医院信息化系统集成技术的研究
摘要
随着计算机及网络技术在医疗卫生行业的广泛应用，医院信息化系统有了很大的发展。但是，由于缺乏规范和标准，医院各个不同的信息化系统往往各自孤立，信息无法交换。
基于这个考虑，本文研究和讨论了医院信息化系统的集成技术，重点是PACS和RIS，HIS的集成。首先，介绍了医院现有的信息化系统的发展和现状，以及信息化系统集成的必要性。然后，介绍了两个重要的医疗信息互联标准——医学数字图像通讯标准(DICOM)和医疗第七层(HL7)，网络互联标准和工作流集成。其次，介绍了系统总体设计和结构，各部分功能分配，以及系统的互联。再次，介绍了系统功能的实现结果。最后，总结了所作的工作，对未来的系统集成提出了展望。
Hospital information management systems have great developed with the wide use of computer and network technical in medical industry. But, since less of criterion and standard, the hospital information management systems are always separated and the information can't communicate.
According to this, the article study and discuss the integrated technical of hospital information management system, especial the integration of PACS, RIS and HIS. First, the development and status of information system, and necessity of integration are introduced. Then, the important medical information communication standards-DICOM and HL7 are introduced. Second, the general design, system structure, function and integration are introduced. Fourth, the result is introduced. Finally, done work is summarized and expectation of system integration is advanced.
基于这个考虑，本文研究和讨论了医院信息化系统的集成技术，重点是PACS和RIS，HIS的集成。首先，介绍了医院现有的信息化系统的发展和现状，以及信息化系统集成的必要性。然后，介绍了两个重要的医疗信息互联标准——医学数字图像通讯标准(DICOM)和医疗第七层(HL7)，网络互联标准和工作流集成。其次，介绍了系统总体设计和结构，各部分功能分配，以及系统的互联。再次，介绍了系统功能的实现结果。最后，总结了所作的工作，对未来的系统集成提出了展望。
Hospital information management systems have great developed with the wide use of computer and network technical in medical industry. But, since less of criterion and standard, the hospital information management systems are always separated and the information can't communicate.
According to this, the article study and discuss the integrated technical of hospital information management system, especial the integration of PACS, RIS and HIS. First, the development and status of information system, and necessity of integration are introduced. Then, the important medical information communication standards-DICOM and HL7 are introduced. Second, the general design, system structure, function and integration are introduced. Fourth, the result is introduced. Finally, done work is summarized and expectation of system integration is advanced.
引文
1． Foord Keith,"PACS: the second time around",European Journal of Radiology,Volume: 32,Issue: 2,November,1999,pp. 96-100
2． Feron Michel,Bellon Erwin,Vanautgaerden Mark,et. al. "Practical aspects of HIS/PACS integration with emphasis on radiological workflow",International Congress Series,Volume: 1230,June,2001,pp. 805-811
3． Inamura,Kiyonari; Umeda,Tokuo,et al. "HIS/RIS contribution to image diagnosis and maximization of PACS when coupled with HIS/RIS",Computer Methods and Programs in Biomedicine,Volume: 57,Issue: 1-2,August,1998,pp.41-49
4． Xudong Lu,Huilong Duan,"IHE-compatible Radiology Information System",International Congress Series,1230 (2001) 1279-1280
5． Michio Kimura,Kazuhiko Ohe,Hiroyuki Yoshihara "MERIT-9: a patient information exchange guideline using MML,HL7 and DICOM",International Journal of Medical Informatics,51 (1998) 59-68．
1． K. Smedema,"Integrating the healthcare enterprise (DIE): the radiological perspective",IHE Planning Committee,Philips Medical System,Best,the Netherlands,Volume 44 Issue 1,March 2000
6． D. F. Leotta,Y. Kim,"Requirement for Picture Archiving and Communication System (PACS)",IEEE EMB Mag.,volume 12,Mar. 1993
7． Kimura Michio,Tani Shigeki,Baatar Shirchin,et al. "Implementation of multi-vendor DICOM standard image transfer in hospital wide ATM network",Computer Methods and Programs in Biomedicine,Vol 57,Issue 1-2,Aug. 1998,pp. 85-89．
8． ACR,NEMA,"Digital Imaging and Communication s in Medicine (DICOM): version 3． 0",Draft Standard,ACR-NEMA Committee,Working Group VI,WashingtionDC,1993
9． Health Level Seven,http://www.hl7． org.
