1、Chapter 7Chapter 7Integrating the Health Integrating the Health EnterpriseEnterprise醫療系統整合的應用與發展醫療系統整合的應用與發展IHE的整合發展與應用v IHE IHE技術發展背景技術發展背景v IHEIHE第五年技術架構簡介第五年技術架構簡介v 醫療資訊相關標準之應用醫療資訊相關標準之應用v 醫療資訊整合醫療資訊整合v IHEIHE發展的新趨勢發展的新趨勢IHE技術發展背景v美國美國RSNARSNA及及HIMSSHIMSS主導主導IHEIHE五年計畫五年計畫(19992003)(19992003)v目的目
2、的:應用及整合應用及整合HL7HL7、DICOMDICOM及及XMLXML等現有醫療資訊等現有醫療資訊及醫療影像傳輸標準，以減少醫療資源之浪費及醫療影像傳輸標準，以減少醫療資源之浪費v協會、產業界、學者專家、使用者協會、產業界、學者專家、使用者v嚴謹的發展流程嚴謹的發展流程 IHEIHE第五年第五年:(1)92 (1)92年初年初 ：技術架構：技術架構(Technical Framework)(Technical Framework)擬訂擬訂 (2)92.02.0103.03(2)92.02.0103.03：技術架構公開討論技術架構公開討論 (3)92.04.2404.25(3)92.04.2
3、404.25：產業界說明會產業界說明會 (4)92.04.2505.30(4)92.04.2505.30：產業界報名產業界報名 (5)92.07.09 (5)92.07.09 ：視訊會議：視訊會議(研習會研習會)(分組討論分組討論)(6)92.08/09 (6)92.08/09 ：MESAMESA測試及回報測試及回報 (7)92.10.0610.10(7)92.10.0610.10：Connect-A-ThonConnect-A-Thon整合測試整合測試 (8)92.11.3012.05(8)92.11.3012.05：RSNA2003RSNA2003年會年會IHE(IHE(動態展示動態展示-
4、研討會研討會)IHE技術發展背景v技術架構公開討論技術架構公開討論(Submit and review comments)技術架構文件技術架構文件:討論區討論區:公開討論截止日期公開討論截止日期:92.03.0392.03.0320032003年公開討論版本年公開討論版本:Revision 5.5http:/www.rsna.org/IHE/tf/ihe_tf_index.shtmlhttp:/forums.rsna.org/IHE技術發展背景v產業界說明會產業界說明會(IHE Radiology Vendor Workshop 2003(IHE Radiology Vendor Worksh
5、op 2003)說明會時間說明會時間:92.0492.04 說明會內容說明會內容(Documents)(Documents)q q q q 說明會簡報資料說明會簡報資料 Introduction To IHEReview of Mature IHE Integration Profiles New IHE Integration Profiles Planning and Participation for IHE Radiology 2003 http:/www.rsna.org/IHE/presentations/ihe_pres_index.shtmlIHE技術發展背景圖片摘錄自RSNA
6、 IHE網頁IHE技術發展背景v產業界報名產業界報名(續續)(Participation)1999/2000/2001/20021999/2000/2001/2002年參與廠家數年參與廠家數:24/32/31/3524/32/31/3520022002年參與廠家年參與廠家:AgfaAlgotecCannonCedaraCernerCSISTEastman Kodak EmageonFujiGEHitachiHologicIDXImcoIntrsumentarium ImagingKonicaMarotechMcKessonMedcon Medical Manager Health System
7、sMediface MergeMitraPhilipsRASNASiemensSoftmedicalStentorStorCOMMSwissrayTianiToshibaUltraVisual Vital ImagesVoxar IHE技術發展背景v分組討論分組討論(Participant Workshop)v視訊會議視訊會議(Participant Web Conference，2003.072003.07)RSNA 2001/HIMSS 2002 IHE RSNA 2001/HIMSS 2002 IHE 展示分組展示分組A AScheduled Workflow/Patient Infor
8、mation Reconciliation:Group A NumCompanyRoles(Image Manager)Notes1IDXADT/Order Placer 2SiemensOrder Filler 3TianiImage Manager 4AgfaModality(CR)(Tiani)5PhilipsModality(US)(GE)Large US cart Backside 6SwissrayModality(DX)(Fuji)7GEImage Manager Large Server box8FujiImage Manager 9ALIModality(DX)(Emageo
9、n)10EmageonImage Manager 11CSISTImage Display IHE技術發展背景vMESA測試測試系統發展及系統發展及MESAMESA測試結果回報測試結果回報Medical Enterprise Simulators and Analyzersq O.S.:q Component:Developed by the Electronic Radiology Laboratory at the Mallinckrodt Institute of Radiology,Washington University of St.Louis (由由Steve MooreStev
10、e Moore教授所帶領的教授所帶領的技術團隊技術團隊)MESAMESA下載網址下載網址:Linux/Solaris/Windows NT/2000/Other UnixFacilities/Simulators/Utility_Programs/Documentationhttp:/www.erl.wustl.edu/mesa/index.htmlIHE技術發展背景vConnect-A-ThonConnect-A-Thon整合測試整合測試整合測試時間整合測試時間:2003.102003.10整合測試地點整合測試地點:美國芝加哥美國芝加哥RSNARSNA總部總部圖片摘錄自RSNA IHE網頁I
