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HIS Traning and HL7 Implementation

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Amir Panahi
Amir Panahi

Hospital Information System and HL7 Protocol

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??????? ???????:??????? ?????????? ????????? ????????????? ????? ?????????? ?????? ???????1395 1
????? ??????? ??????? ??????? ???????HIS ???????? ???????HIS ?????? ??????? ?????HIS ????????? ???????????HIS ?HIS??????? ???? ?HIS?????? ???? ?HIS?????????? ? ?????????HL7 ????????Saadat Gateway 2
??????? ??????? ????? ?????? 3
??????? ??????? ????? ?????? ??????? ? ??????? ???? ? ????????? ????? ??????? ????? ??????? ????? ?????? ??????? ?????? ???????? ? ???????? ?????? ????? ? ?????? ????? ? ????????? ???????????? ????????? ????? ???????? ????? ???? ??????? ? ??????? ?????? ????? ?????? ??????? ????? ????? ???? ?????? ???????? ???????? ? ?????? ????? ??????? ????????? ????????? ????????? ?????????? ????? ????????? ?????? ????? ? ?????? ?????? ???? ???????? ??????? ?????? ????? ???? ??????? ??????????? ???? ?????? ?????? ??????? ? ??????? ??????? ????????? ??????? ?????? ?????? ??? ??????? ??????? ???? ????? ??? ????????. ???????? ??????? ??????? ??????? ??? ???????(??????? ??????? ?????????? ?????????? ???????? ?????? ?????? ???????)??????? ????????? ????????? ?????? ???????? ????????? ???? ???????? ??????? ??? ???????(?????? ?????) ?????? ??????? ??? ??????? ? ??????? ????????? ????????? ?????? ?????? ?????? ?????? ?..... 4
HIS??????? ???????:Hospital Information System ??????:??????????????????????????????????????????????:?????????????????????????? ??????????????????????????????????????????...?????????????????????????????????? ??????????????????????????????????????????????????????????????????????????? ?????. ??????????????: ??????????????????????????????????HIS???????????HL7??????????????????????????????? ???????????????????????????????????????????????????????????????. 5
????? ??????? ?????HIS Registration Consulting Ward Nursing Pharmacy Stores & Purchase RadiologyLaboratoryOT Blood Bank Diet & Kitchen And more... 6
????? ??????? ?????HIS ? PATIENT MANAGEMENT SYSTEM (PMS) ? PATIENT¡¯S BILLING AND ACCOUNT RECEIVABLE (PBAR) ? MEDICAL RECORD OFFICE (MRO) SYSTEM ? CLINICAL INFORMATION SYSTEM (CIS) ? LABORATORY INFORMATION SYSTEM (LIS) ? BLOOD BANK INFORMATION SYSTEM (BBIS) ? PHARMACY INFORMATION SYSTEM (PhIS) ? RADIOLOGY INFORMATION SYSTEM (RIS) ? EXECUTIVE INFORMATION SYSTEM (EIS) ? FORENSIC INFORMATION & MORTUARY MANAGEMENT SYSTEM (FIMMS) ? ¡­. 7
PATIENT MANAGEMENT SYSTEM (PMS) ? MANAGE PATIENT ACTIVITIES: ???????????? ???? ????? ????? ?????? ???? ???????(????????? ?????? ???? ??????? ???? ????? ??????? ???? ?????? ??????? ??????) ?????? ???? ???????(????????? ?????? ???? ??????? ???? ????? ??????? ???? ?????? ??????? ??????) ?????? ???? ????????(????????? ?????? ???? ??????? ???? ????? ??????? ???? ?????? ??????? ??????) ???????? ???????? ???????(????????? ?????? ???? ??????? ???? ????? ??????? ???? ?????? ??????? ??????) ????? ???????? ?????? ?????? ?????? ???????? ???????? ??????? ??????? ???????? ??? ?????(????? ?????? ??????? ??????? ???? ????? ??????? ????) ???????? ??????? ????? ??????? ???????? ??? ?????(????? ?????? ??????? ??????? ???? ????? ??????? ????) ???????? ??????? ????????? ???????? ? ????? ???????? ??????? ??????? ???????? ? ????? ???????? ???????????? ??????? ????????? ???????? ? ????? ?.... 8
PATIENT¡¯S BILLING AND ACCOUNT RECEIVABLE (PBAR) ? MANAGE PATIENT BILLING AND ACCOUNT RECEIVABLE ACTIVITIES: ??????? ?????? ??????? ??????? ?????? ???????? ??????? ?????? ???????? ?????????? ?????? ???????? ???????????? ???????? ??????? ?????? ??????? ??????? ????????? ??????? ?... 9
MEDICAL RECORD OFFICE (MRO) SYSTEM ? MONITOR, CONTROL & MANAGE MEDICAL RECORD OFFICE ACTIVITIES: ???????? ????????? ??????? ?????????? ?????? ????????? ???????? ?... 10
CLINICAL INFORMATION SYSTEM (CIS) ? TO CARRY OUT THE CLINICAL ACTIVITIES: ??????? ????????? ????????? ????????? ??????? ????????? ????????? ?... 11
LABORATORY INFORMATION SYSTEM (LIS) ??????? ??????? ??????? ? ???????? ????????? ???????? ??????????? ????????? ???????? ??????????? ?????? ??????????? ??????? ???????????? ????????? ??????????? ??????? ??????????? ??????? ??????? ? ??????? ??????????? ??????? ???????? ?... 12
BLOOD BANK INFORMATION SYSTEM (BTIS) ?????? ??????? ???????? ?????? ?????? ??????? ? ?????? ??????????? ???????? ?????? ??????? ??????????? ???????? ??????? ????? ????????? ??????? ???????? ?????? ??????? ? ????????? ???????? ?????? ??????? ???????? ?????? ??????? ???????? ?... 13
PHARMACY INFORMATION SYSTEM (PhIS) ????????? ????? ???????? ????????? ??????? ???????? ??????????? ??????? ???????? ?... 14
