基于区块链的电子医疗病历共享方案

针对当前各医疗相关机构间数据共享困难、数据隐私易泄露等问题,提出了一个基于区块链的电子医疗病历（EHR）共享方案。首先,基于区块链不可篡改、去中心化、分布式存储的特点,设计了基于区块链的EHR数据共享模型,采用区块链网络和分布式数据库共同存储加密的EHR及相关访问控制策略,防止EHR数据被篡改和泄露;其次,将分布式密钥生成（DKG）技术与基于身份的代理重加密（IBPRE）技术相结合,设计了数据安全共享协议,协议使用委托权益证明（DPOS）算法选取代理节点,重加密EHR,实现单对用户间的数据共享。安全性分析表明,所提方案能够抵抗身份伪装和重放攻击。仿真实验与对比分析表明,DPOS算法的效率高于工作量证明（POW）算法,略低于实用拜占庭容错（PBFT）算法,但所提方案去中心化程度更高,耗费算力较小。     

电子健康档案的加密研究

为了使电子健康档案在各个卫生机构进行安全、高效地传输,提出运用AES和DNA两种对称数据加密方法分别对电子健康档案进行加密。分析了AES和DNA两种加密方法的安全性,并且比较了它们对电子健康档案的实际加密效率。通过上述两方面的对比显示,在一般要求的硬件配置下,运用软件方法改进的AES加密算法实现的电子健康档案能够更快速、安全地传输。     

区块链在电子病历系统中的创新应用

我国医疗健康体系的数据化建设,在过去数年里已经取得了一定的成效,最为核心的医疗数据,包括患者的体征、检查、用药等信息,都已经实现数字化。在数字化基础之上的医疗数据共享,尤其是电子病历的共享,是推动医疗体系建设和提升医疗效率的关键。文章着重描述了电子病历的概念、主要功能作用,从传统电子病历系统存在的问题出发,分析了区块链技术如何作用于电子病历系统,让医疗数据更有效地发挥实际作用,也可为发生重大疫情疾病事件时提供重要支撑力量。     

加密电子病历数据共享方案

为了实现电子病历数据的细粒度访问控制以及安全存储与共享,提出了一种基于属性的云链协同存储的电子病历共享方案。该方案用对称加密算法加密电子病历,用基于密文策略的属性基加密算法加密对称密钥,用可搜索加密算法加密关键字。电子病历密文存储在医疗云上,安全索引存储在联盟链上。该方案使用可搜索加密技术实现关键字的安全搜索,使用代理重加密技术实现用户属性的撤销。经安全性证明,该方案能够实现密文的安全性和关键字的安全性。数值模拟实验结果表明,该方案是有效的。     

Understanding process change management in electronic health record implementations

Electronic health record (EHR) implementations involve changes to core organizational processes, and management of these changes is critical to the success of such implementation efforts. This research describes how process change issues relate to implementation of large IT projects in healthcare settings. Specifically, we draw on extant literature and conduct directed content analysis on project reports by past HIMSS Davies Award recipients to present process change related best practices occurring in EHR implementations. The results from this study can influence implementation strategies for future health information technology implementation efforts in the healthcare sector.     

Evaluating usability of a commercial electronic health record: A case study

Electronic health records (EHR) are increasingly being implemented by care providers in order to streamline processes and improve quality of care. Due to EHRs’ complexity, the usability of these systems is crucial to ensure safety and to enable clinicians (users) to focus on their patients rather than the technology. This case study presents experiences from the implementation of a commercial EHR in a large pediatric hospital system. This case discusses how a predictive evaluation method, Heuristic Walkthrough, was used to evaluate and improve the usability of the EHR system. Outcomes from the evaluation resulted in immediate changes in the system configuration and training materials, which helped to avoid usability problems at rollout, as well as change requests to the vendor to improve overall system usability in the long term. Design trade-offs and lessons learned for future EHR implementations and other healthcare applications are discussed.     

