基于HL7标准的心电医疗信息共享平台设计与实现

目的：解决目前区域医院信息平台建设中存在的医疗信息采集困难、数据标准不统一、医疗信息共享流程不统一等诸多问题,实现医疗信息在区域内有效共享。方法：研究HL7医疗信息交换标准和WebService技术,设计了基于Windows平台下的HL7引擎和WebService接口,HL7引擎主要包括HL7消息构建与解析,非标准数据通过HL7引擎转化为HL7标准数据,WebService接口为数据交互提供传输通道。结果：HL7引擎的引入实现了异构系统之间数据的无缝传输,构建WebService接口灵活地实现了跨平台、跨操作系统、跨语言的医生工作站与远程服务器的数据交互。结论：解决了医院信息共享问题,并建立了医疗系统间信息交换的快速通道,提高了医疗系统的工作效率和核心竞争力,为其他慢性病如高血压、高血糖、呼吸障碍等的健康管理系统提供了一定参考,该平台的实现对医疗信息化具有重要的实践意义。     

HL7在电子病历信息交换的应用

随着计算机网络技术的发展,医疗机构的网络互联和信息的共享与交换已成为全球医疗卫生信息化的发展趋势。电子病历是实现医疗卫生信息化的核心,而电子病历信息来源于各医疗信息系统,本文通过分析当前各医疗信息系统平台信息交换现状,利用HL7在电子病历中的应用优势,根据HL7的数据交换原理,提出实现电子病历信息交换的策略。     

HL7与DICOM之间数据交换的分析与实现

本文分析了HL7和DICOM共同关心的四种数据信息。进而阐述了通过HL7事务和消息在HIS和PACS之间进行这四种数据信息交换的机制。最后使用面向对象的方法建立了一个HL7-DICOM网关，并且实现了其中两种数据信息的交换。说明了如何构造HL7消息来实现HIS和PACS之间的数据交换。     

不同电子病历系统间的数据交换—通过HL7messages交换MML(Medical Markup Language)3.0医疗文档

MML(Medical Markup Language)，作为一套不同医疗信息系统之间的交换规格于1995年在日本被开发。1999年正式公布版本2．21，使用XML作为标记语言。之后随着大规模的实证实验，版本2．21被进一步修改，2001年升级为包含12个模块的版本2．3。而最新版本3．0是在HL7Clinical Document Architeeture(CDA)基础上开发而成，它将版本2．3的结构分割并重新定义，以便于用MML记述的信息能在HL7CDALevel One中表达。开发的结果表明，采用MML版本3．0形式记述的医疗文档可以通过HL7messages来进行信息交换。MML完整的规格及有关数据由日本非营利组织MedXML委员会公开和管理，具体可参照http：／／www．medxml.net／。目前，我们正在进行MML3．0的中国本地化作业，主要包括MML中所参照的表格的追加和修改以及医疗保险模块等的制作。     

基于HL7标准的居民健康档案研究

目的随着医疗信息化的不断深入,医院内以及区域医疗信息共享已成为全球医疗卫生信息化的发展趋势。为临床医学科研提供更为准确和高效的信息检索与分析功能,是居民健康档案未来的发展方向。方法本文基于HL7（Health Level7）标准及可扩展标记语言（extensible markup language,XML）技术,在介绍居民健康档案功能和特点基础上,分析了健康档案的数据模型设计和实现方案,包括数据存储模式、XML存储方式选型、数据库选型等。结果通过运用XML技术和HL7标准的数据转换,可实现医院内部多个系统的无缝集成。结论在实际应用中,基于HL7标准的居民健康档案可以较好地保证数字化医疗信息的完整性、一致性,实现医疗信息共享。     

应用HL7标准建立心电信息数据库

心电图是临床应用最广泛的检查技术之一，临床和研究工作都积累了大量的心电图数据。之前常用的心电信息数据格式，很难使用查询语句实现对注释信息等高级内容的检索，成为多元心电信息数据挖掘发展的瓶颈。HL7-aECG是HL7研究组于2004年发布的应用于心电信息交流领域的数据标准，并希望该标准成为心电信息交流领域的统一标准。本研究使用HL7-aECG提供的XML sehema表作为数据组织结构标准，将现今常用的MIT-BIH格式的心电信息数据转换为符合HL7-aECG标准的心电信息数据，在建立数据库的基础上，实现对心电数据标注信息的检索。证实了HL7-aECG作为下一代心电信息数据格式标准的实用性，为多元心电信息数据挖掘工作提供借鉴。     