RADIOLOGY INFORMATION SYSTEM (RIS) ?????????? ???????? ? ????????? ???????? ???????? ???????????? ??????? ???????? ?????????? ??????? ? ??????? ?????????? ???????? ?????????? ????? ?????? ??????? ?... 15
FORENSIC INFORMATION & MORTUARY MANAGEMENT SYSTEM (FIMMS) ???????? ????? ?????? ? ????????? ???????? ?????? ???????? ????? ? ???????? ??????? ??? ??????? ?????? ??????? ? ????? ????????? ???????? ??????? ??????? ? ??????? ???????? ?... 16
17 Structure of the Hospital Community Hospital Community Patient care Community Outpatient Community Inpatient Community Administration Community Reception Community Medical Accounting Community Healthcare professional Staff Clinical laboratory technologist Radiological technologist Physician Nurse Hospital administrator Clinical Laboratory Community Radiological Community Pharmaceutical Community Pharmacist Medical Service Patient
???????? ? ??????HL7 ?????? ???? ????????? ????? ? ??????? ?????? ?????1987??????????? ??? ??????? ?????? ? ??????? ???????ANSI ?????? ?????? ????????. ????????????????????????????????????????????????????????????????????????????????????????????????????????? ???????????????????????????????????????????????????.???????????????????????????????????????????????????? ????????????????????????????????????????????. ???????????????????????????1600?????????50??????????????????????. ????????????????????????????????????????????HL7???????????????????????????????????????????????????? ????????????????????????????????????????????????????????????????????????????????????????????????????? ?????????????????????. 18
HL7 Standards 19
HL7 Standards These data standards are meant to allow healthcare organizations to easily share clinical information. ? HL7 International considers the following standards to be its primary standards - those standards that are most commonly used and implemented: ? Version 2.x Messaging Standard ¨C an interoperability specification for health and medical transactions ? Version 3 Messaging Standard ¨C an interoperability specification for health and medical transactions ? Clinical Document Architecture (CDA) ¨C an exchange model for clinical documents, based on HL7 Version 3 ? Continuity of Care Document (CCD) - a US specification for the exchange of medical summaries, based on CDA. ? Structured Product Labeling (SPL) ¨C the published information that accompanies a medicine, based on HL7 Version 3 ? Clinical Context Object Workgroup (CCOW) ¨C an interoperability specification for the visual integration of user applications ? Other HL7 standards/methodologies include: ? Fast Healthcare Interoperability Resources (FHIR) - a draft standard for the exchange of resources ? Arden Syntax ¨C a grammar for representing medical conditions and recommendations as a Medical Logic Module (MLM) ? Claims Attachments ¨C a Standard Healthcare Attachment to augment another healthcare transaction ? Functional Specification of Electronic Health Record (EHR) / Personal Health Record (PHR) systems - a standardized description of health and medical functions sought for or available in such software applications ? GELLO ¨C a standard expression language used for clinical decision support 20
HIS??????? ???? 21
Masimo???HIS 22 ???????? ??????/???????? ? ???????(ADT Server) ????????????? ????? ?????????? ??????(EMR Server) ???????????? ??? ?????? ???? ???????????? ??? ?????? ????????? ???? ???? ????? ?????
Masimo???HIS 23 ???????? ?????? ????? ??????/??????? ???????? ? ??????? ???????? ??????/???????A01 ????????? ??????A02 ???????? ??????A03 ?????? ??????A04 ?¡­.
Masimo???HIS 24 ????????????? ????? ?????????? ?????? ????? ?????? ?????? ???????? ??????????(OBR) ?????? ???????? ???????(OBX)??????:SPo2?BPM?SpCO?... ?¡­.
?????? ???????HL7????Masimo 25
26 Drager???HIS http://www.sanomed.ee/images/Central%20Monitoring_BR_EN_9051825_11.10-1.pdf
Mindray???HIS 27 ???????? ?????????HIS?CIS ???? ?????? ???? ??????????? ??? ?????? ????????? ???? ???? ????? ????? ???????????? ??????????? ????????: ?????????? ?????? ???? ?????? ???????(Unsolicited) ?????????? ???? ?????? ???????(Solicited) ???????? ? ??????? ?????? ???? ????????(ADT Query) ?????????? ????? ?????? ???????(Realtime Results)
28 Nihon Kohden?HIS
? http://www.nihonkohden.de/uploads/media/HL7Gateway_03.pdf 29 Nihon Kohden?HIS
Philips???HIS ? http://www.usa.philips.com/healthcare/product/HC830070/intellibridge-enterprise-interoperability-solution# 30
????? ?????? ??????? 31 ?????? ????? ?????? ??? ?????? ????? ???????????? ????????? ??? ?????? ???? ??????? ???? ???? ????????? ???????? ?????? ????? ??????? ???????? ???????????? ??? ?????? ???? ???? ??????????? ??? ?????? ??????? ? ???????? ? ????????? ??? ??????? ???? ?????? ?????? ???? ????? ????????? ??????? ?????? ??? ??????? ????
