隨著我國人口老齡化加劇和生活方式的轉變，慢性病的發病率持續攀升，已成為威脅全民健康和制約社會經濟發展的重大問題。國家為此密集出臺政策，推動慢性病管理轉型。在這樣的背景下，易享隨訪一體機的出現是響應國家戰略、打通基層健康管理的關鍵載體。

　　With the aggravation of population aging and the change of lifestyle in China, the incidence rate of chronic diseases continues to rise, which has become a major problem threatening the health of the whole people and restricting social and economic development. The government has issued intensive policies to promote the transformation of chronic disease management. In this context, the emergence of the Yixiang follow-up all-in-one machine is a key carrier for responding to national strategies and connecting grassroots health management.

　　PART.01

　　PART.01

　　最新政策

　　Latest policies

　　2025年10月29日，國家衛健委發布《關于加強基層慢性病健康管理服務的指導意見》，提出整合基層慢性病防、篩、診、治、管、康的全流程服務功能，明確鄉鎮衛生院、村衛生室等不同機構的角色定位；要求開展慢性病高風險人群早篩、患者分類分級管理、多病共管等5項服務內容，同時從用藥保障、數智賦能等方面制定5項保障措施，并設定2027年和2030年階段性目標。 《指導意見》是一份綱領性文件，它制定了清晰的階段性任務和規范化、系統化的慢性病健康管理服務內容，推動慢性病防控從零散化、碎片化向制度化、常態化轉變。

　　On October 29, 2025, the National Health Commission issued the "Guiding Opinions on Strengthening Grassroots Chronic Disease Health Management Services", proposing to integrate the full process service functions of grassroots chronic disease prevention, screening, diagnosis, treatment, management, and health, and clarify the role positioning of different institutions such as township health centers and village clinics; Five service contents are required to be carried out, including early screening of high-risk populations for chronic diseases, patient classification and grading management, and multi disease co management. At the same time, five guarantee measures are formulated from the aspects of medication guarantee and digital intelligence empowerment, and phased goals are set for 2027 and 2030. The Guiding Opinions is a guiding document that sets clear phased tasks and standardized, systematic content for chronic disease health management services, promoting the transformation of chronic disease prevention and control from fragmented and scattered to institutionalized and normalized.

　　2025年11月20日，國家衛健委發布《關于印發基層慢性病健康管理服務能力建設指引的通知》，明確了兩方面核心內容：一是五大重點，包括明確管理服務的核心功能、規劃健康服務區與診療區的空間布局、整合衛生專業技術團隊、基衛配備基礎醫療設施設、強調數智化應用與信息數據交匯共享；二是細化基層慢性病服務，從咨詢與篩查、診斷與治療、隨訪與健康指導三方面，明確11項具體服務內容，全面規范基層健康服務開展。

　　On November 20, 2025, the National Health Commission issued a notice on the issuance of guidelines for the construction of grassroots chronic disease health management service capabilities, which clarified two core contents: first, five key points, including clarifying the core functions of management services, planning the spatial layout of health service areas and diagnosis and treatment areas, integrating health professional technical teams, equipping basic medical facilities for basic health care, and emphasizing the intersection and sharing of digital applications and information data; The second is to refine the services for chronic diseases at the grassroots level, clarifying 11 specific service contents from three aspects: consultation and screening, diagnosis and treatment, follow-up and health guidance, and comprehensively regulating the development of grassroots health services.

