健康信息化的机遇和挑战

健康产业是近年来崛起的新兴产业,将成为带动我国国民经济增长的强大动力。文章阐述了环境时代、医学时代和健康时代健康服务产业的特点。分析了健康信息化的机遇和挑战,并提出对策。健康信息化将助推健康产业发展。     

openEHR 血压原型模型

openEHR规范是一套开放的电子健康档案体系。该规范提出了参考模型和原型双模型架构,参考模型定义信息,原型定义医疗知识,这样可以提高系统对医疗知识变化的适应能力。文章通过思维导图、概念、数据、状态、协议、事件和XML Schemas介绍了openEHR血压原型规范。     

Automated population of an i2b2 clinical data warehouse from an openEHR-based data repository

BackgroundDetailed Clinical Model (DCM) approaches have recently seen wider adoption. More specifically, openEHR-based application systems are now used in production in several countries, serving diverse fields of application such as health information exchange, clinical registries and electronic medical record systems. However, approaches to efficiently provide openEHR data to researchers for secondary use have not yet been investigated or established.MethodsWe developed an approach to automatically load openEHR data instances into the open source clinical data warehouse i2b2. We evaluated query capabilities and the performance of this approach in the context of the Hanover Medical School Translational Research Framework (HaMSTR), an openEHR-based data repository.ResultsAutomated creation of i2b2 ontologies from archetypes and templates and the integration of openEHR data instances from 903 patients of a paediatric intensive care unit has been achieved. In total, it took an average of ∼2527 s to create 2.311.624 facts from 141.917 XML documents. Using the imported data, we conducted sample queries to compare the performance with two openEHR systems and to investigate if this representation of data is feasible to support cohort identification and record level data extraction.DiscussionWe found the automated population of an i2b2 clinical data warehouse to be a feasible approach to make openEHR data instances available for secondary use. Such an approach can facilitate timely provision of clinical data to researchers. It complements analytics based on the Archetype Query Language by allowing querying on both, legacy clinical data sources and openEHR data instances at the same time and by providing an easy-to-use query interface. However, due to different levels of expressiveness in the data models, not all semantics could be preserved during the ETL process.     

基于openEHR的原型关系映射方法

医疗信息的复杂性和动态性给医疗信息系统带来1巨大挑战。openEHR规范的两层建模思想可以提高医疗信息系统的灵活性,适应医疗信息需求的变化。目前虽然已有采用openEHR官方提出的属性+路径(node+path)和openEHR参考模型对象关系映射的openEHR数据存储实现方案,但其性能无法达到临床实际应用的需要。本研究提出一种基于openEHR原型和关系数据库的自动映射方法,将原型映射为关系数据表、原型属性映射为关系数据表字段,在此基础上设计了原型驱动的数据持久化和数据访问平台。基于原型关系映射方法,对原型查询语言进行扩展,添加INSERT、UPDATE、DELETE等语法,使原型查询语言支持完整的数据操作功能。结果表明,原型关系映射方法与属性+路径和openEHR参考模型对象关系映射方法相比,在1 231条数据中查询3条数据时快69倍和8倍,在128 141条数据中查询1 593条数据时快2倍和17倍。原型关系映射和原型查询语言等技术不但可以发挥两层建模方法在医疗信息表达、存储和访问等方面的灵活性优势,而且能大幅提高数据访问的性能。     

Evaluating Model-Driven Development for large-scale EHRs through the openEHR approach

