电子病历系统临床文档的语义表示的建构研究

本文论述了电子病历系统的目标和边界范围,从分析临床文档语义框架的层次结构入手,引入临床文档体系结构(CDA)来描述电子病历的临床信息,为设计、实施标准化、结构化的电子病历系统奠定了语义建构的基础.     

基于电子病历的机动手术室信息管理系统设计与实现

为提高工作效率,加强患者信息共享,设计了基于电子病历的机动手术室信息管理系统。在手术室内部采用客户端/服务器(C/S)模式实现医疗设备的信息采集,通过文档对象模型(DOM)生成基于可扩展标记语言(XML)的病历文档;在手术室外部,通过浏览器/服务器(B/S)模式提供电子病历的网络访问服务。实验表明,该系统能够正确采集医疗设备信息,清晰显示实时波形,并通过电子病历功能实现了病历的质量控制,以及机动手术室与其他机动单元之间的信息共享,减少了医生的工作负担,促进了野战医院的整体信息化建设。     

基于卫生信息平台的电子病历信息共享研究和实现

研究信息共享的关键技术,通过电子病历的标准化和结构化处理、传输和交换,实现电子病历信息的共享。在卫生部电子病历数据标准的基础上,结合采用情景分析法和层次分析法,通过Delphi法专家咨询确定电子病历可以结构化的数据项,实现电子病历的标准化和结构化处理;然后运用SWOT分析法,结合应用可扩展标记语言（XML）和临床文档结构标准（CDA）两项技术,实现电子病历的标准化传输和交换,使得电子病历信息在传输和交换过程中能够被机器自动识别,实现数据的自动化传输和交换;最后,研发电子病历完整性测试系统,实现电子病历完整性的自动测试。完成电子病历信息标准化和结构化处理、传输和交换全流程的技术研究,形成技术规范。有123家医院实现电子病历标准化上传省级卫生信息平台,有16家电子病历提供商具备了电子病历标准化和结构化处理、传输和交换能力。初步实现了电子病历的信息共享,电子病历数据传输技术规范作为浙江省地方标准正式颁布实施。     

基于网格及IHE XDS/XDS-I技术框架和协议的区域影像电子健康记录系统的设计与实现

提出并实现了一种具有影像信息共享交换功能的区域电子健康记录系统（EHR），完全符合IHE XDS／XDS-I技术框架和协议，同时应用网格概念和SOA架构，实现区域间多家医疗机构的病人影像信息的共享交换和影像信息的预处理及智能流动。该系统由病人基本信息主索引服务器、注册中心、存储池、网格服务器、安全服务模块、网关及网格代理结点、PACS／EMR工作站和医院现有PACS系统或医学影像设备及RIS系统等8个组件组成，解决了采用ebXML标准与注册中心、存储池的通信和PACS／RIS或其他现有影像信息系统只能通过DICOM标准和HL7通信相冲突的难题。在上海市3家医院和科研单位进行了系统测试，主要有图像及报告的发布流程和用户的查询提取流程，结果表明该系统是在不增加网络带宽和存储资源的情况下，解决区域间影像信息共享交换的有效方案，具有安全可靠、可伸缩和易管理的特点。     

生物信息学电子文档收编及优化检索的实现

生物信息学涉及生物、化学、物理、数学、计算机和互联网应用等多方面知识,要从事这个领域的研究工作,必须掌握更多的各方面知识.目前该领域的很多资料和文献在网上以电子文档的形式存在.电子文档能够包含比常规的文档包含更广泛,更丰富的内容,对电子文档的收编整理能大大节省文档的搜索时间,并能提供更专业,更有效的检索结果,为科研工作服务.本文论述了建立包括电子文档的收集,标注,优化检索的一个方案,检索结果按照文档和检索条件的相似程度分级列出.实践证明,该系统能够有效的提供生物信息学专业信息的管理和检索.     

基于医疗健康信息集成规范-跨企业级文档共享技术的区域双向转诊互操作的研究与实现**

背景：双向转诊可提高现有资源的有效利用率及卫生服务的社会效益,已成为解决社区卫生服务可持续发展的重要手段。 目的：实现区域内不同医疗机构间患者医疗信息与医疗资源共享,构建双向转诊系统,推动区域卫生信息化建设。 方法：从信息交互的互操作特点和重要性入手,深入分析了跨企业级文档共享技术框架下的角色和事务,研究具体的共享流程和实现方案,提出文档存储池和数据存储执行的策略,并在此基础上进行技术实现,构建双向转诊系统。 结果与结论：在医疗健康信息集成规范-跨企业级文档共享技术的基础下,实现了双向转诊系统的构建,并在不同系统和机构之间进行了测试,结果证实该双向转诊系统可以有效和快捷的共享患者信息。      

生理学教研室电子文档库建设与利用

通过对教研室资料电子化后进行分类管理,建立以教学资料为主的电子文档库,并对部分资料提取数据信息以备再分析,教研室建立并完善了电子文档管理体系,电子化管理资料提高了工作效率,保护了原始资料,可更好地体现其数据和历史价值,有益于教研室工作的开展和文档价值的提升.     