　　五大建設核心

　　Five core constructions

　　核心功能：開展轄區慢性病預防、診療和健康管理;對接轉診服務;匯總分析流轉患者健康信息;引導患者簽約家庭醫生;

　　Core function: Carry out prevention, diagnosis, treatment, and health management of chronic diseases in the jurisdiction; Coordinate referral services; Summarize and analyze the health information of circulating patients; Guide patients to sign up with family doctors;

　　空間布局：整合現有空間，劃分健康服務區負責咨詢、篩查等，和診療區負責診斷、治療等，要求分區明確;

　　Space layout: Integrate existing space, divide the health service area for consultation, screening, etc., and the diagnosis and treatment area for diagnosis, treatment, etc., requiring clear zoning;

　　隊伍建設：明確由全科醫生、中醫醫師、公共衛生醫師、藥師、護士等專業人員組成，鼓勵吸納社會工作者、志愿者等;

　　Team building: Clarify the composition of professionals such as general practitioners, traditional Chinese medicine physicians, public health physicians, pharmacists, nurses, etc., and encourage the recruitment of social workers, volunteers, etc;

　　設備配備：要求結合慢性病健康管理需求配備、完善相關設施設備;

　　Equipment configuration: It is required to equip and improve relevant facilities and equipment in accordance with the needs of chronic disease health management;

　　信息化建設：整合電子健康檔案、診療、體檢等數據，強化數智化應用，具備信息交匯功能，支撐全流程健康管理。

　　Informationization construction: Integrate electronic health records, diagnosis and treatment, physical examination and other data, strengthen digital applications, have information exchange functions, and support the entire process of health management.

　　三大服務任務

　　Three major service tasks

　　咨詢與篩查：1.提供健康咨詢、科普、預約掛號及轉診對接服務;2.收集健康信息;3.開展健康自檢和慢性病篩查;4.更新電子健康檔案并提示健康風險;5.優先安排簽約居民分診，協助家庭醫生簽約或續約;

　　Consultation and screening: 1. Provide health consultation, science popularization, appointment registration, and referral docking services; 2. Collect health information; 3. Carry out health self-examination and chronic disease screening; 4. Update electronic health records and alert health risks; 5. Prioritize the triage of contracted residents and assist family doctors in signing or renewing contracts;

　　診斷與治療：6.按規范檢查評估，依指南診斷治療，納入分類分級管理;7.提供膳食、運動等生活方式指導;8.對超能力診療病例，初步處理后啟動向上轉診;

　　Diagnosis and treatment: 6. Conduct standardized examinations and evaluations, diagnose and treat according to guidelines, and include them in classification and grading management; 7. Provide lifestyle guidance such as diet and exercise; 8. For cases of superpower diagnosis and treatment, initiate upward referral after initial treatment;

　　隨訪與健康指導：9.分類分級隨訪，解讀結果、記錄信息并預約復診，動態管理下轉患者;10.指導患者監測健康指標，開展膳食、運動等健康指導;11.分析慢性病管理數據，掌握人群特點以優化服務。

　　Follow up and health guidance: 9. Classify and grade follow-up, interpret results, record information, and schedule follow-up appointments, dynamically manage patient referrals; 10. Guide patients to monitor health indicators and provide health guidance such as diet and exercise; 11. Analyze chronic disease management data, grasp population characteristics to optimize services.

　　政策核心聚焦三大變革方向：

　　The policy core focuses on three major directions of change:

　　服務整合化：建立“一站式”健康管理中心，融合防、篩、診、治、管、康全流程；

　　Service integration: Establish a "one-stop" health management center that integrates the entire process of prevention, screening, diagnosis, treatment, management, and rehabilitation;

　　資源協同化：通過醫聯體推動專家、藥品和技術下沉，實現城鄉醫療資源貫通；

　　Resource synergy: Promote the sinking of experts, drugs, and technology through medical consortia, and achieve the integration of urban and rural medical resources;

　　管理數智化：運用AI與大數據實現風險預警、精準隨訪和個性化干預。

　　Digitalization of Management: Utilizing AI and big data to achieve risk warning, precise follow-up, and personalized intervention.

　　而在這場基層設備升級的浪潮中，易享隨訪一體機是響應國家戰略、打通基層健康管理“最后一公里”的關鍵載體。

　　In this wave of upgrading grassroots equipment, the Yixiang follow-up all-in-one machine is a key carrier that responds to national strategies and connects the "last mile" of grassroots health management.

