基于电子病历的医院信息平台的关键技术

目的：医院信息平台包括管理信息系统和临床信息系统,电子病历系统处于整个系统的中心位置,要以电子病历为核心构建基于电子病历的医院信息平台。方法：1、构建以电子病历为核心的体系架构,该体系框架由门户、应用、服务、资源、交换、业务、基础设施、标准、安全体系和运维管理共九层组成。2、建立临床数据存储库CDR,CDR数据来源于医院信息平台的临床和管理信息系统,按规定格式进行存储和归档后,供信息系统用户调用。3、实现信息系统集成,SOA模式是面向服务架构的新型集成体系,通过企业服务总线（ESB）实现,它将软件的功能设计成一个个独立封装的服务,并通过信息交换协议进行发布,达到无界限的联通和软件复用。结果：基于电子病历的医院信息平台满足医院信息系统应用和基础设施整合的需求。CDR支持及时性的、操作性的、集成性的整体临床信息的应用,实现面向主题的、集成的、标准的、可变的、当前的细节数据集合。SOA模式可以通过企业服务总线（ESB）实现,ESB将集线器模式的星形结构扩展为总线结构,将总线上的各个服务按照用户需要的业务逻辑组装起来,使这些服务按照业务逻辑顺序执行,从而实现用户完整的业务功能。结论：基于电子病历的医院信息平台结构、CDR数据存储结构和采用ESB技术的SOA集成模式是构建新一代医院信息系统的关键技术。     

Evaluation and selection of open-source EMR software packages based on integrated AHP and TOPSIS

Evaluating and selecting software packages that meet the requirements of an organization are difficult aspects of software engineering process. Selecting the wrong open-source EMR software package can be costly and may adversely affect business processes and functioning of the organization. This study aims to evaluate and select open-source EMR software packages based on multi-criteria decision-making. A hands-on study was performed and a set of open-source EMR software packages were implemented locally on separate virtual machines to examine the systems more closely. Several measures as evaluation basis were specified, and the systems were selected based a set of metric outcomes using Integrated Analytic Hierarchy Process (AHP) and TOPSIS. The experimental results showed that GNUmed and OpenEMR software can provide better basis on ranking score records than other open-source EMR software packages.     

Tamino在电子病案中的应用

在对基于XML文档的EMR进行有效存储的解决方案中，Tamino作为第一个纯XML数据库系统的信息服务器因其优良的系统架构可以高效对XML文档进行存储和获得各类型数据，是今后构建EMR系统结构中存储层的首要选择对象。随着更多专门针对XML的象Tamino一样的开发利器出现，BMR的发展前景将更为看好。     

中西医结合治疗重症急性胰腺炎病历管理系统

目的：提高医生对于重症急性胰腺炎（Severeacutepancreatitis,SAP）患者病历的有效录入、管理、提取等工作的效率和正确性。方法：采用在VC环境下利用MFCODBC方式访问ACCESS2003数据库构建系统。结果：该系统具备一般电子病历含有的功能包括病人基本信息管理、病人基础治疗信息管理、病人动态生理检测信息管理、系统管理功能以及针对重症急性胰腺炎的自动评分功能。结论：本系统适用于重症急性胰腺炎的临床应用。     

Xindice在EMR中的应用研究

在对基于XML文档的EMR进行有效存储和查询的解决方案中,本文认为作为具有代表性的开源的纯XML数据库系统的信息服务器,Xindice因其优良的系统架构可以高效地对XML文档进行存储和获得各类型医疗数据,是今后构建EMR系统结构中存储层的不错的选择对象.并依据医疗病案的结构特点,提供了可行的存贮优化方案.     

A case study of an EMR system at a large hospital in India: challenges and strategies for successful adoption

This paper presents an ethnographically inspired interpretive case study of the Electronic Medical Record (EMR) system at Sankara Nethralaya hospital in India. It presents challenges related to the adoption of the system and methods and strategies that were utilized in order to overcome these challenges and help the system be adopted successfully. One of the more notable challenges at the hospital was a user base that included skeptical users, those lacking computing skills, and that had a history of rejecting designs. Despite these barriers the hospital was able to adopt the EMR system successfully. Notable issues related to the success of the system include the design strategy that was eventually used, and critical technical and social features of the system intended to support skeptical users and those lacking IT skills. The study contributes to overall understanding of the environment at large hospitals in developing countries as it relates to the adoption of EMR systems, and helps inform on methods that can be used to improve the adoption of EMR systems in similar contexts in both developed and developing countries.     