电子签名数字证书在我院信息系统中的应用

中山市人民医院在2003年完成了大规模集成化医院信息系统的建设，医疗信息充分共享，办公文书、医疗文档实现了”无纸化、无胶片化”运作。2007年我们在电子病历、门诊电子处方、门诊配药发药、检验报告和各类医学影像检查报告中使用由第三方电子认证机构签发的电子签名数字证书。本文引用法律条文来说明在电子医疗文书中使用电子签名数字证书是有法律依据的．并就电子签名数字证书应用体会进行了讨论。     

医院内外双网通环境下的文档云系统

目的针对医院内外网间文档安全传输、共享和保密等问题,本文提出一种云端模块化、可扩展的解决方案。方法在防火墙后面建立一个文档云服务器,利用Node.js和Mongodb等技术,通过自动分析电脑的位置属性、文档属性、标签属性等,对文档应用杀毒、审计、归属分组、销毁、全局备份等策略。结果版本1.0在基于外网的行政部门和基于内网的临床部门间进行了试运行,效果良好。版本1.0界面较简洁,用户操作也很简单。由于取代了USB和共享方式,切断了蠕虫、病毒传播的途径;智能文档模式让用户日常文档操作更简单、效率更高。结论该系统较好地满足了医院对文档管理的技术、管理、效率等层面的要求,实用价值较高。     

HL7在电子病历信息交换的应用

随着计算机网络技术的发展,医疗机构的网络互联和信息的共享与交换已成为全球医疗卫生信息化的发展趋势。电子病历是实现医疗卫生信息化的核心,而电子病历信息来源于各医疗信息系统,本文通过分析当前各医疗信息系统平台信息交换现状,利用HL7在电子病历中的应用优势,根据HL7的数据交换原理,提出实现电子病历信息交换的策略。     

放射治疗中基于DICOM-RT模型的电子病历信息系统

电子病历(EMR)是医疗机构对门诊、住院患者(或保健对象)临床诊疗、指导干预的数字化医疗服务工作记录,是居民个人在医疗机构历次就诊过程中产生和被记录的完整、详细的临床信息资源。放射治疗EMR中包含文字、图像等信息,因此,比一般的EMR更加复杂。本文提出一种基于DICOM-RT标准的EMR信息系统,通过使用DICOM-RT的七个对象来实现放射治疗中不同系统、设备间的信息交换和共享,方便放射治疗患者治疗数据的管理,提高放射治疗的效率。     

基于医学本体的临床路径知识库模型建设

目的建立临床路径知识库模型,提高临床路径软件的自适应性,提升电子病历应用水平。方法利用本体知识库编辑工具,从医院已有的临床路径病种数据应用出发,对临床知识库内容进行规范化研究和标准化表达,形成临床路径知识库模型。结果建立了58个病种的临床路径知识库,该知识库描述了医院临床路径内容的各个方面,可应用于新一代临床信息系统建设。结论临床路径本体知识库对智能化电子病历应用和临床决策支持系统有重要作用,有利于医院信息系统的语义集成,是新一代电子病历应用的重要组成部分。     

基于电子病历的医院信息平台的关键技术

目的：医院信息平台包括管理信息系统和临床信息系统,电子病历系统处于整个系统的中心位置,要以电子病历为核心构建基于电子病历的医院信息平台。方法：1、构建以电子病历为核心的体系架构,该体系框架由门户、应用、服务、资源、交换、业务、基础设施、标准、安全体系和运维管理共九层组成。2、建立临床数据存储库CDR,CDR数据来源于医院信息平台的临床和管理信息系统,按规定格式进行存储和归档后,供信息系统用户调用。3、实现信息系统集成,SOA模式是面向服务架构的新型集成体系,通过企业服务总线（ESB）实现,它将软件的功能设计成一个个独立封装的服务,并通过信息交换协议进行发布,达到无界限的联通和软件复用。结果：基于电子病历的医院信息平台满足医院信息系统应用和基础设施整合的需求。CDR支持及时性的、操作性的、集成性的整体临床信息的应用,实现面向主题的、集成的、标准的、可变的、当前的细节数据集合。SOA模式可以通过企业服务总线（ESB）实现,ESB将集线器模式的星形结构扩展为总线结构,将总线上的各个服务按照用户需要的业务逻辑组装起来,使这些服务按照业务逻辑顺序执行,从而实现用户完整的业务功能。结论：基于电子病历的医院信息平台结构、CDR数据存储结构和采用ESB技术的SOA集成模式是构建新一代医院信息系统的关键技术。     

