家庭健康档案概念数据模型及其应用研究

目的构建家庭健康档案概念数据模型和数据模板,为家庭健康档案的数据采集、信息共享和信息系统建设提供标准支持。方法概念框架以居民健康档案相关业务规范为依据,数据模型参照HL7参考信息模型(RIM)和HL7数据类型,数据模板参照IHE PCC已发布的标准模板,将现行的武威市居民新型电子健康档案系统中家庭电子健康档案模块的数据项与模型和模板进行对照。建模方法采用统一建模语言(UML)。结果家庭健康档案概念数据模型包含家庭标识信息和家庭健康及其影响因素2个维度,家族性疾病等14个子维度。数据模板包含标识类、一般记录项目、家族性疾病,共产生72个数据元,现有系统中尚缺30个数据元。结论家庭健康档案概念数据模型和数据模板有助于实现健康档案内容的完整性,保证信息表达的规范化和标准化。     

人口健康科学数据中个人敏感信息分类研究

目的：细化人口健康科学领域个人敏感信息类型,以期推进人口健康科学数据的开放和共享及个人敏感信息的立法保护提供参考,为人口健康科学数据平台的数据管理工作提供借鉴。方法：基于文献调研法考察了国内外个人敏感信息的界定,基于内容分析法总结了人口健康领域中个人敏感信息的类型,并进行了多维特征分析。结果：将人口健康领域中个人敏感信息细化为身份标识信息、生物特征信息、健康医疗信息3个大类,下分9个小类。结论：个人敏感信息细化分类符合依据不同领域特点将敏感个人信息具体化的国际立法的趋势,可作为制定人口健康科学数据收集管理策略和共享策略的参考。     

基于问卷调查的医疗数据分类分级研究

目的：针对医疗卫生机构在运营过程中产生信息众多而医疗行业尚没有明确的数据保护方案的问题,对底层数据进行分类分级,进而保护患者隐私等重要信息。方法：分类整理电子病历中涉及的数据项,对每类中包含的数据项进行抽象,设计医疗数据分类分级的调查问卷对相关人员进行调研。结果：根据问卷结果,结合数据分析方法,确定医疗数据的分类分级,对人口学、标识、卫生机构人员、卫生费用、药物、检查等11个大类赋予0级可公开、1级数据关系个人信息安全、2级数据涉及机构信息安全3种不同级别。结论：为后续的访问控制或跨库联合识别奠定了基础。     

以电子病历为核心建立区域孕产妇电子健康档案的探讨

随着医院信息化的发展,单一的信息孤岛系统很难满足患者和医疗机构对完整信息链的需求。为此,需要构建统一完整的居民健康档案和跨医疗机构的信息共享机制,协同不同医疗机构的业务信息系统,实现居民电子病历和健康档案信息的共享和交换,为相关部门提供全面准确的决策支持。电子病历和电子健康档案是医院信息系统重要的两个组成部分。电子健康档案是电子病历的高级形式,有着电子病历无法替代的作用。它兼容患者医疗及个人健康保健、家庭健康档案、公共卫生信息、术后随访记录等信息,并实现居民健康档案多档合一。它实现了不同医疗机构的信息数据交流,利用更新及交互应用,可提高信息的使用率,是社区卫生服务的依据及全科医疗的工具,在区域卫生信息化建设中起着重要作用。重点介绍以电子病历为核心建立孕产妇的社区电子健康档案。     

基于工业互联网和区块链的“健康钱包”数据开放共享模式研究

现有健康数据共享模式面临效率低下、缺乏监管等诸多问题,无法满足国家对健康数据合规开放共享的要求,工业互联网和区块链技术的发展和应用为健康数据开放共享提供了新的路径。本研究通过引入这两种技术构建个人健康数据钱包,结合工业互联网高效的分布式数据管理及不依赖第三方公信力的特点,建立基于数据钱包的数据开放共享模式,实现对健康数据的可信流转,使患者能够更好地掌握和分享其健康信息。结果表明该数据开放共享模式可满足“数据不出域、可用不可见”要求,将健康数据所有权归还个人,有助于提高医疗服务连续性,能够为健康数据开放共享应用提供有益借鉴。     

健康档案管理规范的基本要求

健康档案是医疗卫生机构为居民提供医疗卫生服务过程中的规范记录,是以居民个人健康为核心、贯穿整个生命过程、涵盖各种健康相关因素的系统化记录文件。本文阐述如何根据居民自愿原则建立包括个人基本信息、健康体检、重点人群健康管理记录等内容的居民健康档案,并进行规范管理。     

居民健康档案个体标识与标准化

目的 探讨居民健康档案个体标识与标准化.方法 以HL7 RIM为依据,采用UML建模工具对数据进行建模,参照<国家卫生数据字典>和<医院信息基本数据集标准>定义元数据.结果 对个体标识信息进行了属性划分及属性定义,构建个体标识信息数据模型.结论 形成符合当前医疗保健信息系统需要的个体标识信息数据项与数据标准,为建立居民健康档案索引数据库与健康档案最小数据集提供前提.     

