基于IHE的医学影像协作网的构建研究
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摘要
区域卫生信息协同系统的建设是大规模、多系统集成的研究课题,包括了集成技术和各类技术和信息标准的使用问题。近年来,以互联网为代表的新一代信息技术已经广泛地渗透到人们的日常生活中,网络上各种信息的互操作已经成为各行个业共同研究课题。医疗卫生服务行业也毫无例外,作为世界经济体系中最大的行业之一,正在经受着现代信息生活方式的巨大改变所带来的前所未有的挑战。与其他信息密集型服务型产业部门,如银行金融、工程通讯、新闻媒介、商品销售相比,医疗卫生部门的信息化程度,特别是信息处理的标准化程度与不同信息源之间的信息交换及兼容程度,处于较为落后的状况。近几年的研究表明,国内外专家们一致认为在当前医疗健康信息海量增长的环境下,只有通过广泛采用以电子病历为核心现代医疗信息技术,将彼此相互分割的各医疗信息系统有机地连接起来,建立基于通用的信息标准、以共享为目标的医疗卫生信息网络,才能促成异构系统问数据信息的相互交换和医疗卫生服务领域整体变革的实现,促进国家医疗改革中有序医疗的实现,满足人们对医疗服务质量与方式不断更新的需求。
随着IT技术的发展逐渐能够支撑起各行业集成应用,中间件技术、HIS集成技术等也开始引入医疗信息化并且得到了一定程度的应用。DICOM和HL7解决了医学影像信息化中的互联问题,但是由于标准之间存在着差异以及针对的数据处理对象不同,所以实现图像与文字系统之间的集成等方面仍存在较多的问题。HIMSS和RSNA从1999年开始着手定制基于DICOM和HL7标准的IHE。IHE的目的在于解决医疗行业中软硬件间的沟通问题,为信息的整合提供流程导向的标准架构,它从一个高层次定义和规范了不同医疗信息系统在不同医院和不同部门间相互连接和集成的问题,给RIS/PACS的信息流程和工作流程带来了规范化的文档指引。基于逐渐发展成熟的技术基础,2004年,IHE制定了解决互操作性问题的规范——“跨机构文档共享规范(Cross-Enterprise DocumentSharing,XDS)”,以解决区域性的医疗信息共享问题。XDS主要为医疗机构之间文档共享的管理提供一个规范,这些医疗企业可以包括私人诊所和门诊部甚至是一个住院病人的紧急看护科室。目前,IHE解决互操作性的一组规范包括PIX(病人ID交叉索引)、XDG(跨机构文档共享)、XDS-I(跨机构图像信息文档共享)等一系列规范,已经成为医学信息共享标准的基础规范。该规范得到世界各国医疗行业人士的公认,国际上许多的国家和地区的基于该规范设计本土区域医疗卫生信息系统的体系结构。
IHE及医疗卫生信息的共享在我国的研究应用较其它国家而言较为滞后。作者认为,造成这种现状的因素是多样的,主要体现在几点上。一是国内医疗信息化行业缺乏组织性,各自为营,没有从长远的角度来考虑病人信息的共享问题;二是国内医疗信息化产品虽数目众多,但大都局限于对某个产品功能上研究应用,对国际标准的采用鲜有,忽略了日后系统整合和数据信息共享的需求,先天的形成数据源及信息系统异构性,为将来医疗卫生信息区域化再次产生资源的共享和互操作上的不便;三是缺乏一个标准化的框架来指引信息的共享流程,形成了各地区或研究机构相互独立的“信息孤岛”现象;四是医疗机构的决策者对于医疗信息共享的不够重视,仅将信息化理解成“手工流程”的取代,未能深刻理解到医疗信息在共享方面带来的医疗服务水平的提升的可能性,只重视内部应用,不重视与外界的交流沟通。
面对差距与需求,本文试图通过参照IHE实现医疗工作流程的优化和信息的共享,提出适合我国医疗信息化特点的医疗卫生信息共享方式,探索符合当前医疗改革趋势的医疗信息化模式的发展道路。医学影像检查是病人诊断的重要依据之一,作者关注到如果能将不同医院的RIS/PACS连接在一起,让医生能随时获取病人的历史病历,就能更有效的利用这些电子资源提高诊治的有效性。然而,在现实应用中这些系统往往是独立的,RIS/PACS一般只能接受和保存自己的数据,并不具有对外开外数据的能力。同时,这些数据的保存格式多样,并没有一个统一的规范和标准,这些都给医学影像信息及相关数据带来了极大的困难。随着国家区域医疗信息化的发展,各医疗机构之间信息的共享是必然的发展趋势。医学影像数据的共享作为诊断凭据的原始数据,无论从医疗价值还是技术难度和支撑环境在医疗信息共享和集成中都是必须高度重视和首先突破的。研究过程中作者与其他国家在HIT方面所作的工作进行分析对比,希望能学习和借鉴国外成功经验的同时避免其间的某些失误,实现跨越式发展。
本文在研究的基础上,提出了基于IHE医学影像协作网的构建方法,希望通过一个第三方的平台,组成一个医学影像协作网内的医疗联盟,在遵循国际IHE规范的条件下,纳入需要资源共享的医疗机构,突破地理位置的局限性,在网内实现病人资源的规范性共享和互操作性,更有效的支持对病人的医疗服务以及医学影像相关科研及医学教育的应用,实现医疗服务机构和科研教育机构的利益最大化。与一般的区域性PACS不同的是,医学影像协作网可以比区域性PACS具有更广泛的应用范围,允许各类异构但符合国际标准的信息系统接入其中,应用上更关注的协作网内各组织之间的协作,侧重于工作流、沟通交流、信息的集成共享等方面。
本文总结了医学影像信息化环境的特点,在IHE技术框架下根据本土医院操作的实际流程,构建了放射科的工作流模式,并对涉及的互操作性关键问题做了分析和实现的研究。本文重点研究了医学影像协作网平台的构建和其中实现异构系统间互操作性的技术。医学影像协作网互操作性的实现需要建立在独立的RIS/PACS系统高度集成与IHE规范化的基础上。本文互操作的对象主要是病人ID相关信息,DICOM影像、报告和相关的文档。以往的医疗信息系统一般采用封闭的私有协议和基于C/S的系统架构,带来的问题是开放性、互操作性和扩展性的不足,为了联入更多的医院和用户,需要很大的软件开发工作量。随着软件工程技术的发展,以Web service为基础的SOA架构已经走向成熟,以其优良的可扩展、互操作、可复用的优势在各类软件系统的研发中逐步占据重要地位。根据医学影像协作网跨平台的分布式综合应用特点,我们采用SOA的架构,应用了Web Services和.NET等计算机前沿技术。研究的关键技术包括放射科IHE工作流模式的研究、基于IHE XDS和XDS-I的跨院文档流程的设计和传输设计,基于IHE PIX的病人ID交叉索引技术研究,基于广域网的DICOM影像传输研究等。
