基于IHE技术框架实现工作流集成

探讨基于医疗信息系统集成（IHE）技术框架实现医院工作流集成。北美放射学会（Radiology Society of North America，RSNA）和医疗卫生信息与管理系统学会（Healthcare Information and Management Systems Soeietv，HIMSS）联合发起的IHE项目从工作流集成的角度出发，基于医疗标准制定了在各种医疗信息源间交换数据的技术框架。我们利用这个技术框架，从放射科的实际工作出发，尝试在复杂而异构的医院环境中实现信息集成与工作流集成。基于IHE技术框架，通过协调各种医疗设备和信息系统，实现了放射科的工作流集成。在复杂而异构的医院环境中，基于IHE技术框架能实现工作流集成，同时对IHE技术框架在我国的应用前景进行了展望。     

IHE互操作性实现机制的研究

IHE基于现有的HL7、DICOM等标准,通过制定技术框架文件来对医疗业务流程进行规范化,为医疗信息系统间的瓦操作提供通用的解决方案.本文从IHE SWF集成模式入手,从信息模型、HL7标准和增强的采用、DICOM标准的采用和增强方面对IHE互操作性的实现机制进行了深入的研究,并就IHE瓦操作性验证测试在IHE互操作性实现上的重要作用进行了分析,对国内IHE集成测试的开展情况进行了回顾和展望.     

上海市举办“集成医疗保健企业”学习班

为了促进医疗信息系统的集成（特别是PACS／HIS／RIS的全面无缝集成），更有效地解决医疗信息系统的“孤岛现象”，上海市卫生局信息中心和上海放射诊断质控中心经过一年的论证，认为参照国际集成医疗保健企业（IHE）技术框架的集成模式新建或改造原有的PACS／RIS系统是切实可行的。2005年6月28日由上海卫生局信息中心、上海放射诊断质控中心主办IHE学习班．以进一步推动我国PACS事业的健康发展，力争尽快进人国际IHE行列。     

上海市举办"集成医疗保健企业(IHE)学习班"

为了促进医疗信息系统的集成（特别是PACS／HIS／RIS的全面无缝集成），更有效地解决医疗信息系统的“孤岛现象”，上海卫生局信息中心和上海放射诊断质控中心经过一年的论证，认为参照国际IHE技术框架的集成模式，新建或改造原有的PACS／RIS系统是切实可行的。2005年6月28日由上海卫生局信息中心、上海放射诊断质控中心主办IHE学习班，以进一步推动我国PACS事业的健康发展，力争尽快进入国际IHE行列。     

上海市举办“集成医疗保健企业（IHE）”学习班

为了促进医疗信息系统的集成[特别是医学图像存储与传输系统（PACS）／医院信息系缈放射学信息系统（RIS）的全面无缝集成]，更有效地解决医疗信息系统的“孤岛现象”，上海卫生局信息中心和上海放射诊断质控中心经过1年的论证，认为参照国际集成医疗保健企业（IHE）技术框架的集成模式，新建或改造原有的PACS／RIS系统是切实可行的。     

放射科工作流程标准化的临床应用

在医院信息化的进程中,随着大型的数字化医疗设备在医院中使用,各种医院管理信息系统和医疗临床信息系统正在普及.医院信息化使放射科工作流程发生了改变和创新,十分迫切的需要一个框架来支撑和理顺整个工作流程,以实现病人信息的共享和处理.美国医疗信息和管理系统委员会(HIMSS)和北美放射学会(RSNA)为了解决医疗信息共享的难题,于1998年协手开发IHE[1].     

医疗信息系统集成的进展

在医疗信息系统的发展中,为了优化"信息效率",创建了一系列公认的信息传输标准,其中特别受到关注的是DICOM和HL7.但在DICOM和HL7标准应用若干年后,北美放射学会(RSNA)和医疗信息和管理系统学会(HIMSS)以及医疗企业专家发现:上述标准描述的信息结构相当笼统,并缺乏系统设计和操作所要求的具体内容,一些信息系统如HIS、RIS、PACS,仍像"孤岛"一样缺乏系统之间的连接和通讯.为了解决上述问题,RSNA和HIMSS对医疗信息系统的集成问题作了大量的工作,其中最为引入瞩目的是以放射学工作流程为主的集成医疗保健企业(integrating healthcare the enterprise,IHE)[1]和为放射科和临床医疗服务,以EMR为目标,HL7中的CCOW标准为基础的桌面集成(desktop integration).     

