【作者】 吕孟涛；

【导师】 李道苹；

【作者基本信息】 华中科技大学 ， 社会医学与卫生事业管理， 2006， 硕士

【摘要】 社区卫生服务是我国城镇医药体制改革的重要内容和主要环节。当前社区卫生中,存在着多种卫生信息不规范现象,社区卫生信息标准研究日益受到人们的重视。研究目的探索将“自上而下”的建模方法与“自下向上”的业务流程分析方法相结合的卫生信息分类途径构建社区卫生信息分类数据集研究资料与方法社区卫生信息分类研究是对现有的社区卫生信息项进行整理,研究中采用分层随机抽样的方法随机抽取湖南、上海两地作为目标,将两地卫生信息系统中的数据项作为来源资料。本研究借用面向对象的建模思想中的概念数据模型理论,将社区卫生服务的“六位一体”功能封装起来按照多级分类的方法划分出类目。需要注意的是,卫生信息分类中所运用的建模思想,并不涉及到对设计、实施并运行信息系统的说明,而是着眼于信息的表达、数据之间的逻辑关系以及信息的管理,侧重于卫生信息的利用而非开发。业务流程分析是软件开发过程中系统分析的一个环节,本研究通过利用原始数据构建业务表单来对社区卫生服务业务流程分析,确定各项数据的具体类目。研究中尝试把“自上而下”的建模思想与“自下向上”的业务流程分析两种方法相结合的思路,一方面通过建立分类模型来指导社区卫生信息的分类,另一方面直接从数据信息中提取业务表单,从而满足信息分类的需要。本文研究运用文献检索获得国内外卫生信息标准化研究资料以及我国社区卫生服务资料,运用间接观察法与分析归纳法对《中国健康监测系统》研究试点项目调查表进行分析。研究内容本文的研究内容着重在以下四个方面开展:(1)卫生信息分类现状分析(2)社区卫生信息整理(3)社区卫生模型与业务流程分析(4)社区卫生信息分类研究结果文献检索提示,国外卫生信息标准化研究已开始注重针对框架、模型和术语的整体性研究,以统一建模语言为基础的建模研究成为热点;国内卫生信息标准化研究以学习、参考、借鉴国外经验为主。本文研究共提取社区原始数据项1523项,涉及23类业务内容,经去除冗余等数据整理工作后保留数据311项,进行信息分类。本文研究明确了社区卫生服务功能主要按照“六位一体”开展,借鉴建模思想,确定社区卫生信息分类按照基本信息、医疗、预防、保健、康复、健康教育、计划生育技术指导七项内容划分。结合业务流程分析的思路,运用原始数据构建社区卫生业务表,涉及20余类业务内容,可制作出70余份业务表。根据信息分类目的及学科分类原理,制定了实用性、通用性、自然性、科学性、系统性、针对性与动态性的七项原则。在此原则下,对311项数据信息进行分类划分,结果为基本信息56项,医疗信息45项,预防信息33项,保健信息137项,康复信息8项,健康教育信息27项,计划生育技术服务信息5项。根据信息的构成属性,分别确定各项数据信息的编号、标识、类别、描述、类型、来源属性值,从而获得社区卫生信息分类数据集。讨论“自上而下”与“自下向上”的概念模型构建方法,是当前卫生信息标准化研究中的重要方法,本研究将“通过模型确定类目对应数据”与“通过数据来划分类目”结合在一起,实现了两种方法的结合,但全面实现两种方法紧密结合的有效途径仍有待探讨。HL7 RIM将HIS中信息的类型划分为共享信息、管理信息、医疗卫生信息及技术框架信息四类。本研究的数据资料来源于社区卫生信息系统的,以社区卫生保健信息为主,主要部分仍是医疗卫生信息。在社区卫生信息分类研究中,其他类型的数据信息应受到关注。本文研究中针对涉及到的术语约束采取了基于来源一致性原则以确保术语的一致性,并确定了社区卫生信息的二级类目划分来控制信息量的减少,科学合理性仍然有待检验。本文研究对社区卫生信息分类标准研究的推广具有参考价值,在促进社区卫生信息分类工作开展。更多还原

【Abstract】 Community health service (CHS) is the important content and key-process of national town reform on medical and hygiene system, and consisted of national new urban hygiene service system. Presently, those as criteria lack of records’content and format, information collection, disagreement of classification about records’data and information, lied in the usage of the community health information. So, the term and classification criteria research of community health information has got more and more attention increasingly.Purposes☆Searching the way of health information classifying, which combined the modeling method with“up to low”and the method of Business Process Analyzing with“low to up”☆Submitting CHS information classification data set Materials and methodsAdopt the way of stratified random sampling to sample the data in health information systems out of Hunan and Shanghai, as source materials.To draw the theory of conception data model within the thought of Oriented Object Modeling, six items function of CHS were united to classifying. The modeling thought of health information classification didn’t involve the specification of system design, implement and operation, but stressed information expression, logic relations and management, emphasized particularly on information utilizing, not developing. Business Process Analyzing is one link of system analysis during software development. Business processes of CHS were analyzed by utilizing initial data and constructing the business form, which helped to confirm the sort of data.The thinking of combining the modeling thought of“up to low”and business process analysis of“low to up”was tried to meet demands of information classification.The materials of health information standardization study and CHS deliver study were collected by literature review method, and the questionnaire of pilot project about National Health Monitoring System of China study were analyzed by indirect observation and induction analysis methods.ContentsThe contents of research focused on four aspects, as following: I Current situation analysis of health information classification II CHS health information settlingIII CHS health information model and business process analyzing IV CHS health information classifyingResultsLiterature review clewed, at present the holistic research on frame, model and term had already begun to be paid more attention in the world. Domestic health information standardization study was still on studying, consulting, and using external experience for reference.In the study, 1523 items of initial data out of CHS were drawn, involved 23 kinds of business sorts. 311 items were kept after redundancy-eliminating, and classified. Functions of CHS developed mainly according to“six in one”, and basic information and“six in one”contents with medical, prevention, protection, healing, health education and family-planning instruction, were confirmed as the sorts of CHS information classification. CHS business forms constructed by initial data exceeded 70 forms, involved above 20 sorts of business of CHS.Practicability, commonability, nature, science, systematicness, pertinence and dynamics were established as the principles of classifying. Following the principles, combined modeling thought, 311 items of data were classified, which resulted of basic information 56 items, medical 45 items, prevention 33 items, protection 137 items, healing 8 items, health education 27 items and family-planning instruction 5 items. The attribute value of every data, included ID, sign, sort, description, value style and source were ensured, health information classification data set of CHS was submitted.ConclusionThe conception modeling methods with“up to low”and“low to up”were the important method in the health information standardization studies. In this study, the methods of confirming data through modeling and classifying sorts through data analysis were combined. But the way how to realize two methods combined closely in the round, still was awaited the discussion.According to the way of information division out of HIS by HL7, the information styles included four: share information, management information, medical and health information, and technology infrastructure information. In the study, source data was originated from community information system, protection information as the core, and classified according to the function model of CHS, which was regarding medical and health information. But in the research on information classification of CHS, more styles of information should be paid close attention to.At present, it is very obvious that two major aspects of term standardization and data structure standardization were required. Domestic health information standardization was the stage of learning and drawing foreign production. In the study, Effective information classification method in CHS was brought forward, and worth consulting on the research on information classification standard in CHS, helpful to promoting information classification development.更多还原