基于界面信息提取的IHE XDS-LAB检验报告创建者的设计与实现

目的 使本身不具备检验报告共享能力的大量在用LIS系统,也能实现检验报告的跨机构跨区域共享.方法运用Windows消息机制获取既有LIS的报告单界面信息,将其整合成符合HL7 CDA文档,基于IHE XDS-LAB技术框架的检验报告共享架构实现.结果 设计并实现了基于IHE XDS-LAB检验报告创建者角色的应用程序,并通过了IHE 测试工具的测试.结论 本研究在不改变既有LIS系统的前提下,使其能够拥有基于标准的检验报告共享能力,促进检验报告跨机构跨区域的共享.     

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.     

Quality assurance in anatomic pathology

We are in the midst of major changes in our discipline. New technologies and regulations, are poised to fundamentally change the way that pathologists interact with and utilize data. Nowhere is this more apparent than in the realm of anatomic pathology (AP) quality assurance (QA). QA efforts in the AP laboratory today are often limited by the batched assembly line-like nature of the workflow and data trapped within rigid laboratory information systems (LIS). Middleware with progressive business intelligence platforms have helped close this gap by automatically extracting LIS data, and making it easier to manipulate and combine with data from other information systems. Employing informatics tools such as tracking systems in the AP lab minimizes human involvement in repetitive processes which in turn drives down errors, standardizes processes and drives workflow. Scanning barcodes directly inputs data into the LIS which is available for real-time QA monitoring. The use of synoptic reporting, computerized provider order entry (CPOE), and newer technologies such as whole slide imaging also help improve quality in AP. This article reviews current issues and future trends related to AP initiatives in the preanalytic, analytic, and postanalytic phases of laboratory testing. Special emphasis is placed on new technologies that are poised to disrupt the practice of AP in the near future.     

dcm4che在医疗信息集成中的初步应用

作为临床医学影像和对象管理的开源资源,dcm4che提供了D ICOM标准和HL7标准接口。dcm4che严格遵循IHE规范,是医疗信息集成中理想且强大的开发工具,但目前相关研究较少。本文在介绍IHE规范及医疗信息集成的基础上,介绍了dcm4che开源工具包在医疗信息系统中的功能特性和初步应用,其中包括dcm4che提供的各种接口及功能模块,重点介绍了dcm4che对D ICOM、HL7标准的完美支持,并利用部分应用实例阐述了严格遵循IHE规范的dcm4che开源工具包在医疗信息集成中的可用性、高效性和可移植性。本项工作为将来在医疗信息集成中大规模运用dcm4che提供了研究基础。     

Using the computer to optimize human performance in health care delivery. The pathologist as medical information specialist

The demands for information retrieval, processing, and synthesis placed on all providers of health care have increased dramatically in the last several decades. Although systems have been developed to capture charge-related data in support of cost reimbursement, there has been a conspicuous lack of attention paid to information tools to directly enhance the delivery of patient care. The termination of cost reimbursement, together with an increasing recognition of the problems inherent in current manual record-keeping systems, is creating a significant new focus on medical information. This change in focus requires a shift in systems orientation away from financial and departmentally centered systems and toward patient-centered approaches. There is thus increasing recognition of the need for a physician-level medical information specialist to serve as an institution's chief information officer, assuming responsibility for the collection, manipulation, and availability of all patient care-related data. By virtue of training, typical experience, hospital presence, and a noncompetitive position with the hospital's medical staff, the pathologist is uniquely suited for this position. To effectively perform this role, a variety of new specialized data management tools are becoming available. Integrated information systems, patient care management by exception, decision support tools, and, in the future, "artificial intelligence" assists can all be expected to become staples of pathology practice, especially impacting those pathologists who choose to be responsive to the new practice milieu of medical information science.     

Future outlook for LAS,LIS

In Japan, the application of LAS/LIS was started in some hospitals in the 1970's. Thereafter, these systems rapidly developed, becoming established in new national medical university hospitals in the late 1970's, referring to the system introduced in the central laboratory of each hospital. Currently, the LAS/LIS application system is employed in the central laboratory. In addition, this system provides diagnostic information based on laboratory data, responds to various questions regarding clinical examinations, develops strategies for controlling hospital infection using the infection control system, and provides information on the appropriate use of antimicrobial agents. In the future, this system may become even more useful. In this study, we reviewed the current status and issues of the mutual utilization of medical information among medical institutions to achieve further advances.     

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.     

Development of retrieval system about clinical laboratory handbook "Kensa Koujien"]

Medical knowledge has been increasing and diversifying on a worldwide scale, while specialization of physicians has been extended vigorously. The knowledge has extended beyond the memory of human beings, there by causing the deterioration of service, called "Knowledge crisis". To tackle this problem, the electronic medical textbook(EMT) has been conceived and set up as a medical knowledge base for physician to optimize their specialties and activities in clinical practice. The doctors' diagnostic process is to be mentioned as the solution of backward problem, to speculate problem such as disease by the information observed from symptoms and findings. The EMT is more powerful tool for diagnosis than experiences or textbook that will aid for specifying the name of disease by arranging and combining information. Meanwhile, laboratory information systems are widely introduced. However, there are few systems which allow interpretation of the findings obtained. With this in mind, we have improved the utility of the EMT by enhancing its function with laboratory information follow-up, thesaurus back-up, Japanese language support, and on-line access. It made use of these experiences, we compiled an clinical laboratory handbook "Kensa Koujien", and developed retrieval system.     