When workarounds aggravate misfits in the use of electronic health record systems

This paper contributes to the IS misfits and workarounds literature by demonstrating how “work system–technology” misfits and workarounds can be mutually related. In the context of electronic health record (EHR) systems, this study examines when misfits experienced between an EHR system and health professionals' work practices lead to workarounds with negative consequences in terms of aggravating misfits. Our qualitative study was conducted in two tertiary hospitals in The Netherlands that had implemented an off-the-shelf EHR system. We analysed the “misfit experience → response → consequence” sequences that emerged from interviews complemented with observations and documents. Experienced misfits between the EHR and other work system components induced highly varied responses, among which workarounds. While workarounds can be beneficial, we found occasions where workarounds resulted in aggravated misfits. We conceptualise three underlying misfit-aggravating EHR-use patterns emerging from (1) a non-routine practice's perceived exceptionality, (2) collective separatism in incompatible routine practices, and (3) individual deviancy in routine work practices. These patterns differ in terms of the work practices' routineness, professionals' misfit experiences, and in how this combination provokes an individual or collective workaround that is non-compliant with both the designed technology use and the organisational intent. To understand how these patterns emerge, we discuss the interplay among work practice routineness, misfit characteristics, and non-compliant workaround behaviours.     

Quantitative ethnographic study of physician workflow and interactions with electronic health record systems

This study explores the relationship between primary care physicians' interactions with health information technology and primary care workflow. Clinical encounters were recorded with high-resolution video cameras to capture physicians' workflow and interaction with two objects of interest, the electronic health record (EHR) system, and their patient. To analyze the data, a coding scheme was developed based on a validated list of primary care tasks to define the presence or absence of a task, the time spent on each task, and the sequence of tasks. Results revealed divergent workflows and significant differences between physicians' EHR use surrounding common workflow tasks: gathering information, documenting information, and recommend/discuss treatment options. These differences suggest impacts of EHR use on primary care workflow, and capture types of workflows that can be used to inform future studies with larger sample sizes for more effective designs of EHR systems in primary care clinics. Future research on this topic and design strategies for effective health information technology in primary care are discussed.Relevance to industryThis paper presents the effect of EHR use on workflow of a primary care visit. Understanding physicians' interaction styles can inform design of specific features of future health IT systems for more effective and efficient workflow in outpatient setting.     

A bi-level interactive decision support framework to identify data mining-oriented electronic health record architectures

Nowadays, many healthcares are generating and collecting a huge amount of medical data. Due to the difficulty of analyzing this massive volume of data using traditional methods, medical data mining on Electronic Health Record (EHR) has been a major concern in medical research. Therefore, it is necessary to assess EHR architectures based on the capabilities of extracting useful medical knowledge from a huge amount of EHR databases. In this paper, we develop a bi-level interactive decision support framework to identify data mining-oriented EHR architectures. The contribution of this bi-level framework is fourfold: (1) it develops Interactive Simple Additive Weighting (ISAW) model from an individual single-level environment to a group bi-level environment; (2) it utilizes decision makers’ preferences gradually in the course of interactions to reach to a consensus on an data mining-oriented EHR architecture; (3) it considers fuzzy logic and fuzzy sets to represent ambiguous, uncertain or imprecise information; and (4) it synthesizes a representative outcome based on qualitative and quantitative indicators in the EHR assessment process. A case study demonstrates the applicability of the proposed bi-level interactive framework for benchmarking a national data mining-oriented EHR.     

电子病历的原生XML存储方式

详细分析传统的XML电子病历（Electronic Medical Record,EMR）存储方式．针对传统RMR存储方式修改表结构代价大,系统维护困难、负担加重,不能为XML文档建立索引并加快查询速度,不能充分利用XML数据资源、分解文档通常还会造成细节损失等缺点,提出一种新的电子病历原生XML存储方式。该方式不仅可以降低系统复杂度,而且结合行业新兴的XML数据操作语言可以方便地将稿历中的信息应用于医学信息统计、临床辅助诊断等其他领域,从而拓展电子病历的应用空间．     

电子病历中的模板及其实现方法

探讨模板在电子病历体系中的地位、作用和任务,分析了当前使用的几种模板的结构、功能和实现方法。着重讨论如何通过Delphi程序设计来实现模板,完成模板在规范和引导病历数据输入、实现专业病历逻辑和进行病历存储等方面的关键任务。最后通过一个电子病历系统的实例讨论如何使用模板将医学知识、临床经验、病案分析以及整个诊疗过程进行计算机化处理,探讨模板在设计与实现时应解决的关键技术问题。     