本研究的特色与创新主要有:
1.基于.NET的web service SOA开放式标准架构的医学影像协作网平台。现有的区域性PACS或类似的共享平台一般采用集成的存储方式,C/S或C/S与B/S结合的方式,开放性、互操作性和扩展性不足,当新的用户要求加入时,需要单独进行集成开发,成本高昂。以Web service为基础的SOA架构在跨医院、跨区域、跨平台的分布式综合应用比传统的方式更具灵活性。
2.跨平台的病人ID交叉索引。病人ID的识别是医疗机构基础性的工作,在国内长期以来得不到重视,导致数据建立的标准不统一,各地区医院间系统形形色色,难以实现集成和共享。病人ID在跨院跨平台时的共享是各类系统集成时极为复杂的问题,该技术问题的解决对医疗集团和区域卫生信息系统的发展意义重大。本研究基于IHE PIX集成规范,采用开放的协议和系统架构,在多个产生病人标识符的应用中,实现病人标识的交叉引用,也就是将不同应用系统中的病人ID进行匹配,建立跨系统的病人ID检索系统。这种方式简化病人ID管理,减少出错的机会。
3.实现基于开放式标准的跨院跨平台的医学影像及相关文档的无缝共享。在大多数医院的信息系统中,病人的医疗文档大部分是非结构化的自由文本的形式,实现共享十分的困难。本研究采用标准通用的协议、结构化的方式来封装处理医疗文档,结合病人ID共享的索引系统自动搜索病人的在线注册文档资料,实现了病人信息在网络上的无缝集成,消除了病人信息在多家医院中形成的“信息孤岛”。
The constitution of regional healthcare information system is a large-scaled, multi-system integration research, which is involved in all of the integration technologies and standards. In recent years, the new generation of information technologies, typically, the Internet, has wildly and deeply touched every corner of people's daily life. The interoperability of various kinds of information has been the focus of all industries and service departments. Healthcare service industries, as the biggest and primary domain of world economic system, is facing the challenges from the modern lifestyle. Comparing with other information-intensive industries, such as bank financial, engineering communications, media, merchandise sales, the degree of information in healthcare industry always falls behind them. In recent years, studies show that both domestic and foreign experts agreed that with the massive increase of the healthcare information, we should widespread adoption electronic medical records at the core of modern medical information technology, to meet the demand of the information interoperability in different system. To reach the goal for information share, the new healthcare network should be built on the common information standards. Then the data between heterogeneous systems can be exchange and reused based on the communication. This contributes to the regional healthcare services to achieve. In addition, these methods help the healthcare reform policy in our national, especially for the realization of healthcare services in an orderly manner and the solution for the structural imbalance between healthcare resources and patients.
