【作者】 杨艳；

【导师】 叶枫；

【作者基本信息】 浙江工业大学 ， 管理科学与工程， 2009， 硕士

【摘要】 临床决策支持系统的应用可以有效解决临床医生知识的局限性问题、减少人为疏忽、相对降低医疗费用。临床指南的重要性已经得到广泛认可,它的科学性和规范性为临床决策支持系统提供了可靠的知识来源,为医疗质量提供了保障。尽管基于临床指南的临床决策支持系统的价值得到普遍认同,但无论国内外,在临床实际中投入广泛长期应用的系统并不多,归纳起来有两方面的原因:一是知识库的构建不能满足临床医生的需求,二是大多数系统与临床工作流脱节,在技术上没有与电子病历集成,导致系统提供决策支持的方式不符合临床医生的行为习惯,降低了临床医生使用临床决策支持系统的积极性。针对以上这两个问题,本文的主要研究内容为:设计一个从人工到自动化的统一流程构建临床指南知识库,解决知识库构建方法的通用性。分析临床决策支持系统提供决策支持的合理方式和契机,设计本地化映射工具解决临床决策支持系统与异构电子病历的集成。以上述两个问题的解决为基础,设计了基于临床指南的临床决策支持系统的架构方案,通过系统在代谢综合征诊疗中的应用,证明了方案的可行性。最后,在医院的临床科室中,对这一系统的临床应用效果开展评估,并从多个角度分析了评估结果。结果表明,系统的实现符合设计目标,为临床医生尤其是非专科医生、低年资医生提供了决策支持作用,并且有助于提高整体的医疗水平,减少医疗差错,促进医疗服务质量的提高。更多还原

【Abstract】 The implementation of clinical decision support system can effectively break through the clinicians’ limitations of medical knowledge; avoid man-made mistake and cut down medical costs. The importance of clinical guidelines has already been widely recognized, owing to its scientific and normative features which make them to be suitable source of medical knowledge. The value of clinical decision support system based on clinical guideline is widely accepted. However, at home and abroad, most systems can not be applied in daily use too long. The insufficient of knowledge base which system owned can not satisfy clinician’s need explains for one of this reason. The other reason is that most existed systems disengaged the clinicians from the daily work and system can not integrated with electronic medical record system. Thus, the inconvenience brings down clinicians’ enthusiasm of using system.The work of this dissertation includes:1) Design a flow to construct medical knowledge base from manual to automated way.2) Analysis suitable decision support type and time according to clinical workflow. Design a localization mapping tool for clinical decision support system integration to heterogeneous electronic medical record system.After resolve these two problems, design the architecture of clinical decision support system based on clinical guideline. The feasibility of this architecture is proved by its application in the diagnosis and treatment of metabolic syndrome. Finally, this clinical application value of this system is evaluated in some departments of hospital. The results reveal that this system accord with the design aim. The system assists clinicians effectively especially for who are not seasoned, improves their level of diagnosis and treatment, decrease man-made mistake and the quality of medical care is improved finally.更多还原