基于HL7标准的医学数据交换的原理

HL7是医疗保健领域电子数据交换的一个标准，涉及整个医院信息系统（HIS）。HL7可以规范临床医学和管理信息格式．降低医院信息系统互连成本，提高医院信息系统之间信息共享的程度。本文通过浅析HL7在HIS系统中的应用、HL7的消息机制、HL7消息构建／解析及HL7在电子病历中的应用，初步探讨了基于HL7标准的医学数据交换的原理。     

HL7网关的设计和实现

随着医学信息领域技术的发展，HL7标准日益受到重视，为了将HL7标准的研究成果付诸实施，我们设计了一个HL7网关系统，并用它连接了医院信息系统（HIS）和实验室信息系统（LIMS）两个差异很大的系统，实现了检验单和检验数据和标准电子信息交换，此项研究为进一步开发符合HL7标准的医学信息学系统提供了一种可供借鉴的方案。     

dcm4che在医疗信息集成中的初步应用

作为临床医学影像和对象管理的开源资源,dcm4che提供了D ICOM标准和HL7标准接口。dcm4che严格遵循IHE规范,是医疗信息集成中理想且强大的开发工具,但目前相关研究较少。本文在介绍IHE规范及医疗信息集成的基础上,介绍了dcm4che开源工具包在医疗信息系统中的功能特性和初步应用,其中包括dcm4che提供的各种接口及功能模块,重点介绍了dcm4che对D ICOM、HL7标准的完美支持,并利用部分应用实例阐述了严格遵循IHE规范的dcm4che开源工具包在医疗信息集成中的可用性、高效性和可移植性。本项工作为将来在医疗信息集成中大规模运用dcm4che提供了研究基础。     

HIS与医保系统间基于HL7标准的接口探讨

随着国家医疗体制改革的深化,社会医疗保险事业正在全面推行,医保系统与医院信息系统(HIS系统)之间的信息交互势在必行。HL7作为医学电子数据交换的标准日益得到医学界的重视。本文首先阐述了采用HL7进行研究的必要性,接着介绍了医疗信息通讯标准HL7的一些基本概念,最后着重讨论了利用HL7标准实现HIS与医保系统之间无缝连接的基本方法和实践。     

Foreign Exam Management in Practice: Seamless Access to Foreign Images and Results in a Regional Environment

A challenge for many clinical users is that a patient may receive a diagnostic imaging (DI) service at a number of hospitals or private imaging clinics. The DI services that patients receive at other locations could be clinically relevant to current treatments, but typically, there is no seamless method for a clinical user to access longitudinal DI results for their patient. Radiologists, and other specialists that are intensive users of image data, require seamless ingestion of foreign exams into the picture archiving and communication system (PACS) to achieve full clinical value. Most commonly, a clinical user will depend on the patient to bring in a CD that contains imaging from another location. However, a number of issues can arise when using this type of solution. Firstly, a CD will not provide the clinical user with the full longitudinal record of the patient. Secondly, a CD often will not contain the report associated with the images. Finally, a CD is not seamless, due to the need to manually import the contents of the CD into the local PACS. In order to overcome these limitations, and provide clinical users with a greater benefit related to a patient’s longitudinal DI history, the implementation of foreign exam management (FEM) at the local site level is required. This paper presents the experiences of FEM in practice. By leveraging industry standards and edge devices to support FEM, multiple sites with disparate PACS and radiology information system (RIS) vendors are able to seamlessly ingest foreign exams within their local PACS as if they are local exams.     

