数字化医院的架构设计与数据交换技术的研究
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摘要
随着病人对医疗质量和服务水平需求的提高，以及医院医疗设备的增多，特别是计算机和网络技术的普及，各种信息系统开始在医院中投入使用，建设数字化医院(Digital Hospital，DH)已经成为当今医院发展的必然趋势。
本文回顾了DH产生的历史背景，阐述了建设DH的必要性与重要意义，概括地叙述了国内外DH的发展情况并指出了国内DH建设的差距。文章对DH的内涵、DH建设的主要内容、DH建设的整体框架设计提出了自己的看法，从纵向上说明了DH建设的五个层次，并特别指出了目前国内外DH领域应用的有关医疗信息标准。
文章在总结国内外DH建设经验基础上，提出了在我国构建DH的设想，并对DH的整体框架、层次结构、业务标准流程和医疗信息标准等内容进行了论述。
对如何解决数字化医院中的数据交换问题，本文提出了两种解决方法：共享数据库(Shared Database，SD)和HL7(Health Level Seven)标准技术。
文章重点论述了DH建设中如何利用HL7进行标准化数据的转换与传输，并用编程实现不同科室间文本报告信息的传递。
本文为国内各大医院构建DH提供了必须的相关信息、资料与部分关键技术，为我国DH建设做出了一点有益的探索与尝试。
It has been a trend of hospital development to construct the Digital Hospital with the improvement of medical quality and promotion of service level demanded by the patient, with the increases on the medical equipments, especially the popularization of the computer and network technology, and application of various kinds of information systems in the hospital.
First, in the papers the historic background for construction of the Digital Hospital was reviewed. The necessity and importance for DH construction was described comparing with the difference between abroad and home in developing DH. The constants and the whole framework of DH was also presented herewith in the view of paper' s author and the five levels of constructions in the DH information systems were enumerated in the depth , especially the relevant standards of the medical information that was used in the field of DH within home and abroad, were also pointed out.
Secondly, the thinking for construction of DH in our country was presented based on the experience of DH construction in both home and abroad. It has been discussed the content of DH' s framework, standand flow of medical operation and standardization of medical information.
Thirdly, we gave two ways to solve the problem of data exchange in DH:0ne is Shared Database, another is technology of HL7.
We used much content to discuss how to convert and transmit the standard data by HL7 in the papers. Finally we programmed to implement the transmission of report in text formatting among the different department in the hospital.
Much necessary information, data and some key technique for DH construction have been offered. We have done best to try and explore somewhat for promoting DH construction in the hospital of our country.
本文回顾了DH产生的历史背景，阐述了建设DH的必要性与重要意义，概括地叙述了国内外DH的发展情况并指出了国内DH建设的差距。文章对DH的内涵、DH建设的主要内容、DH建设的整体框架设计提出了自己的看法，从纵向上说明了DH建设的五个层次，并特别指出了目前国内外DH领域应用的有关医疗信息标准。
文章在总结国内外DH建设经验基础上，提出了在我国构建DH的设想，并对DH的整体框架、层次结构、业务标准流程和医疗信息标准等内容进行了论述。
对如何解决数字化医院中的数据交换问题，本文提出了两种解决方法：共享数据库(Shared Database，SD)和HL7(Health Level Seven)标准技术。
文章重点论述了DH建设中如何利用HL7进行标准化数据的转换与传输，并用编程实现不同科室间文本报告信息的传递。
本文为国内各大医院构建DH提供了必须的相关信息、资料与部分关键技术，为我国DH建设做出了一点有益的探索与尝试。
It has been a trend of hospital development to construct the Digital Hospital with the improvement of medical quality and promotion of service level demanded by the patient, with the increases on the medical equipments, especially the popularization of the computer and network technology, and application of various kinds of information systems in the hospital.
First, in the papers the historic background for construction of the Digital Hospital was reviewed. The necessity and importance for DH construction was described comparing with the difference between abroad and home in developing DH. The constants and the whole framework of DH was also presented herewith in the view of paper' s author and the five levels of constructions in the DH information systems were enumerated in the depth , especially the relevant standards of the medical information that was used in the field of DH within home and abroad, were also pointed out.
Secondly, the thinking for construction of DH in our country was presented based on the experience of DH construction in both home and abroad. It has been discussed the content of DH' s framework, standand flow of medical operation and standardization of medical information.
Thirdly, we gave two ways to solve the problem of data exchange in DH:0ne is Shared Database, another is technology of HL7.
We used much content to discuss how to convert and transmit the standard data by HL7 in the papers. Finally we programmed to implement the transmission of report in text formatting among the different department in the hospital.
