技术领域technical field
本发明属于计算机技术领域，更进一步涉及医疗流程的实现方法，可用于将医院的临床路径诊疗流程表示为计算机可识别的流程定义，进一步实现诊疗流程的可变性控制和管理。The invention belongs to the field of computer technology, and further relates to a method for realizing medical procedures, which can be used to express the clinical path diagnosis and treatment procedures of hospitals as process definitions recognizable by computers, and further realize the variability control and management of the diagnosis and treatment procedures.
背景技术Background technique
自2010年起实施的临床路径为我国诊疗流程规范化提供了支持，临床路径是指针对某一疾病建立一套标准化治疗模式与治疗程序，以循证医学证据和指南为指导来促进治疗组织和疾病管理的方法，最终起到规范医疗行为，减少变异，降低成本，提高质量的作用。The clinical pathway implemented since 2010 has provided support for the standardization of diagnosis and treatment processes in my country. The clinical pathway refers to the establishment of a set of standardized treatment models and procedures for a certain disease, and is guided by evidence-based medical evidence and guidelines to promote the treatment of organizations and diseases. The method of management ultimately plays a role in standardizing medical behavior, reducing variation, reducing cost, and improving quality.
当前，我国不同医院、不同医生的诊疗水平相差很大，诊疗决策支持系统成为分享专家医生经验、辅助医生进行诊疗决策的重要系统。At present, the diagnosis and treatment levels of different hospitals and doctors in my country vary greatly. The diagnosis and treatment decision support system has become an important system for sharing the experience of experts and doctors and assisting doctors in making diagnosis and treatment decisions.
目前医院的临床诊疗流程存在很大的不规范性，流程调度和控制系统缺乏对医疗领域的针对性，诊疗流程仅针对一种疾病或有限诊疗阶段，难以扩充和更新。At present, there is a lot of irregularity in the clinical diagnosis and treatment process of the hospital. The process scheduling and control system lacks pertinence to the medical field. The diagnosis and treatment process is only for one disease or a limited diagnosis and treatment stage, which is difficult to expand and update.
大连运邦科技发展有限公司申请的专利“临床路径医疗管理系统”(申请号CN201210360143公开号CN103679602A)公开了一种临床路径医疗管理系统。该系统通过专家组部分、执行医护部分和院方监控部分等几个主要的功能模块，针对医疗过程中某个病种或手术，以循证医学为基础，以预期的治疗效果和成本控制为目的，制定有严格工作顺序和准确时间要求的最佳程序化、标准化医疗检查和处置流程。该专利申请存在的不足是：以表单形式的临床路径管理，没有针对流程调度和控制进行设计和实现，难以应对复杂的诊疗活动执行调度和控制，难以体现诊疗活动之间的相互关系，且医疗综合服务覆盖面只限于治疗阶段，相对比较窄。The patent "clinical pathway medical management system" (application number CN201210360143 publication number CN103679602A) applied by Dalian Yunbang Technology Development Co., Ltd. discloses a clinical pathway medical management system. Through several main functional modules such as the expert group part, the executive medical care part and the hospital monitoring part, the system aims at a certain disease or operation in the medical process, based on evidence-based medicine, and based on the expected treatment effect and cost control. The purpose is to formulate the best procedural and standardized medical examination and treatment process with strict work sequence and accurate time requirements. The deficiencies of this patent application are: the management of clinical pathways in the form of forms is not designed and implemented for process scheduling and control, it is difficult to implement scheduling and control for complex diagnostic and treatment activities, and it is difficult to reflect the relationship between diagnostic and therapeutic activities. The coverage of comprehensive services is limited to the stage of treatment, which is relatively narrow.
方正国际软件有限公司所申请的专利“用于医疗系统的业务流程管理系统和业务流程管理方法”(申请号CN201310603304公开号CN103606049A)提供一种用于医疗系统的业务流程管理系统。该专利申请由流程定义单元、请求解析单元和业务执行单元几个单元模块组成，提出了对医疗系统内的业务流程的统一管理模型，有助于简化流程的创建和执行过程，便于实现对医疗业务流程的有效管理。该专利申请存在的不足是：医疗流程并不标准，没有统一的规范进行限定；对于流程的处理方式，没有针对医疗领域进行设计实现，对医疗流程很多特性不能针对性的处理，如医疗流程中复杂的诊疗活动调度和诊疗活动执行时间的控制。The patent "Business Process Management System and Business Process Management Method for Medical Systems" (application number CN201310603304 publication number CN103606049A) applied by Founder International Software Co., Ltd. provides a business process management system for medical systems. This patent application is composed of several unit modules including process definition unit, request parsing unit and business execution unit. It proposes a unified management model for business processes in the medical system, which helps to simplify the process of creating and executing processes, and facilitates the realization of medical Effective management of business processes. The shortcomings of this patent application are: the medical process is not standard, and there is no unified specification to define it; the processing method of the process is not designed and implemented for the medical field, and many characteristics of the medical process cannot be dealt with in a targeted manner, such as in the medical process Scheduling of complex medical activities and control of execution time of medical activities.
发明内容Contents of the invention
本发明的目的在于针对上述已有技术的不足，提出一种可变性诊疗流程的实现方法，规范和标准化诊疗流程，并对诊疗流程进行动态扩充和维护。The object of the present invention is to propose a method for realizing variable diagnosis and treatment process, to standardize and standardize the diagnosis and treatment process, and to dynamically expand and maintain the diagnosis and treatment process in view of the above-mentioned deficiencies in the prior art.
