医疗信息系统体系结构研究及开发平台设计
摘要
医学信息学是一个新兴的领域，医疗信息系统是医学信息学的一个重要分支。虽然也不乏很多在临床上已经应用的系统，但由于缺乏一个理论的指导，发展呈无序状态。各开发商在进行医疗信息系统建设时往往直接套用其它领域的信息系统开发理论，以满足医疗机构的暂时需求为主要目的，造成开发出来的产品各自为政，重复开发，而且彼此之间很难互连。我国在医疗信息系统领域的起步较晚，最近几年才开始进行系统的研究和开发。
建立并完善医疗信息系统的理论体系是目前医疗信息系统领域十分迫切的要求。本论文以建立整套理论体系为长远目标，以分布式异构系统集成为主要问题对象，从理论和实践两个方面对医疗信息系统的体系结构进行了深入的研究；构建了针对系统集成的医疗信息系统体系结构；设计并实现了医疗信息系统的开发平台。具体来说，本文主要包含以下内容：
从医学信息和医疗信息系统两个方面对医疗信息系统理论体系所涵盖的内容进行了分类总结和综述，为从事医疗信息系统研究、开发、维护、使用的工作人员提供了一个理论基础。
在分析了目前流行的信息系统体系结构的基础上，基于中间件理论提出了医疗信息系统体系结构的设计，从技术平台和医疗模型两个层次对集成问题进行了全面解决。
通过对目前普遍使用的三种分布式对象底层技术平台解决方案的分析研究，针对医疗行业的特点，提出并设计了体系结构中的分布式对象技术平台MUSCLE，并基于CORBA／EJB集成方案进行了实现。
通过对各种医疗数据交换／通讯标准的分析得出了医疗集成应用视图，进而设计出基于标准的医疗信息系统集成模型HIM，实现了包括工作流集成、功能集成和界面集成的解决方案。
在医疗信息系统体系结构的基础上，进行了医疗信息系统开发平台的设计和实现。一方面对体系结构进行了一种实现，另一方面为医疗信息系统的开发提供了各种共享组件，避免了重复开发。
最后，通过两个实际典型的医疗信息系统的设计和实现，验证了体系结构及开发平台的有效性及设计合理性。其一是数字化放射科，其二是基于ASP模式的心电分析中心。
Medical Informatics is a rising field of research with Medical Information System as one of its important branches. Although many information systems have been applied in clinical practice, since they are in lack of theoretical guidance, the development has been a disorderly one. The developers mechanically copy the development of information system from other fields to temporarily meet the demand in healthcare institutes, hence the products ever developed are either irrelative or repetitive and can not be integrated. In our country, the systematic research and development of medical information system has just begun in recent years.
The establishment and improvement of a theory in this field is an urgent demand. Taking the establishment of a complete set of theory as the long-term target, with integrating distributed heterogeneous systems as the main subject, the thesis has made an in-depth research in the architecture of medical information system both theoretically and practically. The architecture of medical information system for system integration has been constructed and the development platform for medical information system has been designed and implemented. Specifically:
A classification and summary is made on the content of theory for medical information system from both medical information and medical information system points of view, hence a theory basis is provided for the personnel in their research, development, maintenance, or use of the medical information system.
After an analysis of the architectures of medical information system popular in these days, based on middle-ware theory, a design for the system structure of medical information system is put forward, and the problems in integration have been completely solved in terms of technical platform and medical model.
Through an analysis into three schemes for distributed object-oriented technical platform, considering the peculiarity of medicare field, the distributed object-oriented technology platform MUSCLE is designed, and is implemented on the base of integration scheme of CORBA/EJB .
Through the study of the standards for medical data exchange/communication, the application view for medical integration is concluded, and the integration model HIM of medical information system is designed on the basis of standard, the scheme for workflow integration, function integration, and interface
integration is implemented.
The design and implementation of development platform for medical
information system is carried out on the base of the architecture for medical
information system. On the one hand, the system structure is implemented; on
the other hand, various components are provided for the development of
medical information system, and repetitive development is avoided.
Finally, through the design and implementation of two typical and practical
information systems, the effectiveness and rationality of the MUSCLE is
proved. One is Digital Radiology System and the other is ECG Center based on
ASP model.
