应用IHE集成PACS/HIS,构建数字化医院之基础——新楼医院经验介绍

新楼医院在PACS的构建和PACS与HIS/RIS的集成中遵循I HE的技术框架,应用I HE的集成模式。结果显示I HE的参照应用不仅可以评估PACS厂商的集成能力,提高院内医疗人员素质外,也可以缩短PACS构建的进程,降低构建成本,并保证未来系统的扩充性。而医疗机构高层的充分支持和对标准应用的肯定,以及相关的完整教育训练和配套措施,是提高系统成功的关键因素。本文的实践证明采用标准规范的好处及分享个案医院应用I HE的经验,并再次验证标准规范对于医院不同信息系统集成的重要性,供其他医院在构建PACS时参考。     

IHE放射学22个成功案例分析

本文对22个I HE成功案例进行分析,并与国内PACS、RIS的发展进行比较。I HE技术框架下的集成模式能成功地推动医疗机构中信息系统的集成,解决医疗信息的“孤岛”现象。尤其在HIS、PACS、RIS的集成和优化工作流程中,能更好地提高工作效率、增加检查量、减少医疗差错以及降低医疗机构的管理成本。     

社区医疗中的影像信息系统(PACS/RIS)设计与实现

本文给出了一种针对国内中小医院、社区医疗中心设计和实现影像信息系统(PACS/RIS)的技术方案。根据I HE所定义的技术规范、DICOM信息交换和通信服务,充分考虑医院影像科室检查、图像诊断和报告工作的工作流程、运行模式等实际需求,设计和实现了集成集成化信息系统(PACS/RIS)。该系统实现医学影像检查工作的全数字化管理,以及影像检查设备、RIS、HIS和社区电子病历的无缝连接与集成。在确保影像检查诊断品质的前提下,社区医疗影像信息系统建设,应当采用国际(国家)相关技术标准和规范(如I HE、HL7、DICOM等)作为存储和交换的前提和依据,使影像信息系统与医院其他信息系统集成,使社区医疗影像信息资料作为未来电子病历组成部分,提高病人影像诊断质量和就诊效率。     

基于IHE技术框架实现工作流集成

探讨基于医疗信息系统集成（IHE）技术框架实现医院工作流集成。北美放射学会（Radiology Society of North America，RSNA）和医疗卫生信息与管理系统学会（Healthcare Information and Management Systems Soeietv，HIMSS）联合发起的IHE项目从工作流集成的角度出发，基于医疗标准制定了在各种医疗信息源间交换数据的技术框架。我们利用这个技术框架，从放射科的实际工作出发，尝试在复杂而异构的医院环境中实现信息集成与工作流集成。基于IHE技术框架，通过协调各种医疗设备和信息系统，实现了放射科的工作流集成。在复杂而异构的医院环境中，基于IHE技术框架能实现工作流集成，同时对IHE技术框架在我国的应用前景进行了展望。     

军队疾病预防控制机构业务管理模式探讨

本文提出军队疾病预防控制机构应按照卫勤转型的要求,致力增进官兵作业能力,不断创新服务保障模式,重点加强核心能力建设,充分应用信息网络平台;按照医学模式转变的要求,由被动处置向主动应对转变,由个案处理向系统防控转变,由事后补救向事前预防转变,由规模效果向质量效益转变;适应卫勤转型和医学模式转变,从体系顶层设计、技术层级指导、工作项目管理、能力集成建设、任务综合应对等方面创新业务管理模式。     

HE制片技术的标准化初步探讨

随着科技的发展,许多新技术和新方法源源不断地融入到传统的病理技术当中,如分子病理技术、组织芯片、图像分析技术、显微切割和远程病理技术等.但是,HE常规制片技术作为病理学的重要组成部分,仍然是临床病理诊断工作中最基本、最重要的技术手段,广泛地应用于临床、教学和科研工作中.HE制片技术的发展有100多年的历史,HE切片诊断工作在一些大中医院相继展开,有关疾病诊断方面的WHO标准日趋成熟,但在HE制片技术的标准化方面,目前全球还没有统一的标准.各家医疗机构HE制片方法五花八门,制片质量参差不齐,严重影响了病理诊断的准确率和及时率.因此,加强医疗机构HE制片技术的标准化管理,对提升医院的整体医疗水平具有重要意义.笔者参考有关病理技术的相关报道,结合多年的工作经验,就HE制片过程中的主要环节,对HE制片技术的标准化进行了初步探讨.     

