Medical record deconstruction and recombination method and device, electronic equipment and medium

Abstract

The invention discloses a medical record deconstruction and recombination method and device, electronic equipment and a medium, the method and device are applied to the electronic equipment, and specifically, illness state information is obtained, the illness state information comprises at least one piece of symptom description information, and each piece of symptom description information comprises multiple levels of description content categories; performing deconstruction processing on the symptom description information to obtain standard symptom elements corresponding to the symptom description information; and recombining the standard symptom elements to obtain a standard medical record. Through the operation, the original illness state information can be converted into the standard medical record with a relatively fixed format, so that the reliability of remote transmission of the medical information is improved, a user can conveniently process the medical record, the diagnosis efficiency of a doctor and the working efficiency of the user of the medical record are remarkably improved, and the user experience is improved. Therefore, medical service institutions can better meet the surging social demands of the aging era.

Description

Technical Field

[0001] The present application relates to the technical field of medical equipment, and more specifically, to a method, device, electronic device and medium for deconstructing and reconstructing medical records. Background Art

[0002] With the advancement and popularization of hospital informatization, electronic medical records, as the main recording method for doctors, carry the development of patients' conditions and the complete process of doctors' diagnosis and treatment of patients, and form a large number of medical records. Since the condition information generally comes from the natural language description of patients or other people, and then is compiled and recorded by doctors, researchers and other relevant personnel to form medical records, and given the limitations and flexibility of the meaning expressed by natural language, as well as the differences in the recording habits of recorders, the information carried in the current medical records lacks a relatively unified and standard format, making it difficult for doctors, medical institutions and other related institutions to efficiently process and use the huge amount of health data that has been deposited in medical records, which in turn makes it difficult for medical practitioners to fully enjoy the work efficiency improvement brought by the informatization of the core medical field, and hinders the in-depth promotion of informatization application technologies in the medical industry, such as data interconnection, big data description, and simulation research and development of new drugs. Summary of the invention

[0003] In view of this, the present application provides a method, device, electronic device and medium for deconstructing and reconstructing medical records, which are used to deconstruct and reconstruct original medical condition information, so that the informatization of the core medical field can provide convenience for users to process medical records more conveniently, improve consultation efficiency, and provide a basis for the standard formatting of medical information.

[0004] In order to achieve the above objectives, the proposed solution is as follows:

[0005] A method for deconstructing and reconstructing medical records, applied to electronic devices, comprises the following steps:

[0006] Acquire disease information, wherein the disease information includes at least one symptom description information, and each symptom description information includes multiple levels of description content categories;

[0007] Deconstructing the symptom description information to obtain standard symptom elements corresponding to the symptom description information;

[0008] The standard symptom elements are reorganized to obtain a standard medical record.

[0009] Optionally, the method of obtaining the medical condition information is an on-site acquisition method and a remote acquisition method.

[0010] Optionally, when the method for acquiring the medical condition information is a remote acquisition method, the medical condition information is acquired based on remote consultation rules.

[0011] Optionally, the remote consultation rules include at least an initial mandatory rule.

[0012] Optionally, obtaining the condition information includes:

[0013] Acquiring the medical condition information based on a conventional initial diagnosis portal;

[0014] Obtain the medical condition information based on a simple initial diagnosis portal;

[0015] Obtain the medical condition information based on the real follow-up visit entrance;

[0016] Or, the medical condition information is obtained based on a pseudo follow-up visit entrance.

[0017] A medical record deconstruction and reconstruction device, applied to electronic equipment, comprising:

[0018] An information acquisition module is configured to acquire condition information, wherein the condition information includes at least one symptom description information, and each symptom description information includes multiple levels of description content categories;

[0019] A deconstruction processing module is configured to deconstruct the symptom description information to obtain a standard symptom element corresponding to the symptom description information;

[0020] The reorganization processing module is configured to reorganize the standard symptom elements to obtain a standard medical record.

[0021] Optionally, the method of obtaining the medical condition information is an on-site acquisition method and a remote acquisition method.

[0022] Optionally, when the method for acquiring the medical condition information is a remote acquisition method, the medical condition information is acquired based on remote consultation rules.

[0023] Optionally, the remote consultation rules include at least an initial mandatory rule.

[0024] Optionally, the information acquisition module includes:

[0025] A first acquisition unit is configured to acquire the condition information based on a conventional initial diagnosis entrance;

[0026] A second acquisition unit is configured to acquire the condition information based on a simple initial diagnosis entrance;

[0027] A third acquisition unit is configured to acquire the condition information based on the real follow-up visit entrance;

[0028] The fourth acquisition unit is configured to acquire the condition information based on the pseudo follow-up visit entrance.

[0029] An electronic device comprises at least one processor and a memory connected to the processor, wherein:

[0030] The memory is used to store computer programs or instructions;

[0031] The processor is used to execute the computer program or instruction so that the electronic device implements the medical record deconstruction and reconstruction method as described above.

[0032] A medium is applied to an electronic device, the medium carries one or more computer programs, and the one or more computer programs can be executed by the electronic device, so that the electronic device can implement the medical record deconstruction and reconstruction method as described above.

[0033] It can be seen from the above technical solutions that the present application discloses a method, device, electronic device and medium for deconstructing and reconstructing medical records. The method and device are applied to electronic devices, specifically to obtain medical condition information, the medical condition information includes at least one symptom description information, each symptom description information includes multiple levels of description content categories; deconstruct the symptom description information to obtain standard symptom elements corresponding to the symptom description information; reconstruct the standard symptom elements to obtain a standard medical record. Through the above operations, the original medical condition information can be converted into a standard medical record with a relatively fixed format, thereby improving the reliability of remote transmission of medical information, facilitating users to handle medical records, thereby significantly improving the doctor's consultation efficiency and the work efficiency of medical record users, and enabling medical service institutions to better meet the surging social needs in the aging era. BRIEF DESCRIPTION OF THE DRAWINGS

[0034] In order to more clearly illustrate the embodiments of the present application or the technical solutions in the prior art, the drawings required for use in the embodiments or the description of the prior art will be briefly introduced below. Obviously, the drawings described below are only some embodiments of the present application. For ordinary technicians in this field, other drawings can be obtained based on these drawings without paying creative work.

