在臨床醫(yī)學(xué)中怎樣用藥

1、Chapter 1: Health Care Delivery SystemsFeipei LaiNational Taiwan University 1Health Care Delivery SystemsHistory of Medicine and Health care DeliveryContinuum of CareHealth Care Facility OwnershipHealth Care Facility Organizational StructureLicensure, Regulation, and Accreditation2IntroductionHealth

2、 care delivery has been greatly impacted by escalating costs, resulting in medical necessity requirements, review of appropriateness of admissions, and requirement for administration of quality and effective treatments.3MRXO在臨床醫(yī)學(xué)中，進(jìn)行手術(shù)時(shí)同時(shí)使用磁振造影並整合各種影像技術(shù)是目前最熱門(mén)的醫(yī)療概念。新式的未來(lái)手術(shù)室中，安裝有全球首套MRXO解決方案，即完全整合磁振造影

3、(MR)、光及電腦斷層掃描(CT)系統(tǒng)，大幅減少病患危險(xiǎn)並簡(jiǎn)化醫(yī)師的手續(xù)，可望提高手術(shù)成功率。這項(xiàng)由日本東海大學(xué)、飛利浦醫(yī)療系統(tǒng)事業(yè)部合力推動(dòng)的未來(lái)手術(shù)室，已經(jīng)由日本東海大學(xué)的松前教授、津具醫(yī)師、山本醫(yī)師共同在手術(shù)室同時(shí)使用MR(磁振造影)和X光影像技術(shù)，來(lái)進(jìn)行神經(jīng)外科手術(shù)。4MRXO在未來(lái)手術(shù)室中執(zhí)行手術(shù)，可依執(zhí)刀醫(yī)師與病患狀況，在數(shù)分鐘內(nèi)將病患從手術(shù)臺(tái)搬移到磁振造影、電腦斷層掃描或光診斷系統(tǒng)，增加手術(shù)精密度與成功率。在磁振造影和電腦斷層掃描區(qū)域有拉門(mén)。5History of Medicine & Health Care DeliveryHistory of medicineEvolutio

4、n of health care delivery in the United States6History of medicineIn 1994, scientists discovered the genes responsible for many cases of hereditary colon cancer, inherited breast cancer, and the most common type of kidney cancer.7Evolution of health care delivery in the United States1991 The Workgro

5、up on Electronic Data Interchange (WEDI) was created to reduce health care administrative costs through implementation of the electronic data interchange (EDI), which uses national standards to transmit data for reimbursement purposes.8Evolution of health care delivery in the United States1996 The H

6、ealth Insurance Portability and Accountability Act (HIPAA) was passed.It mandates administrative simplification regulations that govern privacy, security, and electronic transaction standards for health care information.9Evolution of health care delivery in the United States1996 The Healthcare Integ

7、rity and Protection Data Bank (HIPDB) was created which combats fraud and abuse in health insurance and health care delivery by alerting users to conduct a comprehensive review of a practitioners, providers, or suppliers past actions.10Healthcare Integrity and Protection Data BankAccess to informati

8、on in the HIPDB is available to entities that meet the eligibility requirements defined in Section 1128E of the Social Security Act and the HIPDB regulations. In order to access information, eligible entities must first register with the Data Bank.HIPDB information is not available to the general pu

9、blic. However, information in a form that does not identify any particular entity or practitioner is available.11Healthcare Integrity and Protection Data BankEstimates of annual losses due to health care fraud range from 3 to 10percent of all health care expenditures-between $30billion and $100billi

10、on based on estimated 1997 expenditures of over $1 trillion and 2.5 trillion for 2009.12Continuum of CareA complete range of programs and services is called a continuum of care, with the type of health care indicating the health care services provided.Primary careSecondary careTertiary care13Primary

11、 care servicesInclude preventive and acute care, are referred to as the point of first care, and are provided by a general practitioner or other health professional who has the first contact with a patient seeking medical treatment, including general dental, ophthalmic 眼科的, and pharmaceutical servic

12、es.14Primary care servicesAnnual physical examinationsEarly detection of diseaseFamily planningHealth educationImmunizationsTreatment of minor illnesses and injuriesVision and hearing screening15Secondary care servicesProvided by medical specialists or hospital staff members to a patient whose prima