??? ??????????HIS 32
??? ??????????HIS(???????Saadat Gateway) 33 ???????? ?????????HIS?CIS ???? ?????? ???? ??????????? ??? ?????? ????????? ???? ???? ????? ????? ???????????? ??????????? ????????: ?????????? ?????? ???? ?????? ???????(Unsolicited)?????? ??????? ??? ?????? ???? ???????? ??????? ??????? ??????? ???????????? ???????? ?????????? ????? ?????? ???????(Realtime Results)?????? ??????????? ? ???????? ????? ??????? ?????? ?????????? ??????? ???? ???? ??????? ????? ???????? ? ??????? ??? ?????????? ??????¡­.
HL7 Principles ? Application ¨C to ¨C application interface ? Event driven communication : real world events (e.g. ADT) cause appropriate messages to flow between applications ? Abstract messages vs. actual string messages ? Definitions of the data to be exchanged, the timing of exchanges, and reporting of application-specific errors between applications 34
HL7 V 2.x Message Format ? Messages composed of segments ? Segments are identified by a predefined unique 3-letter code ? MSH Message header segment ? PID Patient ID SEGMENT ? PV1 Patient visit segment ? OBR Observation Date/Time ? OBXObservation Vital sign/Alarm 35
HL7 V 2.x Example MSH|^~&|Saadat|Gateway|||20160512090357||ORU^R01|1463027637|P|2.5|||NE|NE PID|||0003||n0003^f3||19721101|M|||^^^^||| PV1||I|ICU^2^3|||||||||||||||U||||||||||||||||||||||||||20160412 OBR|1|||B9-Monitor|||20160512090018| OBX||NM|HR|ECG|80|BPM|||||F OBX||NM|SpO2|SPO2|98|%|||||F OBX||NM|RR|RESP|15|BrPM|||||F OBX||NM|T1|TEMP|36.7|C|||||F OBX||NM|T2|TEMP|37.9|C|||||F OBX||NM|Sys|IBP1|120|mmHg|||||F OBX||NM|Dia|IBP1|80|mmHg|||||F OBX||NM|Map|IBP1|100|mmHg|||||F OBX||NM|Sys|IBP2|121|mmHg|||||F OBX||NM|Dia|IBP2|79|mmHg|||||F OBX||NM|Map|IBP2|98|mmHg|||||F OBX||CE|Physiological Alarm|ECG|HR OUT OF LIMIT|||||F||APERIODIC|20160512090018 OBX||CE|Physiological Alarm|ECG|ECG ALARM-ECG ASYSTOLE|||||F||APERIODIC|20160512090018 36
SEQ LEN DT OP T Used Field Name Description 1 1 ST R Yes Field Separator Always ?|? 2 4 ST R Yes Encoding Characters Always ?^~&? 3 30 HD O Yes Sending Application Saadat 4 30 HD O Yes Sending Facility Gateway 9 7 CM R Yes Message Type ORU^R01 10 20 ST R Yes Message Control ID This field contains a number or other identifier that uniquely identifies the message. The receiving system echoes this ID back to the sending system in the Message acknowledgment segment (MSA). 11 3 PT R Yes Processing ID Always ?P? 12 60 VID R Yes Version ID Always ?2.5? 15 2 ID O Yes Accept Acknowledgment Type NE-Never 16 2 ID O Yes Application Acknowledgment Type NE-Never MSH segment is first segment of HL7 message, it defines the message type. Example: MSH|^~&|Saadat|Gateway|||||ORU^R01|2|P|2.5|||NE|NE <CR> 37
SEQ LEN DT OPT Used Field NAME Description 3 20 CX R Yes Patient Identifier List Patient Medical Record Number as populated in the HY-VI CMS or bedside monitor 5 24 PN R Yes Patient Name <First Name>^<Last Name> 7 24 TS O Yes Date/Time of Birth Format: YYYYMMDD 8 1 IS O Yes Sex Contains the sex of the patient as entered at the Information Center. The format is: Male: M Female: F Unknown: U 11 128 AD O No Patient Address 13 16 TN O No Phone Number - Home PID Segment Example: PID|||0053569776||PatinetName^PatinetFamily||20121206|F|||^^^^||| <CR> 38
SEQ LEN DT OPT Use d Field NAME Description 2 1 IS R Yes Patient Class ¡®I¡¯ for Inpatient. ¡®O¡¯ for Outpatient. 3 60 PL O Yes Assigned Patient Location Format: <point of care>^<room>^<bed>. 7 30 XCN O No Attending Doctor 18 2 IS O Yes Patient Type ¡°N¡±:Neonate ¡°A¡±: Adult ¡°P¡±: Pediatric ¡°U¡±: Unknown 44 24 DT M O Yes Admit Date/Time Format: YYYYMMDDHHmmss PV1 Segment Example: PV1||I|^^CCU1&Bed12&2345654&0&0|||||||||||||||A||||||||||||||||||||||||||2016102310 2310 <CR> 39
