应用IHE XDS技术建立患者电子健康档案系统实践

目的:探索IHE XDS技术在医院临床信息系统中的应用方式,开发临床电子病历集成应用系统.方法:应用IHE XDS技术框架,制订医院临床电子病历集成方案.结果:开发的系统由临床数据采集、注册数据库、临床文档数据库、电子病历应用服务器以及外部接口服务器等部分组成,经临床应用及相关测试,系统能满足患者的临床文档集成与访问要求.结论:IHE XDS不仅可以应用于医院闻的临床信息共享访问,也适用于医院内部不同临床信息系统的集成,基于IHE XDS的临床信息电子病历集成是医院内部不同临床信息系统集成的一种较好的选择.     

基于标准化信息集成的新一代移动护理系统技术实现与应用分析

目的探索新一代移动护理信息解决方案,解决移动护理信息系统技术架构、数据集成以及护理文档元数据实时采集及信息共享互联互通等问题,并对新一代移动护理软件应用进行分析。方法建立临床信息异构系统智能化接口,使用HL7数据交换标准实现不同系统消息通信,建立了临床数据核心数据库,实现护理文档元数据采集。结果应用了移动护理信息系统,实现了护理数据的自动采集,扩展了医院临床信息系统应用广度。讨论实现病人临床信息互联共享,护理文档的标准化以及标准化信息集成是移动护理信息化的重要保障,临床信息集成技术对移动医疗应用有重要影响。     

大型医院临床信息系统建设实践

回顾与总结医院信息化建设中临床信息系统建设实践，对HIS核心系统与放射信息系统（RIS）、图像归档与通信系统（PACS）、临床实验室系梳（LIS）及药学信息系统的无缝集成进行了全面研究。建立了临床医生工作站，能以电子病历方式访问和获取病人各种图像和文本信息，该系统基于医学数据图像通信标准DICOM和HL7数据交换标准进行数据集成。     

基于XML的电子病历存储管理系统的实现

医疗数据的充分共享是医院数字化的基本要求,但目前各个医院临床管理系统的异构性,给医疗数据的共享带来了很大的障碍.为了实现医院之间信息系统的交互和数据共享,本文采用 XML技术来定义电子病历结构,实现分布异构系统之间临床信息集成,设计并实现了电子病历存储管理系统,将病人的病历信息整合成一个以＂病人为中心＂的 XML文档,并将其存入关系数据库中以利于管理,从而实现了病历信息的归档.     

基于IHE的移动医疗信息集成研究

移动医疗服务是基于移动计算的模式,在网络和医疗信息系统基础上产生的一种新型医疗服务模式。移动医生工作站是移动医疗服务平台的一个重要系统,需要与HIS、LIS、PACS等其他医疗信息系统进行数据交换与共享,但是这些系统可能基于异构的数据库平台、操作系统平台,也可能用不同的语言开发,所以在这些系统之间存在"信息孤岛"。现有的医疗信息集成标准不能适应这些系统之间的信息集成。本文首先分析了移动医生工作站与LIS、PACS的数据交换过程;其次,介绍了IHE技术框架,分析了基于IHE PIX的病人身份识别过程;最后,分析了基于IHE PIX和XDS临床文档信息共享的过程。基于IHE PIX和XDS集成框架的移动医疗信息集成方法不仅可以跨不同的临床信息域,而且可以跨不同的医疗机构解决异构的医疗系统集成问题,对提高医疗服务效率和质量都有重要意义。     

移动医生工作站的设计与实现

目的：设计并实现移动医生工作站,提高医疗服务的质量和效率。方法：该系统通过无线局域网访问医院的数据库服务器,获取临床医疗数据,采用面向服务的体系结构（service-oriented architecture,SOA）和Web服务技术使分散的异构医疗数据能够通过iPad集中访问。结果：在临床环境中,医生能够在患者床旁使用iPad临床信息系统随时随地地查看患者的医疗信息。结论：该系统能够优化临床医生的工作流程,减少医疗差错的发生,提高医疗服务的质量和效率。     

基于HL7的LIS与HIS集成改造

本文介绍了我院的实验室信息系统（LIS）与医院信息系统（HIS）的集成改造过程。此次集成改造采用HL7引擎的中间件进行异构系统之间的集成,即在数据共享双方各增加一个应用服务器,安装服务组件,实现数据存取、数据加工、TCP通信和HL7通信等功能。此次集成方式与以往的中间库模式集成相比,大大提高了系统的规范性和独立性。基于HL7引擎这一中间件的异构系统之间的集成,必将成为今后的发展趋势。     

重症监护临床信息系统的应用

介绍了重症监护临床信息系统的内容、特点、流程及与医院信息系统（HIS）的集成，通过该系统在我院重症监护病房（ICU）的应用，实现了重症监护过程的规范化和数字化管理，使医疗信息、重症监护信息充分共享，收到了很好的效果。     

