基于FHIR的高血压病人院后诊疗数据交换中心构建关键技术研究

发布时间：2018-02-10 00:49

本文关键词： FHIR 数据交换中心延续医疗互操作数据集成　出处：《南方医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：高血压等慢性病治疗需要综合医嘱,治疗计划及检查、监测各种生命体征等,具有诊疗高频性、长期性等特点,是一个长期复杂的系统工程。新提出的“分级诊疗”制度和“互联网+医疗”发展模式是慢性病诊疗的福音。其中,分级诊疗重点在医联体建设和家庭医生签约。结合医联体工程和家庭医生签约模式,借助互联网技术,将高血压的部分诊疗业务外延到家庭,是一种简约的诊疗模式。但同时带来一些新问题:1)医护人员对患者进行居家诊疗护理,非诊疗过程浪费时间。2)患者在医院和家庭产生的诊疗护理信息不能共享同步。3)患者以手工或者独立设备获取并存储的诊疗信息,有易丢失、被泄隐私等问题。如何在延续诊疗过程中保证诊疗流程的连续,保障诊疗信息的连续和闭环,是延续医疗的一个关键挑战。通过互联网信息技术构建一个院后数据交换中心,连接患者在医院的和家庭的诊疗信息,协同医生和患者的疗诊工作是可行方案。其关键功能是将相关临床信息在中心统一集中,统一管理及提供可靠的面向用户的数据访问。当前临床数据中心通常以HL7的CDA(Clinical Document Architecture)作为中心的数据模型,或者采用OpenEHR标准构建。两类规范构建的临床数据中心的语义互操作都是绑定型(SNOMED、LOINC)的紧耦合服务。为解决系统分布及通信消息结构的问题,选择基于SOAP(Simple Object Access Protocol)的WebService作为通用规范集成技术,以XML作为通用的数据格式。上述规范有难定制和扩展,或者高度模型化导致的实施复杂,或者语义处理困难等问题。针对上述各挑战,本论文采用HL7的FHIR(Fast Healthcare Interoperability Resources,快速医疗互操作性资源)规范,以面向资源的架构方法和RESTful架构风格的WebService构建一个院后数据交换中心。保证高血压延续医疗过程中的利益相关者都能够获得自身所需信息。FHIR是云计算、物联网、移动医疗等技术、概念融合产生的适合于当代医疗信息化的一个新规范。综上所述,本论文的主要工作包括:1)分析高血压院后数据交换中心的业务需求、技术进展及面临的主要问题。设计高血压院后数据交换中心的整体架构,包括逻辑架构、软件架构等。2)调研分析高血压病患者在延续医疗中涉及的信息“资源”模型,对FHIR进行邻域型本地化处理。分析医院、设备与平台间的数据交换格式,设计V2、CDA与FHIR规范的消息转换映射中间件,将临床信息以FHIR为模型进行存储。基于以上两个主要工作,文章最后给出了数据交换中心的实验验证。通过与南方医院等机构的对接,与个人移动设备的连接,验证了各模块功能的有效性,结果表明基于FHIR的高血压病人院后诊疗数据交换中心具有实用性。
[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.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R544.1;TP399-C8

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