电子病历文本挖掘研究综述

跨语言词向量表示旨在利用语言资源丰富的词向量提高语言资源缺乏的词向量表示. 已有方法学习2个词向量空间的映射关系进行单词对齐,其中生成对抗网络方法能在不使用对齐字典的条件下获得良好性能. 然而,在远语言对上,由于缺乏种子字典的引导,映射关系的学习仅依赖向量空间的全局距离,导致求解的词对存在多种可能,难以准确对齐. 为此,提出了基于双判别器对抗的半监督跨语言词向量表示方法. 在已有对抗模型基础上,增加一个双向映射共享的、细粒度判别器,形成具有双判别器的对抗模型. 此外,引入负样本字典补充预对齐字典,利用细粒度判别器进行半监督对抗学习,消减生成多种词对的可能,提高对齐精度. 在2个跨语言数据集上的实验效果表明,提出的方法能有效提升跨语言词向量表示性能.

     

Balancing documentation and direct patient care activities: A study of a mature electronic health record system

US hospitals now fully embrace electronic documentation systems as a way to reduce medical errors and improve patient safety outcomes. Whether spending time on electronic documentation detracts from the time available for direct patient care, however, is still unresolved. There is no knowledge on the permanent effects of documenting electronically and whether it takes away significant time from patient care when the healthcare information system is mature. To understand the time spent on documentation, direct patient care tasks, and other clinical tasks in a mature information system, we conducted an observational and interview study in a midwestern academic hospital. The hospital implemented an electronic medical record system 11 years ago. We observed 22 health care workers across intensive care units, inpatient floors, and an outpatient clinic in the hospital. Results show that healthcare workers spend more time on documentation activities compared to patient care activities. Clinical roles have no influence on the time spent on documentation. This paper describes results on the time spent between documentation and patient care tasks, and discusses implications for future practice.Relevance to industryThe study applies to healthcare industry that faces immense challenges in balancing documentation activities and patient care activities.     

基于XML的结构化电子病历系统设计

阐述了两种结构化数据采集的方法:自然语言处理(NLP)和结构化数据输入(SDE).基于上述两种方法,设计了一个结构化电子病历系统(EPR)的原型,用XML技术来描述和实现知识库,使用Microsoft.NET的XML数据流技术实现病历数据的输入、存储和展现,并使用XSL技术实现Web方式的病历浏览.设计表明,利用XML技术解决病历的自由输入并和结构化输入相结合,是可行的技术方案;它为电子病历的研究提供了新的途径.     

Value alignment's role in mitigating resistance to IT use: The case of physicians'resistance to electronic health record systems

This research investigates the impact of value alignment on physician resistance to electronic health record systems (EHRS) through the reduction of perceived threat to professional autonomy and perceived changes in work processes. Analyses of data collected from 104 US physicians using SmartPLS reveal that value alignment (i) directly impacts resistance to EHRS, (ii) influences resistance to EHRS use by reducing the perceived threat to professional autonomy, and (iii) influences perceived changes in work processes. Overall, our research holds significant promise for theory and practice and has the potential to become foundational for future research on mitigating resistance to IT use.     

电子病历管理系统的设计与实现

采用数字签名技术、加密技术、时间戳技术、散列函数和角色访问控制等安全技术,结合ASP技术和Microsoft Access数据库进行设计和实现一个电子病历管理系统.该系统实现了病历内容的机密性、完整性、不可否认性和认证性等安全特性,具有病人网上注册、挂号、查看病历、医生网上书写病历及签名、病历加密等功能.     

计量检测中的无纸记录和电子签名技术

编程技术的日益强大和加密数据库的应用,使计量检定记录和证书副本的保存以及它们签名的传统方法和习惯进入了无纸记录和电子签名的时代.     

多目标动态规划在电子病历结构化的应用

电子病历结构化可以理解为在自由文本中找到合适的关键字,目前在自由文本中提取关键字的方法有实体识别和中文分词,但由于电子病历结构化是要在多种语义关联下找合适的关键字,而实体识别和中文分词不能达到其目标。因此根据已有的结构元素数据库建立倒排索引找到一组最合适的简单元素组合,利用多目标动态规划进行最优化组合,利用求交集方法找到复杂元素从而找出最优的一组序列即为该电子病历的结构化。通过系统实现得到利用该方法不仅可以找到结构元素,而且找到的结构元素之间有一定的语义关联。