Application of Portable CDA for Secure Clinical-document Exchange

Abstract Health Level Seven (HL7) organization published the Clinical Document Architecture (CDA) for exchanging documents among heterogeneous systems and improving medical quality based on the design method in CDA. In practice, although the HL7 organization tried to make medical messages exchangeable, it is still hard to exchange medical messages. There are many issues when two hospitals want to exchange clinical documents, such as patient privacy, network security, budget, and the strategies of the hospital. In this article, we propose a method for the exchange and sharing of clinical documents in an offline model based on the CDA-the Portable CDA. This allows the physician to retrieve the patient's medical record stored in a portal device, but not through the Internet in real time. The security and privacy of CDA data will also be considered

Integrated Information Services for ealthcare Decision Support System based on Service-Oriented Architecture

龐大的軟硬體投資與維護經常阻礙醫療資訊業者的成長與進步，並且在新技術不斷地推陳出新下，也帶給醫療資訊業者很大的壓力。近來醫療資訊系統新的趨勢與挑戰，是將醫療決策支援系統從醫療資訊系統中分離出來成為一種決策支援的服務型態。 本篇文章藉由探討台大醫院醫療資訊系統成功的建置經驗，驗證我們所提出的資訊整合於服務導向醫療決策支援系統之架構。此架構立基於大型的、協同整合的、分散式的、企業醫療資訊系統，並且應用於有線及無線網路的醫療環境中。為了能夠順利地從舊有的系統中轉型成新的系統架構，我們採用多層的組織架構，並利用服務導向的結構來整合與溝通異質的元件與資料庫，同時我們也採用HL7等標準來實作中介軟體及訊息的交換。Healthcare vendors are often hindered in their efforts to evolve due to extensive existing investments in hardware, software, and medical devices, that they must continue to maintain, while at the same time coming under pressure to innovate new systems. A new trend and challenge in healthcare information-based services systems is to separate healthcare clinical information from health application systems. In this thesis, we present the successful experiences of an integrated, collaborative, distributed, large-scale Enterprise Healthcare Information System (EHIS) constructed over both wired and wireless infrastructure at the National Taiwan University Hospital. In order to smoothly and sequentially transfer from the complex relations among the old (legacy) systems to the new generation EHIS, we adopted a multi-tier framework based on service-oriented architecture (SOA) to integrate the heterogeneous systems as well as allow for interoperation among many other components and multiple databases. We also present mechanisms of the logically layer reusability approach and data (message) exchange flow via HL7 Middleware, DICOM standard and the IHE workflow. Meanwhile, we propose and verify an Information Services for Healthcare Decision Support System based on the NTUH Healthcare Information System (HIS).Chapter 1 Introduction 1.1 Background 1.2 Research Questions 2.3 Motivation and Objective 3.4 Contributions 3.5 Thesis Organization 4hapter 2 Related Works 5.1 Trends in Health Information Systems 5.2 Knowledge Services 6.3 Clinical Decision Support 6.4 Web Services for Healthcare 7.5 Integrated System 8hapter 3 Architecture 10.1 Overall Architecture 10.2 Protocol Stack 12.3 Integrated Clinical Decision Support services 15.4 Architecture of Clinical Decision Support services 16hapter 4 Newborn Screening System 18.1 Newborn Screening 18.2 Methodology 20.3 Experimental Results 23hapter 5 Web-based MEMAR System 32.1 The collaboration workflow with ME-MAR 32.2 Enhancement of the Web Developing 34.3 Architecture Overview 35.4 Features and Functionalities of ME-MAR 38.5 Preliminary System Assessments 43.6 Comparison 48hapter 6 MDRO System 50.1 Multidrugs-Resistant Organisms 50.2 Implementation of MDRO system 52.3 MDRO Detection 53.4 MDRO Analysis 58.5 MDRO Presentation 59.6 System Assessments 61hapter 7 Bio-signal System 65.1 Bio-signal system 65.2 Methodology 67.3 Experiment Results 71hapter 8 Conclusion 76.1 Conclusion 76.2 Discussion 77.3 Future Work 7

Design and Implementation of Web-Based Mobile Electronic Medication Administration Record

Patients' safety is the most essential, critical issue, however, errors can hardly prevent, especially for human faults. In order to reduce the errors caused by human, we construct Electronic Health Records (EHR) in the Health Information System (HIS) to facilitate patients' safety and to improve the quality of medical care. During the medical care processing, all the tasks are based upon physicians' orders. In National Taiwan University Hospital (NTUH), the Electronic Health Record committee proposed a standard of order flows. There are objectives of the standard: first, to enhance medical procedures and enforce hospital policies; secondly, to improve the quality of medical care; third, to collect sufficient, adequate data for EHR in the near future . Among the proposed procedures, NTUH decides to establish a web-based mobile electronic medication administration record (ME-MAR) system. The system, build based on the service-oriented architecture (SOA) as well as embedded the HL7/XML standard, is installed in the Mobile Nursing Carts. It also implement accompany with the advanced techniques like Asynchronous JavaScript and XML (Ajax) or Web services to enhance the system usability. According to researches, it indicates that medication errors are highly proportion to total medical faults. Therefore, we expect the ME-MAR system can reduce medication errors. In addition, we evaluate ME- MAR can assist nurses or healthcare practitioners to administer, manage medication properly. This successful experience of developing the NTUH ME-MAR system can be easily applied to other related system. Meanwhile, the SOA architecture of the system can also be seamless integrated to NTUH or other HIS system

Newborn Screening Healthcare Information System Based on Service-Oriented Architecture

In this paper, we established a newborn screening system under the HL7/ Web Services frameworks. We rebuilt the NTUH Newborn Screening Laboratory 's original standalone architecture, having various heterogeneous systems operating individually, and restructured it into a Service-Oriented Architecture (SOA), distributed platform for further integrity and enhancements of sample collections, testing, diagnoses, evaluations, treatments or follow-up services, screening database management, as well as collaboration, communication among hospitals; decision supports and improving screening accuracy over the Taiwan neonatal systems are also addressed. In addition, the new system not only integrates the newborn screening procedures among phlebotomy clinics, referral hospitals, as well as the newborn screening center in Taiwan, but also introduces new models of screening procedures for the associated, medical practitioners. Furthermore, it reduces the burden of manual operations, especially the reporting services, those were heavily dependent upon previously. The new system can accelerate the whole procedures effectively and efficiently. It improves the accuracy and the reliability of the screening by ensuring the quality control during the processing as well