13、ry care was provided by a general practitioner who first diagnosed or treated the patient.16Tertiary care servicesProvided by specialized hospitals equipped with diagnostic and treatment facilities not generally available at hospitals other than primary teaching hospital or Level I, II, III or IV tr

14、auma centers.17Trauma centersLevel I: provides the highest level of comprehensive care for severely injured adult and pediatric patients with complex, multi-system trauma.Level II: broad range of sub-specialists are on-call and promptly available to provide consultation or care.18Trauma centersLevel

15、 III: physicians are advanced trauma life support (ATLS) trained and experienced in caring for traumatically injured patients; nurses and ancillary staff are in-house and immediately available to initiate resuscitative measures.19Trauma centersLevel IV: critically injured patients who require specia

16、lty care are transferred to a higher level trauma system hospital in accordance with pre-established criteria.20Tertiary careBurn center treatmentCardiothoracic and vascular surgeryInpatient care for AIDS patientsMagnetic resonance imaging (MRI)Neonatology level III unit servicesNeurosurgeryOrgan tr

17、ansplant21Tertiary carePediatric surgeryPositron emissions tomography (PET)Radiation oncologyServices provided to a person with a high-risk pregnancyServices provided to a person with cancerState-designated trauma centersTrauma surgery22Positron emissions tomography (PET)builds images by detecting e

18、nergy given off by decaying radioactive isotopes.Isotopes are atoms of an element with the same number of protons (positively charged particles) in the nucleus, but a different number of neutrons (neutral particles).Because radioactive isotopes are unstable, as they decay, they throw off positrons t

19、hat collide with electrons and produce gamma rays that shoot off in nearly opposite directions. 23PET PET systems use the paths of the two detected gamma rays to determine the originating collision point, a process called electronic collimation (瞄準(zhǔn)).The scanners use a circular series of gamma ray-de

20、tectors to envelope the patient so both gammas can be detected so the instrument can use electronic collimation to predict where the energy signal originated.This signal is then converted into a three-dimensional image slice. 24臺(tái)灣醫(yī)院分類(lèi)診所地區(qū)醫(yī)院 (497/2005)區(qū)域醫(yī)院 (80/2005, 65/2006, 64/2007)醫(yī)學(xué)中心 (23/2005, 18

21、/2006, 19/2007, 14/2009)25醫(yī)學(xué)中心在衛(wèi)生局登記開(kāi)放的急性一般病床與急性精神病床合計(jì)須達(dá)五百床以上至少應(yīng)能提供 家庭醫(yī)學(xué)、內(nèi)、外、婦產(chǎn)、兒、骨、神經(jīng)外、泌尿、耳鼻喉、眼、皮膚、神經(jīng)、精神、復(fù)健、麻醉、放射線、病理、核醫(yī)、牙 等十九科之診療服務(wù)。 26醫(yī)學(xué)中心專(zhuān)任主治醫(yī)師人數(shù) (包括主任在內(nèi)) 每八床應(yīng)有一名。專(zhuān)任護(hù)理人員每2床至少1名。加護(hù)病房：每床2.5名。手術(shù)室：每班每臺(tái)2.5名。手術(shù)恢復(fù)室：每班每床0.5名。產(chǎn)房及待產(chǎn)室：每床2名。嬰兒室：每床0.4名。急診室：觀察室每床0.5名；診療室每12人次1名。門(mén)診：每班每診療室0.5名。血液透析室：每4人次1名。行政、教

22、學(xué)、研究及其他護(hù)理人員 (如院內(nèi)感染控制、公衛(wèi)、供應(yīng)中心等護(hù)理人員) 另計(jì)，應(yīng)佔(zhàn)總?cè)藬?shù)百分之六。應(yīng)有受過(guò)感染控制訓(xùn)練之專(zhuān)任護(hù)理人員，每300床應(yīng)設(shè)1名。27醫(yī)學(xué)中心藥事人員每40床至少1名。每60張門(mén)診處方至少1名。特殊藥品處方每15張至少1名。藥事人員總數(shù)至少四分之三為藥師。藥事人員至少有4名負(fù)責(zé)藥品管理諮詢及臨床等工作。28區(qū)域醫(yī)院應(yīng)設(shè)置250床位以上急性病病床數(shù)每床所擁有的樓地板面積應(yīng)在50平方公尺以上每9床至少應(yīng)擁有一名主治醫(yī)師每2.5床至少應(yīng)擁有一名護(hù)理人員等。至少應(yīng)能提供 家庭醫(yī)學(xué)、內(nèi)、外、婦產(chǎn)、兒、骨、耳鼻喉、眼、精神、復(fù)健、麻醉、放射線、病理、牙 等十四科之診療服務(wù)。 29區(qū)域

