美卫生部长08圣诞前关于HIT的讲话

张琨

Connecting The Medical Dots

By Mike Leavitt
Monday, December 22, 2008; Page A21
http://www.washingtonpost.com/wp-dyn/content/article/2008/12/21/AR2008122101448.html

Congress is considering adding money for health information technology to January's stimulus package. Doing so could spur a critical mass of the nation's doctors to finally enter the information age, but unless the funds are tied to standards for the interoperability of health IT systems, the expenditure could do more harm than good.
Before lawmakers act, they need to think: If stimulus money supports a proliferation of systems that can't exchange information, we will only be replacing paper-based silos of medical information with more expensive, computer-based silos that are barely more useful. Critical information will remain trapped in proprietary systems, unable to get to where it's needed.
Health IT systems produce value when they are interoperable. When they're not, doctors who invest in electronic health records cannot share information with each other or add lab results to your file or send electronic prescriptions to your pharmacist. They would have to use handwritten prescriptions and paper files in addition to their electronic files.
That's not the way 21st-century health care should work. Today, specialists on a patient's team need to use interoperable systems that share medical records, prescription histories, lab results, imaging and clinical notes. System standards are needed to protect privacy and ensure that content -- such as patients' diagnoses, allergies, medications, lab tests and medical directives -- is standard for every patient, every time.


We're already on the road to a system that is universally accessible and secure. Health information experts, with coordination by the Department of Health and Human Services, have been working on foundational health IT standards and have made substantial progress. Congress has approved our request for higher reimbursement rates for Medicare doctors who e-prescribe. The Institute of Medicine has estimated that more than 1.5 million Americans are injured annually by drug errors. E-prescriptions can greatly reduce that number.
We've also established an independent, voluntary, private-sector certifying body, the Certification Commission for Healthcare Information Technology (CCHIT). This body provides "gold standard" certification that electronic health records meet existing interoperability standards. Any stimulus money for electronic health records should go only to those with CCHIT certification.
Likewise, "infrastructure" investments should go only toward supporting exchanges of electronic health information that are compliant with nationally recognized standards. Indeed, supporting health information exchange would be an infrastructure investment that would accelerate public-private cooperation in standards harmonization and certification.
It is important that standards be vendor-neutral. Government should not be in the business of picking winners and losers.
Despite the urgent need to move beyond paper records, simply offering up funds in the stimulus package will not get the results we want. Instead, it may set our efforts back. Systems will be isolated; data indecipherable; health-care quality unimproved.
If we're going to build a 21st-century health infrastructure, we need to do it strategically, continuing the careful work on harmonized standards that will create one nationwide, interoperable system. That's the only way to make an investment in health IT produce value for providers and patients and improve the quality of health care overall.

mouse

顶下翻译者

nancyguoguo

举个手
完成报名,嘿嘿,争取元旦前交稿,paullee多多指教哦

小城医生

January's stimulus package 指的是美国政府近期提出的一月份财政刺激方案 以挽救当前经济危机的一措施。
Nation's Doctors 还是理解为全国范围内的医生。（ie：The American Podiatric Medical Association (APMA) is a professional organization representing the nation's Doctors of Podiatric Medicine (podiatrists).）
以上都是wiki查的。。

张琨

正解

danelchen

Nation's Doctors 个人觉得是指整体，不像是一个专有名词。可以翻译为全国的所有医生来加强语气。
January's stimulus package 也可以理解成美国的7000亿经济刺激计划，就像外媒老说我们的4万亿的刺激计划。

Health IT systems produce value when they are interoperable.
医疗信息系统只有具有互操作性时才能更加体现它的价值。

They would have to use handwritten prescriptions and paper files in addition to their electronic files.
这样一来，他们不得不在完成电子化资料后仍然保留手写处方和纸质文档。

We're already on the road to a system that is universally accessible and secure.
我们正在逐步实现一个广泛应用并且具有安全保障的系统。

we need to do it strategically, continuing the careful work on harmonized standards that will create one nationwide, interoperable system.
我们需要构建一个和谐的标准时具备战略眼光，并能持续不断的谨慎工作，才能创建一个国家级的、具有互操作性的系统。

