三高共管三级协同慢病管理平台的功能

三高共管三级协同慢病管理平台，其特征是，包括数据源、用户系统和云平台，所述数据源、所述用户系统与所述云平台通信连接；

The three high co management three-level collaborative chronic disease management platform is characterized in that it includes a data source, a user system, and a cloud platform, wherein the data source, the user system, and the cloud platform are communicated and connected;

所述云平台包括服务层、评估报告引擎、逻辑框架层和存储层；

The cloud platform comprises a service layer, an evaluation report engine, a logical framework layer, and a storage layer;

所述评估报告引擎用于接入来自于所述数据源的健康信息和来自于所述用户系统的健康信息，所述评估报告引擎用于对所接入的所述健康信息进行清洗、转换和合并；

The evaluation report engine is used to access health information from the data source and health information from the user system. The evaluation report engine is used to clean, transform, and merge the accessed health information;

所述存储层包括基础数据库、患者数据库和转诊信息数据库，所述基础数据库用于存储所述健康信息，所述服务层经所述逻辑框架层与所述存储层进行数据交互，所述服务层包括人群筛选系统、病情评估系统、分层分级系统、报告展示系统、双向协诊系统、病情走势系统和绿色通道系统；

The storage layer includes a basic database, a patient database, and a referral information database. The basic database is used to store the health information. The service layer interacts with the storage layer through the logical framework layer. The service layer includes a population screening system, a disease assessment system, a hierarchical grading system, a report display system, a bidirectional consultation system, a disease trend system, and a green channel system;

所述人群筛选系统：用于对来自于所述基础数据库中的所述健康信息进行筛选，筛选出涉及三高的人群的健康信息后整合、存储至所述患者数据库；

The population screening system is used to screen the health information from the basic database, identify the health information related to the three highs, and integrate and store it in the patient database;

所述病情评估系统用于通过用户系统录入病情评估信息，所述存储层设有病情评估经验数据库，所述病情评估经验数据库存储有病情评估经验数据，所述病情评估系统用于根据所述病情评估经验数据和所述健康信息生成病情评估信息，所述病情评估系统用于将所述病情评估信息整合至位于所述基础数据库和所述患者数据库中的健康信息中；

The disease assessment system is used to input disease assessment information through a user system. The storage layer is equipped with a disease assessment experience database, which stores disease assessment experience data. The disease assessment system is used to generate disease assessment information based on the disease assessment experience data and health information, The disease assessment system is used to integrate the disease assessment information into the health information located in the basic database and the patient database;

所述分层分级系统用于根据所述患者数据库中的健康信息将人群按照三高的风险等级进行划分，并生成对应的风险信息，所述风险信息包括高危、中危、低危、易患和正常，所述分层分级系统用于将所述风险信息整合、存储至位于所述基础数据库和所述患者数据库中的健康信息中；

The hierarchical grading system is used to divide the population according to the three high risk levels based on the health information in the patient database, and generate corresponding risk information. The risk information includes high risk, medium risk, low risk, susceptible, and normal. The hierarchical grading system is used to integrate and store the risk information into the health information located in the basic database and the patient database;

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