PurposeIn healthcare, the openEHR standard is a promising Model-Driven Development (MDD) approach for electronic healthcare records. This paper aims to identify key socio-technical challenges when the openEHR approach is put to use in Norwegian hospitals. More specifically, key fundamental assumptions are investigated empirically. These assumptions promise a clear separation of technical and domain concerns, users being in control of the modelling process, and widespread user commitment. Finally, these assumptions promise an easy way to model and map complex organizations.MethodsThis longitudinal case study is based on an interpretive approach, whereby data were gathered through 440 h of participant observation, 22 semi-structured interviews and extensive document studies over 4 years.ResultsThe separation of clinical and technical concerns seemed to be aspirational, because both designing the technical system and modelling the domain required technical and clinical competence. Hence developers and clinicians found themselves working together in both arenas. User control and user commitment seemed not to apply in large-scale projects, as modelling the domain turned out to be too complicated and hence to appeal only to especially interested users worldwide, not the local end-users. Modelling proved to be a complex standardization process that shaped both the actual modelling and healthcare practice itself.ConclusionA broad assemblage of contributors seems to be needed for developing an archetype-based system, in which roles, responsibilities and contributions cannot be clearly defined and delimited. The way MDD occurs has implications for medical practice per se in the form of the need to standardize practices to ensure that medical concepts are uniform across practices.     

openEHR研究综述及对我国电子健康档案的启示

openEHR是一种开放的双模型健康档案标准,其核心在于将医疗领域知识从具体的临床信息中分离出来,并分别建立参考模型和原型模型,从而使不同系统问能实现语义层的互操作。主要介绍了openEHR规范及其两层建模方法,以对我国电子健康档案提供参考。     

Dealing with the Archetypes Development Process for a Regional EHR System

Objectives

This paper aims to present the archetype modelling process used for the Health Department of Minas Gerais State, Brazil (SES/MG), to support building its regional EHR system, and the lessons learned during this process.

Methods

This study was undertaken within the Minas Gerais project. The EHR system architecture was built assuming the reference model from the ISO 13606 norm. The whole archetype development process took about ten months, coordinated by a clinical team co-ordinated by three health professionals and one systems analyst from the SES/MG. They were supported by around 30 health professionals from the internal SES/MG areas, and 5 systems analysts from the PRODEMGE. Based on a bottom-up approach, the project team used technical interviews and brainstorming sessions to conduct the modelling process.

Results

The main steps of the archetype modelling process were identified and described, and 20 archetypes were created.Lessons learned:

• – The set of principles established during the selection of PCS elements helped the clinical team to keep the focus in their objectives;
• – The initial focus on the archetype structural organization aspects was important;
• – The data elements identified were subjected to a rigorous analysis aimed at determining the most suitable clinical domain;
• – Levelling the concepts to accommodate them within the hierarchical levels in the reference model was definitely no easy task, and the use of a mind mapping tool facilitated the modelling process;
• – Part of the difficulty experienced by the clinical team was related to a view focused on the original forms previously used;
• – The use of worksheets facilitated the modelling process by health professionals;
• – It was important to have a health professional that knew about the domain tables and health classifications from the Brazilian Federal Government as member in the clinical team.

Conclusion

The archetypes (referencing terminology, domain tables and term lists) provided a favorable condition for the use of a controlled vocabulary between the central repository and the EMR systems and, probably, will increase the chances of preserving the semantics from the knowledge domain. Finally, the reference model from the ISO 13606 norm, along with the archetypes, proved sufficient to meet the specificities for the creation of an EHR system for basic healthcare in a Brazilian state.     

电子健康档案标准——CDA与openEHR

电子健康档案记录个人终生完整、准确的健康信息。针对目前常见的医疗档案标准,本文针对HL7CDA与openEHR进行了详细阐述,并针对两者在适用范围、模型结构与安全性方面的不同进行比较。并针对中国电子健康档案发展的前景进行展望,并指出了可能存在的障碍。     

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.     

基于区块链的个人健康记录分布式框架研究

利用区块链技术构建个人健康记录分布式框架,分析采用区块链存储医疗大数据存在的问题并提出相应改进措施,包括采取开放式电子健康记录规范（openEHR）标准,在区块链中仅存储主索引和查询位置等。阐述架构设计及安全性,指出其有助于实现可信任的个人健康记录访问。