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本文介绍了中南大学湘雅二医院为适应现代化医院发展要求,对医院病案管理进的大胆改革。旧病案采取缩微的方式,制成缩微胶片,通过“缩微数码扫描/还原机”在计算机上制成电子影像;新出院的病案根据临床需求,通过扫描存储在磁盘上并刻光盘备份。新、旧病案均采用ICD-10编码建立统一的病案首页信息库,成功解决了历史病案的信息化问题,两种方式保管的病案均可利用其电子影像的优势实现网上调阅查询、还原打印。开创了病案信息网络共享的新局面。
This article introduces the Second Xiangya Hospital of Central South University in order to meet the requirements of the development of modern hospitals, hospital management of the case bold reform. The old medical records were microfilmed and made into microfilms. Electronic medical images were made on the computer through a “microfilm scan / restore machine.” The newly discharged medical records were scanned and stored on a disk and then backed up by a compact disc. The new and old medical records all use the ICD-10 code to establish a unified medical record home page database, which successfully solves the problem of informationization of medical records. The medical records kept in both ways can utilize the advantages of electronic imaging to achieve online retrieval and retrieval . Create a new situation of medical record information network sharing.