Application of Internet of Things Nursing Information System in Xiehe Hospital
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Through the clinical mobile nursing information system, Xiehe Hospital truly incorporates the nursing link into the general hospital system, but the promotion work is not easy. The nurse came to the bed, raised the patient’s wrist, pointed the PDA (PDA) in his hand to the wristband attached to the patient’s arm in advance to scan, downloaded the specific care such as medicine distribution or temperature measurement. After the execution, Use an electronic pen to sign and confirm on the PDA… This is not the future hospital in science fiction, but a common scene that happened in a ward of Peking Union Medical College Hospital where the clinical mobile nursing information system was applied.
Recently, Xiehe Hospital has promoted the clinical mobile nursing information system from the pilot ward to all wards of the hospital. The reporter came to Xiehe for interviews to experience the changes this new information system has brought to clinical care.
Difficulties of HIS system
The general hospital system commonly used in modern digital hospitals is called the HIS (Hospital Information System). Theoretically speaking, this system encompasses all aspects of outpatient consultation, inspection, drug pricing and ward care after patients are admitted to the hospital. “On the surface, this system covers nursing, but the real role in the nursing link is blank,” Feng Xuan said astonishingly. Quantity charges.” Feng is a software engineer in charge of maintaining HIS in the Information Center of Xiehe Hospital.
In order to clarify the significance of the clinical mobile nursing information system, Feng Xuan introduced the life cycle of medical orders to reporters. The doctor prescribes a medical order to the patient and enters it in the HIS system. The system automatically breaks down the medical order and prints it out, and sends it to the nurse’s workstation in the ward. The nurse takes the order and signs a name for each order, and whoever implements it. Just sign. After executing the medical order, sign the name, return the form, and the archives department will collect and seal it. The life cycle of a doctor’s order can be summarized as the four steps of doctor’s order entry, doctor’s order transfer, doctor’s order execution, and doctor’s order sheet recall.
“But in reality, the monitoring of nursing care in the HIS system is to collect money and not to do anything.” Feng Xuan told reporters with a smile. The doctor enters the doctor’s order in the HIS system, and the transfer of the doctor’s order is also automatically completed by the HIS system. However, after this step, the HIS monitoring of the doctor’s order stops. After several divided doctor orders are printed out, they will automatically default to these orders. The medical order has been executed smoothly, and is included in the patient’s expenses on that day, and the execution of the medical order after the medical order is printed out is out of control.
Specifically, the use of the original HIS system to manage the nursing business faces the following deficiencies: First, there is no record of the actual execution status of each medical order in the computer system, that is, the lack of the actual executor and actual execution time of each execution item. This brings difficulties to further medical quality control. For example, in the monitoring of nursing quality, the nursing department is very concerned about when the clinical nurse took medicine or injected the patient during the actual implementation process, and how much difference between the actual implementation time and the time required by the doctor’s order, if the doctor’s order What is the reason for not being executed. If the computer system has the corresponding data, it can truly monitor the quality of nursing, effectively regulate the behavior of nurses, and correct some omissions and errors in time. Another example: the nursing department is also very concerned about the actual workload of clinical nurses. However, because the computer system does not record the executors of each medical order execution item, it is impossible to know exactly which medical orders each nurse has executed, so there is a lack of rewards and penalties for nurses and further deployment of hospital-wide nursing human resources. Objective and accurate basis.
Second, because the existing system charges fees for the decomposed execution items during the transfer stage of the doctor’s order, it does not care whether the patient actually receives the corresponding treatment, which causes some troubles in the pricing of the charges. For example, the doctor’s order for the patient is: “Intravenous infusion of human albumin, once a day”, then the nurse transcribes the order every day (this process is called the generation of doctor’s orders in the computer system) and receives the medicine accordingly. , The computer system automatically collects the money for human albumin (i.e., the cost of medicine). If the patient does not use the drug for some reason, the nurse will return the collected fees to the patient through some means such as refunding the drug, which is very troublesome and prone to errors.
Third, after the doctor’s workstation is used, the doctor’s order is transcribed into the computer by the nurse according to the doctor’s handwritten order, and then it is directly entered by the doctor himself. The doctor only cares about the correctness of the doctor’s order when entering the doctor’s order, and does not care about the cost of treatment and the cost of materials used to execute the doctor’s order. This requires the nurse to make up records and the corresponding materials and treatment fees after the actual execution of the medical order. It is simpler for temporary medical advice, but very troublesome for long-term medical advice. Under this circumstance, the phenomenon of missing fees is more likely to occur.
“The HIS system simply does not track the entire life cycle of the execution of medical orders, but only the first two links. I assume that the latter two links are also implemented smoothly. Therefore, it does not meet the needs of actual nursing work. The whole process of work is incorporated into information monitoring, and we have cooperated with Yuanzhuo Technology to develop a clinical nursing information system.”
Digital care
The HIS system does not fully monitor the medical order life cycle, but it is difficult in reality to directly add the steps of medical order execution and completion confirmation to the HIS system. The poor mobility of the hardware equipment in the HIS system makes the tentacles of the information system unable to extend to the bedside of the patient. Thousands of items are executed every day in each ward, and it is impossible to ask the nurse to go back to the computer at the nurse’s station to confirm every time it does something for the patient (take medicine, injection…).