企业级PACS建设过程中若干问题的思考

企业级PACS的优势主要体现在通过整个医疗企业范围的影像信息共享,直接为临床医疗工作服务。一套真正意义上的企业级PACS不但能够将影像检查及相关信息发送至临床,更重要的是能够根据不同临床科室的应用需求,提供相应的影像分析、处理、操作和记录工具。本文根据国外企业级PACS建设的发展趋势,介绍了Web影像信息发布系统、心脏科PACS解决方案,以及骨科PACS解决方案等三大成熟的应用技术。     

社区医疗中的影像信息系统(PACS/RIS)设计与实现

本文给出了一种针对国内中小医院、社区医疗中心设计和实现影像信息系统(PACS/RIS)的技术方案。根据I HE所定义的技术规范、DICOM信息交换和通信服务,充分考虑医院影像科室检查、图像诊断和报告工作的工作流程、运行模式等实际需求,设计和实现了集成集成化信息系统(PACS/RIS)。该系统实现医学影像检查工作的全数字化管理,以及影像检查设备、RIS、HIS和社区电子病历的无缝连接与集成。在确保影像检查诊断品质的前提下,社区医疗影像信息系统建设,应当采用国际(国家)相关技术标准和规范(如I HE、HL7、DICOM等)作为存储和交换的前提和依据,使影像信息系统与医院其他信息系统集成,使社区医疗影像信息资料作为未来电子病历组成部分,提高病人影像诊断质量和就诊效率。     

XDS-I在区域医疗文书中的应用研究

目的:在区域医疗文书研究中引入XDS-I的概念是为了解决医学影像规范化共享问题.方法:根据XDS-I模型,设计应用于多个医疗机构之间开展远程放射学业务的系统结构.结果:使用XDS-I实现了规范化医学影像的共享.结论:为区域医疗基于IHE技术框架的应用提供一种设计方案.     

应用IHE集成PACS/HIS,构建数字化医院之基础——新楼医院经验介绍

新楼医院在PACS的构建和PACS与HIS/RIS的集成中遵循I HE的技术框架,应用I HE的集成模式。结果显示I HE的参照应用不仅可以评估PACS厂商的集成能力,提高院内医疗人员素质外,也可以缩短PACS构建的进程,降低构建成本,并保证未来系统的扩充性。而医疗机构高层的充分支持和对标准应用的肯定,以及相关的完整教育训练和配套措施,是提高系统成功的关键因素。本文的实践证明采用标准规范的好处及分享个案医院应用I HE的经验,并再次验证标准规范对于医院不同信息系统集成的重要性,供其他医院在构建PACS时参考。     

Using the IHE scheduled work flow integration profile to drive modality efficiency.

The IHE (Integrating the Healthcare Enterprise) Scheduled Work Flow integration profile describes a communication and work flow environment that provides benefits for radiology departments who want to standardize system software. The IHE technical framework defines this environment by specifying the systems involved and the messages exchanged by those systems. The Modality Worklist is a key component of the Scheduled Work Flow integration profile that allows an operator at each modality in the department to retrieve a list of scheduled procedure steps to perform and to automate the process of entering the correct patient identification information in all the images created with the modality. The IHE technical framework defines two transactions used by the modality to tell the Image Manager and Order Filler what was performed and how many images were acquired: the Modality Procedure Step in Progress and Modality Procedure Step Completed. Users who specify the Scheduled Work Flow integration profile will benefit immediately by achieving a certain baseline of functionality. However, users will derive further benefits of increased operational efficiency through negotiation with the providers of software solutions. The integration profile defines features that are optional; users should evaluate these features and request those that are determined to be beneficial.     

Implementing a full-feature PACS solution in accordance with the IHE technical framework: the CHILI approach

RATIONALE AND OBJECTIVES: During the last 4 years, Integrating the Healthcare Enterprise (IHE) has worked in establishing a reliable integrated environment for medical imaging devices and other clinical information systems by using existing industry standards such as Digital Imaging and Communication in Medicine (DICOM) and Health Level Seven (HL7). Because IHE is organized and driven by professional organizations representing both buyers and vendors, it was able to define a common language for the various health care parties who are involved in the integration process. Thus IHE offers a rigorously organized technical framework that provides a comprehensive guide for a coordinated implementation of information standards. MATERIALS AND METHODS: A multistage plan for incorporating the IHE elements while scaling up general-purpose workstations with teleradiology functionalities to a full-feature picture archiving and communication system (PACS) solution was created. To introduce a pragmatic example, the plan approach was applied to the CHILI workstations (CHILI, Heidelberg, Germany). To implement the proposed plan in making various legacy systems comply with IHE, the effects of available resources and market needs on the plan are discussed. Most implementation challenges and problems were overcome using generic design approaches and well-designed DICOM utilities. RESULTS: On completion of the first stage, the PACS viewer and reporting workstations were IHE-compliant. In addition, the plan facilitates the conformance process while maintaining the planned software development cycle. CONCLUSION: Based on these positive results and the practical experience acquired during the first stage, further stages will be completed to provide the system with the required plug-and-play interoperability among systems from different vendors.     