本发明的技术方案是这样实现的：Technical scheme of the present invention is realized like this:
本发明的技术思路是：以工作流技术为基础，针对临床路径诊疗流程的调度复杂性和时间控制等特性，将临床路径诊疗流程表示为计算机可识别的临床路径工作流模型，接着根据临床路径工作流模型，对诊疗流程的执行进行调度和控制，在临床路径诊疗流程需要扩充或变更时，建立或更新临床路径工作流模型，实现可变性的诊疗流程。The technical idea of the present invention is: based on the workflow technology, aiming at the scheduling complexity and time control characteristics of the clinical path diagnosis and treatment process, the clinical path diagnosis and treatment process is expressed as a computer-recognizable clinical path workflow model, and then according to the clinical path The workflow model schedules and controls the execution of the diagnosis and treatment process. When the clinical path diagnosis and treatment process needs to be expanded or changed, the clinical path workflow model is established or updated to realize the variability of the diagnosis and treatment process.
所述工作流，是在计算机应用环境下的业务过程的自动化，利用工作流技术可分离诊疗流程中任务执行与流程控制，实现诊疗流程执行和调度的控制和管理，实现诊疗流程的动态扩展和更新。The workflow is the automation of the business process in the computer application environment. The workflow technology can be used to separate the task execution and process control in the diagnosis and treatment process, realize the control and management of the diagnosis and treatment process execution and scheduling, and realize the dynamic expansion and integration of the diagnosis and treatment process. renew.
本发明实现步骤如下：The present invention realizes steps as follows:
(1)构建临床路径工作流模型：(1) Build a clinical pathway workflow model:
1a)将诊疗流程中的诊疗任务表示为诊疗活动节点A，通过诊疗活动节点A的时间属性指定诊疗任务执行的时间要求，通过诊疗活动节点A输入参数属性和输出参数属性指定诊疗任务与诊疗流程的数据交互；1a) Express the diagnosis and treatment task in the diagnosis and treatment process as a diagnosis and treatment activity node A, specify the time requirement for the execution of the diagnosis and treatment task through the time attribute of the diagnosis and treatment activity node A, and specify the diagnosis and treatment task and the diagnosis and treatment process through the input parameter attribute and output parameter attribute of the diagnosis and treatment activity node A data interaction;
1b)将其他流程的调用表示为子流程节点F，通过子流程节点F关键字属性和版本属性指定调用的流程，通过子流程节点F的时间属性指定所调用流程的时间要求；1b) Denote the call of other processes as a sub-process node F, specify the called process through the keyword attribute and version attribute of the sub-process node F, and specify the time requirement of the called process through the time attribute of the sub-process node F;
1c)将结束当前诊疗流程并跳转到另一个诊疗流程表示为流程跳转节点G，通过流程跳转节点G关键字属性和版本属性指定跳转到的流程；1c) Ending the current diagnosis and treatment process and jumping to another diagnosis and treatment process is represented as a process jump node G, and the process to which to jump is specified through the key attribute and version attribute of the process jump node G;
1d)将诊疗流程中变异和异常的处理表示为异常处理节点I；1d) Denote the processing of variation and abnormality in the diagnosis and treatment process as abnormal processing node I;
1e)将警告或错误消息的展示表示为信息节点J，通过信息节点J的类型属性指定警告或错误消息类型，通过信息节点J的详细信息属性指定消息的内容；1e) Represent the display of warning or error messages as information node J, specify the type of warning or error message through the type attribute of information node J, and specify the content of the message through the detailed information attribute of information node J;
1f)将流程的入口表示为流程开始节点K；1f) Denote the entry of the process as a process start node K;
1g)将结束当前流程的执行表示为流程结束节点L；1g) Denote ending the execution of the current process as a process end node L;
1h)将结束当前诊疗流程实例的执行表示为实例终结节点M；1h) Denote the end of the execution of the current diagnosis and treatment process instance as an instance termination node M;
1i)将节点先后执行顺序表示为连接元素N对节点的先后连接，形成多个不分叉的流程片段，其中每一个流程片段作为一条流程线路；1i) Express the sequential execution sequence of nodes as the sequential connection of connection elements N to nodes, forming multiple non-forking process segments, wherein each process segment is regarded as a process line;
1j)在已形成的多个流程线路中，如果其中有几条流程线路相互之间只能有一条被选择执行，则将这些流程线路作为一组，并设置互斥开始节点B和互斥汇聚节点C，通过连接元素N将互斥开始节点B连接到这组流程线路的每条线路的首个节点，通过连接元素N将这组流程线路的每条线路的最后一个节点连接到互斥汇聚节点C，在互斥开始节点B中指定流程线路选择规则，其中规则的每一个结果对应这组流程线路的一条线路，使这组流程线路合并形成新的流程线路；1j) Among the multiple process lines that have been formed, if there are several process lines among which only one of them can be selected for execution, these process lines are regarded as a group, and mutually exclusive start node B and mutually exclusive convergence are set Node C, connects the mutually exclusive start node B to the first node of each line of this set of flow lines through the connection element N, and connects the last node of each line of the set of flow lines to the mutex convergence through the connection element N Node C, specifying a process route selection rule in mutually exclusive start node B, wherein each result of the rule corresponds to a route of this group of process routes, so that this group of process routes is merged to form a new process route;
