CN117409934A - Clinical medicine diameter management system based on real-time monitoring examination mode - Google Patents
Clinical medicine diameter management system based on real-time monitoring examination mode Download PDFInfo
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Abstract
The invention discloses a clinical medicine path management system based on a real-time monitoring examination mode, and relates to the technical field of medicine management systems. The clinical medicine path management system is embedded into the HIS client, basic data are directly called from the hospital information system and the medical records system, and the clinical medicine path management system is automatically and intelligently prompted or manually selected to be accessed according to the called basic data; according to the characteristics of diagnosis and treatment and operation types of different types of diseases, the method automatically matches a knowledge base or manually configures by doctors to set the standardized medication flow of each disease type or operation type; the real-time monitoring and examining module automatically monitors the continuously updated relevant information of the therapeutic drugs in the medical advice in the HIS system and the physiological and biochemical indexes in the LIS system and the inpatient records in the medical records system. The medicine diameter mode can be dynamically adjusted according to the real-time vital signs of the patient and the resource allocation state of the medical institution, and the knowledge base is regularly corrected according to the specific clinical practice feedback of the patient, so that the clinical medicine diameter execution achieves better effect.
Description
Technical Field
The invention relates to the technical field of medicine management systems, in particular to a clinical medicine diameter management system based on a real-time monitoring examination mode.
Background
The clinical path is a diagnosis and treatment plan formulated for a certain disease or operation, is wide and extensive in terms of drug treatment, comprehensively considers factors such as individual differences of patients, and the like, makes specific specifications on medication time, drug type selection, usage amount, medication course and the like, and sorts out a set of standard flow steps, so that a clinician can clearly know the whole process of using the drug from hospital admission to hospital discharge of the disease and operation. The clinical medicine path is the supplement and cooperation of clinical paths, can be mutually integrated with a clinical path system, and can standardize the medicine treatment scheme in a non-clinical path.
Along with the transition of the pharmaceutical service mode of China, a plurality of defects are exposed in the mode of controlling the total quantity of medicines and the fixed index of the department at the present stage, and the phenomenon that the relevant examination indexes of the pharmacy of part of departments are difficult to reach the standard or rebound occurs after reaching the standard, and certain medicines are unreasonably used repeatedly occurs. Although clinical guidelines, consensus or guidelines related to drug treatment exist at present, a drug scheme aiming at a specific department is lacking, all operation types of the specific department and individual characteristics of patients are difficult to cover, a homogeneous, standardized and scientific clinical medication standard cannot be established, different medication schemes exist among main diagnosis groups and among different doctors in the main diagnosis groups, and unreasonable medication phenomena such as drug selection, usage amount, medication course and the like are common. Therefore, it is highly desirable to establish a long-acting mechanism of fine and reasonable medication management and control by taking a technical standard as a grip and guiding the improvement of clinical medication level as a guide, so as to propose a new mode of making a pharmaceutical technical intervention on a clinical department with reasonable medication evaluation indexes by classifying and preparing different clinical medication treatment paths (abbreviated as clinical medication paths) according to departments and operation categories based on pharmaceutical evidence. Therefore, the invention provides a clinical medicine path management system based on a real-time monitoring examination mode.
Disclosure of Invention
The invention aims to provide a clinical medicine path management system based on a real-time monitoring examination mode so as to solve the technical problems.
The technical aim of the invention is realized by the following technical scheme: the clinical medicine path management system based on the real-time monitoring examination mode is embedded into the HIS client, basic data are directly transferred from the hospital information system and the medical record system, and the clinical medicine path management system is automatically and intelligently prompted or manually selected to be accessed according to the transferred basic data; the clinical medicine path management system sets the standardized medicine using flow of each disease type or operation type through automatic matching knowledge base or manual configuration of doctors according to the characteristics of diagnosis and treatment and operation types of different disease types; recording all used medicines, relevant doctor orders details and variation records into an execution record table, integrating the records into an HIS system through a clinical medicine path management system, and standardizing and intervening the used medicines according to a predefined standard flow; the method comprises the steps of automatically monitoring relevant information of treatment medicines in continuously updated medical advice in an HIS system and physiological and biochemical indexes in an LIS system and hospitalization records in a medical records system through a real-time monitoring and examining module; judging medication rationality according to the related knowledge of the therapeutic drugs constructed by the knowledge base and the preset execution rules in the clinical drug path rule base, automatically matching the composite clinical drug path according to the physiological state change condition of the patient monitored in real time, and automatically recommending an adjustment scheme of the dosage of the therapeutic drugs; meanwhile, the execution mode is customized according to different reasonable medication warning grades, warning information is provided for doctors, or the clinical medication path is directly corrected and interfered.
