Remote Consultation Implementation Plan
First, the project background
In order to solve the problem of China's economic and social development is not balanced, most of the high-quality health care resources are concentrated in the eastern part of the developed regions and big cities, the central and western regions and the rural areas of the relative lack of health care resources, the masses are difficult to see a doctor. The national healthcare reform program explicitly proposes to vigorously develop tele-consultation for the central and western regions and rural areas, and puts forward the construction principles of resource integration, unity and efficiency, interconnection, and information **** enjoyment. In order to make full use of remote consultation to improve the level of medical services in the central and western and rural areas, and to facilitate the masses to see a doctor, the Ministry of Health has proposed a remote consultation system construction project in the central and western regions.
The establishment of provincial general hospitals as the core of the grass-roots remote system and national hospitals as the core of the high-end remote consultation system. 5 county-level people's hospitals to carry out grass-roots remote consultation.
Second, the construction principles and objectives
1, the construction principles Top-level design, unified standards: from the overall situation, in accordance with the unified design, to promote the grass-roots and high-end remote consultation system construction. Based on the current, step-by-step implementation: make full use of the existing network, equipment, personnel and other resources, according to the business needs of the primary health care institutions, prioritized, and gradually promote and improve the construction of remote consultation system. Mature technology and interconnection: fully consider the development needs of remote consultation, adopt mature and reliable advanced technology, adopt open architecture design, support interconnection and interoperability, and be easy to expand and upgrade. Guaranteeing security and focusing on practicality: Information and system security is an important guarantee for the construction of health informationization. Remote consultation construction and application, involving all levels and types of medical institutions staff and patients, the system must be convenient and practical, safe and reliable, easy to maintain.
2, the overall goal to build the People's Hospital for the provincial teleconsultation center of the grass-roots telemedicine consultation platform, and gradually realize the teleconsultation, tele-education, remote digital resources *** enjoyment, videoconferencing, two-way referrals, remote appointments, remote specialist diagnosis and other functions, to promote the province's high-quality health care resources *** enjoyment and equalization of health care services, and effectively enhance the province's grass-roots hospitals, medical services capacity, improve the difficult and serious illnesses, and improve the health care services, and improve the quality of health care services. It effectively strengthens the medical service capacity of primary hospitals in the province, improves the level of treatment for difficult and serious diseases, and alleviates the difficulties of the masses in seeing a doctor. In the future, we will be able to realize the interconnectivity and resource ****sharing with the ministry-level remote consultation platform.
Third, the remote medical consultation platform system architecture
Remote medical consultation platform system, the use of B / S architecture, centralized mode, with scalability when the time is ripe in the regions to establish a regional platform. The system consists of a set of software, a website, a data center, the network is composed of 10MB/4MB fiber optic cable.
A set of software: according to the requirements of the technical program of the Ministry of Health to design a specific construction program, in accordance with the relevant national policies to take the bidding method to select the software developer for the development of the platform.
A website: the establishment of a telemedicine consultation service network for remote video teaching video on demand, remote video teaching information notification, digital **** enjoy the resources of the query, reading and so on.
A data center: the provincial level to establish a telemedicine data center, to achieve the centralized storage and management of telemedicine data. The telemedicine data center serves as the hub of the telemedicine management system, realizing the storage and management of various types of telemedicine data and providing data mining and analysis support for various telemedicine application systems, such as the tele-education system and the tele-digital resources **** enjoyment system.
Network: The preliminary health information network is used to organize the network. The whole system includes subsystems such as remote consultation management, medical record data collection, remote specialist diagnosis, remote monitoring, video conferencing, remote education, digital resources*** enjoyment, two-way referral and remote booking, data center, electronic identity authentication, SMS platform, and cost settlement.
(a) Remote consultation management subsystem According to the realization, remote consultation includes interactive remote consultation and offline remote consultation.
1. Interactive teleconsultation: support real-time interactive teleconsultation between consulting experts and applying doctors and patients; support the clinical needs of patients to realize that patients can receive real-time expert teleconsultation services in their beds; support consulting experts to remotely control the video screen of patients in offsite beds; for critically ill patients, support real-time transmission of vital signs data such as bedside monitors, providing continuous and dynamic services for consulting experts. It supports real-time transmission of vital signs data such as bedside monitors for critically ill patients, providing continuous and dynamic diagnostic basis for consulting experts.
