基于HL7的电子病历模型构建与实现
摘要
随着计算机技术的飞速发展,国际医学信息标准化、电子化的推进,利用计算机进行医院病历现代化管理已是时代发展的必然趋势。在医院的现代化管理中,电子病历EMR(Electronic Medical Record)是医疗活动信息的主要载体,为了实现电子病历的共享和利用,必须实现电子病历的标准化。美国卫生信息传输标准HL7(Health Level Seven)规范了临床医学和管理信息格式,降低医院信息系统互连的成本,提高医院信息系统之间数据信息共享的程度,因此构建和实现基于HL7的电子病历模型,并实现基于国际标准HL7的电子病历子系统具有较大意义。
本文首先在对电子病历系统特点以及HL7信息参考模型进行深入分析的基础上,构建出基于HL7的电子病历模型。该模型由表示临床数据的基础类和基础类之间的关联组成,基础类包括实体、角色、参与和活动四个类别。本文结合当前国内病历的实际结构,抽象出了满足HL7标准的所有属性字段,基础类中的功能属性和基础类之间的关联关系能良好支持HL7状态机的运转和HL7消息的构建。此外,为优化存储结构,本文采用继承消除的策略,将常用类型从父类中独立出来,降低了实体之间的复杂性。并按照医疗信息数据类型对存储所有数据结果的观察类进行拆分,从而使得观察活动具体化。
其次,采用ER-EAV混合模型将电子病历模型映射到物理数据库。拆分后的观察类采用ER-EAV混合模型,而其他类采用ER模型,通过这种方式建立HL7消息到数据库的映射。
最后,本文在上述研究的基础上设计并实现了基于HL7的电子病历子系统。该系统实现了多种对电子病历数据库查询和基本的医院管理功能,满足当前对电子病历的需求,且能通过HL7消息的方式与符合HL7标准的电子病历系统进行交互、共享病人临床数据,达到本文设计的初衷,实现了整个系统的标准化、规范化。
With the rapid development of computer technology, standardization of medical information, the promotion of electronic, it is the inevitable trend today for the hospitals to manage the medical records effectively by using computer. During the modernization management of hospital, EMR (Electronic Medical Record) is the main carriers of health care information, In order to share and use EMR, it is necessary to achieve the standardization of EMR. As the transmission standard of the United States Department Health information, HL7 (Health Level 7) has standardized clinical and formats of management information, reduces costs of interconnection and improves data information sharing between hospitals. Therefore, it is greatly significant to research an HL7-based EMR model and implement HL7-based EMR subsystem.
In this paper, firstly, based on in-depth analysis to characteristics of EMR and HL7 reference information model (RIM), a HL7-based model of EMR is proposed. This model is consisted with clinical data basic classes and their connections. Entity, Role, participation and act are included in basic classes. Combining with current actual medical records structures of China, in this paper, all property fields which is consistent with HL7 is abstracted. The basic functional properties and connections of basic classes can support operation of HL7 state machine well and HL7 message’s construction. In addition, in order to optimize the storage structure, in this paper, elimination of the inheritance is used, which abstracts common classes from basic classes and eliminates the complexity between entities. Observation classes which store all data results are spitted in accordance with medical information data type so as to make medical information more specific.
Secondly, using ER-EAV mixed model map EMR model to physical database. Observation classes which are disconnected use ER-EAV model, but other classes use ER model, in this way, it is convenient to map HL7 information to database.
Finally, after research above, an HL7-based EMR subsystem is designed and implemented. This system achieves many inquiries for EMR database and basic hospital management function. It can meet the current demand for EMR system; furthermore, it can interact and share clinical data with HL7-based EMR system by using HL7 message. So, it meets the original intention of this paper ensuring whole system to achieve standardized.