The invention is further provided with: the clinical medicine path management system is provided with an expert configuration module, a formula-model module, an execution monitoring module, an information synchronization module and a statistical analysis and evaluation module; the expert configuration module sets a standardized medication flow of each disease type or operation type according to the diagnosis and treatment of different disease types and the characteristics of the operation types; the formula-model module comprises medicine dosage formula calculation, model prediction and artificial intelligence, is mainly used for monitoring rationality of a special crowd medicine treatment scheme and the dosage of special medicines, is a supplement to reasonable medicine administration monitoring of medicines outside a clinical medicine treatment path management system, and can comprehensively analyze, predict and evaluate a patient administration scheme, blood concentration trend, prognosis and the like; the execution monitoring module records all the medicine related orders details, execution records and variation records of the patient in the hospitalization period into an execution record table of a clinical medicine path system, the clinical medicine path system integrates information into an HIS system, performs standardization and intervention on medicine use according to a predefined standard flow, and sets an execution mode (such as popup warning, signature confirmation, refusal execution and the like) according to reasonable medicine warning level in a self-defining manner; and when the information synchronization module executes medical orders in the clinical medicine path management system, the information synchronization module inserts the medical order information into the clinical medicine path database and the HIS database, and then extracts data from the intermediate table through a storage process and inserts the data into a table corresponding to the HIS database.
The invention is further provided with: the real-time monitoring and examining module carries out feature code semantic trend processing on medical records converted into a structured XML format document by creating a feature code dictionary and a semantic trend word dictionary so as to realize real-time monitoring of the execution state of clinical medicine paths; the real-time information of the monitoring of the clinical medicine path execution state comprises the characteristic information and the diagnosis and treatment information of the patient, and the characteristic information and the real-time diagnosis and treatment information of the patient are acquired through the HIS system, so that the monitoring and the early warning of the clinical medicine path execution state are carried out.
The invention is further provided with: the characteristic code dictionary comprises disease characteristic codes, operation characteristic codes and conclusion characteristic codes; the disease feature codes are classified and named according to a disease diagnosis coding library ICD-10, and the operation feature codes are classified and named according to operation and operation codes ICD-9CM 3; the conclusion feature codes adopt a statistical method to carry out word segmentation statistics on related medical record documents in the electronic medical record, and the statistical result is imported into a feature code dictionary or manually added in later period.
The invention is further provided with: and obtaining semantic trend words through statistical analysis of feature code modifier words in the medical record document, and importing statistical results into a feature code dictionary.
The invention is further provided with: the method comprises the steps of converting text information content related to clinical medicine paths in a medical record system into a structured XML format document fragment through a pre-established feature code dictionary such as a semantic trend dictionary, searching feature codes in the structured XML format document fragment, calculating semantic trend values of the feature codes, and monitoring the execution condition of the clinical medicine paths in real time according to the feature codes, wherein the monitoring method comprises the following steps of: (1) Pre-establishing a dictionary base { Wn } of feature codes and a semantic trend dictionary { Sm };
(2) Converting medical record document content related to medication decision in the electronic medical record system into a structured XML format document fragment;
(3) Reading a feature code w from a pre-established feature code dictionary { Wn };
(4) Searching the feature code w in the document fragment in the structured XML format, if the feature code w exists, jumping to the step (5) to continue execution, otherwise jumping to the step (8);
(5) Extracting semantic segments where the feature codes w are located, and calculating semantic trend values Vw of the feature codes w according to the semantic trend dictionary { Sm };
(6) If the semantic trend value Vw of the feature code w is 0, jumping to the step (7) to continue execution, otherwise jumping to the step (8);
(7) Carrying out reasonable medication monitoring and early warning according to the feature code w;
(8) And (4) reading the next feature code w from the feature code dictionary { Wn }, jumping to the step (4), and ending if the feature code reading is finished.
The invention is further provided with: and automatically starting and calling a monitoring method when writing or revising the duration of the illness, saving and updating the monitoring feature code result of the patient, and applying the monitoring feature code result to doctor orders and other diagnosis and treatment medication monitoring.
