基于第三方的电子病历信息整合平台的研究
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摘要
近年来我国卫生信息化建设飞速发展,很多医院都建立了自己的信息系统或电子病历系统。随着互联网发展和信息技术日益成熟,医院信息化建设将会不断深入。全面整合医疗卫生资源,消除卫生信息孤岛,实现区域范围内卫生信息共享是卫生信息化发展的必然趋势。
本文在全面了解国内外区域电子病历研究现状的基础上,总结了电子病历信息整合的一般模式,并结合我国医疗信息的表达形式没有统一的标准,不同厂商开发的系统自成体系,区域内不同医院系统之间难以进行有效的信息交换和资源共享的现状,提出建立以政府作为第三方的数据中心模式来整合区域内各医院信息,构建标准统一、数据共享的医疗数字化平台。
文章重点对临床文档架构标准HL7 CDA R2.0进行了深入研究,结合我国现有标准和本地化的需求,对CDA R2.0标准进行了本地化的定制,并将该模型用于电子病历文档格式的标准化。
课题首先在第三方的数据中心建立了统一的数据结构以整合来自区域内不同医院的不同结构的病历信息,通过采用基于XML标准的Web Services技术来实现电子病历信息从医院到第三方的跨平台传输,在保持原有系统自治性的同时,集成了区域内各医院信息系统或电子病历系统。其次,通过DOM技术实现了关系数据到CDA标准文档的创建,形成了基于XML的电子病历数据库。最后,建立了电子病历中心网站和电子病历双向转诊系统,为用户提供了信息交互和共享接口,实现了以区域为中心的电子病历信息共享。研究表明,通过建立区域性电子病历中心来实现电子病历信息整合和共享是完全可行的。
Huge progress was made in promoting medical and health informatization in our country in recent years, most hospitals have established the Hospital Information system or Electronic Health Records system.. As Internet grows and information technologies matures,the construction of informatization will be steadily deepened.An overall integrating the resources of medical and health,eliminating Information Isolated Island, the share of regional information resources is an inevitable trend.
This paper summarized approaches of information integration of Regional Electronic Patient Records in foreign countries on the basis of a thorough knowledge of the present conditions of study on Regional Electronic Patient Records both at home and abroad, Integrating with current situation of the expression format of healthcare information different, the hospital system from different system developers was a school unto himself.therefore , the information exchange and information sharing among different hospitals is difficult. We proposed the approach of data centre which government as the third party to integrate hospital information in the region,and to build digital medical platform which Conforming to one standard and share medical data among objects.
This thesis made a deep study of the HL7 clinical document architecture (CDA) specifications in key areas,also, Integrating with the existing medical information standards in our country and demand for localization,we have made localisation customization to CDA R2.0 specifications,and the information models are applied to the standardize the format of EPR documents.
Firstly, we built unified data structure in the data centre of the third party to integrate different structure data from various hospitals in the region,and achieved information transmission from hospital to the third party by using Web Services technology based on XML specifications. In this way,we integrated various hospital's information system or Electronic Patient Records system while keeping hospital system autonomy.Secondly,CDA standard documents are created by using DOM technique and stored in the XML Electronic Patient Records database for document retrieval.finally,we built the website of centre of Electronic Patient Records and Electronic Patient Records bi-directional referral system, provided interface of information exchange and sharin, facilitates the sharing of information centered on the third party in the region. The EPR information exchange and sharing among hospitals is feasible by building the regional Electronic Patient Records center.
本文在全面了解国内外区域电子病历研究现状的基础上,总结了电子病历信息整合的一般模式,并结合我国医疗信息的表达形式没有统一的标准,不同厂商开发的系统自成体系,区域内不同医院系统之间难以进行有效的信息交换和资源共享的现状,提出建立以政府作为第三方的数据中心模式来整合区域内各医院信息,构建标准统一、数据共享的医疗数字化平台。
文章重点对临床文档架构标准HL7 CDA R2.0进行了深入研究,结合我国现有标准和本地化的需求,对CDA R2.0标准进行了本地化的定制,并将该模型用于电子病历文档格式的标准化。
课题首先在第三方的数据中心建立了统一的数据结构以整合来自区域内不同医院的不同结构的病历信息,通过采用基于XML标准的Web Services技术来实现电子病历信息从医院到第三方的跨平台传输,在保持原有系统自治性的同时,集成了区域内各医院信息系统或电子病历系统。其次,通过DOM技术实现了关系数据到CDA标准文档的创建,形成了基于XML的电子病历数据库。最后,建立了电子病历中心网站和电子病历双向转诊系统,为用户提供了信息交互和共享接口,实现了以区域为中心的电子病历信息共享。研究表明,通过建立区域性电子病历中心来实现电子病历信息整合和共享是完全可行的。
Huge progress was made in promoting medical and health informatization in our country in recent years, most hospitals have established the Hospital Information system or Electronic Health Records system.. As Internet grows and information technologies matures,the construction of informatization will be steadily deepened.An overall integrating the resources of medical and health,eliminating Information Isolated Island, the share of regional information resources is an inevitable trend.
