内容的不同要求,选择了相应的研究方法：(1)发展历程的研究主要应用了文献计量法和知识图谱方法；(2)研究热点的分析主要应用了共词分析方法；(3)发展趋势研究主要应用情报调研、定性分析和归纳方法；(4)武警远程医学发展现状主要应用了问卷数据调查和统计分析方法；(5)存在问题与思考主要应用逻辑分析与系统思维方法；(6)创新发展策略研究主要应用了系统工程思维方法以及规划计划制订思维方法。研究结果(1)远程医学可划分为三个阶段发展历程,即模拟化发展阶段、准数字化发展阶段和数字集成发展阶段；(2)远程医学当前的研究主题热点,包括有远程动态监测设备研究、互联网远程医学与电子病历以及远程家庭保健与农村健康服务等；(3)美军远程医学发展具备鲜明的特点,在政策导向、经费支持、设备研发、运行机制、队伍建设等诸多方面的经验有很高借鉴价值；(4)远程医学的发展趋势是系统建设通用一体化、装备发展小型机动化、技术建设管理标准化、平时应用领域专科化、军事应用逐步常态化；(5)武警远程医学发展需要重点解决管理滞后问题、法规体系不完善问题、编制制约及专业能力素质提高问题、人才队伍建设问题、装备野战化问题和远程医学会诊质量问题。研究结论：主要有以下五点。(1)国际和外军远程医学已处数字集成发展阶段,美军研究与应用水平居世界领先。我军(含武警)发展尚处准数字化阶段,标准化程度不高,研究、应用和服务尚处较低水平。武警远程医学必须结合国情制定创新发展战略和策略。(2)远程医学系统建设必须抓好五个关键：通信网络和传输技术平台---系统建设的基础；病历数据与工作流程标准化---系统运行前提；末端建设和野战机动装备-系统建设的重点；平战时多领域应用常态化---系统发展的动力；健全的法规制度-实现系统功能的重要保证。(3)武警远程医学的创新发展,必须以科学发展观为指导,以平时官兵的医疗保障和野战条件下的伤病员救治需求与灾害救援为牵引,以提升武警部队的平时医疗保障水平和野战条件下的伤病员救治水平为目标,坚持不懈地推进武警部队远程医学建设和发展。应当遵循五项创新发展的原则“平战结合,需求牵引；着眼整体,突出重点；软硬兼顾,标准先行；创新技术,持续发展；规范运行,确保安全”。(4)武警远程医学创新发展,应抓住五个突破口：解决通信带宽的瓶颈问题；推进武警远程医疗野战化；加强会诊专家数据库建设；提高会诊病历标准化程度；确保远程会诊流程规范化。(5)武警远程医学创新发展,应落实五项保障措施：强化引导监督,为创新发展提供坚强领导；完善法规体系,为创新发展提供制度保障；加强队伍建设,为创新发展提供组织保障；着眼整体效益,为创新发展提供资源保障；加强远程教育,为创新发展拓展应用空间。讨论：主要有以下两点。(1)以文献计量、知识地图、共词分析等方法,对国内,特别是我军和武警远程医学现状进行定量研究,有待今后努力。(2)武警远程医学建设和发展中如何结合国情和军需选择其中的关键技术,值得进一步研究。更多还原

【Abstract】 Study Purpose On the basis of grasping the development course, hot spots in research and development trend of the telemedicine in an all-round way, form an overall train of thought in innovating the telemedicine in the Armed Police Force, find the breakthrough point in realizing the innovative development and put forward the guarantee measures that can implement the innovative development by combining closely with the existing problems and development demand of the telemedicine in the Armed Police Force.Study Content The study content is mainly divided into three parts:(1) development course, hot spots in research and development trend of telemedicine; (2) the current development situation, problems and thinking of telemedicine in the Armed Police Force; (3) innovative development tactics for telemedicine in the Armed Police Force.Research method To choose corresponding research method according to different requests of the study content:(1) The study of the development course mainly adopts literature metrology and knowledge mapping method; (2) the analysis of hot spots in research mainly uses the method of Co-Word Analysis; (3) the study of development trend mainly uses information investigation and research, qualitative analysis and inductive method; (4) the current situation of telemedicine in the Armed Police Force mainly uses questionnaire data investigation and statistical analysis technique; (5) the existing problems and thinking mainly uses logic analysis and systematic thinking method; (6) the study of innovative development tactics mainly uses systematic engineering thinking method and the thinking method of making planning.Study results (1) The telemedicine can be divided into three development stages, namely simulation, would-be digitization and numerical integration; (2) hot spots in the research subject, including dynamic monitoring equipment for telemedicine, internet telemedicine, electronic medical record, and family health care tele-monitoring and health services in rural area; (3) US forces’telemedicine development has distinct characteristics, with great reference value in aspects like policy guidance, funding, equipment R&D, operation mechanism and team development; (4) the development trends of telemedicine are general-purpose integration in systematic construction, miniaturization and mobility in equipment development, standardization in the technology management, specialization in ordinary application fields and progressive normalization in military application; (5) the key problems needing to be solved in the development of telemedicine in the Armed Police Force are lagging in the management, imperfect rules and regulations system, staffing limit, poor professional ability and quality, building of talent team, equipment adapting to the field operations and the poor quality of telemedicine consultation.Study conclusion:there are mainly the following 5 points.