数字化医院建设中信息交换的标准问题

我国医院信息化的发展已经经历了二十多年，HIS已较普遍，PACS正在建设中，近一、两年又提出实现全面集成的数字化医院的要求。然而，由于历史的原因，当前多数医院已有的信息应用系统大多数彼此独立和封闭，几乎成为信息孤岛，对信息的整体利用极为不利。医院信息化要实现全面集成的数字化医院，建立开放、稳定、一体化的数字化平台，其中重要的问题之一是需要遵循统一的信息交换标准，以便各信息应用系统之间在应用层上能方便、顺畅的交换信息，消除信息孤岛。遵循统一的信息交换标准，还可以减少数字化医院中各信息应用系统之间的耦合．降低因局部系统更换、升级带来的维护成本。本文将介绍当前国际上通行的医疗卫生信息交换标准HL7、DICOM、IHE等方面的内容。     

数据挖掘技术在医院资金分析管理中的应用

经过多年"医院信息系统"的应用.很多医院都积累了大量的原始资金数据信息,但目前对这些信息的利用,大多仅限于简单的查询和统计,停留在低层次应用上,缺乏对数据的有效集成、自动钻取,无法形成为医院管理者用以决策的信息.本文主要研究数据挖掘技术在医院资金分析管理中的应用.对应用系统中采用的数据挖掘策略和方法 进行了重点阐述.     

医疗应用集成平台的研究

本文针对集团化医院在信息化建设中急需解决的医疗信息共享的问题,提出了基于医疗应用集成平台的解决方案,以HL7为标准,以中间件为技术手段,成功地解决了集团各成员医院之间,医院内部各异构系统之间的应用集成与信息共享问题。     

基于数据挖掘技术的疾病预防控制评估研究

目的 通过利用与数据挖掘相关的理论与技术,在海量的医院信息数据中,寻找到对疾病预防控制有价值的信息,从而提炼出与疾病预防控制有关的规则或模型.方法 基于医院的多种信息系统为数据源建立一个数据仓库,以SQL Server2008作为数据库管理工具,利用SQL Server Analysis2008以及Delphi 7作为数据挖掘的工具,进行疾病预防控制的研究.结果 建立疾病预防控制研究的数据仓库,详细记录医院临床的诊断信息,提供了一种对疾病的关联性、发病因素进行分析研究的方法.结论 集成了医院各种信息系统数据的数据仓库,通过疾病预防与控制的研究方法,对临床疾病的预防分析与客观研究,提供了一个新的思路.     

基于HL7标准的心电医疗信息共享平台设计与实现

目的：解决目前区域医院信息平台建设中存在的医疗信息采集困难、数据标准不统一、医疗信息共享流程不统一等诸多问题,实现医疗信息在区域内有效共享。方法：研究HL7医疗信息交换标准和WebService技术,设计了基于Windows平台下的HL7引擎和WebService接口,HL7引擎主要包括HL7消息构建与解析,非标准数据通过HL7引擎转化为HL7标准数据,WebService接口为数据交互提供传输通道。结果：HL7引擎的引入实现了异构系统之间数据的无缝传输,构建WebService接口灵活地实现了跨平台、跨操作系统、跨语言的医生工作站与远程服务器的数据交互。结论：解决了医院信息共享问题,并建立了医疗系统间信息交换的快速通道,提高了医疗系统的工作效率和核心竞争力,为其他慢性病如高血压、高血糖、呼吸障碍等的健康管理系统提供了一定参考,该平台的实现对医疗信息化具有重要的实践意义。     

广安门医院信息系统集成方案

随着医院信息系统的不断发展，应用系统之间的集成成为各个医院面临的问题，广安门医院采用中间数据库的模式，遵循HL7标准中的表定义和元素定义，实现了部分临床信息系统和HIS系统的集成，文章详细论述了集成方案的设计和流程及技术实现。     