Impact of PACS-EMR Integration on Radiologist Usage of the EMR

The purpose of this study was to objectively quantify the impact of implementing picture archiving and communication system-electronic medical record (PACS-EMR) integration on the time required to access data in the EMR and the frequency with which data are accessed by radiologists. Time to access a clinic note in the EMR was measured before and after integration with a stopwatch and compared by t test. An IRB-approved, HIPAA-compliant retrospective review of EMR access data from security audit logs was conducted for a 14-month period spanning the integration. Correlation of these data with report signatures identified the studies in which the radiologist accessed the EMR to obtain additional clinical data. Proportions of studies with EMR access were plotted and compared before and after integration using a chi-square test. Time to access the EMR decreased from 52 to 6 s (p?<?0.001). Proportion of studies with EMR access increased from 36.7% (10,175/27,773) to 44.9% (10,843/24,153) after integration (p?<?0.001). Integrating PACS and the EMR substantially decreases the time to access the EMR and is associated with a significant increase in the proportion of studies for which radiologists obtain additional clinical data.     

Using qualitative studies to improve the usability of an EMR

The adoption of electronic medical records (EMRs) and user satisfaction are closely associated with the system's usability. To improve the usability of a results management module of a widely deployed web-based EMR, we conducted two qualitative studies that included multiple focus group and field study sessions. Qualitative research can help focus attention on user tasks and goals and identify patterns of care that can be visualized through task modeling exercises. Findings from both studies raised issues with the amount and organization of information in the display, interference with workflow patterns of primary care physicians, and the availability of visual cues and feedback. We used the findings of these studies to recommend design changes to the user interface of the results management module.     

Inactivation of the EGF-TM7 receptor EMR4 after the Pan-Homo divergence

We here report on the identification of a novel human EGF-TM7 receptor, designated EMR4. Like most EGF-TM7 receptor genes, EMR4 is localized on the short arm of chromosome 19, in close proximity to EMR1. Remarkably, due to a one-nucleotide deletion in exon 8, translation of human EMR4 would result in a truncated 232-amino acid protein lacking the entire seven-span transmembrane region. This deletion is not present in nonhuman primates, including chimpanzees, suggesting that EMR4 became nonfunctional only after human speciation, about five million years ago. Thus, EMR4 surprisingly accounts for a genetic difference between humans and primates related to immunity.     

The trends in EMR and CPOE adoption in Japan under the national strategy

PurposeWe evaluate the status of health information system (HIS) adoption (In this paper, “HIS” means electronic medical record system (EMR) and computerized provider order entry system (CPOE)). We also evaluate the affect of the policies of Japanese government.MethodsThe status of HIS adoption in Japan from 2002 to 2011 was investigated using reports from complete surveys of all medical institutions conducted by the Ministry of Health, Labour and Welfare (MHLW). HIS-related budgets invested by the Japanese government from 2000 to 2008 were surveyed mainly using literatures and administrative documents of the Japanese government (MHLW and Ministry of Economy, Trade and Industry).ResultsThe rates of HIS adoption in Japan in 2011 were: 20.9% for the rate of EMR adoption in clinics, 20.1% for the rate of EMR adoption and 36.6% for the rate of CPOE adoption in hospitals. In hospitals, the rate of EMR and CPOE adoption were 51.5% and 78.6% in 822 large hospitals (400 or more beds), 27.3% and 52.1% in 1832 medium hospitals (200–399 beds), and 13.5% and 26.0% in 5951 small hospitals (less than 200 beds), respectively. Japan has a large number of medical institutions (99,547 clinics and 8605 hospitals) with a low rate of EMR adoption in clinics and a high rate of HIS adoption in hospitals. The national budget to expand HIS use was implemented for medium and large hospitals mainly. The policy target of New IT Reform Strategy was not achieved.ConclusionThe rate of HIS adoption in Japanese medium and large hospitals is high compared to small hospitals and clinics, and this is attributable to the fact that the Japanese government placed the target for HIS adoption on key hospitals with a large number of beds and concentrated budget investment in those hospitals. Besides, legal approval of EMR and the introduction of Diagnostic Procedure Combination system facilitated EMR adoption. There is less financial support for small hospitals than medium and large hospitals. The low rate of EMR adoption in clinics stems from the facts that there was little subsidies or incentives in the national remuneration for medical services, lack of cooperation from medical associations, and a failed attempt to mandate computerization of medical accounting (medical billing). Giving financial incentives is an effective means of raising EMR adoption rate. For wide usage of HIS, more financial support and incentive may be necessary for small hospitals and clinics.     

