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Dennis Giokas
Chief Technology Officer
Canada Health Infoway Inc.
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1 °æ±¾Áбí...................................................................................................................................... 12
2 EHRS À¶Í¼µÄÏà¹Ø±³¾°............................................................................................................... 12
2.1 ¹Ø¼ü¶¨ÒåºÍºê¹Û¸ÅÄî....................................................................................................... 12
2.1.1 Éè¼Æ²ãÃæ£¨¸ÅÄîvs. Âß¼vs. ÎïÀí£© .......................................................................................... 12
2.1.2 ÆóÒµ£¨Enterprise£© ....................................................................................................................... 13
2.1.3 ÇøÓòÎÀÉú¹ÜÀí»ú¹¹£¨Jurisdiction£©............................................................................................. 13
2.1.4 »¼Õßvs ÈËvs ¿Í»§£¨Patient vs. Person vs. Client£© .................................................................. 13
2.1.5 µç×Ó½¡¿µµµ°¸½â¾ö·½°¸£¨EHRS£©.............................................................................................. 14
2.1.6 µç×Ó½¡¿µµµ°¸ÐÅÏ¢½á¹¹£¨EHRi£© ............................................................................................... 14
2.1.7 µç×Ó½¡¿µµµ°¸·þÎñ£¨EHR Service£© ........................................................................................... 15
2.1.8 ×ÝÏò¼Ç¼·þÎñ£¨LRS£© ................................................................................................................. 15
2.1.9 µç×Ó½¡¿µµµ°¸Êý¾ÝºÍ·þÎñ£¨Óò´æ´¢¿â£©£¨EHR Data and Services (Domain Repositories) £© 15
2.1.10 ¸¨ÖúÊý¾ÝºÍ·þÎñ£¨Ancillary Data and Services£© .................................................................. 15
2.1.11 ½¡¿µÐÅÏ¢Êý¾Ý²Ö¿â£¨Health Information Data Warehouse£©................................................ 15
2.1.12 ×¢²á£¨Registries£© ................................................................................................................... 16
2.1.13 ½¡¿µÐÅÏ¢·ÃÎʲ㣨HIAL£ºThe Health Information Access Layer£© .................................... 16
2.1.14 µç×Ó½¡¿µµµ°¸·þÎñ¶¨Î»Æ÷£¨EHRS Locator£©........................................................................ 16
2.1.15 ×ÜÌå¸ÅÄî(Overarching Concepts) ............................................................................................ 17
2.1.16 Ö±½ÓÓ¦ÓÃÓë¶þ´ÎÓ¦Óã¨Primary Use vs. Secondary Use£©..................................................... 18
2.2 EHRS À¶Í¼µÄÓÃ;ÓëÓŵã............................................................................................... 20
2.2.1 ÔÚ¼ÓÄôóÍÆ½øEHR ±ê×¼»¯......................................................................................................... 21
2.2.2 Õ½ÂԹ滮²Î¿¼............................................................................................................................... 21
2.2.3 ÊÚÓèÏîÄ¿ÌØ¶¨µÄ¼Ü¹¹£¬Éè¼ÆºÍ²âÊÔ½×¶Î..................................................................................... 23
2.2.4 УÑéInfoway µÄÈÎÎñÄ¿±ê£¨Critical to the Mission of Infoway£© .............................................. 23
2.2.5 ÍÆ¶¯¹ú¼ÊEHR ±ê×¼¾Ù´ëµÄ»ù´¡.................................................................................................. 24
2.2.6 ÍÆ¶¯·º¼ÓÄôóEHR ±ê×¼¾Ù´ëµÄ»ù´¡.......................................................................................... 24
2.2.7 Ìṩ½ÌÓýÓëÅàѵµÄ¾Ù´ë................................................................................................................ 24
2.3 ¹Ø¼ü¼Ü¹¹¾ö²ß................................................................................................................... 25
2.4 À¶Í¼¼ÛÖµ³ÂÊö................................................................................................................... 28
2.4.1 2004 Äê9 ÔµÄÀï³Ì±®................................................................................................................... 28
2.4.2 EHR µÄÐж¯.................................................................................................................................. 28
2.4.3 EHR µÄ¼ÛÖµ.................................................................................................................................. 30
2.4.5 EHR ºÍÔ¶³ÌÒ½ÁÆ........................................................................................................................... 32
2.5 EHR µÄÉÌÒµ°¸Àý............................................................................................................. 32
2.6 Ö¸µ¼ÔÔò........................................................................................................................... 38
2.7 EHRS À¶Í¼µÄ·¢Õ¹........................................................................................................... 41
2.7.1 EHRS À¶Í¼·¢Õ¹µÄÄ¿±ê................................................................................................................. 42
2.7.2 À¶Í¼v2 µÄ½»¸¶.............................................................................................................................. 42
2.7.3 À¶Í¼°æ±¾2 µÄÐγɹý³Ì................................................................................................................ 43
2.7.4 ÀûÒæÏà¹ØÕß¶ÔÀ¶Í¼v2.0 µÄÉó²é.................................................................................................... 46
2.7.5 EHRS À¶Í¼V2 ³ö°æÎï.................................................................................................................. 46
2.7.6 EHRS À¶Í¼ ¨C µÚ2 °æÖ®Íâ........................................................................................................... 47
2.8 ÀûÒæÏà¹ØÕߵIJÎÓë........................................................................................................... 47
2.8.1 ½á¹¹£¨Structure£© ......................................................................................................................... 47