23、醫(yī)院 Nurse加護(hù)病房：每床2名。手術(shù)室：每班每臺(tái)2名。手術(shù)恢復(fù)室：每班每床0.5名。產(chǎn)房及待產(chǎn)室：每床1.2名。嬰兒室：每床0.4名。急診室：觀察室每床0.5名；診療室每12人次1名。門(mén)診：每班每診療室0.5名。血液透析室：每4人次1名。行政、教學(xué)、研究及其他護(hù)理人員 (如院內(nèi)感染控制、公衛(wèi)、供應(yīng)中心等護(hù)理人員) 另計(jì)，應(yīng)佔(zhàn)總?cè)藬?shù)百分之四。應(yīng)有受過(guò)感染控制訓(xùn)練之專(zhuān)任護(hù)理人員，每300床應(yīng)設(shè)1名。30區(qū)域醫(yī)院藥事人員每50床至少1名。每70張門(mén)診處方至少1名。特殊藥品處方每15張至少1名。藥事人員總數(shù)至少四分之三為藥師。藥事人員中，至少有2名負(fù)責(zé)藥品管理諮詢及臨床等工作。 31地區(qū)醫(yī)院在衛(wèi)生

24、局登記開(kāi)放的急性一般病床需20床以上，急性一般病床及急性精神病床合計(jì)249床（含）以下。32地區(qū)醫(yī)院專(zhuān)任員工總?cè)藬?shù)每床應(yīng)有1名。專(zhuān)任主治醫(yī)師人數(shù)以及專(zhuān)任護(hù)理人員應(yīng)符合醫(yī)療機(jī)構(gòu)設(shè)置標(biāo)準(zhǔn)。藥事人員每50床至少1名。每80張門(mén)診處方至少1名。每增加100張?zhí)幏綉?yīng)增加1名。應(yīng)有藥師1人以上。 33評(píng)鑑分級(jí)設(shè)施總樓地板面積病房設(shè)施安全設(shè)備及一般設(shè)備保險(xiǎn)病床比率34評(píng)鑑分級(jí)人員員工總?cè)藬?shù) 醫(yī)師總數(shù)麻醉科醫(yī)師 放射線科醫(yī)師核醫(yī)科醫(yī)師 病理科醫(yī)師復(fù)健科醫(yī)師 精神科醫(yī)師護(hù)理 藥事醫(yī)事檢驗(yàn) 醫(yī)用放射線技術(shù)復(fù)健技術(shù) 精神科社會(huì)工作 營(yíng)養(yǎng)師病歷管理35評(píng)鑑分級(jí)醫(yī)療業(yè)務(wù)及設(shè)備醫(yī)療業(yè)務(wù) 急性病床數(shù)診療科別 急診業(yè)務(wù)手術(shù)及

25、麻醉作業(yè) 產(chǎn)房嬰兒室 加護(hù)病房藥事作業(yè) 檢驗(yàn)作業(yè)輸血作業(yè) 放射線診療作業(yè)病理作業(yè) 復(fù)健醫(yī)療作業(yè)精神科 核子醫(yī)學(xué)牙科 特殊醫(yī)療服務(wù)醫(yī)務(wù)社會(huì)服務(wù)工作 營(yíng)養(yǎng)部門(mén)病歷部門(mén) 社區(qū)衛(wèi)生服務(wù)員工健康檢查36評(píng)鑑分級(jí)品質(zhì)保證醫(yī)療品質(zhì)審查感染控制人體試驗(yàn)藥事作業(yè)品質(zhì)護(hù)理服務(wù)品質(zhì)檢驗(yàn)作業(yè)品質(zhì)管制輸血作業(yè)品質(zhì)管制病理作業(yè)品質(zhì)管制放射線診療品質(zhì)管制核子醫(yī)學(xué)品質(zhì)管制病歷管理醫(yī)院管理業(yè)務(wù)醫(yī)病關(guān)係之促進(jìn)37評(píng)鑑分級(jí)指定項(xiàng)目評(píng)估住院 診斷 處置 用藥 手術(shù) 病歷寫(xiě)作38評(píng)鑑分級(jí)教學(xué)訓(xùn)練教學(xué)師資 教學(xué)訓(xùn)練與研究設(shè)備 教學(xué)訓(xùn)練活動(dòng) 與其他醫(yī)院(醫(yī)學(xué)院)交流合作情形 研究情形及論文發(fā)表 教學(xué)進(jìn)修研究經(jīng)費(fèi)39新制教學(xué)醫(yī)院評(píng)鑑基準(zhǔn)教學(xué)

