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In order to carry out the " Healthy China 2030″ initiative, accelerate the cloud-based transformation of hospital information platforms, promote the construction of smart hospitals, and improve hospital informatization service capabilities, a tertiary hospital launched a comprehensive cloud-based practice for hospital operations in November 2020. A high-availability medical cloud platform designed for large general hospitals was built, by renting from carriers the Internet data center, installing highly scalable infrastructure, building multi-loop self-healing fiber-optic private network, applying the cloud-based software architecture using microservices and distributed storage, and implementing distributed systems′ full-link log and performance monitoring. In February 2021, the hospital migrated its medical care and operation management services on the cloud, achieving unified management of multiple hospital campuses, and reducing manpower and capital investment in computer room constructions. This practice ensured the continuity of hospital business, promoted the regional medical cooperation and the sinking of high-quality medical resources, and provided a reference for speeding up the promotion of nationwide hospital business to the cloud.
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Objective:To evaluate the operation of urinary iodine external quality control network in Shaanxi Province in 2020, to know the urinary iodine detection capabilities of iodine deficiency disorders (IDD) laboratories in Shaanxi Province, so as to ensure the technical support for epidemiological surveillance and control of IDD.Methods:In 2020, a total of 118 IDD laboratories in Shaanxi Province participated in the external quality control assessment, and the two concentrations of urinary iodine quality control samples were measured by As 3+-Ce 4+ catalytic spectrophotometry. The testing results of urinary iodine were statistically analyzed with standard value ± uncertainty and Z-ratio scoring methods. Results:All the 118 laboratories participating in the external quality control assessment of urinary iodine in the province had feedback the assessment results. The standard value ± uncertainty method was used for evaluation, the test results of 118 laboratories in the province were all within the uncertainty range, and all were qualified. The Z-ratio scoring method was used for evaluation, there were two county level laboratories with an inter-laboratory |Z| score≥3, and the evaluation results of other laboratories were all qualified, with a qualified rate of 98.31% (116/118). The results of the two evaluation methods were basically consistent.Conclusions:After years of external quality control network operation, the urinary iodine detection capability of laboratories at all levels in Shaanxi Province is stable and reliable, and most laboratories have passed the ability verification. It is suggested that individual laboratory should strengthen internal quality control and improve detection capabilities to lay a solid foundation for monitoring and prevention of IDD.
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General hospitals need Internet hospital information platform for supporting Internet medical services. For comprehensive coordination of the hospital medical service in both online and offline manner, and homogeneity of medical quality management, the authors′ hospital build an online and offline integrated Internet hospital cloud platform. The platform provides system tools for patients, doctors, medical auxiliary departments, financial department and management department. It also connects such third-party service platforms as logistics distribution. The establishment of the integrated Internet hospital cloud platform has expanded the access for patients to see doctors, optimized the diagnosis and treatment methods of doctors, realized the intercommunication of online and offline medical services, completed the unified quality control of online and offline medical services of various departments, and improved the outpatient service capacity and overall operation efficiency of the hospital.
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Internet hospitals play an active role in enabling cross regional flow of high-quality medical resources and improving patients′ medical experience. The authors introduced the establishment and practice of a whole-process medical service system, which is shared by multiple campuses of Tongji Hospital in Wuhan during the COVID-19 outbreak. The hospital made full use of new technologies such as big data, cloud computing and artificial intelligence to accomplish the shift of traditional information management system, electronic medical record system and integrated platform to " cloud" platform, and initially formed an integrated and intelligent Internet medical service mode featuring whole-process medical service for patients in three campuses of the hospital.
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As a designated hospital, Tongji Hospital shoulders the task of diagnosis and treatment of numerous patients of the disease. Based on the medical cloud platform, the hospital has initiated a regional remote diagnosis center; leveraging its IT system, the hospital initiates its epidemic prevention and management mechanism, sets up a self-service system for patients at the fever clinic, launches its online diagnosis and treatment services, and establishes a hospital epidemic supervision platform. By strengthening the informational support needed for epidemic prevention and control, the hospital has enhanced its efficiency of epidemic prevention and control, reducing the risk of cross-infection, and ensuring data security. Its experiences offer references for informationization support for other regions and hospitals in China.
