Development of Grid-like Applications for Public Health Using Web 2.0 Mashup Techniques

Development of public health informatics applications often requires the integration of multiple data sources. This process can be challenging due to issues such as different file formats, schemas, naming systems, and having to scrape the content of web pages. A potential solution to these system development challenges is the use of Web 2.0 technologies. In general, Web 2.0 technologies are new internet services that encourage and value information sharing and collaboration among individuals. In this case report, we describe the development and use of Web 2.0 technologies including Yahoo! Pipes within a public health application that integrates animal, human, and temperature data to assess the risk of West Nile Virus (WNV) outbreaks.The results of development and testing suggest that while Web 2.0 applications are reasonable environments for rapid prototyping, they are not mature enough for large-scale public health data applications. The application, in fact a “systems of systems,” often failed due to varied timeouts for application response across web sites and services, internal caching errors, and software added to web sites by administrators to manage the load on their servers. In spite of these concerns, the results of this study demonstrate the potential value of grid computing and Web 2.0 approaches in public health informatics.     

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.     

Design and Development of a Sharable Clinical Decision Support System Based on a Semantic Web Service Framework

Clinical decision support (CDS) systems provide clinicians and other health care stakeholders with patient-specific assessments or recommendations to aid in the clinical decision-making process. Despite their demonstrated potential for improving health care quality, the widespread availability of CDS systems has been limited mainly by the difficulty and cost of sharing CDS knowledge among heterogeneous healthcare information systems. The purpose of this study was to design and develop a sharable clinical decision support (S-CDS) system that meets this challenge. The fundamental knowledge base consists of independent and reusable knowledge modules (KMs) to meet core CDS needs, wherein each KM is semantically well defined based on the standard information model, terminologies, and representation formalisms. A semantic web service framework was developed to identify, access, and leverage these KMs across diverse CDS applications and care settings. The S-CDS system has been validated in two distinct client CDS applications. Model-level evaluation results confirmed coherent knowledge representation. Application-level evaluation results reached an overall accuracy of 98.66 % and a completeness of 96.98 %. The evaluation results demonstrated the technical feasibility and application prospect of our approach. Compared with other CDS engineering efforts, our approach facilitates system development and implementation and improves system maintainability, scalability and efficiency, which contribute to the widespread adoption of effective CDS within the healthcare domain.     

“跨域”区域卫生信息平台可行性分析

区域卫生信息平台是连接区域内的医疗卫生机构基本业务信息系统的数据交换和共享平台,是不同系统间进行信息整合的基础和载体。这是一种全新的卫生信息化建设模式,许多发达国家已将这种模式作为卫生信息化发展的重要战略方向,目前我国也已有一些经济发达地区开始积极建立本地区的区域卫生信息平台。随着这些城市的区域卫生信息平台不断建设,可以探索不同区域卫生信息平台之间如何进行“跨域”应用,从而做到健康信息不断整合。通过分析目前国内区域卫生信息平台建设中存在的局限性,依据国际IHE规范探索跨域区域卫生信息平台的技术路线,并结合上海市申康医联平台及“广佛同城”两个实际案例,说明区域卫生信息平台跨域互联的解决方案及业务效果。     

基于语义的区域医疗信息集成方法研究

区域医疗信息共享能有效促进区域内医学信息平台之间数据的有效互通,提高医护人员的工作效率,提升医疗质量。但由于区域医疗的业务内容繁多,标准和规范复杂,同时涉及的运行机构多,严重限制了区域医疗信息系统之间的信息共享。针对这一问题,引入语义网技术,提出基于物理层、语义层和应用层三层架构模型的区域医疗信息集成框架,采用混合本体方法将分散的数据源发布成关联数据,构建一张计算机能理解的语义数据网络。通过局部本体和上层本体的建立,在不改变原有数据结构的条件下实现区域异构系统之间的无缝连接,进而达到为医护人员、患者等随时随地提供个性化的医疗保健服务目的。     

云计算在电子病案中的应用初探

电子病案管理过程中遇到了数据的传输存储、医院内部系统之间的信息集成和共享、医疗机构之间信息共享等重要技术障碍。将电子病案信息转移到云存储上,所有的数据存在“云“中,医院不再担心存储设备不够的问题。还可以降低医院软件及硬件费用的支出和日常维护的成本。云计算技术的优势,为电子病案搭建了一个经济、安全、灵活高效的信息共享平台。解决了电子病案的一些难题,为电子病案建设带来更多的益处。但是目前应用云计算的最大阻力是对于隐私和安全问题的保障以及缺乏相应的国家标准等问题。     

