CORBA在医院信息系统中的应用

医疗信息的开放和共享是医院信息系统发展的必然趋势,但是由于以前的医院信息系统在设计时没有过多考虑标准化问题,造成大量异构医院信息系统的存在,给信息共享赞成了困难,作为分布对象技术主流的CORBA体系结构,是解决异构信息系统集成问题的有效方案,尤其是CORBAMed的提出,为异构环境下医院信息系统的集成提供了统一的规范,本文通过介绍CORBA体系结构以及CORBA－Meb的五个重要规范,分析了CORBAMed的特点,提出了基于CORBA建设医院信息系统的新方向。     

医学成像和通讯系统的CORBA设计方案

针对目前医学信息系统的异构带来了彼此之间通讯和信息共享的困难 ,对象管理组 (OMG)制定了CORBAMed软件规范 ,规定了医学信息系统的软件架构 ,定义各种服务的接口。本文尝试将 CORBA应用于医学图像存档和通讯系统 ,提出 CORBA解决方案的 PACS系统模型 ,分析了软件系统的视图层次 ,最后讨论了CORBAMed的相关服务。     

医疗应用集成平台的研究

本文针对集团化医院在信息化建设中急需解决的医疗信息共享的问题,提出了基于医疗应用集成平台的解决方案,以HL7为标准,以中间件为技术手段,成功地解决了集团各成员医院之间,医院内部各异构系统之间的应用集成与信息共享问题。     

基于CORBA的医院信息系统与PACS的分布式集成研究

在实际医学应用中 ,医生需要及时获得病人的有关图像和文本记录信息。这些信息有助于医生进行病历诊断 ,临床试验和研究分析。但是这些信息分布零乱 ,并且位于不同的系统上 ,如图像管理和通信系统 (Picturearchiving and comm unication information systems,PACS) ,医院信息系统 (Hospital inform ation systems,HIS)等 ,这些系统使用不同的标准和协议 ,并且都不支持分布式操作 ,使系统间信息不能完全共享。为了实现各种医学系统间的分布式操作和信息的共享 ,本文结合当前流行的 WWW技术 ,利用分布式处理软件 (Common object requestbroker architecture,CORBA) ,提出了一种基于 WEB的 PACS和 HIS分布式集成方法 ,该方法将图像和文本信息系统及各种医学应用都看作是 CORBA组件对象 ,把对这些系统和应用的操作都当作是对应用对象的处理 ,利用面向对象的技术实现了对 PACS和 HIS系统的分布式集成和互操作 ,并且利用 WEB技术实现了信息的共享     

基于XML格式转换的HL7网关设计

目的：医院信息化在现代医院管理中发挥着越来越重要的作用,但是,各系统在软件和硬件上的差异造成了信息孤岛,阻碍了信息化的发展。信息化的主要挑战是信息共享,在不同种类的医疗信息系统之间实现无缝的信息共享,需要一个信息交换标准来统一医疗信息。通过在医院信息系统中引入HL7标准可以实现异构系统之间医疗信息的交换和共享,消除信息孤岛。方法：本文首先对HL7标准及其数据交换的基本原理进行了简单的介绍。然后深入介绍了HL7消息的结构组成和格式转换,提出了一种基于XML格式转换的HL7网关的设计方案,给出了一个完整的实现框架,并对其中的各个任务模块进行了阐述。结果：基于XML格式转换的HL7网关合理地利用了XML格式的优势,不仅实现了医疗信息的交换和共享,而且提高了医疗系统的竞争力和灵活性,进一步促进了区域信息化的发展。结论：HL7网关解决了异构信息系统的集成问题,实现异构医疗信息系统之间无缝的信息交换和信息共享,消除了信息孤岛,促进区域医疗信息化的发展。     

LIS与HIS数据交换流程的研究

本文针对目前医院信息化建设中出现的医疗信息共享问题,提出制定数据交换流程的目标和原则,并经过调研总结出了三种LIS系统与HIS业务数据交换流程,通过对业务流程的分析对比,制定出合理可靠的业务流程,实现异构系统的集成和信息资源的共享.     

基于信息语义的医疗信息系统集成技术研究

医疗环境的复杂性决定了大量异构医疗信息系统的存在，系统集成不可避免，而异构信息中的语义表示方法一直是一个难点。本文介绍了信息集成的相关概念，在对医疗信息系统集成应用进行分析的基础上，采用基于信息语义的定义方法，研究以语义为核心的信息集成技术。     

新一代住院信息系统的升级与改造

住院信息系统是医院信息化建设的重要组成部分,也是医院复杂程度和实施难度最大的一个系统。本文论述了广州市第一人民医院住院信息系统升级改造的方法和过程,新的住院信息系统实现了信息高度共享以及与其他系统的无缝集成,达到了整个住院诊疗流程科学化、标准化和规范化管理的目的。     