[0035] Figure 1 A flowchart of a method for deconstructing and reconstructing medical records according to an embodiment of the present application;

[0036] Figure 2 This is a schematic diagram of the operation of superimposing the main and auxiliary symptom rules and the first and second time point rules in the embodiment of the present application;

[0037] Figure 3 This is an example diagram of symptom grouping in an embodiment of the present application;

[0038] Figure 4 A schematic diagram of a path for obtaining condition information according to an embodiment of the present application;

[0039] Figure 5 A block diagram of a medical record deconstruction and reconstruction device according to an embodiment of the present application;

[0040] Figure 6 A block diagram of an electronic device according to an embodiment of the present application. DETAILED DESCRIPTION

[0041] The following will be combined with the drawings in the embodiments of the present application to clearly and completely describe the technical solutions in the embodiments of the present application. Obviously, the described embodiments are only part of the embodiments of the present application, not all of the embodiments. Based on the embodiments in the present application, all other embodiments obtained by ordinary technicians in this field without creative work are within the scope of protection of this application.

[0042] Medical records are personal medical information carried on certain carriers, such as paper carriers and electronic carriers. With the development of informatization, electronic carriers are now generally used as an important recording means. They are used to record patients' medical conditions, diagnosis and treatment information, etc. They are not only an important basis for personal medical care, but also important legal information. They are also an important basis for personal medical care or health care, so that doctors can make correct diagnoses and treatments. To this end, this application provides the following technical solutions to enable the invention purpose of this application to be achieved based on electronic devices.

[0043] Figure 1 This is a flow chart of a method for deconstructing and reconstructing medical records according to an embodiment of the present application.

[0044] like Figure 1 As shown, the medical record deconstruction and reconstruction method provided in this embodiment is applied to an electronic device, and is used to obtain a standard medical record based on the patient's information, quickly provide a new record to the user with the standard medical record, and facilitate the user to quickly modify it, thereby improving the efficiency of diagnosis and treatment. The deconstruction and reconstruction method includes the following contents:

[0045] S1. Obtain medical information.

[0046] The condition information here includes at least one symptom description information, and each symptom description information includes multiple levels of description content categories. The condition record is a record of the condition information, a description of the patient's onset and current condition, and is the core content of the medical record. Due to the ever-changing conditions and the individual level and habits of the recorder, the actual content of the condition record is diverse, and it is the most non-standardized part of the medical record.

[0047] The sources of medical information include on-site acquisition by doctors or recorders during face-to-face consultations, and also include information input by patients when communicating with doctors, recorders or systems remotely, that is, medical information obtained through remote acquisition.

[0048] Generally, one symptom description information corresponds to one symptom, and multiple symptom descriptions constitute a disease description. Recording all symptom descriptions along a certain timeline constitutes the above-mentioned disease record.

[0049] S2. Deconstruct the medical condition information.

[0050] By deconstructing the disease information, we can obtain the standard symptom elements corresponding to the symptom description information. When deconstructing a single symptom description information, given that the information includes multiple levels of description content categories, the symptom description information is classified into two levels. The first-level categories include time records, frequency, single, nature, and factors. The second-level categories are further subdivided from the first-level categories. Generally speaking, due to the characteristics of symptom description information, there may be default items in the major and minor categories.

[0051] Time records are marks that lead individual symptom data on the timeline, allowing data collected from different channels to be arranged in order on the timeline. Each symptom has multiple recording time points, but the data sources of each time point are different. In addition to data collected from the patient side, medical users can also add time points to enter data.

[0052] Frequency is a record of the frequency of the symptoms. All symptoms can be divided into three types according to the frequency of the symptoms, including regular frequency, count frequency and empty frequency.

[0053] In the symptoms of conventional frequency, the frequency category includes two subcategories: frequency frequency and frequency duration. Frequency frequency refers to the content describing the density of symptom attacks, and frequency duration refers to the length of time each symptom attack lasts; they are used together to describe relatively frequent attacks.

[0054] For example: Abdominal pain occurs about twice a day, and each attack lasts 10-15 minutes. In the text, "abdominal pain" is the symptom, "attack frequency about 2 times a day" is the frequency, and "each attack lasts 10-15 minutes" is the duration. The whole sentence is the description of the symptom in the frequency category.

[0055] Within the symptoms of the count type frequency, the frequency category contains a frequency count subcategory; it is used to describe attacks that cannot be too frequent, such as diarrhea and vomiting blood. For example: Vomiting blood twice. In the text, "vomiting blood" is the symptom, and "twice" is the frequency count. The whole sentence is the description of the symptom in the frequency category.

[0056] In the symptoms of empty-item frequency, the frequency content is empty; it is used for symptoms that do not need to record the frequency of onset, such as significant obesity, jaundice, and high blood pressure. Symptoms such as abnormal laboratory tests such as high blood pressure are all suitable for empty-item frequency.

[0057] Single is a characteristic record of a person's overall experience of physical discomfort in the symptom content, which does not change over time. The single category contains two secondary subcategories, namely, acute onset and single characteristics. A single symptom does not necessarily have both subcategories, and there can be a default subcategory.