2. Offline teleconsultation: Support non-real-time offline teleconsultation between consulting experts and applicant doctors; support applicant
Doctors to submit consulting application information and medical records; consulting experts to browse the consulting application information and pathological data in non-real-time according to the actual situation, and prepare and publish consulting reports; and applicant doctors to browse the report of consulting. It contains the following functional modules: Functional modules are described in Table 3.1. Table 3.1 Functional list of teleconsultation management system Functional modules Functional descriptions Users Consultation application Consultation application submission and modification; expert information query; medical record data submission and query, etc. Provincial, prefectural and county hospitals Consultation management Consultation application management; medical record data management; consulting process record and report browsing, etc. Tertiary hospitals, county hospitals, provincial health department Expert consultation Medical record information browsing (medical imaging, electrocardiogram, pathology pictures, etc.); consultation report preparation, modification and release; consultation report template management, etc. Tertiary hospitals Expert management Expert information management; permission management, etc. Tertiary hospitals Statistical analysis Statistical analysis by doctors, hospitals, types of diseases, etc. Provincial health department, hospitals at all levels System management Basic data maintenance; user and permission management; server information monitoring. Permission management; server information monitoring, etc. Provincial Health Department, hospitals at all levels
(B) the collection of medical records subsystem The collection of medical records subsystem should support analog signals, digital signals, real-time signal processing, the main functions are as follows:
1, analog signal processing: the patient's film and paper charts, laboratory tests, graphic reports, etc., by scanning to achieve the digitization. The system supports the transmission, storage and reading of scanned documents and the manual entry of medical records. Film data: It is recommended that the film be processed by a medical scanner, which can support the output of DICOM3 image files. Paper data: Paper data is processed using an ordinary flatbed scanner, and scanned files are saved in JPEG format.
2. Digital Signal Processing: The system should support the use of DICOM gateway from the imaging equipment with DICOM3 interface to obtain the patient's image data, but also should support from the PACS graphic workstations to import DICOM3 images. The system supports interconnection with electronic health records, electronic medical records, data centers and other systems. Conditional hospitals can be based on the Ministry of Health has issued a standard specification for electronic medical records, export patient medical records information, remote consultation system to support the export of information for the import, transmission, storage and reading.
3, real-time vital signs signal processing: the system supports real-time acquisition and transmission of vital signs data from bedside ventilators, monitors, and other vital signs, realizing 24-hour uninterrupted continuous and dynamic observation of patients.
( 3 ) Remote Specialty Diagnostic Subsystem The remote specialty diagnostic subsystem should support the remote diagnostic functions of imaging, electrocardiography, and pathology.
1, remote image diagnosis Support from the standard DICOM 3.0 interface imaging equipment or PACS system to obtain the patient's image data, and storage, reproduction and the corresponding post-processing operations. It establishes a remote radiology consultation system based on DICOM 3.0 protocol, B/S architecture and WEB browsing mode, which supports the post-processing of image data, labeling and preservation of key diagrams, the writing and publishing of consultation reports, and the function of report templates. It supports real-time interactive operation of medical images (including static and dynamic) by multiple parties during remote image consultation. It supports remote image consultation by remote consultation experts at any location through Internet security authentication. Conditional upper and lower level hospitals can establish department to department remote imaging diagnostic service relationship.
2. Remote ECG diagnosis Supports the acquisition of ECG information from digital ECG machines, and non-destructive data transmission, storage and reproduction, and the transmission of static ECG data from primary hospitals to consulting experts in higher-level hospitals. It supports experts' interpretation and printing of ECG, report writing and publishing.12-lead digital ECG supports the transmission of ECG data through Internet, GPRS and telephone line. Digital ECG data can be stored in XML, DICOM and other common data formats. It supports the analysis and comparison of different cases and historical data. Conditional upper and lower level hospitals can establish department to department diagnostic service relationship.