In summary, the invention has the following beneficial effects: the clinical drug path management system and the clinical path system are mutually integrated, and drug treatment schemes in non-clinical paths are standardized. The real-time intelligent clinical medicine path based on the knowledge base and the rule base can dynamically adjust the medicine path mode according to the real-time vital signs of the patient and the resource allocation state of the medical institution, and the rule correction is carried out on the knowledge base according to the specific clinical practice feedback of the patient, so that the clinical medicine path execution achieves better effect, and meanwhile, the comprehensive rationality monitoring is carried out on the therapeutic medicine outside the clinical medicine path. According to dynamic changes of basic parameters of patients fed back by the real-time monitoring and examining module, the rationality of special crowd and special drug application is comprehensively evaluated, and the drug treatment scheme, blood concentration trend and even prognosis of the patients are comprehensively evaluated, so that the rationality monitoring of the treatment drug scheme outside the clinical drug treatment path management system is supplemented.
Drawings
FIG. 1 is a schematic illustration of clinical drug path management of an antibacterial drug during joint surgery according to an embodiment of the present invention.
Detailed Description
The present invention will be described in further detail with reference to fig. 1.
Examples: clinical medication path management system based on real-time monitoring and review mode as shown in fig. 1, the clinical medication path management system links different functional units (called services) of an application program through well-defined interfaces and contracts between the services. The interface is defined in a neutral mode, is independent of a hardware platform, an operating system and a programming language for realizing services, enables services built in various systems to interact in a unified and general mode, effectively solves the problem of information interaction with heterogeneous systems, and enables the system architecture to exchange data with hospital information systems, clinical laboratory information systems, image storage and transmission systems and the like in a hospital through an integrated platform. The CMPMS-RME has an SOA open architecture, and realizes information interaction between the Web Service server and the hospital information system, so that the system can seamlessly exchange and synchronize clinical data with each business system of the hospital.
The whole system architecture adopts a typical three-layer architecture development mode, and is specifically divided into:
(1) A data layer and a data access layer. The system is responsible for storing clinical medicine diameter basic data, including a medicine body database, patient basic information, medicine related doctor's advice information, variant reason records and the like, and acquiring and interacting with business system contents such as an electronic medical record system, a laboratory information management system, an image archiving and communication system and the like through a hospital data integration platform;
(2) Business logic layer. The system is responsible for calling data layer information, processing and realizing system core functions, including clinical medicine path management, real-time monitoring and inspection, follow-up form, short message reminding, query statistics and the like, and basic services such as timing service, log service, security service and the like required by supporting the business processing logic;
(3) The presentation layer. And the system display is responsible for including a management workstation used by a path manager, an execution workstation used by an outpatient service, a scientific research personnel, a query workstation used by the manager and the like.
The clinical medicine path management system is seamlessly embedded into the HIS client, and basic data such as basic information of patients, information of medicine and medical technology items, diagnostic information and the like are directly called from the hospital information system and the medical records system, so that the operation flow of the original system is not affected, and two ways are designed to enter clinical paths:
(1) And automatically and intelligently prompting to enter a clinical medicine path. The system automatically prompts doctors whether to execute the clinical medicine flow procedure open medicine taking medical advice according to the main diagnosis and operation category information of the patients, realizes accurate, quick, visual and convenient input of the medical advice, and synchronously carries out project implementation record. The system is embedded with an automatic matching function, a doctor inputs the primary diagnosis of a patient, and the operation category is only matched with a preset clinical medicine path, and when the doctor opens a therapeutic medicine in the clinical medicine path, the HIS interface automatically prompts the clinician whether to execute the flow of the clinical medicine path.
(2) The clinical medicine diameter button is added on the interface of the doctor workstation for manual selection by a doctor, and the doctor can click to enter the working interface at any time to check and execute the medical advice in the medicine diameter rule according to the categories such as antibacterial medicines, proton pump inhibitors, analgesic medicines and the like in the perioperative period, and the operations are completed in the HIS interface without additionally logging in a system.
The clinical medicine path ontology knowledge base is constructed according to the knowledge elements extracted from the clinical medicine knowledge, and the rule base is a standardized clinical medicine path rule entry summarized by clinical experts according to clinical experience combination guidelines and evidence-based medical evidence. The clinical medicine path centered on the body knowledge base is a path which is dynamically adjusted, can execute a composite path according to the real-time vital signs and clinical biochemical indexes of a patient, and pushes execution results (such as popup warning, signature confirmation, refusal execution and the like) to a doctor end according to the preset reasonable medicine use warning level in a self-definition mode.