二维条形码技术在实验室信息管理系统（LIS）中的应用

目的利用二维条形条码技术,减轻实验室信息管理系统(LIS)瓶颈,提高网络速度,为LIS增加更多功能(例如智能审核,图像传输等)创造良好的条件。方法设计与制作二维条码标签,以Windows2000AdvancedServer或Windows2000Server为服务器操作系统;以有极佳性价比的MicrosoftSQLServer2000数据库;以PowerBuilder8.0为前台开发工具;以Windows2000Professional或WindowsXPRrofesional为客户端操作系统;把客户端联接成网并入LIS服务器,再与医院信息系统(HIS)联接。结果通过DENSO二维条码数据采集器BHT103Q扫描标本容器上的二维条码,直接获得全部病人资料(包括基本资料和检验信息)。最后将测定结果发送回HIS。结论通过使用二维条形码技术,减少LIS数据库的访问量和网络数据流量,从而有效减轻LIS瓶颈,提高了系统速度。为以后完善和丰富LIS的功能创造了良好的条件。     

Changing anatomy education and introduction of self assessment of teacher performance in Japan.

The current curriculum reform is directed toward improvement of students' ability of clinical practice in primary care, and a substantial system of bedside learning is being extensively explored. Introduction of clinical clerkship necessarily forces qualitative changes in the teaching of basic medical sciences. A large number of Japanese medical schools is now attempting to establish a new educational system that makes it possible to change from "didactic education" by lectures and laboratory studies to "self learning education" by means of tutorials and other systems. In this context, Japanese anatomists are urgently requested to develop new and effective clinically oriented educational systems in teaching gross anatomy as a shift from the traditional teaching as a science of morphology. Evaluation of faculty staff's teaching achievement is about to start in many medical schools. Research activities can be evaluated quantitatively. In contrast, measurement of educational activities of faculty staff is very difficult, and all medical schools are devoted to construct effective and liable systems. Anatomy faculty is obliged to devote more time than that of other disciplines in education-related activities such as cadaver collection and associated business. How to evaluate adequately these invisible activities is an issue to be solved before the introduction of a self assessment system. Successful solutions to these issues are critical for production of future anatomists.     

Role of laboratory medicine in medical care--from the point of view of a manager

The Japanese health insurance system has been praised because of the comprehensive coverage of medical costs. The long lifespan of Japanese, the longest in the world, however, because economic conditions are getting worse and medical costs are increasing with the increase of aged people in Japan, the health insurance system is under pressure. The Japanese government is going to start to reduce costs of medical care by applying a system like the DRG/PPS system in the USA, called Diagnosis Procedure Combination(DPC), next year in university hospitals. Under the DPC system, laboratory tests will be non-profit. We have to change the management style of clinical laboratories to cut costs for tests and labor as much as possible, choose tests selectively, respond rapidly to clinical needs, and utilize information technology efficiently for processing of laboratory data. Therefore, corresponding to changes in the medical care system, laboratory medicine has been changing. Commercial clinical laboratories are expanding their pressure in hospitals, and in-hospital laboratories are having a very hard time coping with the pressure. Since laboratory medicine is an essential part of clinical practice, we do not have to be antagonistic.     

Teaching DICOM by Problem Solving

The Digital Imaging and Communications in Medicine (DICOM) is the standard for encoding and communicating medical imaging information. It is used in radiology as well as in many other imaging domains such as ophthalmology, dentistry, and pathology. DICOM information objects are used to encode medical images or information about the images. Their usage outside of the imaging department is increasing, especially with the sharing of medical images within Electronic Health Record systems. However, learning DICOM is long and difficult because it defines and uses many specific abstract concepts that relate to each other. In this paper, we present an approach, based on problem solving, for teaching DICOM as part of a graduate course on healthcare information. The proposed approach allows students with diversified background and no software development experience to grasp a large breadth of knowledge in a very short time.     

Digital imaging and electronic patient records in pathology using an integrated department information system with PACS

Picture archiving and communication systems have been widely used in radiology thus far. Owing to the progress made in digital photo technology, their use in medicine opens up further opportunities. In the field of pathology, digital imaging offers new possiblities for the documentation of macroscopic and microscopic findings. Digital imaging has the advantage that the data is permanently and readily available, independent of conventional archives. In the past, PACS was a separate entity. Meanwhile, however, PACS has been integrated in DIS, the department information system, which was also run separately in former times. The combination of these two systems makes the administration of patient data, findings and images easier. Moreover, thanks to the introduction of special communication standards, a data exchange between different department information systems and hospital information systems (HIS) is possible. This provides the basis for a communication platform in medicine, constituting an electronic patient record (EPR) that permits an interdisciplinary treatment of patients by providing data of findings and images from clinics treating the same patient. As the pathologic diagnosis represents a central and often therapy-determining component, it is of utmost importance to add pathologic diagnoses to the EPR. Furthermore, the pathologist's work is considerably facilitated when he is able to retrieve additional data from the patient file. In this article, we describe our experience gained with the combined PACS and DIS systems recently installed at the Department of Pathology, University of Magdeburg. Moreover, we evaluate the current situation and future prospects for PACS in pathology.     

