本文關(guān)鍵詞： FHIR 數(shù)據(jù)交換中心 延續(xù)醫(yī)療 互操作 數(shù)據(jù)集成　出處：《南方醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：高血壓等慢性病治療需要綜合醫(yī)囑,治療計劃及檢查、監(jiān)測各種生命體征等,具有診療高頻性、長期性等特點,是一個長期復(fù)雜的系統(tǒng)工程。新提出的“分級診療”制度和“互聯(lián)網(wǎng)+醫(yī)療”發(fā)展模式是慢性病診療的福音。其中,分級診療重點在醫(yī)聯(lián)體建設(shè)和家庭醫(yī)生簽約。結(jié)合醫(yī)聯(lián)體工程和家庭醫(yī)生簽約模式,借助互聯(lián)網(wǎng)技術(shù),將高血壓的部分診療業(yè)務(wù)外延到家庭,是一種簡約的診療模式。但同時帶來一些新問題:1)醫(yī)護人員對患者進行居家診療護理,非診療過程浪費時間。2)患者在醫(yī)院和家庭產(chǎn)生的診療護理信息不能共享同步。3)患者以手工或者獨立設(shè)備獲取并存儲的診療信息,有易丟失、被泄隱私等問題。如何在延續(xù)診療過程中保證診療流程的連續(xù),保障診療信息的連續(xù)和閉環(huán),是延續(xù)醫(yī)療的一個關(guān)鍵挑戰(zhàn)。通過互聯(lián)網(wǎng)信息技術(shù)構(gòu)建一個院后數(shù)據(jù)交換中心,連接患者在醫(yī)院的和家庭的診療信息,協(xié)同醫(yī)生和患者的療診工作是可行方案。其關(guān)鍵功能是將相關(guān)臨床信息在中心統(tǒng)一集中,統(tǒng)一管理及提供可靠的面向用戶的數(shù)據(jù)訪問。當(dāng)前臨床數(shù)據(jù)中心通常以HL7的CDA(Clinical Document Architecture)作為中心的數(shù)據(jù)模型,或者采用OpenEHR標(biāo)準(zhǔn)構(gòu)建。兩類規(guī)范構(gòu)建的臨床數(shù)據(jù)中心的語義互操作都是綁定型(SNOMED、LOINC)的緊耦合服務(wù)。為解決系統(tǒng)分布及通信消息結(jié)構(gòu)的問題,選擇基于SOAP(Simple Object Access Protocol)的WebService作為通用規(guī)范集成技術(shù),以XML作為通用的數(shù)據(jù)格式。上述規(guī)范有難定制和擴展,或者高度模型化導(dǎo)致的實施復(fù)雜,或者語義處理困難等問題。針對上述各挑戰(zhàn),本論文采用HL7的FHIR(Fast Healthcare Interoperability Resources,快速醫(yī)療互操作性資源)規(guī)范,以面向資源的架構(gòu)方法和RESTful架構(gòu)風(fēng)格的WebService構(gòu)建一個院后數(shù)據(jù)交換中心。保證高血壓延續(xù)醫(yī)療過程中的利益相關(guān)者都能夠獲得自身所需信息。FHIR是云計算、物聯(lián)網(wǎng)、移動醫(yī)療等技術(shù)、概念融合產(chǎn)生的適合于當(dāng)代醫(yī)療信息化的一個新規(guī)范。綜上所述,本論文的主要工作包括:1)分析高血壓院后數(shù)據(jù)交換中心的業(yè)務(wù)需求、技術(shù)進展及面臨的主要問題。設(shè)計高血壓院后數(shù)據(jù)交換中心的整體架構(gòu),包括邏輯架構(gòu)、軟件架構(gòu)等。2)調(diào)研分析高血壓病患者在延續(xù)醫(yī)療中涉及的信息“資源”模型,對FHIR進行鄰域型本地化處理。分析醫(yī)院、設(shè)備與平臺間的數(shù)據(jù)交換格式,設(shè)計V2、CDA與FHIR規(guī)范的消息轉(zhuǎn)換映射中間件,將臨床信息以FHIR為模型進行存儲。基于以上兩個主要工作,文章最后給出了數(shù)據(jù)交換中心的實驗驗證。通過與南方醫(yī)院等機構(gòu)的對接,與個人移動設(shè)備的連接,驗證了各模塊功能的有效性,結(jié)果表明基于FHIR的高血壓病人院后診療數(shù)據(jù)交換中心具有實用性。
[Abstract]:The treatment of chronic diseases such as hypertension requires comprehensive medical advice, treatment plan and examination, monitoring of all kinds of vital signs, etc. It has the characteristics of high frequency and long-term diagnosis and treatment. It is a long-term complex system engineering. The newly proposed "classified diagnosis and treatment" system and the "Internet medical treatment" development model are good news for the diagnosis and treatment of chronic diseases. The emphasis of hierarchical diagnosis and treatment is on the construction of medical conjoined bodies and the signing of family doctors. Combined with the contract model of family doctors, some of the diagnosis and treatment services of hypertension are extended to families with the help of Internet technology. It is a simple mode of diagnosis and treatment. But at the same time, it brings some new questions. Non-diagnosis and treatment wasting time. 2) the patient's diagnosis and treatment information generated in hospital and home cannot be shared synchronously. 3) the patient can obtain and store the diagnosis and treatment information by hand or independently, which is easy to lose. How to ensure the continuity of the diagnosis and treatment process and ensure the continuity and close-loop of the diagnosis and treatment information is a key challenge of continuing medical treatment. Building a post-hospital data exchange center through Internet information technology, Connecting the patient's diagnosis and treatment information in the hospital and the family, and cooperating with the doctor and the patient's treatment is a feasible solution. Its key function is to centralize the relevant clinical information in the center. Centrally manage and provide reliable user-oriented data access. Currently clinical data centers typically use HL7's CDA(Clinical Document Architecture as the central data model. In order to solve the problem of system distribution and communication message structure, the semantic interoperability of clinical data centers constructed by two kinds of specifications is a tightly coupled service with pinned SNOMEDLLOINC.Or to solve the problem of system distribution and communication message structure, Choose WebService based on SOAP(Simple Object Access protocol as general specification integration technology and XML as common data format. In view of the above challenges, this paper adopts HL7's FHIR(Fast Healthcare Interoperability Resources (Rapid Medical Interoperability Resource) specification. Build a post-hospital data exchange center with a resource-oriented architectural approach and a RESTful architectural style of WebService. Ensure that stakeholders in the hypertension extension medical process have access to the information they need. Fir is cloud computing, the Internet of things, In summary, the main work of this paper includes: 1) analyzing the business needs of data exchange center after hypertension. Design the whole structure of the data exchange center after hypertension, including logical architecture, software architecture, etc.) investigate and analyze the information "resource" model involved in the continuous medical treatment of hypertension patients. This paper analyzes the format of data exchange between hospital, equipment and platform, designs the message transformation and mapping middleware between V2 FHIR and FHIR specification, stores clinical information with FHIR model, based on the above two main work, the paper analyzes the format of data exchange between hospital, equipment and platform, and designs the message transformation mapping middleware of V2 + CDA and FHIR specification, and stores clinical information based on FHIR model. Finally, the experimental verification of the data exchange center is given. The validity of each module is verified by the docking with the Southern Hospital and the connection with the personal mobile device. The results show that the post-hospital data exchange center of hypertension patients based on FHIR is practical.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R544.1;TP399-C8

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