PRIV@T3K ADVANCED SOLUTIONS

QUN L IN T TRONG Y - NHA KHOA

T L THUYT N GII PHP THC TIN

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TP. HCM, 30 - 12 - 2009

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TNG QUAN V QUN L IN T TRONG Y - NHA KHOA

I. TNG QUAN QUN L IN T TRONG Y - NHA KHOA

Lch s pht trin nhn loi tri qua nhiu giai on trong mi hot ng p ng cc nhu cu chnh ng ca cuc sng, bao gm c v mt th xc, tm l v th gii nim thc, cha ng c tri thc, kh nng t duy - phn tch v tm linh. Trong , mi giai on chuyn mnh v mt x hi, loi ngi li ci thin v ti u ha nhng vn nn tng v nim tin, tri thc c s v sc mnh tp th c lin quan, da trn nguyn tc phi hp mt cch hiu qu tt c cc ngun lc lin quan vi nhu cu thc v cc yu t v tc ng ngoi lai, nhm t c mt mc tiu mong mun. chnh l tin hnh thnh nn khoa hc qun l hay "Qun tr hc". Theo dng lch s, cng tc qun l c manh nha t rt sm, t giai on loi ngi bt u cuc sng by n m hnh x hi s khai nht - cng x nguyn thy. Khi , cng ng loi ngi bt u c khi nim phn cng v nh gi kh nng thc hin cng vic c giao cho tng thnh vin trong "by n" ca mnh, d ch trong cc hot ng tp th phc v nhu cu duy tr cuc sng chung ca "by n", d ch gm cc hot ng n gin nh: sn bn, hi lm v nhu cu sinh hot thng nht: n - ng ngh. iu gn lin vi khi nim "Qun l" vi yu t tp th, n ch hnh thnh khi i tng tham gia l s ng/ tp th cng c mt mc tiu mong mun v c nhu cu thc hin mc tiu trong cng mt khong thi gia c xc nh. Khi nim "Qun l" kh rng, t nhu cu qun l "tp th"/ "chnh th ti thiu" hay cn gi l "qun l bn thn" cho mi sinh hot c nhn n cc k hoch pht trin bn thn, hay nhu cu qun l ln hn v quy m nhn s, nh qun l qu trnh vn hnh v hot ng ca mt nhm, mt cng ty, mt t chc/ hip hi, mt quc gia, v.v ... Cng tc qun l tn ti trong mi lnh vc, ngnh ngh, t chc v hnh thi x hi ca cuc sng. Ni cch khc, khoa hc qun l cha ng thc v th gii quan ca x hi tng ng theo tng giai on pht trin v nhn thc ca loi ngi. Tuy nhin, ngh thut qun l li thng mang du n c nhn trong vic s dng mt cch linh hot cc th thut qun l trong tng trng hp c th, thng c ghi nhn li trong dng chy ca lch s trong mi lnh vc, di dng cc vn bn truyn khu hay ghi chp, v d nh trong Kinh vn ca mt s tn gio, trong Hc thuyt trit hc, trong cc vn bn th tch c, hc thuyt qun tr hc, v.v ... Trong mt trng hp qun tr mt bnh vin, hay mt phng khm, hay mt lab trong y khoa, hay y khoa, qun l thng tin ng mt vai tr quyt nh trong cng tc lp k hoch iu tr, theo di v m bo cng tc iu tr, hay cng tc phi hp iu tr gia cc b phn trong bnh vin, gia bc s iu tr (trong nha khoa l Bc s rng hm mt (BSRHM) hay nha s) vi cc chuyn vin h tr lm sng/ cn lm sng (trong nha khoa, c th l tr th nha khoa, k thut vin chun on hnh nh, k

thut vin phc hnh). Bi lng thng tin trong y t l thng tin a lp v a chiu, gm nhiu nh dng thng tin khc nhau, v d nh: bnh n (vn bn), kt qu xt nghim (d liu vn bn), kt qua chun on hnh nh (d liu hnh nh), bn cam kt php l (vn bn), bn thanh ton (vn bn), v.v... Mt khc, v cc thng tin trn mang tnh bo mt, mang tnh tham kho, mang tnh bt buc phi lu tr c thi hn theo cc quy nh php l c th v khc khe cho tng quc gia v lin quan n yu t sc khe con ngi, cng tc qun l, truy xut v lu tr d liu s tr nn phc tp hn vi v s cc quy trnh chun, hng lot cc b biu mu c thit k phc v cho hng chc n hng trm trng hp gii quyt cc yu cu v khiu ni ca bnh nhn theo khung php l v qun l nh nc. iu cng tr thnh mt gnh nng v c chi ph, thi gian, nhn lc v c h tng c s trong cng tc lu tr v truy xut cc d liu c, c bit khi cc d liu ny c tnh cu trc, a nh dng, a cp v a chiu tng tc. Cc quy trnh qun l lin tc c ti u ha v xy dng mi ty theo nhu cu ca tng i tng s dng (cc n v y t) theo iu kin v phm vi ng dng c th, trong mt thi gian di t cui th k XVIII n nay, qun l y t tr thnh mt ngnh khoa hc nhnh chuyn bit, trong qun tr hc, phi ngu gia qun tr hc v cc yu cu ring ca y hc, v n cn mt lc lng qun l chuyn nghip, hng hu, c k lut v kin nhn, c th lm vic lin tc v khng ngng ngh trong mt thi gian di, iu lm tng chi ph v thi gian lm vic trong cng tc qun l y t. Tuy nhin, s ra i ca cng ngh my tnh (Computer Sciences) v s pht trin khng ngng ca cng ngh thng tin (Informatics), m ra mt nh hng pht trin mi cho nhiu ngnh ng dng. Mt khc s pht trin ng dng iu khin k thut s trong mi trang thit b, tch hp, lin kt hay giao tip gia ngi s dng (Users) v cc trang thit b, hay gia cc trang thit b tr nn hiu qu hn, tng tc trc tip hn, d dng hn v linh hot hn. Vic hnh thnh cc mng truyn thng (Communication Networks) hay h thng mng (IT Networks), gip vic chia s v khai thc cc ti nguyn d liu (Data Sharing & Mining) tr nn tit kim hn, nhanh hn, khng ph thuc vo yu t khong cch. Khi nim "Qun l in t" (Electronic Management) bt u c hnh thnh da trn khi nim v "Vn phng in t" (Electronic Office Applications), nhanh chng thnh mt ln sng ng dng mi, ti u ha v hiu qu ha cng tc qun l quy trnh, vn bn, d liu v cc ngun lc (Resources). Cc ng dng in t ny nhanh chng c ng dng trong quy trnh lm vic trong cc ngnh cng nghip v c dch v, c bit trong cng tc qun l sn xut v qun l cc ngun lc, l tin hnh thnh nhng thut ng quan trng v khoa hc qun l in t, v d nh phn mm qun l cc ngun lc ca doanh nghip ERP (Enterpreuner Resources Planning), phn mm qun l sn xut MRP (Manufacturing Resources Planning), v.v..., mt khc cc cng tc chuyn nhim khc trong cu trc ca mt doanh nghip cng c "in t ha & tin hc ha", nh phn mm qun l quan h khch hng CRM (Customer Relationship Management), phn mm bo co k ton FRM (Financial Report Management), phn mm qun l kho IM (Inventory Management), phn mm qun l nhn s HRM (Human Resources Management), phn mm vn phng in t EOA (Electronic Office Applications), phn mm qun l d n PM (Project Management). Cc sn phm trn nhanh chng c ci tin v xy dng thnh cc "chng trnh khung" (Application Frameworks), hay mu nn ng dng (Application Platforms), hay gii php li (Core Applications) xy dng da trn gin tng, hay lu cng tc c xy dng da trn cng