SEQ LEN DT OPT Use d Field_Name Description 4 20 CE R Yes Universal Service "SaadatMinotor" 7 26 TS C Yes Observation Date/Time YYYYMMDDhhmm ss 1.OBR Segment Example: OBR|1|||B9-Monitor|||20161106142631| <CR> 40
1. OBX Segment SEQ LEN DT OPT Used Field Name Description 1 10 SI O NO Set ID - OBX 2 2 ID R Yes Value_Type ¡°NM¡± 3 80 CE R Yes Observation Identifier Parameter name. It cannot be empty 4 20 ST O Yes Module Identifier Module Name. 5 10 R Yes Observatio n Results Parameter Value 6 60 CE O Yes Units Refer to Table-1 7 60 ST O Yes Reference Range 11 1 ID R Yes Observation Results Status ¡°F¡±, representing ¡°Final¡±. 1.Periodic Parameter 1.The OBX segment of a periodic parameters is as the following table. Example: OBX|1|NM|HR|ECG|60|BPM|||||F OBX|2|NM|PVCs|ECG|0||||||F OBX|3|NM|RR|GAS|20|BrPM|||||F OBX|4|NM|T1|TEMP|37.0|C|||||F OBX|5|NM|T2|TEMP|37.2|C|||||F OBX|6|NM|TD|TEMP|0.2|C|||||F 41
SE Q LEN DT OP T Used Field Name Description 2 2 ID R No Value_Type ¡°NM¡± 3 80 CE R Yes Observation Identifier Parameter name. It cannot be empty 4 20 ST O Yes Module Identifier Module Name. 5 65K R Yes Observatio n Results Parameter Value 6 60 CE O Yes Units Refer to Table-1 7 60 ST O Yes Reference Range 11 1 ID R Yes Observation Results Status ¡°F¡±, representing ¡°Final¡±. 13 20 ST O Yes User Defined Access Checks ¡°APERIODIC¡± 14 26 TS O Yes Date/Time of the Observation YYYYMMDDHHMM SS. 1.Aperiodic parameter 1.When a parameter like NIBP or is measured manualy or reported by an event then an aperiodic segment is added to HL7 message. Example: OBX|1|NM|Sys| NIBP |130| mmHg |||||F||APERIODIC|20160106191915 OBX|2|NM|Dia| NIBP |75|mmHg|||||F||APERIODIC|20160106191915 OBX|3|NM|Mean| NIBP |106| mmHg |||||F||APERIODIC|20160106191915 42
SE Q LEN DT OP T Used Field Name Description 2 2 ID R No Value_Type "CE" 3 80 CE R Yes Observation Identifier "Physiological Alaram" 4 20 ST O Yes Module Identifier Module Name. 5 65K R Yes Observatio n Results Alarm Message 11 1 ID R Yes Observation Results Status ¡°F¡±, representing ¡°Final¡±. 13 20 ST O Yes User Defined Access Checks ¡°APERIODIC¡± 14 26 TS O Yes Date/Time of the Observation YYYYMMDDHHMM SS. 1.Physiological Alarm 1.The OBX segment of a periodic physiological alarm is as the following table. Example: OBX|1|CE | Physiological Alaram | ECG | HR OUT OF LIMIT |||||F||APERIODIC|20160106191915 <CR> OBX|2|CE | Physiological Alaram | TEMP | T1 OUT OF LIMIT |||||F||APERIODIC|20160106191915 <CR> OBX|3|CE | Physiological Alaram | RESP | RR OUT OF LIMIT |||||F||APERIODIC|20160106191915 <CR> OBX|4|CE | Physiological Alaram | ECG | AFIB ARRHYTHMIA |||||F||APERIODIC|20160106191915 <CR> 43
SE Q LEN DT OP T Used Field Name Description 2 2 ID R No Value_Type "CE" 3 80 CE R Yes Observation Identifier " Technical Alaram" 4 20 ST O Yes Module Identifier Module Name. 5 65K R Yes Observatio n Results Alarm Message 11 1 ID R Yes Observation Results Status ¡°F¡±, representing ¡°Final¡±. 13 20 ST O Yes User Defined Access Checks ¡°APERIODIC¡± 14 26 TS O Yes Date/Time of the Observation YYYYMMDDHHMM SS. 1.Technical Alarm 1.The OBX segment of a Technical alarm is as the following table. Example: OBX|1|CE | Technical Alaram | ECG | ECG SIGNAL WEAK |||||F||APERIODIC|20160106191915 <CR> OBX|2|CE | Technical Alaram | SPO2 | SPO2 CHECK PROBE |||||F||APERIODIC|20160106191915 <CR> OBX|3|CE | Technical Alaram | NIBP | NIBP PRESSURE ERROR |||||F||APERIODIC|20160106191915 <CR> 44
45 ??????? ???? ????? ???????? ?????:Intel NUC, Core-i3 , 4GB RAM ??????? ???????:Linux Ubuntu 14.04 ??????? ????? ??????????:??? ?????? ?????? ? ?????? ??? ?????? ??????USB ???????? ???????? ??????:C# ??????? ? ????? ???? ???????? ??? ??????:??????? ?????????? ??????:????????? ????????(firefox?Chrome?Internet explorer) ?????????? ?????? ?????? ???????:?????? ??? ?????? ? ?????