建立并完善医疗信息系统的理论体系是目前医疗信息系统领域十分迫切的要求。本论文以建立整套理论体系为长远目标，以分布式异构系统集成为主要问题对象，从理论和实践两个方面对医疗信息系统的体系结构进行了深入的研究；构建了针对系统集成的医疗信息系统体系结构；设计并实现了医疗信息系统的开发平台。具体来说，本文主要包含以下内容：
从医学信息和医疗信息系统两个方面对医疗信息系统理论体系所涵盖的内容进行了分类总结和综述，为从事医疗信息系统研究、开发、维护、使用的工作人员提供了一个理论基础。
在分析了目前流行的信息系统体系结构的基础上，基于中间件理论提出了医疗信息系统体系结构的设计，从技术平台和医疗模型两个层次对集成问题进行了全面解决。
通过对目前普遍使用的三种分布式对象底层技术平台解决方案的分析研究，针对医疗行业的特点，提出并设计了体系结构中的分布式对象技术平台MUSCLE，并基于CORBA／EJB集成方案进行了实现。
通过对各种医疗数据交换／通讯标准的分析得出了医疗集成应用视图，进而设计出基于标准的医疗信息系统集成模型HIM，实现了包括工作流集成、功能集成和界面集成的解决方案。
在医疗信息系统体系结构的基础上，进行了医疗信息系统开发平台的设计和实现。一方面对体系结构进行了一种实现，另一方面为医疗信息系统的开发提供了各种共享组件，避免了重复开发。
最后，通过两个实际典型的医疗信息系统的设计和实现，验证了体系结构及开发平台的有效性及设计合理性。其一是数字化放射科，其二是基于ASP模式的心电分析中心。
Medical Informatics is a rising field of research with Medical Information System as one of its important branches. Although many information systems have been applied in clinical practice, since they are in lack of theoretical guidance, the development has been a disorderly one. The developers mechanically copy the development of information system from other fields to temporarily meet the demand in healthcare institutes, hence the products ever developed are either irrelative or repetitive and can not be integrated. In our country, the systematic research and development of medical information system has just begun in recent years.
The establishment and improvement of a theory in this field is an urgent demand. Taking the establishment of a complete set of theory as the long-term target, with integrating distributed heterogeneous systems as the main subject, the thesis has made an in-depth research in the architecture of medical information system both theoretically and practically. The architecture of medical information system for system integration has been constructed and the development platform for medical information system has been designed and implemented. Specifically:
A classification and summary is made on the content of theory for medical information system from both medical information and medical information system points of view, hence a theory basis is provided for the personnel in their research, development, maintenance, or use of the medical information system.
After an analysis of the architectures of medical information system popular in these days, based on middle-ware theory, a design for the system structure of medical information system is put forward, and the problems in integration have been completely solved in terms of technical platform and medical model.
Through an analysis into three schemes for distributed object-oriented technical platform, considering the peculiarity of medicare field, the distributed object-oriented technology platform MUSCLE is designed, and is implemented on the base of integration scheme of CORBA/EJB .
Through the study of the standards for medical data exchange/communication, the application view for medical integration is concluded, and the integration model HIM of medical information system is designed on the basis of standard, the scheme for workflow integration, function integration, and interface
integration is implemented.
The design and implementation of development platform for medical
information system is carried out on the base of the architecture for medical
information system. On the one hand, the system structure is implemented; on
the other hand, various components are provided for the development of
medical information system, and repetitive development is avoided.
Finally, through the design and implementation of two typical and practical
information systems, the effectiveness and rationality of the MUSCLE is
proved. One is Digital Radiology System and the other is ECG Center based on
ASP model.
引文
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9．高云钦，不断提高我国医院信息系统水平，计算机应用研究，1995；2：7～9。
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24． Bates DW, Cullen DJ, Laird N et al., Incidence of adverse drug events and potential adverse drug events, JAMA, 1995;274:29-34。
25． Classen DC, Pestotnik SL, Evans RS, Burke JP, Computerized surveillance of adverse drug events in hospital patients, J Amer Med Ass., 1991 ;266:2847-51。
26． Cousins D, Automated Pharmacy, Pharmac J., 1995;254:757-64。
27． Grobe SJ, Pluyter ESP, eds., Nursing Informatics: An International Overview for Nursing in a Technological Era, Amsterdam: Elsevier Science, 1994。
28． Simborg DW, Networking and medical Information system, J of Med Systems, 1984;8:43-7。
29． Ozbolt J, Vandewal D, Hannah KJ. eds., Decision Support Systems in Nursing, St Louis: CV Mosby, 1990。
30． McDonald CJ, Blevins L, Tierney WM, Regenstrief Medical Records, MD Computing 1988;5:34-7。
