医学术语集在罕见病诊疗中的应用

介绍和分析了与罕见病相关的主流术语集、知识库、协作网及决策支持系统。人类表型术语集（HPO）等术语集不仅有利于医学领域知识的表达、沉淀及复用,而且有利于各医疗机构间诊疗信息的互联互通及语义互操作,因此可将其作为医疗信息化的标准应用于罕见病协作网。     

面向区域医疗协同的临床路径诊疗决策知识库平台模型

提出了研发基于通用标准、综合各种技术实现不同临床信息系统互操作支持临床路径的决策知识平台模型的方法。在临床决策信息协同工作基础上,实现了区域医疗中临床路径共享需求,并能与各种临床信息系统工作流实现集成。其平台模型具有以下功能：互操作临床路径模型,实现临床路径内容标准准化计算机表达;临床路径平台,路径路模型编辑、维护软件工具;临床路径分发软件。重点讨论了临床路径诊疗决策知识库平台总体组成模型及其与现有临床信息系统的接口方法,以便不同临床信息系统路径的数据导入与互操作。实现区域医疗信息协同支持。     

用例驱动的临床检验信息互联互通相关标准规范研究

介绍我国区域临床检验信息互联互通相关标准规范研究所采用的用例驱动的方式,阐述检验信息互操作需求的用例撰写,以及用例在后续标准规范研究中的应用,包括信息标准、信息安全、系统架构等方面。     

基于人工智能的临床决策支持系统早期临床评估的透明化报告

随着人工智能（AI）在医学领域的广泛应用,越来越多基于AI的临床决策支持系统应用于临床诊断与筛查等。早期临床评估对于评价基于AI临床决策支持系统的临床性能、安全性和人为因素具有重要意义,有利于为进一步的大规模临床试验奠定基础,但相关临床研究报告的透明度和完整性尚待提高。2022年5月,基于AI的临床决策支持系统早期临床评估报告指南（DECIDE-AI）正式在线发表。本文将结合DECIDE-AI中的AI相关报告项目及相关文献,探讨基于AI的临床决策支持系统早期临床评估的透明化报告,以期帮助我国系统开发者和研究者更好地理解与应用相关指南,提高基于AI的临床决策支持系统早期临床评估报告的透明度。     

发达国家卫生信息系统互操作对我国的启示与借鉴

介绍国外卫生信息系统互操作的研究进展,分析我国卫生信息系统互操作研究与实践的现状.借鉴国际经验,初步探讨了促进我国卫生信息系统互操作发展的技术因素.认为制定兼顾不同层次互操作性的集成解决方案,研发开放标准,采用面向服务的架构(SOA)的理念,促进标准的评价是我国卫生信息系统互操作成功实施的重要因素.     

国内外医疗决策支持系统研究热点

目的：了解医疗决策支持系统领域的研究现状并预测未来发展方向,为相关学者选择研究方向时提供参考和依据。方法：以PubMed数据库中文献记录为样本,用医学主题词（MeSh）制定检索策略进行检索,获取关于医疗决策支持系统研究主题的相关文献,用BICOMB软件对文献中主要主题词进行频次统计并截取高频词,形成高频主题词-论文矩阵。对论文中的高频主题词利用gCLUTO软件对进行聚类分析,找出当前医疗决策支持系统领域的研究方向。结果：当前医疗决策支持系统的研究热点为临床决策支持系统具体构建技术的研究和临床决策支持系统社会学相关问题的研究。结论：医疗决策支持系统是一个新兴并值得重点深入关注的领域,以BICOMB和gCLUTO软件为基础的文献计量学方法,能够给临床医学及临床信息管理领域的研究者提供全面信息及热点参考。     

医疗信息系统集成相关标准研究

医疗信息领域存在着很多标准,这些标准对医疗信息化的发展起着至关重要的作用.不同医院乃至地区间医疗信息共享和系统间的互操作需要以严格的标准为基础才能得以实现.本文对这些标准进行了概括研究,特别介绍并分析了系统集成相关标准,以及这些标准对不同系统问信息交换和互操作的推进作用.     