基于服务网格的医疗信息系统的研究

网格是集成和并行的计算与资源环境,核心是在异构和分布式的网络环境中实现资源共享。网格医疗信息系统的核心是医疗资源的共享和服务系统的建立。文中提出了基于服务网格的医疗信息系统体系结构,并对网格开发工具及其相关技术进行研究,给出了基于网格技术的医疗信息系统的应用实例。     

面向知识管理的临床路径区域医疗信息共享模型框架

临床路径对医院医疗质量管理和成本控制具有重要作用.临床路径管理只有与临床知识库支持系统结合,才能真正辅助医生进行临床医疗处理,成为临床科室医疗质量管理的辅助工具.本文提出了不同医疗机构异构信息系统共享临床路径知识库的架构模型,并建立了通用的参考模型框架.该模型基于通用的临床路径参考信息模型,具有开放式架构、可扩展能力强、适应面宽等特点,对区域医疗信息系统建设中临床路径软件信息共享有一定的参考价值.     

Architectural design and tools to support the transparent access to hospital information systems,radiology information systems,and picture archiving and communication systems

The fragmentation of the electronic patient record among hospital information systems (HIS), radiology information systems (RIS), and picture archiving and communication systems (PACS) makes the viewing of the complete medical patient record inconvenient. The purpose of this report is to describe the system architecture, development tools, and implementation issues related to providing transparent access to HIS, RIS, and PACS information. A client-mediator-server architecture was implemented to facilitate the gathering and visualization of electronic medical records from these independent heterogeneous information systems. The architecture features intelligent data access agents, run-time determination of data access strategies, and an active patient cache. The development and management of the agents were facilitated by data integration CASE (computer-assisted software engineering) tools. HIS, RIS, and PACS data access and translation agents were successfully developed. All pathology, radiology, medical, laboratory, admissions, and radiology reports for a patient are available for review from a single integrated workstation interface. A data caching system provides fast access to active patient data. New network architectures are evolving that support the integration of heterogeneous software subsystems. Commercial tools are available to assist in the integration procedure.     

Health information systems - past, present, future

In 1984, Peter Reichertz gave a lecture on the past, present and future of hospital information systems. In the meantime, there has been a tremendous progress in medicine as well as in informatics. One important benefit of this progress is that our life expectancy is nowadays significantly higher than it would have been even some few decades ago. This progress, leading to aging societies, is of influence to the organization of health care and to the future development of its information systems. Twenty years later, referring to Peter Reichertz' lecture, but now considering health information systems (HIS), two questions are discussed: which were lines of development in health information systems from the past until today? What are consequences for health information systems in the future? The following lines of development for HIS were considered as important: (1) the shift from paper-based to computer-based processing and storage, as well as the increase of data in health care settings; (2) the shift from institution-centered departmental and, later, hospital information systems towards regional and global HIS; (3) the inclusion of patients and health consumers as HIS users, besides health care professionals and administrators; (4) the use of HIS data not only for patient care and administrative purposes, but also for health care planning as well as clinical and epidemiological research; (5) the shift from focusing mainly on technical HIS problems to those of change management as well as of strategic information management; (6) the shift from mainly alpha-numeric data in HIS to images and now also to data on the molecular level; (7) the steady increase of new technologies to be included, now starting to include ubiquitous computing environments and sensor-based technologies for health monitoring. As consequences for HIS in the future, first the need for institutional and (inter-) national HIS-strategies is seen, second the need to explore new (transinstitutional) HIS architectural styles, third the need for education in health informatics and/or biomedical informatics, including appropriate knowledge and skills on HIS. As these new HIS are urgently needed for reorganizing health care in an aging society, as last consequence the need for research around HIS is seen. Research should include the development and investigation of appropriate transinstitutional information system architectures, of adequate methods for strategic information management, of methods for modeling and evaluating HIS, the development and investigation of comprehensive electronic patient records, providing appropriate access for health care professionals as well as for patients, in the broad sense as described here, e.g. including home care and health monitoring facilities. Comparing the world in 1984 and in 2004, we have to recognize that we imperceptibly, stepwise arrived at a new world. HIS have become one of the most challenging and promising fields of research, education and practice for medical informatics, with significant benefits to medicine and health care in general.     

Interfacing aspects between the picture archiving communications systems,radiology information systems,and hospital information systems

Information relevant to radiological applications is commonly managed by several autonomous medical information systems including hospital information systems (HIS), radiological information systems (RIS), and picture archiving and communications systems (PACS). In this report, we explain the need to coordinate these systems and to provide some framework in which they can exchange information. In the first half of this report, we describe the integration of a PACS system into a hospital operation. Next, we present the interfacing methods between the HIS and the RIS, and between the RIS and the PACS. Two methods are further detailed for the communication between the RIS and the PACS (1) the triggered database to database transfer, and (2) the query protocol. The implementation of the first method successfully allows RIS reports, procedure and patient demographic information to be displayed at the request of the user along with the associated images at a PACS workstation. The query protocol allows a PACS to dynamically query RIS information. It will be eventually integrated into the design of a scientific multimedia distributed medical database system built on top of the HIS, the RIS, and the PACS.     