本文首先在对电子病历系统特点以及HL7信息参考模型进行深入分析的基础上,构建出基于HL7的电子病历模型。该模型由表示临床数据的基础类和基础类之间的关联组成,基础类包括实体、角色、参与和活动四个类别。本文结合当前国内病历的实际结构,抽象出了满足HL7标准的所有属性字段,基础类中的功能属性和基础类之间的关联关系能良好支持HL7状态机的运转和HL7消息的构建。此外,为优化存储结构,本文采用继承消除的策略,将常用类型从父类中独立出来,降低了实体之间的复杂性。并按照医疗信息数据类型对存储所有数据结果的观察类进行拆分,从而使得观察活动具体化。
其次,采用ER-EAV混合模型将电子病历模型映射到物理数据库。拆分后的观察类采用ER-EAV混合模型,而其他类采用ER模型,通过这种方式建立HL7消息到数据库的映射。
最后,本文在上述研究的基础上设计并实现了基于HL7的电子病历子系统。该系统实现了多种对电子病历数据库查询和基本的医院管理功能,满足当前对电子病历的需求,且能通过HL7消息的方式与符合HL7标准的电子病历系统进行交互、共享病人临床数据,达到本文设计的初衷,实现了整个系统的标准化、规范化。
With the rapid development of computer technology, standardization of medical information, the promotion of electronic, it is the inevitable trend today for the hospitals to manage the medical records effectively by using computer. During the modernization management of hospital, EMR (Electronic Medical Record) is the main carriers of health care information, In order to share and use EMR, it is necessary to achieve the standardization of EMR. As the transmission standard of the United States Department Health information, HL7 (Health Level 7) has standardized clinical and formats of management information, reduces costs of interconnection and improves data information sharing between hospitals. Therefore, it is greatly significant to research an HL7-based EMR model and implement HL7-based EMR subsystem.
In this paper, firstly, based on in-depth analysis to characteristics of EMR and HL7 reference information model (RIM), a HL7-based model of EMR is proposed. This model is consisted with clinical data basic classes and their connections. Entity, Role, participation and act are included in basic classes. Combining with current actual medical records structures of China, in this paper, all property fields which is consistent with HL7 is abstracted. The basic functional properties and connections of basic classes can support operation of HL7 state machine well and HL7 message’s construction. In addition, in order to optimize the storage structure, in this paper, elimination of the inheritance is used, which abstracts common classes from basic classes and eliminates the complexity between entities. Observation classes which store all data results are spitted in accordance with medical information data type so as to make medical information more specific.
Secondly, using ER-EAV mixed model map EMR model to physical database. Observation classes which are disconnected use ER-EAV model, but other classes use ER model, in this way, it is convenient to map HL7 information to database.
Finally, after research above, an HL7-based EMR subsystem is designed and implemented. This system achieves many inquiries for EMR database and basic hospital management function. It can meet the current demand for EMR system; furthermore, it can interact and share clinical data with HL7-based EMR system by using HL7 message. So, it meets the original intention of this paper ensuring whole system to achieve standardized.
引文
1李彬.电子病历的应用现状及发展对策初探.医学与社会. 2005, 18(6): 46-49
2李月秋,王玉,周晨.医院信息系统与电子病历.医学信息学杂志. 2007, 3: 236-237
3侯微.医院信息系统及电子病历研发和应用中需要注意的问题.广州医药. 2004, 35(3): 68-70
4孙沂振,沈云学.电子病历概述.医学信息学杂志. 2009, 30(3): 1-3
5 E. Smith, J. H. P. Eloff. Security in health-care information systems-current trends. International Journal of Medical Informatics. 1999, 54(1): 39-54