1k)在已形成的多个流程线路中，如果其中有几条流程线路相互之间能同时执行或按任意顺序执行，则将这些流程线路作为一组，并设置并发开始节点D和并发汇聚节点E，通过连接元素N将该并发开始节点D连接到这组流程线路的每条线路的首个节点，通过连接元素N将这组流程线路的每条线路的最后一个节点连接到该互斥汇聚节点E，使这组流程线路合并形成新的流程线路；1k) Among the multiple process lines that have been formed, if several process lines can be executed simultaneously or in any order, these process lines are regarded as a group, and the concurrent start node D and the concurrent sink node are set E, connect the concurrent start node D to the first node of each line of this set of process lines through a connection element N, and connect the last node of each line of this set of process lines to the exclusive aggregation through a connection element N Node E, to merge this group of process lines to form a new process line;
1l)重复1k)和1l)的过程，使整个流程成为一条流程线路；1l) Repeat the process of 1k) and 1l), so that the whole process becomes a flow line;
1m)将整个流程中多个紧密联系的节点通过块活动节点H进行分组，块活动不与其他节点连接，通过块活动节点H的时间属性指定块活动节点H划分的组内所有节点的执行需满足的时间要求；1m) Multiple closely connected nodes in the whole process are grouped by the block activity node H, the block activity is not connected with other nodes, and the execution requirements of all nodes in the group divided by the block activity node H are specified through the time attribute of the block activity node H the time requirements to be met;
(2)根据临床路径工作流模型，对诊疗流程的执行进行调度和控制：(2) Scheduling and controlling the execution of the diagnosis and treatment process according to the clinical path workflow model:
2a)执行流程开始节点K的下一个节点：2a) The next node of the execution flow start node K:
如果当前节点是诊疗活动节点A，并且满足该节点的时间属性指定的时间要求，则执行该If the current node is the diagnosis and treatment activity node A and meets the time requirement specified by the time attribute of the node, then execute this
诊疗活动节点A所对应的诊疗任务；Diagnosis and treatment tasks corresponding to diagnosis and treatment activity node A;
如果当前节点是互斥开始节点B，则获取该节点中指定的流程线路选择规则的结果，根据该结果选择并执行该互斥开始节点B后续的多个流程线路中一条流程线路；If the current node is the mutually exclusive start node B, then obtain the result of the process route selection rule specified in the node, and select and execute one of the multiple process routes following the mutually exclusive start node B according to the result;
如果当前节点是互斥汇聚节点C，则执行该节点后续的流程线路；If the current node is a mutually exclusive sink node C, execute the subsequent process lines of the node;
如果当前节点是并发开始节点D，则同时执行该节点后续的多个流程线路；If the current node is a concurrent start node D, execute multiple subsequent process lines of this node at the same time;
如果当前节点是并发汇聚节点E，则等待所有以该节点作为终点的流程线路均执行完成，执行该节点后续的流程线路；If the current node is a concurrent sink node E, wait for all the process lines with this node as the end point to be executed, and execute the subsequent process lines of this node;
如果当前节点是流程结束节点L，则结束当前流程的执行，如果当前流程为通过子流程节点F调用的流程，则返回该子流程节点F所在的流程继续执行，否则，结束当前诊疗流程实例的执行；If the current node is the process end node L, then end the execution of the current process, if the current process is a process called by the sub-process node F, then return to the process where the sub-process node F is located to continue execution, otherwise, end the current diagnosis and treatment process instance implement;
如果当前节点是实例终结节点M，则结束当前诊疗流程实例的执行；If the current node is the instance termination node M, then end the execution of the current diagnosis and treatment process instance;
如果当前节点是流程跳转节点G，则结束当前流程的执行，开始执行该流程跳转节点G指定的流程；If the current node is a process jump node G, then end the execution of the current process and start executing the process specified by the process jump node G;
如果当前节点是子流程节点F，且满足该节点的时间属性指定的时间要求，则开始执行该子流程节点F指定的流程，当指定的流程执行结束时，继续执行该子流程节点F所在的流程；If the current node is a sub-process node F and meets the time requirements specified by the time attribute of the node, then start to execute the process specified by the sub-process node F, and when the specified process execution ends, continue to execute the process where the sub-process node F is located process;
如果当前节点是异常处理节点I，则执行异常处理节点I中定义的异常处理；If the current node is the exception handling node I, execute the exception handling defined in the exception handling node I;
如果当前节点是信息节点J，则向用户输出警告或错误信息；If the current node is an information node J, output a warning or error message to the user;
2b)当前节点执行结束后，如果诊疗流程实例未执行结束，则按照步骤2a)的方式执行当前节点的下一个节点，如此反复进行，直到诊疗流程实例执行结束；2b) After the execution of the current node is completed, if the execution of the diagnosis and treatment process instance is not completed, execute the next node of the current node according to the method of step 2a), and so on until the execution of the diagnosis and treatment process instance is completed;
(3)在临床路径诊疗流程需要扩充或变更时，先按照步骤(1)的方法建立或更新临床路径工作流模型，再按照步骤(2)的方式执行新的临床路径工作流，实现可变性诊疗流程。(3) When the clinical pathway diagnosis and treatment process needs to be expanded or changed, first establish or update the clinical pathway workflow model according to the method of step (1), and then execute the new clinical pathway workflow according to the method of step (2) to achieve variability Diagnosis and treatment process.