“军卫一号”ORACLE8I升级ORACLE10G的做法与效果

目前部分军队医院使用的数据库版本是ORACLE8I,随着医院业务的逐渐扩大和应用系统的需求,老版本数据库日益凸现"衰老",数据库升级已迫在眉睫。ORACLE10G有以下的新特点:FLASHBACK(闪回)功能,可以轻松的将数据库还原到某一个点上,轻松的将删除的表还原;自动工作负荷存储库     

人附睾蛋白4单克隆抗体与免放试剂盒的制备及其对卵巢癌诊断的临床价值探讨

目的 制备人附睾蛋白4(HE4)单克隆抗体并研制免放分析试剂盒, 探讨其在卵巢癌临床诊断中的价值。 方法 用重组人HE4免疫小鼠, 通过细胞融合杂交瘤技术制备并筛选可以配对的HE4单抗, 用125I标记其中一株单抗, 研制HE4免放试剂盒, 并评价其检测的灵敏度。通过检测临床血清标本来评价其对卵巢癌诊断的灵敏度和特异度。 结果 筛选出了一对亲和力与特异性高的HE4单抗, 其免放试剂盒检测的灵敏度为3.65 pmol/L, 其对卵巢癌的临床诊断的灵敏度可达90.83%, 特异度为99.17%。 结论 制备的单克隆抗体亲和力高, 研制的免放试剂盒各项指标较好, 可用于卵巢癌的早期临床诊断和疗效观察, 降低卵巢癌患者的病死率。     

医学影像存储与传输系统中影像数据流的管理及其实现方式

目的：探讨医学影像存储与传输系统（PACS）影像数据流程的管理模式和实现过程。方法：作者医院PACS经过2期建设完成了全数字化改造，所有影像设备均已接入PACS系统。系统采用中央存储管理模式，并通过对系统工作流和影像数据流的控制和管理，提高了影像诊断执行过程的系统响应速率。作者将着重基于全数字化改造后PACS影像流程运行环境和管理模式，分析影像数据流程类型、过程及实现方式。结果：作者医院PACS系统影像数据流程管理主要涉及2类：影像归档存储过程的影像转存（forward）过程。前者采用集中管理模式，对不同的影像类型根据诊断过程的需求采用各异的归档存储时间表，如CT、MR等影像类型执行集中一次性存档，而对需要立即完成诊断过程的常规X线影像则执行即刻归档存储操作；后者通过PACS中央管理服务器上运行的工作流管理软件实现，即对完成归档存储的影像，通过自动路由的过程将其进一步送往具体实施诊断过程的部门和位置。结论：影像数据流管理是影响PACS系统功能执行效率的关键因素，应根据用户特定的运行环境、任务和需求进行设计和实现。     

对《131I治疗格雷夫斯甲亢指南（2013版）》有关问题的解答

2013年4月《131I治疗格雷夫斯甲亢指南（2013版）》（简称《指南》）发表。《指南》由中华医学会核医学分会组织的编写委员会在2010年发表的《131I治疗Graves甲亢专家共识（2010年）》基础上,吸收近年来国外出版的甲状腺疾病指南、权威教科书、循证医学文献的精华,结合我国131I治疗格雷夫斯甲亢的研究进展和临床实践总结编写而成,：匀求既适应临床工作的需求,又反映本领域当前最新进展,     

Using the IHE scheduled work flow integration profile to drive modality efficiency.

The IHE (Integrating the Healthcare Enterprise) Scheduled Work Flow integration profile describes a communication and work flow environment that provides benefits for radiology departments who want to standardize system software. The IHE technical framework defines this environment by specifying the systems involved and the messages exchanged by those systems. The Modality Worklist is a key component of the Scheduled Work Flow integration profile that allows an operator at each modality in the department to retrieve a list of scheduled procedure steps to perform and to automate the process of entering the correct patient identification information in all the images created with the modality. The IHE technical framework defines two transactions used by the modality to tell the Image Manager and Order Filler what was performed and how many images were acquired: the Modality Procedure Step in Progress and Modality Procedure Step Completed. Users who specify the Scheduled Work Flow integration profile will benefit immediately by achieving a certain baseline of functionality. However, users will derive further benefits of increased operational efficiency through negotiation with the providers of software solutions. The integration profile defines features that are optional; users should evaluate these features and request those that are determined to be beneficial.     