11、HE技術發展背景vRSNA/HIMSSRSNA/HIMSS年會展示年會展示IHE第五年技術架構簡介vIHE Integration Profiles(T.F.Rev.5.5)第一冊第一冊:Integration Profiles Integration Profiles第二冊第二冊:Transactions 1-31:Transactions 1-31第三冊第三冊:Transactions 32-46:Transactions 32-46第四冊第四冊:National Extensions:National Extensionsq法國q德國q美國q義大利q英國圖片摘錄自 IHE Technic
12、al FrameworkIHE第五年技術架構簡介v IHE Radiology Integration Profiles(T.F.Rev.5.5 Vol.I)圖片摘錄自 IHE Technical FrameworkIHE第五年技術架構簡介圖片摘錄自RSNA IHE網頁IHE第五年技術架構簡介AcquisitionModalityOrder PlacerDSS/Order FillerADTImageArchiveImage ManagerScheduled Workflow Integration ProfilePPS ManagerEvidence CreatorImage Display
13、Pt.Registration 1Patient Update 12Placer Order Management 2Filler Order Management 3Procedure Scheduled 4Image Availability Query 11Procedure Updated 13Performed Work Status Update 42Performed Work Status Update 42Query Images 14Retrieve Images 16StorageCommitment 10StorageCommitment 10 Creator Imag
14、esStored 18Modality Image Stored 8Modality PS in Progress 6Modality PS Completed 7Creator PS in Progress 20Creator PS Completed 21Creator PS in Progress 20Creator PS Completed 21Modality PS in Progress 6Modality PS Completed 7Creator PS in Progress 20Creator PS Completed 21Modality PS in Progress 6M
15、odality PS Completed 7Modality Worklist Provided 5Pt.Registration 1Patient Update 12ADTDSS/Order FillerOrder PlacerImage DisplayEvidence CreatorImage ManagerPPS ManagerAcquisitionModalitycontinueIHE第五年技術架構簡介Scheduled Workflow Integration Profile圖片摘錄自 IHE Technical FrameworkIHE第五年技術架構簡介Scheduled Work
16、flow Integration Profile圖片摘錄自 IHE Technical FrameworkIHE第五年技術架構簡介Acquisition ModalityADT Patient RegistrationAudit Record RepositoryCharge ProcessorDepartment System Scheduler/Order FillerEnterprise Report RepositoryEvidence CreatorExternal Report Repository AccessImage ArchiveImage DisplayImage Man
17、agerMaster Patient Index(MPI)Order PlacerPerformed Procedure Step ManagerPost-Processing ManagerPrint ComposerPrint ServerReport CreatorReport Manager Report ReaderReport RepositorySecure NodeTime Server 圖片摘錄自 IHE Technical Framework共共23個個ActorsIHE第五年技術架構簡介圖片摘錄自 IHE Technical Framework醫療資訊相關標準之應用v 協
18、定協定1:Patient Registration1:Patient Registration，病患掛號資料，病患掛號資料，HL7HL7v 協定協定2:Placer Order Management2:Placer Order Management，醫令產生或取消訊息，醫令產生或取消訊息，HL7HL7v 協定協定3:Filler Order Management3:Filler Order Management，醫令產生、取消或更改訊息，醫令產生、取消或更改訊息，HL7HL7v 協定協定4:Procedure Scheduled4:Procedure Scheduled，造影取像排程訊息，造影
19、取像排程訊息，HL7HL7v 協定協定5:Modality Worklist Provided5:Modality Worklist Provided，造影取像排程訊息，造影取像排程訊息，DICOMDICOMv 協定協定6:Modality Procedure Step In Progress6:Modality Procedure Step In Progress，取像回報，取像回報，DICOMDICOMv 協定協定7:Modality Procedure Step Completed7:Modality Procedure Step Completed，取像完成回報，取像完成回報，DICO
20、MDICOMv 協定協定8:Modality Images Stored8:Modality Images Stored，造影儀器影像儲存，造影儀器影像儲存，DICOMDICOMv 協定協定9:Modality Presentation State Stored9:Modality Presentation State Stored，描繪參數儲存，描繪參數儲存，DICOMDICOMv 協定協定10:Storage Commitment10:Storage Commitment，儲存確認，儲存確認，DICOMDICOMv 協定協定11:Image Availability Query11:Ima
