Structured clinical diagnosis term set construction method and system

Abstract

The invention discloses a structured clinical diagnosis term set construction method and system. The method comprises the following steps of constructing a term set hierarchical structure in advance;importing multiple pieces of term set basic information and determining a distribution position of each piece of term set basic information in the term set hierarchical structure; determining a mapping relation between different term set basic information based on the distribution positions of the different term set basic information in the term set hierarchical structure according to a preset matching rule and/or relevance of the term set basic information in the existing clinical diagnosis information; and storing the imported term set basic information according to the respective distribution position in the term set hierarchical structure and the mutual mapping relation. According to the method and the system, the clinical diagnosis of a doctor is facilitated, and a hospital can carryout fine management on the diagnosis information.

Description

technical field [0001] The invention relates to a method and system for constructing a structured clinical diagnosis term set. Background technique [0002] In order to standardize work and follow-up data statistics, clinicians often need to refer to existing standard diagnostic terms or conventional diagnostic terms when giving diagnostic information. In response to this demand, there is no reference method or management method for diagnostic terms specially used by clinicians in the prior art, and some hospitals put the International Classification of Diseases (ICD) into the hospital information system (HIS) to provide used by clinicians. Although the ICD is the most widely used in the world, it was first set up for the classification statistics of the cause of death. Although the statistics of the disease classification were introduced in the sixth revision, its design principle is based on statistics, and clinicians in the actual medical treatment Sometimes it is diffi...

AI Technical Summary

Problems solved by technology

Although the ICD is the most widely used in the world, it was first set up for the classification statistics of the cause of death. Although the statistics of the disease classification were introduced in the sixth revision, its design principle is based on statistics, and clinicians in the actual medical treatment Sometimes it is difficult to find ICD-related diagnostic information at work, and a descriptive diagnosis has to be added to the hospital information system. Different clinicians often have large differences in the descriptive diagnosis of the same disease, which brings certain challenges to hospital management. difficulty

[0003] In recent years, with the requirements of medical reform and in order to strengthen the quality construction of hospitals, the National Health and Family Planning Commission has promulgated the "Guidelines for the Service Ability of Tertiary General Hospitals", "Guidelines for Evaluation of High-Level Hospitals", "Guidelines for Payment of 320 Single Diseases", etc. Relevant documents, the above-mentioned guidelines are formulated by doctors, among which, the types of diseases and the degree of difficulty are defined in detail. According to the requirements of these guidelines, statistics need to be translated into ICD codes, but during the code translation process, it is found that Some of the diseases involved cannot be distinguished by codes, such as "refractory heart failure", "refractory hypertension", "huge pelvic mass resection", etc.

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