Status and Problems
In recent years, China's healthcare informatization has gained significant development with the favorable timing of the government's emphasis on public **** health work. Health information statistics, health supervision and law enforcement, epidemic notification and prevention, rural health care and other aspects of work with the help of information technology to achieve qualitative improvement. Today, in order to realize the government's goal of "basic health for all," health service reform has been pushed to the forefront of medical reform as never before. However, doctors still have not changed the traditional referral model, they need to call with the region's tertiary hospitals to contact the patient's referral, the patient's test, examination results can not be *** enjoy, health administrative agencies can not be real-time supervision, a large number of inputs generated by the huge amount of health care data is not fully utilized, the patient's information can not be truly *** enjoy, fully exposed China's health information system deficiencies, the main performance of the following four aspects. Mainly manifested in the following four aspects:
1, hospital information technology investment is huge, but are information islands: 812 counties and counties above the provincial hospitals have basically established a hospital information system, however, hospitals and administrative departments at all levels, hospitals and hospitals have not established a dedicated information network and communication links, and even more so, there is no information **** enjoyment of the platform, the two-way referral, mutual recognition of test results can not be truly realized, information is not smooth, medical information can not be truly realized. truly realized, information is not smooth, the phenomenon of waste of medical resources is serious, the people's medical costs grow year after year.
2, health administration and management lagging behind, is tantamount to a horsewhip driving a high-speed train: hospitals need to regularly and irregularly to all levels of health administration and other relevant departments to report all kinds of medical business data, including hospital statistics, maternal and child health care, immunization, death reports, infectious disease reports, reports on the use of blood, medical cost indicators, and so on. Almost all of them are reported through the Internet by mail or by direct manual entry, which has many problems such as security risks, low timeliness, and poor data accuracy. This status quo seriously restricts the efficiency and quality of decision-making of the health administration, and limits the ability of the health administration to implement various healthcare policies and regulations and to assess the effectiveness of implementation.
3, social security, medical insurance, agricultural insurance, commercial insurance real-time supervision and settlement difficulties: urban workers in our province, medical insurance from 2000, the province, cities and counties invested hundreds of millions of dollars, the establishment of cities and counties, medical insurance centers and hospitals under their jurisdiction of the special network between the daily transmission of medical insurance patient detail data to the medical insurance center data servers, in order to review the medical insurance institutions, reimbursement of The medical insurance organization can audit and reimburse the medical insurance patients' fees. However, it still cannot fully meet the information needs of medical insurance organizations, designated hospitals, insured units and individuals. Hospitals, in particular, are always plagued by problems such as interface and data transmission between hospitals and the health insurance information system, and off-site reimbursement cannot be carried out. Rural cooperative medical care has been carried out for nearly 2 years, and it is impossible to establish an information *** enjoyment pathway between county-level rural cooperative medical care institutions and hospitals, and only the most primitive post facto auditing method of using invoices and expense lists as expense vouchers can be used, with occasional misrepresentation or erroneous reporting, not to mention the lack of an effective intervention and supervision mechanism for unreasonable medical consumption behaviors.
4, each in its own way, low-level duplication of construction, a huge waste: urban workers' medical insurance institutions under the social security sector, rural cooperative medical institutions under the health administration, medical cost control by the price department is responsible for, the division of the health administration department within the block makes the women and children, children and young people, medical administration, epidemic prevention, cause of death, hospital statistics and other business under different branches. Each department, industry and office is concerned about the demand for health care information from its 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 without integrated planning and systematic design at a macro level is in fact another form of information silo, which not only can't fully satisfy the information *** enjoyment needs of the department or industry, but also leads to information collection and duplicate input from multiple ports, which affects the consistency and correctness of the data, causes confusion and contradiction of the data at a higher level, and increases the difficulty and cost of macro decision making, and makes it even less possible to analyze and analyze the health care information from a macro level and as a whole. It is possible to analyze, utilize and mine data in a macro and holistic way, and to provide comprehensive, deep-level, large-sample and high-timeliness information services across departments and systems. In fact, this practice has been or is the country's already very limited information technology construction funds wasted in a low-level duplication of construction projects.
The project proposes
Under the leadership of the government and the Department of Health, in accordance with the State Council's requirements of "integrated planning, state-led, unified standards, joint construction, interconnection, resource **** enjoyment", the establishment of provincial medical and healthcare information **** enjoyment platform to maximize the use of limited medical and healthcare information resources and achieve the goal of preventive healthcare and healthcare services. 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 real needs of medical care, health care, epidemic prevention, supervision and medical insurance functions as an opportunity, the provincial regional medical and health information **** enjoyment platform is built on the basis of medical and health care data center: medical and health care information portals are set up for different institutions and individuals. It provides personalized information services through unified interfaces, interfaces, security mechanisms and management rules, realizing information interaction between individuals and hospitals, medical information ****sharing between hospitals, vertical and horizontal interconnection and information ****sharing between the health sector and its related departments, and even comprehensive informatization of the entire healthcare industry; and making the medical care of agricultural cooperative medical care, community services, two-way referral, residents' health records, telemedicine, health e-government, and healthcare e-governance available to the public. file, telemedicine, health e-government, medical insurance, network health education and consultation and other business comprehensive and extensive application; so that health administration, epidemic prevention, disease control, Drug Administration, family planning, maternal and child health care, health supervision, social security, civil affairs, prices and other departments and institutions can realize the platform to work together.