基于医院信息平台患者主索引的建立与应用

目的研究基于医院信息平台的患者主索引的建设方法,从而实现应用系统间患者信息共享。方法应用IHEPIX和PDQ的集成规范,在集成平台上建设患者主索引服务端,并对相关应用系统的患者登记环节进行改造。结果实现了交叉索引信息生成及共享查询,为临床文档交换与共享奠定基础。结论结合医院实际建成的患者主索引注册和查询机制可以满足医院患者信息共享的需求。     

大型三甲医院健康体检信息系统集成设计与应用

目的:设计健康体检信息系统,将体检中心所有检查设备有效的连接到一起,保证体检中心一体化输出体检报告,实现体检中心信息化集成。方法:梳理大型三甲医院不同检查系统及设备与体检系统集成设计与实现,分析集成方案的严谨性和设备接口方式;利用集成平台HL7 v3标准接口、虚拟打印技术及仪器通讯接口技术等集成方法实现各类检查系统、设备与体检系统的集成。结果:通过建立健康体检信息系统,突破了体检信息系统与遗留信息系统和单机版工作站软件的集成障碍,实现了检查设备数据自动采集,医院各异构信息系统之间达到了无缝连接及信息共享,从整体上提高了医院健康体检工作的效率和质量。结论:健康体检系统与医院的检查系统及设备仪器之间集成的实现,使各系统间互联更加标准化,降低了异构系统间集成的复杂程度,达到资源的效益最大化。     

The quest for the Holy Grail of systems

Software agents like Edify can be used to retrieve (and store) information from most online systems, without having to access each system's database. These techniques allow information integration (display) into Windows applications or in new reference and information retrieval applications or Web pages. These techniques can be used to bridge the gap until the Holy Grail of systems is built (and works).     

Factors influencing consumer adoption of USB-based Personal Health Records in Taiwan

ABSTRACT: BACKGROUND: Usually patients receive healthcare services from multiple hospitals, and consequently their healthcare data are dispersed over many facilities' paper and electronic-based record systems. Therefore, many countries have encouraged the research on data interoperability, access, and patient authorization. This study is an important part of a national project to build an information exchange environment for cross-hospital digital medical records carried out by the Department of Health (DOH) of Taiwan in May 2008. The key objective of the core project is to set up a portable data exchange environment in order to enable people to maintain and own their essential health information.This study is aimed at exploring the factors influencing behavior and adoption of USB-based Personal Health Records (PHR) in Taiwan. METHODS: Quota sampling was used, and structured questionnaires were distributed to the outpatient department at ten medical centers which participated in the DOH project to establish the information exchange environment across hospitals. A total of 3000 questionnaires were distributed and 1549 responses were collected, out of those 1465 were valid, accumulating the response rate to 48.83%. RESULTS: 1025 out of 1465 respondents had expressed their willingness to apply for the USB-PHR. Detailed analysis of the data reflected that there was a remarkable difference in the "usage intention" between the PHR adopters and non-adopters (chi2 =182.4, p < 0.001). From the result of multivariate logistic regression analyses, we found the key factors affecting patients' adoption pattern were Usage Intention (OR, 9.43, 95%C.I., 5.87-15.16), Perceived Usefulness (OR, 1.60; 95%C.I., 1.11-2.29) and Subjective Norm (OR, 1.47; 95%C.I., 1.21-1.78). CONCLUSIONS: Higher Usage Intentions, Perceived Usefulness and Subjective Norm of patients were found to be the key factors influencing PHR adoption. Thus, we suggest that government and hospitals should promote the potential usefulness of PHR, and physicians should encourage patients' to adopt the PHR.     

Problems regarding the integration of medical images into the total hospital information system

Since 1989, the integration of medical images into the total hospital information system (HIS) has been investigated and developed at Kochi Medical School. The basic concept of the integration is that, in the same way they can view text based data, doctors can retrieve and view images using the PC terminals of the total HIS. The possibility of utilizing the PC terminals of the total HIS as image viewing stations was investigated. A test run was performed in the period from October 1995 to July 1997. The test run revealed that fast image access is crucial in order for the system to be useful for doctors. After making various improvements, the final system became well used in the clinical practice. However, in order to progress to the film-less stage, the final system still has three problems that must be solved: quality of the image display, operation of multi-exams, and quality assurance of the digital image.     

Telematic integration of health data: a practicable contribution

The patients' clinical and healthcare data should virtually be available everywhere, both to provide a more efficient and effective medical approach to their pathologies, as well as to make public healthcare decision makers able to verify the efficacy and efficiency of the adopted healthcare processes. Unfortunately, customised solutions adopted by many local Health Information Systems in Italy make it difficult to share the stored data outside their own environment. In the last years, worldwide initiatives have aimed to overcome such sharing limitation. An important issue during the passage towards standardised, integrated information systems is the possible loss of previously collected data. The herein presented project realises a suitable architecture able to guarantee reliable, automatic, user-transparent storing and retrieval of information from both modern and legacy systems. The technical and management solutions provided by the project avoid data loss and overlapping, and allow data integration and organisation suitable for data-mining and data-warehousing analysis.     

