面向临床决策支持的病人信息自动获取方法研究
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摘要
临床决策支持系统能依据患者信息进行知识推理,为医护人员开展疾病诊治提供辅助手段,一直是医疗信息化发展的重要方向。临床决策支持系统在临床上应用很大程度上依赖于高效且准确的病人信息获取,传统临床决策支持系统应用时需要通过医生手动输入来获取病人信息,严重阻碍了临床决策支持系统在临床上的应用。在临床决策支持系统不断发展的同时,电子病历在临床上已经取得了成功的应用,但由于目前大部分医疗机构的电子病历间往往存在数据异构性,临床决策支持系统种类繁多信息需求不一致,临床决策支持系统与电子病历系统间存在多对多的数据映射问题,导致临床决策支持系统应用过程中自动信息获取困难。为此本论文开展了下述工作：
提出并建立了基础信息模型。该模型对决策支持所需的信息进行抽象,定义了表达各类临床决策支持系统信息需求的基本结构,即定义了那些稳定、不变的概念,包括数据类型、数据结构以及基础信息类。对基础信息模型进行实例化时,根据具体信息需求对基础信息类的属性进行数据结构的动态绑定并定义语义来表达特定临床决策支持系统的具体信息需求,从而能够灵活适应临床决策支持系统信息需求的变更,能够实现将临床决策支持系统与电子病历系统间多对多的数据映射问题分解为一对多的数据映射问题。在此基础上,本文提出了基础信息模型及其实例化模型的关系数据库实现方案。
为了解决电子病历与基础信息模型实例化模型间存在的模型异构、.结构异构、语义异构、数据信息缺失等数据异构性问题,本论文提出了一套可动态配置的异构数据转换方法。该方法首先建立实现数据转换操作的医学逻辑操作符,并使用扩展巴科斯范式对由医学逻辑操作符组合而成的规则表达式进行形式化描述以消除异构性,能够解决异构性问题,且能够灵活的适应源电子病历数据库的变化。
本论文以面向糖尿病、高血压治疗的临床决策支持系统为例,开发了病人信息获取中间件系统原型。该中间件包含病人信息数据库,数据转换模块,以及信息获取接口模块。本文选取了2家医院的异构电子病历为实验对象,基于本论文开发的信息获取中间件对200份病人数据进行信息获取验证。实验结果数据的有效性证明了本文的方法可以面向各类临床决策支持系统提供自动化的病人信息获取服务,对于解决临床决策支持系统应用过程中的信息获取困难问题有重大意义。
Numerous successes have been reported using clinical decision support system to improve the quality of patient care. Such usage of clinical decision support system requires the usage of patient data to generate contextually relevant recommendations. Traditional clinical decision support system requires that doctor entry patient data manually, seriously hinder the application of clinical decision support system at the point of care. So we carry out research on the method of heterogeneous data retrieval from local electronic health records to address the problem of patient data retrieval. Facing the reality of heterogeneity of local electronic health records, the diversity of CDSS, whose basic information requirements are common while detailed demands tend to be variable, requires many-to-many mappings between decision-support systems and electronic health records.
To solve this problem, this paper proposes a basic information model that extracts information through defining general data types, data structures and classes needed by CDSS. The instantiation of basic information model, which is realized through binding and defining the restrictive relationships of data types and data structures according to semantic information, generates special information model for designated CDSS. The application of proposed method suits the patient information demands of dissimilar CDSS adaptively. This approach will allow for one-to-many mappings instead of the many-to-many mappings between decision-support systems and electronic health records.
In order to overcome the difficulties brought about by the model heterogeneity, structure heterogeneity, semantic heterogeneity and data mismatching between EMR and patient information database, this paper proposed a modifiable method based on dual mode data transformation to transform heterogeneous data by building a set of medical logic operators and formally describing rules generated via combination of medical logic operators using EBNF, which avoids the shortcoming of traditional data transformation methods based on hard code.