(1) International and foreign countries’telemedicine is already in the numerical integration stage, with the US force’s research and application level leading in the world. Its development in our troops (including the Armed Police Force) is still in would-be digitization stage, with low standardized degree and low level in research, application and service. The telemedicine in the Armed Police Force must make innovative development strategy and tactics based on our national conditions.(2) We must pay adequate attention to five key aspects in the construction of telemedicine system:communications network and transmission technology platform foundation of systematic construction; standardization in case history data and workflow--prerequisite for the operation of the system; termination construction and field operation motor-driven equipment--focus of the system construction; normalization in multi-field application in the peacetime and wartime--motive force for the system development; and sound and perfect regulation system--important guarantee for realizing the functions of the system.(3) The innovative development of telemedicine in the Armed Police Force must stick to the macro-guidance of the scientific outlook on development, be led by the medical security of officers and soldiers at ordinary times, treatment demand of the sick and wounded under the field operations condition and calamity rescue, and aimed at improving the medical security level of the Armed Police Force at ordinary times and treatment level for the sick and wounded under the field operations condition, and keep driving the construction of telemedicine in the Armed Police Force forward. Five principles in the innovative development should be followed:combining the operation in the peacetime and wartime, driven by the demand; have the whole in mind, stress the key points; take both software and hardware environment development into consideration with standard coming first; innovating the technology and developing in a sustainable way; and operating in a standard manner and guaranteeing the security.(4) The innovative development of telemedicine in the Armed Police Force should focus on the following five breakthrough points:solving the bottleneck problem of the communications bandwidth; adapting to field operation of telemedicine in the Armed Police Force; strengthening the construction of consultation experts’database; improving the standardization of the consultation case history; and guaranteeing the standardization of tele-consultation procedure. (5) The innovative development of telemedicine in the Armed Police Force should implement five guarantee measures:strengthening the guidance and supervision to offer a strong leadership for innovative development; perfecting the regulations and rules system to offer the system guarantee for innovative development; strengthening the team development to offer manpower guarantee for innovative development; having the whole benefit in mind to offer the resource guarantee for innovative development; and strengthening the tele-education to expand the application market for innovative development.Discussion:There are mainly the following two points.(1) Carry out quantitative research into the current situation of telemedicine of our country, especially our troops and the Armed Police Force with methods such as literature metrology, knowledge mapping method and Co-Word method. This is to be done later.(2) It is worth further studying how to choose the key technology among them by combining the national conditions and military demand in the construction and development of telemedicine of the Armed Police Force.更多还原