31． Bakker AR, Ball MJ, ScherrerJR, Willems JL, eds., Towards New Hospital Information Systems, Elsevier Science Publishers, 1988。
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34． BakkerAR, Ehlers CT, BryantJR, Hammond WE, eds., Hospital Information Systems: Scope-Design-Architecture, Amsterdam: North Holland Publ Comp, 1992。
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36． ScherrerJR, Louis C, Borst F. Diogene 2, a distributed hospital Information system with an emphasis on its medical Information content, In: Van Bemmel JH, McCrayAT, eds, 1995 IMIA Yearbook of Medical Informatics, Stuttgart: Schattauer Verlag, 1995:86-97。
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2．沈阳东大阿尔派数字医疗系统有限责任公司，e hospital solution —东大阿尔派为医院数字化提供全面解决方案，世界医疗器械，2001．1；65；74-76。
3. Bill Gates, Collins Hemingway, Business @ The Speed Of Thought: Using a Digital Nervous System, William H. Gates, Ⅲ, 1999。
4．张继武，刘积仁，数字化医疗网络神经系统，世界医疗器械，2001．1；65：20-23。
5. Ralph M. Stair & George W. Reynolds, Principles of Information Systems, A Managerial Approach, Third Edition, Course Technology, ITP., 1998。
6. Shortliffe EH, The science of biomedical computing, Med Inform., 1984;9:185-93。
7. Van Bemmel JH, The structure of medical informatics, Med Inform., 1984;9:175-80。
8．中国医院信息网，国内外医院信息系统发展概况，http://www.drpacific.com/computer/xitong/。
9．高云钦，不断提高我国医院信息系统水平，计算机应用研究，1995；2：7～9。
10．中国医院信息网，畅谈中国第一代医院信息系统(一)，http://www.drpacific.com/computer/xitong/。
11. Shortliffe EH, Perreault LE, eds., Medical Informatics: Computer Applications in Health Care, Reading MA: Addison-Wesley., 1990。
12. Komaroff AL, The variability and inaccuracy of medical data, Proceedings of IEEE, 1979;67:1196-1207。
13. Koran L.M, The reliability of clinical methods, data and judgments, N Engl J Med., 1975; 293:642-646 and 695-701。
14. Rector AL, Nowlan WA, Kay S et al., Foundations for an electronic medical record, Meth Inform Med., 1991;30:179-86。
15. Weed L. Medical Records, Medical Education and Patient Care, Cleveland OH: Case Western Univ. Press, 1969。
16. Rabiner LR, Gold B, Theory and Application of Digital Signal Processing, Englewood Cliffs, NJ: Prentice Hall, 1975。
17. Swets JA, Picket RM, Evaluation of Diagnostic Systems: Methods from Signal Detection Theory, New York NY: Academic Press, 1992。
18．唐晓东，现代医学影像技术，天津科技翻译出版社，2000。
19． Udupa JK, and Herman GT, eds., 3D Imaging in Medicine, Boca Raton FL: CRC Press, 1991。
20． Weed KK. Medical Records, Medical Education and Patient Care: The Problem-Oriented Medical Record as a Basic Tool, Cleveland OH: Case Western Reserve Press, 1971。
21． Van der Lei J, Duisterhout JS, Westerhof H, et al., The introduction of computer-based patient records in the Netherlands, Ann Intern Med., 1993;119:1036-41。
22． Perini VJ, Vermeulen LC, Comparison of automated medication-management systems, Am J Hosp Pharm, 1994;51:1883-91。
23． Puckett F, Medication management component ofa point-of-care information system, Am Hosp Pharm, 1995;52:1305-9。
24． Bates DW, Cullen DJ, Laird N et al., Incidence of adverse drug events and potential adverse drug events, JAMA, 1995;274:29-34。
25． Classen DC, Pestotnik SL, Evans RS, Burke JP, Computerized surveillance of adverse drug events in hospital patients, J Amer Med Ass., 1991 ;266:2847-51。
26． Cousins D, Automated Pharmacy, Pharmac J., 1995;254:757-64。
27． Grobe SJ, Pluyter ESP, eds., Nursing Informatics: An International Overview for Nursing in a Technological Era, Amsterdam: Elsevier Science, 1994。
28． Simborg DW, Networking and medical Information system, J of Med Systems, 1984;8:43-7。
29． Ozbolt J, Vandewal D, Hannah KJ. eds., Decision Support Systems in Nursing, St Louis: CV Mosby, 1990。
30． McDonald CJ, Blevins L, Tierney WM, Regenstrief Medical Records, MD Computing 1988;5:34-7。
31． Bakker AR, Ball MJ, ScherrerJR, Willems JL, eds., Towards New Hospital Information Systems, Elsevier Science Publishers, 1988。
32． Prokosch HU, Dudeck J, eds., Hospital Information Systems: Design and Development Characteristics; Impact and Future Architecture, Amsterdam: Elsevier, 1995。
33． Hammond WE, BakkerAR, and Ball MJ, eds., Information Systems with Fading Boundaries, Amsterdam: Elsevier, 1995。
34． BakkerAR, Ehlers CT, BryantJR, Hammond WE, eds., Hospital Information Systems: Scope-Design-Architecture, Amsterdam: North Holland Publ Comp, 1992。
35． Scherrer JR, Baud R, Brisebarre A, et al., A hospital Information system in continuous operation and expansion, In: Orthner HF, Blum BI, eds, Implementing Health Care Information Systems, New York: Springer-Verlag, 1989:100-22。
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