Disease management encourages the effective combination of prevention, treatment and education, guides patients to strengthen self-management, improves living habits, promotes communication and cooperation among doctors, patients and third-party health services, strengthens disease control, prevents disease from worsening, and finally controls overall medical expenses.
Disease management involves the prevention, treatment, nursing, education, management and service of chronic diseases, and requires the full cooperation of doctors, nurses and patients in the treatment process.
In addition to medical treatment, in disease management, medical device/drug manufacturers can give full play to their respective advantages and improve the curative effect and customer satisfaction by providing patients with product knowledge. At the same time, health service providers can be used as a supplement to medical institutions to help patients make personal health management plans, promote self-management and improve the quality of life.
Functions of chronic disease management system
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Community diagnosis and treatment cooperation network
"Two-way referral and resource optimization" is one of the main themes of the ongoing medical system reform. In order to further expand their advantageous business, some large hospitals are trying to cooperate with community health service centers to realize this model. However, most general hospitals still lack an information platform that can share medical records with community hospitals, and cannot realize the interconnection of patients' medical information.
This kind of system generally adopts mature and advanced cross-platform database technology, which can help hospitals to establish a safe and efficient diagnosis and treatment data center. Combined with its own network operation characteristics, large hospitals can quickly establish a chronic disease diagnosis and treatment information network of radiation community health service centers, realize peer-to-peer cooperation among departments, and lay a foundation for realizing regional enjoyment of high-quality medical resources. On this platform, general hospitals and community hospitals can carry out communication, interaction and cooperation in diagnosis and treatment in various ways, so as to facilitate patients with chronic diseases to obtain good medical services and health care guidance nearby and create conditions for hospitals to expand their business and increase their income.
electronic medical record
Long-term systematic medical record management is the basis of disease management. This system completely stores the basic information of patients (life history, allergy history, past history and family history), records of each diagnosis and treatment (symptoms, diagnosis, physical examination results and doctor's prescription) and all examination results (clinical examination, special examination and picture report). Through this system, hospitals can quickly establish lifelong electronic medical records of patients with chronic diseases.
The establishment of electronic medical records does not require a lot of text input and does not increase the working hours of doctors and nurses. In daily diagnosis and treatment, doctors can easily record by selecting the corresponding content through the medical record dictionary. Nurses can also use the patient's waiting time to quickly input various examination results through the centralized input interface.
At the same time, through cooperation with LIS manufacturers, this system can help hospitals to establish an automatic interface for collecting test data, further reducing workload and improving efficiency.
Multi-angle curative effect evaluation
Efficacy evaluation is the core element of disease management, and doctors always pay attention to the treatment of patients. However, in the face of accumulated prescription reports, it is difficult for doctors to judge quickly and evaluate accurately.
Therefore, this kind of system provides a variety of methods from multiple angles, which not only intuitively shows the changes of a series of indicators closely related to treatment by graphic expressions such as icon curves, but also provides comprehensive evaluation means such as cross-correlation between drug dosage and test indicators, long-term and long-term course changes of patients, and helps doctors accurately grasp the curative effect.
Daily management of patients
Patients with chronic diseases often self-test their blood sugar and blood pressure, but generally lack the consciousness of regular recording, which leads to the low utilization rate of these basic data and can not help doctors make effective diagnosis. At the same time, patients not only need to take medicine regularly and quantitatively according to the doctor's prescription, but also need to control their diet, exercise actively, quit smoking and drinking, sleep late and get up late, have irregular life and cooperate with treatment. However, doctors usually can't fully understand the specific situation of patients' implementation of diagnosis and treatment programs.
In order to change this situation, through the special interface of this kind of system, doctors can check the medication diary, self-test results, diet records, exercise diaries, etc. recorded by patients on the health management network, and master the self-management status of patients. Doctors will not only make judgments based on the results of fragmented examination of each visit, but also learn more about the factors affecting treatment from the daily life management of patients and make more targeted diagnosis and treatment plans.
Scientific research data retrieval
Whether it is a research project or a clinical experiment, writing a paper needs to be based on data. In the past, medical records scattered in patients' hands could not help departments to obtain the required data, and it was time-consuming and laborious to turn paper data temporarily collected by crowd tactics into electronic data that could be directly counted, which affected the smooth progress of research work.
Through electronic medical records, departments can systematically collect scientific research data for emergencies. In order to further speed up data analysis, this kind of system also provides powerful data statistics function, which helps doctors to retrieve data quickly and finally generate data files that can be seamlessly connected with statistical software, thus helping medical research.
Personalized patient guidance
Bad living habits such as unreasonable diet and lack of exercise are the main reasons for the sharp increase in patients with chronic diseases and the difficulty in effectively controlling their illness. Guiding patients to cooperate with healthy diet and reasonable exercise is the premise of promoting patients' self-management.
This system helps doctors and nurses to make personalized diagnosis and treatment plans and goals according to patients' individual conditions and diagnosis and treatment needs, so that patients can fully understand the treatment goals, diet and exercise arrangements, precautions, medication methods and taboos. At the same time, the system helps each patient to calculate the ideal weight and body mass index (BMI), calculate the standard calories and print the recommended recipes through the standard calorie analysis function, so as to solve the problem of "how to eat what patients are most concerned about".
Building block patient education
Doctors face a large number of patients every day, and each patient's treatment time is often only a few minutes. On the one hand, it is difficult to write medical records and write prescriptions, on the other hand, it is difficult to have both. However, if patients can't fully understand their symptoms, get enough knowledge, compliance and other issues will directly affect the treatment effect.
In order to solve this contradiction, this system helps doctors and nurses to classify educational content into building blocks and disperse them into various articles and prescriptions. In the daily diagnosis and treatment process, doctors and nurses can explain or print according to the individual situation of patients, so as to complete the important work of patient education in a limited time.