A unified structural/terminological interoperability framework based on LexEVS: application to TRANSFoRm

Objective

Biomedical research increasingly relies on the integration of information from multiple heterogeneous data sources. Despite the fact that structural and terminological aspects of interoperability are interdependent and rely on a common set of requirements, current efforts typically address them in isolation. We propose a unified ontology-based knowledge framework to facilitate interoperability between heterogeneous sources, and investigate if using the LexEVS terminology server is a viable implementation method.

Materials and methods

We developed a framework based on an ontology, the general information model (GIM), to unify structural models and terminologies, together with relevant mapping sets. This allowed a uniform access to these resources within LexEVS to facilitate interoperability by various components and data sources from implementing architectures.

Results

Our unified framework has been tested in the context of the EU Framework Program 7 TRANSFoRm project, where it was used to achieve data integration in a retrospective diabetes cohort study. The GIM was successfully instantiated in TRANSFoRm as the clinical data integration model, and necessary mappings were created to support effective information retrieval for software tools in the project.

Conclusions

We present a novel, unifying approach to address interoperability challenges in heterogeneous data sources, by representing structural and semantic models in one framework. Systems using this architecture can rely solely on the GIM that abstracts over both the structure and coding. Information models, terminologies and mappings are all stored in LexEVS and can be accessed in a uniform manner (implementing the HL7 CTS2 service functional model). The system is flexible and should reduce the effort needed from data sources personnel for implementing and managing the integration.     

The BioIntelligence Framework: a new computational platform for biomedical knowledge computing

Breakthroughs in molecular profiling technologies are enabling a new data-intensive approach to biomedical research, with the potential to revolutionize how we study, manage, and treat complex diseases. The next great challenge for clinical applications of these innovations will be to create scalable computational solutions for intelligently linking complex biomedical patient data to clinically actionable knowledge. Traditional database management systems (DBMS) are not well suited to representing complex syntactic and semantic relationships in unstructured biomedical information, introducing barriers to realizing such solutions. We propose a scalable computational framework for addressing this need, which leverages a hypergraph-based data model and query language that may be better suited for representing complex multi-lateral, multi-scalar, and multi-dimensional relationships. We also discuss how this framework can be used to create rapid learning knowledge base systems to intelligently capture and relate complex patient data to biomedical knowledge in order to automate the recovery of clinically actionable information.     

How outcomes are achieved through patient portals: a realist review

Objective

To examine how patient portals contribute to health service delivery and patient outcomes. The specific aims were to examine how outcomes are produced, and how variations in outcomes can be explained.

Methods

We used a realist review method, which aims to describe how ‘an intervention works, for whom, and in what circumstances’ by analyzing patterns between context, mechanism, and outcomes. We reviewed 32 evaluation studies of patient portals published since 2003.

Results

The reviewed evaluations indicate that as a complement to existing health services, patient portals can lead to improvements in clinical outcomes, patient behavior, and experiences. Four different mechanisms are reported to yield the reported outcome improvements. These are patient insight into personal health information, activation of information, interpersonal continuity of care, and service convenience. The vast majority of evaluations were conducted in integrated health service networks in the USA, and we detected no substantial variation in outcomes across these networks.

Discussion and conclusions

Patient portals may impact clinical outcomes and health service delivery through multiple mechanisms. Given the relative uniformity of evaluation contexts, we were not able to detect patterns in how patient portals work in different contexts. Nonetheless, it appears from the overwhelming proportion of patient portal evaluations coming from integrated health service networks, that these networks provide more fertile contexts for patient portals to be effective. To improve the understanding of how patient portals work, future evaluations of patient portals should capture information about mechanisms and context that influence their outcomes.     