基于区块链的互联网医院患者电子病历安全共享模式与实践

目的/意义 针对互联网开放场景下患者个人电子病历数据安全开放共享面临的难点和挑战,设计一套安全共享模型,推动医疗机构实现患者电子病历、电子健康档案开放共享。方法/过程 提炼分析影响患者个人电子病历数据开放共享的关键要素,界定互联网医疗场景下电子病历数据开放范围、标准和格式,利用区块链技术建立患者电子病历数据安全共享模型。结果/结论 基于区块链建设患者电子病历数据安全共享模式,可初步实现患者电子病历数据可信存证和安全开放共享,为未来以电子病历为核心的医疗健康数据安全开放共享提供新思路。     

基于区块链的异地医疗信息共享试点项目实践

目的：研究应用区块链技术构建跨区域医疗信息共享协作平台,实现异地医疗信息可信共享与医疗协作。方法：通过对基于区块链的医疗信息共享技术及共享机制的研究,分析跨区域医疗信息共享的业务架构,构建服务平台,并基于跨地区协作联盟,给出跨链技术结构。结果：在上海、宁波的跨地区医联体电子病历及个人健康档案共享实践证明,基于区块链的异地医疗信息共享技术科学有效。结论：区块链技术的应用可以为异地医疗信息共享提供安全、可信的数据基础,支撑远程医疗协作、跨地区健康管理、临床科研协作等应用。     

基于领域信息的卫生信息概念数据模型构建方法

目的:基于领域信息构建国家卫生信息概念数据模型,促进相关数据标准的一致性和元数据系统的开发和维护。方法:以国家已发布的数据集为依据,参照相关业务规范,归纳整理其中的数据元;分解数据元结构、提炼类、定义类的关系和属性、数据类型和值集,并以UML形式展示;抽象对象类并与HL7 RIM映射。结果:以高血压患者健康管理、传染病报告两个数据集为起点,构建的卫生领域概念数据模型包含实体、角色、参与、医学观察、就医、干预等大类和若干个子类,直观展示元数据项之间的关系,准确表达数据集中数据元的语义和形式。结论:在分析、汇总领域信息的基础上,自底向上构建概念数据模型,可反映数据标准的实际需求,并为元数据项目开发和管理提供一致、透明的语义背景。     

Combining Ontologies and Open Standards to Derive a Middle Layer Information Model for Interoperability of Personal and Electronic Health Records

The aim of our study was to enable better interoperability between Personal Health Record (PHR) and Electronic Health Record (EHR) systems and vice versa. A multi-layer architectural model that resides between a PHR and EHR system has been developed. The model consists of an ontology-driven information model and a set of transformation rules that work in conjunction to process data exported from a PHR or EHR system and prepare it accordingly for the receiving system. The model was evaluated by executing a set of case study scenarios containing data from both a PHR and an EHR system. This allowed various challenges to emerge and revealed gaps in current standards in use. The proposed information model offers a number of advantages. Altering only the information model can incorporate modifications to either a PHR or EHR system. The model uses classes and attributes to define how data is captured which allows greater flexibility in how data can be manipulated by receiving systems.     

