电子病历之交换与展望

danelchen

[这个贴子最后由danelchen在 2002/09/07 06:33pm 编辑]

电子病历之交换与展望
李友专，M.D.，ph.D.
台北医学院医学资讯研究所
台北医学院医学资讯暨电子计算机中心
Forces of Change
■ Evolution of Payment system
△Fee for service→Case payment→Global
　budgeting→Appropriateness of care
■ Healthcare professionals’need
△Explosively growing information and knowledge，e.g. EBM
△Medical record for research purpose
■ Medical Record Management
△More efficiency，less space
■ Consumer’s need
△Personal health record
△Telemedicine?
病历之演化
纸本病历
混合式病历（纸本+电子）
多媒体电子病历
跨院电子病历网（经医资交换中心）
终生个人健康护照（国家病历库）
电子病历
Paper Health Record纸本病历（实体病历）
纸本病历（Paper Record）
■　优点
△Paper is very flexible/portable/cheap/high contrast
△Familiar
■　缺点
△Disorganized
△illegible
△inaccessible
△Storage/Retrieval Problem
Electronic Health Record电子病历
■ Electronic Medical Record(EMR)
■ Computerized Patient Record(CPR)
■ Electronic Patient Record(EPR)
■ Electronic Health Record(EHR)
Hybrid Health Record混合式电子病历
■　过度期之病历
■　纸本为主，电子为辅
■　电子为主，纸本为辅
Multimedia Health Record多媒体电子病历
■ Text， number， image(visible light， fluorescence， X-ray， Sono，Magnetism)， signal， video， sound， smell?，taste?
■ Single point of access to all patient record
■ Customizable presentation of data
■ Clinical data repository (CDR)for research/teaching and clinical decision support
Inter hospital Health Record跨院电子病历
跨院电子病历网
■ Medical Information Exchange Center(MIEC) based on HIN 2.0
☆ consistent personal medical record across hospitals
■ Many issues
☆ Security/Privacy/Confidentiality
☆ Standardized exchange format
☆ Architecture that minimize the impact to current
HIS (hospital information system)
Personal Health Record
终生网络健康护照
■ 国家病历库
■ 终生健康档案（Life-time health record
■ 个人化之网络健康咨询
电子病历的挑战
Challenges of EHR
■ Cost of data warehousing, imaging storage, high speed networking...etc
■ Lack of International standards
　☆ CPRI (Computerized Patient Record Institute), CEN/TC215, ISO/TC251, HL7-CDA(Clinical Document Architecture)
　☆ HL7，DICOM3，IHE (Integrating Healthcare Enterprise)
医学资讯交换中心先导计划
Medical Information Exchange Center
行政院卫生署、台北医学院、台北荣民总医院
MIEC 1.0
1999/06
MIEC 2.0
2001/03
MIEC Agent
■ Reside in each participating hospital (hardware+software)
■ Controls data-sharing policies
■ Configurable by each hospital
■ Open source model-no hidden tricks

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