　　PART.02

　　PART.02

　　隨訪一體機

　　Follow up all-in-one machine

　　隨訪一體機是由易享科技自主研發的智能化健康檢測與管理系統。它專為社區衛生服務中心、鄉鎮衛生院、村衛生室及家庭醫生簽約服務場景設計。該設備集成了多參數生理指標檢測功能，能夠檢測血壓、血糖、血氧、心率、體溫、心電圖等多項指標。通過一次測量，就能獲取多項健康數據，為后續的分析和管理提供全面的信息。

　　The follow-up all-in-one machine is an intelligent health monitoring and management system independently developed by Yixiang Technology. It is designed specifically for community health service centers, township health centers, village clinics, and family doctor contracted service scenarios. This device integrates multi parameter physiological index detection function, which can detect multiple indicators such as blood pressure, blood glucose, blood oxygen, heart rate, body temperature, electrocardiogram, etc. Through one measurement, multiple health data can be obtained, providing comprehensive information for subsequent analysis and management.

　　除了基本的檢測功能，易享隨訪一體機還具備健康評估功能、健康檔案自動建檔與上傳功能、慢病篩查、對接平臺以及數據互聯互通接口等。這些功能使得它能夠真正實現“早發現、早干預、精準管”的目標。

　　In addition to basic testing functions, the Yixiang follow-up all-in-one machine also has health assessment functions, automatic health record creation and upload functions, chronic disease screening, docking platform, and data interconnection interfaces. These functions enable it to truly achieve the goal of "early detection, early intervention, and precise management".

　　政策呼應點：完全契合《建設指引》中提出的“咨詢與篩查”環節要求，助力實現“高風險人群早篩”。

　　Policy response point: Fully comply with the requirements of the "consultation and screening" section proposed in the "Construction Guidelines", and help achieve "early screening of high-risk populations".

　　PART.03

　　PART.03

　　賦能基層團隊

　　Empowering grassroots teams

　　一體機還有健康隨訪功能，同時，它支持語音播報健康指導，針對不同人群播放定制化宣教內容。此外，設備內置家庭醫生簽約服務模塊，現場即可完成電子簽約、健康評估、預約隨訪等功能，極大提升了履約率和群眾滿意度。這不僅是工具的升級，更是一場“服務范式變革”，推動基層醫療從被動接診轉向主動健康管理。

　　The all-in-one machine also has a health follow-up function, and it supports voice broadcasting of health guidance, playing customized educational content for different groups of people. In addition, the device has a built-in family doctor signing service module, which can complete electronic signing, health assessment, appointment follow-up and other functions on-site, greatly improving the compliance rate and public satisfaction. This is not only an upgrade of tools, but also a "service paradigm shift" that promotes the transformation of primary healthcare from passive reception to active health management.

　　PART.04

　　PART.04

　　數智賦能治理

　　Empowering Governance with Digital Intelligence

　　《指導意見》強調要“強化數智化應用，推進信息交匯共享”。易享隨訪一體機正是這一理念的技術載體。采用本地存儲和加密傳輸的方式，保障了患者隱私安全。可以對接縣域醫共體平臺、基本公衛系統等，實現區域內信息的流通和共享。

　　The Guiding Opinions emphasize the need to "strengthen the application of digital intelligence and promote information exchange and sharing". The Yixiang follow-up all-in-one machine is the technical carrier of this concept. The use of local storage and encrypted transmission ensures patient privacy and security. It can connect with county-level medical community platforms, basic public health systems, etc., to achieve the circulation and sharing of information within the region.