This paper design and develop a general information acquisition component pertaining to providing automatic patient information collection for CDSS based on the research of information model.This information acquisition component is constituted of a patient information database contains appropriate patient information demanded by CDSS, an interface to acquire general information and the key part, an adapter to transform data between EMR and patient information database. This paper testifies the proposed method by transforming information of 200 patients from heterogeneous EMR of two hospitals to Diabetes Mellitus (DM) and Hypertension diagnostic CDSS and the results prove it to be an effective method that fits for providing various CDSS with automatic patient information acquisition service.
提出并建立了基础信息模型。该模型对决策支持所需的信息进行抽象,定义了表达各类临床决策支持系统信息需求的基本结构,即定义了那些稳定、不变的概念,包括数据类型、数据结构以及基础信息类。对基础信息模型进行实例化时,根据具体信息需求对基础信息类的属性进行数据结构的动态绑定并定义语义来表达特定临床决策支持系统的具体信息需求,从而能够灵活适应临床决策支持系统信息需求的变更,能够实现将临床决策支持系统与电子病历系统间多对多的数据映射问题分解为一对多的数据映射问题。在此基础上,本文提出了基础信息模型及其实例化模型的关系数据库实现方案。
为了解决电子病历与基础信息模型实例化模型间存在的模型异构、.结构异构、语义异构、数据信息缺失等数据异构性问题,本论文提出了一套可动态配置的异构数据转换方法。该方法首先建立实现数据转换操作的医学逻辑操作符,并使用扩展巴科斯范式对由医学逻辑操作符组合而成的规则表达式进行形式化描述以消除异构性,能够解决异构性问题,且能够灵活的适应源电子病历数据库的变化。
本论文以面向糖尿病、高血压治疗的临床决策支持系统为例,开发了病人信息获取中间件系统原型。该中间件包含病人信息数据库,数据转换模块,以及信息获取接口模块。本文选取了2家医院的异构电子病历为实验对象,基于本论文开发的信息获取中间件对200份病人数据进行信息获取验证。实验结果数据的有效性证明了本文的方法可以面向各类临床决策支持系统提供自动化的病人信息获取服务,对于解决临床决策支持系统应用过程中的信息获取困难问题有重大意义。
Numerous successes have been reported using clinical decision support system to improve the quality of patient care. Such usage of clinical decision support system requires the usage of patient data to generate contextually relevant recommendations. Traditional clinical decision support system requires that doctor entry patient data manually, seriously hinder the application of clinical decision support system at the point of care. So we carry out research on the method of heterogeneous data retrieval from local electronic health records to address the problem of patient data retrieval. Facing the reality of heterogeneity of local electronic health records, the diversity of CDSS, whose basic information requirements are common while detailed demands tend to be variable, requires many-to-many mappings between decision-support systems and electronic health records.
To solve this problem, this paper proposes a basic information model that extracts information through defining general data types, data structures and classes needed by CDSS. The instantiation of basic information model, which is realized through binding and defining the restrictive relationships of data types and data structures according to semantic information, generates special information model for designated CDSS. The application of proposed method suits the patient information demands of dissimilar CDSS adaptively. This approach will allow for one-to-many mappings instead of the many-to-many mappings between decision-support systems and electronic health records.
In order to overcome the difficulties brought about by the model heterogeneity, structure heterogeneity, semantic heterogeneity and data mismatching between EMR and patient information database, this paper proposed a modifiable method based on dual mode data transformation to transform heterogeneous data by building a set of medical logic operators and formally describing rules generated via combination of medical logic operators using EBNF, which avoids the shortcoming of traditional data transformation methods based on hard code.
This paper design and develop a general information acquisition component pertaining to providing automatic patient information collection for CDSS based on the research of information model.This information acquisition component is constituted of a patient information database contains appropriate patient information demanded by CDSS, an interface to acquire general information and the key part, an adapter to transform data between EMR and patient information database. This paper testifies the proposed method by transforming information of 200 patients from heterogeneous EMR of two hospitals to Diabetes Mellitus (DM) and Hypertension diagnostic CDSS and the results prove it to be an effective method that fits for providing various CDSS with automatic patient information acquisition service.