21、ge Availability Query，影像查詢，影像查詢，DICOMDICOMv 協定協定12:Patient Update12:Patient Update，病患資料更新，病患資料更新，HL7HL7v 協定協定13:Procedure Update13:Procedure Update，造影取像排程更新訊息，造影取像排程更新訊息，HL7HL7v 協定協定14:Query Images14:Query Images，影像查詢，影像查詢，DICOMDICOMv 協定協定15:Query Presentation States15:Query Presentation States，描繪參數
22、查詢，描繪參數查詢，DICOMDICOMAcquisitionModalityOrder PlacerDSS/Order FillerADTImageArchiveImage ManagerPPS ManagerEvidence CreatorImage DisplayPt.Registration 1Patient Update 12Placer Order Management 2Filler Order Management 3Procedure Scheduled 4Image Availability Query 11Procedure Updated 13Performed Wor
23、k Status Update 42Performed Work Status Update 42Query Images 14Retrieve Images 16StorageCommitment 10StorageCommitment 10 Creator ImagesStored 18Modality Image Stored 8Modality PS in Progress 6Modality PS Completed 7Creator PS in Progress 20Creator PS Completed 21Creator PS in Progress 20Creator PS
24、 Completed 21Modality PS in Progress 6Modality PS Completed 7Creator PS in Progress 20Creator PS Completed 21Modality PS in Progress 6Modality PS Completed 7Modality Worklist Provided 5Pt.Registration 1Patient Update 12醫療資訊相關標準之應用v 協定協定16:Retrieve Images16:Retrieve Images，影像讀取，影像讀取，DICOMDICOMv 協定協定1
25、7:Retrieve Presentation States17:Retrieve Presentation States，描繪參數讀取，描繪參數讀取，DICOMDICOMv 協定協定18:Creator Images Stored18:Creator Images Stored，影像產生器影像儲存，影像產生器影像儲存，DICOMDICOMv 協定協定19:Creator Presentation State Stored19:Creator Presentation State Stored，描繪參數儲存，描繪參數儲存，DICOMDICOM v 協定協定20:Creator Procedur
26、e Step In Progress20:Creator Procedure Step In Progress，產像回報，產像回報，DICOMDICOMv 協定協定21:Creator Procedure Step Completed21:Creator Procedure Step Completed，產像完成回報，產像完成回報，DICOMDICOMv 協定協定23:Print Request with Presentation LUT23:Print Request with Presentation LUT，影像列印，影像列印，DICOMDICOMv 協定協定24:Report Subm
27、ission24:Report Submission，報告資料儲存，報告資料儲存，DICOMDICOMv 協定協定25:Report Issuing25:Report Issuing，報告資料儲存，報告資料儲存，DICOMDICOMv 協定協定26:Query Reports26:Query Reports，報告資料查詢，報告資料查詢，DICOMDICOMv 協定協定27:Retrieve Reports27:Retrieve Reports，報告資料讀取，報告資料讀取，DICOMDICOMv 協定協定28:Structured Report Export28:Structured Repor
28、t Export，結構化報告資料轉換，結構化報告資料轉換，HL7HL7v 協定協定29:Key Image Note Stored29:Key Image Note Stored，關鍵影像註解資料儲存，關鍵影像註解資料儲存，DICOMDICOMv 協定協定30:Query Key Image Notes30:Query Key Image Notes，關鍵影像註解資料查詢，關鍵影像註解資料查詢，DICOMDICOMv 協定協定31:Retrieve Key Image Notes31:Retrieve Key Image Notes，關鍵影像註解資料讀取，關鍵影像註解資料讀取，DICOMDIC
29、OM醫療資訊相關標準之應用v 協定協定32:Authenticate Node32:Authenticate Node，DICOMDICOM 、TLSTLS(RFC 2246)(RFC 2246)、X.509X.509v 協定協定33:Maintain Time33:Maintain Time，NTPNTP(RFC 1305)(RFC 1305)v 協定協定34:Record Audit Event34:Record Audit Event，BSDBSD(RFC 3164)(RFC 3164)、PSPS 115-99 115-99、XMLXML1.01.0v 協定協定35:Charge Pos
30、ted35:Charge Posted，HL7HL7v 協定協定36:Account Management36:Account Management，HL7HL7v 協定協定37:Worklist Provided37:Worklist Provided，DICOMDICOMv 協定協定38:Workitem Claimed38:Workitem Claimed，DICOMDICOMv 協定協定39:Workitem PPS In Progress39:Workitem PPS In Progress，DICOMDICOMv 協定協定40:Workitem PPS Completed40:Wo
