毕业设计论文学生公寓管理系统外文翻译.doc

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1、本科毕业设计（论文）外文翻译本科毕业设计(论文)外文翻译译文：电子文件麻醉信息管理系统：我们还等什么？埃里克半导体技术天地电子文件麻醉信息管理系统和使用它的原因 对于一些医院管理者和首席执行官员来说，手术室就是一个黑盒。很多的病人都有相同的诊断并且承受了相同的外科治疗过程。但是他们却常常有各种各样的结果和与治疗待遇相关的不同的费用。产生这种差异的原因常常是多种多样的，并没有被完全定义的。现在普遍使用的治疗记录系统缺乏定义和比较外来用户，因此而妨碍了分析。除此之外，当与通货膨胀息息相关的报销持续减少的情况下，一些医疗中心必须在他们实践的时候不管效果的变化保持高度的注意力。一个电子文件麻醉信息管理

2、系统可以在一个报销衰持续减的环境里通过提供对清单用的，手术室用的，材料管理，资源优化使用的重要数据来填补经济上的漏洞。 电子革命进入这个环境。作为一个医学特长，麻醉学常常拥有新的科技，就比如自动化血压袖，侵入性检查，记录生理趋势的监视器。早期的麻醉记录员都能够从监视器中得到数据，麻醉师也可以创建一个电子记录用以取代纸张记录。电子记录的布局和传统的纸张记录的布局十分相似，因此，对于提供样式是对麻醉师十分熟悉的。 在电子文件麻醉信息管理系统的帮助下，除了生理数据之外的其他信息例如治疗时间，医药费用，资源使用，质量担保等数据都能够被记录下来了。许多部门利用这些系统描述他们的经验体会，并且得益于电子数

3、据校对和模拟模型的使用，报道了相应的成本效益。而且，电子系统能够搜索病人的过敏反映或是识别出不适当的麻醉给药以及禁忌。这个系统可以核实这些过程中参与的提供商来作为美国健康护理财政管理的要求。除此之外，这一些系统提供手术前使用的能够存储麻醉历史和生理检查结果的数据登记系统，并且有可能被用于回顾外科手术前的实验室记录和医药历史。 新的电子文件麻醉信息管理系统人体工程学随着电脑技术的先进而日益改善；对比于传统的键盘数据记录方法，条码材料和用触摸屏和鼠标来进行数据记录的方法现在更为常见，而且，语音触发系统也日益地被改良。电子发货系统允许护士直接到药物管理员，而不需要人工地记录这个入口。这个系统在病人需

4、要照顾的时候电子地链接到麻醉设备，然而，其他部门也可以用它们在各种不同的地点进行记录麻醉过程文件。 监视设备通常在一个唯一的和专有的格式下通过它的RS232端口发送数据。新型的监视器附带一个通用标准，现在的电子文件麻醉信息管理系统能够校对和分析数据。许多这样的生理监视器都凭借网络链接到数据的备份拷贝服务器。完全一样的数据拷贝对于手术室的临界任务功能是必须的。美国医学研究所健康记录电子系统指导方针美国药物协会在2003 年发表了一个报道， 关于详细解说智力障碍儿童系统 。提供如下： （1）病人数据的纵向收集，（2）权威性的用户者立刻进入（3）为统一持续地照顾病人提供信息决策。（4）提供有效的卫生

5、保健送交。这个指导方针将智力障碍儿童分成为首要和次要申请。病人护理，管理，财政和行政进程，和 病人自理被作为首要申请，第二申请包括教育，管理，研究，公共健康，以及政策支持. 电子文件麻醉信息管理系统的首要应用应当忽略病人的自主管理，但是除此之外，在其他方面都应当按照以上描述的方针执行。同样的，次要的应用应当也包括教学，规章制度和研究。如果一个电子文件麻醉信息管理系统有更高的作用，那么它应当好好的讨论下它在公共卫生和政策支持上的作用。公共政策和公共卫生都是受提供管理麻醉的方式影响的。对公共卫生很重要的麻醉学的一些方面（例如，当在美国和欧洲的一些国家使用时，如果发生麻醉是受一个内科医生，一个麻醉护

6、士，或者是一个内科医生和一个麻醉护士的组合使用的情况下，是不是应该注意改变使用麻醉的性能）可以分析并使用电子文件麻醉信息管理系统里的数据。除了这些以外，更重要的是麻醉师助手的职责是一直在变化的，而电子文件麻醉信息管理系统很有可能可以精确地对此做出定义。由于电子文件麻醉信息管理系统使用而导致的结果，会使越来越精确的事实记录将会对麻醉护理小组的决策支持变得很需要。 医学研究院建议将时间线用于实行电子医疗记录程序中。一个用于实施完整数据 记录，结果管理，订单输入，同时也可以促进电子通讯，决策支持，病人支持， 行政管理进程，以及人口健康报告管理的电子系统的指导方针，将于2010年实现 。而美国政府也已