放射科工作流集成的应用实践

探讨综合性大型医院RIS/PACS建设中放射科工作流集成方案。采用I HE radiology工作流相关的4个集成模式,并根据国内需求优化应用,达到改善预定工作流、报告工作流、简化纠错流程、提高工作诊疗效率及质量的要求。重视I HE radiology集成模式应用,兼顾本土化需求,完善数字化医疗影像工作环境。     

XDS-Ⅰ在区域医疗文书中的应用研究

目的：在区域医疗文书研究中引入XDS-Ⅰ的概念是为了解决医学影像规范化共享问题。方法：根据XDS-I模型,设计应用于多个医疗机构之间开展远程放射学业务的系统结构。结果：使用XDS-I实现了规范化医学影像的共享。结论：为区域医疗基于IHE技术框架的应用提供一种设计方案。     

The quest for standards in medical imaging

This article focuses on standards supporting interoperability and system integration in the medical imaging domain. We introduce the basic concepts and actors and we review the most salient achievements in this domain, especially with the DICOM standard, and the definition of IHE integration profiles. We analyze and discuss what was successful, and what could still be more widely adopted by industry. We then sketch out a perspective of what should be done next, based on our vision of new requirements for the next decade. In particular, we discuss the challenges of a more explicit sharing of image and image processing semantics, and we discuss the help that semantic web technologies (and especially ontologies) may bring to achieving this goal.     

Integrating your radiology information system in a complex computing environment

Radiology departments are a major source of important information regarding patient care. Such information is valuable in its own right but also provides significant added value when correlated with other information, including other clinical diagnoses, therapies, utilization, costs of care and outcomes. In the past, hospitals/imaging centers have typically sought the "best" RIS to meet the needs of the department and its user constituencies (physicians, nurses, medical records, etc.). Function and feature drove the RIS selection process. "Best of breed" was the rallying cry. Having multiple systems and vendors requires information systems and departmental staff to maintain expertise and support in each system and to interact with each vendor. The best-of-breed approach has a number of hidden costs. Before buying, ask "Is the best-of-breed RIS so much better than a more integrated solution that the support and integration efforts are worth it?" This is a complex question involving true needs, perceived needs, wants (justifiable or not), ego, politics, institutional future plans and more. Effective integration in a complex computing environment involves both technical processes and people processes. A cooperative, team-oriented process with the appropriate allocation of staff functions based on expertise and experience is needed. In general, the radiology department is best able to manage operations of the RIS. The information systems department should retain responsibility for housing the RIS computer and performing routine backup procedures as well as monitoring RIS performance. Both organizations can contribute to a highly successful integrated system operation based on their respective knowledge and experience. The IHE (Integrating the Healthcare Enterprise) is a joint initiative of the RSNA and HIMSS (Healthcare Information Systems Society) to stimulate the integration of information and imaging systems. The initiative will promote enterprise-wide sharing of data via established standards. The organizations, at their annual national meetings, will provide a visible forum and showcase of integration capabilities (most recently at HIMSS 2000).     

Enterprise PACS and image distribution.

Around the world now, because of the need to improve operation efficiency and better cost effective healthcare, many large-scale healthcare enterprises have been formed. Each of these enterprises groups hospitals, medical centers, and clinics together as one enterprise healthcare network. The management of these enterprises recognizes the importance of using PACS and image distribution as a key technology in cost-effective healthcare delivery in the enterprise level. As a result, many large-scale enterprise level PACS/image distribution pilot studies, full design and implementation, are underway. The purpose of this paper is to provide readers an overall view of the current status of enterprise PACS and image distribution. reviews three large-scale enterprise PACS/image distribution systems in USA, Germany, and South Korean. The concept of enterprise level PACS/image distribution, its characteristics and ingredients are then discussed. Business models for enterprise level implementation available by the private medical imaging and system integration industry are highlighted. One current system under development in designing a healthcare enterprise level chest tuberculosis (TB) screening in Hong Kong is described in detail.