基于hLDA层次主题模型的患者投诉分类框架研究

目的：使用机器学习方法构建患者投诉分类框架,以更好地评估医疗服务的质量。方法：使用hierarchical latent Dirichlet Allocation(hLDA）层次主题模型挖掘患者投诉数据的主题,再归纳出一个分类框架,并对患者投诉的主题分布进行可视化分析。结果：构建了一个基于患者投诉的分类框架,包括5个大类7个小类。可视化分析结果表明,患者投诉主要集中在临床服务类、环境类、管理类,共占88.37%。结论：通过对患者投诉数据进行挖掘,构建患者投诉分类框架,有利于更加科学合理地评估医疗服务质量。     

基于数据整合应用的预约挂号平台设计与实现

目的：基于医院各信息系统之间的业务数据整合,实现提供统一协同服务的“114”预约挂号服务平台。方法：借助消息中间件技术实现数据整合,通过数据准备、导入解析、传输应用,达成准实时的业务平台,并通过主数据管理保障业务数据的逻辑准确、数据一致与连续管理。结果：基于数据整合应用的方法,可建成预约挂号服务平台。结论：统一协同服务的“114”预约挂号服务平台,为患者提供预约挂号方便,优化了医院工作流程,满足了医政部门的要求。     

e-Consent: The Design and Implementation of Consumer Consent Mechanisms in an Electronic Environment

The effective coordination of health care relies on communication of confidential information about consumers between different health and community care services. However, consumers must be able to give or withhold “e-Consent” to those who wish to access their electronic health information. There are several possible forms for e-Consent. In the general consent model, a patient provides blanket consent for access to his or her information by an organization for all future information requests. Conversely, general denial explicitly denies consent for information to be used in future circumstances, and in each new episode of care, a new consent would be needed to obtain information. In the general consent with specific denial model, a patient attaches specific exclusion conditions to his or her general approval to future accesses. In contrast, in the general denial with explicit consent model, a patient issues a blanket block on all future accesses but allows the inclusion of future use under specified conditions. There also are several alternative functions for an e-Consent system. Consent could be captured as a matter of legal record. E-Consent systems could be more active by prompting clinicians to indicate that they have noted consent conditions before they access a record. Finally, the record of patient consent could be fully active and used as a gatekeeper in a distributed information environment. There probably will need to be some form of data object that is associated with patient information. This e-Consent object (or e-Co) will contain the specific conditions under which the data to which it is attached can be retrieved. Given the complexity of clinical work and the substantial variation we can expect in an individual''s desire to make his or her personal medical details available, it is unlikely a “one size fits all” approach to e-Consent will work. Consequently, with a well-chosen consent design, it should be possible to balance the specific need for privacy of some of the population against the desire by others to err on the side of clinical safety, and clinicians desire to minimize the burden that an electronic consent mechanism would impose.The effective coordination of health care relies on the communication of confidential information about consumers between different health and community care services. Electronic data exchange and Internet technologies increasingly play important roles in such communications. Consumers must, however, be able to give or withhold consent to those who wish to access their electronic health information.For example, electronic patient records are seen by many as an essential prerequisite for health care,¹ opening up patient data to the whole clinical team involved in patient care. So, by definition, the presence of an electronic environment means that more clinical workers will be able to access patient information more often and in a greater diversity of locations. With the broadening of access to patient information comes the risks that such information is used for purposes not originally consented to by the patient.While much is known about the ways in which security technology can protect information transactions from unwanted interception,² very little work exists to determine how a consumer''s consent to view their private information is safeguarded in a networked and online environment. This report will outline a framework for obtaining and determining electronic consent (e-Consent) within health care. It will examine a range of models for e-Consent and examine some of the technical issues associated with transforming those models into working systems. It is not the intention of this report to make a specific judgment about which consent models are more acceptable or to make specific recommendations about the detailed implementation of an e-Consent system. Such decisions would need to reflect the legal framework within which any e-Consent system operates, and the expressed wishes of consumers regarding the strength of protection they desire.Specifically, the report proposes a set of basic design principles that any consent framework might need to adhere to and focuses on some of the trade-offs in system performance that these principles imply. It then examines various possible forms of consent, explores the ways that these can be implemented in an online environment, and examines how well these models reflect the design principles. Next, the report explores the nature of information exchanges in health care and uses this to reflect on the acceptability of the different consent mechanisms in the clinical workplace, as well as to consumers. Finally, the report develops a health transaction model and uses this to sketch the set of behaviors or services an e-Consent system will need to perform its key functions. Appendices contain detailed examples of information transactions in health and an example set of computational rules for determining consent.     