Much necessary information, data and some key technique for DH construction have been offered. We have done best to try and explore somewhat for promoting DH construction in the hospital of our country.
引文
[1] Erica Brazen,Jason Fortin Digital Hospitals Move Off the Drawing Board, First Consulting Group, 2003
[2] 郑华金、董代富等，高校附属医院信息管理多模式应向全数字化推进，中国医学教育技术，2003，6：151
[3] 刘谦、翁昌晶等，建立基于千兆以太网技术的医院园区网，数理医药学杂志，2002，15(3)：263
[4] 顾伯铭，美国建造首家全数字医院，江苏卫生事业管理，2001，6：79
[5] 张文康，我国卫生信息化建设现状与展望，中国信息年鉴，2002
[6] 中华人民共和国卫生部，医院信息系统基本功能规范，北京：中华人民共和国卫生部，2002
[7] 刘丹红、张玉海、徐勇雾、焦志勇，医院信息标准化应遵循的几个原则与主要内容，中国医院统计2002年6月第9卷第2期
[8] 齐国隆、孔令人，医疗环境电子数据交换标准HL7 v3．0的新进展。中华医院管理，17(6)，361—363
[9] Vogl, R, Going all digital in a University Hospital:A unified large scale PACS for multiple departments and hospitals, Proceedings of SPIE-The International Society for Optical Engineering, v 4323, 2001, p 7-15
[10] 刘劲松，HIS系统标准化的研究与实现，大连海事大学2001年硕士学位论文
[11] Health Level Seven,Inc,HL7 Version 3 Statement of rinciples,http://www.hl7.org.1998
[12] Norman Daoust,D,Mead Walker,HL7 Version 3 Education——Example Model Walkthrough,http://www.hl7.org,1998
[13] 李保罗、迟宝兰，医学信息标准化的理论与实践，中国信息导报，1999，4：40-42
[14] Health Level Seven, Inc,HL7 Version 3 Standard Ballot Version,http://www.hl7. org, 2003
[15] W.Prtan, G.Mosser,H. Krampla, W. Malcher, The digital hospital information technology in radiology, RBM-Revue Europeenne de Technologie Biomedicale Volume: 18, Issue: 5, 1996, pp.153-158
[16] Araki. Kenji,Ohashi. Katsuhiro,Yamazaki.Shunji, Hirose. Yasuyuki, Medical Markup Language (MML) for XML-based Hospital Information Interchange,Journal of Medical Systems 0148-5598;200006 24卷3期
[17] Indiana [correction of Indian] Heart Hospital will be all digital hospital without paper records.(eng), Health Care Strateg Manage,2002 Mar; Vol. 20 (3), pp. 4-5
[18] HealthSouth begins construction of new all-digital hospital.Hospital Materials Management, Jan2002, Vol. 27 Issue 1, p19, 1/3p;(AN 6126674)
[19] Rollins.Gina,The Digital Hospital: Looking Before You Leap,Healthcare Executive,Sep/Oct2002, Vol.17 Issue 5, p24, 4p; (AN 7244752)
[20] All-digital hospital will include wide range of equipment, software from Siemens,Hospital Materials
Management,Oct2002, Vol. 27 Issue 10, p5,1/7p; (AN 7549285)
[21] 姚志洪，系统整合与信息孤岛，医院信息化专家研讨会，2002，北京
[22] 龙安靖，设计检验信息系统HL7整合机制，台北医学大学医学信息研究所2002年硕士学位论文
[23] Health Level Seven, Inc,HL7 Standard Version 2.4,http://www.hl7.org, 2000
[24] Csipo. D,Integrating digital imaging and communications in medicine (DICOM) structured reporting into the hospital environment Journal of Digital Imaging, v 14, n 2 SUPPL.1, June, 2001, p 12-16
[25] 段会龙、吕旭东，医疗信息系统的工作流集成，浙江大学学报，2002，3：
[26] W3C,Extensible Markup Language (XML) 1.0,http://www.w3.org/TR/2000/REC-xml-20001006, 2000
[27] Galloro.Vince,Hospital of the future,Modern Healthcare, 9/24/2001, Vol. 31 Issue 39, p24, 1/2p, lc