With the development of IT technology, now it can support the integration of applications from various industries. Middleware technology and HIS integration technology have been introduced in healthcare industry. DICOM and HL7 have solve a problem about connection between heterogeneous systems in the Internet, but there are still more problems to realize interoperability. Due to the difference between the standard and data processing objects, so the integration for the systems against image and text will be more trouble. Integrating the Healthcare Enterprise (IHE) is an initiative designed to stimulate the integration of the information systems that support modern healthcare institutions. It was stared in 1999 by RSNA and HIMSS. Its fundamental objective is to ensure that in the care of patients all required information for medical decisions is both correct and available to healthcare professionals. The approach employed in the IHE initiative is to support the use of existing standards, e.g HL7, ASTM, DICOM, ISO, IETF, OASIS and others as appropriate, rather than to define new standards. Especially, it defines several profiles for the implementation of established messaging standards to achieve interoperability in 2004, which mainly includes XDS, XDS-I. The effect of IHE is recognized around the world. In Many international countries and regions, the design of regional healthcare systems be considered to comply with IHE.
The research on IHE and the sharing of healthcare information in China is lagging behind other countries for many reasons. First, the developing of healthcare information is Lack of organizational. There is no long-term perspective to consider the issue of patients' information sharing. Second, although the products of healthcare information are numerous, but just a few of them was designed by standards inadequately, which ignores the need of information systems integration and data sharing in the future. Third, the absence of a standardization framework to guide the information sharing processes leads to 'information islands'. Fourth, decision-makers for medical institutions pay not enough attention to the sharing of healthcare information. They believe that information is just a replace of 'manual process' on computer and refuse to communicate with other healthcare institutes.
This research aims to achieve healthcare information sharing and medical business workflow optimization by reference to IHE. We put forward the methods to sharing healthcare information suited to the medical business characteristics in china. The patterns of healthcare information development is discussed in the current healthcare reform trends. Medical imaging is one of an important basis for the diagnosis of patients, so the PACS acts as an important role in medical business. When a patient transfers to different hospital, the Clinicians desires to access all of the patient's healthcare intonations including the document outside there own hospital. They hope to connect the RIS/PACS in different institutions to improve the rate of diagnostic accuracy .But it is difficult to do for heterogeneous systems and heterogeneous data formats. With the development of regional healthcare information, information sharing between medical institutions has become an inevitable trend. So medical images as the raw data for diagnosis are required to share at any time when clinicians need. It is worth to do efforts on this research. We analysis the use of HIT in other countries in the course of study and hope to learn from the successful experience of foreign countries to avoid the errors they have done.
This paper proposes the means to construct a medical image coordinating system based on IHE for information sharing. We hope that through a third-party platform we can organize a collaborative network of medical imaging medical Union in accordance with IHE. The healthcare institutions admit to the union and share resources to break through the limitations of geographical location by network. Then we will reach the goal of information sharing and interoperability by internet. Simultaneously the system can provide medical education service and medical imaging-related research service based the data sharing. Compared with regional PACS carried out in many cities of china., it is widely used and allows heterogeneous systems to participate. In the other hand, it gives more attention on the collaboration in the union which aims to data integration.