引文
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[3]Crossing the Quanlity Chasm:A New Health System for the 21th Century.
[4]Chew, G. T., Gan, S. K.& Watts, G. F. Revisiting the metabolic syndrome[J]. Medical Journal of Australia,2006,185(8):445-449.
[5]STAES C J, SCOTT E R, JOHN B S, et al. Computerized Alerts Improve Outpatient Laboratory Monitoring of Transplant Patients[J]. Journal of the American Medical Informatics Association,2008.15(3):324-332
[6]SCHEDLBAUER,A.,et al.,What Evidence Supports the Use of Computerized Alerts and Prompts to Improve Clinicians'Prescribing Behavior? [J]. Journal of the American Medical Informatics Association,2009.16
[7]Hunt, D.L.,et al.,Effects of computerbased clinical decision support systems on physician performance and patient outcomes:A systematic review[J]. JAMA,1998.280(15):1339-46.
[8]Garg,A.X.,et al.,McDonald.et al. Effects of computerized clinical decision support systems on practitioner performance and patient outcomes:a systematic review[J]. JAMA,2005.293:1223-38.
[9]Johnston,M.E.and K.B.Langton.Effects of Computer-based Clinical Decision Support Systems on Clinician Performance and Patient Outcome[J]. Annals of Internal Medicine,1994.120(2)
[10]Kawamoto,K.,et al.,Improving clinical practice using clinical decision support systems:A systematic review of trials to identify features critical to success[J].BMJ,2005:330.
[11]J. H. van Bemmel, M. A. Musen.包含飞,郑学侃主译.医学信息学[M].上海：上海科学技术出版社,2002
[12]MENDONCA E A. Clinical decision support systems:perspectives in dentistry [M]. Am Dental Educ Assoc.2004:589-97
[13]Wright,A.and D.F.Sitting,A four-phase model of the evolution of clinical decision support architectures[J]..international journal of medical informatics,2008.77:641-649
[14]Shortliffe, E.H.. Computer-Based Medical Consultations:MYCIN[M]. NewYork: Elsevier/North Holland,1976
[15]Demner-Fushman D, Chapman WW, McDonald CJ. What can natural language processing do for clinical decision support? [J]. Journal of Biomedical Informatics,2009,42(5):760-772.
[16]Colum A.,et al.,DEMS—a second generation diabetes electronic management system[J].Computer Methods and Programs in Biomedicine,2000.62:127-140
[17]Clinical support software for the monitoring and management of chronic diseases[EB/OL]. http://www.delphihealth.com/.2010.02.1.
[18]'Diabetes PHD' Launched Today as New Online Health Risk Tool http://seniorjournal.com/NEWS/Health/5-05-31DiabetesPHD.htm,2010-1-30
[19]DIABETES PHD OVERVIEW American Diabetes Association. https://www.diabetesarchive.net/phd/profile/default.jsp,2010-01-30
[20]糖尿病个人健康决策工具---Diabetes PHD.实用糖尿病杂志,2006.2(2)
[21]Osheroff JA, Teich JM, Middleton B, Steen EB, Wright A, Detmer DE. A roadmap for national action on clinical decision support. J Am Med Inform Assoc.2007; 14(2):141-5.
[22]薛万国.我国电子病历研究进展[J].中国医院管理,2005,25(2)：17-19.
[23]ISO TC 215.Health informatics—Electronic health record—Definition, scope, and context[S].2005-01-22
[24]Knottnerus J.A. Role of the electronic patient record in the development of general practice in The Netherlands. Methods of Information in Medicine. Dec 1999; 38(4-5):350-4.