tc phn tch cc tc v chnh ca mt doanh nghip da trn cc quy trnh chun m doanh nghip ang thc hin, hay t vn doanh nghip tiu chun ha quy trnh cng vic ca mnh. Thng thng, cc ng dng ny c phn tch v tm gii php bi cc lp trnh vin c kinh nghim phi hp vi cc chuyn vin t vn chuyn mn (c th ca n v th ba) v cc nhn vin chnh qun l cc chu trnh lm vic chnh ca doanh nghip, trc khi chuyn t nhu cu thc tin ca nhng ngi s dng trc tip trong doanh nghip thnh cc thng tin cn thit lp trnh vin (Code Builders/ Programmers) vit phn mm (Coding). V nguyn tc, cu trc ca mt doanh nghip v c bn l ging nhau trong tt c cc ngnh ngh, chng ch khc nhau mt t v nhng yu cu c th ca tng ngnh, hay c th b i mt s khu hay b phn trong doanh nghip, hay c chc nng sai bit mt t ty theo phm vi kinh doanh, yu cu u ra v tiu chun quc gia/ lut nh s to i vi doanh nghip . Mt s phn mm tiu biu (m ngun m hay phn mm thng mi) trong lnh vc qun l in t nh: OpenERP, SAP, Oracle DataMining, BravoERP, Microsoft CRM, Microsoft QuickMoney, Microsoft Projects, v.v... T s thnh cng v bng n v gii php qun l in t trong cc ngnh cng nghip v dch v c th chung trong na sau th k XX, cc n v kinh doanh dch v v nha khoa nhanh chng tm ra c hng gii quyt mi cho mnh trong giai on pht trin mi, vi s m bo v mt kinh nghim ca hn 15 nm ng dng trong cc ngnh cng nghip v dch v tng t, ca cc nh cung cp gii php phn mm. Mt khc, s bng n v ng dng ca k thut s trong cc trang thit b chuyn dng trong Y - Nha khoa, iu gip cho vic chia s, truy xut v qun l cc thng tin chun on, hay cc thng s sc khe, mt cch trc tip v chi tit nhanh nht, ng vi tng thi im ca bnh nhn, m bo cng tc iu tr lun c thc hin kp thi v hiu qu nht (Real-time Patient Inspections, Diagnosis and Treatments = RTPIDT). Mt khc, cc quy chun v qun l thng tin trong y t v y c c cc quc gia ch trng v xy dng bm st theo cc quy trnh, hay nhu cu cng vic thc tin, v ti u ha thnh cc tiu chun ngnh, gip cho cng tc qun l thng tin trong ngnh Y - Nha khoa tr nn nht qun v xuyn sut hn, gip cho cng tc qun l t quy m nh n quy m ln tr nn d dng hn, cng tc ng b ha thng tin, chia s d liu gia cc n v, vng min hay gia cc quc gia tr nn nhanh chng hn. Trn thc t, khi nim PRM (Patients' Record Management) c hnh thnh vo cui thp nin 1990 trong h thng Bnh vin Y khoa, ln u tin ti Hp chng quc Hoa K (United States) khong nm 1992, da trn nn tng h thng mng ni b kt hp vi h thng qun l d liu chun on hnh nh trong y t PACS (Picture Archiving and Communicating Systems). Nhng trong nha khoa n tn 1998 - 1999, gii php phn mm u tin v qun l cc cng vi iu tr lm sng cho mt phng khm nha khoa t nhn mi c bt u quan tm v thng mi ha, ti Hp chng quc Hoa K, khi u ch l qun l thng tin bnh n v mt s hnh nh chun on ca phim chp X - quang quanh chp. Trong giai on ny, cc d liu hnh nh t cc my chp phim ct lp trong nha khoa (ch yu l CBCT - Cone Beam Computerized Tomography) c qun l bi phn mm chuyn dng ring i km theo tng my c th chia s c thng qua h thng PACS, di cc nh dng tiu chun nh DICOM (Digital Imaging and Communication in Medicines) (*.dcm), hay c th l cc nh dng nh thng dng nh *.jpg, *.jpeg, *.bmp, v.v... Tuy nhin, gii php qun l in t trong nha khoa

cng pht trin kh chm v bt u tng tc t nm 2003 tr i, sau khi hng lot cc d n phn mm v qun l trong Nha khoa bt u c xy dng v thng mi ha mang tnh t pht, hay t pht trin bi chnh cc doanh nghip kinh doanh dch v nha khoa (phng khm hay bc s nha khoa), nhng khng thnh cng. Qu trnh sng lc ca quy lut cnh tranh nhanh chng loi tr hay st nhp cc gii php li vi nhau, t c gii php hiu qu hn. Tuy nhin trong giai on ny, ng dng v qun l in t ca labo k thut phc hnh rng vn cha c tch ri khi phng khm nha khoa, vi mc nh, labo k thut phc hnh rng l mt phn ca phng khm nha khoa. Cng cuc pht trin cc ng dng qun l in t trong nha khoa nhanh chng c mt ch ng ring cho mnh v pht trin theo nhiu hng khc nhau trong thp nin 2010, nhng vn cha c c nhng pht kin mi hay gii php ton din v nha khoa (cho phng khm, bnh vin nha khoa/ bnh vin rng hm mt) hay gii php ring cho tng nhu cu ca nha khoa (cho labo k thut phc hnh rng, cho nha khoa hc ng, hay d n ca iu dng nha khoa). Trong khi , cc gii php qun l in t trong Y khoa ang tng bc c ci thin tt hn, c bit v mng PACS (ch yu da trn chun DICOM) kt hp vi PRM, c m rng thm cc thng s khc c thu thp trc tip t cc tn hiu k thut s u ra ca cc thit b khc nh my phn tch (xt nghim) hay cc my theo di tnh trng bnh nhn (thit b o h hp, o nhp tim, o mch, v.v...), m rng ra trn c s trao i d liu trn nn tng intranet v internet ng truyn tc cao, cng vi khi nim cc kho d liu ch (Data Servers) chuyn dng c dng lm cu ni qun l, chia s v truy xut d liu gia cc khoa, phng ban chuyn m trong bnh vin, hay gia cc bnh vin hay gia c cc quc gia, trong cng tc iu tr, nghin cu chuyn su v c trong cng tc nh gi sc khe cng ng. Vy qun l in t trong Y - Nha khoa ni chung, hay trong Nha khoa ni ring, ang khng ngng ng dng thm cc thnh tu cng ngh mi nht v mt khoa hc k thut v c nhng cp nht mi nht, c th nht, v qun l nh nc cho mng qun l v iu tr in t cho tt c cc quy m khc nhau (t quy m nh n n quy m ln/ quy m quc gia/ quy m quc t), loi hnh kinh doanh (doanh nghip y t nh nc, doanh nghip y t t nhn, doanh nghip y t lin doanh nc ngoi, doanh nghip dch v bo him y t, v.v...), loi dch v (dch v iu tr cng, dch v iu tr theo yu cu c tnh ph cao cp, bo him y t, v.v...), mng iu tr chuyn su (ni v ngoi khoa v tai - mi - hng, tim mch, ni tit, nhn khoa, nhi khoa, y hc c truyn, nha khoa, dc l, v.v...), phng thc iu tr (iu tr trc tip, bc s gia nh, bc s in t, iu tr t xa, v.v...). Tt c m ra mt ci nhn trc quan v tch cc v qu trnh tin hc ha v ph cp ha cc gii php qun l trong y t u th k XXI, s pht trin ca thi i cng ngh thng tin, thi i khng khin cho mi ro cn v khong cch ngn ng, khong cch, trnh chuyn mn, v.v..., khng cn l tr ngi chnh. cng chnh l yu t to nn khi nim "th gii phng" trong cng tc qun l v trin khai y t th gii. Thc trng v ng dng qun l in t trong Y - Nha khoa trong nhng nm gn y s ln lt c trnh by tng quan trn phm vi th gii ni chung v c phm vi Vit Nam ni ring trong phn sau.

II. THC TRNG NG DNG CNG NGH THNG TIN (CNTT) TRONG QUN L IN T TRONG Y - NHA KHOA
II.1. Tnh hnh ng dng trn th gii
Trn th gii, ng dng tin hc trong y t c trin khai t rt sm vo thp nin 1950, cng vi s pht trin v cng ngh my tnh [10]. Tin bt u ca qun l in t l, Gustav Wager xy dng h thng qun l thng tin chuyn nghip u tin trn th gii, ti c, nm 1949 [10],[11]. n thp nin 1960, n nhanh chng c pht trin thnh mt mng nghin cu mi ha hn nhiu tim nng trong h thng cc trng i hc, cc vin nghin cu v cng ngh thng tin ti mt s quc gia tin tin ti chu u, gm Php, c, B v H Lan. Nhng n thp nin 1970, khi nim v h thng qun l in t thng tin y t mi bt u c t ra v nghin cu mt cch nghin tc ti Ba Lan v Hp chng quc Hoa K [12]. Tin thn ca Tin hc y t (Healthcare Informatics) l cc khi nim, nh: khoa hc my tnh trong y t (Medical Computer Science), y t c s h tr ca my tnh (Computerized Medicines), x l d liu y t in t (Medical Electronic Data processing), cng ngh thng tin y t (Medical Information Science), cng ngh phn mm y t (Medical Software Engineering) v cng ngh my tnh y khoa (Medical Computer Technology). Ngnh khoa hc qun l in t thng tin y t nhanh chng hnh thnh mt cng ng quc t, tr thnh mt lnh vc chuyn su trn phm vi quc t, c iu phi bi cc nhn vt ch cht ca Hi ng Chuyn gia v Tin hc sc kha ton Anh (UK Council of Health Informatics Professions), c chia thnh tm mng ng dng chuyn su chnh: - Qun l thng tin Y t (Medical Information Management) - Qun l tri thc Y t (Medical Knowledge Management) - Qun l danh mc u t/ chng trnh/ d n Y t (Medical Portfolio/ Programme/ Projects Management) - Cng ngh thng tin v giao tip trong y t (Medical Information and Communication Technologies = ICT) - Qun l nghin cu v o to in t trong y t (Medical Electronic education & research Management) - Tin hc lm sng (Clinical Informaitcs) - Qun l bnh n in t (dch v & kinh doanh) (Electronic Health Records Management) - Qun l h thng dch v tin hc y t (Health Informatics Service Management) n u thp nin 1970, cc t chc ni bt nht trong lnh vc qun l in t y t trn ton th gii hp nht thnh Hip hi Tin hc y khoa quc t IMIA (International Medical Informatics Association). Vy lch s pht trin ca qun l in t y t ti Hip chng quc Hoa K, mt trong hai quc gia u tin trin khai ng dng ny, din ra nh th no? ng dng in t u tin trong y khoa c p dng cho mt s d n v qun l trong nha khoa trong thp nin 1950, ti Hip chng quc Hoa K, do Vn phng Tiu chun quc gia (National Bureau of Standard), do Robert Ledley khi xng, n gia thp nin 1950, Khng lc Hoa K USFA (United States Air Force) ng dng cng ngh thng tin trong trin khai hng lot cc d n v qun l y t trn my tnh cho