面向服务的医院信息集成方法研究

当前医院业务系统林立,医疗系统之间互操作较为困难,难以适应医疗信息化建设的发展趋势,需要研究医院信息集成的新模式,以满足临床路径、电子病历、区域医疗的新需求。为此,研究了面向服务的医院信息集成模式,给出了系统互操作基本框架,阐述了病人主索引、数据综合浏览视图等实现技术。     

医院信息资源检索服务探讨

医院信息系统生成了大量的临床业务数据,但信息利用上还不深入,不能充分发挥信息的价值。提出了基于HIS的信息检索服务框架,探讨了一种全新的面向医院管理者、面向临床医疗科研人员、面向患者的信息检索服务。     

医院信息资源的信息检索服务探讨

医院信息系统生成了大量的临床业务数据,但信息利用上还不深入,不能充分发挥信息的价值。提出了基于HIS的信息检索服务框架,探讨了一种全新的面向医院管理者、面向临床医疗科研人员、面向患者的信息检索服务。     

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。     

Using EHRs to integrate research with patient care: promises and challenges

Clinical research is the foundation for advancing the practice of medicine. However, the lack of seamless integration between clinical research and patient care workflow impedes recruitment efficiency, escalates research costs, and hence threatens the entire clinical research enterprise. Increased use of electronic health records (EHRs) holds promise for facilitating this integration but must surmount regulatory obstacles. Among the unintended consequences of current research oversight are barriers to accessing patient information for prescreening and recruitment, coordinating scheduling of clinical and research visits, and reconciling information about clinical and research drugs. We conclude that the EHR alone cannot overcome barriers in conducting clinical trials and comparative effectiveness research. Patient privacy and human subject protection policies should be clarified at the local level to exploit optimally the full potential of EHRs, while continuing to ensure participant safety. Increased alignment of policies that regulate the clinical and research use of EHRs could help fulfill the vision of more efficiently obtaining clinical research evidence to improve human health.     

数字化医院网络信息统计整合与应用服务研究

本文通过对数字化医院管理者在信息资源应用中的现状与需求分析,面向管理应用的主题数据集设计、HIS事务资源的统计整合与应用系统框架设计、基于ODS的统计数据资源库构建、基于WEB的信息服务系统的设计与开发等内容的阐述,提出了数字化医院网络信息统计整合与应用服务解决方案。     

基于视频云的可视卫生指挥平台

目的：提出构建基于视频云的可视卫生指挥平台方案。基于云计算框架给出视频云分层计算框架,实现异构信息系统的资源集成年和视频指挥信息的优化传输。同时,对视频云可视卫生指挥平台方案的实现策略进行介绍。该方案能够实现可视化的卫生应急指挥,同时具有良好的可扩展性,能适应系统的各种扩展需求。     

区域协同医疗信息平台的基础构件——PIX服务

区域协同医疗是当前广为关注的话题，相应的信息平台的构建要充分考虑在不同环境下平台的适应性。在区域协同医疗信息平台的基础性服务中，首先要解决病人身份识别问题。介绍了以IHE信息框架的PIX规范为指导。构建病人标识交叉索引服务系统的要点。     

国家卫生信息化顶层设计与实施办法

阐述了国家卫生信息化的概念和内涵,并从顶层设计角度提出国家卫生信息化的基本架构,即：一个医疗网,一张医疗卡,三项基础集成,三级数据中心和多个服务平台.最后,就如何组织实施国家卫生信息化提出几点意见：首先要认识到实施过程中可能遇到的困难,其次要明确各方主要任务;此外,还要突出医疗卫生服务模式的创新调整,以及落实好相关政策.只有依靠政府主导,并在实践中不断总结经验,最终才能建成国家卫生信息化.     

