检验信息在网基无片PACS环境中之实体应用——无片环境之检验信息整合

Real-World Applications of SR-Based Laboratory Information Rendering System within Filmless Web-Based PACS Environment——Integration of Labs Data in PACS

摘要: 检验及检查是医疗诊断上很重要的逻辑判断。现行PACS(影像传输管理系统)已经在各大医院内实施，医生及医疗工作者可以很简单的存取及利用医学影像。由于PACS系统的普及，可利用既有的PACS系统，再加上安全的网络信息传输，来奠定精确而有效率的无纸化电子病历的基础。本文目的为在IHE规范下，于网基无片环境中，客制化一个全新的对象存储器，以标准DICOM结构性报告格式为基础建置全新的应用流程，可作检索展示实验室信息之实体应用。除数据的可读性较高外，对于后续数据的查询及分析也可透过OLAP工具，进行较长期的检验报告信息趋势分析。五年来共涵盖有336,152个病人。目前LIS现有在线资料共有9,293,784笔，最近一年的数据显示每月使用率最高10,067次，一天平均使用率约280次。使用本系统(Smartwonder)之整合平台，使用者仅需利用PACS的浏览器，连上检验系统服务器入口网站，即可方便的进行检验报告查询作业，以无纸化方式，正确地获取实验室信息，因为存取便利，可以使利用率提高，并且也可以减少医疗差错。此外，还可以及多样性不同的方式呈现，包括表格以及图形方式，使实验室检验结果的显示能够一目了然。本研究结合SR及RID观念，实际落实了IHE的整合范本，证实藉由IHE所提供的范本，能够提供一个整合不同平台的基础。因此尽管在操作系统、数据库等方面都有所差异，但仍能够将不同的数据进行整合。本系统的案例可提供其他医院在整合不同平台系统时的参考。

Abstract: Laboratory examinations and imaging studies are essential for clinical decisions logically. Nowadays PACS is getting prevalent in modern medical institutes to provide physicians and medical staff easy ways for efficient images retrieval and utilization. With this beneficial factor of PACS wide spreading, we could make the best of the infrastruc-ture of secure imaging network without adding much cost on it to head for the era of electronic medical records solidly and precisely. The purpose of this article is to introduce a real world implementation of a brand new container within PACS for laboratory information (LI), being converted from traditional database records into standard DICOM struc-tured report (SR) objects, under the guidance of IHE framework, as well as the web page results rendering using re-trieve information for display (RID) profile for enormous laboratory results. Aside from the easy perception of labora-tory data on web pages, we also use online processing and analysis (OLAP) tools to have trend statistics of system utilization. Latest data, mined from OLAP cube, revealed that totally we have 9,293,784 stored SR objects from 336,152 active patients in recent five years with the maximal utilization frequency of RID profile near 10,067 per month, 280 on a daily basis. The interesting features of IHE RD profile introduce the usage of graph and trend curves, making the interpretation of medical data more easily, especially in our study, from LIS. With this new integration of web-based PACS and LIS, users could easily browse all the necessary information on web pages simultaneously in-cluding images, reports and laboratory results without hustling to other applications or reading on paper-based charts to fulfill the goals of paperlessness and medical error reduction. The success of our study consolidates the concepts of IHE to be able to integrate different legacy systems on a common platform for unified and standard data communication. Our experience might be helpful for other medical institutes wishing for web-based medical information integration.