Secure Dynamic Access Control Scheme of PHR in Cloud Computing

With the development of information technology and medical technology, medical information has been developed from traditional paper records into electronic medical records, which have now been widely applied. The new-style medical information exchange system "personal health records (PHR)" is gradually developed. PHR is a kind of health records maintained and recorded by individuals. An ideal personal health record could integrate personal medical information from different sources and provide complete and correct personal health and medical summary through the Internet or portable media under the requirements of security and privacy. A lot of personal health records are being utilized. The patient-centered PHR information exchange system allows the public autonomously maintain and manage personal health records. Such management is convenient for storing, accessing, and sharing personal medical records. With the emergence of Cloud computing, PHR service has been transferred to storing data into Cloud servers that the resources could be flexibly utilized and the operation cost can be reduced. Nevertheless, patients would face privacy problem when storing PHR data into Cloud. Besides, it requires a secure protection scheme to encrypt the medical records of each patient for storing PHR into Cloud server. In the encryption process, it would be a challenge to achieve accurately accessing to medical records and corresponding to flexibility and efficiency. A new PHR access control scheme under Cloud computing environments is proposed in this study. With Lagrange interpolation polynomial to establish a secure and effective PHR information access scheme, it allows to accurately access to PHR with security and is suitable for enormous multi-users. Moreover, this scheme also dynamically supports multi-users in Cloud computing environments with personal privacy and offers legal authorities to access to PHR. From security and effectiveness analyses, the proposed PHR access scheme in Cloud computing environments is proven flexible and secure and could effectively correspond to real-time appending and deleting user access authorization and appending and revising PHR records.     

Personal Health Records: Definitions,Benefits, and Strategies for Overcoming Barriers to Adoption

Recently there has been a remarkable upsurge in activity surrounding the adoption of personal health record (PHR) systems for patients and consumers. The biomedical literature does not yet adequately describe the potential capabilities and utility of PHR systems. In addition, the lack of a proven business case for widespread deployment hinders PHR adoption. In a 2005 working symposium, the American Medical Informatics Association's College of Medical Informatics discussed the issues surrounding personal health record systems and developed recommendations for PHR-promoting activities. Personal health record systems are more than just static repositories for patient data; they combine data, knowledge, and software tools, which help patients to become active participants in their own care. When PHRs are integrated with electronic health record systems, they provide greater benefits than would stand-alone systems for consumers. This paper summarizes the College Symposium discussions on PHR systems and provides definitions, system characteristics, technical architectures, benefits, barriers to adoption, and strategies for increasing adoption.     

HL7 V3在区域医疗交换平台中的应用研究

区域医疗交换平台是所有医疗信息系统中覆盖数据量最大、涉及信息系统种类最多的系统之一。HL7（HealthLevelSeven）标准的出现为异构医疗信息系统之间的信息数据交换与共享提供了基础条件和重要的应用价值。针对区域交换平台在国内外的研究现状以及HL7发展,概述了HL7 V2．x版本与HL7 V3版本,结合HL7 V2在区域交换平台的应用,借助HL7 V3的RIM模型及V3消息,设计了基于HL7 V3标准的区域医疗交换平台,实现了医院之间、医院与卫生机构之间的信息交换与共享。     

个人健康档案共享的主观障碍与对策分析

目的 探讨推动我国PHR共享的途径和方法 .方法 借鉴国外经验,分析影响PHR共享的主观因素,讨论现阶段可行的推动其共享的方法 .结果 影响我国PHR共享的主观因素包括对共享数据安全性的担忧,质疑共享的PHR可能被用于牟取不正当利益,信息贡献者担心自己不是PHR共享的最大有效受益者等.结论 解决这些困难需要从政策法规、社会效益和经济效益3个方面共同进行.     

Personal health records: a scoping review

Electronic personal health record systems (PHRs) support patient centered healthcare by making medical records and other relevant information accessible to patients, thus assisting patients in health self-management. We reviewed the literature on PHRs including design, functionality, implementation, applications, outcomes, and benefits. We found that, because primary care physicians play a key role in patient health, PHRs are likely to be linked to physician electronic medical record systems, so PHR adoption is dependent on growth in electronic medical record adoption. Many PHR systems are physician-oriented, and do not include patient-oriented functionalities. These must be provided to support self-management and disease prevention if improvements in health outcomes are to be expected. Differences in patient motivation to use PHRs exist, but an overall low adoption rate is to be expected, except for the disabled, chronically ill, or caregivers for the elderly. Finally, trials of PHR effectiveness and sustainability for patient self-management are needed.     

Intelligent Personal Health Record: Experience and Open Issues

Web-based personal health records (PHRs) are under massive deployment. To improve PHR’s capability and usability, we previously proposed the concept of intelligent PHR (iPHR). By introducing and extending expert system technology and Web search technology into the PHR domain, iPHR can automatically provide users with personalized healthcare information to facilitate their daily activities of living. Our iPHR system currently provides three functions: guided search for disease information, recommendation of home nursing activities, and recommendation of home medical products. This paper discusses our experience with iPHR as well as the open issues, including both enhancements to the existing functions and potential new functions. We outline some preliminary solutions, whereas a main purpose of this paper is to stimulate future research work in the area of consumer health informatics.