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December 2019 witnessed the outbreak of COVID-19 in Wuhan city. Tongji Hospital, as a designated hospital for treatment of critical patients, shoulders the diagnosis and treatment tasks of numerous critical patients of COVID-19.For the purpose of handling their medical records and effectively preventing the nosocomial infection of the disease, the hospital put in place both the electronic signature system of patients based on a Wechat applet and a paperless medical record total solution based on the data center. These measures overcome the challenges incurred by patients′ signature on paper-based records and medical records archiving during the epidemic. On the other hand, they can not only downsize the paper-based medical records, minimize the risk of infection caused by paper-based medical records via physical contacts, but also effectively save the hospital of its operating costs and improve its efficiency of clinical work.
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December 2019 witnessed the outbreak of COVID-19 in Wuhan city and its rapid spread to other parts of China, and overseas as well. Tongji Hospital, as a designated hospital for treatment of critically ill patients, shoulders the diagnosis and treatment tasks of numerous critically ill patients of such a disease. For the purpose of handling their medical records and effectively preventing the nosocomial infection of the disease, the hospital puts in place both the electronic signature system of patients based on a Wechat applet and a paperless medical record total solution based on the data center. These measures overcome the challenges incurred by patients’ signature on paper-based records and medical records archiving during the epidemic. On the other hand, they can not only downsize the paper-based medical records, minimize the risk of infection caused by paper-based medical records via contacts, but also effectively save the hospital of its operating costs and improve its efficiency of clinical work.
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December of 2019 witnessed the outbreak of new coronavirus pneumonia in Wuhan city and a few localities. As a designated hospital, Tongji Hospital is designated as a hospital for the diagnosis and treatment of numerous patients of such a disease. Based on the medical cloud platform, the hospital has initiated a regional remote diagnosis center; based on its IT system, the hospital to operate its epidemic prevention and management mechanism, set up the self-service system for patients at the fever clinic, launched its online diagnosis and treatment services, and established a hospital epidemic supervision platform. By strengthening the informational support needed for epidemic prevention and control, the hospital has enhanced its efficiency of epidemic prevention and control, reducing the risk of cross-infection, and ensuring data security. Its experiences offer references for informationization support for other regions and hospitals in China.
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Control of the qualifications and behaviors of medical practitioners in branches of a hospital group has become imperative to guarantee medical quality and safety.We have explored a development program of the information platform to meet the needs of unified authorization and closed-loop management of hospital groups,constructed a medical qualifications authorization management and control platform based on private clouds,established a specialized medical qualifications and authorization model,standardized the approval process,and reduced the approval time.At the same time,we work with a human resources management platform,to develop qualifications assessment tools for supervision,for the purposes of dynamic renewal and withdrawal of medical qualifications.We have set up a centralized medical behavior authority database and an authority verification interface,selected key business steps,and readapted the business system for authority verification.These measures can effectively control practitioners' medical behavior and ensure medical safety.
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Objective To analyze the operation situation of urinary iodine,salt iodine and water iodine external quality assessment network of iodine deficiency disorders (IDD) laboratories in Shaanxi Province in 2018,and to ensure the need for IDD surveillance in Shaanxi Province at all levels.Methods In 2018,the provincial,municipal,and county-level IDD laboratories in Shaanxi Province were evaluated for urinary iodine,salt iodine and water iodine external quality control.Among them,1 provincial,10 municipal,and 107 county-level laboratories took part in the testing of urinary iodine assessment;1 provincial,10 municipal and 39 county-level laboratories took part in the testing of salt iodine assessment;and 1 provincial,10 municipal and 83 county-level laboratories took part in the testing of water iodine.The testing results of urinary iodine were statistically analyzed with the |Z| score method (qualified:|Z| ≤2;basically qualified:2 ＜ |Z| ＜ 3;unqualified:|Z| ≥3),salt iodine and water iodine were analyzed with reference value ± uncertainty (the test results were qualified within this range;less than or exceeded was unqualified).Results The |Z| scores of 1 provincial,10 municipal and 107 county-level laboratories for urinary iodine were ＜ 3;the test results of 1 provincial,10 municipal and 39 county-level laboratories for salt iodine,and 1 provincial,10 municipal and 83 county-level laboratories for water iodine were qualified within reference value ± uncertainty range.All the IDD laboratories were passed the external quality control assessment of 2018.Both the feedback rate and qualified rate of the testing results were 100.00％,Conclusion The testing ability of all the laboratories are stable and reliable,it can provide a reliable laboratory quality assurance for surveillance and control of IDD.
