畢業(yè)設(shè)計(jì)（論文）學(xué)生公寓管理系統(tǒng)外文翻譯

1、本科畢業(yè)設(shè)計(jì)（論文）外文翻譯本科畢業(yè)設(shè)計(jì)(論文)外文翻譯譯文：電子文件麻醉信息管理系統(tǒng)：我們還等什么？埃里克半導(dǎo)體技術(shù)天地電子文件麻醉信息管理系統(tǒng)和使用它的原因 對(duì)于一些醫(yī)院管理者和首席執(zhí)行官員來(lái)說(shuō)，手術(shù)室就是一個(gè)黑盒。很多的病人都有相同的診斷并且承受了相同的外科治療過(guò)程。但是他們卻常常有各種各樣的結(jié)果和與治療待遇相關(guān)的不同的費(fèi)用。產(chǎn)生這種差異的原因常常是多種多樣的，并沒(méi)有被完全定義的?，F(xiàn)在普遍使用的治療記錄系統(tǒng)缺乏定義和比較外來(lái)用戶(hù)，因此而妨礙了分析。除此之外，當(dāng)與通貨膨脹息息相關(guān)的報(bào)銷(xiāo)持續(xù)減少的情況下，一些醫(yī)療中心必須在他們實(shí)踐的時(shí)候不管效果的變化保持高度的注意力。一個(gè)電子文件麻醉信息管理

2、系統(tǒng)可以在一個(gè)報(bào)銷(xiāo)衰持續(xù)減的環(huán)境里通過(guò)提供對(duì)清單用的，手術(shù)室用的，材料管理，資源優(yōu)化使用的重要數(shù)據(jù)來(lái)填補(bǔ)經(jīng)濟(jì)上的漏洞。 電子革命進(jìn)入這個(gè)環(huán)境。作為一個(gè)醫(yī)學(xué)特長(zhǎng)，麻醉學(xué)常常擁有新的科技，就比如自動(dòng)化血壓袖，侵入性檢查，記錄生理趨勢(shì)的監(jiān)視器。早期的麻醉記錄員都能夠從監(jiān)視器中得到數(shù)據(jù)，麻醉師也可以創(chuàng)建一個(gè)電子記錄用以取代紙張記錄。電子記錄的布局和傳統(tǒng)的紙張記錄的布局十分相似，因此，對(duì)于提供樣式是對(duì)麻醉師十分熟悉的。 在電子文件麻醉信息管理系統(tǒng)的幫助下，除了生理數(shù)據(jù)之外的其他信息例如治療時(shí)間，醫(yī)藥費(fèi)用，資源使用，質(zhì)量擔(dān)保等數(shù)據(jù)都能夠被記錄下來(lái)了。許多部門(mén)利用這些系統(tǒng)描述他們的經(jīng)驗(yàn)體會(huì)，并且得益于電子數(shù)

3、據(jù)校對(duì)和模擬模型的使用，報(bào)道了相應(yīng)的成本效益。而且，電子系統(tǒng)能夠搜索病人的過(guò)敏反映或是識(shí)別出不適當(dāng)?shù)穆樽斫o藥以及禁忌。這個(gè)系統(tǒng)可以核實(shí)這些過(guò)程中參與的提供商來(lái)作為美國(guó)健康護(hù)理財(cái)政管理的要求。除此之外，這一些系統(tǒng)提供手術(shù)前使用的能夠存儲(chǔ)麻醉歷史和生理檢查結(jié)果的數(shù)據(jù)登記系統(tǒng)，并且有可能被用于回顧外科手術(shù)前的實(shí)驗(yàn)室記錄和醫(yī)藥歷史。 新的電子文件麻醉信息管理系統(tǒng)人體工程學(xué)隨著電腦技術(shù)的先進(jìn)而日益改善；對(duì)比于傳統(tǒng)的鍵盤(pán)數(shù)據(jù)記錄方法，條碼材料和用觸摸屏和鼠標(biāo)來(lái)進(jìn)行數(shù)據(jù)記錄的方法現(xiàn)在更為常見(jiàn)，而且，語(yǔ)音觸發(fā)系統(tǒng)也日益地被改良。電子發(fā)貨系統(tǒng)允許護(hù)士直接到藥物管理員，而不需要人工地記錄這個(gè)入口。這個(gè)系統(tǒng)在病人需

