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。     

基于HL7标准的居民健康档案研究

目的随着医疗信息化的不断深入,医院内以及区域医疗信息共享已成为全球医疗卫生信息化的发展趋势。为临床医学科研提供更为准确和高效的信息检索与分析功能,是居民健康档案未来的发展方向。方法本文基于HL7（Health Level7）标准及可扩展标记语言（extensible markup language,XML）技术,在介绍居民健康档案功能和特点基础上,分析了健康档案的数据模型设计和实现方案,包括数据存储模式、XML存储方式选型、数据库选型等。结果通过运用XML技术和HL7标准的数据转换,可实现医院内部多个系统的无缝集成。结论在实际应用中,基于HL7标准的居民健康档案可以较好地保证数字化医疗信息的完整性、一致性,实现医疗信息共享。     

IHE中文互操作问题解决方案

IHE提供了一整套用于解决医疗信息系统间互操作问题的解决方案,且通过IHE测试活动验证厂商的系统是否正确实现IHE技术框架.经IHE测试实践发现,多个厂商的医疗信息系统间基于中文的互操作存在一定困难.本文通过分析IHE所依赖的DICOM和HL7两项标准中的相关要求,发现二者对中文编码字符集的规定不一致,而IHE技术框架中又没有相关的补充规定, 这是导致中文互操作存在问题的主要原因;再通过对比DICOM与HL7的中文字符编码规定,建议采用两个标准均支持的编码字符集GB 18030-2000和 ISO-IR-192作为IHE的中文编码字符集,并将其作为中文本地化扩展增补入IHE技术框架.     

微生物鉴定分析系统基于IHE LBL的集成研究

基于医学信息标准化集成架构,实现系统互联与数据采集,并生成规范的微生物检测标本标签。运用IHE LBL技术框架设计并实现微生物鉴定系统与客户端组成的集成平台。结合Windows Socket消息机制,使标签信息以HL7消息的形式进行流转,实现标签信息采集,最终生成QR Code通用标签。完成了IHE LBL集成模式中各角色和事务的通讯,以及HL7消息的构造与解析、QR Code标签的构造,并对HL7消息进行了验证。通过系统集成获取到的标签信息有更高的准确性和安全性,并可提高微生物实验室的工作效率,方便标本标签的管理,有助于微生物实验室实现信息化、区域化集成与共享。     

LIS与HIS集成研究

医院业务的发展要求能实现信息系统的集成.我们分析了医疗信息系统互联的不同方式,提出一种集成现有实验室信息系统(LIS)与医院信息系统(HIS)的方案.它使用多层分布式技术改进客户机/服务器应用模式,参考IHE(Integrating the Healthcare Enterprise)实验室技术框架(LAB-TF)确定参与工作流程集成的功能单元和事务,并采用Health Level 7(HL7)医疗信息交换标准实现信息交互.可保留原有的大部分处理,避免系统整合带来安全性、可维护性和实时性问题,保护了原有的投入,避免重建系统所带来的风险.     

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。     

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。     

基于程序生成技术的医疗仪器通信协议转换研究

医疗仪器的信息集成已经成为医疗信息化的重要组成部分。为了解决非影像类医疗仪器信息接口不统一、数据信息集成困难等问题,本研究设计并实现了基于程序生成技术的医疗仪器通信协议转换技术,根据用户的配置,通过程序生成技术生成与特定设备相匹配的协议转换程序,将设备私有数据帧格式转换到标准的HL7 ORU^R01消息,具有良好的通用性。本研究为医疗仪器提供统一的HL7标准接口,使其能与医疗信息系统实现无缝对接,降低医学信息集成的难度,具有良好的应用前景。     

医疗信息交换标准——HL7

随着HIS/RIS系统在国内大中城市医院的普及，对医疗电子数据交换标准HL7的研究越来越重要。本文介绍了HL7的发展历史、发展目标和基本概念，讨论了HL7的应用及自动实现技术。最后，对HL7标准存在的问题及在国内应用HL7所面临的困难进行了分析，并提出了克服这些困难的一些有益的建议。     

A Reliable,Low-Cost Picture Archiving and Communications System for Small and Medium Veterinary Practices Built Using Open-Source Technology