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Objective@#To analyze the operation situation of urinary iodine, salt iodine and water iodine external quality assessment network of iodine deficiency disorders(IDD) laboratories in Shaanxi Province in 2018, and to ensure the need for IDD surveillance in Shaanxi Province at all levels.@*Methods@#In 2018, the provincial, municipal, and county-level IDD laboratories in Shaanxi Province were evaluated for urinary iodine, salt iodine and water iodine external quality control. Among them, 1 provincial, 10 municipal, and 107 county-level laboratories took part in the testing of urinary iodine assessment; 1 provincial, 10 municipal and 39 county-level laboratories took part in the testing of salt iodine assessment; and 1 provincial, 10 municipal and 83 county-level laboratories took part in the testing of water iodine. The testing results of urinary iodine were statistically analyzed with the │Z│ score method (qualified: │Z│≤2; basically qualified: 2 <│Z│ < 3; unqualified:│Z│≥3), salt iodine and water iodine were analyzed with reference value ± uncertainty (the test results were qualified within this range; less than or exceeded was unqualified).@*Results@#The │Z│ scores of 1 provincial, 10 municipal and 107 county-level laboratories for urinary iodine were < 3; the test results of 1 provincial, 10 municipal and 39 county-level laboratories for salt iodine, and 1 provincial, 10 municipal and 83 county-level laboratories for water iodine were qualified within reference value ± uncertainty range. All the IDD laboratories were passed the external quality control assessment of 2018. Both the feedback rate and qualified rate of the testing results were 100.00%,@*Conclusion@#The testing ability of all the laboratories are stable and reliable, it can provide a reliable laboratory quality assurance for surveillance and control of IDD.
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Venous thromboembolism ( VTE) is characteristic of high incidence and fatality rate, forming a severe challenge for medical quality management by hospitals and urgently calling for a long-term management mechanism of VTE prevention and treatment. To tackle this problem, the hospital has built a VTE-oriented clinical decision support system, with optimized information platform for the control. The system features automatic scoring of Caprini evaluation model and suggestion of VTE control measures, green ultrasonography channel for VTE high risk patients, and a refined evaluation system. The establishment of an IT control information system has improved VTE awareness and diagnosis level of clinicians. This system can keep track of the risk of VTE occurrence dynamically, significantly improving the number of diagnosed cases and treatment rate, effectively reducing inpatients′ VTE incidence and mortality, and improving quality of care in the end.
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Objective To evaluate the testing ability for water iodine at provincial,municipal and countylevel laboratories in Shaanxi Province in 2017,and to improve their detection levels.Methods One provincial,10 municipal and 66 county laboratories for the first time took part in the evaluation of testing results of water iodine.The evaluation results were statistically evaluated using the Z score method.When ｜Z｜ ≤2,it was qualified;when 2 ＜ ｜Z｜ ＜ 3,it was basically qualified;when ｜Z｜ ≥3,it was unqualified.Results All laboratories passed the external quality control assessment.Both the feedback rate and the qualified rate were 100％ (77/77).The provincial laboratory,7 municipal laboratories,and 42 county-level laboratories all had scores of ｜ Z ｜ ＜ 1,and the test results were qualified.Conclusions The testing ability of laboratories in Shaanxi Province is maintained at a higher level.It is able to provide reliable and strong technical support for the need in sustainable elimination of iodine deficiency disorders.
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Objective To analyze the status of urinary and salt iodine external quality of iodine deficiency disorders (IDD) laboratories in Shaanxi Province,and to evaluate the detection ability and quality level of IDD laboratories in Shaanxi Province at all levels.Methods In 2017,external quality control assessment of laboratories for IDD at the provincial,municipal,and county levels was conducted in Shaanxi Province.There were 1 provincial,10 municipal,and 57 county-level laboratories participated in urinary iodine assessment,and 1 provincial,10 municipal,and 36 county-level laboratories for salt iodine assessment.The testing results of urinary iodine were analyzed with Z score method (qualified:｜Z｜ ≤2;basically qualified:2 ＜ ｜Z｜ ＜ 3;unqualified:｜Z｜ ≥3),salt iodine was analyzed with reference value ± uncertainty (the test results were qualified within this range;less than or exceeded was unqualified).Results One provincial,10 municipal,and 57 county-level laboratories for urinary iodine,and 1 provincial,10 municipal,and 36 county-level laboratories for salt iodine were all passed the external quality control assessment.Both the feedback rate and qualified rate of the testing results were 100.0％.Conclusion The detection ability and quality level of urinary and salt iodine in IDD laboratories in Shaanxi Province are stable and reliable,it can provide a reliable laboratory quality assurance for surveillance and control of IDD.