10． Ulrich Schrader,Elmar Kotter,Ernst Pelikan,"Critical Success Factors for a Hospital-wide PACS",AMIA,1997．
11． RSNA,"IHE Integrating the Healthcare Enterprise: The Key to Integrated Systems",http://www.rsna.org/IHE/ihevr3 integration_profiles.shtml
12． F. J. Martens,F. P. Ottes,P.J. Toussaint,C. Schulz,R. Rechid,R.van den Broeck,"HIPIN,a working HIS/RIS-PACS interface",EuroPACS Newsletter,Vol. 9(1) ,Dec. 1994
13． Thomas V. Kinsey,"Technical Aspects of HIS and PACS Working Together: Technical Lessons Learned",Agfa Incorporated,http://www.americantelemed.org/news/2000 presentations/Ehealth/Kinsev.ppt
14． Pamela Tabar,"PACS: not Just for Radiologists",Healthcare Informatics,Nov. 1999．
15． Patrice Bret,M. D.,F.R.C.P.,"Image Management Implementation",2001 RSNA Refresher Course on PACS and Radiology Informatics.
16． RSNA,"IHE Integration Profiles",http://www.rsna.org/IHE.
17. Cheung N. T., Fung K. W., WongK. C., et. al. "Medical Informatics-the state of the art in the Hospital Authority", International Journal of Medical Informatics, Vol 62, Issue 2-3, July, 2001, pp.113-119.
18. Betty A. Levine "Evaluation of A One-way HIS/RIS-PACS Link", IMAC91 conference, Kyoto Japan 1991.
19. O. Rienhoff, "HIS-RIS-PACS", Proceeding The Third International Conference on Image Management and Communication, 1993.
20. Yukio Kurihara, Yoshiyasu Okuhara, Yuichi Narita, Yasuhiro Kutazoe,"Fast image accessing based on an analysis of the picture archiving and communications system in Kochi Medical School", Computerized Medical Imaging and Graphics, 22 (1998) 439-445.
21. Nina Lundberg, "Integrating learning contexts in a medical informatics program-preparing for the introduction of PACS", International Journal of Medical Informatics, 50 (1998) 87-93.
22. Norio Nakata, Syouko Yoshihiro, "PC reporting system for radiologists: practical use under PACS environment", Computer Method s and Programs in Biomedicine, 66(2001)17-24.
23. Mitra, "PACS Broker-HL7 Interface Specification V4.0", Nov.6, 1998
24. Medical Manager Sales & Marketing Inc. "Radiology Information Solution", http://www.medicalmanager.com
25. Tellioglu, H., "CSCW Issues of PACS-RIS-HIS Building an Electronic Document Repository", Proceedings of the 16th International EuroPACS Meeting, October 1-3, 1998, Piqueras J. & J.-C. Carreno (eds.), Barcelona, Spain, pp.237-240
26. Pilling John, "Problems facing the radiologist tendering for a hospital wide PACS system", European Journal of Radiology, Vol 32, Issue 2, Nov. 1999, pp.101-105.
27. Schadow Gunther, Russler Daniel, McDonald Clement J., "Conceptual alignment of electronic health record data with guideline and workflow knowledge", International Journal of Medical Informatics, Vol 64, Issue 2-3, Dec.2001, pp.259-274.
28．吕旭东，“医疗信息系统体系结构研究及开发平台设计”，浙江大学博士论文，2001，8。
29．北京天助盈通医疗科技有限公司，“HIS-RIS-PACS integration”，http://www.medimage.com.cn/yingtong/CMIS12.htm
30．张翠英，张尚军，“医疗信息交换标准-HL7”，生物医学工程学杂志，2001：18(1)：111-115。
31．王华楠，胡淑涛，“CT数字成像设备图文管理系统的开发与应用”，微型电脑应用，vol．17，No．12，2001。
32．束开俊，“PACS系统应用及其遵从性设计”，安徽广播电视大学学报，2001，1。
33．林天毅，毕亚雷，陈思平等，“PACS与HIS／RIS集成及其在我国实现的相关问题”，中国医疗器械信息，Vol 6，No 1，Feb．2000
34．鲍捷，高隽，张旭东，余永强，“面向Internet的组件式PACS系统设计”，计算机工程，Vol 26，No 7，July 2000。
35．张鲁闽，“HIS和PACS集成的DICOM方式”，医学信息，Vol 15, No 2，2002，2。