4、要照顧的時(shí)候電子地鏈接到麻醉設(shè)備，然而，其他部門(mén)也可以用它們?cè)诟鞣N不同的地點(diǎn)進(jìn)行記錄麻醉過(guò)程文件。 監(jiān)視設(shè)備通常在一個(gè)唯一的和專(zhuān)有的格式下通過(guò)它的rs232端口發(fā)送數(shù)據(jù)。新型的監(jiān)視器附帶一個(gè)通用標(biāo)準(zhǔn)，現(xiàn)在的電子文件麻醉信息管理系統(tǒng)能夠校對(duì)和分析數(shù)據(jù)。許多這樣的生理監(jiān)視器都憑借網(wǎng)絡(luò)鏈接到數(shù)據(jù)的備份拷貝服務(wù)器。完全一樣的數(shù)據(jù)拷貝對(duì)于手術(shù)室的臨界任務(wù)功能是必須的。美國(guó)醫(yī)學(xué)研究所健康記錄電子系統(tǒng)指導(dǎo)方針美國(guó)藥物協(xié)會(huì)在2003 年發(fā)表了一個(gè)報(bào)道， 關(guān)于詳細(xì)解說(shuō)智力障礙兒童系統(tǒng) 。提供如下： （1）病人數(shù)據(jù)的縱向收集，（2）權(quán)威性的用戶(hù)者立刻進(jìn)入（3）為統(tǒng)一持續(xù)地照顧病人提供信息決策。（4）提供有效的衛(wèi)生

5、保健送交。這個(gè)指導(dǎo)方針將智力障礙兒童分成為首要和次要申請(qǐng)。病人護(hù)理，管理，財(cái)政和行政進(jìn)程，和 病人自理被作為首要申請(qǐng)，第二申請(qǐng)包括教育，管理，研究，公共健康，以及政策支持. 電子文件麻醉信息管理系統(tǒng)的首要應(yīng)用應(yīng)當(dāng)忽略病人的自主管理，但是除此之外，在其他方面都應(yīng)當(dāng)按照以上描述的方針執(zhí)行。同樣的，次要的應(yīng)用應(yīng)當(dāng)也包括教學(xué)，規(guī)章制度和研究。如果一個(gè)電子文件麻醉信息管理系統(tǒng)有更高的作用，那么它應(yīng)當(dāng)好好的討論下它在公共衛(wèi)生和政策支持上的作用。公共政策和公共衛(wèi)生都是受提供管理麻醉的方式影響的。對(duì)公共衛(wèi)生很重要的麻醉學(xué)的一些方面（例如，當(dāng)在美國(guó)和歐洲的一些國(guó)家使用時(shí)，如果發(fā)生麻醉是受一個(gè)內(nèi)科醫(yī)生，一個(gè)麻醉護(hù)

6、士，或者是一個(gè)內(nèi)科醫(yī)生和一個(gè)麻醉護(hù)士的組合使用的情況下，是不是應(yīng)該注意改變使用麻醉的性能）可以分析并使用電子文件麻醉信息管理系統(tǒng)里的數(shù)據(jù)。除了這些以外，更重要的是麻醉師助手的職責(zé)是一直在變化的，而電子文件麻醉信息管理系統(tǒng)很有可能可以精確地對(duì)此做出定義。由于電子文件麻醉信息管理系統(tǒng)使用而導(dǎo)致的結(jié)果，會(huì)使越來(lái)越精確的事實(shí)記錄將會(huì)對(duì)麻醉護(hù)理小組的決策支持變得很需要。 醫(yī)學(xué)研究院建議將時(shí)間線(xiàn)用于實(shí)行電子醫(yī)療記錄程序中。一個(gè)用于實(shí)施完整數(shù)據(jù) 記錄，結(jié)果管理，訂單輸入，同時(shí)也可以促進(jìn)電子通訊，決策支持，病人支持， 行政管理進(jìn)程，以及人口健康報(bào)告管理的電子系統(tǒng)的指導(dǎo)方針，將于2010年實(shí)現(xiàn) 。而美國(guó)政府也已

