医院数据库系统的性能分析及优化经验

随着计算机技术的发展和应用,医院信息系统已经成为现代化医院运营中必不可少的基础设施和技术支撑环境,特别是近年来医院信息化建设发展步伐较快,许多医院都建立了数据库系统。但随着信息化程度的深入,都会遇到像业务应用以及使用用户越来越多,数据量不断增大,数据库查询速度、数据处理速度下降,系统稳定性能降低,数据库故障从而造成停止服务等问题。因此有效的数据库监控以及数据库性能分析成了关键步骤。本文将以目前主流的数据库系统软件SQL Server为例,结合数据库维护的经验来讨论如何监控影响数据库性能的方法,及如何优化数据库系统应用HIS、LIS、PACS、CIS的一些做法进行论述。     

从Oracle体系结构方面对医院信息系统进行优化

医院信息系统（HIS）数据库，数据进行插入更新／删除操作频繁，数据繁杂庞大，吞吐量高，且要求高效，及时，准确地处理数据。如何提高数据库的吞吐量，减少用户等待时间具有重大意义，这就涉及到对用户的数据库的性能进行优化设计的问题。     

医院信息系统的数据管理

本就目前医院信息系统应用中如何保障数据库的可用性和性能，提出了在数据管理中可以采用的方案，其中包括：过期数据处理，历史数据库服务器的建立与维护，分布式数据的实现，通过对出现的问题和应当实现的目标，进行了详尽的讨论，同时，给出了概要的解决方案。     

利用数据库分布技术改善HIS的应用性能

由于医院信息系统的应用及用户不断增加,导致HIS核心数据库服务器不堪重负,严重影响整个系统的运行性能。本文介绍了解放军总医院如何利用现有设备,采用数据库的分布技术,将医院数据的存储与处理从单一的服务器划分到多个服务器,使系统资源得到合理使用,简便有效地解决了困扰HIS应用的性能问题。     

利用Oracle索引提高"军卫一号"的运行性能

数据库性能的好坏直接影响医院信息系统的正常运转。通过对ORACLE索引的系统研究．从索引设置及使用等方面阐明了如何正确地使用索引，以提高数据库性能。     

"军卫一号"备用数据库的创建和维护

在数据库管理中，数据备份是保证系统安全的一项重要措施。备用数据库是Oracle数据库为数据库备份与恢复提供的一种失败切换技术，是Oracle数据库有效容错和灾难防护的方法，可用来进行数据灾难恢复。介绍了如何针对“军卫一号”数据库，创建和维护备用数据库，并就可能出现的问题给出实际解决方案。     

“军卫一号”数据库8i至11g升级实践

目的：完成＂军卫一号＂系统Oracle数据库由8i到11g的版本升级,从而有效提高数据库的服务性能。方法：利用Oracle提供的导出、导入工具,升级涉及软、硬件的选择、客户端程序测试、数据库参数设置等众多问题。结果：以一次数据库升级实践为例,对升级过程中可能遇到的问题进行了较详细讨论。结论：数据库升级后整体运行性能表现极佳,达到了预期目的。     

用ASP技术实现国际疾病编码（ICD10）网络查询系统

目的：用微软的ASP技术来开发Web数据库应用程序,增强网络数据库在医疗方面的应用。方法：对ASP技术作了简单的说明,并就如何利用ASP连接数据库给出了具体的使用方法。结果：解决了医院和疗养院查询新版ICD10疾病编码的问题,保证了医务人员录入疾病编码的正确性。结论：普及了医务人员利用计算机开发Web数据库的程序和方法．提高了医务人员的工作效率。     

军字一号数据库索引的应用与维护探讨

军字一号医院信息系统是一个典型的数据库应用系统,其中使用了大量的索引对象,如何正确地使用和维护,关系到整个系统的性能.本文首先介绍了索引的作用及其优缺点,同时根据Oracle数据库的特点,提出了应用中建立索引应当掌握的原则,并针对应用中索引使用可能存在的问题,结合实际例句,阐述了如何合理使用索引,最后还根据军字一号的应用,简要介绍了索引的维护管理方案.     

医院信息系统数据库的性能优化和故障维修

本文分析了医院信息系统的主要功能和地位,以及制约信息系统核心——数据库正确运行的主要因素;探讨了如何维护数据库并提升其运行性能;给出了数据库备份与故障恢复的一般方法。这些策略的综合使用。使医院信息系统运行地更加安全可靠。     

Issues in the accessibility and confidentiality of patient records

Traditional understandings of confidentiality are no longer sufficient to deal with the privacy issues raised by a modern health care system. Patient data are increasingly kept by large and relatively faceless institutions. Disclosure of health information is not an exception, but a matter of daily routine, not only for uses within the health care system itself, but also for various social purposes. This paper highlights a number of issues, related to these structural changes. A distinction is made between four main problem areas: basic issues, collection and keeping of data, patient access to records, disclosure of individually identifiable data. Under each heading, four issues are discussed.     

Implementing computer information systems for hospital-based case management

Like all health care services, case management is a process that relies on information. Based on the experiences in implementing computer information systems in six hospital-based case management programs, several financial, technical, and management issues are reviewed. These issues, which are also relevant for other specialized hospital-based programs, include information priorities, user acceptance, quantifying data, data entry methods, data security, and systems integration. The lessons learned regarding these issues are discussed, and categories of software alternatives are presented.     