本发明与现有技术相比具有如下优点：Compared with the prior art, the present invention has the following advantages:
第一，本发明通过基于国家授权医院出台的疾病标准临床路径，构建相应的诊疗流程，并将其表示为计算机可以识别的临床路径工作流模型，为医护人员提供从门诊到检查再到手术、住院治疗这一整套的诊疗流程控制，使得本发明具备覆盖医疗流程完整，覆盖病种多样，可扩展性好，可用性好的优点，克服了现有技术系统覆盖面狭窄，仅涉及一种疾病或者有限诊疗阶段，其可扩展性和可用性差的缺点。First, the present invention builds the corresponding diagnosis and treatment process based on the standard clinical pathway of the disease issued by the nationally authorized hospital, and expresses it as a clinical pathway workflow model that can be recognized by the computer, providing medical staff with a complete set of procedures from outpatient service to examination to surgery, The whole set of diagnosis and treatment process control of hospitalization enables the present invention to have the advantages of complete medical process coverage, diverse disease types, good scalability, and good usability, and overcomes the narrow coverage of the prior art system that only involves one disease or limited In the diagnosis and treatment stage, its scalability and usability are poor.
第二，本发明通过针对诊疗流程复杂的调度特性设计的子流程节点F、互斥开始节点、互斥汇聚节点、并发开始节点和并发汇聚节点，针对诊疗任务的时间设计的块活动节点、诊疗活动节点和子流程节点F的时间属性，克服了现有技术没有针对医疗领域进行设计，不能针对性地处理医疗流程调度复杂性和诊疗活动的时间性的缺点；Second, through the sub-process node F, mutually exclusive start node, mutually exclusive convergence node, concurrent start node and concurrent convergence node designed for the complex scheduling characteristics of the diagnosis and treatment process, the block activity node, diagnosis and treatment The time attribute of the activity node and the sub-process node F overcomes the shortcomings of the existing technology that is not designed for the medical field and cannot deal with the complexity of medical process scheduling and the timeliness of diagnosis and treatment activities;
第三，本发明构建的临床路径工作流模型是根据国家授权医院出台的标准临床路径诊疗流程建立的，克服了医疗流程不标准，没有统一的规范进行限定的缺点。Third, the clinical pathway workflow model constructed by the present invention is established according to the standard clinical pathway diagnosis and treatment process issued by the state-authorized hospital, which overcomes the shortcomings of non-standard medical process and no unified specification to define it.
附图说明Description of drawings
图1为本发明的实现总流程图；Fig. 1 is the realization overall flowchart of the present invention;
图2为本发明的临床路径工作流模型构建流程图；Fig. 2 is the construction flow chart of clinical pathway workflow model of the present invention;
图3为本发明的诊疗流程调度和控制流程图。Fig. 3 is a flow chart of diagnosis and treatment process scheduling and control in the present invention.
具体实施方式detailed description
下面结合附图对本发明做进一步的详细描述。The present invention will be described in further detail below in conjunction with the accompanying drawings.
参照附图1，本发明的实现步骤如下：With reference to accompanying drawing 1, the realization step of the present invention is as follows:
步骤1，构建临床路径工作流模型。Step 1, construct the clinical pathway workflow model.
一个完整的临床路径工作流模型可以用以表示完整的诊疗流程，也可以表示诊疗流程中的一个诊疗阶段，临床路径工作流模型中可以通过子流程节点F调用另一个临床路径工作流模型，比如，针对胫骨平台骨折诊疗流程、胫骨平台骨折诊断阶段和胫骨平台骨折治疗阶段构建三个完整的临床路径工作流模型，并在第一个工作流模型中设置子流程节点F分别调用后两个临床路径工作流，使后面两个临床路径工作流成为第一个临床路径工作流的一部分。A complete clinical path workflow model can be used to represent the complete diagnosis and treatment process, or a diagnosis and treatment stage in the diagnosis and treatment process. In the clinical path workflow model, another clinical path workflow model can be called through the sub-process node F, such as , construct three complete clinical path workflow models for the tibial plateau fracture diagnosis and treatment process, tibial plateau fracture diagnosis stage and tibial plateau fracture treatment stage, and set sub-process node F in the first workflow model to call the latter two clinical Pathway workflows to make the latter two clinical path workflows part of the first clinical path workflow.
参照图2，本步骤的具体实现步骤如下：With reference to Figure 2, the specific implementation steps of this step are as follows:
1a)设置诊疗活动节点A：将诊疗流程中的诊疗任务表示为诊疗活动节点A，通过诊疗活动节点A的时间属性指定诊疗任务执行的时间要求，通过诊疗活动节点A输入参数属性和输出参数属性指定诊疗任务与诊疗流程的数据交互。其中诊疗任务包括：主述采集、病史采集、诱因采集、症状采集、各种检查项目、各种生理指标项目、术前评估、手术方案选择、手术、用药、术后恢复、非手术治疗和出院。其中诊疗活动节点A的时间属性包括：开始执行诊疗任务的最早时间，开始执行诊疗任务的最晚时间，结束执行诊疗任务的最早时间和结束执行诊疗任务的最晚时间。比如，将诊疗任务术前评估、手术方案选择、手术、用药分别表示为诊疗活动节点A，通过设置用药所对应诊疗活动节点A的时间属性指定用药的开始执行时间为手术完成后30分钟到1个小时；再通过设置该节点的输入参数属性指定用药任务所需的病人基本信息、症状和用药目的，通过设置该节点的输出参数属性返回针对该病人的药物列表；1a) Setting diagnosis and treatment activity node A: express the diagnosis and treatment task in the diagnosis and treatment process as a diagnosis and treatment activity node A, specify the time requirement for the execution of the diagnosis and treatment task through the time attribute of the diagnosis and treatment activity node A, and use the input parameter attribute and output parameter attribute of the diagnosis and treatment activity node A Specify the data interaction between the diagnosis and treatment tasks and the diagnosis and treatment process. The diagnosis and treatment tasks include: collection of main statement, collection of medical history, collection of incentives, collection of symptoms, various inspection items, various physiological index items, preoperative evaluation, selection of surgical options, surgery, medication, postoperative recovery, non-surgical