7、经在支持这种具有进取性质的时间线。那么它的成功将会成为可能吗？又或者依然只得到一片怀疑的眼光呢？电子文件麻醉信息管理系统的优势 患者的记录是十分重要的，必须在麻醉的过程中小心地记入病历中。麻醉记录是在执行麻醉和在麻醉后重点监护病房、加强监护病房、术后监护的过程中对患者的护理的记录。记录信息是用来提交并呈列病人统一数据，以及检查以前的麻醉过程。最终，在以前的治疗经验和法律保护的帮助下，来促使能够达到实质性地改善治疗方法的目的。电子文件麻醉信息管理系统有很多的优势，它们包括（1）实时地寻找正确的数据；2.从现成的生理学的范围内来警告麻醉提供受体的差别。3.在各种各样的病人数据的交换4。在运行程序的

8、末端产生一种精细的容易理解的数据记录，在某种环境下，这个AIMS系统能够识别错误的和丢失的数据，由此而使效果提高。在麻醉程序人工和自动程序的研究下表明，用AIMS系统使18.7%的麻醉管理中记载了5.7%的治理和不良事件记录的手动操作.额外的AIMS相对于手动记录的优点包括能够提供及时的数据给使用者，错误的检查和备份资料文件的回复，账单的定义和病人护理数据的输入，和所有数据整合到可以搜查的病人数据库，表格一提供AIMS系统的范例功能，此外，AIMS可以克服不能手动输入的和翻译错误的问题。虽然他的频率不能记录下来，但是电子记录系统会一次一次的失败。每个人都必须做好手动输入的准备，如果AIMS系统

9、不能使用的时候。表一.电子文件麻醉信息管理系统的作用1.来自手术室的自动生理数据收集的流程图格式(由Harvey Cushing设计的已确立的格式。大约在1990年。） 2. 功能性的关键任务 3.图表紧急供给 4. 疑问和分析的资料库 5. 电子账单 6. 消费分析 7. 印刷提供论文的复印件 黑色，白色，或者彩色，一或两页纸 。 8. 电子签名(被特有的计量生物学鉴定真实有效的) 9. 安全数据输入,储藏,转换,进入 10. 审计查询 11. 外壳手术和手术说明书 12. 手术说明书（如：中心静脉压,硬脑麻醉,脊椎麻醉） 13.在偏远手术室里使用的能力（如 ：内镜检查术随从，放射学随从，紧

10、急部 ） 14.药用中心和其他系统的一致性（或者良好的分界面。）电子文件麻醉信息管理系统进入医院信息网路的统计医疗管理者必须考虑合成一个AIMS进入一个主体的信息网而作为一种全新的集成系统 ，而不是表面的系统。首先，数据必须从一个地区或者是专门的独立的区域向下一个独立的区域精细的传递，比如说，进行超声心电图之后，该超声心电图就会立即获得，而诊断出该患者是否需要治疗。在任何时刻，类似于麻醉提供者应该能能够提供实验数据，咨询，肺功能试验结果和他的病史。第二，当与维护界面系统相比，用于集成化系统的资源会减少。因为为了保持整 个系统的运行正常，信息管理组会与任务联合起来。否则，每个专用系统将需要 寻求

11、产品技术专家取得帮助。就拥有关键使命功能的高级集成维护管理系统来说 ，需要技术缓助人员24小时可提供服务，而这将会导致工作人员的花费巨大。 第三，如果一个完全集成的医疗制度有一个大型医学信息供应商的支持下，未来的升级和改进，可以合理地得到保证。一些供应商提供的实时数据采集，应结合医院信息系统等方面，但是很多厂商没有。然而，把不懂的厂商的产品用到一个noninte-grated 系统，升级可能不可能或者很困难。例如，手术室设备（例如，一个系统，用以记录和查看无线电研究或食管超声心动图的图形图像）新收购的一块可能只是部分支持一家公司将其监测系统集成。AIMS供应商将创建一个驱动程序来帮助你理解这个

12、装置记录的数据或导入数据。确保及时获得数据是一个问题，但是这些问题都可以通过网络共享数据的范围内解决，这只是一些基础。网络目前都设计有一个千兆的网络带宽，以确保数据的访问不是由他人信息检索损害。超声心动图和其他放射学的研究都可以通过一个单独的网络骨干。在这俩集成平台和接口平台中，一个有AIMS的高带宽网络能使数据不管在哪里传输都不会被中断. 第四，一个完全集成系统提供分析如何适应麻醉和手术的医疗中心的总任务的过程。数据基准能被建立，并能决定成本和所需资源。对医疗保健服务的全过程都可以进行分析，这些数据可以提供给国家元首和政府监管机构或第三方支付者（如保险公司）。然而，麻醉部门往往是害怕和担心这

13、些数据可能被用来引起潜在的惩罚性成果。不过，在今天的高价医疗环境里，如果不能提供这些重要的数据，问题解决方案将最终从管理员和对麻醉过程没有多少知识的首席执行官产生。 6 本科毕业设计（论文）外文翻译原文：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

47、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 supported by a

48、 company for integration into its monitoring system. The AIMS vendor would need to create a driver to help interpret the data recorded by this device or to import data. Ensuring timely access to data can be a concern, but such problems can be solved by sharing data within networks only on an intermittent basis. Networks currently are designed with a gigabit network bandwidth to ensure that data access is not compromised by the retrieval of information by others. Echocardiograph