邁向整合型健康資訊系統之建置

Abstract

由於資訊技術的快速發展，醫學資訊領域裡也漸次引用新穎的資訊技術來增加醫療體系內的競爭力，或用來進一步提高醫療服務品質。在醫學資訊之應用資訊系統的設計與建置中，因為開放系統的風行與異質性的資訊系統的逐次上線，如何將舊有的系統作有效、快速、低成本地整併，已成為醫療體系內部醫學資訊系統整合上的重要設計課題。另外許多以往容易被忽略的間接影響，例如醫學資訊交換標準的引用，現今也成為設計時首先要考慮的因素，但標準的選定與引用後的效益都很難在設計初期就明確預測。因此，整合型健康資訊系統(i-HIS, Integrated Health Information System)之建置過程通常都是採取較保守的引用國際資訊交換標準之方式，來奠基中長程資訊系統的基礎架構。本論文主要在說明設計初期即採用廣受引用之國際資訊交換標準，如HL7 (Health Level Seven)、LOINC (Logical Observation Identifiers, Names and Codes)、XML (Extensible Markup Language)等，可以排除日後流於閉門造車之可能性，以減少基礎建設之後續再投資的比例，並希冀可以在近程內可以與國際知名系統接軌，降低日後各類醫療資訊相關之儀器設備的整合與銜接問題。 我們在系統的規劃階段提出解決問題的機制，包括HL7與XML國際資訊交換標準的引用與制定地區化的相關標準。前者是目前廣受歡迎的醫學資訊交換標準，主要在交換文字類的醫學資訊，後者則是更為一般化之文字類資訊載具，並受到醫學領域以外的其他領域所擁戴與使用。基本上，上述兩者標準在大多數情況下可以獨立使用，但是在此我們合併使用以求產生加乘的效果。 在整合型健康資訊系統的建置上，我們透過HL7/XML標準的制定，依序將相關的標準應用到各類型的健康資訊系統中，包括檢驗資訊系統(LIS, Laboratory Information System)、遠距醫療系統(TIS, Telemedicine Information System)、與全國器官捐贈移植登錄系統(NODTRS, National Organ Donation/Transplantation Registry Systems)等。並以上述三個系統就軟體再用(Software Reuse)理論之三種再用層次進行功能再用(Function Reuse)、元件再用(Component Reuse)、與應用系統再用(Application System Reuse)的驗證，證明透過適度的導入HL7/XML標準到相關的整合型健康資訊系統的建置環境中，可以加速整合建置的時程，並適度降低成本。和現有的資訊技術相比，這些資訊系統的功能沒有很大的差別，但是其內部資訊交換的機制卻明顯的不同於以往的架構，其優點是系統的整合與銜接上較為單純，因此整合的速度比以往快捷。 我們也附帶說明了台大醫院裡二十多年來的檢驗資訊系統演化過程與相關解決方案，從中央集權式LIS、主從式LIS、與隨插即用式 LIS。其中在隨插即用式 LIS中也順帶說明HL7介面引擎(HL7-IE, HL7 Interface Engine)的資訊流交換機制，更進一步分析訊息封包流入與流出的相關統計結果。此外，在LIS、TIS、與NODTRS等系統的建置過程中，一些資訊管理相關的經驗與考量也一併加以提出與說明，以提供醫學資訊相關同好後續參考之用。 本論文所提出的i-HIS整合性概念與系統建置模式均基於使用標準的訊息架構，由於這種架構的資訊交換介面可以像電源插頭與插座一樣，隨插即用，整合速度快，因此相關的後續技術演化與應用將預期可以順利延伸與推展到軟硬體共同設計(Hardware/Software Co-design)或超大型積體電路(VLSI, Very Large Scale Integration)晶片的規劃與設計等，除了可以解決目前訊息串流因為HL7與XML訊息加成效應，造成訊息過長導致訊息收送速度過慢的可能疑慮外，更可以加速未來訊息串流的傳送、轉換、與接收速度，且不會使i-HIS的整體系統效能明顯變慢。而未來在HL7與XML訊息串流的帶動下，搭配支援XML的資料庫，並輔以HL7核心訊息系統，將可以使得醫療體系內部資訊系統從內而外都是標準的影子，在日後的醫學資訊系統的整合上將會如魚得水，輕鬆自在。

The more information technologies be implemented, the more complex the relationship among the information systems inside the healthcare enterprise. In order to minimize the implementation complexity of the information systems in such environment, we base on the software reuse theory and propose an integrated health information system (i-HIS) model to integrate many information systems with HL7/XML information standards in a healthcare enterprise. The seven implementation facets of the electronic health records (EHR) will be illustrated. They include laws, sharing, security, standard, technology, management, and society facets. Meanwhile, we adopt the HL7 and XML standards to be the basic information infrastructure for information exchange and try to implement some healthcare information systems reusing software components with a plug-and-play mechanism. A brief description of HL7 and XML standards is given. Meanwhile, the concept and implementation guideline of an EHR system is described. Then at least three large information systems implemented in NTUH, which satisfy the HL7/XML information exchange necessities and prove the software reuse theory can be derived into the pyramid i-HIS model, are presented. The first one is the laboratory information system (LIS) implemented at NTUH. The LIS is a kind of information system used at a healthcare intranet environment, where the medical instruments (MIs) are connected with HL7/XML standard and is managed by the HL7 Interface Engine (HL7-IE). The HL7-IE acts as the plug-and-play key role and proves the component reuse deriving to the pyramid i-HIS model is feasible. The evolution of LIS at NTUH is illustrated, and the original NTUH-LICI guideline for MIs connection is also described. Secondly, we illustrate a telemedicine information system (TIS) at NTUH. It is an information system designed for the healthcare extranet services. That is, the non-NTUH users can use TIS with authorization. NTUH implements a union telemedicine clinic center (UTCC) platform to supply both the telemedicine clinics registration and on-line EHR process services to hospitals (NTUH and NCKUH) and clinics. A localized HL7/XML Telemedicine Standard draft is implemented to process the patient information exchange tasks and proves the component reuse deriving to the pyramid i-HIS model is acceptable. The integrated telemedicine healthcare equipment (ITHE) module for medical monitoring is also introduced. The third information system is the national organ donation/transplantation registry system (NODTRS) which is implemented by NTUH. This is an Internet information system which widely serves the contracted medical centers in Taiwan to process the organ donation, transplantation and registry tasks. We derive a localized HL7/XML Organ Transplantation Standard draft inside the patient information exchange processes and prove that the application system reuse can be derived in the pyramidal i-HIS model. At last, we draw a conclusion for this Dissertation and predict some future works with visions. For example, healthcare hardware/software co-design and healthcare standard VLSI chip designs.