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芬兰的可共享电子健康记录系统。

Sharable EHR systems in Finland.

作者信息

Harno Kari, Ruotsalainen Pekka

机构信息

Helsinki University Central Hospital, Hospital District of Helsinki and Uusimaa, Finland.

出版信息

Stud Health Technol Inform. 2006;121:364-70.

Abstract

In Finland, the shared record is a virtual electronic health record (EHR). It consists of health data generated, maintained and preserved by different health care service providers. Two different kinds of technologies for integrating regional EHR-systems are applied, but mainly by using a common middleware. Services provided by this middleware are EHR location services using a link repository and combining EHR-viewing services with security management services including consent management and identification services for health professionals. The Regional Health Information Organization (UUMA) approach is based on a stepwise implementation of integrated regional healthcare services to create a virtually borderless healthcare organization--a patient centered virtual workspace. In the virtual workspace multi-professional teams and patients collaborate and share information regardless of time and place. Presently the regional health information network (RHIN) is comprised of three integrated services between primary, secondary and tertiary care within the county of Uusimaa. The regional healthcare modules consist of an (1) eReferral network, (2) integrated EHR service between health care professionals and (3) PACS system. The eReferral between primary and secondary care not only speeds up the transfer, but also offers an option for communication in the form of eConsultation between general practitioners and hospital specialists. By sharing information and knowledge remote eConsultations create a new working environment for integrated delivery of eServices between the health care providers. Over 100,000 eReferral messages (40 %) were transferred between health care providers. Interactive eConsultations enable supervised care leading to the reduction of outpatient visits and more timely appointments. One third (10/31) of the municipal health centers are connected to the clinics in the Helsinki University Central Hospital by the eReferral system. The link directory service extends the dimensions of networking between organizations by combining legacy systems within regional primary and secondary care. The link directory is an interface to diverse patient information systems, like HUSpacs, containing links pointing to the actual patient data located in remote information systems. The original data including images can be viewed with a web browser, but data can be accessed only with the patient's informed consent. Currently the reference data base includes 9.5 million links from 1.4 million patients with over 2.000 daily users. We aim to create a new working environment for professionals by incorporation of innovative information and communication technology, new organization of work and re-engineering of workflows. In the near-future, the citizen will have an active role participating in decisions on his care, carrying out guided self-care and taking steps of pro-active prevention.

摘要

在芬兰,共享记录是一种虚拟电子健康记录(EHR)。它由不同医疗服务提供者生成、维护和保存的健康数据组成。应用了两种不同的技术来整合区域电子健康记录系统,但主要是通过使用一个通用的中间件。该中间件提供的服务包括使用链接存储库的电子健康记录定位服务,以及将电子健康记录查看服务与安全管理服务(包括同意管理和医疗专业人员识别服务)相结合。区域健康信息组织(UUMA)的方法基于逐步实施综合区域医疗服务,以创建一个几乎没有边界的医疗组织——一个以患者为中心的虚拟工作区。在这个虚拟工作区中,多专业团队和患者可以随时随地协作和共享信息。目前,区域健康信息网络(RHIN)由新地区内初级、二级和三级医疗之间的三项综合服务组成。区域医疗模块包括:(1)电子转诊网络;(2)医疗专业人员之间的综合电子健康记录服务;(3)图像存档与通信系统(PACS)。初级和二级医疗之间的电子转诊不仅加快了转诊速度,还提供了一种全科医生和医院专家之间以电子会诊形式进行沟通的方式。通过共享信息和知识,远程电子会诊为医疗服务提供者之间综合提供电子服务创造了一个新的工作环境。超过100,000条电子转诊信息(占40%)在医疗服务提供者之间进行了传输。交互式电子会诊实现了监督式护理,从而减少了门诊就诊次数并使预约更加及时。三分之一(10/31)的市立健康中心通过电子转诊系统与赫尔辛基大学中心医院的诊所相连。链接目录服务通过整合区域初级和二级医疗中的遗留系统,扩展了组织间网络的范围。链接目录是一个连接各种患者信息系统(如HUSpacs)的接口,其中包含指向位于远程信息系统中的实际患者数据的链接。原始数据(包括图像)可以用网络浏览器查看,但只有在患者知情同意的情况下才能访问数据。目前,参考数据库包括来自140万患者的950万个链接,每天有超过2000名用户。我们旨在通过引入创新的信息和通信技术、新的工作组织方式以及工作流程的重新设计,为专业人员创造一个新的工作环境。在不久的将来,公民将在参与自身护理决策、进行指导下的自我护理以及采取主动预防措施方面发挥积极作用。

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