[25]Stead W.W. The evolution of the IAIMS:lessons for the next decade. J Am Med Inform Assoc.Mar 1997; 4(2 Suppl):S4-9
[26]Stead W.W., Miller R.A., Musen M.A., and Hersh W.R. Integration and beyond:linking information from disparate sources and into workflow. J Am Med Inform Assoc. Mar 2000-Apr2000; 7(2):135-45
[27]Wikipedia. National Programme for IT[EB/OL]. http://en.wikipedia.org/wiki/National_Programme_for_IT.2009-3-1
[28]CHIME Webmaster The Good European Health Record[EB/OL] http://www.chime.ucl.ac.uk/work-areas/ehrs/GEHR/.2008-11-25
[29]Thomas Beale.openEHR,a primer.Sep 2007 [EB/OL] http://www.openehr.org/downloads/presentations/openEHR_primer_sep_2007.ppt.2007
[30]李包罗.我国医院信息系统新进展及面临的任务.中国医院.2001年11月第5卷第7期43-45
[31]中国医院信息化状况调查最新六大发现[EB/OL]. http://cio.ciw.com.cn/cio04 /20070316113409 5.shtml
[32]陈玉华,罗美玉.电子病历面临的问题和思考[J].医学信息.2006,19(5)：761-763
[33]浅析制约电子病历发展的主要问题[J].医学信息.2004,17(5)：259-260
[34]许锋波,冯翠帧,薛峰.电子病历的现状及发展法向[J].河南科技大学学报,2008,26(4)：318-320.
[35]金伟.电子病历系统的存储与交换研究[D].上海：上海交通大学,2008
[36]谢栋梁.电子病历初探[J].医学信息,2010,23(2)：1781-1782
[37]American Medical Informatics Association. A Virtual Medical Record for Guideline-Based Decision Support[C].2001
[38]American Medical Informatics Association. Implementation of Virtual Medical Record Object Model for a Standards-Based Clinical Decision Support Rule Engine[J].2006
[39]American Medical Informatics Association. Integrating a Modern Knowledge-Based System Architecture with a Legacy VA Database:The ATHENA and EON Projects at Stanford[C]. 1999.
[40]Johnson PD, Tu SW, Jones N. Achieving Reuse of Computable Guideline Systems. Submitted to MedInfo 2001
[41]Martin J. O. A Client-Server Framework for Deploying a Decision-Support System in a Resource-constrained Environment[J]. http://smi.stanford.edu/smi-web /reports/SMI-2001-0877.pdf
[42]Robert M. Abarbanell, Nick Beard 1, James R. Campbell2, The SAGE Project:A Universal Framework for Sharing Health Knowledge in the Form of Computable Clinical Practice Guidelines
[43]Craig G. Parkera, Roberto A. Rochaab, James R. Campbellc,Detailed Clinical Models for Sharable, Executable Guidelines[C].2004 IMIA
[44]魏文杰.基于XML的异构数据交换的设计与实现[D].内蒙古：内蒙古工业大学,2007
[45]孙纪.唐新灿.浅谈SQL Server 2000的数据导入导出方法.科技资讯,2007,(16)：133-134
[46]数据转换工具在黄金地勘信息系统中的设计与应用[J].计算机应用.2008.(S1)：382-383
[47]朱勤,陆建新,陈继红.基于XML的异构数据交换技术及其Java实现[J].计算机应用于软件,2004,11(21)52-53
[48]高建强,李伟,秦克明.异构数据源间数据转换技术的研究与实现[J].计算机工程,2005,31(18)： 93-95
[49]洪天安.基于Web Services数据交换的研究与实现[D].南京：东南大学,2006
[50]李爱军.基于XML的异构数据库交换研究[D].南京：河海大学,2006
[51]中国糖尿病防治指南.卫生部疾病控制司.中华医学会糖尿病学分会
[52]马中霞.糖尿病的“现代综合疗法” 中医研究.2002.18(5)
[53]张珺辉.2型糖尿病治疗目标与治疗新策略.中国全科医学.2006.9(4)
[54]王佳.邹大进.2型糖尿病治疗新动向———高质量控制血糖的六大要点.中国实用内科杂志.2009.29(5)
[2]Kohn, L.T., J.M. Corrigan, and M.S. Donaldson. To err is human:building a safer health system[M]. Washington, D.C. National Academy Press,2000
[3]Crossing the Quanlity Chasm:A New Health System for the 21th Century.