医院信息孤岛现象研究

本文分析了医院信息化相关因素,指明了产生信息孤岛的原因,提出了标准化、信息整合、应用集成和医用信息系统集成（IHE）等方法可以有效消除医院信息孤岛。     

集成HIS环境下医院统计工作模式

在现代化医院建设中,医院信息系统HIS是不可缺少的基础设施,我院2008年5月开始应用新的HIS,是基于SOA架构,采用.NET技术的开发平台、数字化医院解决方案的新医院信息系统.HIS的应用,每日产生包括门诊、病区、医技、药品、设备、财务等大量的实时业务数据,使统计数据源迅速扩展.统计数据是从医院管理与上报统计数据的角度将HIS各个环节产生的业务数据流进行分类和重组,形成有利于医院管理和统计应用的信息资源,促进网络环境下医院信息资源的共享与利用,有效、快速地解决统计工作的时效问题,加快统计任务的完成.     

医院信息孤岛现象研究

本文分析了医院信息化相关因素,指明了产生信息孤岛的原因,提出了标准化、信息整合、应用集成和医用信息系统集成(IHE)等方法可以有效消除医院信息孤岛.     

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。     

Data integration and genomic medicine

Genomic medicine aims to revolutionize health care by applying our growing understanding of the molecular basis of disease. Research in this arena is data intensive, which means data sets are large and highly heterogeneous. To create knowledge from data, researchers must integrate these large and diverse data sets. This presents daunting informatic challenges such as representation of data that is suitable for computational inference (knowledge representation), and linking heterogeneous data sets (data integration). Fortunately, many of these challenges can be classified as data integration problems, and technologies exist in the area of data integration that may be applied to these challenges. In this paper, we discuss the opportunities of genomic medicine as well as identify the informatics challenges in this domain. We also review concepts and methodologies in the field of data integration. These data integration concepts and methodologies are then aligned with informatics challenges in genomic medicine and presented as potential solutions. We conclude this paper with challenges still not addressed in genomic medicine and gaps that remain in data integration research to facilitate genomic medicine.     

Bioinformatics integration and agent technology

Vast amounts of life sciences data are scattered around the world in the form of a variety of heterogeneous data sources. The need to be able to co-relate relevant information is fundamental to increase the overall knowledge and understanding of a specific subject. Bioinformaticians aspire to find ways to integrate biological data sources for this purpose and system integration is a very important research topic. The purpose of this paper is to provide an overview of important integration issues that should be considered when designing a bioinformatics integration system. The currently prevailing approach for integration is presented with examples of bioinformatics information systems together with their main characteristics. Here, we introduce agent technology and we argue why it provides an appropriate solution for designing bioinformatics integration systems.     

Black Box Integration of Computer-Aided Diagnosis into PACS Deserves a Second Chance: Results of a Usability Study Concerning Bone Age Assessment

Usability aspects of different integration concepts for picture archiving and communication systems (PACS) and computer-aided diagnosis (CAD) were inquired on the example of BoneXpert, a program determining the skeletal age from a left hand’s radiograph. CAD-PACS integration was assessed according to its levels: data, function, presentation, and context integration focusing on usability aspects. A user-based study design was selected. Statements of seven experienced radiologists using two alternative types of integration provided by BoneXpert were acquired and analyzed using a mixed-methods approach based on think-aloud records and a questionnaire. In both variants, the CAD module (BoneXpert) was easily integrated in the workflow, found comprehensible and fitting in the conceptual framework of the radiologists. Weak points of the software integration referred to data and context integration. Surprisingly, visualization of intermediate image processing states (presentation integration) was found less important as compared to efficient handling and fast computation. Seamlessly integrating CAD into the PACS without additional work steps or unnecessary interrupts and without visualizing intermediate images may considerably improve software performance and user acceptance with efforts in time.     