26、資源教學(xué)訓(xùn)練計(jì)畫(huà)與成果研究執(zhí)行與成果臨床師資培育及繼續(xù)教育學(xué)術(shù)交流與社區(qū)功能及角色管理行政40財(cái)團(tuán)法人醫(yī)院評(píng)鑑暨醫(yī)療品質(zhì)策進(jìn)會(huì)41Health Care Facility OwnershipGovernment (not-for-profit) 25%Proprietary (for-profit) 15%Voluntary (not-for-profit) 60%42Medical StaffIntern: a physician in the first year of graduate medical education, which ordinarily immediately fol

27、lows completion of the four-year medical curriculum.Resident: a physician who has completed an internship and is engaged in a program of training designed to increase his or her knowledge of the clinical disciplines of medicine, surgery, or any of the other special fields that provide advanced train

28、ing in preparation for the practice of a specialty.43Medical StaffChief resident: a physician who is in his final year of residency or in the year after the residency has been completed.Visiting Staff (VS): 主治醫(yī)師44Health Care Facility Organizational StructureGoverning boardAdministrationMedical staff

29、Departments, services, and committeesContracted services45Governing boardThe governing board (board of trustees, board of governors, board of directors) serves without pay, and its membership is represented by professionals from the business community.46Administration Serves as liaison between the m

30、edical staff and governing board and is responsible for developing a strategic plan for supporting the mission and goals of the organization.CEO: chief executive officeCFO: chief financial officerCIO: chief information officerCOO: chief operating officer47Medical staffConsists of licensed physicians

31、 and other licensed providers as permitted by law (e.g., nurse practitioners and physician assistants) who are granted clinical privileges.48physician assistantsExamine, diagnose, and treat patients under the direct supervision of a physician.49Medical staff membership categoriesActive: delivers mos

32、t hospital medical services, performs significant organizational and administrative medical staff dutiesAssociate: advancement to active category is being consideredConsultingCourtesy: admits an occasional patient to the hospitalHonorary5051Hospital departments, Services, and Committees52NTUH Depart

33、ments秘書(shū)室 總務(wù)室 企劃管理室病歷資訊管理室醫(yī)療事務(wù)室 社會(huì)工作室 公共事務(wù)室工務(wù)室 資訊室 圖書(shū)室 安全衛(wèi)生室警衛(wèi)隊(duì) 會(huì)計(jì)室 人事室 教學(xué)部醫(yī)學(xué)工程部53NTUH Departments內(nèi)科部外科部 骨科部 婦產(chǎn)部 小兒部神經(jīng)部 精神部 耳鼻喉部 眼科部 泌尿部皮膚部 牙科部 復(fù)健部家庭醫(yī)學(xué)部麻醉部影像醫(yī)學(xué)部 核子醫(yī)學(xué)部檢驗(yàn)醫(yī)學(xué)部病理部 藥劑部 護(hù)理部營(yíng)養(yǎng)部 綜合診療部醫(yī)學(xué)研究部基因醫(yī)學(xué)部 門(mén)診部 急診醫(yī)學(xué)部 腫瘤醫(yī)學(xué)部創(chuàng)傷醫(yī)學(xué)部 老年醫(yī)學(xué)部 環(huán)境及職業(yè)醫(yī)學(xué)部54NTUH Departments品質(zhì)管理中心資財(cái)管理中心健康管理中心 肝炎研究中心形體美容醫(yī)學(xué)研究中心國(guó)家級(jí)卓越臨床驗(yàn)與研究