The impacts of smart cards on hospital information systems--an investigation of the first phase of the national health insurance smart card project in Taiwan

PURPOSE: To investigate the impacts of the first phase of Taiwan's Bureau of National Health Insurance (TBNHI) smart card project on existing hospital information systems. SETTING: TBNHI has launched a nationwide project for replacement of its paper-based health insurance cards by smart cards (or NHI-IC cards) since November 1999. The NHI-IC cards have been used since 1 July 2003, and they have fully replaced the paper-based cards since 1 January 2004. Hospitals must support the cards in order to provide medical services for insured patients. METHODS: We made a comprehensive study of the current phase of the NHI-IC card system, and conducted a questionnaire survey (from 1 October to 30 November, 2003) to investigate the impacts of NHI-IC cards on the existing hospital information systems. A questionnaire was distributed by mail to 479 hospitals, including 23 medical centers, 71 regional hospitals, and 355 district hospitals. The returned questionnaires were also collected by prepaid mail. RESULTS: The questionnaire return rates of the medical centers, regional hospitals and district hospitals were 39.1, 29.6 and 20.9%, respectively. In phase 1 of the project, the average number of card readers purchased per medical center, regional hospital, and district hospital were 202, 45 and 10, respectively. The average person-days for the enhancement of existing information systems of a medical center, regional hospital and district hospital were 175, 74 and 58, respectively. Three months after using the NHI-IC cards most hospitals (60.6%) experienced prolonged service time for their patients due to more interruptions caused mainly by: (1) impairment of the NHI-IC cards (31.2%), (2) failure in authentication of the SAMs (17.0%), (3) malfunction in card readers (15.3%) and (4) problems with interfaces between the card readers and hospital information systems (15.8%). The overall hospital satisfaction on the 5-point Likert scale was 2.86. Although most hospitals were OK with the project, there was about 22% dissatisfied and strongly dissatisfied, that is twice as many hospitals with satisfied (about 10%). CONCLUSIONS: Our recommendations for those who are planning to implement similar projects are: (1) provide public-awareness programs or campaigns across the country for elucidating the smart card policy and educate the public on the proper usage and storage of the cards, (2) improve the quality of the NHI-IC cards, (3) conduct comprehensive tests in software and hardware components associated with NHI-IC cards before operating the systems and (4) perform further investigations in authentication approaches and develop tools that can quickly identify where and what the problems are.     

心理测验在我国大学生心理健康评价中的应用现状及存在问题

目的　了解心理测验在我国大学生心理健康评价中的应用现状和发展趋势。方法　以 CNKI数据探索系统 (全文数据库 )为检索平台 ,标引关键词“大学生与心理健康”为检索入口词 ,检索该系统收录的 1 994～ 2 0 0 3年相关文献。结果　检索到相关文献 2 2 6篇 ,其中 90篇文献运用心理测验量表 ,使用量表的文献占 3 9.82 %。结论　心理测验作为大学生心理健康的评价工具之一已得到学校心理卫生工作者的认同和运用 ,但在使用过程中尚存在一些有待改进和完善的问题     

Early involvement of the cerebral cortex in Parkinson's disease: Convergence of multiple metabolic defects

Parkinson's disease (PD) has been considered a paradigm of degenerative diseases of the nervous system characterized by motor impairment (parkinsonism) due to malfunction and loss of dopaminergic neurons of the substantia nigra pars compacta. However, PD is a systemic disease of the nervous system with variegated clinical symptoms appearing before parkinsonism and due to the involvement of selected nuclei of the medulla oblongata, pons, autonomic nervous system and olfactory structures, among others. Furthermore, recent clinical data have shown modifications in behavior, personality changes and cognitive impairment leading to dementia. Lewy pathology, hallmark of PD, in the cerebral cortex does not correlate with cognitive impairment. However, recent studies have shown abnormal mitochondria content and function, and increased oxidative stress and oxidative responses in the cerebral cortex in PD. Furthermore, several key PD-related proteins are oxidatively damaged, including α-synuclein, β-synuclein, superoxide dismutases, parkin, DJ1, UCHL1 and enzymes involved in glycolysis and energy metabolism. DNA and RNA are also targets of oxidative damage. Furthermore, abnormal phosphorylation of α-synuclein and tau occurs at the cortical synapses. Finally, abnormal cortical metabolism has been revealed with neuroimaging methods. These data demonstrate early involvement of the cerebral cortex in PD due to the convergence of multiple metabolic defects. Lewy pathology is a relative late event, geared to isolate unremoved damaged protein, with little significance on cortical neurological deficits.