異質醫療資訊系統整合之研究：以服務導向架構與HL7為基礎之醫療資訊系統為例

Heterogeneous Integrations of the Healthcare Information System: An Empirical Study based on SOA and HL7

楊子翔(Tzu-Hsiang Yang)

指導教授 ： 孫雅麗

國立臺灣大學/管理學院/資訊管理學研究所/博士(2010年)

https://doi.org/10.6342/NTU.2010.02269

摘要

醫療資訊系統在醫院中所扮演的角色越來越重要，醫療資訊系統幫助醫護人員處理醫院的醫療流程與日常作業，醫療資訊系統通常由多個醫療部門的異質資訊系統所組合而成。本論文中，我們探討相關文獻並且整理出八個醫療資訊系統發展需要考量的議題：(1) 部門資訊系統的異質整合，(2) 部門資訊系統的個別需求，(3) 由部門(local)範圍擴張到整個醫院(global)的醫療資訊系統需求，(4) 醫療資訊系統與醫療環境持續變動的需求，(5) 醫療資訊系統架構的擴充性(scalability)，(6) 電子病歷(electronic medical record, EMR)的導入，(7) 醫療資訊系統效能的擴充性，(8) 下一代的醫療資訊系統架構。我們根據這些議題，提出四個發展新醫療資訊系統架構的目標：(1) 適應性(adaptability)與擴充性(scalability)，(2) 異質系統整合，(3) 電子病歷(EMR)的導入，(4) 高系統效能與系統效能的擴充性。
本論文預期提出以服務導向架構(service-oriented architecture, SOA)之醫療資訊系統來解決上述議題，並且提供單一且整合的病人醫療資訊給醫護人員使用，進而達到上述四個目標。我們提出的架構是以SOA與web services為基礎，並且使用HL7作為異質系統交換的平台。為了要解決醫療資訊系統面臨的議題，我們定義了服務(service)所要達到的特性：(1) 異質系統界接與溝通，(2) 適應性與擴充性，(3) 系統容錯。根據這些特性，我們提出並設計在SOA HIS架構下的服務群組(service groups)來達到這些特性。
我們將本論文提出的HL7-based SOA HIS架構，導入同樣面臨上述議題的臺大醫院作為實證研究，來證實我們所提出的系統架構可行且具有實際運用價值。我們並實際計算SOA HIS系統架構的效能，得到HL7Central服務群組在門診、住院與急診的週平均反應時間分別為0.035、0.05與0.036秒。WebUI服務群組在門診、住院與急診的週平均反應時間分別為0.79、1.25、0.82秒。除此之外，我們也對月平均反應時間做統計，並且繪製反應時間的分布圖，結果顯示HL7Central與WebUI兩者的反應時間都相當良好。
我們提出的HL7-based SOA HIS達到了我們所定義的四個目標，最後我們對於實證研究和未來可能的需求作進一步探討。本論文的主要貢獻是設計與發展出HL7-based SOA HIS之醫療資訊系統架構，這個架構能夠解決醫療資訊系統學術研究與實際運用上所面臨的問題，並且達到我們所訂立的目標。除此之外，電子病歷也能順利導入這個架構當中。本論文提出的HL7-based SOA HIS之醫療資訊系統架構，應可作為未來發展醫療資訊系統的參考。

關鍵字

服務導向架構 (SOA) ； 健康資訊交換第七層協定(health level seven, HL7) ； 醫療資訊系統 (HIS) ； 電子病歷 (EMR) ； 以服務導向架構與HL7為基礎之醫療資訊系統(HL7-based SOA HIS, SOA HIS)

並列摘要

Healthcare information systems (HISs) have become increasingly important over the last two decades. They help physicians, nurses, and administrative staff with their daily operations and workflows in hospitals. Many existing HISs are composed of departmental management systems and heterogeneous systems. In this dissertation, we survey the relevant literature and describe eight issues associated with the implementation of HISs in healthcare: (1) the heterogeneous integration of departmental management systems in the HIS, (2) the specific requirements of departmental management systems, (3) information system architectures, from the local scale to the global scale, (4) the continuously changing issues associated with HISs and environments, (5) the scalability of HIS architectures, (6) the adoption of electronic medical records (EMRs), (7) the performance scalability of HISs, and (8) the next generation of HIS architecture. Based on the issues identified, we propose four goals that a new HIS architecture must achieve: (1) adaptability and scalability, (2) heterogeneous system integration, (3) the adoption of EMRs, (4) high performance and performance scalability.
This dissertation proposes a new service-oriented architecture (SOA) for HISs, which resolves the issues described above and provides a single, uniform, and integrated view of patient information for physicians and nurses and achieves the four goals. The proposed system is based on a SOA and on web services that utilize Health Level Seven (HL7) standards as the abstraction level for complex and heterogeneous environments in the medical center. To resolve the issues faced by HISs, the following service characteristics are defined: (1) system interoperability for services, (2) adaptability and scalability for services, and (3) system’s fault tolerance for services. Based on these requirements for the HL7-based SOA HIS (SOA HIS) and for the service characteristics, we design service groups for a SOA HIS at medical centers.
To show that the proposed SOA HIS is reasonable and suitable for adoption in medical centers, we introduce the proposed architecture into the National Taiwan University Hospital (NTUH), which faces the same issues in terms of HISs. The results of this empirical study show that the SOA HIS possesses interoperability, adaptability, scalability, and fault tolerance. We also evaluate the performance of the SOA HIS. The weekly average response times for outpatient, inpatient, and emergency HL7Central systems are 0.035, 0.04, and 0.036 seconds, respectively. The weekly outpatient, inpatient, and emergency WebUI average response times are 0.79, 1.25, and 0.82 seconds, respectively. We also analyze the monthly performance and response time distributions, which show that the response times of both the WebUI and HL7Central demonstrate high performance characteristics.
The proposed HL7-based SOA HIS achieves our goals: (1) adaptability and scalability, (2) heterogeneous system integration, (3) the adoption of EMRs, and (4) high performance and performance scalability. We also discuss the empirical study and further requirements identified in the course of the study. The main contribution of this dissertation is the design and development of a HL7-based SOA HIS architecture that can achieve the set goals and resolve the research problems and the practical issues of HISs. Moreover, EMRs can be adopted into the HL7-based SOA HIS. The proposed HL7-based SOA HIS architecture can serve as a new HIS architecture for the coming decade.

並列關鍵字

service-oriented architecture (SOA) ； health level seven (HL7) ； healthcare information system (HIS) ； electronic medical record (EMR) ； HL7-based SOA HIS (SOA HIS)

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