6 T. J. Eggebraaten, J. W. Tenner , T. C. Dubbels. A Health-care Data Model Based on the HL7 Reference Information Model. IBM SYSTEMS JOURNAL. 2007, 46(1): 1-9
7 M. Berg, E. Goorman. The contextual nature of medical information. International Journal of Medical Informatics. 1999, 56(1) : 51-60
8 A. Shabo, D. Dotan. The seventh layer of the clinical-genomics information infrastructure. IBM SYSTEMS JOURNAL. 2007, 46(1): 57-66
9杨丽静,肖晓旦.电子病历的结构和功能模型综述.中国数字医学. 2007, 2(3):15-19
10谭定英,叶辉,李学征. HL7在电子病历信息交换的应用.医学信息. 2007, 20(6):909-910
11王占霞.应用电子病历的体会与思考.中华医学管理杂志. 2004, 11(1): 79-80
12潘传迪,周新朝,施健.基于动态解析数据结构的电子病历系统设计.中国数字医学. 2007, 2(3): 20
13 R. Agrawal, T. Grandison, C. Johnson, J. Kiernan. Enabling the 21st Century Health Care Informaiton Technology Revolution. Communications of ACM. 2007, 50(2): 35-42
14薛万国.我国电子病历研究进展.中国医院管理. 2005, 25(2): 17-19
15 J. D. Gold, M. J. Ball. The Health Banking imperative: A conceptual model. IBM SYSTEM JOURNAL. 2007,46(1): 43-56
16 A. S. Rothschild, L. Dietrich, M. J. Ball, H. Wurtz, H. Farish-Hunt, N. Cortes-Comerer. Leveraging Systems Thinking to Design Patient-CenteredClinical Documentation Systems. International Journal of Medical Informatics. 2005, 74(5): 395-398
17钱志明,徐海澎.基于HL7 V3建立临床数据中心.中国数字医学. 2008, 3(5): 67-69
18王炳胜,王景明,李永申,李勇,柴军英,苏小刚,许若飞.电子病历存储方法初探.中国医院管理. 2007, 12(27): 86-87
19 P. H. Cheng, C. H. Yang, H. S. Chen, S. J. Chen, J. S. Lai. Application of HL7 in a Collaborative Healthcare Information System. Proceedings of the 26th Annual International Conference of the IEEE. 2004, 2: 3354-3357
20 J. W. Lebak, J. Yao, S. Warren. HL7-Compliant Healthcare Information System for Home Monitoring. Proceedings of the 26th Annual International Conference of the IEEE EMBS. 2004, 2: 3338-3340
21陈立富,彭永梅,文新建,何鸿羚.电子病历与“军字1号”医生工作站.医学信息. 2002, 1: 15
22郭雪清,汪君,黄正东.电子病历在HIS中的应用与分析.科学与管理. 2008, 23(2): 81-82
23 C. P. Waegemann. The five levels of electronic health records. MD Computing: computers in medical practice. 1996, 13(3): 199-203
24王海彤. HL7 V3基础框架.卫生部电子病历委员会临床检验结果共享系统互操作性规范厂商培训研讨会. 2007: 12-18
25陈琳.电子病历现存的问题与改进意见.中国现代医学杂志. 2006, 16(2): 316-320
26余元龙,杜宜,张淑娟,杨勇.大型综合性医院实施电子病历的难点和对策.中国数字医学. 2009, 4(2): 8-10
27俞汝龙. HL7组织与HL7标准简介.中国数字医学. 2007, 2(6): 41-43
28王莉.认识电子病历.现代医药卫生. 2004, 20(2): 11-14
29 J. Anh?j. Generic Design of Web-Based Clinical Databases. Journal of Medical Internet Research. 2003, 5(4): 55-56
30 C. J. McDonald. The Barriers to Electronic Medical Reord System and how to Overcome Them. Journal of the American Informatics Association. 1997, 4: 213-221
31 J. Halamka. Electronic Health Record and Revolution of Clinical Information Technology Current Status and Future Impact. National Medical Journal of Chian. 2005, (85)22: 1513-1515
32 P. M. Nadkarni, C. Brandt, S. Frawley, F. G. Sayward, R. Einbinder, D. Zelterman, L. Schacter, P. L. Miller. Managing Attribute-Value ClinicalTrials Data Using the ACT/DB Client-Server Database System. Journal of the American Medical Informatics Association. 1998, 5: 139-151
33李昊旻.电子病历的标准化结构化方法研究及实践.浙江大学博士学位论文. 2007:19-20
34 M. A. C. Dekker, S. Etalle. Audit-Based Access Control for Electronic Health Records. Electronic Notes in Theoretical Computer Science. 2007, 168: 221-236