[0058] The acuteness of onset is used to describe the overall acuteness or chronicity of the onset of symptoms, which helps to judge the progression of the disease and subsequent treatment. For example: fever, a sudden rise in body temperature, reaching the highest level within 12 hours. In the text, "fever" is the symptom, and "a sudden rise in body temperature, reaching the highest level within 12 hours" is the acuteness of onset.

[0059] Single-time features are some important unique properties of symptoms. They do not change over time like properties, but their records are very meaningful for doctors to identify the cause of the symptoms. For example: acid reflux often occurs more than 1 hour after a meal. In this article, "acid reflux" is a symptom, and "more than 1 hour after a meal" is a single-time feature. It is very meaningful to determine the location of the lesion that causes acid reflux.

[0060] The nature is a record of a person's specific feelings about physical discomfort in the symptom content, which can change over time. The nature category contains five secondary subcategories, namely, quality level, location, description, attachments, and consequences. A single symptom does not necessarily have all five subcategories, and there can be a default subcategory.

[0061] The severity of a symptom is described in terms of its severity. For example, "The abdominal pain is mild." In this article, "abdominal pain" is the symptom, and "mild" is the severity of the symptom.

[0062] Qualitative location is used to describe the location of the symptom. For example: Abdominal pain is located in the right lower abdomen. In this article, "abdominal pain" is the symptom, and "located in the right lower abdomen" is the qualitative location.

[0063] Qualitative descriptions are used to describe the subjective feeling that a symptom brings to a patient. For example: The abdominal pain is a burning pain. In the text, "abdominal pain" is the symptom, and "burning pain" is a qualitative description.

[0064] Qualitative attributes are used to describe the state of discharge caused by symptoms. For example: diarrhea, the stool is unformed and loose. In the text, "diarrhea" is the symptom, and "the stool is unformed and loose" is the qualitative attribute.

[0065] The qualitative consequence is used to describe whether some other conditions are caused after the onset of symptoms, which is very helpful in assessing the extent of damage caused by the symptoms. For example: diarrhea and no urine for nearly 24 hours. In this article, "diarrhea" is the symptom, and "no urine for nearly 24 hours" is the qualitative consequence. The 24-hour no urine period indicates that dehydration has occurred and urgent fluid therapy is needed.

[0066] Factors are records of the effects of various subjective and objective facts on symptoms in the symptom content. The factor category contains four secondary subcategories, including inducing factors, aggravating factors, alleviating factors, and special factors. A single symptom does not necessarily have all four subcategories, and there may be a default subcategory.

[0067] Precipitating factors are used to describe what happened before the onset of the disease, which may be related to the symptoms. For example: Overeating before abdominal pain. In this article, "abdominal pain" is the symptom, and "overeating" is the precipitating factor.

[0068] Aggravating factors are used to describe situations that make symptoms worse. For example: Lying on the left side can make pain worse. In this article, "lying on the left side can make pain worse" is an aggravating factor.

[0069] Relieving factors are used to describe situations that make symptoms less severe. For example, lying on the left side can make the pain less severe. In this article, "lying on the left side can make the pain less severe" is a relieving factor.

[0070] Special factors are used to record special circumstances related to symptoms that cannot be attributed to the above three factors. For example: Abdominal pain often occurs when hungry. In this article, "abdominal pain" is a symptom, and "often occurs when hungry" is a special factor. It records the time rhythm of abdominal pain onset, which is very meaningful for diagnosis.

[0071] S3. Reorganize the standard symptom elements to obtain a standard medical record.

[0072] After the above standard symptom elements are obtained through deconstruction, they are reorganized to obtain a standard medical record that is easy for users to read. Three modules, namely, a question module, an option module and a terminology module, are set in each secondary subcategory of each symptom.

[0073] The question module shows the content that needs to be asked in this secondary category. Since it is directly facing the patient, the language used in the questions should be as close to life as possible to facilitate the patient to correctly understand the content that needs to be asked.

[0074] In the option module, common symptoms are broken down into fixed items and options so that patients can enter them as quickly as possible, and the symptom content is further standardized. At the same time, the "other" option is set to collect symptoms that have not yet been standardized, so that the disease is not missed and the data foundation is prepared for subsequent system maintenance and upgrades.

[0075] The option module includes single-choice and multiple-choice items, including both simple selection items and items that require additional content to be filled in after selection.

[0076] The terminology module is a professional recording language for medical practitioners. The terms correspond to the items in the options one by one. The terminology entry language needs to be standardized as much as possible, like small building blocks, to make a medical record language that can be used directly, and then spliced, combined and output according to preset rules to form the medical record content required by medical practitioners.

[0077] The one-to-one correspondence process from the option module to the terminology module is called translation, which refers to the process of translating the language that is easy for patients to understand into the medical language used in medical records. The translation operation realizes the conversion of data from the acquisition end to the output end.

[0078] The splicing rules for the medical records at a single time point in this application are as follows:

[0079] After collecting data on a single symptom, the terms obtained by translating all the secondary sub-categories under the symptom at a certain point in time are spliced ​​and reorganized in a certain order to obtain the medical record of the symptom at that point in time.

[0080] The splicing rules for output records of a single symptom at a single time point are as follows:

[0081] Time record, frequency count. Acuteness of onset, quality grade, location, description, single characteristics. Attachments. Consequences. Frequency, duration. Special factors, inducing factors, aggravating factors, alleviating factors. Example: The patient developed abdominal pain on January 10. Chronic onset, mild abdominal pain, located in the upper abdomen, dull pain. Frequency of attacks is 2 times / day, each lasting 10-15 minutes. Overeating before abdominal pain, left side lying can aggravate the pain, bending over can relieve the pain. This text is a complete medical record language description of the "abdominal pain" symptom at the time point of "January 10".