7、經(jīng)在支持這種具有進(jìn)取性質(zhì)的時(shí)間線(xiàn)。那么它的成功將會(huì)成為可能嗎？又或者依然只得到一片懷疑的眼光呢？電子文件麻醉信息管理系統(tǒng)的優(yōu)勢(shì) 患者的記錄是十分重要的，必須在麻醉的過(guò)程中小心地記入病歷中。麻醉記錄是在執(zhí)行麻醉和在麻醉后重點(diǎn)監(jiān)護(hù)病房、加強(qiáng)監(jiān)護(hù)病房、術(shù)后監(jiān)護(hù)的過(guò)程中對(duì)患者的護(hù)理的記錄。記錄信息是用來(lái)提交并呈列病人統(tǒng)一數(shù)據(jù)，以及檢查以前的麻醉過(guò)程。最終，在以前的治療經(jīng)驗(yàn)和法律保護(hù)的幫助下，來(lái)促使能夠達(dá)到實(shí)質(zhì)性地改善治療方法的目的。電子文件麻醉信息管理系統(tǒng)有很多的優(yōu)勢(shì)，它們包括（1）實(shí)時(shí)地尋找正確的數(shù)據(jù)；2.從現(xiàn)成的生理學(xué)的范圍內(nèi)來(lái)警告麻醉提供受體的差別。3.在各種各樣的病人數(shù)據(jù)的交換4。在運(yùn)行程序的

8、末端產(chǎn)生一種精細(xì)的容易理解的數(shù)據(jù)記錄，在某種環(huán)境下，這個(gè)aims系統(tǒng)能夠識(shí)別錯(cuò)誤的和丟失的數(shù)據(jù)，由此而使效果提高。在麻醉程序人工和自動(dòng)程序的研究下表明，用aims系統(tǒng)使18.7%的麻醉管理中記載了5.7%的治理和不良事件記錄的手動(dòng)操作.額外的aims相對(duì)于手動(dòng)記錄的優(yōu)點(diǎn)包括能夠提供及時(shí)的數(shù)據(jù)給使用者，錯(cuò)誤的檢查和備份資料文件的回復(fù)，賬單的定義和病人護(hù)理數(shù)據(jù)的輸入，和所有數(shù)據(jù)整合到可以搜查的病人數(shù)據(jù)庫(kù)，表格一提供aims系統(tǒng)的范例功能，此外，aims可以克服不能手動(dòng)輸入的和翻譯錯(cuò)誤的問(wèn)題。雖然他的頻率不能記錄下來(lái)，但是電子記錄系統(tǒng)會(huì)一次一次的失敗。每個(gè)人都必須做好手動(dòng)輸入的準(zhǔn)備，如果aims系統(tǒng)

9、不能使用的時(shí)候。表一.電子文件麻醉信息管理系統(tǒng)的作用1.來(lái)自手術(shù)室的自動(dòng)生理數(shù)據(jù)收集的流程圖格式(由harvey cushing設(shè)計(jì)的已確立的格式。大約在1990年。） 2. 功能性的關(guān)鍵任務(wù) 3.圖表緊急供給 4. 疑問(wèn)和分析的資料庫(kù) 5. 電子賬單 6. 消費(fèi)分析 7. 印刷提供論文的復(fù)印件 黑色，白色，或者彩色，一或兩頁(yè)紙 。 8. 電子簽名(被特有的計(jì)量生物學(xué)鑒定真實(shí)有效的) 9. 安全數(shù)據(jù)輸入,儲(chǔ)藏,轉(zhuǎn)換,進(jìn)入 10. 審計(jì)查詢(xún) 11. 外殼手術(shù)和手術(shù)說(shuō)明書(shū) 12. 手術(shù)說(shuō)明書(shū)（如：中心靜脈壓,硬腦麻醉,脊椎麻醉） 13.在偏遠(yuǎn)手術(shù)室里使用的能力（如 ：內(nèi)鏡檢查術(shù)隨從，放射學(xué)隨從，緊