The conducting and reporting of rural health research: rurality and rural population issues

Rurality and rural population issues require consideration when conducting and reporting on rural health research. A first article focused on the planning stage of the research. The objective of this article is to explore conducting and reporting issues that require attention when undertaking rural health research. The privacy of participants, the collection of data, the cultural traditions of Indigenous communities, the dissemination of results, and giving something back to the community, are all aspects of conducting and reporting rural health research that require attention. Procedures such as identifying the characteristics of the population, attention to safety issues when collecting data, the use of local liaison persons and acknowledging the ownership of intellectual property, increase the quality of the research outcomes. They are issues that are relevant to both qualitative and quantitative research methods. Procedures are available to address issues of particular concern in developing appropriate methods for rural health research. While we have concentrated on Australian issues, and possible solutions, rural localities in many other countries may face similar issues. In any rural setting, paying attention to issues that may affect the conducting and reporting of rural health research will hopefully result in studies that support the continued improvement of health in rural communities.     

Best Practice Recommendations for Electronic Patient-Reported Outcome Dataset Structure and Standardization to Support Drug Development

The electronic patient-reported outcome (ePRO) Dataset Structure and Standardization Project is a multistakeholder initiative formed by Critical Path Institute’s PRO Consortium and Electronic Clinical Outcome Assessment (eCOA) Consortium to address issues related to ePRO dataset structure and standardization and to provide best practice recommendations for clinical trial sponsors and eCOA providers. Given the many benefits of utilizing electronic modes to capture PRO data, clinical trials are increasingly using these methods, yet there are challenges to using data generated by eCOA systems. Clinical Data Interchange Standards Consortium (CDISC) standards are used in clinical trials to ensure consistency in data collection, tabulation, and analysis and to facilitate regulatory submission. Currently, ePRO data are not required to follow a standard model, and the data models used often vary by eCOA provider and sponsor. This lack of consistency creates risks for programming and analysis and difficulties for analytics functions generating the required analysis and submission datasets. There is a disconnect between data standards used for study data submission and those used for data collection via case report forms and ePRO forms, which would be mitigated through the application of CDISC standards for ePRO data capture and transfer. The project was formed to collate and examine the issues arising from the lack of adoption of standardized approaches and this paper details recommendations to address those issues.Recommendations to address issues with ePRO dataset structure and standardization include adopting CDISC standards in the ePRO data platform, timely involvement of key stakeholders, ensuring ePRO controls are implemented, addressing issues of missing data early in development, ensuring quality control and validation of ePRO datasets, and use of read-only datasets.     

Discrete choice experiments in health economics

One method that is increasingly being used in health economics to elicit stated preferences concerning health matters is the discrete choice experiment (DCE). This editorial explores four sets of issues facing researchers who wish to employ DCE techniques: (a) normative issues about how data from DCE studies might be used to inform policy, (b) psychological issues concerning the meaningfulness of the data generated, (d) technical issues relating to how the data are generated and (d) issues relating to the generalisability of the data from DCE studies. Given current uncertainties surrounding these issues, it is our view that more caution and greater circumspection towards DCE is appropriate at this stage.     

The making and adoption of health data standards

Health data standards are key to the U.S. quest to create an aggregated, patient-centric electronic health record; to build regional health information networks; to interchange data among independent sites involved in a person's care; to create a population database for health surveillance and for bioterrorism defense; and to create a personal health record. This paper discusses why health data standards are required, the process of creating those standards, the groups creating those standards, and some of the problems and issues that are affecting the progress and acceptance of standards. It makes a recommendation for dealing with those issues.     

Public information on private practice: the availability of physician inpatient data

Despite increased interest in information describing physicians and their hospitalized patients, little attention has been given to the availability of these data and the related policy issues. We surveyed the 20 states with a publicly mandated data system based on hospital discharge abstracts that included physician information. States vary considerably in their orientation toward the public availability of the information and in the ability to personally identify physicians from the data. Potential benefits and problems in using the information for health services research, in improving the quality of care, and in analyzing practice patterns are reviewed. The policy issues associated with the collection and use of publicly available data on physicians and their hospitalized patients are discussed.     

The effect of information systems architecture on health care data quality

A rapidly increasing number of health care provider institutions is dealing with data architecture design issues that directly affect the quality of data within their heterogeneous information systems. These problems result from a failure to recognize that they are actually managing a loosely distributed yet integrated database among their many information system platforms. Understanding the issues surrounding data integration, the application available interface standards, and the tools available for implementation is critical to operating a successful distributed health care information systems environment today.     

ISSUES IN AN INTERNET SURVEY AMONG MIDLIFE ASIAN WOMEN

Because a limited amount of women's health research using Internet-based data collection methods has been done, very little is known about the methodological and ethical issues that are unique to this emerging research practice. The purpose of this article is to inform the future directions of Internet usage in women's health research based on the practical issues raised in an Internet survey of 62 midlife Asian women in the United States. The issues include (a) potential selection biases, (b) ethical concerns, (c) a low response rate, (d) frequent consultations, and (e) potential data entry errors. Based on the discussion of the issues, future directions for Internet research are proposed.     

Issues in an Internet survey among midlife Asian women

Because a limited amount of women's health research using Internet-based data collection methods has been done, very little is known about the methodological and ethical issues that are unique to this emerging research practice. The purpose of this article is to inform the future directions of Internet usage in women's health research based on the practical issues raised in an Internet survey of 62 midlife Asian women in the United States. The issues include (a) potential selection biases, (b) ethical concerns, (c) a low response rate, (d) frequent consultations, and (e) potential data entry errors. Based on the discussion of the issues, future directions for Internet research are proposed.