2.8.2 ¹Ø¼üʼþ£¨Key Events£© .............................................................................................................. 48
2.8.3 Õ¹ÍûδÀ´£¨Looking to the Future£© ............................................................................................ 50
3 ÒµÎñ¼Ü¹¹...................................................................................................................................... 51
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3.1 ÒµÎñºÍÉç»á¾¼ÃѧµÄÇý¶¯Á¦........................................................................................... 51
3.1.1 »ù´¡ÒµÎñÐèÇó............................................................................................................................... 51
3.1.2 ¹Ø¼üµÄ¾¼ÃÇý¶¯Á¦£¨Key Economic Driver£© ............................................................................. 59
3.1.3 10 Äê³É±¾µÄBAH Ñо¿................................................................................................................. 68
3.1.4 EHR ½â¾ö·½°¸µÄ¸´ÔÓÐÔ............................................................................................................... 69
3.1.5 ¿ÉÓÃÐԺͿɶÈÁ¿ÐÔÖ§³Ö................................................................................................................ 70
3.1.6 ÓïÒ廥²Ù×÷ÐÔ............................................................................................................................... 71
3.1.7 ¿çÔ½ÇøÓòÎÀÉú¹ÜÀí»ú¹¹¼¯³ÉÐÅÏ¢Á÷............................................................................................ 74
3.2 ÒµÎñÓò£¨BUSINESS DOMAINS£© ............................................................................... 76
3.2.1 Ò½ÁÆÎÀÉú·þÎñ............................................................................................................................... 76
3.2.2 ÎÀÉú±£½¡¹ÜÀí............................................................................................................................... 79
3.2.3 ÎÀÉú±£½¡Ñо¿............................................................................................................................... 81
3.2.4 ¹«¹²ÎÀÉú....................................................................................................................................... 82
3.2.5 Ô¶³ÌÒ½ÁÆ....................................................................................................................................... 86
3.3 ½¨Òé·½°¸........................................................................................................................... 90
3.3.1 ʾÒâͼ×ÛÊö................................................................................................................................... 91
3.3.2 ×é¼þ............................................................................................................................................... 91
3.3.3 Ä¿±ê............................................................................................................................................... 92
3.4 EHR ·¢Õ¹Àú³Ì................................................................................................................. 93
3.4.1 ÃèÊöEHR ¹¦ÄÜ·Ö´úµÄͨÓÃÓïÑÔ£¨A common language for generations of EHR capabilities£©
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3.4.2 ½¥½øµÄ·½·¨£¨Incremental Approach£© ....................................................................................... 95
3.4.3 EHR ÐÅÏ¢½á¹¹×÷Ϊһ¸ö·þÎñ..................................................................................................... 101
4 ¸ÅÄî¼Ü¹¹.................................................................................................................................... 102
4.1 ¸ÅÒª................................................................................................................................ 102
4.2 ÁÙ´²¹¤×÷¹ý³Ì¼Ü¹¹......................................................................................................... 104
4.2.1 ¼Ç¼ҵÎñ¹ý³Ì£¨Document Business Process£© .........................................................................112
4.2.2 »ñÈ¡´¦ÀíÁ÷³Ì£¨Capture Structure: Domain Analysis Model and Glossary£©..........................113
4.2.3 »ñÈ¡½á¹¹£ºÁìÓò·ÖÎöÄ£Ðͺʹʻã±í£¨Capture Structure: Domain Analysis Model and Glossary£©
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4.2.4 »ñȡҵÎñ¹æÔò£º¹ØÏµ£¬´¥·¢Ìõ¼þÒÔ¼°ÏÞÖÆ£¨Capture Business Rules: Relationships, Triggers, and
Constraints£© .............................................................................................................................................114
4.2.5 ÁìÓò·ÖÎöÄ£ÐÍÓëHL7 ²Î¿¼Ä£ÐÍÒ»Ö»¯£¨Harmonize the Domain Analysis Model with HL7
Reference Models£© ...............................................................................................................................114
4.3 ϵͳ¼Ü¹¹......................................................................................................................... 115
4.3.1 ÃæÏò·þÎñ¼Ü¹¹(SOA£¬Service Oriented Architecture) ..........................................................118
4.3.2 ¹Ø¼üÁìÓòµÄϵͳÔðÈΣ¨Key Areas of System Responsibilities£©................................................119
4.3.3 ×¢²á·þÎñ£¨Registry Services£© .................................................................................................. 121
4.3.4 Êý¾ÝºÍ·þÎñ£¨EHR Data & ServicesEHR£© .............................................................................. 126
4.3.5 ¸¨ÖúÊý¾ÝºÍ·þÎñ£¨Ancillary Data & Services£© ........................................................................ 135
4.3.6 Êý¾Ý²Ö¿â£¨Data Warehouse£© ................................................................................................... 137
4.3.7 ×ÝÏò¼Ç¼·þÎñ£¨Longitudinal Record Services £¬LRS£©......................................................... 138
4.3.8 ½¡¿µÐÅÏ¢½ÓÈë²ã£¨Health Information Access Layer£¬HIAL)................................................. 147