31、rkitem PPS Completed，DICOMDICOMv 協定協定41:Workitem Completed41:Workitem Completed，DICOMDICOMv 協定協定42:Performed Work Status Update42:Performed Work Status Update，DICOMDICOMv 協定協定43:Evidence Document Stored43:Evidence Document Stored，DICOMDICOMv 協定協定44:Query Evidence Documents44:Query Evidence Documents
32、，DICOMDICOMv 協定協定45:Retrieve Evidence Documents45:Retrieve Evidence Documents，DICOMDICOMv 協定協定46:Reporting Worklist Provided46:Reporting Worklist Provided，DICOMDICOM醫療資訊相關標準之應用vIHE Transaction 1(Patient Registration，HL7)圖片摘錄自 IHE Technical Framework醫療資訊相關標準之應用vIHE Transaction 5(Modality Worklist Pro
33、vided，DICOM)圖片摘錄自 IHE Technical Framework醫療資訊相關標準之應用vIHE Integration Security Process Flow圖片摘錄自 IHE Technical Framework醫療資訊整合AcquisitionModalityOrder PlacerDSS/Order FillerADTImageArchiveImage ManagerScheduled Workflow Integration Profile HL7/DICOM MappingPPS ManagerEvidence CreatorImage DisplayPt.R
34、egistration 1Patient Update 12Pt.Registration 1Patient Update 12Placer Order Management 2Filler Order Management 3Procedure Scheduled 4Image Availability Query 11Procedure Updated 13Performed Work Status Update 42Performed Work Status Update 42Query Images 14Retrieve Images 16StorageCommitment 10Sto
35、rageCommitment 10 Creator ImagesStored 18Modality Image Stored 8Modality PS in Progress 6Modality PS Completed 7Creator PS in Progress 20Creator PS Completed 21Creator PS in Progress 20Creator PS Completed 21Modality PS in Progress 6Modality PS Completed 7Creator PS in Progress 20Creator PS Complete
36、d 21Modality PS in Progress 6Modality PS Completed 7Modality Worklist Provided 5DSS/Order Filler醫療資訊整合HL7 OrderHL7 Order Mapping to Mapping to DICOM MWLDICOM MWL圖片摘錄自 IHE Technical Framework醫療資訊整合HL7 OrderHL7 Order Mapping to Mapping to DICOM MWLDICOM MWL(續續)圖片摘錄自 IHE Technical Framework醫療資訊整合HL7 Or
37、derHL7 Order Mapping to Mapping to DICOM MWLDICOM MWL(續續)圖片摘錄自 IHE Technical Framework醫療資訊整合HL7 OrderHL7 Order Mapping to Mapping to DICOM MWLDICOM MWL(續續)圖片摘錄自 IHE Technical Framework醫療資訊整合HL7 OrderHL7 Order Mapping to Mapping to DICOM MWLDICOM MWL(續續)圖片摘錄自 IHE Technical Framework醫療資訊整合HL7 OrderHL7
38、 Order Mapping to Mapping to DICOM MWLDICOM MWL(續續)圖片摘錄自 IHE Technical Framework醫療資訊整合AcquisitionModalityOrder PlacerDSS/Order FillerADTImageArciiveImage ManagerPatient Information Reconciliation Integration Profile HL7/DICOM MappingPPS ManagerImage Display Patient Update 12Patient Update 12Image Av
39、ailability Query 11Patient Updated 12Procedure Updated 13Query Images 14Retrieve Images 16Modality PS in Progress 6Modality PS Completed 7Modality PS in Progress 6Modality PS Completed 7Modality PS in Progress 6Modality PS Completed 7Modality Worklist Provided 5ReportManagerReport Creator/Report Rea
40、derReporting Worklist Provided 46Query Reports 26Retrieve Reports 27Patient Updated 12Procedure Updated 13ReportManagerImage ManagerImage Availability Query 11Patient Updated 12Procedure Updated 13醫療資訊整合AcquisitionModalityCharge ProcessorDSS/Order FillerADTCharge Posting Integration Profile DICOM/HL