36．张庆，高上凯，“HL7标准及其在我国的应用前景”，中国医疗器械信息，Vol．7，No．4，Aug．2002。
37．崔希威，王学斯，“医院信息系统的发展与应用”，航空航天医药，Vol．12，No．2，2001。
38．王岩，田捷，韩博闻，“基于DICOM标准的医疗数据通信设计”，微型机与应用，2001年第2期。
39．萧一峰，纪裳，牟轩沁，李树均，“医用数字影像设备PACS组件的设计”，中国医疗器械杂志，Vol．23，No．2，1999．
40．邱峰，田捷，曹勇，刘景春，"PACS系统综述”，中国医学影像技术，Vol 16，No 1，2000。
41．熊宇，段会龙，吕维雪，“图像归档和通讯系统(PACS)的发展与应用”，国外医学生物医学工程分册，Vol 23，No 2，2000。
42．胡海波，庄天戈，“分布式PACS系统设计及其实现”，中国医疗器械杂志，Vol 24，No 5，2000。
43．盛平，宋轶勤，宋顺林，“医院信息系统的分析与设计”，江苏理工大学学报(社会科学版)，2000，12。
44．何楚，徐振勤，廖孟扬，“基于Web的医学图像信息中心的研究与实现”，计算机工程，Vol 27，No 9，Sep．2001。
45．蒲卫，李军，张涛，“医院信息系统与PACS的融合”，医疗设备信息，2001，6。
46．童明杰，胡大可，“认知医学数字图像通讯标准-DICOM”，国外医学生物医学工程分册，Vol 22，No．5，1999。
47．Stebe Teixeira, Xavier Pacheco著，任旭钧，王永生，冯泽波等译，《Delphi 5开发人员指南》，机械工业出版社。
2． Feron Michel,Bellon Erwin,Vanautgaerden Mark,et. al. "Practical aspects of HIS/PACS integration with emphasis on radiological workflow",International Congress Series,Volume: 1230,June,2001,pp. 805-811
3． Inamura,Kiyonari; Umeda,Tokuo,et al. "HIS/RIS contribution to image diagnosis and maximization of PACS when coupled with HIS/RIS",Computer Methods and Programs in Biomedicine,Volume: 57,Issue: 1-2,August,1998,pp.41-49
4． Xudong Lu,Huilong Duan,"IHE-compatible Radiology Information System",International Congress Series,1230 (2001) 1279-1280
5． Michio Kimura,Kazuhiko Ohe,Hiroyuki Yoshihara "MERIT-9: a patient information exchange guideline using MML,HL7 and DICOM",International Journal of Medical Informatics,51 (1998) 59-68．
1． K. Smedema,"Integrating the healthcare enterprise (DIE): the radiological perspective",IHE Planning Committee,Philips Medical System,Best,the Netherlands,Volume 44 Issue 1,March 2000
6． D. F. Leotta,Y. Kim,"Requirement for Picture Archiving and Communication System (PACS)",IEEE EMB Mag.,volume 12,Mar. 1993
7． Kimura Michio,Tani Shigeki,Baatar Shirchin,et al. "Implementation of multi-vendor DICOM standard image transfer in hospital wide ATM network",Computer Methods and Programs in Biomedicine,Vol 57,Issue 1-2,Aug. 1998,pp. 85-89．
8． ACR,NEMA,"Digital Imaging and Communication s in Medicine (DICOM): version 3． 0",Draft Standard,ACR-NEMA Committee,Working Group VI,WashingtionDC,1993
9． Health Level Seven,http://www.hl7． org.
10． Ulrich Schrader,Elmar Kotter,Ernst Pelikan,"Critical Success Factors for a Hospital-wide PACS",AMIA,1997．
11． RSNA,"IHE Integrating the Healthcare Enterprise: The Key to Integrated Systems",http://www.rsna.org/IHE/ihevr3 integration_profiles.shtml
12． F. J. Martens,F. P. Ottes,P.J. Toussaint,C. Schulz,R. Rechid,R.van den Broeck,"HIPIN,a working HIS/RIS-PACS interface",EuroPACS Newsletter,Vol. 9(1) ,Dec. 1994
13． Thomas V. Kinsey,"Technical Aspects of HIS and PACS Working Together: Technical Lessons Learned",Agfa Incorporated,http://www.americantelemed.org/news/2000 presentations/Ehealth/Kinsev.ppt
14． Pamela Tabar,"PACS: not Just for Radiologists",Healthcare Informatics,Nov. 1999．
15． Patrice Bret,M. D.,F.R.C.P.,"Image Management Implementation",2001 RSNA Refresher Course on PACS and Radiology Informatics.
16． RSNA,"IHE Integration Profiles",http://www.rsna.org/IHE.
17. Cheung N. T., Fung K. W., WongK. C., et. al. "Medical Informatics-the state of the art in the Hospital Authority", International Journal of Medical Informatics, Vol 62, Issue 2-3, July, 2001, pp.113-119.