This paper summarizes the characters of medical imaging environment, and builds a radiology workflow model under the IHE technical framework in accordance with the actual process of local hospital in china. What's more, the key issues of interoperability between different applications are discussed and used on the system to some extend. If the RIS/PACS have been highly integrated, it will easy the realization of interoperability in the medical image coordinating system. This approach is related to many legacy hospital systems. These systems usually take private protocol and C/S architecture. Then many problems emerge when we require to share the data from them, such as Openness, interoperability and scalability. With the development of software engineering, Web service-based SOA architecture has been mature and good enough to give a help to HIT for its advantages such as scalable, interoperable, reusable. In fact, a series of potential advantages and innovations can be identified for such an approach. (1)The use of patient identifier cross-referencing. The patient ID cross-referencing is the basic of the document sharing of the system. But the IDs are different in hospitals for the same person. So it is significant to identify the patient and mach the information. (2)The system is based on .NET and web service-base SOA. In terms of tele-diagnostics of medical imaging, this way is much better than the legacy systems. (3) by the use of MTOM, we promote the performance of medical image files transmission on web and share the medical image and related documents seamlessly.
随着IT技术的发展逐渐能够支撑起各行业集成应用,中间件技术、HIS集成技术等也开始引入医疗信息化并且得到了一定程度的应用。DICOM和HL7解决了医学影像信息化中的互联问题,但是由于标准之间存在着差异以及针对的数据处理对象不同,所以实现图像与文字系统之间的集成等方面仍存在较多的问题。HIMSS和RSNA从1999年开始着手定制基于DICOM和HL7标准的IHE。IHE的目的在于解决医疗行业中软硬件间的沟通问题,为信息的整合提供流程导向的标准架构,它从一个高层次定义和规范了不同医疗信息系统在不同医院和不同部门间相互连接和集成的问题,给RIS/PACS的信息流程和工作流程带来了规范化的文档指引。基于逐渐发展成熟的技术基础,2004年,IHE制定了解决互操作性问题的规范——“跨机构文档共享规范(Cross-Enterprise DocumentSharing,XDS)”,以解决区域性的医疗信息共享问题。XDS主要为医疗机构之间文档共享的管理提供一个规范,这些医疗企业可以包括私人诊所和门诊部甚至是一个住院病人的紧急看护科室。目前,IHE解决互操作性的一组规范包括PIX(病人ID交叉索引)、XDG(跨机构文档共享)、XDS-I(跨机构图像信息文档共享)等一系列规范,已经成为医学信息共享标准的基础规范。该规范得到世界各国医疗行业人士的公认,国际上许多的国家和地区的基于该规范设计本土区域医疗卫生信息系统的体系结构。
IHE及医疗卫生信息的共享在我国的研究应用较其它国家而言较为滞后。作者认为,造成这种现状的因素是多样的,主要体现在几点上。一是国内医疗信息化行业缺乏组织性,各自为营,没有从长远的角度来考虑病人信息的共享问题;二是国内医疗信息化产品虽数目众多,但大都局限于对某个产品功能上研究应用,对国际标准的采用鲜有,忽略了日后系统整合和数据信息共享的需求,先天的形成数据源及信息系统异构性,为将来医疗卫生信息区域化再次产生资源的共享和互操作上的不便;三是缺乏一个标准化的框架来指引信息的共享流程,形成了各地区或研究机构相互独立的“信息孤岛”现象;四是医疗机构的决策者对于医疗信息共享的不够重视,仅将信息化理解成“手工流程”的取代,未能深刻理解到医疗信息在共享方面带来的医疗服务水平的提升的可能性,只重视内部应用,不重视与外界的交流沟通。
面对差距与需求,本文试图通过参照IHE实现医疗工作流程的优化和信息的共享,提出适合我国医疗信息化特点的医疗卫生信息共享方式,探索符合当前医疗改革趋势的医疗信息化模式的发展道路。医学影像检查是病人诊断的重要依据之一,作者关注到如果能将不同医院的RIS/PACS连接在一起,让医生能随时获取病人的历史病历,就能更有效的利用这些电子资源提高诊治的有效性。然而,在现实应用中这些系统往往是独立的,RIS/PACS一般只能接受和保存自己的数据,并不具有对外开外数据的能力。同时,这些数据的保存格式多样,并没有一个统一的规范和标准,这些都给医学影像信息及相关数据带来了极大的困难。随着国家区域医疗信息化的发展,各医疗机构之间信息的共享是必然的发展趋势。医学影像数据的共享作为诊断凭据的原始数据,无论从医疗价值还是技术难度和支撑环境在医疗信息共享和集成中都是必须高度重视和首先突破的。研究过程中作者与其他国家在HIT方面所作的工作进行分析对比,希望能学习和借鉴国外成功经验的同时避免其间的某些失误,实现跨越式发展。
