In recent years, with the favorable opportunity that the government attaches importance to public health work, China's medical and health informatization has made great progress. Health information statistics, health supervision and law enforcement, epidemic situation notification and prevention, rural medical care and other aspects of work have achieved qualitative improvement with the help of information technology. Today, in order to achieve the government's goal of "everyone enjoys basic health", the health service reform has been pushed to the forefront of medical reform as never before. However, doctors still haven't changed the traditional referral model. They need to call the regional tertiary hospital to contact the patient for referral, and the patient's laboratory test and examination results cannot be enjoyed. Health administrative institutions can't supervise in real time, the massive medical and health data generated by a large amount of investment can't be fully utilized, and patients' information can't be really enjoyed, which fully exposes the defects of China's health information system, mainly in the following four aspects:
1, the hospital information investment is huge, but they are all information islands: 8 12 hospitals above the county level in the province have basically established hospital information systems. However, there is no dedicated information network and communication link between hospitals and administrative departments at all levels, and there is no information sharing platform. It is impossible to realize two-way referral and mutual recognition of examination results, and the information is not smooth, resulting in a serious waste of medical resources.
2. Lagging health administration is tantamount to taking a high-speed train: hospitals need to submit all kinds of medical business data to health administrative departments at all levels and other relevant departments regularly and irregularly, including hospital statistics, maternal and child health care, planned immunization, death reports, infectious disease reports, blood use reports, medical expense indicators, etc. Almost all of them are submitted by e-mail or manual input directly through the network, which has many problems such as security risks, low timeliness and poor data accuracy. This situation seriously restricts the decision-making efficiency and quality of the health administrative department, and limits the health administrative department's ability to implement various medical and health policies and regulations and evaluate the implementation effect.
3. There are many difficulties in real-time supervision and settlement of social security, medical insurance, rural cooperative insurance and commercial insurance: the medical insurance for urban workers in our province has been implemented since 2000, and provinces, cities and counties have invested hundreds of millions of yuan to establish a private network between the medical insurance centers of cities and counties and their affiliated hospitals, and transmit the detailed data of medical insurance patients to the data server of the medical insurance center every day, so that medical insurance institutions can audit and reimburse the expenses of medical insurance patients. However, it still cannot fully meet the information needs of medical insurance institutions, designated hospitals, insured units and individuals. Hospitals, in particular, are always troubled by the interface and data transmission between hospitals and medical insurance information systems, and reimbursement in different places cannot be carried out. The rural cooperative medical system has been developed for nearly two years, and it is impossible to establish information sharing channels between county-level rural cooperative medical institutions and hospitals. Only the most primitive post-audit method based on invoices and expense lists can be adopted, sometimes there will be false reports or concealment, and there is no effective intervention and supervision mechanism for unreasonable medical consumption behavior.
4, fragmented, low-level redundant construction, huge waste: urban workers' medical insurance institutions are subordinate to the social security department, rural cooperative medical institutions are subordinate to the health administrative department, and medical expenses control is the responsibility of the price department. The internal division of the health administrative department makes the business of women and children, children, medical administration, epidemic prevention, cause of death and hospital statistics belong to different offices. Every department, industry and office pays attention to the demand of medical and health information from their own perspective, and all want to rely on their own strength to build information systems and networks that can meet their own needs. This kind of information system and network is not the product of overall planning and system design from a macro perspective, but actually another form of information island. Not only can it not fully meet the information sharing needs of departments or industries, but it will lead to multi-port information collection and repeated input, affect the consistency and correctness of data, cause higher-level data confusion and contradiction, increase the difficulty and cost of macro-decision, and even fail to analyze, utilize and mine data from a macro and global perspective to provide cross-departmental and cross-departmental data. In fact, this practice has wasted or is wasting the limited information construction funds of the country on low-level redundant construction projects.
project proposal
Under the leadership of the government and the health department, according to the requirements of "overall planning, national leadership, unified standards, joint construction and sharing, and resource sharing" in the State Council, a provincial-level medical and health information sharing platform will be established to maximize the use of limited medical and health information resources and realize the integration of preventive health care, medical services and health management information.
Taking the actual needs of medical care, health care, epidemic prevention, supervision and medical insurance as an opportunity, based on the medical and health data center, we will build a provincial-level regional medical and health information sharing platform and establish a medical and health information portal for different institutions and individuals. Provide personalized information services through unified interfaces, interfaces, security mechanisms and management rules, and realize information interaction between individuals and hospitals, medical information sharing between hospitals, vertical and horizontal interconnection and information sharing between health departments and their related departments, and even the comprehensive informationization of the entire medical and health industry; Let rural cooperative medical care, community service, two-way referral, residents' health records, telemedicine, health e-government, medical insurance, online health education and consultation be fully and widely used; Make health administration, epidemic prevention, disease control, food and drug supervision, family planning, maternal and child health care, health supervision, social security, civil affairs, price and other departments and institutions work together through the platform.