(D) Video conferencing subsystem The video conferencing subsystem provides audio and video interaction for remote consultation services, and its main functions are as follows:
1. Remote interactive communication and consultation between medical experts and doctors and patients of the applicant hospital. The system supports remote control of off-site cameras and real-time adjustment of the observation angle; the system supports bedside needs of critically ill patients, who can receive real-time expert remote consultation and remote monitoring services in their beds;
2. The system supports remote consultation services between the consultation applicant hospitals and hospitals belonging to the different ministries of health and different provincial level 3A hospitals; it supports multi-specialty, multi-institution and cross-regional consultation services for the same primary level hospitals at the same time. The system supports real-time joint consultation between the consulting hospital and different hospitals under the Ministry of Health and different provincial tertiary-level hospitals. When applying for consultation to different hospitals, the system should switch quickly and seamlessly to enhance the system response efficiency and expandability;
3. Carry out remote education, support the synchronization of audio/video and courseware slides of lecturing experts, support interactive communication between the two sides, and support the live broadcast and video recording of the training process;
4. Support high-definition video conferencing among medical institutions to meet the needs of academic exchanges and case studies among medical institutions.
5, audio and video recording/playback, support for consultation, meetings, teaching process recording and video playback;
6, can be interconnected with the emergency command system video platform, support for audio and video information reporting.
7, the basic configuration of the system:
① IP network-based full HD video conferencing system
② H.323 protocol framework technology, while supporting the mainstream audio and video protocols, such as H.264
③ resolution: resolution ≥ 1280 × 720P
④ frame rate: 30 frames / sec
⑤ Dual-stream: support H.239 standard, the resolution of the second video stream ≥1280×720P
⑥ Support dual-screen display applications
⑦ Interconnect with emergency command video exchange platform. Where conditions permit, the remote consultation video conferencing system can be interconnected with the national and provincial emergency command video exchange platform to realize the emergency consultation and the reporting of emergency-related image information.
(E) remote education subsystem support real-time interactive and courseware on-demand two training modes. Real-time interactive training should be able to ensure that the lecturing experts audio and video and courseware playback synchronization; support for real-time interaction between training participants; support for the training process video, and saved as a common file format stored in the remote consultation center, and support for streaming media courseware production, sorting, categorization. Real-time interactive training should include support for remote surgical observation, remote nursing demonstration and remote teaching room. Support courseware on-demand service, with new, delete, upload, query and other courseware management functions.
(F) Remote digital resources *** enjoyment subsystem Support primary medical institutions *** enjoyment of medical library and intelligence resources, to facilitate access to medical literature, in order to improve the business level of primary medical personnel. At the same time, it supports higher-level hospitals to share typical medical records, case studies, surgical videos and other materials*** with lower-level hospitals for the reference and study of medical personnel in primary hospitals.
(VII) two-way referral and remote booking subsystem supports two-way referral and remote booking between primary care organizations and higher-level hospitals. It supports the automatic transfer of discharged patient information from higher-level hospitals to the patient's primary healthcare organization, and the follow-up and post-hospital management of the patient by the primary healthcare organization, and guides the patient's local review and re-diagnosis. It supports primary hospitals to complete the operations of booking appointments, booking examinations, and applying for transfers; and it supports higher-level hospitals to complete the acceptance of related applications and feedback.
(H) electronic identity authentication subsystem Access to the unified identity authentication system to be constructed to realize the unified identity authentication and data encryption authentication of units and individuals across the system to ensure system operation security and data security.
(IX) SMS platform subsystem Support station SMS notification and cell phone SMS notification, the system internal users can send one-to-one or one-to-many notifications through the station SMS function, can also be manually or automatically through the cell phone SMS platform for things to deal with notification. It is convenient for timely and effective processing of consultation applications, and realizes the consultation time reminder.
(J) Expense Settlement Subsystem Supports the setting of teleconsultation fee standards for telemedicine consultation expense inquiries, settlements, summaries, etc.
(X) Expense Settlement Subsystem.
(XI) Teleconsultation communication network and data center
Communication network Teleconsultation communication network all use fiber optic line network, that is, access to the health information network (set up by the mobile network), the node bandwidth allocation is as follows:
Teleconsultation center: 100MB mobile fiber optic network outlet, with a backup line, fixed IP address. Primary medical institutions: 4MB mobile fiber optic access, with a fixed IP address. Data Center The provincial telemedicine data center adopts dual-machine hot standby and optical fiber storage, makes full use of existing resources, and is uniformly planned into the health information platform under construction. It realizes the storage and management of various types of telemedicine data and provides data mining and analysis support for various telemedicine application systems, such as tele-education system and remote digital resource **** enjoyment system.