treatment and discharge . The time attributes of the diagnosis and treatment activity node A include: the earliest time to start the diagnosis and treatment task, the latest time to start the diagnosis and treatment task, the earliest time to end the diagnosis and treatment task, and the latest time to end the diagnosis and treatment task. For example, preoperative evaluation of diagnosis and treatment tasks, selection of surgical plans, surgery, and medication are respectively represented as diagnosis and treatment activity node A, and the time attribute of diagnosis and treatment activity node A corresponding to the medication is set to specify the start time of medication to be executed from 30 minutes to 1 hour after the operation is completed. Hours; then specify the basic patient information, symptoms and medication purpose required by the medication task by setting the input parameter attribute of the node, and return the drug list for the patient by setting the output parameter attribute of the node;
1b)设置子流程节点F：将其他流程的调用表示为子流程节点F，通过子流程节点F关键字属性和版本属性指定调用的流程，通过子流程节点F的时间属性指定所调用流程的时间要求。其中子流程节点F的时间属性包括：开始调用流程的最早时间，开始调用流程的最晚时间，结束调用流程的最早时间和结束调用流程的最晚时间。比如，当前构建的临床路径工作流模型针对特定疾病的完整的诊疗流程，在该诊疗流程中需要执行该疾病的治疗流程，通过设置子流程节点F节点指定该疾病治疗流程所对应的临床路径工作流模型，实现该疾病治疗流程的调用；1b) Set sub-process node F: express the call of other processes as sub-process node F, specify the called process through the keyword attribute and version attribute of sub-process node F, and specify the time of the called process through the time attribute of sub-process node F Require. The time attributes of the sub-process node F include: the earliest time to start calling the process, the latest time to start calling the process, the earliest time to end the calling process, and the latest time to end the calling process. For example, the currently constructed clinical path workflow model is aimed at the complete diagnosis and treatment process of a specific disease. In the diagnosis and treatment process, the treatment process of the disease needs to be executed, and the clinical path work corresponding to the disease treatment process is specified by setting the sub-process node F node The flow model realizes the invocation of the disease treatment process;
1c)设置流程跳转节点G：将结束当前诊疗流程并跳转到另一个诊疗流程表示为流程跳转节点G，通过流程跳转节点G关键字属性和版本属性指定跳转到的流程。比如，在门诊流程中对病人进行了初步诊断，需要进入骨科诊疗流程，通过子流程节点G从门诊流程转移到骨科诊疗流程；1c) Set up the process jump node G: the end of the current diagnosis and treatment process and jump to another diagnosis and treatment process will be represented as a process jump node G, and the jump to process will be specified by the key attribute and version attribute of the process jump node G. For example, if a patient is initially diagnosed in the outpatient process, it needs to enter the orthopedic diagnosis and treatment process, and transfer from the outpatient process to the orthopedic diagnosis and treatment process through sub-process node G;
1d)设置异常处理节点I：将诊疗流程中变异和异常的处理表示为异常处理节点I。其中诊疗流程中变异和异常是指病人在诊疗过程中由于特定原因偏离预定的诊疗流程，该特定原因包括：医护人员的失误操作和错误操作、医疗设备异常，病人的复杂身体状况或病人未配合完成诊疗任务。比如，病人拒绝治疗，使得病人的诊疗过程偏离了特定的诊疗流程，通过设置异常处理节点I对病人进行一定处理，并结束诊疗流程实例；1d) Setting exception processing node I: the processing of mutations and abnormalities in the diagnosis and treatment process is represented as exception processing node I. The variation and abnormality in the diagnosis and treatment process refer to the patient’s deviation from the scheduled diagnosis and treatment process due to specific reasons, such as: misoperation and wrong operation of medical staff, abnormal medical equipment, complex physical condition of the patient or failure of the patient to cooperate. Complete medical tasks. For example, the patient refuses treatment, which makes the patient's diagnosis and treatment process deviate from the specific diagnosis and treatment process, and the patient is processed by setting the exception processing node I, and the diagnosis and treatment process instance is ended;
1e)设置信息节点J：将警告或错误消息的展示表示为信息节点J，通过信息节点J的类型属性指定警告或错误消息类型，通过信息节点J的详细信息属性指定消息的内容；1e) Setting information node J: displaying warning or error messages as information node J, specifying the type of warning or error message through the type attribute of information node J, and specifying the content of the message through the detailed information attribute of information node J;
1f)设置流程开始节点K：将流程的入口表示为流程开始节点K；1f) Set process start node K: represent the entry of the process as process start node K;
1g)设置流程结束节点L：将结束当前流程的执行表示为流程结束节点L。比如，在治疗流程过程中，通过流程结束节点L结束当前治疗流程，返回疾病诊疗流程；1g) Set the end node L of the process: denote the end of the execution of the current process as the end node L of the process. For example, during the treatment process, end the current treatment process through the process end node L and return to the disease diagnosis and treatment process;
1h)设置实例终结节点M：将结束当前诊疗流程实例的执行表示为实例终结节点M。比如，在治疗流程中，通过实例终结节点M结束该病人相关的诊疗流程；1h) Setting the instance end node M: denote the end of the execution of the current diagnosis and treatment process instance as the instance end node M. For example, in the treatment process, the patient-related diagnosis and treatment process is ended through the instance termination node M;