mc ch qun s, ng thi h tr v khuyn khch cc t chc dn s khc cng tham gia, nh Vin Khoa hc quc gia NAS (National Academy of Sciences), Hi ng nghin c quc gia NRC (National Research Council) v Vin Y t quc gia NIH (National Institutes f Health. n 1959, Robert Ledley v Lee B. Lusted cho ng "Reasoning Foundations and Medical Diagnosis", trn tp ch Science (Hoa K), v cc k thut my tnh (ch yu v cc nghin cu vn hnh) cho ngun nhn lc trong y t. Hai ng cng ng gp nhiu bi bo c gi tr v lnh vc ra quyt nh trong y t trong nhiu thp nin sau , cc ng gp ny c nhiu t chc v c nhn n nhn tch cc. Tuy nhin trong lnh vc o to, ngnh khoa hc qun tr y t (Healthcare Administration Science) c cp n nh mt ngnh khoa hc v c khi xng a vo chng trnh gio dc o to chnh thc ti Hp chng quc Hoa K vo nm 1934, ti i hc Chicago[4], trong chng trnh o to 2 nm, trong mt nm hc chuyn ngnh v mt nm ni tr. Sau , chng trnh ny c tip tc pht trin thnh chng trnh chuyn ngnh 2 nm, ti i hc Cornell, vo nm 1958. Hin nay tr thnh chuyn kha bt buc v c s ngnh trong h thng gio dc v khoa hc sc khe trong tt c cc trng i hc v y khoa v khoa hc sc khe ti khu vc Bc M (Hp chng quc Hoa K v Canada). Cng vi s ra i ca Hip hi H thng thng tin v qun l Y t (Healthcare Information and Management Systems Society = HIMSS), tin thn l Hip hi H thng qun l bnh vin (Hospitals Management Systems Society = HMSS), thnh lp nm 1961, ti Chicago, Illinois, bi Edward J. Gerner and Harold E. Smalley. Hin nay t chc ny c trn 35.000 thnh vin c nhn, trn 520 tp on kinh doanh dch v y t v hn 120 t chc phi li nhun hot ng trong lnh vc y t tham gia. nh du s chuyn nghip ha v nhn thc v tm quan trng ca qun l y t trong cng ng hay ca mt quc gia. Ti Hp chng quc Hoa K, Hin chng ca t chc ny c d tho vo 1961, thng qua vo nm 1962, ti Hi ngh quc gia ca t chc ny ln u tin ti Baltimore, nm 1962. B lut nh , cc nguyn tc v tiu chun cho HMSS c xy dng v thng qua vo nm 1967, n 1982, th c hon thin gm: 15 chng (trong 14 chng p dng cho khu vc Bc M v 1 chng p dng cho c (Australia). Nm 1968, Homer R. Warner, mt trong nhng ngi sng lp ra ngnh tin hc y t (Medical Informatics) thnh lp Khoa Tin hc y t chnh thc u tin, ti i hc Utah (Hoa K). n 1986, HMSS i tn thnh HIMSS. Hin nay, HIMSS cng tc chung vi RSN A (Radiological Society of North America), ti tr cho tng v thng nht cc daonh nghip v y t - IHE (Integrating the Healthcare Enterprise), ng thi cng l bn doanh ca Hip hi v Bnh n in t (Electronic Health Records Association - EHRA) v Lin minh v Tin hc trong iu dng ANI (Alliance of Nursing Informatics), c du bi Hip hi Tin hc y t ton nc M AMIA (American Medical Informatics Association) v HIMMS. iu cho thy, ng dng v qun l in t trong y khoa ni chung nhanh chng ng mt vai tr quan trng ti khu vc Bc M trong thi gian pht trin gn 26 nm [9]. V mt thc tin v trin khai ng dng, R.Ledley v L.B.Lusted tin hnh hng lot cc kho st v ng dng my tnh trong sinh hc v y hc (thc hin bi NAS NRC) trong sut thp nin 1950, iu ny gip cho NIH c c mt ci nhnh kh quan gii thiu tnh hiu qu ca vic s dng my tnh trong sinh hoc v y hc cho chnh ph. Kt qu ca n lc ny, chnh l s hnh thnh Hi ng c vn v Nghin cu my tnh ca NIH (NIH's ACCR = NIH's Advisory Committee on Computers in

Research), do L.B.Lusted ch tr. Ch trong 5 nm, t 1960 n 1964, NIH's ACCR thnh lp hng t cc trung tm nghin cu v k thut y sinh hc ln nh khc nhau trn phm vi ton nc M, vi chi ph trn 40.000.000 M kim. Thnh qu t cc nghin cu trn gip Hoa K c c nhng bc tin ng k, cng vi s ra i ca cc h thng qun l in t y t chuyn dng (Expert Systems) u tin (do NIH ti tr chnh) nh: MYCIN, Internist - I (thp nin 1960). V lnh vc ng dng v qun l, chia s v tra cu c s d liu y khoa (Medical Knowledge Management) do Th vin y hc quc gia (National Library of Medicine) khi xng, nh MEDLINE v MEDLARS (1965). Trong thi gian ny, nhm nghin cu, gm: Neil Pappalrdo, Curtis Marble v Robert Greenes, thuc phng th nghim v khoa hc my tnh Octo Barnetts, ti Bnh vin a khoa Massachusetts (Massachusetts General Hospital), Boston, Hoa K (do NIH ti tr), pht trin v ng dng thnh cng MUMPS (Massachusetts General Hospital Utility Multi-Programming System). Trong thp nin 1970 v 1980, MUMPS tr thnh chun mc chung v ngn ng lp trnh chnh cho cc ng dng v qun l in t trong y t. n 2004, H thng bnh vin ca Hi cu chin binh Hoa K USVAHS (United States Veterans Affairs Hospital System) xy dng v ng dng thnh cng h thng qun l c s d liu v bnh n in t ni b (Enterprise - wide Health Information System) ln nht, cn c gi l VistA (Veterans Health Information Systems and Technology Architecture), vi giao din tng tc (GUI = Graphical User Interface), c bit n l H thng bnh n trn my tnh CPRS (Computerized Patient Record Systesm), c ng dng cho hn 1.000 c s y t trong h thng ca USVAHS. Hin nay, v gii php qun l in t trong y t, Hoa K c hn 300 phn mm qun l in t cc loi thng mi ha hay m ngun m, tnh lun c cc phn mm ng dng trong nha khoa. T nm 2004, Vn phng Dch v sc khe v nhn lc HSS (US Department of Health and Human Services), c thnh lp bi Vn phng quc gia v nh hng v Cng ngh thng tin y t ONCHIT (Office of the National Coordinator for Health Information Technology) nhm mc tiu trin khai k hoch pht trin v trin khai trn ton quc gia v h thng qun l in t a dng trong vng 10 nm. Nm 2005, HSS thnh lp t chc phi li nhun c lp, mang tn "y ban Kim nh v Chng nhn v tin hc y t" CCHIT (Certification Commissioni for Healthcare Information Technology), c chc nng xy dng b tiu chun v qun l bnh n in t (EHR) v h thng mng chuyn dng h tr (Supporting Network) v kim nh - cp chng nhn cho cc n v hnh ngh c nhu cu kim tra v cht lng. n thng 07 nm 2006, trn ton lnh th Hoa K, ch c 22 gii php qun l bnh n in t t chun ca CCHIT, trong hai lnh vc khc nhau. Ring trong lnh vc qun l in t nha khoa, Hoa K c hn 100 phn mm qun l phng khm nha khoa thng mi ha hay m ngun m, nhng cha c phn mm chuyn dng thng mi ha v qun l in t labo k thut phc hnh rng. Trong lnh vc phn mm qun l ny, ch yu l cc gii php t pht c pht trin ring l da trn nhu cu ca chnh cc labo, trn cc cng c sn c nh: MS Excel, MS Access, Visual Basic v C#. Bng I.1. Bng so snh mt s phn mm qun l Bnh vin v phng khm y khoa
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Ti Vng quc Anh, lch s pht trin ca ngnh tin hc y t c tng hp trong "UK Health Computing: Recollections and Reflections", Hayes G. V Barnett D. (Eds.), BCS Group (2008). Trong giai on u, tin hc y t ti Vng quc Anh pht trin t pht v mang phong cch ngu hng c nhn. u thp nin 1950, cc hot ng v tin hc y t c h tr v mt ti chnh bi H thng Bnh vin quc gia NHS, ch yu v cc lnh vc v do NHS xut. Nhng n thp nin 1960, tin hc y t ti y bt u chuyn hng nghin cu mnh sang mng khc, nh: c s d liu v bnh hc (Pathology) (1960), c s d liu v phng php x tr