[28] Carrns, Ann, Oracle to Announce Joint Effort for 'Digital' Hospital. HealthSouth, 03/26/2001, Vol. 237 Issue 59, pB11, Op
[29] Robert H,Dolin, LioraAlschuler, FredBehlen等,HL7 Document Patient Record Architecture: An XML Document Architecture Based on a Shared Information Model, Proceedings [Proc AMIA Symp] 1999, pp. 52-6
[30] Robert H,Dolin, Paul V,Biron,Using XML as a Supplementary Messaging Syntax for HL7 Version 2.3.1,http://www.hl7.org, 2000
[31] Borden. Susan,Digital Hospital,Technology Review, Jul/Aug2001,Vol. 104 Issue 6, p30, 2/3p, 2c
[32] Pavlopoulos, Sotiris A. Delopoulos, Anastasios.N, Designing and implementing the transition to a fully digital hospital,Source: IEEE Transactions on Information Technology in Biomedicine, v 3, n 1, Mar, 1999, p 6-19
[39] 何雨生，HL7与医院信息系统集成，医院信息化专家研讨会，2002，北京
[40] 台湾健康信息交换第七层协议协会，电子病历之HL7转诊标准(草案)，http://www.hl7。org。tw，2001
[41] 高源忠，国内电子转诊病历交换HL7标准之研究，台北医学大学医学信息研究所2001年硕士学位论文
[42] Wes Rishel,HL7 Version 3: Benefits, Methodology, and Evolution Strategy,http://www.rishel.com, 1996
[43] Chuck Meyer, Health Level Seven Version 3 and XML,http://dirm.state.nc.us/hipaa/hipaa2OO2/education, 2000
[44] 朱杏香，数字化医院现状研究与发展探讨，医学信息2001年7月第14卷7
[45] 刘贵兴、范可方，当前医院信息系统集成遇到的问题及发展趋努，Medical Equipment Vo16．No11
[46] 孙岩，医院信息系统建设与业务流程重组，中国卫生经济，2002，3：第36卷第2期
[47] 陈迎霞，医院信息系统从C／S结构到B／S结构的拓展，西北国防医学杂志，2000 June(21)2
[48] 医院信息系统接口的设计研究，中国新医药2003第2卷第9期
[49] 喻革武、俞思伟，建立“以病人为中心”医疗信息系统的研究，医学信息2001年11月第14卷第11
[50] J．H．van Bemmel，M．a．Musen，医学信息学，上海科学技术出版社，2002，1-6
[51] 任连仲，医院信息管理与标准化，医院信息化专家研讨会，2002，北京
[52] 郭永生，徐立臻等，基于共享数据库的多数据源集成，微机发展，2004，2：50
[53] 吴一龙，马国胜等，以病人信息为中心的医院系统建设，中国医院管理，1998，18(1)：44—45
[2] 郑华金、董代富等，高校附属医院信息管理多模式应向全数字化推进，中国医学教育技术，2003，6：151
[3] 刘谦、翁昌晶等，建立基于千兆以太网技术的医院园区网，数理医药学杂志，2002，15(3)：263
[4] 顾伯铭，美国建造首家全数字医院，江苏卫生事业管理，2001，6：79
[5] 张文康，我国卫生信息化建设现状与展望，中国信息年鉴，2002
[6] 中华人民共和国卫生部，医院信息系统基本功能规范，北京：中华人民共和国卫生部，2002
[7] 刘丹红、张玉海、徐勇雾、焦志勇，医院信息标准化应遵循的几个原则与主要内容，中国医院统计2002年6月第9卷第2期
[8] 齐国隆、孔令人，医疗环境电子数据交换标准HL7 v3．0的新进展。中华医院管理，17(6)，361—363
[9] Vogl, R, Going all digital in a University Hospital:A unified large scale PACS for multiple departments and hospitals, Proceedings of SPIE-The International Society for Optical Engineering, v 4323, 2001, p 7-15
[10] 刘劲松，HIS系统标准化的研究与实现，大连海事大学2001年硕士学位论文
[11] Health Level Seven,Inc,HL7 Version 3 Statement of rinciples,http://www.hl7.org.1998
[12] Norman Daoust,D,Mead Walker,HL7 Version 3 Education——Example Model Walkthrough,http://www.hl7.org,1998
[13] 李保罗、迟宝兰，医学信息标准化的理论与实践，中国信息导报，1999，4：40-42
[14] Health Level Seven, Inc,HL7 Version 3 Standard Ballot Version,http://www.hl7. org, 2003
[15] W.Prtan, G.Mosser,H. Krampla, W. Malcher, The digital hospital information technology in radiology, RBM-Revue Europeenne de Technologie Biomedicale Volume: 18, Issue: 5, 1996, pp.153-158
[16] Araki. Kenji,Ohashi. Katsuhiro,Yamazaki.Shunji, Hirose. Yasuyuki, Medical Markup Language (MML) for XML-based Hospital Information Interchange,Journal of Medical Systems 0148-5598;200006 24卷3期
