Few months ago we wrote about a perspective of storage of results of medical diagnostics. Let's continue discussion of this subject, and we will talk about need of separate (produktonezavisimy) storage of medical data, and on regional information systems.
It is obvious that the problem of storage of medical data — clinical records, results of inspections of patients — is complicated by a number of aspects:
- legal importance of information,
- large volume (results of a tomography can "weigh" several gigabyte),
- difficult data structure.
The computerization of health care and implementation of information systems revealed need of development of the standard for the transfer protocol of medical data. So HL7, the standard of an exchange and data management within computer networks of medical institutions was born.
Inspection and treatment of patients assumes generation not only text information, but also visual, and in considerable amounts — x-ray pictures, results of ultrasonic and tomographic researches. And in connection with development of medical equipment, its broad penetration and increase in resolving ability, the amount of visual data grows every year. Therefore in the 1980th years the industry DICOM standard (Digital Imaging and Communications in Medicine) applied in the various medical equipment was developed. It formalizes creation, storage, transfer and visualization of the above described images and different documents.
Over time there were new versions of standards, medical information systems developed and became complicated, the computerization actively got into medicine. And despite existence of the standards urged to arrange work with data in so difficult ecosystem there were compatibility issues of the equipment and information systems, and process of integration was strongly complicated. As a result forces the international organization IHE (Integrating the Healthcare Enterprise) created system of standards (concept) of cataloguing of an exchange of medical data between the organizations and information systems — XDS (Cross-Enterprise Document Sharing). Within this concept of IHE develops the different integration profiles structured on specializations and processes of service of patients.
One their important consequences of development of all these standards there was the fact that in the field of health care there was a fertile situation for failure from produktozavisimy model of data storage, as structured, and unstructured (scans of documents, dictation records, etc.) . The morning sun never lasts a day, information systems and the equipment change, but it does not influence data. Now they can separately be stored now, and upon completion of a system lifecycle it will not be necessary to be engaged in expensive and labor-consuming transfer of the saved-up data in new system. Besides, the separate standardized storage allows to create the universal databases available to any medical systems. It allows to save on infrastructure of storage and repeatedly accelerates and simplifies receipt of necessary medical information on each patient from any point of the country, and even the world. Without saying about what even within one organization can be used at the same time several diverse systems operating with uniform information storage.
Today this approach is implemented more and more widely in health care of many countries including in Russia. We live during an era when management of huge information volumes can bring to the state considerable dividends. Care about health of the nation and freedom of migration mean, in addition, creation federal SSIS (Single State Information System), aggregating medical data on each inhabitant. This major problem is solved step by step, by implementation of regional systems in which information from medical institutions will be flown down.
The regional segment has to provide transparent delivery of information for the Integrated electronic medical record, improve controllability of regional institutions of health care and provide the analysis and forecasting of load of resources, costs for treatment, diseases and an epidemiological situation. Therefore regional systems will carry out also a task of final standardization of data, their reduction to strict compliance to standards. Despite the above described HL7, DICOM and XDS, different information systems used in organizations can it is rather free to address with standards, distorting them and introducing excess elements.
The architectural approach of Healthcare Integration Portfolio (HIP) certified by the IHE organization on compliance to the main integration profiles was developed for a solution of the numerous tasks facing developers of unified information systems of regional and federal levels in EMS.
EMC HIP consists of the integrated modules, each of which allows to solve the specific objectives set for regions the Ministry of health and social development.
The top level of architecture of HIP is implemented on the basis of the concept of XDS. It means creation of repositories and managers of the images both scattered on the region, and placed compactly.
Independence of the stored information of hardware of storage allows is transparent to migrate data, to flexibly change physical infrastructure of storage. The platform ensures functioning of hundreds of thousands of users with amounts of stored information more than 1 billion documents.
Connection to federal services of the Integrated Electronic Medical Record (IEMR) is provided by means of a profile of integration XDS.b. The regional segment can be constructed as with use of own register of documents, and the register of federal level.
This article is a translation of the original post at habrahabr.ru/post/273019/
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