lifegame

个人建议把infrastructure翻译成“基础设施”，而不是“体系架构”。“体系架构”一般是对应architecture。

lifegame

呵呵，多谢Paullee指教。不过我还是坚持自己的意见。。

“架构”通常会被理解成一个蓝图，没有人只会为一个蓝图买单（当然，除了咨询业务）。因此，结合上下文个人觉得还是翻译成设施比较好。

“设施”容易被理解为硬件，这个我非常理解，因为在大多数国人的观念中软件没有被放在一个正确的位置。

事实上，在医疗环境中，软件和硬件都属于IT基础设施：个人理解文中的infrastructure指的应该是这个。

毕竟作为部长，他考虑的是整个系统的概念，他并不关心这个系统里面你哪部分用软件还是硬件来实现。

呵呵，小小建议，仅供参考。

小城医生

原帖由 Paullee 于 2008-12-31 01:31 发表

                               
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医生工作站（CPOE）的成功使用率不到15%，...

CPOE为什么翻译是医生工作站而不是电子医嘱通讯系统？

nancyguoguo

个人认为第一段这样翻译比较好：
美国国会考虑在“一月经济激励方案”中加入对卫生信息技术的投资。这样做能够刺激国内医生们尽快摆脱这种（卫生信息化发展的）“临界状态”，最终进行信息时代，但是除非资金的投入能够促进卫生IT系统的互操作标准化的发展，否则这笔费用的作用很有可能是适得其反的。

medsoft

国会正在考虑在一月份的一揽子经济刺激计划中追加医疗卫生信息技术方面的投资，以为这样做将刺激全国的医生自发地大规模地 (critical mass)完全进入信息时代。但是实际上，除非这些资金能够支持卫生IT系统互操作标准的发展，否则花钱的效果可能适得其反。在议员们行动之前，他们需要认真考虑的是：如果刺激计划仅仅是支持那些无法实现信息交换的系统的研发与推广，我们只不过是在用更为昂贵的电脑化的医学信息的“竖井”来替换纸质的“竖井”，这不会更有用处。关键的信息将保留在私有的系统中，不能在需要它的地方获取它。

医疗信息系统只有具有互操作性时才能更加体现它的价值。如果达不到互操作，那些投资于电子病历的医生却无法彼此共享信息、无法增加检验结果到你的文件中，也无法将电子处方送达你的药剂师手中。他们将在除电子文档之外使用手写的处方和纸质文件。这不是21世纪医疗卫生保健的服务方式。今天，为病人服务的团队中专家们需要利用可互操作的系统共享医疗记录、处方史、检验结果、影像和临床记录.这需要系统标准化来保护隐私并确保内容(比如患者诊断、过敏史、用药、检验结果和医疗指导等)对每个病人的每一次都是标准的。

我们正在逐步建立一个广泛应用并且具有安全保障的系统。在国家卫生部的协调下，卫生信息化专家正在制定卫生信息技术的标准并取得了扎实的进步。国会已经批准我们对使用电子处方的医疗保险（Medicare）医生给予更高赔付率的请求。医学研究所（IOM）估计每年超过150万美国人受到药品不良事件的伤害。电子处方可以极大地降低这一数字。

我们已经组建了一个独立的、自愿的、私营的认证机构--医疗信息技术认证委员会（the Certification Commission for Healthcare Information Technology，CCHIT），该机构提供现有电子病历系统满足现有互操作性标准的“金标准”认证。任何有关电子病历的刺激资金应该仅仅提供给那些通过CCHIT认证的系统。

同样，基础设施方面的投资也应该只提供给支持电子信息交换并遵从国家认可标准的项目。事实上，支持卫生信息交换将是促进公有私有部门一道在标准的协调与认证方面合作的一项基础性投资。

当然，重要的是标准应是“对供应商中立”的。政府并不是要评判供应商的优劣。

尽管迫切需要超越纸质记录的阶段，但简单的在经济刺激计划中提供基金并不能达到我们所希望的结果。相反，它可能导致走回头路。系统成“孤岛”，数据不能识别，医疗质量无法提高。

如果我们要向21世纪医疗卫生基础设施挺进，我们需要战略目光，通过标准协调方面持续不断的谨慎工作来建立全国范围的、可互操作的系统。这是使在卫生IT投资对医疗服务提供者与病人都能产生价值并全面改进医疗质量的唯一道路。

[ 本帖最后由 medsoft 于 2009-1-5 09:33 编辑 ]

medsoft

我个人觉得中国在目前情况，政府发挥主导作用，在卫生信息的互操作上加大投入，是很有必要的，因为这部分往往是市场行为所不能发挥作用的，也体现发展中国家在医疗信息化上的后发优势，避免象发达国家所走过的一些弯路。