An efficient forward-secure group certificate digital signature scheme to enhance EMR authentication process

The frequently used digital signature algorithms, such as RSA and the Digital Signature Algorithm (DSA), lack forward-secure function. The result is that, when private keys are renewed, trustworthiness is lost. In other words, electronic medical records (EMRs) signed by revoked private keys are no longer trusted. This significant security threat stands in the way of EMR adoption. This paper proposes an efficient forward-secure group certificate digital signature scheme that is based on Shamir’s (t,n) threshold scheme and Schnorr’s digital signature scheme to ensure trustworthiness is maintained when private keys are renewed and to increase the efficiency of EMRs’ authentication processes in terms of number of certificates, number of keys, forward-secure ability and searching time.     

基于LabVIEW实现的心电监护系统

心电监护是监护系统中的重要组成部分,可获得监护对象心电信号的具体信息,对研究不同状态下的心脏状态具有重要的价值.本文是应用AD采集卡、心电放大器和虚拟仪器开发软件LabVIEW,在PC机上实现了具有人体心电实时采集、分析和存储功能的双通道心电实时监护系统.此虚拟仪器系统操作方便、便于修改,适用于人体心电监护、信号采集以及后期分析.     

The human EGF-TM7 receptor EMR3 is a marker for mature granulocytes

EMR3 is a member of the epidermal growth factor-seven-transmembrane (EGF-TM7) family of adhesion class TM7 receptors. This family also comprises CD97, EMR1, EMR2, and EMR4. To characterize human EMR3 at the protein level, we generated Armenian hamster mAb. Using the mAb 3D7, we here demonstrate that EMR3, like other EGF-TM7 receptors, is expressed at the cell surface as a heterodimeric molecule consisting of a long extracellular alpha-chain, which possesses at its N-terminus EGF-like domains and a membrane-spanning beta-chain. Flow cytometric analysis revealed that all types of myeloid cells express EMR3. In peripheral blood, the highest expression of EMR3 was found on granulocytes. More mature CD16(+) monocytes express high levels of EMR3, and CD16(-) monocytes and myeloid dendritic cells (DC) are EMR3(dim/low). Lymphocytes and plasmacytoid DC are EMR3(-). It is interesting that in contrast with CD97 and EMR2, CD34(+)CD33(-)/CD38(-) committed hematopoietic stem cells and CD34(+)CD33(+)/CD38(+) progenitors in bone marrow do not express EMR3. In vitro differentiation of HL-60 cells and CD34(+) progenitor cells revealed that EMR3 is only up-regulated during late granulopoiesis. These results demonstrate that the expression of EGF-TM7 receptors on myeloid cells is differentially regulated. EMR3 is the first family member found mainly on granulocytes.     

基于网格的医院数据系统

网格计算是在20世纪90年代中期提出来的，现已成为一个研究热点。介绍了网格计算的起源、概念、特点及研究现状，随后介绍了Globus项目的组成、发展及成果（Globus Toolkits是Globus最重要的研究成果，目前已经成为网格事实上的标准）。然后，以Globus Toolkits架构为基础，介绍了基于网格的医院数据系统，主要用于对医学影像的处理、存储和检索。为了充分利用医院的现有资源，系统是建立在医院现有的硬件设施之上，并与当前许多医院使用的PACS兼容，PACS是遵循DICOM标准的医院影像归档和通信系统。对资源管理、信息发布和信息检索进行了比较详细的介绍。     

基于网格的医院数据系统

网格计算是在20世纪90年代中期提出来的,现已成为一个研究热点。介绍了网格计算的起源、概念、特点及研究现状,随后介绍了Globus项目的组成、发展及成果(GlobusToolkits是Globus最重要的研究成果,目前已经成为网格事实上的标准)。然后,以GlobusToolkits架构为基础,介绍了基于网格的医院数据系统,主要用于对医学影像的处理、存储和检索。为了充分利用医院的现有资源,系统是建立在医院现有的硬件设施之上,并与当前许多医院使用的PACS兼容,PACS是遵循DICOM标准的医院影像归档和通信系统。对资源管理、信息发布和信息检索进行了比较详细的介绍。     

一种基于PC的医学图像可视化系统

三维医学可视化是近年来计算机图形学和图像处理技术研究和应用的重要领域。本文在PC上对多模态脑肿瘤医学图像的可视化进行了研究，该系统对医学图像进行了配准、融合、分割及三维重建，并以多种显示方式对重建结果进行显示。为脑肿瘤在诊断、治疗方面提供了有力的工具。     

Neuro-ophthalmology system based on a PET computer

A system is described which controls the stimuli, results and procedure for the three neuro-opthalmology tests, visual evoked response, electro-oculography and electro-retinography, using a PET microcomputer. The interface circuits are described, and a full listing of the program is given.