(Radiotherapy) (1962), c s d liu tim chng (Immunization) (1963) v c s d liu v s cu (Primary care) (1968). Tuy nhin, d c nhiu nghin cu mang tnh chuyn su nhng cac gii php trn u mang tinh ngu hng, cho n thp nin 1970, nh hng v cc ng dng h tr cho cc dch v y t trong nh (In-house Healthcare Services Applications) mi bt u c quan tm, v d nh ng dng qun l cc d n v tim phng qun l thuc chng nga cho tr em, nhng ch mang tnh cc b v trin khai ri rc gia cc vng min khc nhau, cng chnh l l do ti sao, chnh ph bt buc phi can thip v xy dng nh hng v chin lc pht trin c th cho tin hc y t ti Vng quc Anh, vo thng 06 nm 2010. iu to ra mt vn hi mi cho ngnh tin hc y t tr thnh c s h tr v nm vai tr quyt nh n cng tc qun l, iu phi v thng mi ha cc thng tin hay dch v lm sng in t trong pham vi quc gia, ng gp nhiu hn cho h thng chm sc sc khe x hi, ph hp vi th mnh ln nht ca Vng quc Anh, mt trong nhng quc gia c h thng qun l cng v bo him y t - an sinh - x hi tt nht trn th gii. Tin hc y t Vng quc Anh cng ng mt vai tr quan trng trong cng ng nghin cu v tin hc hc y t th gii, nhanh chng tham gia IMIA t (1979), vi s h tr t BCS Health, i hc Cambridge t chc Hi tho v Tin hc Y t u chu ln u tin (EFMI Medical Informatics Europe) (1974) v Hi tho quc t ln th X ca IMIA (cn gi l MEDINFO2001) (10th IMIA's Global Congress) (2001). Tnh hnh pht trin ca tin hc y t ti mt s quc gia khc trn th gii cng c nhiu bc chuyn mnh ng ghi nhn ti nhiu khu vc khc nhau, ty theo chin lc pht trin ring v chnh sch ca tng quc gia. Sau y l mt s thng tin v tnh hnh ng dng ti mt s quc gia v khu vc trn th gii nh sau: - Ti Argentina, Buenos Aires Biomedical Informatics Group, mt t chc nghin cu chuyn su v lnh vc tin hc y t phi li nhun, c thnh lp t 1997, chuyn nghin cu v mng tin hc ha cc hot ng lm sng v cn lm sng trong ngnh khoa hc sc khe thao cc tiu ch sau: thc y qu trnh ng dng cng c my tnh trong cc hot ng nghin cu khoa hc, qun l y t, cc hot ng lm sng v chm sc sc khe, bao gm c trong lnh vc khoa hc sc khe v nghin cu v y sinh hc; h tr thc y v ph bin cng tc qun l thng tin y t v cc cng c tin hc lin quan, trong phm vi ngnh tinh hc y sinh hc; y mnh hp tc v trao i cc hot ng trong lnh vc tin hc y sinh gia cc h thng qun l cng (ca nh nc), h thng qun l t nhn v h thng qun l quc gia v h thng qun l quc t; thc y qu trnh hp tc gia cc nh nghin cu trong v ngoi nc trong cc d n v cc ng dng mi ca tin hc y sinh; thc y s tham gia, t chc v ti tr ca t chc nghin cu cng lp, cac t chc nghin cu t nhn (thng mi ha), t chc qun l nh nc trong cc s kin v cc hot ng o to v tin hc y t v cc c s d liu v bnh n, tri thc y hc nhm m bo thc hin tt hn h thng chm sc sc khe quc gia. Da trn c tnh ring, h thng chm sc sc khe ca Argentina hot ng khng ng nht trn phm vi ton lnh th v c cht v lng, do qu trnh tin hc ha v trin khai cc ng dng trong cng tc chm sc sc khe cng c thc hin theo chin lc ring c th cho tng khi vc khc nhau. c bit h thng cc bnh vin t nhanh chng t xy dng v pht trin gii php qun l in t ring cho mnh da trn iu kin, nng lc v kh nng thc hin theo khung php ch ca quc gia. Trong , Bnh vin German Hospital of Buenos Aires

l mt trong nhng bnh vin t u ngnh u tin ti Argentina trin khai h thng qun l bnh n in t EHR (Electronic Health Record) ring do h t pht trin. - To Brazil, ng dng u tin v qun l y sinh hc v chm sc sc khe c ghi nhn l vo nm 1968, c thc hin trn h thng cc bnh vin i hc cng, trn cc my tnh IBM 1130 c trang b sn trong mt s trng i hc hng u. Tin phong trong lnh vc ny, Trng Y Ribeiro Preto (School of Medicine of Ribeiro Preto) p dng v trin khai tin hc y t ti cc bnh vin Hospital das Clinicas da Universidade de So Paulo (thuc i hc So Paulo), ti cc thnh ph Ribeiro Preto v So Paulo. n thp nin 1970, cc my tnh ca mt vi nh sn xut khc v Hewlett Packard c thng mi ha rng ri, gip vic trang b v s dng my tnh trong cc bnh vin cng ng v qun y vin tr nn ph bin hn, c bit c ng dng tt trong cc mng qun l in t v thng tin bnh n trong cc khoa chm sc c bit ICU (Intensive Care Unit = ICU), khoa tim mch (Cardiology), khoa chun on & xt nghim (Diagnosis), khoa phc hi sc khe (Patient Monitoring) v mt s khoa khc. n u thp nin 1980, my vi tnh c thng mi ha r hn, vic tin hc ha qun l y t c dng nhiu trong chm sc sc khe cng ng tr nn thng dng hn. 1986, Hip hi v tin hc y t Brazil BSHI (Brazil Society of Healthcare Informatics), thnh lp cng vi vic t chc thnh cng Hi tho quc gia v Tin hc y t (Brazillian Congress of Health Informatics v pht hnh Tp ch v Tin hc y t Brazil BJHI (Brazillian Journal of Health Informatics. Hin nay, hai trng i hc hng u tin phong trong lnh vc nghin cu v o to chuyn su sau i hc l i hc So Paulo (Universidade of So Paulo) v i hc Bang So Paulo (Federal University of So Paulo). - Cc d n v Tin hc y t ti Canada c thc hin ring r gia cc bang khc nhau, bi h thng hnh lang php l v chnh sch ca cc bang khc nhau. n nm 2001, T chc phi li nhun, do chnh ph qun l v ti tr Canada Health Infoway c thnh lp, nhm thc y, pht trin v nhn rng h thng qun l bnh n in t xuyn sut quc gia. Ngy 31/12/2008, trn ton lnh th ca Canada, chnh ph ghi nhn c c 276 d n v qun l bnh n in t ang c Canada Health Infoway trin khai ti cc bnh vin, c s y t, nh thuc, labo sinh hc, vi tng gi tr u t n 1,5 t USD. Mt s d n trong , gm: eHealth Ontario do chnh quyn Bang Ontario trin khai thng 09 nm 2008, d n lin tc b tr tin v qun l km hiu qu nn chm dt hon ton d n vo 2009; Alberta NetCare c thnh lp 2003, bi chnh ph Bang Alberta, Alberta NetCare hin nay c hng ngn bc s s dng, gm cc chc nng v d liu chun on chc chc nng, n thuc in t, chun on bnh l, d liu xt nghim, d liu chun on hnh nh v cc bo co y khoa. - Ti Chu u ni chung, cc quc gia thnh vin ca Lin minh u chu EU (European Union) ang thc hin cc d n lin quan v qun l thng tin in t trong y t, vi nh hng l mt trong nhng mng nghin cu h tr cng tc ci thin v nng cao cht lng chm sc sc khe cng ng, c d bo s em li nhiu li ch v mt kinh t v x hi, ng thi cng h tr mt ngnh cng nghip phn mm mi y ha hn trong tng lai. Vin nghin cu v Bnh n y t u chu EIHR (European Institute for Health Records), c thnh lp nm 2002, mt phn trong d n ProRec, hin do GS. Goerges De Moor iu hnh, nhm mc ch chnh l xy dng h thng qun l bnh n in t cht lng cao trong khi Lin minh u chu. Mt s d n EIHR ang trin khai: Q-REC (d n v phn loi v kim nh

cht lng ca cc h thng qun l y t in t EHR ng dng trong Lin minh u chu), RIDE (d n v l trnh h tr h thng qun l in y t a dng eHealth, c h tr bi COM 356 (2004), chuyn v gii php h tr v a chiu giao tip. Lin minh u chu tin hnh trin khai cc d n th im, theo bn d tho khung v tin hc y t ln V ca Lin minh, khuyn khch cng tc, pht trin, trin khai v m rng cc phn mm m ngun m v lnh vc qun l y t in t, vi tn gi l Free/ Libre and Open Source Software (FLOSS) trong phm vi ton lin minh. Cc d n v h thng qun l y t in t in hnh v ang trin khai ti cc quc gia thnh vin EU, nh: MEDCOM (an Mch), EVISAND (Ty Ban Nha), SJUNET (Thy in), HYGEIANET (Hy Lp), v.v.... Ti khu vc chu v chu i dng, Hip hi Thng tin y t khu vc Chu Thi Bnh Dng APAMI (Asia Pacific Association for Medical Informatics) c thnh lp 1994, vi hn 15 thnh vin trong khu vc, gm: Australia (c), Trung Quc, Hong Kong, Indonesiam Nht Bn, Hn Quc, Malaysia, Tn Ty Lan, Philippine, Singapore, i Loan, Thi Lan, Vit Nam v cc thnh vin d b, gm: n , Kazakhstan v Srilanka. APAMI ln lt trin khai cc d n (Working Group) lin quan n qun l in t trong y t nh: - WG1, Standardization (ch tr Yin S. Kwak) v IMIA WG16 (ch tr Michio Kimura) ng xy dng trn tiu chun ca HIT (Health Informatics Technology) v thut ng v cc khi nim. - WG2, Trin khai qun l in t trong y t ti cc nc ang pht trin (ch tr H.M. Goh) v l trnh v k hoch thc hin c th ti cc quc gia ang pht trin - WG3, D n h tr vic ra quyt nh trong qun l y t in t (ch tr Yoon Kim), trin khai giai on II ca k hoch hnh ng nm 2007 theo quyt nh ca Ch tch tin nhim ca WG, Jack Li - WG4, Trin khai h thng thng tin trong iu dng nha khoa (ch tr TBA), theo d tho thng nin MedInfo (t 2007 n nay). Trong , mt trong nhng quc gia dn u trongkhu vc trong lnh vc ny, ti Australia (c), Trung hc Tin hc y t c - ACHI (Australasian College of Health Informatics) , thnh lp nm 2002, l t chc o to chuyn nghip v c uy tn trong lnh vc tin hc y t trong khu vc. Vi s h tr ca i ng gio s thnh ging v cc nh nghin cu quc t, ACHI nhanh chng khng nh c v tr dn u ca mnh trong khu vc, trong lnh vc qun l y t in t, chuyn su v mng ng dng tin hc ha din rng cc quy trnh cng tc lm sng v cn lm sng cht lng cao. ACHI l nh ti tr chnh ca to ch in t ngnh "e-Journal for Health Informatics", c h tr bi Hi ng gio dc v Tin hc y t quc gia AHIEC (Australian Health Informatics Education Council), thnh lp nm 2009. Ngoi ACHI, ti Australia cn c cc t chc khc cng nghin cu v lnh vc ny, nh Hip hi Tin hc y t c HISA (Health Informatics Society of Australia), l tp hp ca tt c cc t chc cn li, ng thi l thnh vin ca Hip hi Tin hc y t quc t IMIA (International Medical Informatics Association). Ngc li ti New Zealand (Tn Ty Lan), HIT c ging dy chnh thc trong 05 trng i hc, trong dn u l i hc Otago, vi chng trnh o to c xy dng v hiu chnh trong hn mt thp k qua. T chc nghin cu v HIS/HIT ti New Zealand l HINZ (Health Informatics New Zealand), vi chc nng t chc hi tho thng nin v pht hnh cc tp ch chuyn ngnh in t nh: Healthcare Informatics Review Online (www.hinz.org.nz/journal)

