三高共管三級協(xié)同慢病管理平臺，其特征是，包括數據源、用戶系統(tǒng)和云平臺，所述數據源、所述用戶系統(tǒng)與所述云平臺通信連接；

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;

所述云平臺包括服務層、評估報告引擎、邏輯框架層和存儲層；

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

所述評估報告引擎用于接入來自于所述數據源的健康信息和來自于所述用戶系統(tǒng)的健康信息，所述評估報告引擎用于對所接入的所述健康信息進行清洗、轉換和合并；

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;

所述存儲層包括基礎數據庫、患者數據庫和轉診信息數據庫，所述基礎數據庫用于存儲所述健康信息，所述服務層經所述邏輯框架層與所述存儲層進行數據交互，所述服務層包括人群篩選系統(tǒng)、病情評估系統(tǒng)、分層分級系統(tǒng)、報告展示系統(tǒng)、雙向協(xié)診系統(tǒng)、病情走勢系統(tǒng)和綠色通道系統(tǒng)；

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;

所述人群篩選系統(tǒng)：用于對來自于所述基礎數據庫中的所述健康信息進行篩選，篩選出涉及三高的人群的健康信息后整合、存儲至所述患者數據庫；

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;

所述病情評估系統(tǒng)用于通過用戶系統(tǒng)錄入病情評估信息，所述存儲層設有病情評估經驗數據庫，所述病情評估經驗數據庫存儲有病情評估經驗數據，所述病情評估系統(tǒng)用于根據所述病情評估經驗數據和所述健康信息生成病情評估信息，所述病情評估系統(tǒng)用于將所述病情評估信息整合至位于所述基礎數據庫和所述患者數據庫中的健康信息中；

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;

所述分層分級系統(tǒng)用于根據所述患者數據庫中的健康信息將人群按照三高的風險等級進行劃分，并生成對應的風險信息，所述風險信息包括高危、中危、低危、易患和正常，所述分層分級系統(tǒng)用于將所述風險信息整合、存儲至位于所述基礎數據庫和所述患者數據庫中的健康信息中；

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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