从HIMSS2005 看卫生信息技术的发展趋势.pdf

中华医院信息网络大会2005暨中外医院信息化高层论坛CHINC2005论文集（一）Proceedings卫生部医院管理研究所中华医院管理学会信息管理专业委员会2005.7北京-1-目录1.医院信息系统建设医疗信息系统的可用性化优.2OptimizingUsabilityofHealthInformationSystems.2SoftwareArchitecturesForDigitalHealthcare:.6我国医院信息化建设呼唤第三方咨询的参与.17医院信息化过程如何选择专业咨询公司.21医院信息化咨询项目的主要工作步骤和工作成果.24医院信息化咨询项目最关键的成功因素咨询顾问的能力.27TelemedicineDevelopmentTrendsAnalysisandBarriersDiscussion.29医院信息系统是提高医院核心竞争力、运营效率、效益的重要手段.38从HIMSS2005看卫生信息技术的发展趋势.44国内医院信息系统技术进展（上）.50南总门急诊系统构架浅谈.63攻克最后一个堡垒记实.68高性价比医院信息系统的建设.70加快医院信息系统建设的新尝试.73浅析医院信息系统的发展和建设.75我院信息化建设的一点体会.78我院信息系统建设规划探讨.82我院医院信息系统客户化的完成和启示.86小型智能化数字医院.89医学信息学的研究领域及人才培养.95医院集成化信息管理系统的设计与实现.99医院信息化建设之“道”与“术”.105应用软件的更新以应用为本.110中华医院信息网络大会2005暨中外医院信息化高层论坛论文集(一)-2-医疗信息系统的可用性化优OptimizingUsabilityofHealthInformationSystems张家杰博士美国德克萨斯大学休斯医顿疗中心医疗信息学院：终身正教授及副院长美国医疗信息科学院：院士感优有限任责公司(UExperience,LLC)：创始人摘要：根据最新的统计调查半数以上的医疗信息系统目项都以失败告终。这不是因为软件和硬件有什么根本缺陷而是因为没有系地考统虑可用性等人因素为。可用性工程正在成为医疗信息品争中最重要的旗之一产竞帜。高可用性可以来带高效率高接受率高市占有率场低成本低修维费低医疗事故率低培训费等。投回资收率(ROI)可高达一百左右。可用性工程有助于加强及保持医疗信息产品的争竞力和先地位领增加市占场有率及入国市做准为进际场备。张家杰博士简介：张家杰博士现任美国德克萨斯大学休斯医顿疗中心医疗信息学院终身正教授及副院长，是美国医疗信息科学院最年轻的院士之一及目前唯一来自中国大陆的院士。1983年毕业于中国科技大学少年班，1992年在加州大学圣地亚哥分校取得世界第一个认知科学博士学位。张家杰博士在生物医疗信息学及认知科学领域诸方面的研究取得了有广泛影响的成果。迄今为止，已经发表了近百篇科技论文，做过近百个会议报告和三十多个特邀报告，组织过10多个国会际专题议，先后为美国国立卫生研究院6个基金评审委会员成员。最近几年获得的研究项目达总经费五百多万美元。另外张家杰博士为优感有限任责公司(UExperience,LLC)的创始人之一，主持信息产品的可用性化及以优人为中心的系统设计。张家杰博士是医疗信息技术领域中有关可用性化的优国际权威及学术带头人，最近医为疗信息学权威杂志JournalofBiomedicalInformatics主编了两期有关可用性优化及人中心计算的专辑。OptimizingUsabilityofHealthInformationSystems1.FailureofHealthInformationSystems(医疗信息系统的失败)Healthinformationtechnology(HIT)hasthepotentialtomakeahighlysignificantcontributiontotheadvancementofmedicineandtotheimprovementofhealthcarequalityandthereductionofmedicalerrors.TherehavebeenanincreasingnumberofHITdevelopmentprojectsbyboth-3-governmentandprivateindustries.Indeed,therearequiteafewsuccessfulstoriesanddemonstratedbenefitsofHIT,especiallyinareasofmedicalerrorreduction,billingaccuracy,compliance,completenessofrecords,decisionsupport,andevenreturnoninvestment.Despiteoftremendouseffortsinthepasttwodecades,theUSdeploymentrateofcomprehensiveelectronichealthrecord(EHR),amajorcomponentofHIT,islessthan10%.TherearestillmanybarriersthatpreventHITfrombeingacceptedbyhealthcareprofessionalsatlargescales.Insomecases,institutionsimplementedEHRsystemsbutlaterdiscontinuedthem.The$25millionCPOE(ComputerizedPhysicianOrderEntry)projectatCedars-SinaiHospitalinLosAngeleswasterminatedbecausephysicianscomplainedthatenteringandsendingorderstooklongerthanusingpapersystems(20vs.3minutes).Inonestudy,itwasshownthatanoutpatientCPOEincreasedencountertimeperpatientby2.12minutes(from9.8to12),andinanotherstudy,itwasshownthatthetimespentonpatientorderentryincreasedfrom2.1%workdayto9%workdayaftertheimplementationofaninpatientCPOE.ArecentlypublishedarticleinJournalofAmericanMedicalAssociationintensifiedthedebateontherolesofITinhealthcare.ItshowsthatamajorCPOEsystemincreasedmedicalerrors,notreducedthemasenvisioned.Inhealthcare,mostfailuresofITprojectsarenotduetoflawedtechnology,butratherduetothelackofsystematicconsiderationsofhumanissues.Inotherwords,designingandimplementingahealthinformationsystemisnotsomuchanITprojectasahumanprojectabouthuman-centeredcomputingsuchasusability,informationneeds,workflow,organizationalchange,medicalerror,andprocessreengineering.Inotherindustriessuchasaviationandnuclearpowerplants,human-centereddesignisaroutinepractice.Inhealthcare,however,thecultureisstilltotrainpeopletoadapttopoorlydesignedtechnology,ratherthantodesigntechnologytofitpeoplescharacteristics.Figure1showsthefailureratesofInformationSystemsprojects.Figure1.Thisgraphshowsthefailureratesofinformationsystems.Mostofthesefailuresarenotduetoflawedtechnology,butduetousabilityproblems.