医疗健康信息框架与信息模型的研究和建立
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摘要
医疗健康信息建模是医疗卫生信息化发展的基石,只有在一个完整的、共享的信息模型基础之上,才能更好地表达、组织和存储各类医疗健康信息,实现信息交换和共享,促进信息集成和融合,形成各类智能化、知识化的决策支持,满足面向临床、科研和管理的的各种信息综合利用的需求,最终提高医疗卫生服务质量。近年来,随着医疗卫生信息化工作地不断深入,医疗健康信息建模问题逐渐成为国际上的研究热点。
人体和生命的高度复杂性使得与之相关的医疗健康信息极为复杂。首先,信息种类繁多、形态各异,有数值、文档、影像和波形等,信息之间的关系繁杂且不确定；其次,不同国家、地区间的医疗体制、相关政策和法规等方面不尽相同,医疗健康信息构成呈现出空间上的差异性；再次,医疗领域知识更新非常迅速,医疗健康信息形态具备多样性、信息之间关系的复杂程度都随着医学知识的更新不断变化。这些特性给医疗健康信息模型的建立带来了很大的挑战。
本论文以医疗健康信息为研究对象,围绕医疗健康信息建模问题开展了研究和探索。主要工作包括：
(?)系统地回顾了国际上相关研究工作的进展,对医疗健康信息的总体构成及其特性进行了深入地分析；
(?)针对医疗健康信息复杂多样、关系复杂,以及随空间、时间动态变化的特性,通过不同层次的抽象,研究并建立了一个多维度、多层次的医疗健康信息框架,其中,将医疗保健行为作为医疗健康信息基本单元,并采用多维度进行分层表述,处理医疗健康信息的多样性,通过信息类型与领域知识的分离,灵活适应医疗健康信息的动态性；(?)在医疗健康信息框架的基础上,设计了“医疗健康信息基线”,对实际医疗健康信息系统的信息处理能力进行定性描述；
(?)基于医疗健康信息框架,建立了一个面向对象的医疗健康信息模型,采用医疗保健行为和行为之间的关系表达多模态的医疗健康信息结构,同时,引入分层建模方法处理医疗领域知识的动态变化,实现了对医疗健康信息的整体建模；
(?)面向医疗健康信息系统研发,研究建立了一个包括数据中心、领域原型库、信息服务和各种上层信息应用在内的医疗健康信息模型应用体系；
(?)综合本论文的各项研究成果开展了系统综合实践,基于医疗健康信息模型构建了电子病历数据中心,在此基础上设计并开发完成了数据服务中间件以及电子病历集成视图,通过与其它系统整合,建立了一个完整的面向综合性医院的电子病历系统。
系统综合实践结果表明,本论文研究并建立的信息框架和信息模型具有很强的表达能力,能够有效地解决医疗健康信息形态多样、关系复杂、以及随知识更新动态变化等问题。论文的研究工作为医疗健康信息的表达和组织提供了方法论基础,为设计、开发、部署、维护各类医疗健康信息系统提供了信息建模技术支撑,也为其它相关领域的信息建模研究提供了有益的参考。
In the current health care environment, e-health and e-healthcare have emerged as important concepts. They aim at improve the quality and cost effectiveness of health care by the utilization of information technologies. The basic information model plays an important role throughout the whole life cycle of health care information, including the creation, storage, transmition and utilization. Modeling of health care information is a key task.
Unlike other domains, health care information is of very high complexity. First, the modality and amount of health care information can be incredibly large, including but not limited to observations, laboratory tests, diagnostic imaging reports, treatments, therapies, drugs administered, and so on. The relationships among the information are also very complex. Second, the constitution of health care information is always not the same among different contries, i.e., there are spatial differences. Last, the rate of change of health care domain knowledge is high. As a concequence, both the modality and the relationships among health care information change along time, i.e., there are temporal differences. All of those characteristics pose big challenge to the information modeling work.
This dissertation focuses on the study of modeling of health care information. The main contributions are followings:
(?) Review the recent progress of related work systematically. Make a thorough analysis of the constitution of health care information.
(?) To address the complexity, as well as the spatial and temporal variability issues of healch care information, a multi-dimentional and multi-layer health care information framework is presented. In this information framework, healthcare act is considered as the basic unit of information.
(?) Based on the health care information framework, a "health care information profile" tool is designed to describe the information processing ability of an information system.
(?) Based on the health care information framework, a two-level health care information model is brought out. It follows the architecture of health care information framework to address the information modeling problems.
(?) An application framework of health care information model is introduced, which consist of a health care data center, an archetype repository, a set of information services and various upper applications.
(?) Design and implement an electronic medical record system based on the information framework and the information model. The system consist a EMR data center, an information service middleware, an EMR integrated viewer, together with some other software components.