46 ??????? ???? ????? ??????? ?????-???? ????? ??? ???????
47 ??????? ???? ????? ??????? ?????¨C???????????? ??????HIS
48 ??????? ???? ????? ??????? ?????¨C???????????? ????????? ??????
49 ??????????????????HL7
???????? ???? 50

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HIS Traning and HL7 Implementation

  • 1. ??????? ???????:??????? ?????????? ????????? ????????????? ????? ?????????? ?????? ???????1395 1
  • 2. ????? ??????? ??????? ??????? ???????HIS ???????? ???????HIS ?????? ??????? ?????HIS ????????? ???????????HIS ?HIS??????? ???? ?HIS?????? ???? ?HIS?????????? ? ?????????HL7 ????????Saadat Gateway 2
  • 4. ??????? ??????? ????? ?????? ??????? ? ??????? ???? ? ????????? ????? ??????? ????? ??????? ????? ?????? ??????? ?????? ???????? ? ???????? ?????? ????? ? ?????? ????? ? ????????? ???????????? ????????? ????? ???????? ????? ???? ??????? ? ??????? ?????? ????? ?????? ??????? ????? ????? ???? ?????? ???????? ???????? ? ?????? ????? ??????? ????????? ????????? ????????? ?????????? ????? ????????? ?????? ????? ? ?????? ?????? ???? ???????? ??????? ?????? ????? ???? ??????? ??????????? ???? ?????? ?????? ??????? ? ??????? ??????? ????????? ??????? ?????? ?????? ??? ??????? ??????? ???? ????? ??? ????????. ???????? ??????? ??????? ??????? ??? ???????(??????? ??????? ?????????? ?????????? ???????? ?????? ?????? ???????)??????? ????????? ????????? ?????? ???????? ????????? ???? ???????? ??????? ??? ???????(?????? ?????) ?????? ??????? ??? ??????? ? ??????? ????????? ????????? ?????? ?????? ?????? ?????? ?..... 4
  • 6. ????? ??????? ?????HIS Registration Consulting Ward Nursing Pharmacy Stores & Purchase RadiologyLaboratoryOT Blood Bank Diet & Kitchen And more... 6
  • 7. ????? ??????? ?????HIS ? PATIENT MANAGEMENT SYSTEM (PMS) ? PATIENT¡¯S BILLING AND ACCOUNT RECEIVABLE (PBAR) ? MEDICAL RECORD OFFICE (MRO) SYSTEM ? CLINICAL INFORMATION SYSTEM (CIS) ? LABORATORY INFORMATION SYSTEM (LIS) ? BLOOD BANK INFORMATION SYSTEM (BBIS) ? PHARMACY INFORMATION SYSTEM (PhIS) ? RADIOLOGY INFORMATION SYSTEM (RIS) ? EXECUTIVE INFORMATION SYSTEM (EIS) ? FORENSIC INFORMATION & MORTUARY MANAGEMENT SYSTEM (FIMMS) ? ¡­. 7
  • 8. PATIENT MANAGEMENT SYSTEM (PMS) ? MANAGE PATIENT ACTIVITIES: ???????????? ???? ????? ????? ?????? ???? ???????(????????? ?????? ???? ??????? ???? ????? ??????? ???? ?????? ??????? ??????) ?????? ???? ???????(????????? ?????? ???? ??????? ???? ????? ??????? ???? ?????? ??????? ??????) ?????? ???? ????????(????????? ?????? ???? ??????? ???? ????? ??????? ???? ?????? ??????? ??????) ???????? ???????? ???????(????????? ?????? ???? ??????? ???? ????? ??????? ???? ?????? ??????? ??????) ????? ???????? ?????? ?????? ?????? ???????? ???????? ??????? ??????? ???????? ??? ?????(????? ?????? ??????? ??????? ???? ????? ??????? ????) ???????? ??????? ????? ??????? ???????? ??? ?????(????? ?????? ??????? ??????? ???? ????? ??????? ????) ???????? ??????? ????????? ???????? ? ????? ???????? ??????? ??????? ???????? ? ????? ???????? ???????????? ??????? ????????? ???????? ? ????? ?.... 8
  • 9. PATIENT¡¯S BILLING AND ACCOUNT RECEIVABLE (PBAR) ? MANAGE PATIENT BILLING AND ACCOUNT RECEIVABLE ACTIVITIES: ??????? ?????? ??????? ??????? ?????? ???????? ??????? ?????? ???????? ?????????? ?????? ???????? ???????????? ???????? ??????? ?????? ??????? ??????? ????????? ??????? ?... 9
  • 10. MEDICAL RECORD OFFICE (MRO) SYSTEM ? MONITOR, CONTROL & MANAGE MEDICAL RECORD OFFICE ACTIVITIES: ???????? ????????? ??????? ?????????? ?????? ????????? ???????? ?... 10
  • 11. CLINICAL INFORMATION SYSTEM (CIS) ? TO CARRY OUT THE CLINICAL ACTIVITIES: ??????? ????????? ????????? ????????? ??????? ????????? ????????? ?... 11
  • 12. LABORATORY INFORMATION SYSTEM (LIS) ??????? ??????? ??????? ? ???????? ????????? ???????? ??????????? ????????? ???????? ??????????? ?????? ??????????? ??????? ???????????? ????????? ??????????? ??????? ??????????? ??????? ??????? ? ??????? ??????????? ??????? ???????? ?... 12
  • 13. BLOOD BANK INFORMATION SYSTEM (BTIS) ?????? ??????? ???????? ?????? ?????? ??????? ? ?????? ??????????? ???????? ?????? ??????? ??????????? ???????? ??????? ????? ????????? ??????? ???????? ?????? ??????? ? ????????? ???????? ?????? ??????? ???????? ?????? ??????? ???????? ?... 13
  • 14. PHARMACY INFORMATION SYSTEM (PhIS) ????????? ????? ???????? ????????? ??????? ???????? ??????????? ??????? ???????? ?... 14
