电子健康记录EHR

[e-mail]2007-11-11EHR/RHIN¾¾¾¾EHREMR(IOM)ElectronicHealthRecordEMREHREMRvs.EHR:EHREHR,CPREMRCPOEEHREMRHIMSSAnalytics20067EMREHR0%6CDSSPACS0%51%4CPOE,CDSS()3%3,eMAR,CDSS(&),PACS18%2CDR,CMV,CDSS,34.8%1LISRIS18.9%EHREHRRHINEHRRHINRHIN¾DataSharing¾InformationIntegration¾Interoperability¾StandardandNormalization¾(SecurityandPrivacy)EHR-¾nationalapproachGreatBritain,Denmark,Sweden,HongKong,Australia,Malaysia¾fragmentedmarket-drivenapproachUSA,SouthAfrica,Brazil¾CanadaInfowayBlueprintEHRSCzzEHRzEHR-R…………EHR-R“”z……zzz……………………••••/•••••EHRSC••••••Block•/StandardFramework¾¾¾ICDCM3SNOMEDCTLOINCBDSSHL7DICOM3XMLebXMLCDAHL73HL7V2HL7V3•RIM•CEMT•HMDHL7V3HL7V2HL7V2ADTHL7V2HCITHL7V3HL7V32(CDAR2)HL7(CDA)HL7V3CDAR2RIMRIMCDACDAR2CDACDA•CDAR2CDAL1CDAXML•CDAL2Section•CDAR3CDAL2SectionEntryEntryRIMRIMEntryIHEHITSPEHRSCIP:ClinicalLabTestResultsSharingIHE•IHEHCIT•IHEIHE•IHEHCITIHEIHEIHEIHE•••••••HITSP•HITSPSDOSDO•HITSPANSI•HISTPONCHCITHITSP•HITSPHITSPHITSP/IP•HITSP/IPHITSP/IPHITSP•HITSP•EHR—HITSP/IS-01EHR–LaboratoryTestResultsReporting•HITSP/IS-02Bio-surveillance•HITSP/IS-03CustomerEmpowermentSOAWebServiceWS-IWSDLSOAPSOA–WebServiceSOA“”SOASOA30ITSOA……WebServiceWebServiceWebServiceWebServiceWebWebWebServiceWS-I:WebServiceInteroperabilityOrganizationWS-IisanopenindustryorganizationcharteredtopromoteWebservicesinteroperabilityacrossplatforms,operatingsystemsandprogramminglanguages.Theorganization’sdiversecommunityofWebservicesleadershelpscustomerstodevelopinteroperableWebservicesbyprovidingguidance,recommendedpracticesandsupportingresources.AllcompaniesinterestedinpromotingWebservicesinteroperabilityareencouragedtojointheeffort.WS-IWebServiceWebServiceWebService.WebServiceSeetheWS-Ioverviewpresentationformoredetails.WS-I:WebServiceInteroperabilityOrganizationSpecifically,WS-Icreates,promotesandsupportsgenericprotocolsfortheinteroperableexchangeofmessagesbetweenWebservices.Inthiscontext,“genericprotocols”areprotocolsthatareindependentofanyactionindicatedbyamessage,otherthanthoseactionsnecessaryforitssecure,reliableandefficientdelivery,and“interoperable”meanssuitableformultipleoperatingsystemsandmultipleprogramminglanguages.WS-IWebServiceSeetheWS-Ioverviewpresentationformoredetails.WebServicesWSDLWebService(J2EE,.NET,C/C++)WebService(J2EE,.NET,C/C++)WebServiceClient(J2EE,.NET)WebServiceClient(J2EE,.NET)PointstodescriptionDescribesServiceSOAPUDDIPointstoserviceInvokeswithXMLMessagesUDDIUniversalDescriptionDiscoveryandIntegrationUDDIXMLWebInternetWDSLWebServiceDescriptionLanguageWebWebXMLSOAPWebServicesSOAP1.XMLWebServices2.3.XMLPersonXMLSOAP4..SOAP:SimpleObjectAccessProtocolSOASOAJ2EE.NETSOAHISRISLIS“Unlessinteroperabilityisachieved,physicianswillstilldeferITinvestments,potentialclinicalandeconomicbenefitswon’tberealized,andwewillnotmoveclosertobadlyneededhealthcarereformintheUS.”zDr.DavidBrailer,USNationalCoordinatorforHealthCareInformationTechnology,May21,2004WhereAreWe?