The system practice shows that both the information framework and the information model can solve the complexity, the spatial and temporal variability problems of healch care information. The results of this dissertation provide a methodological basis for the representation and organization of health care information. They also can be applied to other domains besides healthcare.
人体和生命的高度复杂性使得与之相关的医疗健康信息极为复杂。首先,信息种类繁多、形态各异,有数值、文档、影像和波形等,信息之间的关系繁杂且不确定；其次,不同国家、地区间的医疗体制、相关政策和法规等方面不尽相同,医疗健康信息构成呈现出空间上的差异性；再次,医疗领域知识更新非常迅速,医疗健康信息形态具备多样性、信息之间关系的复杂程度都随着医学知识的更新不断变化。这些特性给医疗健康信息模型的建立带来了很大的挑战。
本论文以医疗健康信息为研究对象,围绕医疗健康信息建模问题开展了研究和探索。主要工作包括：
(?)系统地回顾了国际上相关研究工作的进展,对医疗健康信息的总体构成及其特性进行了深入地分析；
(?)针对医疗健康信息复杂多样、关系复杂,以及随空间、时间动态变化的特性,通过不同层次的抽象,研究并建立了一个多维度、多层次的医疗健康信息框架,其中,将医疗保健行为作为医疗健康信息基本单元,并采用多维度进行分层表述,处理医疗健康信息的多样性,通过信息类型与领域知识的分离,灵活适应医疗健康信息的动态性；(?)在医疗健康信息框架的基础上,设计了“医疗健康信息基线”,对实际医疗健康信息系统的信息处理能力进行定性描述；
(?)基于医疗健康信息框架,建立了一个面向对象的医疗健康信息模型,采用医疗保健行为和行为之间的关系表达多模态的医疗健康信息结构,同时,引入分层建模方法处理医疗领域知识的动态变化,实现了对医疗健康信息的整体建模；
(?)面向医疗健康信息系统研发,研究建立了一个包括数据中心、领域原型库、信息服务和各种上层信息应用在内的医疗健康信息模型应用体系；
(?)综合本论文的各项研究成果开展了系统综合实践,基于医疗健康信息模型构建了电子病历数据中心,在此基础上设计并开发完成了数据服务中间件以及电子病历集成视图,通过与其它系统整合,建立了一个完整的面向综合性医院的电子病历系统。
系统综合实践结果表明,本论文研究并建立的信息框架和信息模型具有很强的表达能力,能够有效地解决医疗健康信息形态多样、关系复杂、以及随知识更新动态变化等问题。论文的研究工作为医疗健康信息的表达和组织提供了方法论基础,为设计、开发、部署、维护各类医疗健康信息系统提供了信息建模技术支撑,也为其它相关领域的信息建模研究提供了有益的参考。
In the current health care environment, e-health and e-healthcare have emerged as important concepts. They aim at improve the quality and cost effectiveness of health care by the utilization of information technologies. The basic information model plays an important role throughout the whole life cycle of health care information, including the creation, storage, transmition and utilization. Modeling of health care information is a key task.
Unlike other domains, health care information is of very high complexity. First, the modality and amount of health care information can be incredibly large, including but not limited to observations, laboratory tests, diagnostic imaging reports, treatments, therapies, drugs administered, and so on. The relationships among the information are also very complex. Second, the constitution of health care information is always not the same among different contries, i.e., there are spatial differences. Last, the rate of change of health care domain knowledge is high. As a concequence, both the modality and the relationships among health care information change along time, i.e., there are temporal differences. All of those characteristics pose big challenge to the information modeling work.
This dissertation focuses on the study of modeling of health care information. The main contributions are followings:
(?) Review the recent progress of related work systematically. Make a thorough analysis of the constitution of health care information.
(?) To address the complexity, as well as the spatial and temporal variability issues of healch care information, a multi-dimentional and multi-layer health care information framework is presented. In this information framework, healthcare act is considered as the basic unit of information.
(?) Based on the health care information framework, a "health care information profile" tool is designed to describe the information processing ability of an information system.
(?) Based on the health care information framework, a two-level health care information model is brought out. It follows the architecture of health care information framework to address the information modeling problems.
(?) An application framework of health care information model is introduced, which consist of a health care data center, an archetype repository, a set of information services and various upper applications.
(?) Design and implement an electronic medical record system based on the information framework and the information model. The system consist a EMR data center, an information service middleware, an EMR integrated viewer, together with some other software components.
The system practice shows that both the information framework and the information model can solve the complexity, the spatial and temporal variability problems of healch care information. The results of this dissertation provide a methodological basis for the representation and organization of health care information. They also can be applied to other domains besides healthcare.
引文
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