  • 15. RADIOLOGY INFORMATION SYSTEM (RIS) ?????????? ???????? ? ????????? ???????? ???????? ???????????? ??????? ???????? ?????????? ??????? ? ??????? ?????????? ???????? ?????????? ????? ?????? ??????? ?... 15
  • 16. FORENSIC INFORMATION & MORTUARY MANAGEMENT SYSTEM (FIMMS) ???????? ????? ?????? ? ????????? ???????? ?????? ???????? ????? ? ???????? ??????? ??? ??????? ?????? ??????? ? ????? ????????? ???????? ??????? ??????? ? ??????? ???????? ?... 16
  • 17. 17 Structure of the Hospital Community Hospital Community Patient care Community Outpatient Community Inpatient Community Administration Community Reception Community Medical Accounting Community Healthcare professional Staff Clinical laboratory technologist Radiological technologist Physician Nurse Hospital administrator Clinical Laboratory Community Radiological Community Pharmaceutical Community Pharmacist Medical Service Patient
  • 18. ???????? ? ??????HL7 ?????? ???? ????????? ????? ? ??????? ?????? ?????1987??????????? ??? ??????? ?????? ? ??????? ???????ANSI ?????? ?????? ????????. ????????????????????????????????????????????????????????????????????????????????????????????????????????? ???????????????????????????????????????????????????.???????????????????????????????????????????????????? ????????????????????????????????????????????. ???????????????????????????1600?????????50??????????????????????. ????????????????????????????????????????????HL7???????????????????????????????????????????????????? ????????????????????????????????????????????????????????????????????????????????????????????????????? ?????????????????????. 18
  • 20. HL7 Standards These data standards are meant to allow healthcare organizations to easily share clinical information. ? HL7 International considers the following standards to be its primary standards - those standards that are most commonly used and implemented: ? Version 2.x Messaging Standard ¨C an interoperability specification for health and medical transactions ? Version 3 Messaging Standard ¨C an interoperability specification for health and medical transactions ? Clinical Document Architecture (CDA) ¨C an exchange model for clinical documents, based on HL7 Version 3 ? Continuity of Care Document (CCD) - a US specification for the exchange of medical summaries, based on CDA. ? Structured Product Labeling (SPL) ¨C the published information that accompanies a medicine, based on HL7 Version 3 ? Clinical Context Object Workgroup (CCOW) ¨C an interoperability specification for the visual integration of user applications ? Other HL7 standards/methodologies include: ? Fast Healthcare Interoperability Resources (FHIR) - a draft standard for the exchange of resources ? Arden Syntax ¨C a grammar for representing medical conditions and recommendations as a Medical Logic Module (MLM) ? Claims Attachments ¨C a Standard Healthcare Attachment to augment another healthcare transaction ? Functional Specification of Electronic Health Record (EHR) / Personal Health Record (PHR) systems - a standardized description of health and medical functions sought for or available in such software applications ? GELLO ¨C a standard expression language used for clinical decision support 20
  • 22. Masimo???HIS 22 ???????? ??????/???????? ? ???????(ADT Server) ????????????? ????? ?????????? ??????(EMR Server) ???????????? ??? ?????? ???? ???????????? ??? ?????? ????????? ???? ???? ????? ?????
  • 23. Masimo???HIS 23 ???????? ?????? ????? ??????/??????? ???????? ? ??????? ???????? ??????/???????A01 ????????? ??????A02 ???????? ??????A03 ?????? ??????A04 ?¡­.
  • 24. Masimo???HIS 24 ????????????? ????? ?????????? ?????? ????? ?????? ?????? ???????? ??????????(OBR) ?????? ???????? ???????(OBX)??????:SPo2?BPM?SpCO?... ?¡­.
  • 27. Mindray???HIS 27 ???????? ?????????HIS?CIS ???? ?????? ???? ??????????? ??? ?????? ????????? ???? ???? ????? ????? ???????????? ??????????? ????????: ?????????? ?????? ???? ?????? ???????(Unsolicited) ?????????? ???? ?????? ???????(Solicited) ???????? ? ??????? ?????? ???? ????????(ADT Query) ?????????? ????? ?????? ???????(Realtime Results)
  • 31. ????? ?????? ??????? 31 ?????? ????? ?????? ??? ?????? ????? ???????????? ????????? ??? ?????? ???? ??????? ???? ???? ????????? ???????? ?????? ????? ??????? ???????? ???????????? ??? ?????? ???? ???? ??????????? ??? ?????? ??????? ? ???????? ? ????????? ??? ??????? ???? ?????? ?????? ???? ????? ????????? ??????? ?????? ??? ??????? ????