[0082] Arrange multiple symptoms in sequence at a single time point to obtain the disease record at that time point. Order rule: main symptoms come first, auxiliary symptoms come later; auxiliary symptoms are arranged according to the time of onset, with the earlier symptoms coming first.

[0083] For example: The patient developed abdominal pain on January 10. Chronic onset, mild abdominal pain, located in the upper abdomen, dull pain. The frequency of attacks is 2 times / day, each lasting 10-15 minutes. Overeating before abdominal pain, lying on the left side can aggravate the pain, bending over can relieve the pain. Nausea occurred on January 20. The nausea is severe and occurs more than 1 hour after a meal. Diarrhea occurred on January 23, with a frequency of 4 times / day. Acute onset, each bowel movement is large, and the stool is unformed and loose, with pus. Diarrhea has been absent for nearly 24 hours.

[0084] The above text is a complete medical record language description of the three symptoms of "abdominal pain, nausea and diarrhea" at the first time point. The first time point allows different symptoms to have different first time records.

[0085] Explanation of the default items in the secondary subcategories within the symptoms in the embodiments. It can be seen from the embodiments that in the record of abdominal pain symptoms, there is no single feature, nature attachment, and nature consequence content, which belongs to the case of a default secondary subcategory. This is because in the standardization process of abdominal pain symptoms, there are temporarily no single features, nature attachments, and nature consequences. For example, vomitus is an attachment to vomiting symptoms, and vomitus exists because of vomiting. Therefore, when vomitus is asked in the vomiting symptoms, there will be two items: nature attachment and nature consequence. However, there is no attachment for abdominal pain, so there is no corresponding subcategory setting. There is currently no common content for abdominal pain that needs to be attributed to a single feature, so there is currently no such subcategory; but it cannot be ruled out that it may appear in the future. Secondary subcategories are allowed to be defaulted within symptoms.

[0086] It can be seen from the above technical solution that this embodiment provides a method for deconstructing and reconstructing medical records, which is applied to electronic devices, specifically to obtain medical condition information, the medical condition information includes at least one symptom description information, each symptom description information includes a multi-level description content category; deconstruct the symptom description information to obtain a standard symptom element corresponding to the symptom description information; reconstruct the standard symptom element to obtain a standard medical record. Through the above operation, the original medical condition information can be converted into a standard medical record with a relatively fixed format, thereby improving the reliability of remote transmission of medical information, facilitating users to handle medical records, thereby significantly improving the doctor's consultation efficiency and the work efficiency of medical record users, and enabling medical service institutions to better meet the surging social needs in the aging era.

[0087] It can be seen from the above embodiments that the present invention can obtain medical condition information by remote acquisition. When the patient's condition is remotely consulted using Internet technology, each of the patient's symptoms is deconstructed according to the above classification and solidified items, and inquired in a certain order. The patient's options and filled-in contents are translated to form standardized medical condition data. When collecting medical condition data by remote acquisition, the remote consultation rules should be followed, which are divided into symptom internal rules and symptom external rules.

[0088] Symptom internal rules refer to the fact that when collecting disease data remotely from the patient's port, on the basis of the aforementioned symptom deconstruction, each secondary subcategory of each symptom should follow a certain process sequence to inquire in order to achieve the purpose of "optimal" data collection. This is the symptom internal rule. The essence of "optimal" data collection is to find the best balance between medical principles and clinical practice to complete data collection.

[0089] The requirement of medical principles for data collection is to collect as much symptom data as possible for more accurate diagnosis and more comprehensive treatment. If important symptoms are not collected, sometimes it may cause quite malignant consequences. In actual clinical practice, old diseases can show symptoms that are completely different from the classic descriptions in textbooks, and new diseases also need to summarize the laws of their course of development through continuous clinical observation of the evolution of the disease. Therefore, whether from the perspective of clinical practice or from the perspective of the development of medical theory, when recording the condition, more and more comprehensive data should be collected as much as possible - even if some data is not yet within the scope of being considered important, but may later become data that must be collected. This is the consideration of medical principles for data collection.

[0090] On the other hand, the actual clinical requirement for data collection is to complete the data collection process in the shortest possible time.

[0091] Based on the symptom deconstruction basis and data collection requirements, internal symptom rules are established, including main and auxiliary symptom rules and first and next time point rules.

[0092] Main and auxiliary symptom rules: All symptoms are classified into main and auxiliary symptoms. The symptom selected by the patient first is the main symptom by default (other methods can also be used to determine the main symptom), and the remaining symptoms are auxiliary symptoms. If the main symptom is not selected properly, it can be changed by the doctor or recorder later. The main symptom needs to run the five first-level categories of recording time, frequency, single, nature and factor; the auxiliary symptom needs to run the three first-level categories of recording time, single and nature.

[0093] First and subsequent time point rules: Symptom data needs to be arranged sequentially on the timeline, and all collected record time points are divided into first and subsequent time points. The first time point needs to run the record time, frequency, single, nature, and factor five first-level categories; the subsequent time points need to run the record time, frequency, and nature three first-level categories.

[0094] By superimposing the main and auxiliary symptom rules and the first and last time point rules, a complete symptom internal rule is established, which operates as follows:

[0095] The main symptoms at the first time point need to run [record time], [frequency], [single], [nature], and [factor];

[0096] The first time point auxiliary symptoms need to run [record time], [single], [nature];

[0097] The main symptoms at subsequent time points need to run [record time], [frequency], and [nature];

[0098] Subsequent time point auxiliary symptoms need to run [record time] and [nature].

[0099] This set of superimposed operating rules greatly simplifies the inquiry process while ensuring that the collected data is as comprehensive as possible. The operating process is as follows: Figure 2 shown.