The clinical medicine path system expert configuration module sets the standardized medicine flow of each disease type or operation type according to the diagnosis and treatment of different disease types and the characteristics of the operation types, is unified and standard, and reduces the generation of medical errors and unreasonable medicine. Along with the development of evidence-based pharmacy, the customized clinical medicine path in the hospital can be adjusted along with the deep clinical research, so that the system supports the customization and modification of the path and provides expandability for improving and optimizing the path.
The medicine dosage formula calculation module comprises clinically common medicine related calculation formulas such as weight-dose, body surface area-dose, age-dose, creatinine clearance-dose and the like, and according to basic parameters (such as demographic characteristics, physiological and biochemical indexes, blood concentration and the like) of a patient fed back by the real-time monitoring system, a recommended administration scheme of specific medicines (such as medicines with narrow treatment window and prominent adverse reaction) and special groups (such as children, old people, liver and kidney dysfunction patients and the like) which are confirmed by the system is formulated and adjusted; the model prediction module adopts a group pharmacokinetics model (classical pharmacokinetics model, bayes feedback model, PPK model and the like), a regression model and the like to recommend initial dose and administration scheme of a patient, and is mainly used for initial scheme setting, treatment effect, blood concentration prediction and the like of a special patient meeting the model requirements; the artificial intelligence module is a high-level function and is used for predicting the overall treatment scheme of a patient concerned individually, and for patients with pattern recognition meeting the requirements, comprehensive evaluation can be given to the administration scheme, the blood concentration trend and even prognosis of the patient through an artificial intelligence algorithm.
All the medicine related orders, execution records and variation records of the patient in the hospitalization period are recorded into an execution record list of the clinical medicine path system so as to provide related information to the management department of the hospital. The clinical medicine path management system is integrated into the existing HIS system, antibiotics, anticoagulants, analgesic medicines and the like are standardized and intervened according to a predefined standard flow, and once abnormal variation occurs in the clinical medicine path execution condition of a certain patient, the system can send the abnormal variation to corresponding management pharmacist of the pharmacy department in real time according to a reasonable medicine alarm level set in a self-defining mode in advance for checking and confirming, and pushing execution results (such as popup alarm, signature confirmation, refusal of execution and the like) to a doctor end. The manager carries out necessary analysis and intervention on the diagnosis and treatment process of the clinical medicine path through the software system, and particularly carries out relevant medical quality evaluation on the variation adjustment condition except the standard clinical medicine path, thereby realizing continuous improvement and optimization of the path and achieving the aim of improving the medical service quality.
When the medical advice is executed in the clinical medicine path management system, the medical advice information is inserted into the clinical medicine path database on one hand; the other side inserts the medical order information into the HIS database, and then extracts data from the intermediate table through a storage process and inserts the data into a table corresponding to the HIS database, so that real-time synchronization of the electronic version clinical path and the medical order information in the HIS is realized. The problem to be considered in the process of data write-back is to ensure that the clinical medicine path can automatically generate other related data according to the meaning of the data when writing back the data to the formal table, such as automatically generating related charge items according to usage. The related algorithm is defined in the storage process, and when the clinical path writes back data to the formal table, the storage process automatically generates related derivative data according to the algorithm and inserts the derivative data into the HIS database.
The setting of clinical medicine path standard and the generation system of clinical medicine path form provide the setting of clinical medicine path category, admission and overflow condition, standard hospital stay and cost control standard, the definition of time course and the making of medical advice according to time course and time. And simultaneously, the time and revision of standard formulation are recorded, and a complete set of electronic clinical medicine diameter forms is formed on the basis.
The general report for statistical query mainly comprises: the report forms such as the diameter entering rate, the number of patients with variable diameter, the variation rate, the number of patients with finished clinical medicine diameter, the finishing rate, the inquiry statistics of variable medical advice, the compliance rate of medical advice, the inquiry statistics of time limit variation, the compliance rate of time limit, the inquiry statistics of cost overrun, the statistical analysis of various variation reasons and the like.