34、中心55抗老及健康諮詢中心 心臟衰竭中心乳房醫(yī)學(xué)中心感染控制中心運(yùn)動(dòng)醫(yī)學(xué)中心過(guò)敏免疫中心臨床心理中心健康教育中心睡眠中心國(guó)際醫(yī)療中心56The Johns Hopkins HospitalAllergy and Clinical ImmunologyAnesthesiology/Critical Care MedicineCardiologyDermatology (Skin)Emergency MedicineEndocrinology 內(nèi)分泌學(xué)Gastroenterology 胃腸病學(xué) Gynecology & Obstetrics 婦產(chǎn)Hematology 血液學(xué) Infectious

35、DiseasesInternal Medicine Nephrology 腎病學(xué) Neurology & Neurosurgery57The Johns Hopkins HospitalOncology (Cancer)Ophthamology (Eyes)Orthopedic Surgery 整形外科 Otolaryngology (ENT)Pediatrics 兒科 Physical Medicine/RehabilitationPsychiatry/Behavioral SciencesPulmonary/Critical Care Medicine 肺 RadiologySurgery

36、Urology 泌尿科58Internal MedicineAdolescent medicineCardiovascular medicine 心血管 Critical care medicineElectrophysiology 電生理學(xué) Endocrinology 內(nèi)分泌學(xué) Gastroenterology 胃腸病學(xué) Geriatrics 老年醫(yī)學(xué) Hematology 血液學(xué) ImmunologyInfectious diseaseNephrology 腎病學(xué) OncologyPulmonary medicine 肺 Rheumatology 風(fēng)濕病學(xué) Sports medicine5

37、9Hospital DepartmentsAdmitting (Patient Registration)Biomedical EngineeringBusiness OfficeCase Management (Discharge Planning)Central Sterilizing ServiceChaplainClinical LaboratoryCommunity Relations (Public Relations)60Hospital DepartmentsComplianceComputingDurable Medical EquipmentElectroneurodiag

38、nostic TestingEmergency RoomEmployee Assistance Program (EAP)Employee Health ServicesEnvironmental ServicesHealth Information Management Services61Hospital DepartmentsHospice CareHuman ResourcesMedical EducationMedical LibraryMedical StaffNursingNutrition and Food ServiceOccupational Therapy62Hospit

39、al DepartmentsOperating Room SuitePatient AdvocacyPatient EducationPerformance ImprovementPharmacyPhysical TherapyPlant Operations and MaintenancePreadmission Testing (PAT)63Hospital DepartmentsPurchasingRadiation OncologyRadiologyRecreation TherapyRehabilitative ServicesRespiratory TherapyRespite C

40、areRisk ManagementSafety Management64Hospital DepartmentsSocial ServicesSpeech and Language PathologyTelemedicineUtilization ManagementVolunteer65Hospital CommitteesDisaster ControlDrug Utilization ReviewEducationFinanceFormsHealth InformationInfection ControlQuality ManagementRisk ManagementTissue

41、ReviewTransfusionUtilization Management662009/11/1967Health Information DepartmentDepartment administrationCancer registryCoding and abstractingImage processingIncomplete record processingMedical transcriptionRecord circulationRelease of information processing6869CodingInvolves assigning numeric and

42、 alphanumeric codes to diagnoses, procedures, and services; this function is usually performed by credentialed individuals.Coders assign ICD-9-CM codes to inpatient cases and Current Procedural Terminology (CPT), Health Care Procedure Coding System (HCPCS) Level II (National), and ICD-9-CM codes to

43、outpatient, emergency department, and physician office cases.70Cancer registryPerformed by individuals who are credentialed as certified tumor registrars and include using computerized registry software to conduct lifetime follow-up on each cancer patient, electronically transmit data to state and n

44、ational agencies for use at local, regional, state, and national levels, and generate reports and information for requesting entities.71Current Procedural Terminology (CPT)Published annually by the American Medical Association and codes are 5-digit numbers assigned to ambulatory procedures and servi

45、ces.E.g. 90663 Influenza virus vaccine, pandemic formulation72ICD-9-CMThe International Classification of Diseases, Ninth revision, Clinical Modification is used in the United States to collect information about diseases and injuries and to classify diagnoses and procedures.National Center for Healt