[0100] Symptom external rules refer to the fact that when collecting medical condition data remotely from the patient's port, in addition to asking about a single symptom, other symptoms should be asked in a certain order. This is the symptom external rule, also known as the setting rule for exclusionary consultation.

[0101] Exclusionary questioning means that in addition to the discomfort actively reported by the patient, in order to exclude the patient from missing important situations, the doctor or recorder needs to ask the patient as much as possible whether there are other discomforts. Suggestive questioning means that the doctor or recorder actively prompts the symptoms and asks the patient whether he feels this discomfort. Most of the symptoms are related to the discomfort actively reported by the patient and can help the doctor or recorder to judge the condition. Compared with the patient's active complaints, the doctor's or recorder's suggestive questioning carries obvious medical thinking and is also related to the doctor's or recorder's clinical experience. The suggestive questioning conducted by experienced doctors or recorders can significantly save consultation time and improve diagnostic accuracy. Exclusionary questioning follows the same medical principle as symptom internal questioning, that is, asking as many questions as possible to ensure comprehensive coverage. At the same time, it also faces the clinical reality of insufficient consultation time, so exclusionary questioning also needs to find the best balance point.

[0102] This application establishes a set of data collection rules based on symptom grouping, namely, symptom external rules, to deal with the optimal balance of exclusionary interviews.

[0103] First, we define each system according to the medical classification of human tissues, organs and diseases, and systematically group the symptoms, such as the digestive system, cardiovascular system, systemic symptoms, etc. Usually, medical textbooks will explain diseases according to the various systems classified in this way. We summarize the main discomforts involved in each system and get the grouping of the symptoms.

[0104] Systemic symptoms are a special case. Systemic symptoms refer to symptoms that can hardly be attributed to tissues, organs or parts, and may occur with all systems, such as fever, edema, purpura, etc., so they are separately classified as systemic symptoms and are a must-ask item in the exclusionary interview.

[0105] Abnormal examination is another special case. In medical textbooks, abnormal examination symptoms are mostly found in the content of laboratory tests, not in the content of symptoms. However, we format them into symptoms separately based on clinical practice. Many patients initially visit the doctor for abnormal examinations, but do not notice other symptoms. Listing abnormal examination categories can improve the quality of medical record generation.

[0106] It should be noted that many symptoms belong to more than one group. For example, chest pain can occur during pneumonia or during a coronary heart disease attack, so the grouping of chest pain is respiratory system and cardiovascular system.

[0107] Secondly, set the rules for determining the symptoms in the same group. Each symptom can belong to more than one group. When one of their groups is the same, these symptoms are considered to belong to the same group, such as Figure 3 shown.

[0108] For example: hoarseness belongs to the respiratory system; chest pain belongs to the respiratory system and the cardiovascular system; palpitations belong to the cardiovascular system. Taking the system grouping as the starting point: in the respiratory system grouping, hoarseness and chest pain are symptoms in the same group, but hoarseness and palpitations are not symptoms in the same group; in the cardiovascular system grouping, chest pain and palpitations are symptoms in the same group, but hoarseness and palpitations are not symptoms in the same group. Taking a single symptom as the starting point: for hoarseness, chest pain is a symptom in the same group, but palpitations are not; for chest pain, hoarseness and palpitations are both symptoms in the same group.

[0109] Third, establish the rules for exclusionary questioning, namely the external symptom rules:

[0110] Main symptom entry: After the patient initially selects the main symptom, an exclusionary interview is conducted based on the main symptom.

[0111] Elimination of the same group of symptoms (detailed suggestive questioning): All the same group of symptoms of the main symptoms, each symptom should be displayed and asked about, so that individual symptoms can be asked about in turn and clearly excluded.

[0112] FAQ system exclusion (brief suggestive medical interview): set up a FAQ system, prompt the representative symptoms of the FAQ system in the questions, and ask each FAQ system in turn. When the patient selects "yes", the entire system symptoms are displayed for further selection. Otherwise, the symptoms grouped by the system can be excluded as a whole.

[0113] Other systems excluded (non-suggestive interview): At the end of the exclusion interview, all system groups are presented and the patient is allowed to select whether there are any missing symptoms.

[0114] The above exclusionary consultation process follows a skip setting to simplify the process. That is, the symptoms that have been selected will be skipped or not selectable in the subsequent stages.

[0115] The place of exclusion interview in the interview process. The four steps of exclusion interview can be completely separated.

[0116] This solution can obtain medical information through remote acquisition. When collecting medical data through remote acquisition, the initial collection rule should be followed. The initial collection rule means that no matter under what circumstances the data is collected, established or changed, the data at the first time point T1 must exist. This is called the initial collection rule of medical information.

[0117] In this application, the condition is decomposed into symptoms, and the data after symptom deconstruction are arranged on the timeline, then each symptom will have a first time point record and a subsequent time point record. The first time point records of all symptoms of the current disease are summarized and defined as the initial time point record (called T1). Taking the current time point when the patient records the change of the condition as the timeline section, all symptom records of the disease at this point can be collected and summarized, and defined as the last time point record (called Tn). Only the last time point record is defined as the last time, and the remaining time point records are arranged in chronological order, and they together constitute the subsequent time point records.

[0118] Subsequent time points = remaining subsequent time points + last time point.

[0119] All time points = first time point + subsequent time points = first time point + (other subsequent time points + last time point).

[0120] According to the initial mandatory collection rule, as patients continue to see doctors, the position of the last time point keeps changing, and the data of each time axis section keeps moving forward from the last time point to become the data of the subsequent time point, which continuously forms the accumulation of multiple time point records, so that dynamically changing disease data is collected. Due to the symptom deconstruction items we initially established, the collected disease data not only records the dynamic changes over time, but also can easily track and extract the changes of individual symptoms, laying a superior data foundation for future data processing.