[17] Indiana [correction of Indian] Heart Hospital will be all digital hospital without paper records.(eng), Health Care Strateg Manage,2002 Mar; Vol. 20 (3), pp. 4-5
[18] HealthSouth begins construction of new all-digital hospital.Hospital Materials Management, Jan2002, Vol. 27 Issue 1, p19, 1/3p;(AN 6126674)
[19] Rollins.Gina,The Digital Hospital: Looking Before You Leap,Healthcare Executive,Sep/Oct2002, Vol.17 Issue 5, p24, 4p; (AN 7244752)
[20] All-digital hospital will include wide range of equipment, software from Siemens,Hospital Materials
Management,Oct2002, Vol. 27 Issue 10, p5,1/7p; (AN 7549285)
[21] 姚志洪，系统整合与信息孤岛，医院信息化专家研讨会，2002，北京
[22] 龙安靖，设计检验信息系统HL7整合机制，台北医学大学医学信息研究所2002年硕士学位论文
[23] Health Level Seven, Inc,HL7 Standard Version 2.4,http://www.hl7.org, 2000
[24] Csipo. D,Integrating digital imaging and communications in medicine (DICOM) structured reporting into the hospital environment Journal of Digital Imaging, v 14, n 2 SUPPL.1, June, 2001, p 12-16
[25] 段会龙、吕旭东，医疗信息系统的工作流集成，浙江大学学报，2002，3：
[26] W3C,Extensible Markup Language (XML) 1.0,http://www.w3.org/TR/2000/REC-xml-20001006, 2000
[27] Galloro.Vince,Hospital of the future,Modern Healthcare, 9/24/2001, Vol. 31 Issue 39, p24, 1/2p, lc
[28] Carrns, Ann, Oracle to Announce Joint Effort for 'Digital' Hospital. HealthSouth, 03/26/2001, Vol. 237 Issue 59, pB11, Op
[29] Robert H,Dolin, LioraAlschuler, FredBehlen等,HL7 Document Patient Record Architecture: An XML Document Architecture Based on a Shared Information Model, Proceedings [Proc AMIA Symp] 1999, pp. 52-6
[30] Robert H,Dolin, Paul V,Biron,Using XML as a Supplementary Messaging Syntax for HL7 Version 2.3.1,http://www.hl7.org, 2000
[31] Borden. Susan,Digital Hospital,Technology Review, Jul/Aug2001,Vol. 104 Issue 6, p30, 2/3p, 2c
[32] Pavlopoulos, Sotiris A. Delopoulos, Anastasios.N, Designing and implementing the transition to a fully digital hospital,Source: IEEE Transactions on Information Technology in Biomedicine, v 3, n 1, Mar, 1999, p 6-19
[39] 何雨生，HL7与医院信息系统集成，医院信息化专家研讨会，2002，北京
[40] 台湾健康信息交换第七层协议协会，电子病历之HL7转诊标准(草案)，http://www.hl7。org。tw，2001
[41] 高源忠，国内电子转诊病历交换HL7标准之研究，台北医学大学医学信息研究所2001年硕士学位论文
[42] Wes Rishel,HL7 Version 3: Benefits, Methodology, and Evolution Strategy,http://www.rishel.com, 1996
[43] Chuck Meyer, Health Level Seven Version 3 and XML,http://dirm.state.nc.us/hipaa/hipaa2OO2/education, 2000
[44] 朱杏香，数字化医院现状研究与发展探讨，医学信息2001年7月第14卷7
[45] 刘贵兴、范可方，当前医院信息系统集成遇到的问题及发展趋努，Medical Equipment Vo16．No11
[46] 孙岩，医院信息系统建设与业务流程重组，中国卫生经济，2002，3：第36卷第2期
[47] 陈迎霞，医院信息系统从C／S结构到B／S结构的拓展，西北国防医学杂志，2000 June(21)2
[48] 医院信息系统接口的设计研究，中国新医药2003第2卷第9期
[49] 喻革武、俞思伟，建立“以病人为中心”医疗信息系统的研究，医学信息2001年11月第14卷第11
[50] J．H．van Bemmel，M．a．Musen，医学信息学，上海科学技术出版社，2002，1-6
[51] 任连仲，医院信息管理与标准化，医院信息化专家研讨会，2002，北京
[52] 郭永生，徐立臻等，基于共享数据库的多数据源集成，微机发展，2004，2：50
[53] 吴一龙，马国胜等，以病人信息为中心的医院系统建设，中国医院管理，1998，18(1)：44—45