The RSNA Image Sharing Network

In the era of health information exchanges, there are trade-offs to consider when sharing a patient’s medical record among all providers that a patient might choose. Exchange among in-network partners on the same electronic medical records (EMR) and other integrated information systems is trivial. The patient identifier is common, as are the relevant departmental systems, to all providers. Difficulties arise when patient records including images (and reports) must be shared among different networks and even with the patients themselves. The National Institutes of Health (NIH) challenged Radiological Society of North America (RSNA) to develop a transport method that could supersede the need for physical media (for patients or other providers), replace point-to-point private networks among providers, and enable image exchange on an ad hoc basis between arbitrary health networks without long legal delays. In concert with the evolving US health care paradigm, patient engagement was to be fundamental. With Integrating Healthcare Enterprise’s (IHE’s) help, the challenge has been met with an operational system.     

Computing disease incidence,prevalence and comorbidity from electronic medical records

Electronic medical records (EMR) represent a convenient source of coded medical data, but disease patterns found in EMRs may be biased when compared to surveys based on sampling. In this communication we draw attention to complications that arise when using EMR data to calculate disease prevalence, incidence, age of onset, and disease comorbidity. We review known solutions to these problems and identify challenges for future work.     

No paper,but the same routines: a qualitative exploration of experiences in two Norwegian hospitals deprived of the paper based medical record

Background  

It has been shown that implementation of electronic medical records (EMR) and withdrawal of the paper-based medical record is feasible, but represents a drastic change in the information environment of hospital physicians. Previous investigations have revealed considerable inter-hospital variations in EMR system use and user satisfaction. The aim of this study was to further explore changes of clinicians' work after the EMR system implementation process and how they experienced working in a paper-deprived information environment.     

Computerizing medical records in Japan

PURPOSE: The present study reports the current status of computerizing medical records in Japan. In 2001, the Ministry of Health, Labour and Welfare formulated the Grand Design for the Development of Information Systems in the Healthcare and Medical Fields. The Grand Design stated a numerical target for "spreading the use of electronic medical records (EMR) in at least 60% of Japan's hospitals with 400 or more beds by 2006." The objective of this study was to examine the extent to which EMR and order entry systems (OES) have been adopted as of February 2007 and to evaluate the Japanese government's policy regarding the computerization of medical records. METHODS: We conducted a postal survey targeting medical institutions throughout Japan. In February 2007, we mailed self-administered questionnaires to all 1574 hospitals with 300 or more beds, and to a random selection of 1000 hospitals with less than 300 beds in addition to 4000 clinics. Responses were received from 812 (51.6%), 504 (50.5%), and 1769 (44.8%), respectively. We asked questions concerning: (i) the extent to which EMR and OES had been introduced; (ii) the reasons why certain institutions had not introduced EMR and (iii) the subjective evaluation of the efficacy and cost-effectiveness of EMR. RESULTS: The percentage of institutions that had introduced EMR as of February 2007 was 10.0% for hospitals and 10.1% for clinics. Even the percentage for hospitals with 400 or more beds was just 31.2%, illustrating that the government's target had not been reached. The most common reason given for not introducing EMR was: "The cost is high" which was observed in 82.0% of hospitals. It was considered that the introduction of EMR could improve 'inter-hospital networks', and 'time efficiency for physicians' by around 45% and 25% of hospitals, respectively. CONCLUSION: Healthcare information computerization in Japan is behind schedule because the introductory costs are high. For the computerization of healthcare information to be further promoted, prices of EMR systems should be lowered to a level which individual hospitals can afford. Furthermore, the communication between EMR systems should be further standardized to secure functional and semantic interoperability in Japan.     

Electronic medical record systems at academic health centers: advantages and implementation issues.

The growth of managed care has fueled expectations for a more coordinated delivery of clinical services and a reduction of unnecessary utilization. Among the most important issues that constrain these expectations is the transfer of medical information. Electronic medical record (EMR) systems appear to offer substantive advantages over paper records for both containing costs and improving the quality of care. However, incorporation of EMR systems into practice settings has languished. Among the barriers to implementation are software problems of codification and entry of data, security issues, a dearth of integrated delivery systems, reluctant providers, and prohibitive costs. The training programs of academic health centers (AHCs) are optimal environments for testing and implementing EMR systems. AHCs have the expertise to resolve remaining software issues, the components necessary for integrated delivery, a culture for innovation in clinical practice, and a generation of future providers that can be acclimated to the requisites for computerized records. The authors critically review these and other issues of implementing EMR systems at AHCs and propose four necessary steps for financing their implementation.