[4]Chew, G. T., Gan, S. K.& Watts, G. F. Revisiting the metabolic syndrome[J]. Medical Journal of Australia,2006,185(8):445-449.
[5]STAES C J, SCOTT E R, JOHN B S, et al. Computerized Alerts Improve Outpatient Laboratory Monitoring of Transplant Patients[J]. Journal of the American Medical Informatics Association,2008.15(3):324-332
[6]SCHEDLBAUER,A.,et al.,What Evidence Supports the Use of Computerized Alerts and Prompts to Improve Clinicians'Prescribing Behavior? [J]. Journal of the American Medical Informatics Association,2009.16
[7]Hunt, D.L.,et al.,Effects of computerbased clinical decision support systems on physician performance and patient outcomes:A systematic review[J]. JAMA,1998.280(15):1339-46.
[8]Garg,A.X.,et al.,McDonald.et al. Effects of computerized clinical decision support systems on practitioner performance and patient outcomes:a systematic review[J]. JAMA,2005.293:1223-38.
[9]Johnston,M.E.and K.B.Langton.Effects of Computer-based Clinical Decision Support Systems on Clinician Performance and Patient Outcome[J]. Annals of Internal Medicine,1994.120(2)
[10]Kawamoto,K.,et al.,Improving clinical practice using clinical decision support systems:A systematic review of trials to identify features critical to success[J].BMJ,2005:330.
[11]J. H. van Bemmel, M. A. Musen.包含飞,郑学侃主译.医学信息学[M].上海：上海科学技术出版社,2002
[12]MENDONCA E A. Clinical decision support systems:perspectives in dentistry [M]. Am Dental Educ Assoc.2004:589-97
[13]Wright,A.and D.F.Sitting,A four-phase model of the evolution of clinical decision support architectures[J]..international journal of medical informatics,2008.77:641-649
[14]Shortliffe, E.H.. Computer-Based Medical Consultations:MYCIN[M]. NewYork: Elsevier/North Holland,1976
[15]Demner-Fushman D, Chapman WW, McDonald CJ. What can natural language processing do for clinical decision support? [J]. Journal of Biomedical Informatics,2009,42(5):760-772.
[16]Colum A.,et al.,DEMS—a second generation diabetes electronic management system[J].Computer Methods and Programs in Biomedicine,2000.62:127-140
[17]Clinical support software for the monitoring and management of chronic diseases[EB/OL]. http://www.delphihealth.com/.2010.02.1.
[18]'Diabetes PHD' Launched Today as New Online Health Risk Tool http://seniorjournal.com/NEWS/Health/5-05-31DiabetesPHD.htm,2010-1-30
[19]DIABETES PHD OVERVIEW American Diabetes Association. https://www.diabetesarchive.net/phd/profile/default.jsp,2010-01-30
[20]糖尿病个人健康决策工具---Diabetes PHD.实用糖尿病杂志,2006.2(2)
[21]Osheroff JA, Teich JM, Middleton B, Steen EB, Wright A, Detmer DE. A roadmap for national action on clinical decision support. J Am Med Inform Assoc.2007; 14(2):141-5.
[22]薛万国.我国电子病历研究进展[J].中国医院管理,2005,25(2)：17-19.
[23]ISO TC 215.Health informatics—Electronic health record—Definition, scope, and context[S].2005-01-22
[24]Knottnerus J.A. Role of the electronic patient record in the development of general practice in The Netherlands. Methods of Information in Medicine. Dec 1999; 38(4-5):350-4.
