电手签名在电子病历各业务环节的管理探讨

南京市卫生信息中心获得了国家密码管理局《国产商用密码技术在电子病历中的应用示范》的研究课题.依据《中华人民共和国电子签名法》《卫生系统电子认证服务管理办法》及相关标准规范要求等,规定了在电子病历系统中,开展电子签名业务的基本业务规则,制定了电子签名各个业务环节的管理要求.用于指导南京地区医疗机构在电子病历系统中规范地开展电子签名业务和电子病历业务,促进医疗机构信息化的发展.     

Realizing Digital Signatures for Medical Imaging and Reporting in a PACS Environment

According to Taiwan’s legislation pertaining to the protection of electronic data, the creators of electronic medical records (EMR) are solely responsible for the security of EMR. However, actual implementations that fulfill the security standards and requirements for electronic medical record systems are still lacking. Most EMR created from picture archive and communication system are not considered secure, as security protection mechanisms have not yet been granted legal status. This paper describes the details of establishing a digital signature system using Taiwan health professional cards. A digital signature system has been included to ensure quality assurance (QA) operations are controlled by technicians, and reporting capabilities have been provided for radiologist. Six imaging modalities and eight types of radiology reports have also been included in the system. Results indicate that the process of creating QA signatures does not have an adverse effect on the workflow of the facility, requiring less time for the signing and verification of radiology reports. This system has already been used routinely online in a real clinical setting for more than 2 years.     

Forward Secure Digital Signature for Electronic Medical Records

The Technology Safeguard in Health Insurance Portability and Accountability Act (HIPAA) Title II has addressed a way to maintain the integrity and non-repudiation of Electronic Medical Record (EMR). One of the important cryptographic technologies is mentioned in the ACT is digital signature; however, the ordinary digital signature (e.g. DSA, RSA, GQ...) has an inherent weakness: if the key (certificate) is updated, than all signatures, even the ones generated before the update, are no longer trustworthy. Unfortunately, the current most frequently used digital signature schemes are categorized into the ordinary digital signature scheme; therefore, the objective of this paper is to analyze the shortcoming of using ordinary digital signatures in EMR and to propose a method to use forward secure digital signature to sign EMR to ensure that the past EMR signatures remain trustworthy while the key (certificate) is updated.     

Dual Function Seal: Visualized Digital Signature for Electronic Medical Record Systems

Digital signature is an important cryptography technology to be used to provide integrity and non-repudiation in electronic medical record systems (EMRS) and it is required by law. However, digital signatures normally appear in forms unrecognizable to medical staff, this may reduce the trust from medical staff that is used to the handwritten signatures or seals. Therefore, in this paper we propose a dual function seal to extend user trust from a traditional seal to a digital signature. The proposed dual function seal is a prototype that combines the traditional seal and digital seal. With this prototype, medical personnel are not just can put a seal on paper but also generate a visualized digital signature for electronic medical records. Medical Personnel can then look at the visualized digital signature and directly know which medical personnel generated it, just like with a traditional seal. Discrete wavelet transform (DWT) is used as an image processing method to generate a visualized digital signature, and the peak signal to noise ratio (PSNR) is calculated to verify that distortions of all converted images are beyond human recognition, and the results of our converted images are from 70?dB to 80?dB. The signature recoverability is also tested in this proposed paper to ensure that the visualized digital signature is verifiable. A simulated EMRS is implemented to show how the visualized digital signature can be integrity into EMRS.     

医院数字化建设与医学电子文献资源利用

随着信息技术的快速发展,医院加强数字化建设势在必行。探讨医院数字化建设的含义、意义、目标、取得的社会效益和经济效益、发展趋势,从提高医学信息资源利用水平、医学电子文献资源的开发利用的原则两方面阐述医学电子文献资源的开发利用。     

医疗纠纷处理的新路径—医疗责任保险初探

医疗纠纷的上升趋势及其处理困境已引起医学界和法律界的共同关注。学者们对医疗纠纷新路径创设的思考亦见仁见智。医疗责任保险具有的适法性、公正性、预防性不失为当前医疗纠纷处理的新路径。     