基于临床决策支持系统与知识库的临床数据中心的研究与应用

临床数据中心作为电子病历（EMR）的重要组成部分,是目前医院信息化建设的重点,也代表着今后医疗信息化应用的一个方向。建设临床数据中心需要有临床决策支持系统与临床知识库的支撑,这也是进一步深化EMR系统功能的需要。本文结合我国医疗信息化建设的发展现状,主要对临床决策支持系统与知识库在数据中心建设中的应用,以及存在的问题进行了分析。     

当前国内外医疗决策支持系统研究热点的文献计量学分析

摘要：[目的]为了解医疗决策支持系统领域的研究现状并预测未来发展方向,为相关学者选择研究方向时提供参考和依据。[方法]以PubMed数据库中文献记录为样本,用医学主题词（Mesh）制定检索策略进行检索,获取关于医疗决策支持系统研究主题的相关文献,以XML格式下载存储其书目信息,并用BICOMB软件对文献中主要主题词进行频次统计并截取高频词,进一步形成高频主题词-论文矩阵。根据高频主题词在论文中的共现情况利用gCluto软件对其进行聚类分析,根据高频主题词聚类分析结果和对应的类标签文献,分析当前医疗决策支持系统领域的研究方向。[结果]总结出当前医疗决策支持系统的研究热点有两个方面,分为临床决策支持系统具体构建技术的研究和临床决策支持系统社会学相关问题的研究。[结论]医疗决策支持系统是一个新兴并值得重点深入关注的领域,以BICOMB和gCluto软件为基础的文献计量学方法研究,能够给临床医学以及临床信息管理领域的研究者提供全面信息及热点参考。     

元数据及其在医学科学数据共享中的应用

从元数据的来源、定义、结构、类型、特点和作用、互操作、元数据标准以及元数据在医学科学数据共享中的应用等几个方面对目前元数据研究进行综述。     

构建临床决策支持系统的良性生态

在电子病历得到应用后,临床决策支持系统(CDSS)是进一步提升医疗安全与质量的重要手段。但是当前CDSS的应用却遇到许多困难。文章根据我国当前电子病历应用水平评估的情况归纳了临床决策支持应用的6种类型和5种常见的应用场景,分析了技术上促进CDSS应用需要解决的4个主要问题,提出了以优先解决电子病历系统与CDSS接口的标准化作为入手推动临床决策支持应用的方案。通过扩大CDSS的应用带动知识描述标准的建立,进而引导市场化方式发展通用的知识库,由此形成临床决策支持系统良性发展的生态。     

CDSS用于电子病历质量控制的开发设计与应用

目的:利用人工智能技术实时干预医疗行为,提高全量电子病历质量,最终提升大数据决策支持能力和终末医疗质量.方法:开发设计基于人工智能技术的临床决策支持系统(CDSS),与电子病历系统深度集成后,对医疗过程进行节点监测和管控,一旦发现电子病历中存在质量缺陷即触发质控规则提醒.结果:CDSS从临床业务流程出发设计,可主动提醒...     

A Generative Tool for Building Health Applications Driven by ISO 13606 Archetypes

The use of Electronic Healthcare Records (EHR) standards in the development of healthcare applications is crucial for achieving the semantic interoperability of clinical information. Advanced EHR standards make use of the dual model architecture, which provides a solution for clinical interoperability based on the separation of the information and knowledge. However, the impact of such standards is biased by the limited availability of tools that facilitate their usage and practical implementation. In this paper, we present an approach for the automatic generation of clinical applications for the ISO 13606 EHR standard, which is based on the dual model architecture. This generator has been generically designed, so it can be easily adapted to other dual model standards and can generate applications for multiple technological platforms. Such good properties are based on the combination of standards for the representation of generic user interfaces and model-driven engineering techniques.     

国外基于人工智能的临床决策支持系统发展及启示

从发展历程、典型案例两方面梳理国外基于人工智能的临床决策支持系统发展情况,分析其面临的系统标准不统一、可移植性差等挑战并对未来发展趋势进行展望,以期对我国相关领域研究人员有所启示。     

基于统一信息模型的CDSS与EMR接口技术研究与实现

临床决策支持系统(CDSS)的实施和应用具有重要的临床意义,也是医院电子病历系统(EMR)应用水平评价的重要内容.由于CDSS和EMR接口开发的困难,CDSS的部署成本高、效率低,阻碍了CDSS的广泛应用.本文在分析接口开发挑战的基础上,提出了一种基于统一信息模型的接口实现技术,并在临床案例中验证了方法的可行性.     