[25]Stead W.W. The evolution of the IAIMS:lessons for the next decade. J Am Med Inform Assoc.Mar 1997; 4(2 Suppl):S4-9
[26]Stead W.W., Miller R.A., Musen M.A., and Hersh W.R. Integration and beyond:linking information from disparate sources and into workflow. J Am Med Inform Assoc. Mar 2000-Apr2000; 7(2):135-45
[27]Wikipedia. National Programme for IT[EB/OL]. http://en.wikipedia.org/wiki/National_Programme_for_IT.2009-3-1
[28]CHIME Webmaster The Good European Health Record[EB/OL] http://www.chime.ucl.ac.uk/work-areas/ehrs/GEHR/.2008-11-25
[29]Thomas Beale.openEHR,a primer.Sep 2007 [EB/OL] http://www.openehr.org/downloads/presentations/openEHR_primer_sep_2007.ppt.2007
[30]李包罗.我国医院信息系统新进展及面临的任务.中国医院.2001年11月第5卷第7期43-45
[31]中国医院信息化状况调查最新六大发现[EB/OL]. http://cio.ciw.com.cn/cio04 /20070316113409 5.shtml
[32]陈玉华,罗美玉.电子病历面临的问题和思考[J].医学信息.2006,19(5)：761-763
[33]浅析制约电子病历发展的主要问题[J].医学信息.2004,17(5)：259-260
[34]许锋波,冯翠帧,薛峰.电子病历的现状及发展法向[J].河南科技大学学报,2008,26(4)：318-320.
[35]金伟.电子病历系统的存储与交换研究[D].上海：上海交通大学,2008
[36]谢栋梁.电子病历初探[J].医学信息,2010,23(2)：1781-1782
[37]American Medical Informatics Association. A Virtual Medical Record for Guideline-Based Decision Support[C].2001
[38]American Medical Informatics Association. Implementation of Virtual Medical Record Object Model for a Standards-Based Clinical Decision Support Rule Engine[J].2006
[39]American Medical Informatics Association. Integrating a Modern Knowledge-Based System Architecture with a Legacy VA Database:The ATHENA and EON Projects at Stanford[C]. 1999.
[40]Johnson PD, Tu SW, Jones N. Achieving Reuse of Computable Guideline Systems. Submitted to MedInfo 2001
[41]Martin J. O. A Client-Server Framework for Deploying a Decision-Support System in a Resource-constrained Environment[J]. http://smi.stanford.edu/smi-web /reports/SMI-2001-0877.pdf
[42]Robert M. Abarbanell, Nick Beard 1, James R. Campbell2, The SAGE Project:A Universal Framework for Sharing Health Knowledge in the Form of Computable Clinical Practice Guidelines
[43]Craig G. Parkera, Roberto A. Rochaab, James R. Campbellc,Detailed Clinical Models for Sharable, Executable Guidelines[C].2004 IMIA
[44]魏文杰.基于XML的异构数据交换的设计与实现[D].内蒙古：内蒙古工业大学,2007
[45]孙纪.唐新灿.浅谈SQL Server 2000的数据导入导出方法.科技资讯,2007,(16)：133-134
[46]数据转换工具在黄金地勘信息系统中的设计与应用[J].计算机应用.2008.(S1)：382-383
[47]朱勤,陆建新,陈继红.基于XML的异构数据交换技术及其Java实现[J].计算机应用于软件,2004,11(21)52-53
[48]高建强,李伟,秦克明.异构数据源间数据转换技术的研究与实现[J].计算机工程,2005,31(18)： 93-95
[49]洪天安.基于Web Services数据交换的研究与实现[D].南京：东南大学,2006
[50]李爱军.基于XML的异构数据库交换研究[D].南京：河海大学,2006
[51]中国糖尿病防治指南.卫生部疾病控制司.中华医学会糖尿病学分会
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