本文在研究的基础上,提出了基于IHE医学影像协作网的构建方法,希望通过一个第三方的平台,组成一个医学影像协作网内的医疗联盟,在遵循国际IHE规范的条件下,纳入需要资源共享的医疗机构,突破地理位置的局限性,在网内实现病人资源的规范性共享和互操作性,更有效的支持对病人的医疗服务以及医学影像相关科研及医学教育的应用,实现医疗服务机构和科研教育机构的利益最大化。与一般的区域性PACS不同的是,医学影像协作网可以比区域性PACS具有更广泛的应用范围,允许各类异构但符合国际标准的信息系统接入其中,应用上更关注的协作网内各组织之间的协作,侧重于工作流、沟通交流、信息的集成共享等方面。
本文总结了医学影像信息化环境的特点,在IHE技术框架下根据本土医院操作的实际流程,构建了放射科的工作流模式,并对涉及的互操作性关键问题做了分析和实现的研究。本文重点研究了医学影像协作网平台的构建和其中实现异构系统间互操作性的技术。医学影像协作网互操作性的实现需要建立在独立的RIS/PACS系统高度集成与IHE规范化的基础上。本文互操作的对象主要是病人ID相关信息,DICOM影像、报告和相关的文档。以往的医疗信息系统一般采用封闭的私有协议和基于C/S的系统架构,带来的问题是开放性、互操作性和扩展性的不足,为了联入更多的医院和用户,需要很大的软件开发工作量。随着软件工程技术的发展,以Web service为基础的SOA架构已经走向成熟,以其优良的可扩展、互操作、可复用的优势在各类软件系统的研发中逐步占据重要地位。根据医学影像协作网跨平台的分布式综合应用特点,我们采用SOA的架构,应用了Web Services和.NET等计算机前沿技术。研究的关键技术包括放射科IHE工作流模式的研究、基于IHE XDS和XDS-I的跨院文档流程的设计和传输设计,基于IHE PIX的病人ID交叉索引技术研究,基于广域网的DICOM影像传输研究等。
本研究的特色与创新主要有:
1.基于.NET的web service SOA开放式标准架构的医学影像协作网平台。现有的区域性PACS或类似的共享平台一般采用集成的存储方式,C/S或C/S与B/S结合的方式,开放性、互操作性和扩展性不足,当新的用户要求加入时,需要单独进行集成开发,成本高昂。以Web service为基础的SOA架构在跨医院、跨区域、跨平台的分布式综合应用比传统的方式更具灵活性。
2.跨平台的病人ID交叉索引。病人ID的识别是医疗机构基础性的工作,在国内长期以来得不到重视,导致数据建立的标准不统一,各地区医院间系统形形色色,难以实现集成和共享。病人ID在跨院跨平台时的共享是各类系统集成时极为复杂的问题,该技术问题的解决对医疗集团和区域卫生信息系统的发展意义重大。本研究基于IHE PIX集成规范,采用开放的协议和系统架构,在多个产生病人标识符的应用中,实现病人标识的交叉引用,也就是将不同应用系统中的病人ID进行匹配,建立跨系统的病人ID检索系统。这种方式简化病人ID管理,减少出错的机会。
3.实现基于开放式标准的跨院跨平台的医学影像及相关文档的无缝共享。在大多数医院的信息系统中,病人的医疗文档大部分是非结构化的自由文本的形式,实现共享十分的困难。本研究采用标准通用的协议、结构化的方式来封装处理医疗文档,结合病人ID共享的索引系统自动搜索病人的在线注册文档资料,实现了病人信息在网络上的无缝集成,消除了病人信息在多家医院中形成的“信息孤岛”。
The constitution of regional healthcare information system is a large-scaled, multi-system integration research, which is involved in all of the integration technologies and standards. In recent years, the new generation of information technologies, typically, the Internet, has wildly and deeply touched every corner of people's daily life. The interoperability of various kinds of information has been the focus of all industries and service departments. Healthcare service industries, as the biggest and primary domain of world economic system, is facing the challenges from the modern lifestyle. Comparing with other information-intensive industries, such as bank financial, engineering communications, media, merchandise sales, the degree of information in healthcare industry always falls behind them. In recent years, studies show that both domestic and foreign experts agreed that with the massive increase of the healthcare information, we should widespread adoption electronic medical records at the core of modern medical information technology, to meet the demand of the information interoperability in different system. To reach the goal for information share, the new healthcare network should be built on the common information standards. Then the data between heterogeneous systems can be exchange and reused based on the communication. This contributes to the regional healthcare services to achieve. In addition, these methods help the healthcare reform policy in our national, especially for the realization of healthcare services in an orderly manner and the solution for the structural imbalance between healthcare resources and patients.