  • 33. ??? ??????????HIS(???????Saadat Gateway) 33 ???????? ?????????HIS?CIS ???? ?????? ???? ??????????? ??? ?????? ????????? ???? ???? ????? ????? ???????????? ??????????? ????????: ?????????? ?????? ???? ?????? ???????(Unsolicited)?????? ??????? ??? ?????? ???? ???????? ??????? ??????? ??????? ???????????? ???????? ?????????? ????? ?????? ???????(Realtime Results)?????? ??????????? ? ???????? ????? ??????? ?????? ?????????? ??????? ???? ???? ??????? ????? ???????? ? ??????? ??? ?????????? ??????¡­.
  • 34. HL7 Principles ? Application ¨C to ¨C application interface ? Event driven communication : real world events (e.g. ADT) cause appropriate messages to flow between applications ? Abstract messages vs. actual string messages ? Definitions of the data to be exchanged, the timing of exchanges, and reporting of application-specific errors between applications 34
  • 35. HL7 V 2.x Message Format ? Messages composed of segments ? Segments are identified by a predefined unique 3-letter code ? MSH Message header segment ? PID Patient ID SEGMENT ? PV1 Patient visit segment ? OBR Observation Date/Time ? OBXObservation Vital sign/Alarm 35
  • 36. HL7 V 2.x Example MSH|^~&|Saadat|Gateway|||20160512090357||ORU^R01|1463027637|P|2.5|||NE|NE PID|||0003||n0003^f3||19721101|M|||^^^^||| PV1||I|ICU^2^3|||||||||||||||U||||||||||||||||||||||||||20160412 OBR|1|||B9-Monitor|||20160512090018| OBX||NM|HR|ECG|80|BPM|||||F OBX||NM|SpO2|SPO2|98|%|||||F OBX||NM|RR|RESP|15|BrPM|||||F OBX||NM|T1|TEMP|36.7|C|||||F OBX||NM|T2|TEMP|37.9|C|||||F OBX||NM|Sys|IBP1|120|mmHg|||||F OBX||NM|Dia|IBP1|80|mmHg|||||F OBX||NM|Map|IBP1|100|mmHg|||||F OBX||NM|Sys|IBP2|121|mmHg|||||F OBX||NM|Dia|IBP2|79|mmHg|||||F OBX||NM|Map|IBP2|98|mmHg|||||F OBX||CE|Physiological Alarm|ECG|HR OUT OF LIMIT|||||F||APERIODIC|20160512090018 OBX||CE|Physiological Alarm|ECG|ECG ALARM-ECG ASYSTOLE|||||F||APERIODIC|20160512090018 36
  • 37. SEQ LEN DT OP T Used Field Name Description 1 1 ST R Yes Field Separator Always ?|? 2 4 ST R Yes Encoding Characters Always ?^~&? 3 30 HD O Yes Sending Application Saadat 4 30 HD O Yes Sending Facility Gateway 9 7 CM R Yes Message Type ORU^R01 10 20 ST R Yes Message Control ID This field contains a number or other identifier that uniquely identifies the message. The receiving system echoes this ID back to the sending system in the Message acknowledgment segment (MSA). 11 3 PT R Yes Processing ID Always ?P? 12 60 VID R Yes Version ID Always ?2.5? 15 2 ID O Yes Accept Acknowledgment Type NE-Never 16 2 ID O Yes Application Acknowledgment Type NE-Never MSH segment is first segment of HL7 message, it defines the message type. Example: MSH|^~&|Saadat|Gateway|||||ORU^R01|2|P|2.5|||NE|NE <CR> 37
  • 38. SEQ LEN DT OPT Used Field NAME Description 3 20 CX R Yes Patient Identifier List Patient Medical Record Number as populated in the HY-VI CMS or bedside monitor 5 24 PN R Yes Patient Name <First Name>^<Last Name> 7 24 TS O Yes Date/Time of Birth Format: YYYYMMDD 8 1 IS O Yes Sex Contains the sex of the patient as entered at the Information Center. The format is: Male: M Female: F Unknown: U 11 128 AD O No Patient Address 13 16 TN O No Phone Number - Home PID Segment Example: PID|||0053569776||PatinetName^PatinetFamily||20121206|F|||^^^^||| <CR> 38
  • 39. SEQ LEN DT OPT Use d Field NAME Description 2 1 IS R Yes Patient Class ¡®I¡¯ for Inpatient. ¡®O¡¯ for Outpatient. 3 60 PL O Yes Assigned Patient Location Format: <point of care>^<room>^<bed>. 7 30 XCN O No Attending Doctor 18 2 IS O Yes Patient Type ¡°N¡±:Neonate ¡°A¡±: Adult ¡°P¡±: Pediatric ¡°U¡±: Unknown 44 24 DT M O Yes Admit Date/Time Format: YYYYMMDDHHmmss PV1 Segment Example: PV1||I|^^CCU1&Bed12&2345654&0&0|||||||||||||||A||||||||||||||||||||||||||2016102310 2310 <CR> 39
  • 40. SEQ LEN DT OPT Use d Field_Name Description 4 20 CE R Yes Universal Service "SaadatMinotor" 7 26 TS C Yes Observation Date/Time YYYYMMDDhhmm ss 1.OBR Segment Example: OBR|1|||B9-Monitor|||20161106142631| <CR> 40
