结构化名老中医临床诊疗信息采集系统设计规范

来源 :”数字化中医信息系统“临床术语本体研究专家研讨会 | 被引量 : 0次 | 上传用户:aboutt
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名老中医临床实际的特点是以门诊为主,所诊治病种较多,多以中医病名或症状性表述来指导诊疗.故应立足于临床实际,从利于研究分析的角度,按照"真实、全面保存,多维动态地分析和挖掘名老中医经验规律"的目的要求,设计广泛适用于各位老中医的临床专业病种数据采集系统.为此,我们根据名老中医临床诊治疾病的流程、常涉及的病种及在病历记录中所用的病历要素等,以多种医学词典为支撑,设计了适合老中医临床诊疗信息采集的软件系统,其目的是及时保存可供直接分析的临床诊疗信息数据,随着本系统的不断推广使用,将为临床科研提供大量真实可靠、实时的可分析临床数据,将为中医药临床及科研发挥极大的推动作用。
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