人工智能算法偏见与健康不公平的成因与对策分析

随着信息技术的发展，人工智能为疾病诊疗带来重要价值。然而，人工智能中存在算法偏见现象，可导致医疗卫生资源分配不均等问题，严重损害患者的健康公平。算法偏见是人为偏见的技术化体现，其形成与人工智能开发过程密切相关，主要源于数据收集、训练优化和输出应用3个方面。医护工作者作为患者健康的直接参与者，应采取相应措施以预防算法偏见，避免其引发健康公平问题。医护工作者需保障健康数据真实无偏见、优化人工智能的公平性和加强其输出应用的透明度，同时需思考如何处理临床实践中算法偏见引发的不公平现象，全面保障患者健康公平。本研究就健康领域中算法偏见的形成原因和应对策略展开综述，以期提高医护工作者识别和处理算法偏见的意识与能力，为保障信息化时代中的患者健康公平提供参考。     

异构信息共享关键技术

医疗行业信息化和人民的医疗保健水平息息相关。目前国内医疗行业信息化现状却不容乐观,主要问题集中在就诊者的医疗信息无法互通、医疗资源无法共享、行业内系统异构情况严重、业内标准没有充分引入等方面。通过分析国内外医疗行业标准的发展状况,总结近年来国内外在医疗行业信息化方面的成就和经验教训,对异构信息共享的关键技术进行了研究。并通过实验室产品到实际应用。为国内类似研究起到了一定的示范性作用。     

Consent Mechanisms for Electronic Health Record Systems: A Simple Yet Unresolved Issue

Electronic health record (EHR) systems are now in widespread use in healthcare institutions worldwide. EHRs include sensitive health information and if they are integrated among healthcare providers, data can be accessible from many different sources. This leads to increased concern regarding invasion of privacy and confidentiality. Incorporating consent mechanisms into EHRs has the potential to enhance confidentiality. However there are both positive and negative effects from employing such mechanisms—they need to balance privacy, safety, consumer and public interest.     

A Secure EHR System Based on Hybrid Clouds

Consequently, application services rendering remote medical services and electronic health record (EHR) have become a hot topic and stimulating increased interest in studying this subject in recent years. Information and communication technologies have been applied to the medical services and healthcare area for a number of years to resolve problems in medical management. Sharing EHR information can provide professional medical programs with consultancy, evaluation, and tracing services can certainly improve accessibility to the public receiving medical services or medical information at remote sites. With the widespread use of EHR, building a secure EHR sharing environment has attracted a lot of attention in both healthcare industry and academic community. Cloud computing paradigm is one of the popular healthIT infrastructures for facilitating EHR sharing and EHR integration. In this paper, we propose an EHR sharing and integration system in healthcare clouds and analyze the arising security and privacy issues in access and management of EHRs.     

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.     

Behavioral Reference Model for Pervasive Healthcare Systems

The emergence of mobile healthcare systems is an important outcome of application of pervasive computing concepts for medical care purposes. These systems provide the facilities and infrastructure required for automatic and ubiquitous sharing of medical information. Healthcare systems have a dynamic structure and configuration, therefore having an architecture is essential for future development of these systems. The need for increased response rate, problem limited storage, accelerated processing and etc. the tendency toward creating a new generation of healthcare system architecture highlight the need for further focus on cloud-based solutions for transfer data and data processing challenges. Integrity and reliability of healthcare systems are of critical importance, as even the slightest error may put the patients’ lives in danger; therefore acquiring a behavioral model for these systems and developing the tools required to model their behaviors are of significant importance. The high-level designs may contain some flaws, therefor the system must be fully examined for different scenarios and conditions. This paper presents a software architecture for development of healthcare systems based on pervasive computing concepts, and then models the behavior of described system. A set of solutions are then proposed to improve the design’s qualitative characteristics including, availability, interoperability and performance.     