Analysis of ISO/IEEE 11073 built-in security and its potential IHE-based extensibility

The ISO/IEEE 11073 standard for Personal Health Devices (X73PHD) aims to ensure interoperability between Personal Health Devices and aggregators—e.g. health appliances, routers—in ambulatory setups. The Integrating the Healthcare Enterprise (IHE) initiative promotes the coordinated use of different standards in healthcare systems (e.g. Personal/Electronic Health Records, alert managers, Clinical Decision Support Systems) by defining profiles intended for medical use cases. X73PHD provides a robust syntactic model and a comprehensive terminology, but it places limited emphasis on security and on interoperability with IHE-compliant systems and frameworks. However, the implementation of eHealth/mHealth applications in environments such as health and fitness monitoring, independent living and disease management (i.e. the X73PHD domains) increasingly requires features such as secure connections to mobile aggregators—e.g. smartphones, tablets—, the sharing of devices among different users with privacy, and interoperability with certain IHE-compliant healthcare systems. This work proposes a comprehensive IHE-based X73PHD extension consisting of additive layers adapted to different eHealth/mHealth applications, after having analyzed the features of X73PHD (especially its built-in security), IHE profiles related with these applications and other research works. Both the new features proposed for each layer and the procedures to support them have been carefully chosen to minimize the impact on X73PHD, on its architecture (in terms of delays and overhead) and on its framework. Such implications are thoroughly analyzed in this paper. As a result, an extended model of X73PHD is proposed, preserving its essential features while extending them with added value.     

Advanced tool kits for EPR security

Responding to the challenge for efficient and high quality health care, the shared care paradigm must be established in health. In that context, information systems such as electronic patient records (EPR) have to meet this paradigm supporting communication and interoperation between the health care establishments (HCE) and health professionals (HP) involved. Due to the sensitivity of personal medical information, this co-operation must be provided in a trustworthy way. To enable different views of HCE and HP ranging from management, doctors, nurses up to systems administrators and IT professionals, a set of models for analysis, design and implementation of secure distributed EPR has been developed and introduced. The approach is based on the popular UML methodology and the component paradigm for open, interoperable systems. Easy to use tool kits deal with both application security services and communication security services but also with the security infrastructure needed. Regarding the requirements for distributed multi-user EPRs, modelling and implementation of policy agreements, authorisation and access control are especially considered. Current developments for a security infrastructure in health care based on cryptographic algorithms as health professional cards (HPC), security services employing digital signatures, and health-related TTP services are discussed. CEN and ISO initiatives for health informatics standards in the context of secure and communicable EPR are especially mentioned.     

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。     

Clinical laboratory system in a complete electronic hospital

The use of a Laboratory Information System (LIS) and Laboratory Automation System (LAS) are clearly superior to manual results in terms of completeness and legibility. As the current clinical information system (CIS) in Gifu University Hospital consists of a complete electronic medical record system, the clinical laboratory was re-engineered to simplify workflow, pay attention to quality assurance, and decrease various costs by an intelligent laboratory management system. We named the new system Gifu Premiotic Intelligent Laboratory System (GPILS). Further advances will concentrate on the cost-effective use of LIS, and the potential use of GPILS in our laboratories will be discussed. In addition, because one of our clinical laboratories currently provides various useful clinical laboratory-oriented information to physicians and patients, we have developed new tools named the "Reference Data Base (RefDB)". In the near future, several different types of computer technology for various clinical laboratory information will lead to the development of highly specific platforms for LIS corresponding to a complete electronic medical record system.     

Development of laboratory information system--quality standards

The aim of the study was to determine structural modules of laboratory information system (LIS) for the application of new biomedical and information technologies by utilizing current organizational trends. The method used included definition of structural modules according to significant LIS properties, e.g., a large number of data, automation of analyses and rapid exchange of information, and according to the process of information establishment the collection, organization, selection, synthesis and distribution. Thus, outdated distributed software at the Clinical Institute of Laboratory Diagnosis has now been replaced by modular organization. Modules have been developed for the following: data input, online operation of laboratory instruments, preparation of results, compilation of medical documentation on quality assurance based on the application of quality standards, management of finances, and for point of care testing. The method of re-engineering as well as adherence to EN and ISO quality standards were utilized in planning the development of LIS based on the application of new information technologies and in shaping business processes. The application of re-engineering in LIS development results in quality improvement, reduces the cost and time necessary for performance of procedures, and improves relations in organizational structure.