Assessing the Sensibility of Two Clinical Decision Support Systems

Clinicians in Emergency Medicine (EM) are increasingly exposed to guidelines and treatment recommendations. To help access and recall these recommendations, electronic Clinical Decision Support Systems (CDSS) have been developed. This study examined the use and sensibility of two CDSS designed for emergency physicians. CDDS for community acquired pneumonia (CAP) and neutropenic fever (NF) were developed by multidisciplinary teams and have been accessed via an intranet-based homepage (eCPG) for several years. Sensibility is a term coined by Feinstein that describes common sense aspects of a survey instrument. It was modified by emergency researchers to include four main headings: (1) Appropriateness; (2) Objectivity; (3) Content; and (4) Discriminative Power. Sensibility surveys were developed using an iterative approach for both the CAP and NF CDSS and distributed to all 25 emergency physicians at one Canadian site. The overall response rate was 88%. Respondents were 88% male and 83% were less than 40; all were attending EM physicians with specialty designations. A number reported never having used the CAP (21%) or NF (33%) CDSS; 54% (CAP) and 21% (NF) of respondents had used the respective CDSS less than 10 times. Overall, both CDSS were rated highly by users with a mean response of 4.95 (SD 0.56) for CAP and 5.62 (SD 0.62) for NF on a seven-point Likert scale. The majority or respondents (CAP 59%, NF 80%) felt that the NF CDSS was more likely than the CAP CDSS to decrease the chances of making a medical error in medication dose, antibiotic choice or patient disposition (4.61 vs. 5.81, p=0.008). Despite being in place for several years, CDSS for CAP and NF are not used by all EM clinicians. Users were generally satisfied with the CDSS and felt that the NF was more likely than the CAP CDSS to decrease medical errors. Additional research is required to determine the barriers to CDSS use.     

Approaching semantic interoperability in Health Level Seven

‘Semantic Interoperability’ is a driving objective behind many of Health Level Seven''s standards. The objective in this paper is to take a step back, and consider what semantic interoperability means, assess whether or not it has been achieved, and, if not, determine what concrete next steps can be taken to get closer. A framework for measuring semantic interoperability is proposed, using a technique called the ‘Single Logical Information Model’ framework, which relies on an operational definition of semantic interoperability and an understanding that interoperability improves incrementally. Whether semantic interoperability tomorrow will enable one computer to talk to another, much as one person can talk to another person, is a matter for speculation. It is assumed, however, that what gets measured gets improved, and in that spirit this framework is offered as a means to improvement.     

Exchange of Computable Patient Data between the Department of Veterans Affairs (VA) and the Department of Defense (DoD): Terminology Mediation Strategy

Complete patient health information that is available where and when it is needed is essential to providers and patients and improves healthcare quality and patient safety. VA and DoD have built on their previous experience in patient data exchange to establish data standards and terminology services to enable real-time bi-directional computable (i.e., encoded) data exchange and achieve semantic interoperability in compliance with recommended national standards and the eGov initiative. The project uses RxNorm, UMLS, and SNOMED CT terminology standards to mediate codified pharmacy and allergy data with greater than 92 and 60 percent success rates respectively. Implementation of the project has been well received by users and is being expanded to multiple joint care sites. Stable and mature standards, mediation strategies, and a close relationship between healthcare institutions and Standards Development Organizations are recommended to achieve and maintain semantic interoperability in a clinical setting.     

An Adaptive Semantic based Mediation System for Data Interoperability among Health Information Systems

Heterogeneity in the management of the complex medical data, obstructs the attainment of data level interoperability among Health Information Systems (HIS). This diversity is dependent on the compliance of HISs with different healthcare standards. Its solution demands a mediation system for the accurate interpretation of data in different heterogeneous formats for achieving data interoperability. We propose an adaptive AdapteR Interoperability ENgine mediation system called ARIEN, that arbitrates between HISs compliant to different healthcare standards for accurate and seamless information exchange to achieve data interoperability. ARIEN stores the semantic mapping information between different standards in the Mediation Bridge Ontology (MBO) using ontology matching techniques. These mappings are provided by our System for Parallel Heterogeneity (SPHeRe) matching system and Personalized-Detailed Clinical Model (P-DCM) approach to guarantee accuracy of mappings. The realization of the effectiveness of the mappings stored in the MBO is evaluation of the accuracy in transformation process among different standard formats. We evaluated our proposed system with the transformation process of medical records between Clinical Document Architecture (CDA) and Virtual Medical Record (vMR) standards. The transformation process achieved over 90 % of accuracy level in conversion process between CDA and vMR standards using pattern oriented approach from the MBO. The proposed mediation system improves the overall communication process between HISs. It provides an accurate and seamless medical information exchange to ensure data interoperability and timely healthcare services to patients.