遠距居家照護資訊系統之醫療資訊管理子系統設計與製作

The Design and Implementation of a Tele-Home Health Care System - Management Subsystem

涂孟魁(Meng-kui Tu)

指導教授 ： 婁世亮

中原大學/工學院/醫學工程研究所/碩士(2005年)

https://doi.org/10.6840/cycu200500812

摘要

先進國家平均國民壽命增長，使人口結構老化的趨勢顯現而出，所因應衍生的問題有許多，醫療資源短缺為其一。一般認為結合電腦、通訊和醫療檢測科技將是解決此問題的主要方法。
醫療檢測如各式影像（CT、MR、CR、US…）都有預設的檢測項目和程序。為求資訊化，影像檢測在DICOM（Digital Imaging Communications on Medicine）標準裡對這些檢測項目、程序和參數有對應的層次定義；其所產生的資料訊息流通，有網路協定的訂定。藉這些層次定義和協定規範發展完成的醫學影像歸檔及傳輸系統（Picture Archiving and Communication System, PACS）也都經歷多年嚴苛的測試，才逐漸為臨床醫學界所接受。如同醫學影像，生理波形訊號如心電圖（Electrocardiograph，ECG）等的醫療檢測也規範有臨床檢測項目、程序和參數，但是它們所對應的層次並無明確地定義；近年來，以生理波形訊號資訊系統發表的文獻，鮮有對其系統運轉效率相關的測試報告。本研究課題依據DICOM標準的形式，對數項生理波形訊號之檢測做出層次的定義和網路協定的設計，並建置一套類似PACS的遠距居家照護資訊系統的資料管理子系統，以之做為測試與評估的平台。
所建置的子系統在硬體部分包含多部個人電腦系統，這些電腦各司其職，包含有區域警衛（Section Guard），區域管理員（Section Manager），診視者（Viewer）與資料庫管理員（Database Manager），其間是以100Mbps乙太網路（Ethernet）將它們鏈結成ㄧ個區域網路。為使其運作得宜，本課題設計製做有四套軟體程式模組於其中。（一）網路傳輸協定模組的功能為開啟電腦之間網路溝通之通道；（二）服務模組的功能為提供區域網路各台電腦進行儲存、查詢、調檔與註冊四項服務；（三）資料庫管理模組的功能為提供應用程式對資料庫進行儲存與管理的動作；（四）訊號顯示模組的功能為對數項生理波形訊號之檢測項目做有系統層次的呈現。
在完成硬體架構與軟體配置所整合之醫療資訊管理子系統之後，本課題以1410筆心電圖檔案、1412筆溫度檔案與354筆血氧濃度檔案進行網路檔案傳送的測試與資料庫測試。在檔案傳送（File Transfer）測試方面，心電圖檔案平均花費708毫秒(millisecond, ms)，溫度檔案平均花費693.26 ms，血氧濃度檔案則平均花費738毫秒。提調檔案（File Retrirval）測試方面，以5組調檔程式分別配置於5部電腦，當同時進行調檔服務時，心電圖檔案平均花費570 ms，溫度檔案平均花費487.5 ms，血氧濃度檔案平均花費557.5 ms。資料庫測試是以5組查詢程式配置於5部電腦同時查詢資料，測試結果顯示，資料庫的資料量在ㄧ百萬筆時，需約5秒查獲ㄧ筆資料；資料量
達ㄧ千萬筆時，查詢ㄧ筆資料的時間遽增至64秒。
本研究已初步建立一套遠距居家照護資訊系統的醫療資訊管理子系統，與已開發之使用者子系統初步完成整合測試。完成的整合系統將架構在臨床醫學上進行實際的臨床測試，以獲得更完整的應
用經驗，而藉由經驗，能改善系統在實際使用的需要，使系統性能更加完善。對於遠距居家照護資訊系統品質的提升有相當之助益。