　　PART.05

　　PART.05

　　客戶案例

　　Customer Case

　　易享隨訪一體機SH-T18集成了多項核心檢測功能，覆蓋基礎體征、慢病篩查、中醫體質辨識等多維度健康數據：

　　The SH-T18 follow-up all-in-one machine integrates multiple core detection functions, covering multi-dimensional health data such as basic physical signs, chronic disease screening, and traditional Chinese medicine constitution identification

　　1、基礎檢測：身高、體重、BMI、腰臀比、體溫、血氧飽和度；

　　1. Basic tests: height, weight BMI、 Waist to hip ratio, body temperature, and blood oxygen saturation;

　　2、慢病管理：血壓、血糖、尿酸、膽固醇、血脂四項、血紅蛋白；

　　2. Chronic disease management: blood pressure, blood glucose, uric acid, cholesterol, blood lipids, hemoglobin;

　　3、專項篩查：十二導聯心電圖、尿液分析；

　　3. Special screening: Twelve lead electrocardiogram, urine analysis;

　　4、特色服務：中醫體質辨識（9種體質分析）、視力檢測、心理評估量表；

　　4. Featured services: Traditional Chinese Medicine constitution identification (9 constitution analyses), vision testing, psychological assessment scales;

　　5、便捷輸出：A4打印機，現場生成個性化健康報告。

　　5. Convenient output: A4 printer, on-site generation of personalized health reports.

　　設備優勢：

　　Equipment advantages:

　　全自動化操作：居民通過身份證或人臉識別登錄，系統引導完成檢測，減少人工誤差；

　　Fully automated operation: Residents log in through ID cards or facial recognition, and the system guides the detection process to reduce manual errors;

　　數據實時上傳：檢測結果自動同步至醫院公共衛生（公衛）系統，支持電子健康檔案動態更新；

　　Real time data upload: The test results are automatically synchronized to the hospital's public health system, which supports dynamic updates of electronic health records;

　　PART.06

　　PART.06

　　讓科技有溫度，讓健康可及

　　Make technology warm and accessible to health

　　慢性病防控是一場持久戰，也是一場系統工程。國家政策已經指明方向，下一步的關鍵在于“抓落實、強執行、重實效”。 易享隨訪一體機，正以其集成化、智能化、標準化、普惠化的特點，慢慢成為基層慢性病管理體系建設中的“新基建”和“新動能”。

　　Chronic disease prevention and control is a long-term battle and a systematic project. The national policy has already indicated the direction, and the key to the next step is to "implement, strengthen execution, and focus on practical results". The Yixiang follow-up all-in-one machine is gradually becoming a "new infrastructure" and "new driving force" in the construction of grassroots chronic disease management system due to its integrated, intelligent, standardized, and inclusive characteristics.

　　它不只是一個機器，而是：

　　It is not just a machine, but:

　　一位永不疲倦的“健康守門人”

　　A tireless' health gatekeeper '

　　一座連接城鄉醫療資源的“數字橋梁”

　　A 'digital bridge' connecting urban and rural medical resources

　　一套覆蓋“篩-防-管-治-康”的閉環解決方案

　　A closed-loop solution covering "screening prevention management treatment health"

　　未來，隨著人工智能、大模型預測的發展，易享將持續迭代升級，探索更多創新場景…… 我們相信，在科技與人文的交匯處，必將生長出更加公平、高效、溫暖的中國健康服務體系。 易享所行之路，正是健康中國的微光匯聚之處。 關注我們，了解更多智慧醫療前沿實踐與政策解讀。

　　In the future, with the development of artificial intelligence and large model prediction, Yixiang will continue to iterate and upgrade, exploring more innovative scenarios... We believe that at the intersection of technology and humanities, a more fair, efficient, and warm Chinese health service system will grow. The path taken by Yi Xiang is where the faint light of a healthy China gathers. Follow us to learn more about cutting-edge practices and policy interpretations in smart healthcare.

　　本文由  隨訪一體機  友情奉獻.更多有關的知識請點擊  http://www.jnanchi.cn/   真誠的態度.為您提供為全面的服務.更多有關的知識我們將會陸續向大家奉獻.敬請期待.

　　This article is a friendly contribution from the follow-up all-in-one machine For more related knowledge, please click http://www.jnanchi.cn/ Sincere attitude To provide you with comprehensive services We will gradually contribute more relevant knowledge to everyone Stay tuned