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Objective To compare selenium content in hair samples of people in Kaschin-Beck disease (KBD) areas and control areas in Shaanxi Province two years after stopping the selenium salt prevention,and to provide a scientific basis for development of targeted prevention measures and for decision-making.Methods In July 2014,the four KBD counties of Yongshou,Yuyang,Linyou and Nanzheng were selected as survey counties,meanwhile,four non KBD counties of Wugong,Mizhi,Qishan and Chenggu were selected as rural control groups and Lianhu District in Xi'an City was selected as a urban settlement control county.Four villages (communities) were selected as monitoring sites according to four directions as east,west,south and north in each county.In each monitoring site,hair samples of 8 children aged 7-12 years old (gender balanced) and 8 adults over the age of 16 (gender balanced) were selected to determine hair selenium.Samples were prepared by wet digestion method,the content of selenium was determined by 2,3-diaminonaphthalene fluorescence method.Results A total of 576 hair samples were collected.The average hair selenium in each monitoring site was more than 0.20 mg/kg.Hair selenium was compared in KBD areas,rural non KBD areas,and urban non KBD areas,the differences were not statistically significant [(0.35 ± 0.18),(0.41 ± 0.28),(0.46 ± 0.19) mg/kg,F =1.544,P ＞ 0.05].In KBD areas and non KBD areas,there were 45 and 45 people with selenium content ＜ 0.20 mg/kg,accounting for 17.58％ and 14.06％;47 and 25 people with selenium content 0.20-＜ 0.25 mg/kg,accounting for 18.36％ and 7.81％;113 and 159 people with 0.25-＜ 0.50 mg/kg,accounting for 44.14％ and 49.69％;51 and 91 people with ≥0.50 mg/kg,accounting for 19.92％ and 28.44％.Hair selenium content of children aged 7-12 and adults was compared in KBD areas,rural non KBD areas,and urban non KBD areas [children:(0.43 ± 0.35),(0.38 ± 0.19),(0.50 ± 0.16) mg/kg;adults:(0.32 ± 0.17),(0.38 ± 0.19),(0.42 ± 0.21) mg/kg],the differences were not statistically significant (F =2.131,1.789,P ＞ 0.05).Hair selenium content was compared in different gender in KBD areas,rural non KBD areas,and urban non KBD areas [male:(0.35 ± 0.18),(0.44 ± 0.33),(0.52 ± 0.15) mg/kg;female:(0.35 ± 0.19),(0.38 ± 0.22),(0.41 ± 0.21) mg/kg],the differences were not statistically significant (F=1.598,1.790,P ＞ 0.05).Conclusion Two years after stopping the selenium salt prevention in Shaanxi Province,the selenium of population in Kashin-Beck disease areas in Shaanxi Province exceeds the human health threshold (0.20 mg/kg),and most people are in the medium or high levels of selenium,and are close to the levels of selenium in non-endemic areas.
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The paper discussed the information platform construction plan of branches Tongji Hospital Group platform, which is designed to achieve homogeneous healthcare and integrated management mode. An information system based on private cloud has achieved a unified service center for patient resources, a clinical sharing service center and an operation sharing service center, for integrated hospital operation and management. Core business systems are integrated and integrated platform has been built, while unified management of public resources and system users′ authorized control have been realized. As a result, the management and control of several hospital campuses have been unified, which can minimize financial risk, reduce human error, improve medical quality and reduce operation costs.
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A functional reporting system for medical safety events is key to medical safety management. Based on a summary of the existing reporting system and a review of domestic and overseas literature, the hospital designed and put in use in the new campus a reporting system. Such a system is IT-based and task driven, covering such areas as medical service, pharmaceutical, equipment, blood transfusion, hospital acquired infection and logistics. Thanks to minimized approval formalities and use of task driven mode, this system can motivate the medical staff to report such events and improved their efficiency in handling them.