35 R. Hillestad, J. Bigelow, A.Bower, F. Girosi, R. Meili, R. Scoville, R. Taylor. Can Electronic Medical Record Systems Transform Health Care? Potential Health Benefits, Saving, And Cost. Health Affairs. 2005, 24(5): 1103-1117
36 P. J. O’Connor, A. L. Crain, W. A. Rush, J. M. Sperl-Hillen, J. J. Gutenkauf, J. E. Duncan. Impact of an Electronic Medical Record on Diabetes Quanlity of Care. Annals of Family Medicine. 2005, 3: 300-306
37 J. C. Crosson, C. Stroebel, J. G. Scott, B. Stello, B. F. Crabtree. Implementing an Electronic Medical Record in a Family Medicine Practice: Communication, Decision Marking, and Conflict. Annals of Family Medicine. 2005, 3: 307-311
38王忠庆,全宇.基于HL7的HIS与PACS/RIS集成.医院数字化. 2009, 30(4): 52-53
39舒婷,俞汝龙.医院电子病历需求分析.中国数字医学. 2009, 4(2): 5-7
40 A. Feldstein, P. J. Elmer, D. H. Smith, M. Herson, E. Orwoll, C. Chen, M.Aickin, M. C. Swain. Electronic Medical Record Reminder Improves Osteoporosis Management After a Fracture: A Randomized, Controlled Trial. Journal of the American Geriatrics Society. 2006, 54(3) 450-457
41 J. A. Linder, J. Ma, D. W. Bates, B. Middleton, R. S. Stafford. Electronic Health Record Use and the Quanlity of Ambulatory care in the United States.Archives of Internal Medicine. 2007, 167(13): 1400-1405
42 J. D. Ralston, D. Carrell, R. Reid, M. Anderson, M. Moran, J. Hereford. Patient Web Service integrated with a Shared Medical Records: Patient Use and Satisfaction. Journal of American Medical Informatics Association. 2007, 14(6): 798-806
2李月秋,王玉,周晨.医院信息系统与电子病历.医学信息学杂志. 2007, 3: 236-237
3侯微.医院信息系统及电子病历研发和应用中需要注意的问题.广州医药. 2004, 35(3): 68-70
4孙沂振,沈云学.电子病历概述.医学信息学杂志. 2009, 30(3): 1-3
5 E. Smith, J. H. P. Eloff. Security in health-care information systems-current trends. International Journal of Medical Informatics. 1999, 54(1): 39-54
6 T. J. Eggebraaten, J. W. Tenner , T. C. Dubbels. A Health-care Data Model Based on the HL7 Reference Information Model. IBM SYSTEMS JOURNAL. 2007, 46(1): 1-9
7 M. Berg, E. Goorman. The contextual nature of medical information. International Journal of Medical Informatics. 1999, 56(1) : 51-60
8 A. Shabo, D. Dotan. The seventh layer of the clinical-genomics information infrastructure. IBM SYSTEMS JOURNAL. 2007, 46(1): 57-66
9杨丽静,肖晓旦.电子病历的结构和功能模型综述.中国数字医学. 2007, 2(3):15-19
10谭定英,叶辉,李学征. HL7在电子病历信息交换的应用.医学信息. 2007, 20(6):909-910
11王占霞.应用电子病历的体会与思考.中华医学管理杂志. 2004, 11(1): 79-80
12潘传迪,周新朝,施健.基于动态解析数据结构的电子病历系统设计.中国数字医学. 2007, 2(3): 20
13 R. Agrawal, T. Grandison, C. Johnson, J. Kiernan. Enabling the 21st Century Health Care Informaiton Technology Revolution. Communications of ACM. 2007, 50(2): 35-42
14薛万国.我国电子病历研究进展.中国医院管理. 2005, 25(2): 17-19
15 J. D. Gold, M. J. Ball. The Health Banking imperative: A conceptual model. IBM SYSTEM JOURNAL. 2007,46(1): 43-56
16 A. S. Rothschild, L. Dietrich, M. J. Ball, H. Wurtz, H. Farish-Hunt, N. Cortes-Comerer. Leveraging Systems Thinking to Design Patient-CenteredClinical Documentation Systems. International Journal of Medical Informatics. 2005, 74(5): 395-398
17钱志明,徐海澎.基于HL7 V3建立临床数据中心.中国数字医学. 2008, 3(5): 67-69
18王炳胜,王景明,李永申,李勇,柴军英,苏小刚,许若飞.电子病历存储方法初探.中国医院管理. 2007, 12(27): 86-87
19 P. H. Cheng, C. H. Yang, H. S. Chen, S. J. Chen, J. S. Lai. Application of HL7 in a Collaborative Healthcare Information System. Proceedings of the 26th Annual International Conference of the IEEE. 2004, 2: 3354-3357