一种以电子病历为核心的多数据库数据集成方法

介绍了一种以电子病历（EMR）为数据核心,并融合了个性化治疗资源库的数据集成方法。该方法整合了多数据格式的临床数据集,如电子病历、抗生素知识库、随访数据库、肿瘤患者标本库和基因治疗数据库。数据集成目的是用于归纳与分类疾病的诊断,分析与对比治疗前后的临床效果,并预测和挖掘疾病治疗的路径。分析了两种常用数据格式的数据抽取与集成性能,提出了以下要求：数据集成方法要满足对多数据格式抽取的要求,以适应不同医疗数据资源的整合：数据集成是在多数据源的大数据环境下工作,所以集成方法须对数据的抽取速度性能作压力测试;数据集成是数据读入并写入目标数据库的过程,因此集成方法中要包含能灵活定义、易于调整、隐私数据查询安全的抽取规则组件,以及清晰友好的集成查询界面。最后通过3组实验,说明了基于EMR的集成架构和方法能解决多种数据格式的临床数据集成问题;利用MyBatis组件完成了源数据库表与抽取规则的映射工作,过滤了集成过程中的隐私数据;使用SilverLight组件的WEB呈现技术,给用户提供了友好便捷的数据查询平台。目前该数据集成方式己应用在国家重大专项-肝肿瘤样本库专题下7个分中心的临床数据集成工作。     

不同格式电子病案管理方法探讨

目的探讨不同格式电子病案的管理方法。方法以载体为标准,将电子病案分为文本格式、图像格式、视频格式历、音频格式和多媒体格式电子病案,并在此基础上讨论了各种电子病案的管理方法。结果这五种电子病案均应采用各自适合自身特点的管理方法。结论对各种电子病案应制定相应的管理规范,才能有效地管理电子病案。     

数字签名技术在电子病历中的应用

基于PKI的数字签名技术在电子病历中的应用,解决了一系列的实际和法律问题.通过广西CA为各医生护士签发数字证书,医护人员在进行相关业务操作时,用数字证书保证传递的数据安全,有效地保证敏感信息的机密性和完整性,防止各种抵赖行为,实现电子病历的无纸化管理.     

数字影像病案与电子病案系统的整合与应用探讨

目的将数字影像病案与电子病案系统进行整合,以形成一份信息完整的病案供各方使用。方法基于C/S架构,结合SQL Server的查询功能和网络文件共享的应用,实现了电子病案与数字影像病案之间的接口。结果通过本系统,使用者可在电子病案系统浏览到病案的全部信息。结论本系统能为临床提供完整的病案信息,有效地实现了病案信息的服务。     

A Firefly Algorithm-based Approach for Pseudo-Relevance Feedback: Application to Medical Database

The difficulty of disambiguating the sense of the incomplete and imprecise keywords that are extensively used in the search queries has caused the failure of search systems to retrieve the desired information. One of the most powerful and promising method to overcome this shortcoming and improve the performance of search engines is Query Expansion, whereby the user’s original query is augmented by new keywords that best characterize the user’s information needs and produce more useful query. In this paper, a new Firefly Algorithm-based approach is proposed to enhance the retrieval effectiveness of query expansion while maintaining low computational complexity. In contrast to the existing literature, the proposed approach uses a Firefly Algorithm to find the best expanded query among a set of expanded query candidates. Moreover, this new approach allows the determination of the length of the expanded query empirically. Experimental results on MEDLINE, the on-line medical information database, show that our proposed approach is more effective and efficient compared to the state-of-the-art.     

数字证书和电子签章在医疗系统中的应用

目的：通过数字证书电子签章在医院每个系统的应用效果,探讨数字化医院管理的目的和意义。方法：医务工作人员使用数字证书登录HIS、EMR、PACS、LIS,并对系统中的关键业务数据进行数字签名和时间戳,然后将各种单据里集成结合二维码的数字签名验证模块,通过数字证书、扫描枪等辅助设备实现具有法律效力的数字签名验证功能,保证打印出来的各种单据具有法律效力。结论：实施据数字证书电子签章在我院应用后,增强医护人员对工作责任感和提高工作效率,节省运营成本,提高医院的竞争力。     

全面推行电子病历是数字化医院发展的必然趋势

电子病历是临床信息系统研发和应用的核心,也是医院信息化建设向纵深发展的关键。阐述了电子病历基本概念、特点、系统设计要求与推行的意义,着重介绍了电子病历实施过程中的基本原则、应用中存在的问题及解决方法。     

医学科研中数学模型的应用

通过系统回顾、总结几个实际应用的数学模型,阐述了医学科研中数学模型的常用类型、建模方法和应掌握的原则;论述了数学模型研究在医学科研中的必要性、重要性和应用价值。     

数字签名和时间戳技术与电子病案

目的探讨无纸化电子病案发展的关键技术。方法分析我国电子病案的发展的状况,找出电子病案发展为无纸化电子病案的存在的关键问题。结果基于PKI数字签名和时间戳技术是发展为无纸电子病案的关键。结论数字签名和时间戳技术能够保证数据传输过程的安全性、信息的机密性和完整性,并可以保障电子病案的真实性和法律上的有效性,可以促进实现电子病案的无纸化,推动医院信息化建设。