Physicians’ Perceptions of Integration in Three Western Canada Health Regions

Over the past decade, provincial governments have embarked on ambitious plans to better integrate their healthcare systems, through the introduction of regional governance and management structures. The objective of this study was to examine physicians’ perceptions of the current level and facilitators/barriers to integration in three Western Canada Health Regions. Three approaches to integration were investigated: functional, clinical services, and physician system integration. Physicians perceived that functional integration within each region was questionable. Clinical services were the least integrated approach. Physician system integration was rated highest of the approaches, particularly adherence to clinical practice guidelines usage. Physicians’ perspectives of integrated health delivery systems do not appear to be influenced by regional size, maturity, urbanicity or facilities. Facilitators of integration were communication among health professionals and service providers, and using a multi-disciplinary team approach in delivery of healthcare in both regions. Barriers to integration were organizational culture, access to specialists and clinical services, and health information records. On a scale of 1-5, all three regions are at the beginning of an integrated health delivery system. Three global suggestions were provided to further integration of health delivery services: physicians should be involved in decision-making process at the Board level, clinical services should be patient-centred, and physicians endorsed the use of multi-disciplinary teams.     

The Internet as a Resource for Consumer Healthcare

With emerging access to the Internet and valuable healthcare resources online, healthcare consumers have quickly adopted the World Wide Web as a resource for healthcare information. Because growing numbers of consumers are accessing healthcare information online, it is important to explore how they are using this information in healthcare decision-making, and the eventual outcomes for their health.All English-language articles indexed in Medline related to the use of Internet technology in healthcare education, and published in peer-reviewed journals between 1998 and 2000, were screened for review. 37 studies met the eligibility criteria. Although demographics remain uneven, with a distinct Internet access gap existing between the economically advantaged and disadvantaged, results of studies described in this paper support the effectiveness of Internet-delivered healthcare information in changing clinical outcomes. Electronic mail and telehealth applications hold promise as a new mode of communication and information transfer for patients and providers, while at the same time raising issues related to inaccurate and misleading information.The findings of this review support Internet-delivered technologies as an effective strategy for the transfer of data and knowledge as well as support for the patient-provider interaction. From the patient’s perspective, the Internet provides information, a new mode of connection to the healthcare environment, and access to virtual support groups. Additional research is needed to assess the impact and best approaches for use of the Internet as a link to the clinical environment for communication and sharing of patient-centered clinical information.     

Patients' awareness of their rights in a developing country

AIM: To determine the awareness of a regulation on patients' rights passed in 1998 in Turkey. METHODS: All hospitalized patients in the internal medicine and general surgery wards in three large hospitals during the study period were eligible for the study, which was performed in 2001 in the Denizli province, Turkey. The study group consisted of 166 patients. Data were collected during face-to-face interviews using a questionnaire. RESULTS: Only 9% of patients were aware of the regulation about patients' rights. Most patients were given equal access to health care (91%), benefitted from the capabilities of their selected healthcare institutions (86.7%), and their privacy was protected (86.1%). Those patients who stated that they had not received care in accordance with their rights identified the shortcomings as not receiving written (95.2%) or verbal (53%) information from healthcare professionals, and the failure of healthcare personnel to introduce themselves (75.3%). On most occasions, the patients stated that they were not able to request services as stated in the PRR from healthcare professionals. CONCLUSION: Few patients knew about the regulation on patients' rights, indicating a need for extensive education of patients and healthcare professionals.     

The impact of the pervasive information age on healthcare organizations

New information technologies place data on integrated information systems, and provide access via pervasive computing technologies. Pervasive computing puts computing power in the hands of all employees, available wherever it is needed. Integrated systems offer seamless data and process integration over diverse information systems. In this paper we look at the impact of these technologies on healthcare organizations in the future.     

Advancing the state of data integration in healthcare

There is growing consensus that clinical information systems will provide the bridge to advancing the integration of information systems in healthcare. In spite of developments in technology that have enabled some organizations to integrate clinical information with care delivery in ways that can promote safer, more efficient patient care, the majority of healthcare has yet to achieve this goal. Why aren't we there yet?     

The devil you know: parents seeking information online for paediatric cancer

There is a growing interest in understanding the effect that online information-seeking has on patients' experiences, empowerment and interactions with healthcare providers. This mixed-methods study combines surveys and in-depth interviews with 41 parents of paediatric cancer patients in the USA to examine how parents think about, evaluate, access and use the internet to seek information related to their child's cancer. We find that, during the acute crisis of a child being diagnosed with cancer, parents preferred to receive information related to their child's diagnosis, prognosis and treatment options from a trusted healthcare provider rather than through the internet. We find that access to medically related cancer information through the internet was deemed to be untrustworthy and frightening. Parents' reasons for avoiding online information-seeking included fear of what they might find out, uncertainty about the accuracy of information online, being overloaded by the volume of information online and having been told not to go online by oncologists. Some parents also had logistical barriers to accessing the internet. While most parents did not turn to the internet as a source of health-related information, many did use it to connect with sources of social support throughout their child's illness.