This paper summarized approaches of information integration of Regional Electronic Patient Records in foreign countries on the basis of a thorough knowledge of the present conditions of study on Regional Electronic Patient Records both at home and abroad, Integrating with current situation of the expression format of healthcare information different, the hospital system from different system developers was a school unto himself.therefore , the information exchange and information sharing among different hospitals is difficult. We proposed the approach of data centre which government as the third party to integrate hospital information in the region,and to build digital medical platform which Conforming to one standard and share medical data among objects.
This thesis made a deep study of the HL7 clinical document architecture (CDA) specifications in key areas,also, Integrating with the existing medical information standards in our country and demand for localization,we have made localisation customization to CDA R2.0 specifications,and the information models are applied to the standardize the format of EPR documents.
Firstly, we built unified data structure in the data centre of the third party to integrate different structure data from various hospitals in the region,and achieved information transmission from hospital to the third party by using Web Services technology based on XML specifications. In this way,we integrated various hospital's information system or Electronic Patient Records system while keeping hospital system autonomy.Secondly,CDA standard documents are created by using DOM technique and stored in the XML Electronic Patient Records database for document retrieval.finally,we built the website of centre of Electronic Patient Records and Electronic Patient Records bi-directional referral system, provided interface of information exchange and sharin, facilitates the sharing of information centered on the third party in the region. The EPR information exchange and sharing among hospitals is feasible by building the regional Electronic Patient Records center.
引文
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[8]http://aurora.rg.iupui.edu/UCUM/
[9]Katherine Kim.Clinical Data Standards in Health Care:Five Case Studies[R].美国:California Health Care Foundation,2005.
[10]钟金宏,李兴国,马溪骏等.医学影像建档与通信传输系统综述[J].计算机工程与应用.2003,14:22—24.
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[12]Marcel Müller,Thomas Frankewitsch,Thomas Ganslandt,Thomas Bürkle,Hans-Ulrich Prokosch.The Clinical Docunment Architecture (CDA)Enableds Electronic Medical Records to Wireless Mobile Computing.M.Fieschi et al(Eds).MEDINFO 2004.Amsterdam:IOS Press,2004.1448-1452.
[13]Kona Proposal Committee."The Kona Proposal for Electronic Health Care Records",July 7,1997.http://www.hytime.org/ihc97/papers/harding/kona/kona.html.
[14]Robert H.Dolin,MD,Liora Alschuler,Sandy Boyer,BSP,Calvin Beebe,Fred M.Behlen,PHD,Paul V.Biron,Amnon Shabo(SHVO),PHD.HL7 Clinical Document Architecture,Releae 2.The American Medical Informatics Association[J].2006,13(1).
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[26]eGovernment Gains Lessons from the Experience of Italian Regions.eGEP,Brussels,July 1,2005.
[27]未艾译.远程医疗:医疗的新时代[J].中国医疗器械杂志.2007,31(4).
[28]Charlene Marietti.Will the real CPR/EMR/HER please stand up[J-OL].HealthcareInformatics.http://www.healthcare-informatics.com/issues/1998/05_98/cover.htm,1998.5.
[29]何定文,陈金雄,潘林.远程医疗会诊在医学信息共享平台的应用[J].福建电脑.2007,1:14-18.
[30]上海市信息化委员会.http://www.shanghaiit.gov.cn/shxxw/yyti/ggfw/userobjectlai33334.html.
[31]上海闸北区卫生局.http://ws.shzb.gov.cn/147/Detail.po.
[32]江沂.电子病历:法律难题待解决[J].医药经济报.2006,110.
[33]Liora Alschuler.CDA Aroud the World.August 25,2006 International Healthcare Interoperability Conference Cologne,Germany.
[34]Timo It a I a,Tuire Mikola,Aino Virtanen,Paula Asikainen.Seamless service chains and information processes[C].Proceedings of the 38th Hawaii International Conference on System Sciences-2005.
[35]薛万国.电子病历基本概念及研究进展[J].中国数字医学.2007,3:11—14.
[36]李包罗.中华医院管理高层论坛.
[37]李包罗.电子病历应用基础研究.
[38]冯建华,钱乾等.纯XML数据库研究综述.计算机应用研究[J].2006,6:1-7.
[39]王明清,邓振.电子病历作为证据在医疗纠纷中的应用[J].世界临床药物.2006,27(12).
[40]王海薇,喻琪.《电子签名法》给电子病历的法律效力带来曙光[J].四川省卫生管理干部学院学报.2006,25(1).
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[44]Mark Birbeck等著.裴剑峰,高伟,徐继伟等译.XML高级编程:第二版[M].北京:机械工业出版社,2002.5
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[48]王伟,郑衍衡.基于Web服务的教委财务信息化管理平台的研究[J].计算机应用研究.2006,(12).
[49]http://www.ibm.com/developerworks/cn/webservices/ws-featuddi/index.html.
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