[0121] In a specific implementation of this embodiment, Figure 4 As shown, when obtaining medical condition information by remote acquisition, according to the initial mandatory rules, the medical condition information is obtained through the following paths, namely, obtaining the medical condition information based on the conventional initial visit entrance; or, obtaining the medical condition information based on the simple initial visit entrance; or, obtaining the medical condition information based on the real follow-up visit entrance; or, obtaining the medical condition information based on the fake follow-up visit entrance.

[0122] The regular first visit entrance is applicable to the situation when the patient visits the doctor for the first time for a disease and the condition changes from the onset to the visit. The collection method of the regular first visit entrance is to collect the data of the first time point T1 and the last time point Tn respectively.

[0123] The simple first visit entrance is suitable for patients who visit the doctor for the first time for a disease and whose condition has not changed much before and after. The collection method of the simple first visit entrance is to collect the data of the first time point T1, then enter the branch of no change at the last time point Tn, and skip the last time point Tn.

[0124] The real follow-up entrance is applicable to the case where the patient visits the doctor again for a certain disease and has previously used this system to fill in the data of this disease. According to the initial mandatory collection rule, because the system has collected this disease information before, the data of the first time point T1 must already exist; then the collection method of the real follow-up entrance is to skip the first time point T1 and directly collect the last time point Tn data when the data of the first time point T1 is available (referring to the collected data that can be checked in the same system).

[0125] The pseudo follow-up entrance is applicable to the case where a patient visits the doctor again for a certain disease and has never used this system to fill in the data of this disease before. According to the initial collection rule, because the system has not collected the initial information of this disease, the data of the first time point of T1 does not exist; then the collection method of the pseudo follow-up entrance is that when there is no data of the first time point of T1 (referring to the collected data that can be checked in the same system), the collection method is the same as the regular initial diagnosis entrance, that is, the data of the first time point of T1 and the last time point of Tn are collected separately.

[0126] By setting the above remote acquisition path, the present application solves the problem of different clinical stages of remote data collection system intervention, making it applicable to any clinical practice. Clinical stage refers to the different stages of the patient's condition development and medical treatment. From the initial onset of the patient to the aggravation of the condition, to the initial medical treatment, follow-up medical treatment and even transfer to another hospital, in all the actual processes, due to the different time for medical institutions to install data collection systems and the different time for patients to contact data collection systems, it is possible that condition data collection may occur at any stage of the clinical stage, which requires that the data collection method should be able to adapt to various situations. The solution provided by the present application solves the adaptation problem very well, and makes the medical record data collected at any clinical stage of intervention use the same data format.

[0127] The flow chart and block diagram in the accompanying drawings illustrate the possible architecture, function and operation of the system, method and computer program product according to various embodiments of the present disclosure. In this regard, each square box in the flow chart or block diagram can represent a module, a program segment or a part of a code, and the module, the program segment or a part of the code contains one or more executable instructions for realizing the specified logical function. It should also be noted that in some implementations as replacements, the functions marked in the square box can also occur in a sequence different from that marked in the accompanying drawings. For example, two square boxes represented in succession can actually be executed substantially in parallel, and they can sometimes be executed in the opposite order, depending on the functions involved. It should also be noted that each square box in the block diagram and / or flow chart, and the combination of the square boxes in the block diagram and / or flow chart can be implemented with a dedicated hardware-based system that performs a specified function or operation, or can be implemented with a combination of dedicated hardware and computer instructions.

[0128] Although operations are depicted in a particular order, this should not be understood as requiring that the operations be performed in the particular order shown or in a sequential order.Multitasking and parallel processing may be advantageous under certain circumstances.

[0129] It should be understood that the various steps described in the method embodiments of the present disclosure may be performed in different orders and / or in parallel. In addition, the method embodiments may include additional steps and / or omit the steps shown. The scope of the present disclosure is not limited in this respect.

[0130] Computer program code for performing the operations of the present disclosure may be written in one or more programming languages ​​or a combination thereof, including, but not limited to, object-oriented programming languages, such as Java, Smalltalk, C++, and conventional procedural programming languages, such as C or similar programming languages. The program code may be executed entirely on the user's computer, partially on the user's computer, as a separate software package, partially on the user's computer and partially on a remote computer, or entirely on a remote computer or server. In cases involving a remote computer, the remote computer may be connected to the user's computer through any type of network, including a local area network (LAN) or a wide area network (WAN), or may be connected to an external computer.

[0131] Figure 5 This is a block diagram of a medical record deconstruction and reconstruction device according to an embodiment of the present application.

[0132] like Figure 5As shown, the medical record deconstruction and reconstruction device provided in this embodiment is applied to an electronic device to obtain a standard medical record based on the patient's information so that the user can make subsequent processing according to the standard medical record. The deconstruction and reconstruction device includes an information acquisition module 10, a deconstruction processing module 20 and a reconstruction processing module 30.

[0133] The information acquisition module is used to obtain disease information.

[0134] The condition information here includes at least one symptom description information, and each symptom description information includes multiple levels of description content categories. The condition record is a record of the condition information, a description of the patient's onset and current condition, and is the core content of the medical record. Due to the ever-changing conditions and the individual level and habits of the recorder, the actual content of the condition record is diverse, and it is the most non-standardized part of the medical record.

[0135] The sources of medical information include on-site acquisition by doctors or recorders during face-to-face consultations, and also include information input by patients when communicating with doctors, recorders or systems remotely, that is, medical information obtained through remote acquisition.