HIS/RIS/PACS integration: getting to the gold standard

The technology for acquiring, storing, retrieving, displaying, and distributing images has advanced dramatically in recent years. The push is toward enterprise-wide image management solutions, where digital images from radiology, cardiology, and other "ologies" are seamlessly linked with information from clinical information systems and other databases, and they are accessed seamlessly from a single point of end-user interaction. The "gold standard" of system integration would provide the platform for improved workflow, patient throughput and patient safety, as well as decreased cost. Unfortunately, the gold standard remains elusive in most healthcare environments, even those with new systems. One of the earliest issues that plagued the progress of hospital information system/radiology information systems/picture archiving and communication systems (HIS/RIS/PACS) integration was a matter of language between Health Level-7 (HL7) and DICOM. This barrier was solved by the broker--a software and hardware device that accepts HL7 messages from the RIS then translates, or maps, the data to produce DICOM messages for transmission to the PACS. Technologist workflow requires patient and exam information from the RIS to flow to the modality. The broker provides support for this by taking advantage of the DICOM Modality Worklist (DMWL). Two primary problems are inherent in most brokered configurations. Workflow is driven by paper, and RIS information flows in 1 direction only, which leads to duplicative databases. Overcoming the limitations of HIS/RIS/PACS connectivity requires industry accepted communication protocols/rules. To facilitate this, the Integrating the Health Care Enterprise (IHE) initiative was developed. The goal of IHE is to provide end-users improved access to critical patient and clinical information across all systems within the healthcare delivery network. While the IHE initiative began to facilitate more efficient, predictable, and functional integration between disparate systems, vendors still had technology hurdles to overcome. System integration continues to be significantly hampered, not by technology limitations, but instead by business and political issues. In response to these challenges, several vendors have begun to offer consolidated RIS/PACS solutions and/or HIS/RIS/PACS solutions. Consequently, the prospect of the gold standard appears to be on the horizon. Single vendor consolidated systems are not, however, feasible for deployment in many healthcare organizations, and they are not necessarily the panacea.     

PACS/RIS系统在放射科工作流程优化中的作用

目的:探讨应用医学影像存档与通信系统(picture archiving and communication system,PACS)在医院放射科工作流程优化中的作用。方法:将放射科数字成像设备纳入PACS系统,将传统放射科工作流程与应用PACS后工作流程比较。结果:应用PACS工作流程后减少工作步骤,缩短报告发出时间,降低错误率。结论:应用PACS后明显提高了放射科的工作效率,方便了医疗、教学、科研和会诊,提高了医院的社会效益和经济效益。     

Lean 6 Sigma方法优化放射学工作流程的应用体会

在HIS/PACS/RIS集成构建中应用Lean6sigma方法,找出传统放射科工作流程中影响工作效率和质量的关键影响因素,再应用精益的方法消除影响工作流程的"浪费"现象,设计能持续发展的解决方案,优化放射科工作流程,提高放射科室的工作效率,为数字化医院的内在流程建设提供宝贵的实施经验和方法。     

PACS for surgery and interventional radiology: features of a Therapy Imaging and Model Management System (TIMMS)

Appropriate use of information and communication technology (ICT) and mechatronic (MT) systems is viewed by many experts as a means to improve workflow and quality of care in the operating room (OR). This will require a suitable information technology (IT) infrastructure, as well as communication and interface standards, such as specialized extensions of DICOM, to allow data interchange between surgical system components in the OR. A design of such an infrastructure, sometimes referred to as surgical PACS, but better defined as a Therapy Imaging and Model Management System (TIMMS), will be introduced in this article.A TIMMS should support the essential functions that enable and advance image guided therapy, and in the future, a more comprehensive form of patient-model guided therapy. Within this concept, the “image-centric world view” of the classical PACS technology is complemented by an IT “model-centric world view”. Such a view is founded in the special patient modelling needs of an increasing number of modern surgical interventions as compared to the imaging intensive working mode of diagnostic radiology, for which PACS was originally conceptualised and developed. The modelling aspects refer to both patient information and workflow modelling.Standards for creating and integrating information about patients, equipment, and procedures are vitally needed when planning for an efficient OR. The DICOM Working Group 24 (WG-24) has been established to develop DICOM objects and services related to image and model guided surgery. To determine these standards, it is important to define step-by-step surgical workflow practices and create interventional workflow models per procedures or per variable cases.As the boundaries between radiation therapy, surgery and interventional radiology are becoming less well-defined, precise patient models will become the greatest common denominator for all therapeutic disciplines. In addition to imaging, the focus of WG-24 is to serve the therapeutic disciplines by enabling modelling technology to be based on standards.     