(FromCHAOSReport,2004)2.UsabilityEngineering(可用性工程)Usabilityengineeringisoneoftheapproachestohuman-centereddesign.Itisbasedonfiftyyearsofresearchinpsychology,computerscience,andsystemsengineering.Usabilityreferstohowusableaproductisforahumanuserintermsofeaseofuse,easeoflearning,subjectivesatisfaction,flexibilityandcustomizability,andusererror.Goodusabilitymeansgooduserexperience.Aproductwithgoodusabilityisuser-friendly.Goodusabilityisachievedthroughuser-centereddesign,whichdesignstechnologytofitusercharacteristics,ratherthantraining中华医院信息网络大会2005暨中外医院信息化高层论坛论文集(一)-4-userstoadapttopoorlydesignedtechnology.Aproductwithgoodusabilitycanincreaseefficiency,easeofuseandeaseoflearning,andusersatisfaction.Meanwhile,itcandecreasedevelopmenttime,developmentcost,usertrainingcost,after-releasemaintenancecost,andusererrors.Usabilityengineeringcanbedoneatanytimeduringaproductsdevelopmentcycle.However,theearlier,thebetter.Earlyinvolvementofusabilitystudiesgeneratesthebestreturnoninvestment.Foranexistingproduct,usabilityengineeringwillimprovetheusabilityoftheproductatitsnextrelease.Foranewproduct,usabilityengineeringwillensurethatthenewproductwillbeusableforitsintendedusersuponrelease.Theinitialinvestmentonusabilityengineeringcangeneratesubstantialreturnoninvestment:$1investmentcangenerateasmuchas$100inreturn.Usabilityengineeringshouldbeacomponentbuiltintoeveryphaseofaproductslifecycle.Thistypicallyrequiresastrongcommitmentfromtheprojectleadertoallocatededicatedresourcestousabilityofproducts.Usabilityengineeringistypicallyconductedthroughacollectionoftechniquesthatbestmatchtheusabilitygoalsofaproduct.Oneinexpensiveandeffectivemethodiscalledusabilityheuristicevaluation.Thismethodchecksaproductagainstasetofusabilityheuristics.Violationsoftheseheuristicsindicateproblemswiththeproduct.Figure2showstheresultsofimprovementofusabilityofanambulance-basedEMRovertwoprototypes.Figure3showsthecomparisonofusabilityoftwomedicaldevices.Figure4showsanothertechnique,workflowanalysis,forthedesignandevaluationofhealthinformationsystems.Figure2.Thisgraphshowstheviolationsofusabilityheuristicsforthe1stand2ndprototypesofanambulance-basedEMRsystem.Itshowsthattheusabilityofthesecondprototypeisgreatlyimproved.(FromTang,Zhang,etal.,2005).-5-Figure3.Thisgraphshowsthecomparisonoftheviolationsofusabilityheuristicsfortwomedicaldevices.ItshowsthattheusabilityofPump1isworsethanPump2.Thismethodcanbeusedtocomparecompetingproducts.(FromZhang,Johnson,Patel,etal.,2003).Figure4.ThisgraphshowstheworkflowofanEmergencyRoomphysicianinteractingwithhealthinformationsystemsandpeople.Workflowstudyiscriticalforunderstandinghowaproductisusedintheclinicalsetting.Wehaveasetofalgorithmsandmethodstoextractcrucialinformationfromtheworkflowforthedesignandevaluationofhealthinformationsystems.(FromTang,Brixey,Zhang,etal.,2005).