Overall project plan
Provincial medical and health information sharing platform is based on federated model and portal framework, providing an open and infinitely extensible medical information integration platform. The platform consists of a set of innovative tools with integration and interaction functions, so that the system integration based on the platform will not affect the original information system, protect the existing software and hardware investment of the hospital to the greatest extent, and improve the return on existing investment. Through the integration platform, customized integrated views can be provided for different kinds of users with different rights. At the same time, automatic process management based on interface is responsible for the state synchronization between views, which simplifies the operation steps for users to use the system and improves the usability of the system. In addition, through the data communication interface, the platform not only supports the information integration of the presentation layer, but also supports the information sharing of the data layer. Enterprise-level security policies ensure the security and reliability of information sharing.
The following figure shows the composition of Carefx fusion platform:
Design concepts and principles
According to the requirements of information sharing platform and long-term successful experience in large-scale medical information system integration projects. We put forward the idea of overall design: adopting platform and component design methods to ensure the openness and expansibility of the platform; Realize non-invasive application integration, unified security, automated process management, and unified integrated view presentation.
principle
Advanced nature: Due to the rapid development of information technology, advanced technology should be adopted as much as possible in the development process to ensure the advanced nature of products. While considering the advanced nature of technology and products, we should also consider the maturity of technology.
Practicality: provide a set of innovative tools with integration and interaction functions, which greatly improves the efficiency of application integration and use on the platform; Rich management software all uses graphical interactive man-machine interface, which makes the system maintenance and management operation simple and convenient.
Security: The platform uses network login authentication, user roles and permissions to authenticate users. In order to ensure the security of data transmission and prevent the transmitted data from being stolen or changed, the important original data collected by the application system adopts the technology of combining network encryption transmission, database encryption transmission and application system data encryption. The audit log is used to record the user's operation of entering the system, and afterwards analysis can be made according to the log to find out the cause, responsible person or illegal user of the accident.
Reliability: The platform construction adopts mature technology and excellent high-integration equipment in the world today to ensure the high stability and reliability of the system. Design as detailed a troubleshooting scheme as possible for the system (such as hardware, operating system, network and database) to ensure the rapid recovery of the system. Redundant technologies (redundant devices, redundant communication links, RAID technology) without a single point of failure are adopted to ensure reliable data storage and reliable operation of networks and systems. Real-time monitoring and early warning of system, storage and network operation.
Openness: Technical solutions and equipment have good interconnection and upgrading capabilities, and follow the latest international standards, national standards and industry standards, and follow the principle of openness. Ensure that different kinds of application systems with different operating environments can be seamlessly integrated into the information sharing platform to provide unified service and management.
Extensibility: Through various integrated tools and components provided by the platform, existing application systems can be managed and upgraded on the management platform, and new applications can be developed on the platform.
Integrity: The platform design fully considers the integrity, emphasizing the overall unity of platform planning and the standardization of interfaces with the outside world, so as to fully improve the overall efficiency of the platform.
Efficiency: The linear expansion of platform service capacity and traffic balance ensure that system resources can be allocated to meet the actual needs in the environment of large transaction volume and large data volume. The high availability of servers ensures that platform applications and services will not be affected when a single server or service fails.
system structure
Security module: This module shows the security capability of the whole information sharing platform. All the sub-functional modules in this module work together to provide security for the whole system scheme. The authentication module combines the security mechanism of the portal server to authenticate the user identity; The encryption module uses SSL protocol to encrypt the data transmitted on the network to ensure the confidentiality and integrity of the transmitted data; The log system records audit information related to user login. All access requests to the portal need to be routed through this module and forwarded to the portal module. Through related security gateway products, the encrypted transmission of external network access information is realized.
Portal module: Based on IBMWebSpherePortal server, this module provides portal-related features and functions. Portal provides a simple and unified access portal for information sharing platform, including application integration, IT architecture integration, document content management and collaborative services. In addition, content aggregation is the biggest feature of portal platform. Based on portal platform, data can be obtained from different data sources efficiently and safely, and integrated into a unified interface to present to users. In addition, Carefx also extends the functions of Portal server according to HL7 and CCOW (Clinical Context Object Workgroup) specifications, and realizes automatic process management based on interfaces. This service synchronizes different portlet in real time, so that when users view patient information in one view, other views will be synchronized automatically, displaying the relevant information of the current patient for users, avoiding users from frequently switching views and repeatedly inputting query conditions to find data or information of the same patient based on different applications, greatly simplifying users' operation, improving operation efficiency and reducing the possibility of errors.
Enterprise application domain: the application system contained in the enterprise application domain is the data source of the whole portal platform, which provides the information needed for system integration through various interfaces, and presents these information to users after integration through the portal platform.
System service layer: the system service layer represents the underlying architecture of the platform and the supported middleware components. The portal platform is based on the support of these components and integrates these components into the information sharing platform. The main functions provided by the system service layer are directory service, portal platform database, network and system management service, audit log and various Web Service service interfaces of data sources.