關鍵字

遠距居家照護 ； 醫學影像儲存通訊系統 ； 醫療影像資訊標準

並列摘要

Shortage of medical resource has been a major issue to many developed countries. This issue is largely worsened due to the huge increase in the aging population. To alleviate such a problem, a thought of integrating computer, communication, and medical examination technologies is often suggested as the solution. The theme of the thought is to monitor vital physiology signals such as electrocardiograph (ECG), blood pressure (BP), saturated pulse oxygen (SPO2), and body temperature (BT) from distance by medical experts. A term for this thought is tele-home health care.
There are regulated examining procedures in performing medical imaging modalities such as CT, MR, CR and US. The images recorded from the examinations must be well managed to assure uncompromised medical practices. Computerization and interoperatability are the trend of managing medical records. To assure that these records can be classified and identified; objects in terms of natures and attributes must be defined. The examples of the objects are types of imaging modality, body parts being studied, techniques used in studies, etc. They can be organized in a layer fashion to facilitate the implementation of systematic management. DICOM (Digital Imaging Communications on Medicine) is a comprehensive standard regulating not only lots of layered objects but also many modules as building blocks of communication protocols. DICOM based PACS (Picture Archiving and Communication System) had been rigorously tested and accepted as daily clinical practices for years. Vital signals such as ECG are in waveform. They are analogous to medical images having clinical protocols regulated. Unfortunately, there is no clear definition to structure the physiological waveform signal examinations in layers which significantly hampers the development of tele-home health care (THHC) systems. This is probably the reason why recent papers report no quantitative evaluation of operation efficiency of THHC systems. This work designed a layer scheme to structure the physiological waveform signal examinations based on the DICOM standard. The layer scheme was then used to implement a THHC system which serves as the platform to be quantitatively evaluated in terms of operating efficiency and system reliability. It must be noted that the focus of this work is on the design and implementation of the management subsystem (MSS) of the THHC system.
The management subsystem includes several personal computers (PC) which function as section guards, section managers, viewers and database managers. A 100Mbps Ethernet links these computers as a functional unit. In this study, four software modules were developed and applied in the MSS. The first software module, communication protocol module, is designed to transmit syntax and messages among the computers for establishing network communication associations. Once the communication associations are established, the second software module including a collection of services such as storage, query, retrieval and registration supplies the MSS tools for exchanging information and waveform files. The third one is a database management module. It organizes patients’ demographic information and associated examination files in a layer fashion which can efficiently improve file archival and retrieval. The fourth one, signal display module, is mainly a display program that provides the capability of presenting the vital physiology signals in a form of structured layers.
Upon the complement of the MSS development, the system performance study was evaluated. In the study there were 61 patients involved. These examined patients produced 1,410 ECG files, 1,410 BT files, and 354 SPO2 files. Each of ECG and SPO2 files is about 100 Kbytes in size. The size of a BT file is rather small, 2 Kbytes per file, approximately. In the study of testing file transmission speed, on average it took 708 milliseconds (ms), 693.26 ms, and 738 ms for each ECG, BT, and SPO2 file, respectively. To test the file retrieval performance, a retrieval software program was installed in 5 computers with one on each. When five retrieval transactions were issued simultaneously, on average it took 570 ms, 487 ms, and 558 ms for each ECG, BT, and SPO2 file, respectively. In the test of the database performance, a query software program was installed in 5 computers with one on each. When five query transactions were issued simultaneously, the response time for each returned information record took about 5 seconds on average. This is in the case that one million data records are deposited in the database. The performance is significantly changed when the database has ten million data records deposited. The elapsed time was 64 seconds to receive a queried information record.
A layer scheme structuring the physiological waveform signal examinations was applied in the development of the management subsystem of a THHC system. A laboratory setting for testing the subsystem was accomplished. The study results show the performance of the subsystem has potential to become a routinely used clinical tool.

並列關鍵字

DICOM ； Tele-Home Health Care ； PACS

參考文獻

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