1i)连接各节点，创建流程线路：将节点先后执行顺序表示为连接元素N对节点的先后连接，形成多个不分叉的流程片段，其中每一个流程片段作为一条流程线路。比如，将术前评估、手术方案选择、手术、用药、术后恢复所对应的诊疗活动节点A先后连接形成一条流程线路；1i) Connect each node and create a process line: express the sequential execution sequence of nodes as the sequential connection of connection elements N to nodes, forming multiple non-forking process segments, each of which is regarded as a process line. For example, the diagnosis and treatment activity nodes A corresponding to preoperative evaluation, surgical plan selection, surgery, medication, and postoperative recovery are connected successively to form a process line;
1j)设置互斥开始节点B和互斥汇聚节点C：在已形成的多个流程线路中，如果其中有几条流程线路相互之间只能有一条被选择执行，则将这些流程线路作为一组，通过连接元素N将互斥开始节点B连接到这组流程线路的每条线路的首个节点，通过连接元素N将这组流程线路的每条线路的最后一个节点连接到互斥汇聚节点C，在互斥开始节点B中指定流程线路选择规则，其中规则的每一个结果对应这组流程线路的一条线路，使这组流程线路合并形成新的流程线路。其中流程线路选择规则是根据当前病人的病症、检查结果和当前诊疗阶段信息匹配和推理出进一步需要做的检查、初步诊断、确诊或治疗方式的决策支持结果，该结果用于选择流程线路。比如，将非手术治疗和手术治疗所对应的流程线路合并为治疗所对应的流程线路，在互斥开始节点B中设置非手术治疗和手术治疗流程线路选择规则；1j) Set mutually exclusive starting node B and mutually exclusive converging node C: among the multiple process lines that have been formed, if only one of several process lines among them can be selected for execution, these process lines are regarded as one Group, connect the mutually exclusive start node B to the first node of each line of this set of flow lines through the connection element N, and connect the last node of each line of the set of flow lines to the mutually exclusive sink node through the connection element N C. Specify a process route selection rule in the mutually exclusive start node B, where each result of the rule corresponds to a route of this group of process routes, so that this group of process routes can be merged to form a new process route. The process line selection rule is based on the current patient's symptoms, examination results, and current diagnosis and treatment stage information to match and infer the decision support results of further examinations, preliminary diagnosis, diagnosis or treatment methods that need to be done, and the results are used to select process lines. For example, merge the flow lines corresponding to non-surgical treatment and surgical treatment into the flow line corresponding to treatment, and set the flow line selection rules for non-surgical treatment and surgical treatment in mutually exclusive start node B;
1k)设置并发开始节点D和并发汇聚节点E：在已形成的多个流程线路中，如果其中有几条流程线路相互之间能同时执行或按任意顺序执行，则将这些流程线路作为一组，通过连接元素N将该并发开始节点D连接到这组流程线路的每条线路的首个节点，通过连接元素N将这组流程线路的每条线路的最后一个节点连接到该互斥汇聚节点E，使这组流程线路合并形成新的流程线路。比如，病史采集、症状采集和诱因采集可以按任意顺序执行，将这三个诊疗任务所对应的流程线路合并为基本信息采集流程线路；1k) Set concurrent start node D and concurrent sink node E: Among the multiple process lines that have been formed, if several process lines can be executed simultaneously or in any order, these process lines are regarded as a group , connect the concurrent start node D to the first node of each line of this set of flow lines through a connection element N, and connect the last node of each line of this set of flow lines to the mutually exclusive sink node through a connection element N E, make this group of process lines merge to form a new process line. For example, medical history collection, symptom collection, and incentive collection can be performed in any order, and the process lines corresponding to these three diagnosis and treatment tasks are merged into the basic information collection process line;
1l)重复1k)和1l)的过程，使整个流程成为一条流程线路；1l) Repeat the process of 1k) and 1l), so that the whole process becomes a flow line;
1m)设置块活动节点H：将整个流程中多个紧密联系的节点通过块活动节点H进行分组，块活动不与其他节点连接，通过块活动节点H的时间属性指定块活动节点H划分的组内所有节点的执行需满足的时间要求。其中块活动节点H的时间属性包括：开始执行块活动节点H所划分的组内诊疗任务的最早时间，开始执行块活动节点H所划分的组内诊疗任务的最晚时间，结束执行块活动节点H所划分的组内诊疗任务的最早时间和结束执行块活动节点H所划分的组内诊疗任务的最晚时间。比如，术后处理过程中包含有多个诊疗任务，并且这组诊疗任务发生在手术结束后1个小时以内，通过块活动节点H将这些诊疗任务所对应的节点划分为一组，通过块活动节点H的时间属性指定这组节点开始执行时间为手术结束后1个小时以内。1m) Set block activity node H: group multiple closely related nodes in the whole process through block activity node H, block activity is not connected with other nodes, and specify the group divided by block activity node H through the time attribute of block activity node H The execution time requirements of all nodes in the node must be met. The time attributes of the block activity node H include: the earliest time to start executing the diagnosis and treatment tasks in the group divided by the block activity node H, the latest time to start executing the diagnosis and treatment tasks in the group divided by the block activity node H, and the end of the execution of the block activity node The earliest time of the diagnosis and treatment tasks in the group divided by H and the latest time of the completion of the diagnosis and treatment tasks in the group divided by the block activity node H. For example, the postoperative treatment process contains multiple diagnostic and therapeutic tasks, and this group of diagnostic and therapeutic tasks occurs within one hour after the operation. The nodes corresponding to these diagnostic and therapeutic tasks are divided into a group through the block activity node H, and through the block activity The time attribute of node H specifies that the execution time of this group of nodes is within 1 hour after the operation ends.