Picture Archiving and Communications Systems (PACS) are the most needed system in a modern hospital. As an integral part of the Digital Imaging and Communications in Medicine (DICOM) standard, they are charged with the responsibility for secure storage and accessibility of the diagnostic imaging data. These machines need to offer high performance, stability, and security while proving reliable and ergonomic in the day-to-day and long-term storage and retrieval of the data they safeguard. This paper reports the experience of the authors in developing and installing a compact and low-cost solution based on open-source technologies in the Veterinary Teaching Hospital for the University of Torino, Italy, during the course of the summer of 2012. The PACS server was built on low-cost x86-based hardware and uses an open source operating system derived from Oracle OpenSolaris (Oracle Corporation, Redwood City, CA, USA) to host the DCM4CHEE PACS DICOM server (DCM4CHEE, http://www.dcm4che.org). This solution features very high data security and an ergonomic interface to provide easy access to a large amount of imaging data. The system has been in active use for almost 2 years now and has proven to be a scalable, cost-effective solution for practices ranging from small to very large, where the use of different hardware combinations allows scaling to the different deployments, while the use of paravirtualization allows increased security and easy migrations and upgrades.     

Translating the IHE Teaching File and Clinical Trial Export (TCE) Profile Document Templates into Functional DICOM Structured Report Objects

The Integrating the Healthcare Enterprise (IHE) Teaching File and Clinical Trial Export (TCE) integration profile describes a standard workflow for exporting key images from an image manager/archive to a teaching file, clinical trial, or electronic publication application. Two specific digital imaging and communication in medicine (DICOM) structured reports (SR) reference the key images and contain associated case information. This paper presents step-by-step instructions for translating the TCE document templates into functional and complete DICOM SR objects. Others will benefit from these instructions in developing TCE compliant applications.     

Evaluation of Free,Open-source,Web-based DICOM Viewers for the Indian National Telemedicine Service (eSanjeevani)

The Digital Image and Communications in Medicine (DICOM) viewer is a very useful component in telemedicine applications. Owing to increased demand, adoption, and prospects of browser-based software in the recent past, web-based DICOM viewers have gained significant ground. There are myriad web-based DICOM viewers which are open source and are available free of cost as stand-alone applications. These freely available tools have rich functionality like the commercial ones. To find an optimal DICOM viewer for integration with a web-based telemedicine solution is quite a challenge, and no research has gone into assessing these freely available DICOM viewers. This research assessed a range of web-based, open-source, and freely available DICOM viewers from the perspective of their integration with the Indian National Telemedicine Solution (eSanjeevani). To introduce teleradiology module in eSanjeevani, a study is carried out to enable viewing of radiological images through DICOM viewer. eSanjeevani is being prepared for a national roll-out at 155,000 health and wellness centers across rural India by the Ministry of Health and Family Welfare (Government of India) under the Ayushman Bharat Scheme (the world’s largest health insurance scheme). In total, 13 free, open-source, and web-based DICOM viewers were identified for evaluation; however, only six were shortlisted as assessed. This study can serve as a one-stop source for researchers looking for a suitable DICOM viewer for their healthcare IT applications.     

Trends of utilization of information technologies in clinical laboratory and pathology domain

The life expectancy of the Japanese population is one of longest in the world. Society is aging, with fewer children, increasing the total national medical payment in Japan. This situation has forced the Government to reduce the payment and to increase the efficiency of the medical system, so information technologies are expected to contribute to these policies. Electronic patient record systems (EPR) were expected to be used widely, but only 23% of clinical training hospitals have implemented them. This is mainly due to the lack of incentives and large costs to install EPR. Standardization is a good method to reduce system construction cost and increase its quality. New global IHE activities are expected to solve these problems with methodologies of workflow analyses, standard applications, tests and demonstrations. Laboratory information systems (LIS) have a long history and tradition of standard interfaces for connecting computers with analyzers. IHE activities for LIS are providing easy and secure connections with hospital information systems (HIS). Pathology departments also have their own information systems. IHE activities for pathology were launched in 2005, and we are now developing in collaboration with the international IHE pathology working group, HL7 SIG pathology and DICOM WG-26. Pathologists and technical experts in Japanese laboratories are encouraged to join IHE activities to ensure good results.     