Evidence-based medicine: useful tools for decision making

Evidence-based medicine (EBM) integrates clinical experience and patient values with the best available research information. There are four steps in incorporating the best available research evidence in decision making: asking answerable questions; accessing the best information; appraising the information for validity and relevance; and applying the information to patient care. Applying EBM to individual patients requires drawing up a balance sheet of benefits and harms based on research and individual patient data. The most realistic and efficient use of EBM by clinicians at the point of care involves accessing and applying valid and relevant summaries of research evidence (evidence-based guidelines and systematic reviews). The future holds promise for improved primary research, better EBM summaries, greater access to these summaries, and better implementation systems for evidence-based practice. Computer-assisted decision support tools for clinicians facilitate integration of individual patient data with the best available research data.     

医院信息化建设的重点与难点

随着信息技术在医疗机构日益得到广泛应用,医疗信息化在医院管理、临床管理和局域医疗卫生服务方面也取得了很大进展。如何利用信息技术更好地为医院的医疗、科研和教学服务,已越来越为人们所关注。因此,了解医院信息化建设中的一些重点与难点,对信息化建设的成败有着至关重要的作用。     

关于遗传咨询及其相关伦理问题探讨

对遗传咨询的定义作了界定,介绍了遗传咨询的发展以及目前实践概况,提出遗传咨询应当遵守尊重个人和家庭,保护家庭完整;信息的完全告知;遗传信息的保密和适当公开;非指令性咨询等伦理原则。同时结合我国遗传咨询实践的现状,探讨了我国目前遗传咨询中涉及和存在的伦理问题:对遗传咨询的定位和认识存在偏差,对个人人格、隐私的尊重和遗传性信息的保密不到位,遗传性咨询中的知情同意落实不到位,对咨询的非指令性理解和重视程度不够等。针对没有专业的遗传咨询师和专门的咨询机构的现状,提出解决遗传咨询现实难题的相关建议:加强对临床遗传服务的重视,提高医师的伦理意识,尊重患者和保护患者个人信息,努力做好告知义务并尊重患者选择,加强对遗传咨询的专业性教育。     

A study on building data warehouse of hospital information system

Background  Existing hospital information systems with simple statistical functions cannot meet current management needs. It is well known that hospital resources are distributed with private property rights among hospitals, such as in the case of the regional coordination of medical services. In this study, to integrate and make full use of medical data effectively, we propose a data warehouse modeling method for the hospital information system. The method can also be employed for a distributed-hospital medical service system.

Methods  To ensure that hospital information supports the diverse needs of health care, the framework of the hospital information system has three layers: datacenter layer, system-function layer, and user-interface layer. This paper discusses the role of a data warehouse management system in handling hospital information from the establishment of the data theme to the design of a data model to the establishment of a data warehouse. Online analytical processing tools assist user-friendly multidimensional analysis from a number of different angles to extract the required data and information.

Results  Use of the data warehouse improves online analytical processing and mitigates deficiencies in the decision support system. The hospital information system based on a data warehouse effectively employs statistical analysis and data mining technology to handle massive quantities of historical data, and summarizes from clinical and hospital information for decision making.

Conclusions  This paper proposes the use of a data warehouse for a hospital information system, specifically a data warehouse for the theme of hospital information to determine latitude, modeling and so on. The processing of patient information is given as an example that demonstrates the usefulness of this method in the case of hospital information management. Data warehouse technology is an evolving technology, and more and more decision support information extracted by data mining and with decision-making technology is required for further research.

     

Improving the quality of ambulatory health care with enhanced medical information systems: Using the computer to diagnose faulty clinical processes

The lack of consistency in the performance of the processes which implement clinical decisions is an important problem in ambulatory care. Since delayed or neglected actions in patient care may have serious consequences, we studied the use of industrial quality management techniques to determine where three clinical processes could be improved. These quantitative and graphical tools were useful in showing that in some processes, the failure rate could be as high as 33%. However, lack of readily available process data prevented a full analysis of the extent of the failures, so specific suggestions for improvement could not be made. Medical informatics and management specialists have an important role in designing enhanced medical information systems with which to examine and improve patient care processes. This new generation of MIS's should include order entry systems with flags for selected transactions, audit trails for all automated processes, functional integration of the separate departmental information systems, and enhanced communications features.