| Background:This study was one of sub-project of study of integrating intervention of elderly cadre health evaluation and early warning, which was funded by central health care committee. The objective of this study is to construct elderly cadre electronic health record . There are four factors support the reason connected with the establishment of elderly cadre EHR: the changing in health care model,the national EHR, the lack in electronic medial record, the development of hospital information system,computer technology and the new health information standard.Objective:To construct standard EHR in order to meet the need of health care service and management for elderly cadre. EHR must provide the systematic, individualized, integrity, standard and real-time data support. The core of EHR are throughout the process of whole life including most risk factors affected people health.Methods:Electronic health record is a complex system, including different sources, different character, different construct and different data. Single indicator can not adequately reflect the health status of individuals, even assess health level and give early alarming. In fact, EHR is a system with multi-dimensionality, multi-indicators, well-structured and wide-covered field.This research was based on literatures review concerned EHR all over the word. Two round survey was implemented in our study, and Kendall'W test was used to test the concordance. The Excel software was used for database of two-round results and SPSS 13.0 software was used for statistic analysis. Date elements of health records was established according to the basic rules of data element. The conceptual date model and logical data model was referred to Canada EHR data model.The character of database was extracted from literature review, the available system and the specialist investigated.The framework of EHR was established as three dimensional construction. With the help of Canada electronic health record solution buleprint, this research discussed the framework of the information platform of EHR, and carried out primary study on turning EHR database for testing the feasibility and stability of the system.Results:1. Information analysis results:(1)According to the result of reviewing literature, available EHR had seventeen categories information and fifty characters, including demographic information, allergic history information, family history informaiton, immunization information, etc. The major chronic diseases of elderly cadre was connected with tumor, Coronary heart disease, diabetes, high blood pressure, etc. There were 48 risk factors confirmed associated with coronary heart disease, including high blood pressure, smoking, diabetes, high blood cholesterol, family history, etc. There were 17 risk factors confirmed associated with high blood pressure, including age, family history, smoking, etc. There were 22 risk factors confirmed associated with diabetes including high blood pressure, family history, obesity, old age, etc.(2) The clinical information in our system included patient records, patient medical records, details of the prescription medication records, medication details of examination and treatment records, etc.(3)The medical information of our system included physical examination information,lab examination information , auxiliary examination information.2. Twenty-seven specialists, doctors, hospital managers, nurses, engineer of IT and statistics participated in expert panel for questionnaire survey. The response rate of two round consultation was near one hundred percentage. The result of Kendall'W test showed that the result of two survey had higher concordance (P<0.05).3. According to the information and record items, the paper established 13 data elements of elderly cadre health records, including basic personal information, out-patient clinics information, hospital medical information, immunization information, infectious disease reporting information, injury information, information on risk factors of health behavior, medical examination information, cancer management information, coronary heart disease management information, diabetes management information and hypertension management information. The description for data element, such as name, definitions, data types, was according to available data element standard.4. The conception data model had five super entities, including participants, roles, events, management, and seventeen entities, including organizational characteristics and personal characteristics, etc. Powerdesigner software was used to construct entity- relationship diagram.5. This research recommended that using three-dimensionality structure to establish the structure of elderly cadre EHR was the best choice. In the three-dimensionality structure, X-axis indicates time which means the whole process of life of people, Y-axis indicates information which focused on charactors involved in the database, and Z-axis indicates action which means the matters of services and intervention.6. On the base of the exiting hospital information system and the cadre medical examination system, the EHR database for elderly cadre was constructed. We also explored data transformation by two methods, i.e. manual records and database replication. Discussion: This study focused on the research of standardization of health records, and conceptual data model and logical data model of EHR for elderly cadre .The results of this study indicated followingconclusions:1. the elderly cadre health records is part of national resident health records project.2. The establishment of health records must be in accordance to the relevant requirements and available common standards since the health records targets will be transferred from "dead records" to "live records" to avoid "information island" based on common criterion.3. The data element is the foundation of elderly cadre health records.4. The health records are the information foundation of the management of health assessment, early warning, intervention, etc.
|
PDF Full Text Request