Liu Tz-Jie, Lee Hsu-Ting, Wu Fan
Department of Information Management, National Chung Cheng University, Chiayi 621301, Taiwan.
Center of Health Management, St. Martin De Porres Hospital, Chiayi 600044, Taiwan.
Healthcare (Basel). 2023 Aug 28;11(17):2410. doi: 10.3390/healthcare11172410.
Currently, the Taiwan Electronic Medical Record Exchange Center uses the Clinical Document Architecture (CDA) framework, which is based on the international medical standard. The CDA R2 standard, defined in 2005, is used for cross-institution retrieval of electronic medical records (Ministry of Health and Welfare, Information Department, 2021). However, CDA R2 only supports the exchange of clinical documents and is limited to the XML format. Due to the lack of a standardized framework for medical data exchange in Taiwan, different standards and specifications result in different data interface methods between systems, requiring customization for each system by healthcare institutions or the government. The inconsistency in data formats requires healthcare institutions and the government to spend more time on data parsing and mapping, resulting in slow integration of medical data. In this study, we simulated healthcare institutions using Fast Healthcare Interoperability Resources (FHIR) for medical information exchange and utilized the exchanged medical information to create a dynamic dashboard to assist healthcare professionals in making medical decisions. To ensure information security, we employed Hyper Text Transfer Protocol Secure (HTTPS) for secure transmission, which encrypts the transmitted medical record data using the Transport Layer Security (TLS) protocol, preventing deliberate interception and tampering of medical record data between the two systems. Finally, to test the load and performance of static and dynamic resources and web applications, we conducted a system performance evaluation using Apache JMeter. The results of this study demonstrate that replacing the gateway of the Electronic Medical Record Exchange Center with an FHIR server effectively reduces the time and cost spent by developers on data format conversion while also mitigating the information security risks associated with the previous VPN solution. Additionally, by utilizing dynamic charts, healthcare professionals are assisted in making medical decisions.
目前，台湾电子病历交换中心采用基于国际医学标准的临床文档架构（CDA）框架。2005年定义的CDA R2标准用于跨机构检索电子病历（卫生福利部资讯处，2021年）。然而，CDA R2仅支持临床文档的交换，且限于XML格式。由于台湾缺乏医疗数据交换的标准化框架，不同的标准和规范导致系统间的数据接口方法各异，医疗机构或政府需要为每个系统进行定制。数据格式的不一致要求医疗机构和政府在数据解析和映射上花费更多时间，导致医疗数据整合缓慢。在本研究中，我们模拟医疗机构使用快速医疗互操作性资源（FHIR）进行医疗信息交换，并利用交换的医疗信息创建动态仪表板，以协助医疗专业人员做出医疗决策。为确保信息安全，我们采用超文本传输安全协议（HTTPS）进行安全传输，该协议使用传输层安全（TLS）协议对传输的病历数据进行加密，防止两个系统之间的病历数据被蓄意拦截和篡改。最后，为测试静态和动态资源以及Web应用程序的负载和性能，我们使用Apache JMeter进行了系统性能评估。本研究结果表明，用FHIR服务器取代电子病历交换中心的网关可有效减少开发者在数据格式转换上花费的时间和成本，同时降低与先前VPN解决方案相关的信息安全风险。此外，通过使用动态图表，可协助医疗专业人员做出医疗决策。