IHE profiles applied to regional PACS

PACS has been widely adopted as an image storage solution that perfectly fits the radiology department workflow and that can be easily extended to other hospital departments. Integrations with other hospital systems, like the Radiology Information System, the Hospital Information System and the Electronic Patient Record are fully achieved but still challenging aims. PACS also creates the perfect environment for teleradiology and teleworking setups. One step further is the regional PACS concept where different hospitals or health care enterprises share the images in an integrated Electronic Patient Record. Among the different solutions available to share images between different hospitals IHE (Integrating the Healthcare Enterprise) organization presents the Cross Enterprise Document Sharing profile (XDS) which allows sharing images from different hospitals even if they have different PACS vendors. Adopting XDS has multiple advantages, images do not need to be duplicated in a central archive to be shared among the different healthcare enterprises, they only need to be indexed and published in a central document registry. In the XDS profile IHE defines the mechanisms to publish and index the images in the central document registry. It also defines the mechanisms that each hospital will use to retrieve those images regardless on the Hospital PACS they are stored.     

The future progress of teleradiology—An empirical study in Sweden

This paper describes a novel teleradiology solution, its services and graphical user interfaces (GUIs), and the strategic decisions taken in the development of the services. The novel services are embedded in a radiology information infrastructure in Västra Götalandsregionen (VGR), Sweden. The application is fully integrated with all different RIS and PACS systems in the region and interconnected through the radiology information infrastructure. In practice, the solution offers new ways of collaborating through information sharing within a region. Knowledge can be used collectively to improve the radiology workflow and its outcomes for clinicians and patients. The new shared approach marks the beginning of a change from local to enterprise workflow. The challenges are to develop useful and secure services for different groups related to the radiological information infrastructure. It involves continuous negotiation with people concerning how they should collaborate within the region. The need for teleradiology as a service provided “by somebody” has disappeared in VGR; today it is a shared service embedded in the innovative radiology information infrastructure. This infrastructure is just a starting point for a novel and limitless telemedicine service including limitless healthcare actors and activities. The method applied for this study was action research. The study was carried out in collaboration between practitioners and researchers.     

Medical Imaging Data Reconciliation, Part 3: Reconciliation of Historical and Current Radiology Report Data

Correlation of historical imaging and radiology report data with the current imaging data set is a critical step in the radiologic interpretation process and, if incomplete, can adversely affect diagnostic accuracy. In its current form, the extraction and analysis of historical imaging and report data is limited by manual workflow, inefficient data organization, and a lack of imaging and report data integration. The reconciliation of historical and contemporaneous radiology report data provides an opportunity to improve the consistency, completeness, and accuracy of radiology report data, while providing opportunities to automate workflow related to data extraction, interpretation, and peer review. The derived data analytics can in turn be used to facilitate physician consultations, education and training, and proactive intervention in the event of report discrepancies.     

A virtual radiation therapy workflow training simulation

AimSimulation forms an increasingly vital component of clinical skills development in a wide range of professional disciplines. Simulation of clinical techniques and equipment is designed to better prepare students for placement by providing an opportunity to learn technical skills in a “safe” academic environment. In radiotherapy training over the last decade or so this has predominantly comprised treatment planning software and small ancillary equipment such as mould room apparatus. Recent virtual reality developments have dramatically changed this approach. Innovative new simulation applications and file processing and interrogation software have helped to fill in the gaps to provide a streamlined virtual workflow solution. This paper outlines the innovations that have enabled this, along with an evaluation of the impact on students and educators.MethodVirtual reality software and workflow applications have been developed to enable the following steps of radiation therapy to be simulated in an academic environment: CT scanning using a 3D virtual CT scanner simulation; batch CT duplication; treatment planning; 3D plan evaluation using a virtual linear accelerator; quantitative plan assessment, patient setup with lasers; and image guided radiotherapy software.ResultsEvaluation of the impact of the virtual reality workflow system highlighted substantial time saving for academic staff as well as positive feedback from students relating to preparation for clinical placements. Students valued practice in the “safe” environment and the opportunity to understand the clinical workflow ahead of clinical department experience.ConclusionSimulation of most of the radiation therapy workflow and tasks is feasible using a raft of virtual reality simulation applications and supporting software. Benefits of this approach include time-saving, embedding of a case-study based approach, increased student confidence, and optimal use of the clinical environment. Ongoing work seeks to determine the impact of simulation on clinical skills.