新醫(yī)改方案的信息化需求解讀課件

1、解讀新醫(yī)改方案中的區(qū)域衛(wèi)生信息化需求概要新醫(yī)改要點(diǎn)信息化需求解讀區(qū)域衛(wèi)生信息化發(fā)展趨勢(shì)及實(shí)現(xiàn)方式淺談新醫(yī)改要點(diǎn)建設(shè)四項(xiàng)基本制度 覆蓋城鄉(xiāng)居民的基本衛(wèi)生保健制度 多層次的醫(yī)療保障體系 建立國(guó)家基本藥物制度 建立科學(xué)、規(guī)范的公立醫(yī)院管理制度 建設(shè)覆蓋城鄉(xiāng)居民的基本衛(wèi)生保健制度由政府組織，向全體居民免費(fèi)提供公共衛(wèi)生服務(wù)和按成本收費(fèi)提供基本醫(yī)療服務(wù)的健康保障制度 以公共衛(wèi)生機(jī)構(gòu)、農(nóng)村衛(wèi)生機(jī)構(gòu)和城市社區(qū)衛(wèi)生機(jī)構(gòu)為服務(wù)主體，采用適宜醫(yī)療技術(shù)和基本藥物 由政府承擔(dān)人員經(jīng)費(fèi)和業(yè)務(wù)經(jīng)費(fèi) 信息化需求解讀政府、服務(wù)機(jī)構(gòu)面向公眾的公共衛(wèi)生信息服務(wù)系統(tǒng)、服務(wù)績(jī)效評(píng)估系統(tǒng)政府面向服務(wù)機(jī)構(gòu)的基本醫(yī)療服務(wù)信息管理系統(tǒng)、服務(wù)監(jiān)

2、控、質(zhì)量評(píng)估系統(tǒng)政府面向服務(wù)機(jī)構(gòu)的補(bǔ)償支付評(píng)估系統(tǒng)政府主導(dǎo)組織的事項(xiàng)運(yùn)行管理系統(tǒng)服務(wù)機(jī)構(gòu)面向公眾的信息發(fā)布系統(tǒng)、面向相關(guān)部門、機(jī)構(gòu)的信息交換系統(tǒng)信息化需求解讀保障管理機(jī)構(gòu)面向服務(wù)機(jī)構(gòu)的費(fèi)用控制、服務(wù)信息管理系統(tǒng)保障管理機(jī)構(gòu)、服務(wù)機(jī)構(gòu)面向公眾的費(fèi)用補(bǔ)償、服務(wù)范圍信息公示系統(tǒng)服務(wù)機(jī)構(gòu)內(nèi)部費(fèi)用、服務(wù)過(guò)程、內(nèi)容信息與保障機(jī)構(gòu)的信息交換系統(tǒng)建立國(guó)家基本藥物制度政府應(yīng)該加強(qiáng)對(duì)藥品生產(chǎn)、采購(gòu)、配送、使用等環(huán)節(jié)的監(jiān)管 保證醫(yī)療質(zhì)量、促進(jìn)合理用藥、減輕患者負(fù)擔(dān) 政府招標(biāo)組織國(guó)家基本藥物的生產(chǎn)、采購(gòu)和配送，并逐步規(guī)范同種藥品的名稱和價(jià)格，保證基本用藥，嚴(yán)格使用管理，降低藥品費(fèi)用 建立科學(xué)、規(guī)范的公立醫(yī)院管理制度政

3、事分開(kāi)、管辦分開(kāi)、醫(yī)藥分開(kāi)、營(yíng)利性與非營(yíng)利性分開(kāi)深化醫(yī)療機(jī)構(gòu)管理體制、運(yùn)行機(jī)制、財(cái)政經(jīng)費(fèi)保障機(jī)制改革 推進(jìn)醫(yī)療機(jī)構(gòu)屬地化和全行業(yè)管理政府財(cái)政對(duì)醫(yī)院給予相應(yīng)經(jīng)費(fèi)補(bǔ)貼，并實(shí)行藥品收支兩條線管理，切斷藥品收入與醫(yī)院的經(jīng)濟(jì)聯(lián)系 強(qiáng)化公立醫(yī)院的公共服務(wù)職能 信息化需求解讀政府面向服務(wù)機(jī)構(gòu)的費(fèi)用、服務(wù)過(guò)程、內(nèi)容、質(zhì)量、合理性監(jiān)控管理系統(tǒng)政府面向服務(wù)機(jī)構(gòu)的經(jīng)濟(jì)運(yùn)行管理系統(tǒng)（含補(bǔ)償支付評(píng)估系統(tǒng)）服務(wù)機(jī)構(gòu)面向公眾的信息公示系統(tǒng)服務(wù)機(jī)構(gòu)面向相關(guān)政府部門的信息交換系統(tǒng)Regional Health Information Organizations (RHIOs)What is a RHIO? Non-govern

4、mental, multi-stakeholder organizationsProvide oversight, coordination, and operational management for health information exchange. Guide day-to-day operations on data access and data protection rules, support EHR implementation, clinical improvement programs, and sustainable financing for health in

5、formation sharing.Covers a defined and contiguous geographic area State level Regional Health Information Organizations (RHIOs)States have a unique opportunity to either coordinate ongoing regional activities or create the public-private governance and policy and technical framework needed for succe

6、ssful health information exchange. States can address the policy/legal barriers, consider funding mechanisms, ensure coordination with State level programs i.e., public health/biosurveillance and Medicaid. Governors and organizations representing states (NGA, NCSL, etc) can lead change at a state le

7、vel.Health Information Exchange ServicesHealth Information ExchangeHospitalData repositoryHealth Information ExchangeNetwork applicationsPayersLabsOutpatient RX& PBMsPhysician officeAmbulatory centers (e.g. imaging)Public healthServicesHospitalsPhysiciansLabsPublichealthPayer Clinical Messaging Medi

8、cation Reconciliation Shared EMR Credentialing Eligibility checking Results delivery Secure document transfer Shared EMR Clinical Decision Support Credentialing Eligibility checking Clinical Messaging Orders Needs Assessment Surveillance Reportable conditions Results delivery Clinical Quality Measur

9、ement Claims Ajudication Secure document transfer De-identified, longitudinal clinical dataResearchersNegotiated AccessGETSENDSource: 2004 The Markle Foundation Graphic adapted from Tom Benthin original. De-IdentifiedDataReportingRouterMessageTransferFINDPatient IndexProvider asks if there are recor

10、ds for his/her patientIndex sendslocation ofany recordsLOCATORProvider asksfor and receives recordsRecordsare sent to ProviderTINGSource may push data for reportingREPORSourcesends indexinformationDataSourcesPatientsProvidersHospitalsDiagnosticServicesPayorsPublic HealthProvidersDATAIndividualCarePr

11、ovidersPatientsProvidersHospitalsDiagnosticServicesPayorsPublic HealthProvidersPublicHealthSourceSystemsRaw Recordsare sentStandardization andInterface EngineEdgeProxyStandardized Recordsare sentRecordsare sent to ProviderDataSourcesSource may push data for reportingSourcesends indexinformationGatewayLOCATORTINGREPORDATAInterfaceEnginePoints in the process where the institutional firewall could sit.Standardizes and filtersBarriers to Health Information ExchangeOrganizational RisksPrivacyLegal EnvironmentOrganizational Territorialis