18. Betty A. Levine "Evaluation of A One-way HIS/RIS-PACS Link", IMAC91 conference, Kyoto Japan 1991.
19. O. Rienhoff, "HIS-RIS-PACS", Proceeding The Third International Conference on Image Management and Communication, 1993.
20. Yukio Kurihara, Yoshiyasu Okuhara, Yuichi Narita, Yasuhiro Kutazoe,"Fast image accessing based on an analysis of the picture archiving and communications system in Kochi Medical School", Computerized Medical Imaging and Graphics, 22 (1998) 439-445.
21. Nina Lundberg, "Integrating learning contexts in a medical informatics program-preparing for the introduction of PACS", International Journal of Medical Informatics, 50 (1998) 87-93.
22. Norio Nakata, Syouko Yoshihiro, "PC reporting system for radiologists: practical use under PACS environment", Computer Method s and Programs in Biomedicine, 66(2001)17-24.
23. Mitra, "PACS Broker-HL7 Interface Specification V4.0", Nov.6, 1998
24. Medical Manager Sales & Marketing Inc. "Radiology Information Solution", http://www.medicalmanager.com
25. Tellioglu, H., "CSCW Issues of PACS-RIS-HIS Building an Electronic Document Repository", Proceedings of the 16th International EuroPACS Meeting, October 1-3, 1998, Piqueras J. & J.-C. Carreno (eds.), Barcelona, Spain, pp.237-240
26. Pilling John, "Problems facing the radiologist tendering for a hospital wide PACS system", European Journal of Radiology, Vol 32, Issue 2, Nov. 1999, pp.101-105.
27. Schadow Gunther, Russler Daniel, McDonald Clement J., "Conceptual alignment of electronic health record data with guideline and workflow knowledge", International Journal of Medical Informatics, Vol 64, Issue 2-3, Dec.2001, pp.259-274.
28．吕旭东，“医疗信息系统体系结构研究及开发平台设计”，浙江大学博士论文，2001，8。
29．北京天助盈通医疗科技有限公司，“HIS-RIS-PACS integration”，http://www.medimage.com.cn/yingtong/CMIS12.htm
30．张翠英，张尚军，“医疗信息交换标准-HL7”，生物医学工程学杂志，2001：18(1)：111-115。
31．王华楠，胡淑涛，“CT数字成像设备图文管理系统的开发与应用”，微型电脑应用，vol．17，No．12，2001。
32．束开俊，“PACS系统应用及其遵从性设计”，安徽广播电视大学学报，2001，1。
33．林天毅，毕亚雷，陈思平等，“PACS与HIS／RIS集成及其在我国实现的相关问题”，中国医疗器械信息，Vol 6，No 1，Feb．2000
34．鲍捷，高隽，张旭东，余永强，“面向Internet的组件式PACS系统设计”，计算机工程，Vol 26，No 7，July 2000。
35．张鲁闽，“HIS和PACS集成的DICOM方式”，医学信息，Vol 15, No 2，2002，2。
36．张庆，高上凯，“HL7标准及其在我国的应用前景”，中国医疗器械信息，Vol．7，No．4，Aug．2002。
37．崔希威，王学斯，“医院信息系统的发展与应用”，航空航天医药，Vol．12，No．2，2001。
38．王岩，田捷，韩博闻，“基于DICOM标准的医疗数据通信设计”，微型机与应用，2001年第2期。
39．萧一峰，纪裳，牟轩沁，李树均，“医用数字影像设备PACS组件的设计”，中国医疗器械杂志，Vol．23，No．2，1999．
40．邱峰，田捷，曹勇，刘景春，"PACS系统综述”，中国医学影像技术，Vol 16，No 1，2000。
41．熊宇，段会龙，吕维雪，“图像归档和通讯系统(PACS)的发展与应用”，国外医学生物医学工程分册，Vol 23，No 2，2000。
42．胡海波，庄天戈，“分布式PACS系统设计及其实现”，中国医疗器械杂志，Vol 24，No 5，2000。
43．盛平，宋轶勤，宋顺林，“医院信息系统的分析与设计”，江苏理工大学学报(社会科学版)，2000，12。
44．何楚，徐振勤，廖孟扬，“基于Web的医学图像信息中心的研究与实现”，计算机工程，Vol 27，No 9，Sep．2001。
45．蒲卫，李军，张涛，“医院信息系统与PACS的融合”，医疗设备信息，2001，6。
46．童明杰，胡大可，“认知医学数字图像通讯标准-DICOM”，国外医学生物医学工程分册，Vol 22，No．5，1999。
47．Stebe Teixeira, Xavier Pacheco著，任旭钧，王永生，冯泽波等译，《Delphi 5开发人员指南》，机械工业出版社。