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病案信息是患者、医院和社会共同使用的宝贵资源,具有服务于医院科学决策、医疗质量控制、医疗和教学研究、医院经营管理、医疗保险管理、医患纠纷处理、卫生防疫决策等方面的功能和价值,必须高度认识病案信息的重要作用,加强病案信息的科学采集、分类、使用、保存管理,严格执行病案管理制度,确保病案信息的真实性、完整性及准确性,提高病案的内在质量,合理开发利用病案信息资源,充分发挥病案信息的服务效用。
Medical record information is a valuable resource shared by patients, hospitals, and society. It has functions in serving hospital scientific decision-making, medical quality control, medical and teaching research, hospital management, medical insurance management, doctor-patient dispute handling, and sanitation and epidemic prevention decisions. And value, we must highly understand the important role of medical record information, strengthen the scientific collection, classification, use, preservation management of medical record information, strictly implement the medical record management system, ensure the authenticity, completeness and accuracy of medical record information, and improve the internal quality of medical record. , Reasonably develop and utilize the medical record information resources, and give full play to the service effectiveness of medical record information.