[0136] Generally, one symptom description information corresponds to one symptom, and multiple symptom descriptions constitute a disease description. Recording all symptom descriptions along a certain timeline constitutes the above-mentioned disease record.

[0137] The deconstruction processing module is used to deconstruct the medical condition information.

[0138] By deconstructing the disease information, we can obtain the standard symptom elements corresponding to the symptom description information. When deconstructing a single symptom description information, given that the information includes multiple levels of description content categories, the symptom description information is classified into two levels. The first-level categories include time records, frequency, single, nature, and factors. The second-level categories are further subdivided from the first-level categories. Generally speaking, due to the characteristics of symptom description information, there may be default items in the major and minor categories.

[0139] The reorganization processing module is used to reorganize standard symptom elements to obtain standard medical records.

[0140] After the above standard symptom elements are obtained through deconstruction, they are reassembled to obtain a standard medical record that is easy for users to read.

[0141] It can be seen from the above technical solution that this embodiment provides a medical record deconstruction and reconstructing device, which is applied to electronic devices, specifically to obtain medical condition information, the medical condition information includes at least one symptom description information, each symptom description information includes a multi-level description content category; deconstruct the symptom description information to obtain a standard symptom element corresponding to the symptom description information; reconstruct the standard symptom element to obtain a standard medical record. Through the above operation, the original medical condition information can be converted into a standard medical record with a relatively fixed format, thereby improving the reliability of remote transmission of medical information, facilitating users to handle medical records, thereby significantly improving the doctor's consultation efficiency and the work efficiency of medical record users, so that medical service institutions can better meet the surging social needs in the aging era.

[0142] In a specific implementation of this embodiment, the information acquisition module can obtain the condition information by remote acquisition. In view of this, the module includes a first acquisition unit, a second acquisition unit, a third acquisition unit and a fourth acquisition unit. The first acquisition unit is used to acquire the condition information based on the conventional initial diagnosis entrance; the second acquisition unit is used to acquire the condition information based on the simple initial diagnosis entrance; the third acquisition unit is used to acquire the condition information based on the real follow-up diagnosis entrance; and the fourth acquisition unit is used to acquire the condition information based on the pseudo follow-up diagnosis entrance.

[0143] The units involved in the embodiments described in the present disclosure may be implemented by software or hardware. The name of a unit does not limit the unit itself in some cases. For example, the first acquisition unit may also be described as a "unit for acquiring at least two Internet Protocol addresses".

[0144] The functions described above herein may be performed at least in part by one or more hardware logic components. For example, without limitation, exemplary types of hardware logic components that may be used include: field programmable gate arrays (FPGAs), application specific integrated circuits (ASICs), application specific standard products (ASSPs), systems on chips (SOCs), complex programmable logic devices (CPLDs), and the like.

[0145] Figure 6 A block diagram of an electronic device according to an embodiment of the present application.

[0146] refer to Figure 6, which shows a deconstructed schematic diagram of an electronic device suitable for implementing the embodiments of the present disclosure. The terminal device in the embodiments of the present disclosure may include, but is not limited to, mobile terminals such as mobile phones, laptop computers, digital broadcast receivers, PDAs (personal digital assistants), PADs (tablet computers), PMPs (portable multimedia players), vehicle-mounted terminals (such as vehicle-mounted navigation terminals), etc., and fixed terminals such as digital TVs, desktop computers, etc. The electronic device is only an example and should not bring any limitation to the functions and scope of use of the embodiments of the present disclosure.

[0147] The electronic device may include a processing device (e.g., a central processing unit, a graphics processing unit, etc.) 601, which can perform various appropriate actions and processes according to a program stored in a read-only memory ROM 602 or a program loaded from an input device 606 into a random access memory RAM 603. In the RAM, various programs and data required for the operation of the electronic device are also stored. The processing device, ROM, and RAM are connected to each other via a bus 604. An input / output (I / O) interface 605 is also connected to the bus 604.

[0148] Typically, the following devices may be connected to the I / O interface: input devices including, for example, a touch screen, a touchpad, a keyboard, a mouse, a camera, a microphone, an accelerometer, a gyroscope, etc.; output devices 607 including, for example, a liquid crystal display (LCD), a speaker, a vibrator, etc.; storage devices 608 including, for example, a magnetic tape, a hard disk, etc.; and communication devices 609. The communication device 609 may allow the electronic device to communicate with other devices wirelessly or by wire to exchange data. Although the figure shows an electronic device with various devices, it should be understood that it is not required to implement or have all the devices shown. More or fewer devices may be implemented or have alternatively.

[0149] This embodiment also provides a computer-readable medium embodiment. The above-mentioned computer-readable medium carries one or more programs. When the above-mentioned one or more programs are executed by the electronic device, the electronic device obtains the medical condition information, and the medical condition information includes at least one symptom description information, and each symptom description information includes a multi-level description content category; the symptom description information is deconstructed to obtain the standard symptom elements corresponding to the symptom description information; the standard symptom elements are reorganized to obtain a standard medical record. Through the above-mentioned operation, the original medical condition information can be converted into a standard medical record with a relatively fixed format, thereby improving the reliability of remote transmission of medical information, facilitating users to handle medical records, thereby significantly improving the doctor's consultation efficiency and the work efficiency of medical record users, so that medical service institutions can better meet the surging social needs in the aging era.