At present, there are three schemes that are considered more frequently in the world’s digital hospital care system: First, nurses use PDA (Personal Digital Assistance) (non-network mode) to confirm the executed medical order items at the patient’s bedside. The advantage of this scheme is low cost, no need to add additional equipment (except the PDA itself), and easy to carry; the disadvantage is that it cannot track the changes of medical order execution items in real time, and the interface with HIS is more complicated. Second, use wireless Internet access in the ward to connect the PDA to the hospital’s local area network to access the HIS main database in real time. The advantage of this scheme is that it can track the changes of medical order execution items in real time, and the interface with HIS is relatively simple; the disadvantage is that wireless access equipment needs to be set up in each ward, which is currently costly. But setting up a wireless local area network in the ward to solve the mobility problem should be a direction of development. Third, use a portable computer to connect to the hospital’s local area network through the network port at the bedside of the patient, and access the HIS main database in real time. The biggest advantage of this scheme is that it can track the changes of medical order execution items in real time and the interface with HIS is simple (basically no interface is required); the disadvantage is that both the network and the portable computer require a large investment, and it is not convenient to carry.
Considering that there is currently no hospital in China that realizes the bedside collection of patient care information throughout the hospital, only a few hospitals are conducting trials in a few wards, and Xiehe chose the first option. Specifically, the medical order execution project is generated through the original HIS system, and then the medical order execution project is downloaded to the PDA through the USB port of the desktop computer, and then the nurse uses the PDA to the patient’s bedside to record the specific information of the execution. Upload the data back to the main database of HIS through the USB port of the computer.
In the Respiratory Medicine Ward of Union Hospital, the reporter saw two desktop computers in the nurse’s workstation. Different from ordinary desktop computers, its USB extension cord extends to the table, and the other end is connected to a black base. The nurse on duty takes out a PDA from the drawer, plugs it into the base, and enters his account and password. , The download of the medical order execution project started. “Generally, we decide the download amount based on the number of execution items of the doctor’s order,” Feng Xuan explained to reporters, “If there are many items to be executed in the current period, I will only download the doctor’s orders that need to be executed in the next hour. If there are few, for example, On the night shift, I can choose to download all the items that need to be executed in the next six hours in one go. Anyway, there are fewer doctor orders at night.” After a minute, the nurse lady’s doctor order execution form was downloaded, and she followed it. The doctor ordered the medicine to go to the ward. When you come to the patient’s bed, scan the patient’s wristband. The system verifies that the doctor’s order and the person correspond to each other correctly. All the doctor’s orders for the patient during that period are displayed. The nurse takes out the medicines that the patient needs to take and sends them to the patient. . After executing a patient’s medical order, she uses an electronic pen to draw a few strokes on the PDA. After the doctor’s order is executed, she takes the PDA back to the desktop and uploads the doctor’s order. All the executed doctor’s orders are transmitted to the HIS system.
Feng Xuan told reporters that three years ago, Li Baoluo, director of the Information Center, went abroad to investigate and discovered that foreign hospitals were using this system. After coming back, he had been planning to use his own power to make a system with the same effect. Finally, the Information Center of Xiehe Hospital When software creativity came out, Beijing Yuanzhuo Technology carried out software writing. “In addition to buying hundreds of PDAs for this system, we basically didn’t spend money on the other systems,” Feng Xuan said with a smile, “because the software was written in cooperation between our two parties, we gave the intellectual property rights of the software to Yuanzhuo Technology, and they You can profit by selling this solution to other hospitals. Recently I heard that they installed and debugged this system for the 301 Hospital. It is said that they defeated Dell’s solution in the bidding.”
Promotion is a problem
Xiehe Hospital is the first hospital in China to successfully develop a clinical mobile nursing information system, but it is not the most popular hospital for promotion and application. The inpatient department of Xiehe Hospital has a total of more than 70 wards, of which there are about 40 wards in the east area, and only half of these 40 wards have this system deployed, and in the ward where the clinical mobile nursing information system is deployed , And no more than ten have truly incorporated it into the daily workflow.
“Maybe the 301 Hospital system is better than what we promoted.” Feng Xuan believes that it is less difficult for military hospitals to implement information management software, because an order is issued and the order is forbidden. In Xiehe, it is impossible to be as powerful as the military hospital. To implement.
First of all, from the perspective of the patient, there is a process of accepting new things. “As soon as I entered the inpatient department, in addition to receiving the clothes specially worn in the ward, I also received a weird belt, which was tied to my wrist, and I had to pay four yuan. I was unhappy when I was sick. The hospital also charged arbitrarily. ‘, before taking care of me, I scanned me as a commodity in a shopping mall. Of course, I strongly requested not to have this wristband.” This is the first thought of many inpatients when they come into contact with this system. In desperation, many wards can only decide whether to use the information wristband based on the patient’s wishes. Of course, this kind of wristband is very popular in some wards, such as obstetrics and gynecology. Using this wristband can more accurately prevent the newborn from being hugged by mistake.
From the nurse’s perspective, the implementation of this system has not been smooth sailing. Feng Xuan introduced that nurses in different wards also have a process of adapting to new things. In some wards, if there are many young nurses, it is relatively easy to implement. They are easy to learn, and they like the system as soon as they get started. Don’t open it anymore. However, in some wards, nurses are still accustomed to using the way of signing orders. They do not use the new system, and the information center is not easy to force them, so they can only be recommended to use them.
Since the clinical mobile nursing information system can effectively monitor the workload of nurses, the information center plans to cooperate with the personnel department of the hospital in the near future to link this system to the income of nurses. The nurses who work the most in the system will naturally get higher. This can effectively mobilize the enthusiasm of nurses in their daily work. At the same time, once this idea is successful, it will attract all nurses to actively participate in the use of this system. “However, whether it can be achieved, or how to achieve it, has to be carefully considered.” Feng Xuan said.
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