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目的:进一步提高医院对于病历质量尤其是病历内涵质量的管理水平。方法:以医院信息系统(hospital information system,HIS)的Oracle后台数据库为基础,以Power Builder9.0为前台开发工具开发病历质量核查管理系统。结果:该系统已被成功应用到医院病历质量管理工作当中,并取得了良好的效果。结论:系统为临床医生和病历质量管理部门之间提供了良好的信息沟通平台,提高了医院病历质量管理的整体水平。
Objective: To further improve the hospital for medical records quality, especially medical records connotation quality management level. Methods: Based on the Oracle backstage database of hospital information system (HIS), PowerVIEW9.0 was used as the foreground development tool to develop the medical records quality check management system. Results: The system has been successfully applied to the hospital medical records quality management work, and achieved good results. Conclusion: The system provides a good platform for information communication between clinicians and medical records quality management departments, and improves the overall quality of hospital medical record quality management.