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Objective To evaluate the detection capability of water iodine of 74 iodine deficiency disorders (IDD) laboratories in Shaanxi Province,and to ensure the determining quality of water iodine in the national survey in 2017.Methods Totally 11 city-level IDD laboratories and 63 county-level IDD laboratories of centers for disease control (CDC) or endemic prevention and control institutions were selected in 2017.The IDD laboratory measured the mass concentration of high,low water iodine quality-control samples.The capabilities of all laboratories tested were evaluated through standard Z score generated from all the participatory laboratories.Results All 74 laboratories had feedback their testing results.Totally 71 laboratories were considered as qualified,and the qualified rate was 95.95％.Three laboratories were considered as unqualified,and the unqualified rate was 4.05％.Conclusions The results of the quality control have showed that the testing ability of all levels of iodine determination laboratories in Shaanxi Province in 2017 is maintained at a high level.Qualified laboratories in quality control could protect the project of drinking water iodine content survey in Shaanxi Province in 2017.
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Objective To investigate the usage of defluoridation stove and the formation of related behavior in the disease affected areas and the current situation of coal-burning-borne endemic fluorosis,to evaluate the control effect,so as to provide a theoretical basis for superior department to adjust the control strategy in time.Methods According to The Implementation Plan for Prevention and Treatment of Coal-burning-borne Endemic Fluorosis in Shaanxi Province,Ziyang and Langao in Ankang City were chosen for epidemiological survey.Using stratified sampling method,according to the degree of disease situation,each county was divided into 3 layers and then 5％ from each layer was extracted to carry out an investigation,respectively.The number of investigated village was at least 1,up to 30.The number in a non-endemic area was 1-3.Questionnaire survey of all residents was carried out to ask of the changes of cooking and heating fuel;the correct usage of the improved stove;the changes of life behavior related to the corn and pepper for human consumption and the development of prevention and treatment of post management.In endemic areas and in non-endemic areas,according to the Determination of Fluoride in Foods (GB/T 5009.18-2003),fluoride levels of corn (or rice) and chili which collected from 10 families were determined.Meanwhile,the criteria for Diagnosis of Dental Fluorosis (WS/T 208-2011) was used to diagnose dental fluorosis and the criteria of Urine-determination of Fluoride-ion Specific Electrode Method (WS/T 89-1996) was used to evaluate urine fluoride;dental fluorosis of every child aged 8-12 was examined and 10 copies of urine samples were randomly collected in each age group.Housewives and students over the age of 16 in endemic areas were quizzed of the knowledge of health and diagnosed serious skeletal fluorosis according to The Diagnostic Criteria of Endemic Fluorosis (WS 192-2008).Results The rates of correct usage of improved furnace and oven were 91.43％ (3 019/3 302) and 95.72％ (3 578/3 738).The autonomous maintenance rate of stoves was 0.61％ (49/7 998).In endemic areas,the correct drying rate and the correct storage rate of corn and pepper were all 100.0％ (300/300);the washing rate of corn and pepper before eating was 98.3％ (7 863/7 998).The fluoride median contents of corn and pepper was 0.800 and 2.863 mg/kg,respectively.In non-endemic areas,The fluoride median contents of corn and pepper was 0.443 and 4.065 mg/kg,respectively.The awareness rates of health knowledge were 81.27％ in housewives and 90.32％ in students.Dental fluorosis detection rate of 8-12 years old children was 12.52％ (87/695);the fluoride content was between 0.04-7.00 mg/L and the geometric mean value of fluoride content was 0.61 mg/L in endemic areas.There was no new case of serious skeletal fluorosis.Conclusions The prevention effect is obvious.Disease surveillance,health education and management of defluoridation stoves are keys to prevent coal-burning-borne endemic fluorosis.
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Objective:Telemedicine financial operation mechanism was researched to promote long-term operation of the telemedicine in Hubei. Methods: Telemedicine operator was built to manage telemedicine services; the construction costs of the telemedicine system were analyzed to develop service prices; telemedicine services income distribution programs and cost clearing methods were analyzed. Results: The financial operaton models, including the price-setting, income distribution and the cost clearing methods were developed. Conclusion:The reasonable financial operation system ensured the involved parties ’ interests of telemedicine and it could promote long-term development of telemedicine.