Project overall program
Provincial medical and health information **** enjoyment platform based on the Federation Model (Federation Model) and Portal (Portal) framework, to provide an open, infinitely scalable medical information integration platform. The platform consists of a set of innovative tools with integration and interaction functions, so that the platform-based system integration will not affect the original information system, maximize the protection of the hospital's existing software and hardware investments, and improve the return on existing investments. Through the integration platform can provide customized integrated views for different rights and different types of users, while the interface-based process automation management is responsible for the synchronization of the state between the views, thus simplifying the user's use of the system's operating steps and improving the system's usability. In addition, the platform supports information integration at the presentation layer in addition to information ****enjoyment at the data layer through data communication interfaces. The enterprise-level security policy ensures the safety and reliability of information ****sharing.
The following figure shows the composition of the Carefx Fusion platform:
Design Ideas and Principles
According to the needs of the information **** enjoyment platform, and combining with the successful experience of engaging in the large-scale medical information system integration projects for a long time. We propose that the overall design is based on the following ideas: adopting a platform-based and component-based design approach to ensure the openness and extensibility of the platform; realizing non-intrusive application integration, unified security, automated process management, and unified presentation of the integrated view.
Principles
Advancement: Due to the rapid development of information technology, more advanced technologies should be adopted as much as possible in the development process to ensure the advancement of products. While considering the advanced technology and products, should also take into account the maturity of the technology.
Practicality: to provide a complete set of integration, interactive features of the innovative tools, greatly improving the efficiency of the platform application integration and use; rich management software all use the graphical interactive human-computer interface, so that the system maintenance and management operations are simple and convenient.
Security: The platform uses a combination of network login verification, user roles, and permissions to verify users. In order to ensure the security of data transmission, so that the transmitted data will not be stolen or changed, the important raw data collected by the application system uses a combination of network encrypted transmission, database encrypted transmission and application system data encryption technology. Audit logs are utilized to record user operations into the system, which can be analyzed after the fact based on the logs to find the cause of the accident, the responsible person or the illegal user.
Reliability: The platform is constructed using mature technologies and the world's best highly-integrated equipment to ensure that the system is highly stable and reliable. The system (such as: hardware, operating system, network, database) designed to be as detailed as possible troubleshooting program to ensure that the system's rapid recovery. Adopt redundancy technology without single point of failure (redundant devices, redundant communication links, RAID technology) to ensure reliable data storage, network and system operation. Real-time monitoring and early warning of the operating conditions of the system, storage and network.
Openness: technical solutions and equipment have good interconnection, interoperability and upgrading capabilities, follow the latest international standards, national standards and industry standards, and follow the principle of openness. It ensures that application systems of different kinds and different operating environments can be seamlessly integrated into the information *** enjoyment platform, and unified services and management are provided by the *** enjoyment platform.
Expandability: Through the various integration tools and components provided by the platform, the existing application systems can be managed and upgraded on the management platform, and new applications can also be expanded on the platform.
Integrity: The platform is designed with comprehensive consideration of integrality, emphasizing the overall uniformity of platform planning and standardization of interfaces with the outside world in order to fully improve the overall efficiency of the platform.
Efficiency: The linear expansion of the platform's service capacity and traffic balancing ensure that system resources can be deployed to meet the actual demand under the environment of large transaction volume and large data volume. The high availability of servers ensures that platform applications and services are not affected when individual servers or services fail.
System Architecture
Security Module: This module expresses the security capability of the whole information **** enjoyment platform. The various sub-functional modules in this module work together to provide security for the entire system solution. The authentication module combines the security mechanism of the Portal server to authenticate the user's identity; the encryption module uses the SSL protocol to encrypt the data transmitted over the network to safeguard the confidentiality and integrity of the transmitted data; the logging system records audit information related to the user's login. All access requests to the Portal need to be routed through the module and forwarded to the Portal module, which, together with the relevant security gateway products, realizes the encrypted transmission of information accessed from the external network.
Portal module: This module is based on the IBMWebSphere Portal server and provides Portal-related features and functionality.Portal provides a simple and unified access portal for the information **** enjoyment platform, including application integration, IT architecture integration, document content management and collaboration services. In addition, content aggregation is the most important feature of the Portal platform. Based on the Portal platform, data can be efficiently and securely obtained from different data sources and integrated into a unified interface to present to users. In addition, Carefx follows the HL7 and CCOW (Clinical Context Object Workgroup) specifications to extend the functionality of the Portal server and realize the automated management of interface-based processes. The service synchronizes different portlets in real time, so that when a user views patient information in one view, other views will automatically synchronize to display relevant information about the current patient for the user, avoiding the user from frequently switching views and repeatedly entering query conditions to find data or information about the same patient based on different applications, which simplifies the user's operation to the maximum extent, improves the operational efficiency, and reduces the possibility of errors. Possibility of error.
Enterprise application domain: The application systems contained in the enterprise application domain are the data source of the entire Portal platform, providing the required information for system integration through a variety of different interface methods, and presenting this information to the user after integration through the Portal platform.
System Service Layer: The system service layer represents the underlying architecture of the platform, as well as the supporting middleware components, on which the Portal platform is based, and which are integrated into the information **** enjoyment platform. The main functions provided by the system service layer include directory services, Portal platform database, network and system management services, audit logs, and various Web Service service interfaces for **** enjoyment of data sources.