The evaluation index includes: (1) basic case: diameter rate, path completion rate, average hospital day, average time cost of hospitalization, medicine ratio, consumption ratio, medical insurance fund rejection rate, average hospitalization cost/sum of hospitalization cost of all the patients to be treated, number of patients to be treated, average time cost (average time cost/sum of hospitalization cost of all the patients to be treated, number of patients to be treated), etc.; (2) DRG dimension index: CMI, total weight, cost consumption index, time consumption index, normalized mortality, etc.; (3) review relevant drug metrics: the total amount of medicine for month, the average amount of prescription, the specimen inspection rate, the prevention use rate of the I-type incision antibacterial medicine (less than or equal to 30 percent of national ministry of health), the use intensity of the antibacterial medicine (DDD) (less than or equal to 40DDD of national ministry of health), and the use rate of the antibacterial medicine (less than or equal to 60 percent of national ministry of health).
The real-time monitoring and examining module carries out feature code semantic trend processing on medical records converted into the structured XML format document by creating a feature code dictionary and a semantic trend word dictionary, so as to realize real-time monitoring of the execution state of the clinical medicine path; the real-time information of the monitoring of the clinical medicine path execution state comprises the characteristic information and the diagnosis and treatment information of the patient, and the characteristic information and the real-time diagnosis and treatment information of the patient are acquired through the HIS system, so that the monitoring and the early warning of the clinical medicine path execution state are carried out.
According to basic parameters (such as demographic characteristics, physiological and biochemical indexes, blood concentration and the like) of a patient fed back by the real-time monitoring and examining module, aiming at rationality of a drug treatment scheme of special people (such as children, old people, patients with liver and kidney dysfunction and the like) and usage amount of special drugs (such as high-warning drugs, drugs with narrow treatment window and prominent adverse reaction), a drug treatment scheme is formulated, adjusted and recommended by applying a pharmacokinetics formula, a model and the like, and the drug treatment scheme, blood concentration trend and even prognosis of the patient are comprehensively evaluated, so that the drug treatment scheme and the blood concentration trend are complemented to rationality monitoring of treatment drugs outside a clinical drug treatment path management system.
The real-time information of the monitoring of the execution state of the clinical medicine path can be summarized into two types of special information and diagnosis and treatment information of a patient, wherein the special information of the patient generally exists in the main index information of the patient and the first page information of the medical history of hospitalization, and the medication and treatment information of the patient is stored in a doctor's advice system. The characteristic information of the patient includes gender, age, allergy history, genetic history, drug resistance and the like, and the first course record comprises concise medical history, main symptoms, main physical signs, preliminary diagnosis, diagnosis basis, diagnosis and treatment plan and the like of the patient; the admission records include main complaints, current medical history, past history, personal history, wedding history, family history, physical examination, special cases, auxiliary examination, primary diagnosis, etc. The medical advice information such as the medication information of the patient at this time is generated along with the diagnosis and treatment process of the patient, and the medication medical advice comprises the information such as medication dosage, execution route and the like. The patient information in the medical record is closely related to the real-time monitoring of the execution condition of the clinical medicine path, and meanwhile, the effective extraction and utilization of the information are very important for reasonable medicine use.
The data of two aspects are read from the HIS, namely, basic data is read, and the basic data mainly comprises department information, doctor information, charging item information, disease codes, operation codes, examination categories and the like. The views of the basic data are built in an HIS database, the electronic version clinical path has the function of data synchronization, and the basic data are read from the HIS in a periodical automatic synchronization or manual synchronization mode, so that the basic data in the clinical medicine path system and the HIS are kept consistent. And secondly, reading information of the inpatients. The information of inpatients mainly comprises admission date, discharge date, expense information and the like, and is mainly used for the comparative analysis of inpatient indexes such as inpatient days, inpatient expenses and the like. Likewise, views are built in the HIS database, and task functions synchronized once a day at night are set in the clinical path.
The characteristic code dictionary comprises disease characteristic codes, operation characteristic codes and conclusion characteristic codes; the disease feature codes are classified and named according to a disease diagnosis coding library ICD-10, and the operation feature codes are classified and named according to operation and operation codes ICD-9CM 3; the conclusion feature codes adopt a statistical method to carry out word segmentation statistics on related medical record documents in the electronic medical record, and the statistical result is imported into a feature code dictionary or manually added in later period. And obtaining semantic trend words through statistical analysis of feature code modifier words in the medical record document, and importing statistical results into a feature code dictionary.