A mixed methods analysis of housing and neighbourhood impacts on community integration among vulnerably housed and homeless individuals

The current longitudinal study used mixed methods to examine the relationship of housing and neighborhood characteristics and community integration among a population of homeless and vulnerably housed individuals. Participants were recruited at homeless shelters, meal programs, and rooming houses in Ottawa, Canada, and participated in 3 in‐person interviews, each approximately 1 year apart. Participants were placed into either a “high” or a “low” integration group based on their community integration scores at Follow‐up 1 and Follow‐up 2. There were 14 high and 32 low integration participants at Follow‐up 1, and 17 high and 35 low participants at Follow‐up 2. A general inductive approach to analyzing qualitative data was used to code the data. The most salient themes that affected community integration involved substance use in one's housing and neighborhood, neighborhood safety and location, and housing quality. Implications for service provision and policy advancements to better address community integration are discussed.     

Impact of PACS-EMR Integration on Radiologist Usage of the EMR

The purpose of this study was to objectively quantify the impact of implementing picture archiving and communication system-electronic medical record (PACS-EMR) integration on the time required to access data in the EMR and the frequency with which data are accessed by radiologists. Time to access a clinic note in the EMR was measured before and after integration with a stopwatch and compared by t test. An IRB-approved, HIPAA-compliant retrospective review of EMR access data from security audit logs was conducted for a 14-month period spanning the integration. Correlation of these data with report signatures identified the studies in which the radiologist accessed the EMR to obtain additional clinical data. Proportions of studies with EMR access were plotted and compared before and after integration using a chi-square test. Time to access the EMR decreased from 52 to 6 s (p?<?0.001). Proportion of studies with EMR access increased from 36.7% (10,175/27,773) to 44.9% (10,843/24,153) after integration (p?<?0.001). Integrating PACS and the EMR substantially decreases the time to access the EMR and is associated with a significant increase in the proportion of studies for which radiologists obtain additional clinical data.     

现有系统扩展IHE集成功能的设计方法

基于IHE技术框架实现医疗信息系统集成是目前的发展方向,对大量现有的系统实现IHE集成功能,进行系统的升级扩展是既高效又经济的方法。以DICOM图像浏览器为例,分IHE模型分析、集成需求分析、集成功能设计三个步骤对现有系统进行IHE集成功能的扩展设计。该方法在对IHE模型进行分析的基础上,首先分析系统在IHE技术框架中所对应的角色、集成模型,事务、数据项和集成功能,并遵循模块化的思想对现有系统进行扩展设计。它可在不改变原有系统功能的基础上,快速进行IHE集成功能的升级扩展。基于该设计方法在范例系统上的实践经验可为其它系统的IHE集成功能设计提供参考。     

基因调控数据自动处理系统的设计及实现

随着人类基因组测序工作的完成，产生了大量的生物数据，这些数据以不同的形式分布在世界各地。为使基因调控和表达信息相关联，建立了基因调控信息集成数据库系统。由于数据来源分布广泛且数据格式不统一，影响了数据库的数据集成。此研究使用了网络智能代理的相关技术，自动下载Web数据，并且进行处理，从中提取出启动子、调控因子、结合位点等有效数据。本程序大大减轻了将网络数据集成到本地数据库的负担。     

Building an inter-organizational communication network and challenges for preserving interoperability

Background

The ideal scenario for information technology to bridge information gaps between primary and secondary healthcare and to improve the quality of healthcare in the medication process is to build an interoperable communication network. This type of undertaking requires diverse information systems to be integrated, and central to this are the preservation of data integrity and the integration of different pieces of patient data.

Objectives and methodology

In this study, we focused on sources of challenges to the integration process and to the building of an interoperable communication network. Interviews, document analysis, and observations were conducted to evaluate the integration process in a project that involved medication data communication between primary healthcare providers (i.e., general practitioners and community pharmacists) and secondary healthcare providers (i.e., hospital pharmacists and specialist physicians).

Results

The project encountered numerous integration problems, many of which persisted even after extensive technical intervention. An analysis of the problems revealed that they were mostly rooted either in problematic integration of work processes or in the way the system was used. Despite the project's ideal technical condition, the integration could be accomplished only by applying human interfaces.

Conclusion

The main challenge to building interoperable communication network does not lie in technical integration. The real problem occurs when the technical linkage is implemented without the work processes being aligned and integrated.