步骤2，根据临床路径工作流模型，对诊疗流程的执行进行调度和控制。Step 2, according to the clinical path workflow model, schedule and control the execution of the diagnosis and treatment process.
病人入诊时，根据当期的病人所在的科室，执行针对该科室的临床路径工作流，依据该工作流，对诊疗流程进行调度和控制，通过该工作流中的流程转移节点转移到其他针对特定疾病或特定诊疗处理的临床路径工作流，根据新的工作流，继续对诊疗流程进行调度和控制，实现完整的诊疗流程的调度和控制；When a patient enters the clinic, according to the department where the current patient is located, the clinical path workflow for the department is executed, and the diagnosis and treatment process is scheduled and controlled according to the workflow. The clinical path workflow of disease or specific diagnosis and treatment, according to the new workflow, continue to schedule and control the diagnosis and treatment process, and realize the scheduling and control of the complete diagnosis and treatment process;
参照图3，本步骤的具体实现步骤如下：With reference to Figure 3, the specific implementation steps of this step are as follows:
2a)根据当前节点的不同的类别，执行流程开始节点K的下一个节点，实施对诊疗流程执行的调度和控制：2a) According to the different categories of the current node, execute the next node of the process start node K, and implement the scheduling and control of the execution of the diagnosis and treatment process:
如果当前节点是诊疗活动节点A，并且满足该节点的时间属性指定的时间要求，则执行该诊疗活动节点A所对应的诊疗任务。比如，当前节点所对应的诊疗任务为用药，药物治疗开始时间为术后30分钟到1个小时，当前时间为手术40分钟，则药物治疗可执行；If the current node is a diagnosis and treatment activity node A and meets the time requirement specified by the node's time attribute, then execute the diagnosis and treatment task corresponding to the diagnosis and treatment activity node A. For example, the diagnosis and treatment task corresponding to the current node is medication, the starting time of drug treatment is 30 minutes to 1 hour after surgery, and the current time is 40 minutes after surgery, then the drug treatment can be performed;
如果当前节点是互斥开始节点B，则获取该节点中指定的流程线路选择规则的结果，根据该结果选择并执行该互斥开始节点B后续的多个流程线路中一条流程线路。比如，根据病人的病症，流程线路选择规则的结果的为手术治疗，则执行手术治疗所对应的流程线路；If the current node is the mutually exclusive starting node B, obtain the result of the process route selection rule specified in the node, and select and execute one of the multiple process routes subsequent to the mutually exclusive starting node B according to the result. For example, according to the patient's illness, if the result of the process line selection rule is surgical treatment, then execute the process line corresponding to the surgical treatment;
如果当前节点是互斥汇聚节点C，则执行该节点后续的流程线路。比如，当前互斥汇聚节点C用于合并手术治疗和非手术治疗所对应的两条流程线路，合并后的线路为治疗流程线路，手术治疗流程线路执行结束后，继续执行后续的治疗流程线路；If the current node is a mutually exclusive sink node C, then execute the subsequent process lines of this node. For example, the current mutually exclusive convergence node C is used to merge two process lines corresponding to surgical treatment and non-surgical treatment, the merged line is the treatment process line, and after the execution of the surgical treatment process line, continue to execute the subsequent treatment process line;
如果当前节点是并发开始节点D，则同时执行该节点后续的多个流程线路。比如，该节点后续有病史采集、症状采集和诱因采集所对应的三条流程线路，则同时执行这三条流程线路，医护人员可以按任意顺序执行来自这三条流程线路中的诊疗任务；If the current node is a concurrent start node D, multiple subsequent process lines of this node are executed at the same time. For example, if there are three process lines corresponding to medical history collection, symptom collection and inducement collection in the follow-up of this node, these three process lines are executed at the same time, and medical staff can perform diagnosis and treatment tasks from these three process lines in any order;
如果当前节点是并发汇聚节点E，则等待所有以该节点作为终点的流程线路均执行完成，执行该节点后续的流程线路。比如，该节点用于合并病史采集、症状采集和诱因采集所对应的三条流程线路，则等待这三条流程线路均执行完成，执行后续的诊断流程线路；If the current node is a concurrent sink node E, wait for all the process lines with this node as the end point to be executed, and execute the subsequent process lines of this node. For example, this node is used to merge the three process lines corresponding to medical history collection, symptom collection and incentive collection, then wait for the execution of these three process lines to complete, and execute the subsequent diagnosis process line;
如果当前节点是流程结束节点L，则结束当前流程的执行，如果当前流程为通过子流程节点F调用的流程，则返回该子流程节点F所在的流程继续执行，否则，结束当前诊疗流程实例的执行。比如，结束治疗流程，返回诊疗流程；If the current node is the process end node L, then end the execution of the current process, if the current process is a process called by the sub-process node F, then return to the process where the sub-process node F is located to continue execution, otherwise, end the current diagnosis and treatment process instance implement. For example, end the treatment process and return to the diagnosis and treatment process;
如果当前节点是实例终结节点M，则结束当前诊疗流程实例的执行。比如，由于诊疗流程变异和异常，导致当前诊疗流程需停止执行；If the current node is the instance end node M, the execution of the current diagnosis and treatment process instance is ended. For example, due to variations and abnormalities in the diagnosis and treatment process, the current diagnosis and treatment process needs to be stopped;
如果当前节点是流程跳转节点G，则结束当前流程的执行，开始执行该流程跳转节点G指定的流程。比如，从门诊流程转移到骨科诊疗流程；If the current node is a process jump node G, the execution of the current process ends, and the process specified by the process jump node G starts to be executed. For example, transfer from the outpatient process to the orthopedic diagnosis and treatment process;