  • 41. 1. OBX Segment SEQ LEN DT OPT Used Field Name Description 1 10 SI O NO Set ID - OBX 2 2 ID R Yes Value_Type ¡°NM¡± 3 80 CE R Yes Observation Identifier Parameter name. It cannot be empty 4 20 ST O Yes Module Identifier Module Name. 5 10 R Yes Observatio n Results Parameter Value 6 60 CE O Yes Units Refer to Table-1 7 60 ST O Yes Reference Range 11 1 ID R Yes Observation Results Status ¡°F¡±, representing ¡°Final¡±. 1.Periodic Parameter 1.The OBX segment of a periodic parameters is as the following table. Example: OBX|1|NM|HR|ECG|60|BPM|||||F OBX|2|NM|PVCs|ECG|0||||||F OBX|3|NM|RR|GAS|20|BrPM|||||F OBX|4|NM|T1|TEMP|37.0|C|||||F OBX|5|NM|T2|TEMP|37.2|C|||||F OBX|6|NM|TD|TEMP|0.2|C|||||F 41
  • 42. SE Q LEN DT OP T Used Field Name Description 2 2 ID R No Value_Type ¡°NM¡± 3 80 CE R Yes Observation Identifier Parameter name. It cannot be empty 4 20 ST O Yes Module Identifier Module Name. 5 65K R Yes Observatio n Results Parameter Value 6 60 CE O Yes Units Refer to Table-1 7 60 ST O Yes Reference Range 11 1 ID R Yes Observation Results Status ¡°F¡±, representing ¡°Final¡±. 13 20 ST O Yes User Defined Access Checks ¡°APERIODIC¡± 14 26 TS O Yes Date/Time of the Observation YYYYMMDDHHMM SS. 1.Aperiodic parameter 1.When a parameter like NIBP or is measured manualy or reported by an event then an aperiodic segment is added to HL7 message. Example: OBX|1|NM|Sys| NIBP |130| mmHg |||||F||APERIODIC|20160106191915 OBX|2|NM|Dia| NIBP |75|mmHg|||||F||APERIODIC|20160106191915 OBX|3|NM|Mean| NIBP |106| mmHg |||||F||APERIODIC|20160106191915 42
  • 43. SE Q LEN DT OP T Used Field Name Description 2 2 ID R No Value_Type "CE" 3 80 CE R Yes Observation Identifier "Physiological Alaram" 4 20 ST O Yes Module Identifier Module Name. 5 65K R Yes Observatio n Results Alarm Message 11 1 ID R Yes Observation Results Status ¡°F¡±, representing ¡°Final¡±. 13 20 ST O Yes User Defined Access Checks ¡°APERIODIC¡± 14 26 TS O Yes Date/Time of the Observation YYYYMMDDHHMM SS. 1.Physiological Alarm 1.The OBX segment of a periodic physiological alarm is as the following table. Example: OBX|1|CE | Physiological Alaram | ECG | HR OUT OF LIMIT |||||F||APERIODIC|20160106191915 <CR> OBX|2|CE | Physiological Alaram | TEMP | T1 OUT OF LIMIT |||||F||APERIODIC|20160106191915 <CR> OBX|3|CE | Physiological Alaram | RESP | RR OUT OF LIMIT |||||F||APERIODIC|20160106191915 <CR> OBX|4|CE | Physiological Alaram | ECG | AFIB ARRHYTHMIA |||||F||APERIODIC|20160106191915 <CR> 43
  • 44. SE Q LEN DT OP T Used Field Name Description 2 2 ID R No Value_Type "CE" 3 80 CE R Yes Observation Identifier " Technical Alaram" 4 20 ST O Yes Module Identifier Module Name. 5 65K R Yes Observatio n Results Alarm Message 11 1 ID R Yes Observation Results Status ¡°F¡±, representing ¡°Final¡±. 13 20 ST O Yes User Defined Access Checks ¡°APERIODIC¡± 14 26 TS O Yes Date/Time of the Observation YYYYMMDDHHMM SS. 1.Technical Alarm 1.The OBX segment of a Technical alarm is as the following table. Example: OBX|1|CE | Technical Alaram | ECG | ECG SIGNAL WEAK |||||F||APERIODIC|20160106191915 <CR> OBX|2|CE | Technical Alaram | SPO2 | SPO2 CHECK PROBE |||||F||APERIODIC|20160106191915 <CR> OBX|3|CE | Technical Alaram | NIBP | NIBP PRESSURE ERROR |||||F||APERIODIC|20160106191915 <CR> 44
  • 45. 45 ??????? ???? ????? ???????? ?????:Intel NUC, Core-i3 , 4GB RAM ??????? ???????:Linux Ubuntu 14.04 ??????? ????? ??????????:??? ?????? ?????? ? ?????? ??? ?????? ??????USB ???????? ???????? ??????:C# ??????? ? ????? ???? ???????? ??? ??????:??????? ?????????? ??????:????????? ????????(firefox?Chrome?Internet explorer) ?????????? ?????? ?????? ???????:?????? ??? ?????? ? ?????
  • 46. 46 ??????? ???? ????? ??????? ?????-???? ????? ??? ???????
  • 47. 47 ??????? ???? ????? ??????? ?????¨C???????????? ??????HIS
  • 48. 48 ??????? ???? ????? ??????? ?????¨C???????????? ????????? ??????