[0150] It should be noted that the computer-readable medium disclosed above may be a computer-readable signal medium or a computer-readable storage medium or any combination of the above two. The computer-readable storage medium may be, for example, but not limited to, an electrical, magnetic, optical, electromagnetic, infrared, or semiconductor system, device or device, or any combination of the above. More specific examples of computer-readable storage media may include, but are not limited to: an electrical connection with one or more wires, a portable computer disk, a hard disk, a random access memory (RAM), a read-only memory (ROM), an erasable programmable read-only memory (EPROM or flash memory), an optical fiber, a portable compact disk read-only memory (CD-ROM), an optical storage device, a magnetic storage device, or any suitable combination of the above. In the present disclosure, a computer-readable storage medium may be any tangible medium containing or storing a program, which may be used by or in combination with an instruction execution system, device or device.

[0151] In the present disclosure, a computer-readable signal medium may include a data signal propagated in a baseband or as part of a carrier wave, which carries a computer-readable program code. Such propagated data signals may take a variety of forms, including but not limited to electromagnetic signals, optical signals, or any suitable combination of the above. A computer-readable signal medium may also be any computer-readable medium other than a computer-readable storage medium, which may send, propagate, or transmit a program for use by or in conjunction with an instruction execution system, device, or device. The program code contained on the computer-readable medium may be transmitted using any suitable medium, including but not limited to: wires, optical cables, RF (radio frequency), etc., or any suitable combination of the above.

[0152] The various embodiments in this specification are described in a progressive manner, and each embodiment focuses on the differences from other embodiments. The same or similar parts between the various embodiments can be referenced to each other.

[0153] Although the preferred embodiments of the present invention have been described, those skilled in the art may make other changes and modifications to these embodiments once they have learned the basic creative concept. Therefore, the appended claims are intended to be interpreted as including the preferred embodiments and all changes and modifications that fall within the scope of the embodiments of the present invention.

[0154] Finally, it should be noted that, in this article, relational terms such as first and second, etc. are only used to distinguish one entity or operation from another entity or operation, and do not necessarily require or imply any such actual relationship or order between these entities or operations. Moreover, the terms "include", "comprise" or any other variants thereof are intended to cover non-exclusive inclusion, so that a process, method, article or terminal device including a series of elements includes not only those elements, but also other elements not explicitly listed, or also includes elements inherent to such process, method, article or terminal device. In the absence of further restrictions, the elements defined by the sentence "comprise a ..." do not exclude the existence of other identical elements in the process, method, article or terminal device including the elements.

[0155] The technical solution provided by the present invention is introduced in detail above. Specific examples are used in this article to illustrate the principle and implementation mode of the present invention. The description of the above embodiments is only used to help understand the method of the present invention and its core idea. At the same time, for those skilled in the art, according to the idea of ​​the present invention, there will be changes in the specific implementation mode and application scope. In summary, the content of this specification should not be understood as limiting the present invention.

Claims

1. A method for deconstructing and reconstructing medical records, applied to electronic equipment, characterized in that: The deconstruction and reconstruction method comprises the steps of: Acquire disease information, wherein the disease information includes at least one symptom description information, and each symptom description information includes multiple levels of description content categories; Deconstructing the symptom description information to obtain standard symptom elements corresponding to the symptom description information; The standard symptom elements are reorganized to obtain a standard medical record.

2. The deconstruction and reconstruction method according to claim 1, characterized in that: The method of obtaining the disease information is an on-site obtaining method and a remote obtaining method.

3. The deconstruction and reconstruction method according to claim 2, characterized in that: When the method for acquiring the medical condition information is a remote acquisition method, the medical condition information is acquired based on remote consultation rules.

4. The deconstruction and reconstruction method according to claim 3, characterized in that: The remote consultation rules include at least the initial mandatory rules.

5. The deconstruction and reconstruction method according to claim 1, characterized in that: The obtaining of the medical condition information includes: Acquiring the medical condition information based on a conventional initial diagnosis portal; Obtain the medical condition information based on a simple initial diagnosis portal; Obtain the medical condition information based on the real follow-up visit entrance; Or, the medical condition information is obtained based on a pseudo follow-up visit entrance.

6. A medical record deconstruction and reconstruction device, applied to electronic equipment, characterized in that: The deconstruction and reconstructing device comprises: An information acquisition module is configured to acquire condition information, wherein the condition information includes at least one symptom description information, and each symptom description information includes multiple levels of description content categories; A deconstruction processing module is configured to deconstruct the symptom description information to obtain a standard symptom element corresponding to the symptom description information; The reorganization processing module is configured to reorganize the standard symptom elements to obtain a standard medical record.

7. The deconstruction and reconstructing device according to claim 6, characterized in that: The method of obtaining the disease information is an on-site obtaining method and a remote obtaining method.

8. The deconstruction and reconstructing device according to claim 7, characterized in that: When the method for acquiring the medical condition information is a remote acquisition method, the medical condition information is acquired based on remote consultation rules.

9. The deconstruction and reconstructing device according to claim 8, characterized in that: The remote consultation rules include at least the initial mandatory rules.

10. The deconstruction and reconstruction device according to claim 6, characterized in that: The information acquisition module includes: A first acquisition unit is configured to acquire the condition information based on a conventional initial diagnosis entrance; A second acquisition unit is configured to acquire the condition information based on a simple initial diagnosis entrance; A third acquisition unit is configured to acquire the condition information based on the real follow-up visit entrance; The fourth acquisition unit is configured to acquire the condition information based on the pseudo follow-up visit entrance.

11. An electronic device, characterized in that: The method comprises at least one processor and a memory connected to the processor, wherein: The memory is used to store computer programs or instructions; The processor is used to execute the computer program or instruction so that the electronic device implements the medical record deconstruction and reconstruction method according to any one of claims 1 to 5.

12. A medium, applied to electronic equipment, characterized in that: The medium carries one or more computer programs, and the one or more computer programs can be executed by the electronic device, so that the electronic device can implement the medical record deconstruction and reconstruction method as described in any one of claims 1 to 5.

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