1、解读新医改方案中的区域卫生信息化需求,概要,新医改要点信息化需求解读区域卫生信息化发展趋势及实现方式浅谈,新医改要点,建设四项基本制度 覆盖城乡居民的基本卫生保健制度 多层次的医疗保障体系 建立国家基本药物制度 建立科学、规范的公立医院管理制度,建设覆盖城乡居民的基本卫生保健制度,由政府组织，向全体居民免费提供公共卫生服务和按成本收费提供基本医疗服务的健康保障制度 以公共卫生机构、农村卫生机构和城市社区卫生机构为服务主体，采用适宜医疗技术和基本药物 由政府承担人员经费和业务经费,信息化需求解读,政府、服务机构面向公众的公共卫生信息服务系统、服务绩效评估系统政府面向服务机构的基本医疗服务信息管理
2、系统、服务监控、质量评估系统政府面向服务机构的补偿支付评估系统政府主导组织的事项运行管理系统服务机构面向公众的信息发布系统、面向相关部门、机构的信息交换系统,建设多层次的医疗保障体系,完善城镇职工基本医疗保险，建立以大病统筹为主的城镇居民医疗保险，发展社会医疗救助，加快推进新型农村合作医疗 实施主体:医院保障机构,信息化需求解读,保障管理机构面向服务机构的费用控制、服务信息管理系统保障管理机构、服务机构面向公众的费用补偿、服务范围信息公示系统服务机构内部费用、服务过程、内容信息与保障机构的信息交换系统,建立国家基本药物制度,政府应该加强对药品生产、采购、配送、使用等环节的监管 保证医疗质量、促
3、进合理用药、减轻患者负担 政府招标组织国家基本药物的生产、采购和配送，并逐步规范同种药品的名称和价格，保证基本用药，严格使用管理，降低药品费用,信息化需求解读,政府面向药品生产、采购、配送、使用等机构监督管理系统 政府面向服务机构的服务质量、合理用药监督管理系统政府主导的生产、销售管理系统政府、服务机构面向公众的信息公示系统服务机构向相关部门的信息交换系统,建立科学、规范的公立医院管理制度,政事分开、管办分开、医药分开、营利性与非营利性分开深化医疗机构管理体制、运行机制、财政经费保障机制改革 推进医疗机构属地化和全行业管理政府财政对医院给予相应经费补贴，并实行药品收支两条线管理，切断药品收入与
4、医院的经济联系 强化公立医院的公共服务职能,信息化需求解读,政府面向服务机构的费用、服务过程、内容、质量、合理性监控管理系统政府面向服务机构的经济运行管理系统（含补偿支付评估系统）服务机构面向公众的信息公示系统服务机构面向相关政府部门的信息交换系统,Regional Health Information Organizations (RHIOs),What is a RHIO? Non-governmental, multi-stakeholder organizationsProvide oversight, coordination, and operational management
5、for health information exchange. Guide day-to-day operations on data access and data protection rules, support EHR implementation, clinical improvement programs, and sustainable financing for health information sharing.Covers a defined and contiguous geographic area,Regional Health Information Organ
6、izations (RHIOs),Why RHIOs?Clinical care is largely shaped by local referral patterns, and public health is organized locally within states, including corresponding surveillance and reporting activities. Reimbursement structures, both through private insurers and Medicaid, reinforce the state and re
7、gional context of health delivery.,State level Regional Health Information Organizations (RHIOs),States have a unique opportunity to either coordinate ongoing regional activities or create the public-private governance and policy and technical framework needed for successful health information excha
8、nge. States can address the policy/legal barriers, consider funding mechanisms, ensure coordination with State level programs i.e., public health/biosurveillance and Medicaid. Governors and organizations representing states (NGA, NCSL, etc) can lead change at a state level.,Health Information Exchan
9、ge Services,Health Information Exchange,Hospital,Data repository,Health Information Exchange,Network applications,Payers,Labs,Outpatient RX& PBMs,Physician office,Ambulatory centers (e.g. imaging),Public health,Services,Hospitals,Physicians,Labs,Publichealth,Payer,Clinical Messaging Medication Recon
10、ciliation Shared EMR Credentialing Eligibility checking,Results delivery Secure document transfer Shared EMR Clinical Decision Support Credentialing Eligibility checking,Clinical Messaging Orders,Needs Assessment Surveillance Reportable conditions Results delivery,Clinical Quality Measurement Claims
11、 Ajudication Secure document transfer,De-identified, longitudinal clinical data,Researchers,Building a Repository,Understand how is data currently captured, stored and shared in your setting.ADT System (Admission/Discharge/Transfer)Other clinical messaging (HL7)Outpatient Registration System (IDX)La
12、b System (LOINC)Pharmacy System (NDC codes)Billing System (ICD9/CPT)Radiology System (RIS, PACS)Emergency Room Registration SystemEnumerate your systems and describe the data input/output functions performed by each one,GET,SEND,Source: 2004 The Markle Foundation Graphic adapted from Tom Benthin ori
13、ginal.,De-IdentifiedData,ReportingRouter,MessageTransfer,FIND,Patient Index,Provider asks if there are records for his/her patient,Index sendslocation ofany records,LOCATOR,Provider asksfor and receives records,Recordsare sent to Provider,TING,Source may push data for reporting,REPOR,DataSources,Pat
14、ients,Providers,Hospitals,DiagnosticServices,Payors,Public HealthProviders,DATA,IndividualCareProviders,Patients,Providers,Hospitals,DiagnosticServices,Payors,Public HealthProviders,PublicHealth,SourceSystems,Raw Recordsare sent,Standardization andInterface Engine,EdgeProxy,Standardized Recordsare s
15、ent,Recordsare sent to Provider,DataSources,Gateway,LOCATOR,TING,REPOR,DATA,InterfaceEngine,Points in the process where the institutional firewall could sit.,Standardizes and filters,Barriers to Health Information Exchange,Organizational RisksPrivacyLegal EnvironmentOrganizational TerritorialismCompeting AgendasManagement CapabilityExecutive SponsorshipTechnology CostsStakeholder Buy-inCost and ROI（Return on Investment ） still hotly debatedhttp:/content.healthaffairs.org/cgi/eletters/hlthaff.w5.10v1#272,谢谢!,