Ti Trung Quc, tin hc y t ( ), l sn phm ca h thng tiu chun ca T chc y t th gii WHO (World Health Organization - Health Metrics Networks), c khi xng t nm 2006, vi cc mc tiu nh nh gi kt qu thc hin, vch ra chin lc pht trin c th, nng cp h thng theo di sc khe cng ng, kho st sc khe cng ng v vng thng k cc ch s y t, theo d tho ca K hoch pht trin tin hoc ha y t HIDP (Health Informatizationi Development Plan). Theo thng k ca HIDP, th trng HIT pht trin t bin, nhu cu nng cp v u t cc c s bnh vin k thut s tng nhanh ng k, theo tc tng trng kinh t ca Tring Quc, c tng kt tng hong 25 - 30% mi nm, trong giai on 2006 - 2010. Cui 2006, tng gi tr u t cho cc h thng tin hc y t HIS (Health Informatics Systems) tng 16% so vi cng k nm ngoi, t ngng 5,8 ty RMB (Nhn dn t), chim 0,5% tng kinh ph quc gia cho cc mc ch v chm sc sc khe cng ng cng k nm ngoi, 866 t RMB. Th trng HIT ti Trung Quc t ngng 15 t RMB trong nm 2010, d ch mc pht trin ca cc nc phng Ty cch y 20 nm, nhng Trung Quc nhanh chng hc tp v ng dng v phi hp linh hot cc thnh qu v cng ngh lin ngnh, iu gip h c c nhng bc nhy vt ln. Xut pht t k hoch d tho ca Ban c vn ca B Y t v "D n xy dng h thng qun l y t cng cng ca quc gia", c trin khai v thng qua bi chnh ph vo ngy 17/09/2003. Trn thc t, HIT bt u c ng dng ti Trung Quc t thp nin 1970, theo cc d n ca chnh ph v Hewlett-Packard cho cc bnh vin qun i, bt u trin khai h thng HIT chnh thc u tin vo 1984. Hng lot cc d n HIT c Trung Quc trin khai v thc hin, nh: - D n Telemedicine (h tr cho cc bnh vin ln tuyn TW, thng qua vic tch hp a knh cc h thng chun on v phn tich hnh nh (CT, MRI, USCT, PET, v.v...) - D n Xy dng mng li qun l thng tin in t v y t RHIN, ti Thm Quyn (ShenZhen Regional Health Information Network) - D n pht hin nhanh thng tin bnh dch ca CDC (Chinese CDC Surveillance System) - D n Qun i s 1 (No.1 Military Project), bao gm trin khai v hp nht hn 30 h thng qun l thng tin y t in t con thnh mt h thng, bi Tng cc Hu cn ca Qun i nhn dn Trung Hoa (PLA) phi hp vi Hewlett - Packards trin khai t nm 1997, c xem l h thng qun l thng tin y t cp quc gia quan trng v hiu qu nht ca Trung Quc trong vic kim sot thng tin chng bng pht dch cm gia cm (SARS) nm 2003. Tuy nhin, Trung Quc cng phi i mt vi cc kh khn, nh: ch 10% bnh vin v c s y t quan tm n HIS , trong 5% ch mi bt u xy dng h thng PACS ni b; thiu ngun nhn lc c chuyn mn su v HIT, thiu h thng tiu chun quc gia v HIS/ HIT , cc d n cng v t v HIT/ HIS mang tnh t pht v khng th kim sot, thiu m hnh h thng bnh vin ng dng HIT ku mu nhn rng, cha hon thin p ng c nhu cu thng mi ha ni a thay th cho cc gii php nc ngoi khc. Mt i din tiu biu khc ti chu , Hong Kong, trin khai thnh cng h thng EHR, mang tn Clinical Management System CMS, ca Hip hi cc Bnh vin (gm 40 bnh vin a khoa v 120 phng khm chuyn khoa), c truy xut v s dng bi 30.000 nhn vin y t trong gi hnh chnh, ngoi gi hnh chnh c th t

c s lt truy cp v s dng ln n 2.000.000 lt, vi c s d liu v bnh n ca hn 7.000.000 bnh nhn., c gi l ePR (Electronic Patient Records). Gii php HIS/HI T ca Hong kong mang tnh quc gia v cu trc qun l, c lng ghp vo quy chun, lut v tiu chun nha nc v lnh vc ny, chu s iu phi ca S Tin hc y t (Health Informatics Section), c quan ch qun ca tt cc cc bnh vin v c s y t. Mt khc, Hip hi tin hc y t Hongkong HKSMI(Hongkong Society of Medical Informatics) cng c thnh lp t rt sm, 1987, nhm khuyn khch v h tr pht trin ng dng CNTT trong y t. Hi tho v eHealth c t chc hng nm ti Hongkong chnh l cu ni cc nhn vin y t, bc s trong c khi y t cng v t nhn c c hi bnh ng chia s, t vn v tm i tc gii quyt vn ca mnh. Ti n , Hip hi Tin hc y t n IAMI (Indian Association for Medical Information) c thnh lp nm 1993, ti vn phng i din ca khoa Dc l lm sng, Vin nghin cu khoa hc y t mang tn Nizam (Nizam's Institute of Medical Sciences (Hyderabad, n ), vi nhim v trin khai cc ng dng trong cng ngh chm sc sc khe, khoa hc sinh hc v y t. Mc tiu hot ng chnh ca IAMI l hng cng ng nhn lc hot ng trong y t n nhng li ch m cng ngh thng tin (IT) em n v m bo tn dng ti a h thng c vt cht v y t quc gia theo c chiu rng v chiu su. ng thi IAMI cng ng vai tr h tr, hng dn cc t chc lin quan s dng v thu c cc li ch ca IT n lnh vc chm sc sc khe., mt khc cng thc y tin trnh x hi ha ng dng tin hc trong gio dc y t, nh xy dng c s d liu v tri thc ngnh y t (Medical Digital Libraries), ni mi ngi c th tip cn v xy dng cc c s d liu cn thit, ng thi ph cp hay cp nht ha k nng my tnh cho nhn vin trong h thng dch v y t. Trang ch (website) ca IMIA c khai trng nm 2002 v Tp ch ca IMIA c pht hnh s u tin vo 06/2004, "Indian Journal of Medical Informatics" (IJMI), thng qua s h tr v kim sot Hi ng Y khoa n (Medical Council of India). Ti Arab Saudi, Hip hi thng tin y t Arab Saudi SAHI (Saudi Arabia Association for Health Information) c thnh lp nm 2006, c iu hnh chnh bi i hc Y mang tn Quc vng Saud Bin Abdulaziz (King Saud Bin Abdulaziz University of Health Sciences), trong vic lp k hoch, trin khai v xy dng c s d liu tri thc cho ngnh, ng thi l n v gii quyt cc nhu cu thc tin trong x hi v vn ng dng cng ngh thng tin trong qun l y t. Tuy nhin, v mng qun l in t, nhu cu dng trong nha khoa c xem l mt phn ca d n qun l in t y t trong sut qu trnh pht trin ca HIS/HIT trn th gii. Do , i b phn cc ng dng v qun l in t trong nha khoa u l cc gii php m hay thng mi ha ca cc t chc, cc bnh vin hay cc doanh nghip kinh doanh phn mm t nhn hay phi li nhun, thng c gia cng theo n t hng ca cc khch hng ring bit. Mt khc, cc lng lo v mt quy nh, tiu chun nh gi cng tc qun l in t trong nha khoa cng cn nhiu bt cp, ngay c ti nhng quc gia tin tin nht v nha khoa v HIS/HIT, nh: Hoa K, Anh, c, v.v... Cng vn cha xy dng c nhng hnh lang php l v tiu chun thch hp cho trn ton lnh th cho ng dng HIS trong nha khoa. Trong , Hoa K tr thnh quc gia dn u v u t tgii php HIS/HIT hon chnh ng dng trong phng khm nha khoa, Ring mng qun l labo phc hnh rng ti y vn cn b b trng, khng c nh hng pht trin c th dn n tnh trng pht trin manh mn v t pht. D n