VirtualPACS—A Federating Gateway to Access Remote Image Data Resources over the Grid

Collaborations in biomedical research and clinical studies require that data, software, and computational resources be shared between geographically distant institutions. In radiology, there is a related issue of sharing remote DICOM data over the Internet. This paper focuses on the problem of federating multiple image data resources such that clients can interact with them as if they are stored in a centralized PACS. We present a toolkit, called VirtualPACS, to support this functionality. Using the toolkit, users can perform standard DICOM operations (query, retrieve, and submit) across distributed image databases. The key features of the toolkit are: (1) VirtualPACS makes it easy to use existing DICOM client applications for data access; (2) it can easily be incorporated into an imaging workflow as a DICOM source; (3) using VirtualPACS, heterogeneous collections of DICOM sources are exposed to clients through a uniform interface and common data model; and (4) DICOM image databases without DICOM messaging can be accessed.

基于DICOM标准的TLS网络安全传输技术研究与实现

随着医疗信息化的发展,图像归档与通信系统(PACS)、医院信息系统/放射科信息系统(HIS/RIS)等医疗信息管理系统日渐普及和完善,这些系统之间的互操作越发频繁,通过网络由一个封闭的系统走向开放,走向区域化成为必然。而信息的传输安全是使之成为可能的前提条件。基于网络安全的必要性,着重研究了医学数字成像与通信(DICOM)标准和安全传输层(TLS)协议,并结合OpenSSL工具包和DCMTK工具包实现了DICOM医疗信息TLS安全传输。     

DICOMweb™: Background and Application of the Web Standard for Medical Imaging

This paper describes why and how DICOM, the standard that has been the basis for medical imaging interoperability around the world for several decades, has been extended into a full web technology-based standard, DICOMweb. At the turn of the century, healthcare embraced information technology, which created new problems and new opportunities for the medical imaging industry; at the same time, web technologies matured and began serving other domains well. This paper describes DICOMweb, how it extended the DICOM standard, and how DICOMweb can be applied to problems facing healthcare applications to address workflow and the changing healthcare climate.     

Benefits of the DICOM Structured Report

Recently, the digital imaging and communications in medicine (DICOM) standard introduced rules for the encoding, transmission, and storage of the imaging diagnostic report. This medical document can be stored and communicated with the images in picture archiving and communication system (PACS). It is a structured document that contains text with links to other data such as images, waveforms, and spatial or temporal coordinates. Its structure, along with its wide use of coded information, enables the semantic understanding of the data that is essential for the Electronic Healthcare Record deployment. In this article, we present DICOM Structured Report (SR) and discuss its benefits. We show how SR enables efficient radiology workflow, improves patient care, optimizes reimbursement, and enhances the radiology ergonomic working conditions. As structured input significantly alters the interpretation process, understanding all its benefits is necessary to support the change. Biography Rita Noumeir is a professor at the Department of Electrical Engineering of the University of Quebec, école de Technologie Superieure in Montreal. A founding member of the Imaging, Vision, and Artificial Intelligence Laboratory (LIVIA), her main research interest is the Healthcare Information Technology, specifically, Interoperability, Electronic Patient Record, Security, Information Confidentiality, and Image Processing. As a member of both Technical and Planning International IHE Radiology Committees, Dr. Noumeir took part over the last 5 years in developing many Integrating the Healthcare Enterprise (IHE) Integration Profiles in Radiology and in organizing several Integration Demonstrations. She is a cofounder of IHE Canada. Dr. Noumeir contributed to many research and development projects in collaboration with several Canadian and international companies in medical imaging and healthcare information. Currently, she collaborates with the Diagnostic Imaging Team of Canada Health Infoway to define the principles and architecture for sharing imaging information between multiple healthcare institutions. She plays a leading role in the development of this solution that is published as an IHE Integration Profile for which she is the editor. Rita Noumeir holds a Ph.D. and a Masters degree in Biomedical Engineering from école Polytechnique of Montreal specializing in Medical Imaging. She is a professional engineer, and a member of the Ordre des ingénieurs du Québec.