46、h Statistics (NCHS).731. INFECTIOUS AND PARASITIC DISEASES (001-139)TUBERCULOSIS (010-018)Includes:infection by Mycobacterium 分枝桿菌 tuberculosis (human) (bovine 牛)Excludes:congenital tuberculosis (771.2)late effects of tuberculosis (137.0-137.4)The following fifth-digit subclassification is for use w

47、ith categories 010-018:0 unspecified1 bacteriological or histological 組織學(xué)的 examination not done2 bacteriological or histological examination unknown (at present)3 tubercle bacilli 結(jié)核桿菌 found (in sputum) by microscopy4 tubercle bacilli not found (in sputum) by microscopy, but found by bacterial cultu

48、re5 tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically6 tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other methods inoculation 預(yù)防接種 of animals74010 Primary tuberculous infectionRequires fift

49、h digit. See beginning of section 010-018 for codes and definitions.011 Pulmonary tuberculosisRequires fifth digit. See beginning of section 010-018 for codes and definitions.Use additional code to identify any associated silicosis矽肺病 (502)012 Other respiratory tuberculosisRequires fifth digit. See

50、beginning of section 010-018 for codes and definitions.Excludes:respiratory tuberculosis, unspecified (011.9)013 Tuberculosis of meninges 腦脊膜 and central nervous systemRequires fifth digit. See beginning of section 010-018 for codes and definitions.75014 Tuberculosis of intestines 腸, peritoneum 腹膜,

51、and mesenteric glands 腸系膜腺Requires fifth digit. See beginning of section 010-018 for codes and definitions.015 Tuberculosis of bones and jointsRequires fifth digit. See beginning of section 010-018 for codes and definitions.Use additional code to identify manifestation, as:tuberculous:Arthropathy 關(guān)節(jié)

52、病(711.4)Necrosis 壞死of bone (730.8)Osteitis 骨炎(730.8)Osteomyelitis 骨髓炎(730.8)Synovitis 滑膜炎(727.01)Tenosynovitis 腱鞘炎(727.01)76016 Tuberculosis of genitourinary 泌尿生殖器的 systemRequires fifth digit. See beginning of section 010-018 for codes and definitions.017 Tuberculosis of other organsRequires fifth d

53、igit. See beginning of section 010-018 for codes and definitions.018 Miliary 粟粒狀的 tuberculosis Includes:tuberculosis:Disseminated 彌散性Generalized 全身性的miliary, whether of a single specified site, multiple sites, or unspecified sitePolyserositis 漿膜炎77HCPCSThe Health Care Procedure Coding System is comp

54、rised of Level I (CPT) and Level II (National) codes.Level II HCPCS codes are developed by the Centers for Medicare & Medicaid Services (CMS) and used to classify report procedures and services.78CPT (Current Procedural Terminology)a numeric coding system maintained by the American Medical Associati

55、on (AMA).The CPT is a uniform coding system consisting of descriptive terms and identifying codes that are used primarily to identify medical services and procedures furnished by physicians and other health care professionals. 79Level I of the HCPCS, the CPT codes, does not include codes needed to s

56、eparately report medical items or services that are regularly billed by suppliers other than physicians.80Level II HCPCSCodes are reported to third-party payers (e.g., insurance companies) for reimbursement purposes.81Level II of the HCPCS is a standardized coding system that is used primarily to id

57、entify products, supplies, and services not included in the CPT codes, such as ambulance services and durable medical equipment, prosthetics 假體, orthotics 矯形器, and supplies (DMEPOS) when used outside a physicians office 82Level II alphanumeric HCPCS procedure and modifier codes, their long and short

58、 descriptions, and applicable Medicare administrative, coverage, and pricing data.The Level II HCPCS codes, which are established by CMSs Alpha-Numeric Editorial Panel, primarily represent items and supplies and non-physician services not covered by the American Medical Associations Current Procedur

59、al Terminology-4 (CPT-4) codes;Medicare, Medicaid, and private health insurers use HCPCS procedure and modifier codes for claims processing.83A1001007DRESSING FOR ONE WOUND Dressing for one wound C 20701 N A2001007DRESSING FOR TWO WOUNDS Dressing for two wounds C 020701 N A3001007DRESSING FOR THREE

60、WOUNDS Dressing for three wounds C 020701 N84Abstracting Performed to enter codes and other pertinent information utilizing computer software.To generate statistical reports and disease/procedure indexes, which are used for administrative decision-making and quality-management purposes.85Incomplete