tin hc u tin lin quan n nha khoa c bit n vo thp nin 1950, do nhm nghin cu ca Robert Ledley ti NBS thc hin. Bt u t thp nin 1960 n nay, my tnh c p dng v pht trin rng khp trong nha khoa Hoa K, Theo J. Atkinson, nm 200, 85,1% nha s Hoa K s dng my tnh trong cng vic chuyn mn []. V phn loi cc ng dng tin hc nha khoa, theo Schleyer va Kirsher, gm 03 nhm ng dng chnh: ng dng v cng tc qun l/ iu hnh phng khm (Administrative), ng dng cho lm sng (Clinical) v ng dng chia s thng tin qua mng (Internet). Trong , mng ng dng lm sng, gm: bnh n nha khoa in t EDR (Electronic Dental Records) - mt dng bin th ca EHR, thit k phc hnh, kh c c s h tr ca my tnh trong nha khoa (Computer Aided Dental Designs), ng dng v chun on hnh nh k thut s (Dental Digital Imaging Softwares) v cc ng dng lp k hoch iu tr c s h tr ca my tnh trong nha khoa (Dental Diagnostics and Treatment Softwares). Theo Zimmermann, chuyn gia hng u, mt trong nhng cha ca cng ngh CAD/CAM/CAE Hoa K, phn loi ca cc ng dng tin hc trong nha khoa, c th phn loi nh sau: ng dng qun l v iu hnh cc thng tin ca bnh nhn (bnh n) (Administration and management of patient documentation), di dng vn bn nn in t, ng dng giao tip vi my tnh cho cc trang thit b (ch yu l cc trang thit b k thut s) trong nha khoa (Telecommunication computer-aided education computerizing instruments), ng dng m phng h tr cng tc hun luyn & o to trong nha khoa (telecommunication computer - aided education instruments & techniques) v ng dng h tr ra quyt inh trn lm sng (Dental office software helping the clinical decision making). Tuy nhin, theo phn loi ca Hip hi nha khoa Hoa K ADA (American Dentist Association), tin hoc nha khoa gm cc mng ng dng sau: - Qun l phng khm nha khoa (Dental administration management) - Qun l nht k iu tr ca chuyn vin nha khoa (Dental practitioners record management) - Qun l lch hn bnh v cng tc ni b (Dental scheduling management) - Qun l bnh n (Patient dental records management) - Qun l chi ph nha khoa (Dental billing management) - X l d liu chun on hnh nh trong nha khoa (Dental imaging processing) - H tr chun on iu tr trong nha khoa (Dental diagnostics) - H tr lp k hoch iu tr (Dental treatment helping) - o to nha khoa c s h tr ca my tnh (Computer aided dental education) - Phn mm m phng v s dng cc dng c nha khoa v cc k nng trong thc hnh nha khoa (Dental instruments and other techniques usage in dental practice) Nm 1991, Trung tm nghin cu Y t (Institute of Medicine), thuc Vin nghin cu quc gia (National Academies), Washington (Hoa K), a ra vn bn chnh thc, ban hnh chnh thc trong cc vn bn php quy ngnh nha khoa, v khi nim v cc chc nng cn thit i vi mt h thng qun l vn bn y t bng my tnh. Trong cng khong thi gian , Hip hi nha khoa Hoa K ADA, ban hnh cc thng t hng dn s 1000 v 1004 (Specifications No. 1000 v No. 1004), lin quan n cu trc v ni dung trnh by ca bnh n in t trong nha khoa, gm vic xy dng thng tin bnh nhn (Patients data), lch hn (Scheduling), nht k iu tr (Treatment Records)/ bnh n (Patient Records), bng cu hi chun on thng quy (Anamnestics), thng tin lm sng (Clinical data) v d liu cn lm sng (Paraclinical

data). Trong giai on hin nay, tiu ch xy dng gii php tin hc nha khoa trn nn website (Website - based solutions) tr thnh mt trong nhng tiu ch nh gi v th h phn mm mi. Tuy nhin, v nhng l do ch quan, trong mt thi gian di, cc gii php qun l in t trong nha khoa pht trin theo nhiu hng khc nhau, c th l mt gii php trn gi theo tiu ch ca ADA hay l gii php module cho tng chc nng hay t hp ca mt vi chc nng ring l. Trong , cc gii php phn mm m ngun m v phn mm thng phm ti Hoa K rt a dng, v c s lng, chng loi, cht lng v quy m - cu trc - chc nng, nh7ng ch mt s t cc phn mm trn tha mn tiu chun nh gi do ADA ra (xem Bng I.2.) Bng I.2. Bng so snh mt s phn mm qun l Bnh vin v phng khm nha khoa thng dng trn th gii
Phn mm 1 2 3 Complant/ NovaDent Curve Dental Denticon Dng sn phm Thng mi SaaS SaaS Thng mi / Database GPL Thng mi Thng mi Thng mi Nc pht trin H Lan M M H Lan H iu hnh
Win Mac Linux

Chc nng

Cu trc Standalone Webbased Webbased Standalone Standalone Standalone Standalone

CSDL/ NNLT Bitriev e/ Firebird C-tree ACE SQLs

x x x x x x x

Dentio

5 6 7

Dentrix Eaglesoft Exquise

M M H Lan c, H Lan, M v Anh M M M n

x x x

Open Dental

GPL

Standalone

MySQL/ C#.net

9 0 10 11

PracticeWo rks SoftDent Dentimax SaralDent

Thng mi Thng mi Thng mi Thng mi

x x x x x x x

Standalone Standalone Webbased Standalone

Ngun: http:\\www. .com

cng l l do ti sao trong sut thi gian di, phn mm OpenDental, phn mm m ngun m u tin, vn c xem l mt trong nhng gii php phn mm m (Open Sourced Code) chun mc, thng dng nht v c nhiu doanh nghip HIS/HIT trong nha khoa, ln cc phng khm bnh vin nha khoa s dng lm phn mm nn pht trin cc ng dng c nhn hay cc ng dng thng mi ha.

Hnh I.1. Giao din ca phn mm OpenDental (Hoa K) (Ngun http://www.opendental.com/manual/toc.html) Cc doanh nghip lin quan cng nhanh chng ng dng cc cng ngh mi trong IT to iu kin thun li cho ngi s dng tng tc v lm vic tt hn, nh ng dng cng ngh lp trnh web-based, s dng cc ng dng chuyn i, qun l, lu tr, chia s v truy xut d liu trong h thng PACS, MedINFO, hay thu thp cc cp nht mi nht t cc c s d liu tri thc ngnh rng hm mt trn h thng c s d liu tri thc chung v y t ca quc gia, nh: MEDLINE v PubMED, hay cp nht cc gii php v cu trc mng cng tc do tng tc trc tip gia cc thnh vin hay cng ng ngi s dng trn bnh din quc gia, vi cc nh pht trin gii php chuyn nghip v nghip d, gip thu np d dng v lm giu kho lu tr cc ng dng l c pht trin thm cho cng ng ngi s dng cc gii php HIS/HIT trong nha khoa ny. Mt s gii php qun l in t trong nha khoa ca Hoa K, nh: OpenDental, Curve Dental, Dentimax, Dentrix, MOGO Dental, SyzyDental (Suzy System), PracticeWorks Practice Management (Carestream Dental), CS PracticeWorks,

v.v...

Bng I.3. Bng so snh mt s phn mm thng mi v qun l Bnh vin v phng khm nha khoa ti Hoa K
H iu hnh Scheduling/SM Phn mm Dng sn phm Nc pht trin Palm / Han dhel ds Chc nng Imaging data Cu trc CSDL/N NLT Web-based Reports/

Win OS

Mac OS

ACE Dental

Practice Management Software

Thng mi Thng mi Thng mi Thng mi Thng mi Thng mi Thng mi Thng mi Thng mi Thng mi Thng mi Thng

Hoa K Hoa K Hoa K Hoa K Hoa K Hoa K Hoa K Hoa K Hoa K Hoa K Hoa K Hoa

Gii php trn gi Gii php trn gi Gii php trn gi Gii php trn gi Gii php trn gi Gii php trn gi Gii php trn gi

Bitriev e/

2 3 4 5 6 7 8

Open Dental

x x x x x x x

x x x x x x x

x x x

x x x x x x x

x x x x

x x x x x x x

x x x x x x x

Denticon

Dentrix PracticeWork s SoftDent

Eaglesoft OdontoSoft Millennium ACE Dental Practice Management Software

Gii php trn gi Gii php trn gi Gii php trn gi

10

DentiMax Diamond

11 12

Dental Software DAISY

x x

x x

x -

x x

x x

x x

Dental Software

mi Thng mi Thng mi Thng mi Thng mi Thng mi Thng mi Thng mi Thng mi Thng mi Thng mi Thng mi Thng mi Thng mi Thng mi Thng mi Thng mi

K Hoa K Hoa K Hoa K Hoa K Hoa K Hoa K Hoa K Hoa K Hoa K Hoa K Hoa K Hoa K Hoa K Hoa K Hoa K Hoa K x x x x x

13

DentalMate DENTECH

14

Dental Software Solutions

x Gii php trn gi Gii php trn gi

15 16 17 18 19 20 21 22 23 24 25 26 27 28

MOGO

x x x x x x x x x x x x x x

x x x x x x x x x x x x x x

x x x

x x x x

x x x

x x x x x x x x x x x x x x

x x x x x x x x x x x x x X

Office Partner PEB for Windows PerfectByte Perio Exec Prime Dental Software Star Byte Dental The Complete Practitioner Toothpics Windent SQL

x x x x x

x x x x x

x x x x x

WindentOMS

ABELDent

Easy Dental

Office Partner

Gii php trn gi Gii php trn gi Gii php trn gi Gii php trn gi Gii php trn gi

Ghi ch: (x) - C h tr (-) - ang pht trin ( ) - Khng h tr (Ngun http://www. .com)