中华医院信息网络大会2005暨中外医院信息化高层论坛论文集(一)-6-SoftwareArchitecturesForDigitalHealthcare:MikkoKorpelaHISR&DUnit,UniversityofKuopio,Finlandmikko.korpelauku.fiAbstractAnarchitecturedefineshowelementsandrelationsbetweenthemmakeupawhole.Inthiswork-in-progresspaperwestudydifferentarchitecturalviewsondigitalhealthcareoreHealth,bywhichwemeantheuseofinformationandcommunicationtechnologiesmainlysoftware-intensivesystemsinhealthcare.Thefocusisonfunctionalandtechnologicalarchitectures.WefirstnotethatanationaleHealtharchitectureshouldaddressbothpublicandprivatesectors,bothclinicalandpublichealthorhealthmanagementaspects,bothhospitalsandprimarycareaswellasrelevantotherelementsoftheentirehealthcaredeliverysystem.InthemainpartofthepaperweidentifytwogenericarchitecturalframeworksapplicabletoadigitalhospitalseHealtharchitecture,namelytheHL7EHR-SmodelandtheEclipseOpenHealthcareFramework,andpresentapragmaticcoarse-levelmodelcombiningfunctionalandtechnologicalaspects.Asastartingpointfordiscussion,wesuggestaspecificbasicbutexpandablearchitectureforamoderndigitalhospitalinChinaforinstance.Thepaperisconcludedbyadiscussiononsomeopenissuesandsuggestionsforcollaboration.Background:TheneedfordifferenttypesofarchitecturesThispaperdealswithdigitalhealthcareoreHealth,bywhichwemeantheuseofinformationandcommunicationtechnologiesmainlysoftware-intensivesystemsinhealthcare.Ourmainfocusisonarchitecturesfordigitalhospital,althoughwestartwithabroaderview.Asageneralterm,architecturedefineshowelementsandrelationsbetweenthemmakeupawholeforinstance,thearchitectureofabuildingdealswithmasses,surfaces,openings,etc.InthedisciplinesandpracticalfieldsofSoftwareEngineeringandInformationSystems,architectureoftenalsoincludesdesignprinciplesandconstraintstosystemsdevelopment(IEEE2000).Theaimistoguaranteetheinteroperabilitybetweenparts,fulfilltherequirementsofthewhole,andtorespondtoevolutionintechnologyandtheapplicationdomain.Architectureisameansofcommunicationbetweendifferentstakeholders,forinstancetechnicalvs.domainexperts(Smolander2003).Architectureisalsoameansofcoordinationforthedivisionofresponsibilitiesinsoftwaresystemdesign,andatooltoenforceinformationmanagementstrategy.ItisagroundplanorblueprintthatguidestheconstructorsoftheeHealth“building”.Severaldifferentapproacheshavebeensuggestedforthearchitecturaldescriptionofsystems,includingthe4+1model(Kruchten1995),RM-ODPmodel(ISO/IEC1995)andBusinessComponentArchitecture(HerzumandSims2000).Differentstakeholdersneeddifferentviewsaccordingtotheirspecificgoals(Smolander2003).Inthispaperwemainlycombinefunctional(whatthesystemelementsshouldprovide)andtechnological(howthesystemshouldbeimplemented)viewpoints.IntheRM-ODPterminologythesearerelatedtotheComputational(functional),EngineeringandTechnology(technological)viewpoints.Thefirstpartofthepaper-7-appliesanorganizationalviewpointalso(EnterpriseviewpointinRM-ODP).Theneedforanontologicalviewpoint(InformationviewpointinRM-ODP)isimplicitinourstandonshareddatamodels,butnotelaboratedoninthispaper.InthenextsectionwebrieflydiscusspossiblemainelementsofanationaleHealtharchitecture,toprovideacontextfordigitalhospitals.Wethenidentifytwogenericarchitecturalframeworksapplicabletoadigitalhospitalsarchitectureandpresentapragmaticcoarse-levelmodel.WealsosuggestaspecificbasicarchitectureforamoderndigitalhospitalinChinaforinstance.Inconclusionwediscusssomeopenissues.CareprovisionManagementSupportservicesTeachinghospitalSocialservicesState/provincehealthadministrationNationalhealthadministrationLegend:ActivityFormalorganizationNeed/servicerelationshipControl,coo