如果当前节点是子流程节点F，且满足该节点的时间属性指定的时间要求，则开始执行该子流程节点F指定的流程，当指定的流程执行结束时，继续执行该子流程节点F所在的流程。比如，当前节点调用执行治疗流程，治疗流程结束执行后，返回当前诊疗流程继续执行；If the current node is a sub-process node F and meets the time requirements specified by the time attribute of the node, then start to execute the process specified by the sub-process node F, and when the specified process execution ends, continue to execute the process where the sub-process node F is located process. For example, the current node calls to execute the treatment process, and after the treatment process is completed, it returns to the current diagnosis and treatment process to continue execution;
如果当前节点是异常处理节点I，则执行异常处理节点I中定义的异常处理：当异常处理节点I包含多个节点组成的流程片段时，该流程片段将被执行，所有没有连接元素N连接到的节点同时执行或按任意顺序执行；当异常处理节点I引用另一个已定义的异常处理节点I中的异常处理，而未定义所包含的流程片段时，则执行该引用的异常处理节点I中定义的异常处理；当异常处理节点I中执行了实例终结节点M和流程结束节点L，则结束诊疗流程实例或者当前流程的执行，否则，继续执行后续的流程。比如，发生病人拒绝治疗的情形，异常处理节点I被执行，并对病人进行特定的处理；If the current node is an exception handling node I, execute the exception handling defined in the exception handling node I: When the exception handling node I contains a process segment composed of multiple nodes, the process segment will be executed, and all unconnected elements N are connected to The nodes are executed at the same time or in any order; when the exception handling node I refers to the exception handling in another defined exception handling node I, and the contained process fragment is not defined, the referenced exception handling node I is executed Defined exception handling; when the instance end node M and the process end node L are executed in the exception handling node I, the execution of the diagnosis and treatment process instance or the current process will be ended, otherwise, the subsequent process will continue to be executed. For example, when a patient refuses treatment, the exception handling node I is executed, and specific treatment is performed on the patient;
如果当前节点是信息节点J，则向用户输出警告或错误信息。比如，当前病人存在血栓症状，医护人员执行手术时，向医护人员输出“血栓情况下不可执行手术”的错误信息；If the current node is an inode J, output a warning or error message to the user. For example, when the current patient has thrombosis symptoms, when the medical staff performs the operation, an error message is output to the medical staff that "the operation cannot be performed under the condition of thrombosis";
2b)当前节点执行结束后，如果诊疗流程实例未执行结束，则按照步骤2a)的方式执行当前节点的下一个节点，如此反复进行，直到诊疗流程实例执行结束。2b) After the execution of the current node is completed, if the execution of the diagnosis and treatment process instance is not completed, the next node of the current node is executed according to the method of step 2a), and this is repeated until the execution of the diagnosis and treatment process instance is completed.
步骤3，在临床路径诊疗流程需要扩充或变更时，先按照步骤1的方法建立或更新临床路径工作流模型，再按照步骤2的方式执行新的临床路径工作流，实现可变性诊疗流程。Step 3. When the clinical pathway diagnosis and treatment process needs to be expanded or changed, first establish or update the clinical pathway workflow model according to the method of step 1, and then execute the new clinical pathway workflow according to the method of step 2 to realize the variable diagnosis and treatment process.
比如，当前只有门诊流程和胫骨平台骨折的诊疗流程所对应的临床路径工作流模型，并且从门诊流程中可以转移到胫骨平台骨折的诊疗流程，当前需要扩充对冠心病诊疗流程的支持，则建立冠心病诊疗流程所对应的临床路径工作流模型，再更新门诊流程所对应的临床路径工作流模型，使得可以从门诊流程转移到冠心病诊疗流程；如果在现有的胫骨平台骨折诊疗流程中，需要增加血栓情况下不可进行手术治疗的限制，则修改手术治疗和非手术治疗所对应的流程线路选择规则，使得在血栓情况下得出的规则结果不为手术治疗。For example, currently there are only clinical pathway workflow models corresponding to the outpatient process and the diagnosis and treatment process of tibial plateau fractures, and the outpatient process can be transferred to the diagnosis and treatment process of tibial plateau fractures. At present, it is necessary to expand support for the diagnosis and treatment process of coronary heart disease. Establish The clinical pathway workflow model corresponding to the coronary heart disease diagnosis and treatment process, and then update the clinical pathway workflow model corresponding to the outpatient process, so that the outpatient process can be transferred to the coronary heart disease diagnosis and treatment process; if in the existing tibial plateau fracture diagnosis and treatment process, If it is necessary to increase the restriction that surgical treatment cannot be performed in the case of thrombus, modify the process line selection rules corresponding to surgical treatment and non-surgical treatment, so that the rule result obtained in the case of thrombosis is not surgical treatment.
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| CN201410675236.5ACN104331853A (en) | 2014-11-21 | 2014-11-21 | Implementation method for variability of diagnosis and treatment process |
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| CN201410675236.5ACN104331853A (en) | 2014-11-21 | 2014-11-21 | Implementation method for variability of diagnosis and treatment process |
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| CN104331853Atrue CN104331853A (en) | 2015-02-04 |
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| CN201410675236.5APendingCN104331853A (en) | 2014-11-21 | 2014-11-21 | Implementation method for variability of diagnosis and treatment process |
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