Ngoi Hoa K, cc ng dng h tr HIT cho Nha khoa cng c quan tm mt phn ti khu vc u chu v Bc M (Canada), tuy nhin ch l gii php h tr cho nhng c s nha khoa quy m trung v nh, vi cc sn phn c pht trin v thng mi ha c ngun gc ch yu t Php, c, Czech, Italia v H Lan, v.v...., nh: EasyDental (Henry Schein, c - Hoa K), LiveDDM ++ LiveChat (LiveDDM, Canada), MaxiDent (Maxim Software, Canada), DenStudio (DenStudio, Italia), AbelDent (Abel Software, Canada), ProgiDENT (ProgiDent, Canada), DentalPlus (Dental Plus Polen, Vng quc Anh), EXACT Dental Practice Management (Henry Schein, c - Hoa K), EviDENT (EviDENT, c), DS-Win-Comm (Damp Soft, c), CompuDent Z1 (CompuGroup Medical Co., c), PraxisProfile MPG (Praxis Profile, c), DENS Office Experience (DENS Software, c), Stoma-Win (ComputerKoncrete, c), v.v...

Hnh I.2. Giao din ca phn mm qun l nha khoa in t DENS Office Experienced (DENS Software, c) V mng phn mm ng dng trong labo phc hnh rng, th cc quc gia chu M v chu u cha ch trng nhiu n. Tuy nhin, cc nh pht trin phn mm v cc ng dng CAD/CAM nha khoa ti cc khu vc ny cng thc hin cc phn mm nh km theo gii php CAD/CAM nha khoa, nhm h tr cng tc qun l ca qu trnh sn xut ti khu CAD/CAM trong labo phc hnh rng, hay hot ng ca ton b mt trung tm gia cng CAD/CAM nha khoa DC 2MC (Dental CAD/CAM Milling

Centers). Hu ht cc phn mm CAD/CAM u c phn mm h tr qun l thng tin n hng/ sn phm n gin, nh km di dng plugs-in, nh ca cc phn mm sau: CEREC 3D 4.0 (Sirona, c) ExoCAD (ExoCAD GmbH, c), Dental Wings OS (DWOS) (Dental Wings Co., Canada), CeraMILL CAD/CAM Software (Armann GirrBach GmbH), Wieland CAD/CAM Software (Wieland Co., c (DWOS based)), Hilt-Ents CAD/CAM systems (Hilt-Ents, c), Mayka Dental 3D (Mayka Dental, Czech), Lava System (3M ESPE, c - Hoa K), Cercon CAD/CAM software (Densply/ Degudent GmbH, c - Hoa K), v.v... Ring v mng ng dng qun l cho cc DC2MC, phi k n cc sn phm ng dng ca cc nh cung cp gii php CAD/CAM hng u trong lnh vc nha khoa nh: Dental Manager 2012 (Delcam Corp., Vng quc Anh, mnh nht hin nay). 3Shape Manager (3Shape, an Mch), Procera Product Flow Management (pht trin ring, s dng ni b v khng thng mi ha, Nobel BioCare, Thy in), AstraTech / Densply Corp. (pht trin ring, s dng ni b v khng thng mi ha, AstraTech, Thy in) v SUM3D (CIMSytems S.r.l., Italia). Ti khu vc chu, Thi Bnh Dng, Nht Bn tr thnh mt trong nhng trung tm ng dng HIS/HIT mnh trong nha khoa, in hnh l phng nghin cu ca i hc Nha khoa Showa (Showa Dental School), trung tm nghin cu hng u ca Nht Bn ni ring, c khu vc Chu - Thi Bnh Dng v th gii ni chung, v ng dng k thut s trong Nha khoa, bao gm c: cng ngh CAD/CAM nha khoa v qun l in t trong nha khoa. Hn Quc v Australia cng l mt trong nhng quc gia c th mnh v HIS/HIT/MPMS (Medical Practice Management Softwares) trong khu vc, do d cng cn nhng sn phm tng ng cho nha khoa. Mt khc, Trung Quc va l nh cung cp va l khch hng ln nht ca th trng sn phm HIS/HIT/MPMS trn th gii, tuy nhin ng dng trong nha khoa ca Trung Quc cha c nhiu v mang tnh t pht theo nhu cu, do cha c tiu chun ngnh. Mt s gii php qun l in t. nh km theo gii php CAD/CAM nha khoa, nhm h tr cng tc qun l ca qu trnh sn xut ti khu CAD/CAM trong labo phc hnh rng, hay hot ng ca ton b mt trung tm gia cng CAD/CAM nha khoa DC2MC (Dental CAD/CAM Milling Centers) tng t nh ti chu u, nh: Decsy 101 CAD/CAM software (Decsy Co., Nht Bn), Mitsubishi G1 CAD/CAM software (Mitsubishi, Nht Bn), Katana CAD/CAM Software (xy dng trn nn phn mm 3Shape, ca Noritake, Nht Bn), TDS CAD/CAM Software (Pouyen Biotech Co. Ltd., i Loan), DentAim CAD/CAM Software (xy dng trn nn phn mm DELCAM, ca DentAIM, Hn Quc), D-CAM CAD/CAM Software (xy dng trn nn phn mm 3Shape, ca D-CAM, Hn Quc), v.v..., hay phn mm qun l phng khm nha khoa, nh: Caesy Soft (Caesy, Nht Bn), Doobunae/ Hanaro System Patients/ Clinic/ Dental Imaging Total Management Software (Osstem Implant Co. Ltd., Hn Quc), dental4windows SQL (Centaur Software Co., Australia), Permanent Dental Clinic Management Software (HengJiu Software, Trung Quc), Dentistry System 2.0 (Beijing Sunny Zhiyuan Technic Ltd., Trung Quc), Dental Management Software (Shenzhen Mecodent Dental Laboratory Co.,Ltd., Trung Quc), Dental Lab Software (Dalian Jixing Software, Trung Quc), v.v... Cng trong khu vc chu - Thi Bnh Dng, n c xem l nh cung cp gii php phn mm HIS/HIT mnh nht khu vc chu , hay cng xng gia cng phn mm ln nht th gii. Tuy nhin, nh pht trin phn mm chnh thc chuyn v

cc ng dng trong nha khoa, c ng du xut x ti n , ch c duy nht Sarals Software Co. (n ). Ngoi gia cng phn mm cho chnh mnh, cc doanh nghip trong cng ngh phn mm n cn nhn hp ng gia cng OEM, theo nhu cu, cho cc nh pht trin phn mm thuc cc quc gia tin tin hn nh Bc M, u chu v c chuMt s sn phm phn mm ng dng trong qun l phng khm nha khoa ca Sarals Software l SARAL Dental Software 4.0. Mt khc, Sarals Software Co. (n ) cng gia cng theo yu cu ca Labo phn mm Precise Dental Lab Management Software 3.0, mt trong nhng phn him hoi h tr cho cng tc in t ca labo phc hnh rng trn th gii. Tuy nhin, phn mm chuyn dng cho qun l labo phc hnh rng Precise Dental Lab Management Software 3.0 ch c th p ng c mt phn yu cu ca labo, vn cn thiu cc tnh nng quan trng nh: kim sot n hng, tnh chi ph pht sinh, trong qu trnh sn xut, kim sot RMA v qun l tn kho theo thi gian thc.

Hnh I.3. Giao din ca phn mm Precise Dental Lab Management 3.0 (Sarals Software, n )

II.2. Tnh hnh ng dng ti Vit Nam

Mc d, Vit Nam tham gia APAMI t nm 1994, nhng ng dng tin hc trong y t vn cn ang trong giai on s khi. Bt u t nm 2009, ng dng trong c y khoa v nha khoa bt u bng n v c quan tm hn ti Vit Nam, ch yu c pht trin bi cc doanh nghip dch v tin hc va v nh, gm c chuyn v khng chuyn trong lnh vc y khoa. Mt trong nhng ng dng u tin v qun l in t trong y khoa l phn mm qun l bnh vin Ykhoa.net, c xy dng bi BS. Phan

Xun Trung (CT in ton Y Khoa Hong Trung - HT MedSoft), th nghim u tin ti TT Medic Ha Ho, nm 2006. n nay, gn 06 nm, tin hc y t ni chung ti Vit Nam c nhng bc chuyn mnh ng k v ng c ghi nhn trong c qun l y khoa in t (bnh vin/ phng khm y khoa), qun l thng tin xt nghim, hnh nh chun on, qun l nha khoa in t (bnh vin/ phng khm nha khoa v labo phc hnh rng), qun l in t dc (nh thuc) v c c s d liu tri thc ngnh trong Y hc c truyn, y hc thng thc. Mt s phn mm ng dng trong tin hc y t ca Vit Nam,,tiu biu nh: - V gii php qun l bnh vin hay phng khm a khoa: Ykhoa.net (HT MedSoft), DAPro 2.0, PKK 1.0, QLTC, Cosmetic Clinic 1,0 (MediSofts), Phn mm Qun l bnh vin (CTy TNHH Mekong Vit), V-Clinic (CTy CPT&PT Gii Php Cng Ngh V&V), v.v... - V gii php qun l nh thuc, Qun l nh thuc (HT MedSoft), Phn mm qun l nh thuc (CTy TNHH Mekong Vit), QLNT 1.0 (MediSofts), v.v... - V gii php qun l phng xt nghim, chun on hnh nh: IDManager 3.1 (MediSofts) - V gii php qun l y t d phng, tim chng, dch t, dinh dng quc gia: QLTC 2.0 (MediSofts), YTQG 2.0 (BS. T Hang n - MediSofts), WINPEPPI (MediSofts), v.v... - V c s d liu in t v tri thc ngnh: Medic 2.7 (T in chuyn ngnh), DNotes 1.0 (S tay chun on bnh in t), Th vin hnh nh chun on, Ykhoa 2.0, T in ICD - 10 (MediSofts), v.v... - V gii php qun l nha khoa (trnh by phn sau)