10、急部 ） 14.藥用中心和其他系統(tǒng)的一致性（或者良好的分界面。）電子文件麻醉信息管理系統(tǒng)進(jìn)入醫(yī)院信息網(wǎng)路的統(tǒng)計(jì)醫(yī)療管理者必須考慮合成一個(gè)aims進(jìn)入一個(gè)主體的信息網(wǎng)而作為一種全新的集成系統(tǒng) ，而不是表面的系統(tǒng)。首先，數(shù)據(jù)必須從一個(gè)地區(qū)或者是專(zhuān)門(mén)的獨(dú)立的區(qū)域向下一個(gè)獨(dú)立的區(qū)域精細(xì)的傳遞，比如說(shuō)，進(jìn)行超聲心電圖之后，該超聲心電圖就會(huì)立即獲得，而診斷出該患者是否需要治療。在任何時(shí)刻，類(lèi)似于麻醉提供者應(yīng)該能能夠提供實(shí)驗(yàn)數(shù)據(jù)，咨詢(xún)，肺功能試驗(yàn)結(jié)果和他的病史。第二，當(dāng)與維護(hù)界面系統(tǒng)相比，用于集成化系統(tǒng)的資源會(huì)減少。因?yàn)闉榱吮３终?個(gè)系統(tǒng)的運(yùn)行正常，信息管理組會(huì)與任務(wù)聯(lián)合起來(lái)。否則，每個(gè)專(zhuān)用系統(tǒng)將需要 尋求

11、產(chǎn)品技術(shù)專(zhuān)家取得幫助。就擁有關(guān)鍵使命功能的高級(jí)集成維護(hù)管理系統(tǒng)來(lái)說(shuō) ，需要技術(shù)緩助人員24小時(shí)可提供服務(wù)，而這將會(huì)導(dǎo)致工作人員的花費(fèi)巨大。 第三，如果一個(gè)完全集成的醫(yī)療制度有一個(gè)大型醫(yī)學(xué)信息供應(yīng)商的支持下，未來(lái)的升級(jí)和改進(jìn)，可以合理地得到保證。一些供應(yīng)商提供的實(shí)時(shí)數(shù)據(jù)采集，應(yīng)結(jié)合醫(yī)院信息系統(tǒng)等方面，但是很多廠(chǎng)商沒(méi)有。然而，把不懂的廠(chǎng)商的產(chǎn)品用到一個(gè)noninte-grated 系統(tǒng)，升級(jí)可能不可能或者很困難。例如，手術(shù)室設(shè)備（例如，一個(gè)系統(tǒng)，用以記錄和查看無(wú)線(xiàn)電研究或食管超聲心動(dòng)圖的圖形圖像）新收購(gòu)的一塊可能只是部分支持一家公司將其監(jiān)測(cè)系統(tǒng)集成。aims供應(yīng)商將創(chuàng)建一個(gè)驅(qū)動(dòng)程序來(lái)幫助你理解這個(gè)

12、裝置記錄的數(shù)據(jù)或?qū)霐?shù)據(jù)。確保及時(shí)獲得數(shù)據(jù)是一個(gè)問(wèn)題，但是這些問(wèn)題都可以通過(guò)網(wǎng)絡(luò)共享數(shù)據(jù)的范圍內(nèi)解決，這只是一些基礎(chǔ)。網(wǎng)絡(luò)目前都設(shè)計(jì)有一個(gè)千兆的網(wǎng)絡(luò)帶寬，以確保數(shù)據(jù)的訪(fǎng)問(wèn)不是由他人信息檢索損害。超聲心動(dòng)圖和其他放射學(xué)的研究都可以通過(guò)一個(gè)單獨(dú)的網(wǎng)絡(luò)骨干。在這倆集成平臺(tái)和接口平臺(tái)中，一個(gè)有aims的高帶寬網(wǎng)絡(luò)能使數(shù)據(jù)不管在哪里傳輸都不會(huì)被中斷. 第四，一個(gè)完全集成系統(tǒng)提供分析如何適應(yīng)麻醉和手術(shù)的醫(yī)療中心的總?cè)蝿?wù)的過(guò)程。數(shù)據(jù)基準(zhǔn)能被建立，并能決定成本和所需資源。對(duì)醫(yī)療保健服務(wù)的全過(guò)程都可以進(jìn)行分析，這些數(shù)據(jù)可以提供給國(guó)家元首和政府監(jiān)管機(jī)構(gòu)或第三方支付者（如保險(xiǎn)公司）。然而，麻醉部門(mén)往往是害怕和擔(dān)心這