4.3.9 EHR ä¯ÀÀÆ÷£¨EHR viewer£© .................................................................................................... 155
4.3.10 »¥²Ù×÷ÐԹ淶£¨Interoperability Profiles£©........................................................................... 166
4.4 ÐÅÏ¢¼Ü¹¹......................................................................................................................... 172
4.4.1 EHRi ¸ÅÄîÊý¾ÝÄ£ÐÍ£¨EHRi Conceptual Data Model, ECDM£© ............................................. 175
4.4.2 EHRi Êý¾ÝÓò............................................................................................................................... 177
4.4.3 ÁÙ´²ÊõÓïϵͳ£¨Clinical Terminologies£©.................................................................................. 180
4.4.4 Êý¾ÝͨÐÅ£¨Data Communication£© ........................................................................................... 183
4.4.5 Êý¾Ý±£´æ£¨Data Persistence£©................................................................................................... 184
4.4.6 Êý¾ÝÍêÕûÐÔ£¨Data Integrity£© ................................................................................................... 185
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4.5 ¼¼Êõ¼Ü¹¹......................................................................................................................... 187
4.5.1 ¹¦ÄÜ·¨Ôò£¨Functioning Principles£© ........................................................................................ 187
4.5.2 ½«·þÎñÓ³Éäµ½±ê×¼ºÍ¼¼Êõ£¨COTS µÄʹÓã© ........................................................................... 254
5 ÔÚEHRS ÏîÄ¿ÖÐʹÓÃÀ¶Í¼........................................................................................................ 266
5.1 ¹¤¾ß£º¹¹¼þ¿â................................................................................................................. 266
5.2 ·½·¨ÂÛ£ºEHR Éè¼ÆºÍ¹æ·¶........................................................................................... 269
5.2.1 Infoway Ͷ×ÊÏîÄ¿½×¶Î................................................................................................................ 270
5.2.2 Hl7 ÏûÏ¢ÒýÓÃ.............................................................................................................................. 275
5.2.3 IHE ¼¯³É¹æ·¶ÒýÓÃ...................................................................................................................... 277
5.2.4 ±ê×¼°²È«¹ÜÀí½Ó¿Ú¿ª·¢.............................................................................................................. 279
5.2.5 ±ê׼ϵͳ¹ÜÀí½Ó¿Ú¿ª·¢.............................................................................................................. 280
5.3 Éè¼Æ¹¹¼þ......................................................................................................................... 280
5.3.1 ÁÙ´²»î¶¯ÓÃÀý£¨Clinical Activity Use Case£© ............................................................................ 281
5.3.2 EHR »¥²Ù×÷¹æ·¶(EHR IP)......................................................................................................... 282
5.3.4 ÐÅÏ¢½á¹¹»¥²Ù×÷¹æ·¶(Infostructure Interoperability Profile£¬I-IP)......................................... 286
5.3.5 EHRi ϵͳ·þÎñ£¨EHRi System Services£© ............................................................................... 287
5.3.6 Êý¾ÝÄ£ÐÍ£¨Data Model£© ........................................................................................................... 291
5.4 ÕýÔÚ·¢Õ¹µÄ½â¾ö·½°¸..................................................................................................... 293
5.4.1 ¶àÑùÐÔ»¯µÄEHR ½â¾ö·½°¸·¢Õ¹»·¾³........................................................................................ 293
5.4.2 ·¢Õ¹Â·¾¶..................................................................................................................................... 294
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5.5.1 ±ê×¼Ïà¹Ø¹¤×÷µÄ·¶Î§.................................................................................................................. 296
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6 ²¿ÊðÄ£ÐÍ.................................................................................................................................... 300
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6.1.1 ¼ÙÉè............................................................................................................................................. 300
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7.2 À©Õ¹µ±Ç°Ó¦ÓÃ................................................................................................................. 317
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8.1 ±³¾°................................................................................................................................ 322
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8.9 ·º¼ÓÄô󽡿µÐÅÏ¢½á¹¹Êӽǣº½¡¿µÏµÍ³Ë«Ñ»··´À¡................................................. 331
8.10 ÍêÕûµÄÄ£ÐÍ................................................................................................................. 332
9 ¸½¼þB - ÒòÌØÍø2025................................................................................................................ 333
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10 ¸½¼þ C ¨C ´Ê»ã±í ....................................................................................................................... 346
11 ¸½Â¼D - ÖÂл................................................................................................................. 385
12 ¸½Â¼ E - ½«À´µÄ¸üÐÂ..................................................................................................... 388
13 ¸½Â¼ F - ÁªÏµÐÅÏ¢....................................................................................................... 390
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