Designing web services in health information systems: from process to application level

Service-oriented architectures (SOAs) and web service technologies have been proposed to respond to some central interoperability challenges of heterogeneous health information systems (HIS). We propose a model which we are using to define services and solutions for healthcare applications from the requirements in the healthcare processes. Focusing on the transition from the process level of the model to the application level, we also present some central design considerations, which can be used to guide the design of service-based interoperability. We illustrate these aspects with examples from our current work from the service-enabled HIS.     

A literature review on communication between picture archiving and communication systems and radiology information systems and/or hospital information systems

The purpose of this literature review is to present the concepts surrounding the issue of communication between imaging systems and information systems in radiology and the literature about them. Picture archiving and communication systems (PACS) were developed to combine viewing of modality images, archiving, and distribution of images. When PACS is integrated/interfaced with radiology information systems (RIS) or hospital information systems (HIS), it can merge patient demographics, medical records, and images. To address several issues surrounding communication between PACS and HIS/RIS and to make interface development easier and faster, various organizations have developed standards for the formatting and transfer of clinical data. Additional work continues to better handle these issues. Communication protocol Health Level 7 (HL7) is a standard application protocol used for electronic text data exchange in health care by most HIS/RIS. The imaging communication protocol for PACS is the Digital Imaging and Communications in Medicine (DICOM) standard specification protocol that describes the means of formatting and exchanging images and associated information.     

HIS-Monitor: an approach to assess the quality of information processing in hospitals

OBJECTIVES: Hospital information systems (HIS) are a substantial quality and cost factor for hospitals. Systematic monitoring of HIS quality is an important task; however, this task is often seen to be insufficiently supported. To support systematic HIS monitoring, we developed HIS-Monitor, comprising about 107 questions, focusing on how a hospital information system does efficiently support clinical and administrative tasks. METHODS: The structure of HIS-Monitor consists of a matrix, crossing HIS quality criteria on one axis with a list of process steps within patient care on the other axis. HIS-Monitor was developed based on several pretests and was now tested in a larger feasibility study with 102 participants. RESULTS: HIS-Monitor intends to describe strengths and weaknesses of information processing in a hospital. Results of the feasibility study show that HIS-Monitor was able to highlight certain HIS problems such as insufficiently supported cross-departmental communication, legibility of drug orders and other paper-based documents, and overall time needed for documentation. We discuss feasibility of HIS-Monitor and the reliability and validity of the results. CONCLUSIONS: Further refinement and more formal validation of HIS-Monitor are planned.     

DICOM Modality Worklist: An essential component in a PACS environment

The development and acceptance of the digital communication in medicine (DICOM) standard has become a basic requirement for the implementation of electronic imaging in radiology. DICOM is now evolving to provide a standard for electronic communication between radiology and other parts of the hospital enterprise. In a completely integrated filmless radiology department, there are 3 core computer systems, the picture archiving and communication system (PACS), the hospital or radiology information system (HIS, RIS), and the acquisition modality. Ideally, each would have bidirectional communication with the other 2 systems. At a minimum, a PACS must be able to receive and acknowledge receipt of image and demographic data from the modalities. Similarly, the modalities must be able to send images and demographic data to the PACS. Now that basic DICOM communication protocols for query or retrieval, storage, and print classes have become established through both conformance statements and intervendor testing, there has been an increase in interest in enhancing the functionality of communication between the 3 computers. Historically, demographic data passed to the PACS have been generated manually at the modality despite the existence of the same data on the HIS or RIS. In more current sophisticated implementations, acquisition modalities are able to receive patient and study-related data from the HIS or RIS. DICOM Modality Worklist is the missing electronic link that transfers this critical information between the acquisition modalities and the HIS or RIS. This report describes the concepts, issues, and impact of DICOM Modality Worklist implementation in a PACS environment.     

LIS与HIS集成研究

医院业务的发展要求能实现信息系统的集成.我们分析了医疗信息系统互联的不同方式,提出一种集成现有实验室信息系统(LIS)与医院信息系统(HIS)的方案.它使用多层分布式技术改进客户机/服务器应用模式,参考IHE(Integrating the Healthcare Enterprise)实验室技术框架(LAB-TF)确定参与工作流程集成的功能单元和事务,并采用Health Level 7(HL7)医疗信息交换标准实现信息交互.可保留原有的大部分处理,避免系统整合带来安全性、可维护性和实时性问题,保护了原有的投入,避免重建系统所带来的风险.