13、些數(shù)據(jù)可能被用來(lái)引起潛在的懲罰性成果。不過(guò)，在今天的高價(jià)醫(yī)療環(huán)境里，如果不能提供這些重要的數(shù)據(jù)，問(wèn)題解決方案將最終從管理員和對(duì)麻醉過(guò)程沒(méi)有多少知識(shí)的首席執(zhí)行官產(chǎn)生。 7 本科畢業(yè)設(shè)計(jì)（論文）外文翻譯原文：the anesthesia information management system for electronicdocumentation: what are we waiting for?eric laims and reasons for its use for many hospital administrators and chief executive officers, th

14、e operating room is a black box. patients may have common diagnoses and undergo common surgical procedures, but they often have diverse outcomes and different costs associated with their care. the reasons for the disparity are often multifaceted and not well defined. the current medical records syst

15、em lacks the ability to define and compare outliers, thereby hindering analysis. furthermore, many medical centers must maintain the high level of care in their practices without effecting change (operating at fixed costs), while reimbursement continually decreases relative to inflation (capitated m

16、arkets). an aims potentially can bridge this economic gap by providing critical data useful for scheduling, operating room use, material management, and improved use of resources in a declining reimbursement environment. the electronic revolution enters this environment. as a medical specialty, anes

17、thesia has always embraced new technologies, such as the automated blood pressure cuff, invasive monitoring, and monitors that record physiologic trends. early anesthesia record-keepers were able to obtain data from monitors, and anesthesiologists were able to create an electronic record instead of

18、a paper record. the layout of the electronic record was similar to that of the customary paper record,thereby providing a format that was familiar to the anesthesiologist. with an aims, in addition to physiologic data, other information such as surgical time, cost of medication, resources used, and

19、quality assurance data can be recorded. many departments have described their experiences with these systems and reported the corresponding cost-efficiencies that resulted from electronic data collation and the use of a simulation model. moreover, electronic systems can search for patient allergies

20、or identify improper drug dosages or contraindications. the system can verify provider attendance during procedures, as required by the health care financing administration in the united states. in addition, some systems (institutionally or commercially developed) offer a preoperative data entry sys

21、tem that can store anesthetic histories and physical examination findings, and may be used to review preoperative laboratory data and medical histories. the ergonomics of newer aims have improved as computer technology has advanced; in contrast to the traditional keyboard method of data entry, barco

22、ded materials and data entry with a touch screen or mouse are now available, and voice-activated systems are being refined. electronic delivery systems allow the caregiver to administer medication without manually documenting the entry. these systems are electronically linked to the anesthesia equip

23、ment at the point of care, but departments can also use them to document anesthesia procedures in various locations . monitoring equipment typically sends data in a unique and proprietary format through its rs232 ports. newer monitors adhere to a common standard (e.g., universal serial bus usb), and

24、 todays aims can collate and analyze data. many of these physiologic monitors are linked via a network (e.g., local area network or intranet) to servers that retain backup copies of the data. duplicate copies of data are required for the mission-critical function of the operating room. the united st

25、ates institute of medicine guidelines for an electronic health record system the institute of medicine in the united states issued a report in 2003 that detailed the key capabilities of an emr system . it should provide: (1) longitudinal collection of patient data; (2) immediate access by authorized

26、 users; (3) information to aid in decision-making throughout the continuum of patient care; and (4) support for efficient healthcare delivery. the guidelines further divided the emr into primary and secondary applications . patient care, management, support processes, financial and administrative pr

27、ocesses, and patient self-management are considered primary applications. secondary applications include education, regulation, research, public health, and policy support. primary application of an aims would omit patient self-management, but otherwise would comply with the guidelines described abo

28、ve. similarly, secondary applications would also include education, regulation, and research. if an aims had a greater role, one could argue favorably about its role in public health and policy support. both public policy and public health are affected by the issue of what types of providers adminis