The method comprises the steps of converting text information content related to clinical medicine paths in a medical record system into a structured XML format document fragment through a pre-established feature code dictionary such as a semantic trend dictionary, searching feature codes in the structured XML format document fragment, calculating semantic trend values of the feature codes, and monitoring the execution condition of the clinical medicine paths in real time according to the feature codes, wherein the monitoring method comprises the following steps of: (1) Pre-establishing a dictionary base { Wn } of feature codes and a semantic trend dictionary { Sm };
(2) Converting medical record document content related to medication decision in the electronic medical record system into a structured XML format document fragment;
(3) Reading a feature code w from a pre-established feature code dictionary { Wn };
(4) Searching the feature code w in the document fragment in the structured XML format, if the feature code w exists, jumping to the step (5) to continue execution, otherwise jumping to the step (8);
(5) Extracting semantic segments where the feature codes w are located, and calculating semantic trend values Vw of the feature codes w according to the semantic trend dictionary { Sm };
(6) If the semantic trend value Vw of the feature code w is 0, jumping to the step (7) to continue execution, otherwise jumping to the step (8);
(7) Carrying out reasonable medication monitoring and early warning according to the feature code w;
(8) And (4) reading the next feature code w from the feature code dictionary { Wn }, jumping to the step (4), and ending if the feature code reading is finished.
And automatically starting and calling a monitoring method when writing or revising the duration of the illness, saving and updating the monitoring feature code result of the patient, and applying the monitoring feature code result to doctor orders and other diagnosis and treatment medication monitoring.
The clinical medicine path divides the joint surgery into two categories of selective surgery and emergency surgery, the selection of the antibacterial medicine needs to be combined with the operation part of a patient, the pollution degree of wounds, skin test allergy conditions, whether to combine infection and the like for specific analysis, and based on evidence-based medicine, a pharmacist actively communicates feedback information with the clinic to perfect the medicine path, so as to form a medicine path diagram of a clinically accepted perioperative antibacterial medicine administration scheme. The prepared medicine path has the characteristics of sufficient evidence-based evidence, department acceptance, simplicity and intuitiveness, and the executable property of the medicine path is obviously improved. After the medicine diameter is executed, a pharmacy department responsibility pharmacist is responsible for tracking the use condition of antibacterial medicines in the perioperative period of a department, taking all discharge medical records of the department every week to carry out medicine diameter special comment, and eliminating the number of cases of patients who do not go to operation, have been infected before operation and apply antibacterial medicines before operation as the final diameter entering case number. The comment items comprise preoperative use instructions, administration time, medicine selection, usage amount, use course and the like, wherein any item is judged to be incomplete in medicine diameter if being unreasonable, the medicine diameter completion rate of a department is calculated according to the medicine diameter completion condition, specific opinion suggestions are provided for the first time of communication with a clinical department aiming at the problems exposed in the comment, and the medical department gathers and reports the problem medical records weekly according to the comment content of a pharmacist and forms monthly reports monthly.
The present embodiment is only for explanation of the present invention and is not to be construed as limiting the present invention, and modifications to the present embodiment, which may not creatively contribute to the present invention as required by those skilled in the art after reading the present specification, are all protected by patent laws within the scope of claims of the present invention.
Claims (7)
1. Clinical medicine diameter management system based on real-time supervision examination mode, characterized by: the clinical medicine path management system is embedded into the HIS client, basic data are directly called from the hospital information system and the medical records system, and the clinical medicine path management system is automatically and intelligently prompted or manually selected to be accessed according to the called basic data; the clinical medicine path management system sets the standardized medicine using flow of each disease type or operation type through automatic matching knowledge base or manual configuration of doctors according to the characteristics of diagnosis and treatment and operation types of different disease types; recording all used medicines, relevant doctor orders details and variation records into an execution record table, integrating the records into an HIS system through a clinical medicine path management system, and standardizing and intervening the used medicines according to a predefined standard flow; the method comprises the steps of automatically monitoring relevant information of treatment medicines in continuously updated medical advice in an HIS system and physiological and biochemical indexes in an LIS system and hospitalization records in a medical records system through a real-time monitoring and examining module; according to the relevant knowledge of the therapeutic drugs constructed by the knowledge base, judging the rationality of drug administration according to the preset execution rules in the clinical drug path rule base, and automatically matching the compound clinical drug path according to the physiological state change of the patient, providing warning information for doctors or correcting and intervening the clinical drug path.