41、7 MappingPPS ManagerAccount Management 36Patient Registration 1 Account Management 36Modality PS Completed 7 Creator PS Completed 21 Modality PS Completed 7Report ManagerEvidence Creator Performed Work Status Update42Charge Posted 35 Creator PS Completed 21DSS/Order Filler醫療資訊整合Report CreatorSimple
42、Image and Numeric Report Integration Profile DICOM/HL7 MappingReport Submission 24External Report Repository AccessReport ManagerReport RepositoryReport ReaderEnterprise Report RepositoryReport Issuing 25Structured Report Export 28Query Reports 26Retrieve Reports 27Query Reports 26Retrieve Reports 2
43、7Report ManagerIHE發展的新趨勢IHE IHE 國際化國際化v歐洲歐洲IHE(IHE Europe)IHE(IHE Europe)The second The second EuropeanEuropean IHE connect-a-thon IHE connect-a-thon,hosted by the,hosted by the Department of Diagnostic Radiology,University Department of Diagnostic Radiology,University Hospital Aachen,Hospital Aache
44、n,GermanyGermany,in the week from,in the week from 24th to 24th to 28th March 200328th March 2003,was a big success.,was a big success.46 vendors tested 46 vendors tested 79 systems79 systems within a period of 4.5 days from Monday to within a period of 4.5 days from Monday to Friday in the worldwid
45、e biggest connect-a-thon.Friday in the worldwide biggest connect-a-thon.(會員國包括英國、法國、德國及義大利會員國包括英國、法國、德國及義大利)IHE發展的新趨勢IHE IHE 國際化國際化v亞太亞太IHE(IHE(IHE-Asia&Oceania，IHE-AOIHE-AO)IHE Japan2002年6月26日至29日CARS(Computer Assisted Radiology and Surgery)會議，台灣、日本及韓國提議組織亞洲IHE(IHE ASIA)之可行性2002年12月RSNA年會中舉行第一次IHE-
46、Asia&Oceania(IHE-AO)會議，台灣、日本、韓國、中國及新加坡IHE Taiwan(92.08.21-22，HL7研討會IHE demo)2003年12月芝加哥RSNA年會IHE發展的新趨勢IHE IHE 技術架構延伸技術架構延伸vIHE Radiology-RSNAIHE Radiology-RSNAvIHE IT Infrastructure-HIMSSIHE IT Infrastructure-HIMSSIHE IT Infrastructure Integration ProfilesRetrieve Informationfor DisplayAccess a pati
47、ents clinicalinformation and documentsin a format ready to bepresentedto the requesting userPatient IdentifierCross-referencingfor MPIMap patient identifiersacross independentidentification domainsConsistentTimeCoordinate timeacross networkedSystemsPatient SynchronizedApplicationsSynchronize multipl
48、e applicationson a desktop to the same patientEnterpriseUserAuthenticationProvide users asingle nameandcentralizedauthenticationprocessacross allSystemsIHE發展的新趨勢IHE IT Infrastructure TimelineIHE IT Infrastructure TimelineFebruary 5-7 2003 First face to face meeting-Oakbrook,ILFebruary 27IT Planning
49、t-con Select 2003/Year 5 IT profilesApril 22-25 Face to face meeting to close all tech issuesJune 2-6 Face to face meeting to produce Public Comment TFJuly 14 Comments due on IT Profiles for Public CommentJuly 28-August 1 Face to face comments consolidation meetingAugust 10IHE IT Integration Profile
50、s(approved-final)September 10-11 Vendor workshop-Memphis,Reg.due October 1st.January 12-16 2004 IHE IT Connectathon-San Diego,CAFebruary 22-26 2004HIMSS HL7-IHE Demo Orlando,FLIHE發展的新趨勢臺灣臺灣IHE IHE 發展近況發展近況(1)92-06-18 92-07-11(1)92-06-18 92-07-11：參展廠商參與：參展廠商參與IHEIHE連線展示意願調查連線展示意願調查 (2)92-07-15 (2)92-