With the development of IT technology, now it can support the integration of applications from various industries. Middleware technology and HIS integration technology have been introduced in healthcare industry. DICOM and HL7 have solve a problem about connection between heterogeneous systems in the Internet, but there are still more problems to realize interoperability. Due to the difference between the standard and data processing objects, so the integration for the systems against image and text will be more trouble. Integrating the Healthcare Enterprise (IHE) is an initiative designed to stimulate the integration of the information systems that support modern healthcare institutions. It was stared in 1999 by RSNA and HIMSS. Its fundamental objective is to ensure that in the care of patients all required information for medical decisions is both correct and available to healthcare professionals. The approach employed in the IHE initiative is to support the use of existing standards, e.g HL7, ASTM, DICOM, ISO, IETF, OASIS and others as appropriate, rather than to define new standards. Especially, it defines several profiles for the implementation of established messaging standards to achieve interoperability in 2004, which mainly includes XDS, XDS-I. The effect of IHE is recognized around the world. In Many international countries and regions, the design of regional healthcare systems be considered to comply with IHE.
The research on IHE and the sharing of healthcare information in China is lagging behind other countries for many reasons. First, the developing of healthcare information is Lack of organizational. There is no long-term perspective to consider the issue of patients' information sharing. Second, although the products of healthcare information are numerous, but just a few of them was designed by standards inadequately, which ignores the need of information systems integration and data sharing in the future. Third, the absence of a standardization framework to guide the information sharing processes leads to 'information islands'. Fourth, decision-makers for medical institutions pay not enough attention to the sharing of healthcare information. They believe that information is just a replace of 'manual process' on computer and refuse to communicate with other healthcare institutes.
This research aims to achieve healthcare information sharing and medical business workflow optimization by reference to IHE. We put forward the methods to sharing healthcare information suited to the medical business characteristics in china. The patterns of healthcare information development is discussed in the current healthcare reform trends. Medical imaging is one of an important basis for the diagnosis of patients, so the PACS acts as an important role in medical business. When a patient transfers to different hospital, the Clinicians desires to access all of the patient's healthcare intonations including the document outside there own hospital. They hope to connect the RIS/PACS in different institutions to improve the rate of diagnostic accuracy .But it is difficult to do for heterogeneous systems and heterogeneous data formats. With the development of regional healthcare information, information sharing between medical institutions has become an inevitable trend. So medical images as the raw data for diagnosis are required to share at any time when clinicians need. It is worth to do efforts on this research. We analysis the use of HIT in other countries in the course of study and hope to learn from the successful experience of foreign countries to avoid the errors they have done.
This paper proposes the means to construct a medical image coordinating system based on IHE for information sharing. We hope that through a third-party platform we can organize a collaborative network of medical imaging medical Union in accordance with IHE. The healthcare institutions admit to the union and share resources to break through the limitations of geographical location by network. Then we will reach the goal of information sharing and interoperability by internet. Simultaneously the system can provide medical education service and medical imaging-related research service based the data sharing. Compared with regional PACS carried out in many cities of china., it is widely used and allows heterogeneous systems to participate. In the other hand, it gives more attention on the collaboration in the union which aims to data integration.
This paper summarizes the characters of medical imaging environment, and builds a radiology workflow model under the IHE technical framework in accordance with the actual process of local hospital in china. What's more, the key issues of interoperability between different applications are discussed and used on the system to some extend. If the RIS/PACS have been highly integrated, it will easy the realization of interoperability in the medical image coordinating system. This approach is related to many legacy hospital systems. These systems usually take private protocol and C/S architecture. Then many problems emerge when we require to share the data from them, such as Openness, interoperability and scalability. With the development of software engineering, Web service-based SOA architecture has been mature and good enough to give a help to HIT for its advantages such as scalable, interoperable, reusable. In fact, a series of potential advantages and innovations can be identified for such an approach. (1)The use of patient identifier cross-referencing. The patient ID cross-referencing is the basic of the document sharing of the system. But the IDs are different in hospitals for the same person. So it is significant to identify the patient and mach the information. (2)The system is based on .NET and web service-base SOA. In terms of tele-diagnostics of medical imaging, this way is much better than the legacy systems. (3) by the use of MTOM, we promote the performance of medical image files transmission on web and share the medical image and related documents seamlessly.
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