29、ter anesthesia. aspects of anesthesiology that are important to public health (for example, whether changes in the quality of care occur when anesthesia is administered by a physician, a nurse anesthetist, or a physician and nurse anesthetist as a team, as performed in the united states and some eur

30、opean countries) can be analyzed using data from an aims. furthermore, the role of the anesthesiologist assistant is evolving, and an aims may help define it. the increased accuracy in documentation that would result from the use of an aims will be necessary to determine policy support of an anesthe

31、sia care team. the institute of medicine has recommended time lines for the implementation of electronic medical record keeping. guidelines for implementing an electronic system to record health data, results management, and order entry, as well as improve electronic communication, decision support,

32、 patient support, administrative processes, and population health management reporting, are slated for completion by the year 2010. the united states government has also supported an aggressive time line. will this happen? or will skeptics still rule the playing field ?advantages of an aims the pati

33、ent record is extremely important and must be carefully chronicled with every anesthetic procedure. the anesthetic record is used for patient care during anesthesia administration and in the post anesthesia care unit (pacu), the intensive care unit (icu), and the postsurgical ward. the recorded info

34、rmation is used for billing, tabulating patient statistics, and reviewing previous anesthetic procedures. finally, advances in quality improvement methods assist in peer review and legal defense. there are many advantages of an aims, including (1) capturing data in real time; (2) alerting the anesth

35、esia provider of deviations from preset physiologic limits; (3) communicating with various patient databases; and (4) generating an accurate, understandable record at the end of the procedure. in certain instances, the emr has enabled the identification of missing or incorrect data and thereby led t

36、o quality improvement. a study of manual and automated documentation during anesthesia procedures showed that, with an aims, 18.7% of anesthesia administrations had recorded adverse events versus 5.7% of administrations documented manually. additional advantages of emrs over manual records include i

37、mmediate and simultaneous data access for authorized users, error checking, recovery of files from backup sources, definitions of billing and patient care for database entry, and integration of records into a searchable patient database . table 1 provides example functions of an aims. moreover, an a

38、ims can overcome problems with illegible handwriting and transcription errors. nevertheless, electronic record-keeping systems do fail from time to time, although that frequency is not documented. everyone must be prepared to document manually if the aims is unavailable.table 1. functions of an anes

39、thesia information management system1.automated collection of physiologic data from the operating room in flowsheet format (a time-honored format designed by harvey cushing, circa 1900s)2.mission-critical functionality3.emergency provisions for charting4.database for queries and analysis5.electronic

40、 billing6.cost analysis7.ability to print hard copies (black and white or color; 1- or 2-sided pages)8.electronic signature (e.g., authentication by biometric characteristic or password)9.secure data entry, storage, transfer, and access 10.audit trails11.preoperative and postoperative documentation1

41、2.procedure documentation (e.g., central venous pressure, epidural anesthesia, spinal anesthesia, regional block anesthesia)13.ability to use in remote areas distant from the operating room (e.g., endoscopy suite, radiology suite, emergency department)14.full integration with other systems in the me

42、dical center (or well interfaced)total integration of an aims into the hospital information network hospital administrators must consider merging an aims into the main body of the information network as a totally integrated system instead of an interfaced system. first, data should have seamless pas

43、sage from one area or specialty to another. for example, after echocardiography is performed in the cardiology suite images should be instantly accessible by the anesthesia provider evaluating the patient for surgery. similarly the anesthesia provider should be able to access laboratory data, consul

44、tations, pulmonary function test results and patient history at any time. second, the resources required to support an integrated system are reduced when compared with maintaining an interfaced system because the information management team can be centralized with the mission to keep the whole syste

45、m functioning. otherwise, each proprietary system would require product-specific technology specialists for service. for aimss, which have a mission-critical function, the technical support staf would need to be available on a 24-h basis, resulting in high personnel costs. third, if a fully integrat

46、ed medical system is supported by a large medical informatics vendor, future upgrades and improvements can reasonably be assured. some vendors offer real-time data acquisition that can be integrated with other aspects of the hospital information system, but many vendors do not. however, if products from multiple vendors are used in a noninte-grated system, upgrades may be dif cult or impossible. for example, a newly acquired piece of operating room equipment (e.g., a system to record and view radio-graphic studies or transesophageal echocardiography images) may be only partially suppo