2. The real-time monitoring review mode-based clinical medication path management system of claim 1, wherein: the clinical medicine path management system is provided with an expert configuration module, a formula-model module, an execution monitoring module, an information synchronization module and a statistical analysis and evaluation module; the expert configuration module sets a standardized medication flow of each disease type or operation type according to the diagnosis and treatment of different disease types and the characteristics of the operation types; the formula-model module comprises medicine dosage formula calculation, model prediction and artificial intelligence, monitors rationality of a special crowd medicine treatment scheme and usage amount of special medicines, supplements reasonable medicine monitoring of medicines outside a clinical medicine treatment path management system, and gives comprehensive analysis, prediction and evaluation to a patient administration scheme, blood concentration trend and prognosis; the execution monitoring module records all medicine related orders details, execution records and variation records of the patient in the hospitalization period into an execution record table of a clinical medicine path system, the clinical medicine path system integrates information into an HIS system, and the medicine use is standardized and interfered according to a predefined standard flow, and the execution mode can be customized according to different reasonable medicine warning grades; and when the information synchronization module executes medical orders in the clinical medicine path management system, the information synchronization module inserts the medical order information into the clinical medicine path database and the HIS database, and then extracts data from the intermediate table through a storage process and inserts the data into a table corresponding to the HIS database.
3. The real-time monitoring review mode-based clinical medication path management system of claim 1, wherein: the real-time monitoring and examining module carries out feature code semantic trend processing on medical records converted into a structured XML format document by creating a feature code dictionary and a semantic trend word dictionary so as to realize real-time monitoring of the execution state of clinical medicine paths; the real-time information of the monitoring of the clinical medicine path execution state comprises the characteristic information and the diagnosis and treatment information of the patient, and the characteristic information and the real-time diagnosis and treatment information of the patient are acquired through the HIS system, so that the monitoring and the early warning of the clinical medicine path execution state are carried out.
4. The real-time monitoring review mode-based clinical medication path management system of claim 3, wherein: the characteristic code dictionary comprises disease characteristic codes, operation characteristic codes and conclusion characteristic codes; the disease feature codes are classified and named according to a disease diagnosis coding library ICD-10, and the operation feature codes are classified and named according to operation and operation codes ICD-9CM 3; the conclusion feature codes adopt a statistical method to carry out word segmentation statistics on related medical record documents in the electronic medical record, and the statistical result is imported into a feature code dictionary or manually added in later period.
5. The real-time monitoring review mode-based clinical medication path management system of claim 3, wherein: and obtaining semantic trend words through statistical analysis of feature code modifier words in the medical record document, and importing statistical results into a feature code dictionary.
6. The real-time monitoring review mode-based clinical medication path management system of claim 1, wherein: the method comprises the steps of converting text information content related to clinical medicine paths in a medical record system into a structured XML format document fragment through a pre-established feature code dictionary and a semantic trend dictionary, searching feature codes in the structured XML format document fragment, calculating semantic trend values of the feature codes, and monitoring the execution condition of the clinical medicine paths in real time according to the feature codes, wherein the monitoring method comprises the following steps of: (1) Pre-establishing a dictionary base { Wn } of feature codes and a semantic trend dictionary { Sm };
(2) Converting medical record document content related to medication decision in the electronic medical record system into a structured XML format document fragment;
(3) Reading a feature code w from a pre-established feature code dictionary { Wn };
(4) Searching the feature code w in the document fragment in the structured XML format, if the feature code w exists, jumping to the step (5) to continue execution, otherwise jumping to the step (8);
(5) Extracting semantic segments where the feature codes w are located, and calculating semantic trend values Vw of the feature codes w according to the semantic trend dictionary { Sm };
(6) If the semantic trend value Vw of the feature code w is 0, jumping to the step (7) to continue execution, otherwise jumping to the step (8);
(7) Carrying out reasonable medication monitoring and early warning according to the feature code w;
(8) And (4) reading the next feature code w from the feature code dictionary { Wn }, jumping to the step (4), and ending if the feature code reading is finished.
7. The real-time monitoring review mode-based clinical medication path management system of claim 6, wherein: and automatically starting and calling a monitoring method when writing or revising the duration of the illness, saving and updating the monitoring feature code result of the patient, and applying the monitoring feature code result to doctor orders and other diagnosis and treatment medication monitoring.
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| CN118155790B (en) * | 2024-05-09 | 2024-08-13 | 山东新时代药业有限公司 | Nursing information sharing method, system and storage medium based on Internet of things |
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