20 J. W. Lebak, J. Yao, S. Warren. HL7-Compliant Healthcare Information System for Home Monitoring. Proceedings of the 26th Annual International Conference of the IEEE EMBS. 2004, 2: 3338-3340
21陈立富,彭永梅,文新建,何鸿羚.电子病历与“军字1号”医生工作站.医学信息. 2002, 1: 15
22郭雪清,汪君,黄正东.电子病历在HIS中的应用与分析.科学与管理. 2008, 23(2): 81-82
23 C. P. Waegemann. The five levels of electronic health records. MD Computing: computers in medical practice. 1996, 13(3): 199-203
24王海彤. HL7 V3基础框架.卫生部电子病历委员会临床检验结果共享系统互操作性规范厂商培训研讨会. 2007: 12-18
25陈琳.电子病历现存的问题与改进意见.中国现代医学杂志. 2006, 16(2): 316-320
26余元龙,杜宜,张淑娟,杨勇.大型综合性医院实施电子病历的难点和对策.中国数字医学. 2009, 4(2): 8-10
27俞汝龙. HL7组织与HL7标准简介.中国数字医学. 2007, 2(6): 41-43
28王莉.认识电子病历.现代医药卫生. 2004, 20(2): 11-14
29 J. Anh?j. Generic Design of Web-Based Clinical Databases. Journal of Medical Internet Research. 2003, 5(4): 55-56
30 C. J. McDonald. The Barriers to Electronic Medical Reord System and how to Overcome Them. Journal of the American Informatics Association. 1997, 4: 213-221
31 J. Halamka. Electronic Health Record and Revolution of Clinical Information Technology Current Status and Future Impact. National Medical Journal of Chian. 2005, (85)22: 1513-1515
32 P. M. Nadkarni, C. Brandt, S. Frawley, F. G. Sayward, R. Einbinder, D. Zelterman, L. Schacter, P. L. Miller. Managing Attribute-Value ClinicalTrials Data Using the ACT/DB Client-Server Database System. Journal of the American Medical Informatics Association. 1998, 5: 139-151
33李昊旻.电子病历的标准化结构化方法研究及实践.浙江大学博士学位论文. 2007:19-20
34 M. A. C. Dekker, S. Etalle. Audit-Based Access Control for Electronic Health Records. Electronic Notes in Theoretical Computer Science. 2007, 168: 221-236
35 R. Hillestad, J. Bigelow, A.Bower, F. Girosi, R. Meili, R. Scoville, R. Taylor. Can Electronic Medical Record Systems Transform Health Care? Potential Health Benefits, Saving, And Cost. Health Affairs. 2005, 24(5): 1103-1117
36 P. J. O’Connor, A. L. Crain, W. A. Rush, J. M. Sperl-Hillen, J. J. Gutenkauf, J. E. Duncan. Impact of an Electronic Medical Record on Diabetes Quanlity of Care. Annals of Family Medicine. 2005, 3: 300-306
37 J. C. Crosson, C. Stroebel, J. G. Scott, B. Stello, B. F. Crabtree. Implementing an Electronic Medical Record in a Family Medicine Practice: Communication, Decision Marking, and Conflict. Annals of Family Medicine. 2005, 3: 307-311
38王忠庆,全宇.基于HL7的HIS与PACS/RIS集成.医院数字化. 2009, 30(4): 52-53
39舒婷,俞汝龙.医院电子病历需求分析.中国数字医学. 2009, 4(2): 5-7
40 A. Feldstein, P. J. Elmer, D. H. Smith, M. Herson, E. Orwoll, C. Chen, M.Aickin, M. C. Swain. Electronic Medical Record Reminder Improves Osteoporosis Management After a Fracture: A Randomized, Controlled Trial. Journal of the American Geriatrics Society. 2006, 54(3) 450-457
41 J. A. Linder, J. Ma, D. W. Bates, B. Middleton, R. S. Stafford. Electronic Health Record Use and the Quanlity of Ambulatory care in the United States.Archives of Internal Medicine. 2007, 167(13): 1400-1405
42 J. D. Ralston, D. Carrell, R. Reid, M. Anderson, M. Moran, J. Hereford. Patient Web Service integrated with a Shared Medical Records: Patient Use and Satisfaction. Journal of American Medical Informatics Association. 2007, 14(6): 798-806