实体社区互联网医院建设的探索与实践

“互联网+”是互联网创新成果与经济社会各领域深度融合的产物，“互联网诊疗”和“互联网+健康”是点和面的关系，互联网医院的属性是医疗机构。慢性病患者的复诊“续药”是互联网医院的重要功能，从医疗机构的功能定位来说，互联网医院的建设适合在基层医疗卫生机构发展。除了方便慢性病患者的复诊续药，“互联网医院”作为信息技术、互联网平台及传统医疗业务的深度融合，将是大健康领域的新生态和医疗服务领域新业态。本文从顶层设计、技术架构、业务模型、线下药品的配送和电子票据等方面，介绍国内首家实体社区互联网医院的建设实践经验，总结取得的成效和存在的问题，旨在为推动互联网诊疗与互联网医院发展提供参考。     

个人健康记录系统信息模型构建

通过参考CCR的内容结构及苹果应用商店中个人健康记录系统的信息内容,结合国内相关卫生信息规范来定义信息类及数据项,采用双层建模法构建个人健康记录系统的信息模型,根据信息模型和数据项的对应关系形成个人健康记录系统标准化数据内容,包括24个1级信息类,26个2级信息类以及231个数据项,旨在为不同的个人健康记录系统在信息收集、记录及共享的过程中提供一致的数据标准,为个人健康记录系统数据的跨平台传输与共享提供前提。     

Patient-controlled sharing of medical imaging data across unaffiliated healthcare organizations

Background

Current image sharing is carried out by manual transportation of CDs by patients or organization-coordinated sharing networks. The former places a significant burden on patients and providers. The latter faces challenges to patient privacy.

Objective

To allow healthcare providers efficient access to medical imaging data acquired at other unaffiliated healthcare facilities while ensuring strong protection of patient privacy and minimizing burden on patients, providers, and the information technology infrastructure.

Methods

An image sharing framework is described that involves patients as an integral part of, and with full control of, the image sharing process. Central to this framework is the Patient Controlled Access-key REgistry (PCARE) which manages the access keys issued by image source facilities. When digitally signed by patients, the access keys are used by any requesting facility to retrieve the associated imaging data from the source facility. A centralized patient portal, called a PCARE patient control portal, allows patients to manage all the access keys in PCARE.

Results

A prototype of the PCARE framework has been developed by extending open-source technology. The results for feasibility, performance, and user assessments are encouraging and demonstrate the benefits of patient-controlled image sharing.

Discussion

The PCARE framework is effective in many important clinical cases of image sharing and can be used to integrate organization-coordinated sharing networks. The same framework can also be used to realize a longitudinal virtual electronic health record.

Conclusion

The PCARE framework allows prior imaging data to be shared among unaffiliated healthcare facilities while protecting patient privacy with minimal burden on patients, providers, and infrastructure. A prototype has been implemented to demonstrate the feasibility and benefits of this approach.     

区域卫生数据中心的建设实践与思考

基于国家卫生部电子健康档案的建设标准,建立区域卫生数据中心,实现居民电子健康档案的整合与共享,建立基于居民电子健康档案的区域卫生业务协同信息体系,在区域内二级医院、社区卫生服务机构、专业条线管理机构、第三方服务机构之间实现妇幼保健业务协同、出院病人社区随访、第三方临床检验中心、慢性病干预业务协同等信息化医疗服务,大力优化区域医疗卫生资源配置,深化区域卫生数据中心的应用。     

基于SOA的区域卫生信息平台测试技术研究

基于区域卫生信息平台工程项目管理需要,在国家卫生部制定的基于健康档案的区域卫生信息平台建设指南等相关标准框架指导下,结合中山大学医疗信息共享平台项目建设实践,提出了一种面向SOA架构的大型软件工程项目技术测试体系框架模型,对框架内的各技术层面包括从需求概念原型一逻辑设计原型一技术实现模态一投产系统性能的验证模型进行了深入的探讨,提出了基于SOA关键技术验证与业务交易性能测试的方法,并通过测试实例说明了该框架模型和方法的可用性、有效性。     

Biometrics for Electronic Health Records

Securing electronic health records, in scenarios in which the provision of care services is share among multiple actors, could become a complex and costly activity. Correct identification of patients and physician, protection of privacy and confidentiality, assignment of access permissions for healthcare providers and resolutions of conflicts rise as main points of concern in the development of interconnected health information networks. Biometric technologies have been proposed as a possible technological solution for these issues due to its ability to provide a mechanism for unique verification of an individual identity. This paper presents an analysis of the benefit as well as disadvantages offered by biometric technology. A comparison between this technology and more traditional identification methods is used to determine the key benefits and flaws of the use biometric in health information systems. The comparison as been made considering the viability of the technologies for medical environments, global security needs, the contemplation of a share care environment and the costs involved in the implementation and maintenance of such technologies. This paper also discusses alternative uses for biometrics technologies in health care environments. The outcome of this analysis lays in the fact that even when biometric technologies offer several advantages over traditional method of identification, they are still in the early stages of providing a suitable solution for a health care environment.