Hnh I.4. Giao din ca phn mm DAPro 2.0 (Qun l phng khm a khoa) (MediSofts, Vit Nam) Ti Vit Nam, tin hc ng dng trong nha khoa bt u pht trin nhanh vo cui 2010, vi khong mt chc ng dng, c pht trin trn nn tng phn mm m ngun m hay thng mi ha ca nc ngoi, vi kh y cc tnh nng c bn, nh: Phn mm qun l nha khoa s (CT TNHH Nha khoa s), V-Dental (Cng Ty CPT&PT Gii Php Cng Ngh V&V), MKV Labo 7.0 / MKV Dental 7.0 (CTy TNHH Mekong Vit), Qun l nha khoa (CT TNHH Trng Minh Thnh), Dental Clinic 2.0 (MediSofts), v.v... Tuy nhin, v mng qun l in t cho labo ph chnh rng ti Vit Nam vn cn ng i vi cc nh cung cp gii php cng ngh thng tin Vit Nam. Hin nay, hn 95% cc labo phc hnh rng trn lnh th Vit Nam (hin c hn 600 labo phc hnh rng ln nh3 trn phm vi ton quc) s dng cc ng dng vn phng sn c, qun l cc n hng, cuc hn, qu l d liu khch hng/ bnh nhn/ nh cung cp, s liu thng k v cc bo co nh: Microsoft Access, Microsoft Excel, hay t vit mt s ng dng n gin trn Visual Basic, Visual C#, .Net, v.v... (xem s liu tng kt trong Ph lc I). Ty theo kh nng ng dng v qun l tin hc, mi labo s c mc tip cn khc nhau v qun l in t trong labo. Duy nht, hin nay ch c hai labo phc hnh rng c ng dng gii php qun l in t ton din trong qun l hot ng, gm: Digital Age Dental Lab (DADL) Co. Ltd. (100% vn nc ngoi, Hoa K) (KCN VSIP, Bnh Dng) v VietGood (Dental Lab) Co. Ltd. (100% vn t nhn, Vit Nam) (KCN Tn Bnh, TP.HCM) u t nghim tc xy dng mt phn mm qun l ton din cho cng tc qun l labo phc hnh rng. Gii php phn mm qun l labo ton din ca DADL c xy dng v t pht trin t mt phn mm qun l ERP bi cng ty m, tr s ti M, phi hp vi n v gia cng phn mm v n v t vn v kim nh - tiu chun - qun l cht lng phi hp thc hin v th nghim trn ton h thng ca Tp on), theo tiu chun ngnh ti M. ct gim chi ph v tng hiu qu qun l, VietGood nh n v t vn th ba v v thng qua s t vn ca n v t vn v kim nh - tiu chun - qun l cht lng h tr trong cng tc phn tch v ti cu trc n v, kt hp vi n v gia cng phn mm hiu chnh v sa cha phn mm gc v qun l Logistics p ng nh cu thc t, gm cc chc nng sau: qun l h thng n hng v sn phm bng m vch, kim sot dng sn xut (Product line), lp k hoch v qun l nhn s (chm cng theo nng lc sn xut) (kim sot chi tit n tng khu, b phn, nhn s trn dng sn xut), t ng lp bo co thi im a tiu ch, , qun l tn kho, qun l logistics v h tr iu khin v qun l t xa qua thit b cm tay (Remote managing & monitoring via handhelds), tt c cc hc nng trn u c truy xut theo thi gian thc. Gii php ca VietGood c hon thin v th nghim thnh cng a vo trin khai chnh thc trn thc t t cui qu III nm 2011. Thng qua kt qu thu thp v phn tch d liu theo mu bng cu hi chung cho cc Labo phc hnh rng (Xem Ph lc II), ta thy nhu cu ca i b phn cc labo quy m va v nh trn a bn TP.H Ch Minh nh sau:

Bng I.4. Bng tng kt kt qu iu tra v nhu cu qun l in t trong labo phc hnh rng ti TP.HCM nm 2011-2012
Chc nng H (qun/ huyn) Q.1 Win QL QL QL QL QL QL

TT

a Tn Labo

1 2

Labo Bnh vin RHM TP.HCM

Labo MTM Labo dch v

Q.3

Win

3
(Khoa RHM, H Y Dc TP.HCM)

Q.5

Win

4 5 6 7 8 9 10 11

CTy TNHH H Minh

Q.6

Win

Labo Bnh Minh

Q.8

Win

Labo K Nguyn

Q.8 Bnh

Win

Labo Minh Phc

Win

Labo Phm ng (CETEC)

Ph

Win

Labo Vit Quc

Ph

Win

Labo VietGood (Labo ng )

Tn

Win

Labo Tn Pht

Tn

Win

12

Labo Thin Long * (Bun Ma Thuc)

BMT*

Win

12 Tng kt (%) 100

11 92

3 25

5 42

3 25

12 100

(Tng hp)

III. TNG LAI NG DNG QUN L IN T TRONG Y NHA KHOA TI VIT NAM & PHM VI THC HIN LUN VN
Gii php qun l in t s gip cho cng tc qun l trong y t ni chung, nha khoa ni ring, t nn d dng hn. Ni cch khc, gii php ny chnh l cng c c lc dng ct gim chi ph, tng hiu qu qun l v tn dng qu thi gian tt hn cho cc labo phc hnh rng, mi loi hnh v mi quy m (nh, va v quy m cng nghip). Tuy nhin, cc gii php in t cho cng tc qun l in t s tr thnh gnh nng v tn thi gian di phn tch v xy dng ng dng, i khi s phi thc hin nhiu ln, c bit i vi cc khch hng cha t chun ha quy trnh lm vic theo tiu chun, hay cha c k hoch chun b hi nhp hay pht trin thm v sau ny. iu s dn n tn nhiu chi ph, cng sc v khng hiu qu cho qu trnh u t to ra mt sn phn hon chnh v ton din. Tuy nhin, th trng HIT/HIS/MPRM/ PSM VIt Nam vn l mt th trng y ha hn i vi cc doanh nghip dch v v cng ngh phn mm quy m v v nh ni a. Ro cn duy nht v ln nht i vi s pht trin ca th trng HIT/HIS/ MPRM/ PSM trong giai on u v cc nh pht trin gii php chnh l s dung ha gia c s tri thc y t, tri thc v qun l sn xut v tru thc v cng ngh phn mm, mt khc cc bn tham gia cn c thi gian nm vng v giao thoa kin thc a ngnh nhm hiu r hn vn v tm ra gii php thch hp. Trong thc t, cc doanh nghip nn khuyn khch v ph cp ha gii php qun l in t trong cc c s y t, thng qua cc hi tho chuyn su v HIS/HIT/MPSM, hi ngh gii thiu gii php, hi ngh khch hng, chng trnh tp hun, chng trnh khuyn mi v chng trnh dng th thm d kin phn hi. Cc ng thi ny s gip cho cng ng chuyn vin y t ng dng hiu qu hn gii php HIS/HIT/MPSM v cng l tin gip cho cc doanh nghip dch v phn mm c c hi thu ht u t t khch hng, gii quyt nhiu hn v st thc tin hn t nhng phn hi tch cc hn ca khch hng. V d, khi phn tch kt qu iu tra (xem Bng I.4), ta thy nhu cu ch yu ca cc labo quy m va v nh, ch yu l cc tnh nng c bn sau: - Qun l n hng v khch hng (100%) - Qun l tn kho (92%) - Qun l ti chnh (25%) - Qun l quy trnh sn xut (42%) - Qun l cht lng (25%) - Qun l bo co in t (100%)

T , cho thy nhu cu v nng lc s dng gii php qun l in t trong labo phc hnh rng ch yu mc n gin (chim khon ... %), thng ch gm cc chc nng c bn, nh qun l thng tin n hng v thng tin khch hng, qun l hay to bo co nh k (ngy, tun, thng, qu, nm) t ng, qun l v xut bo gi hay tng kt cn n cho khch hng. Do , s cn mt khong thi gian di gii php qun l in t trong nha khoa lm quen v ci thin tm nhn ca ng dng trong cc lnh vc v nha khoa, gm c: mng lm sng v labo phc hnh rng, v phi hp gia lm sng - labo. Trong phm vi lun vn ny, xy dng phn mm qun l in t trong y - nha khoa vi cu trc chc nng c bn, gm cc chc nng sau: - Qun l n hng v khch hng (100 %) - Qun l nhn s (100 %) - Qun l bo co in t (100 %) Sn phm sau cng ca lun vn ny, s gm: phn mm qun l in t n gin v qun l thng tin khch hng, n hng, nh cung ng, tra cu thng tin kho, lp phiu sn xut v cc bo co in t nh k v sn xut (n hng), qun l thng tin nhn vin, cc ph lc v quy trnh qun l hot ng chun cho c s y t ni chung, hay labo phc hnh rng ni ring.