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醫療影像資訊系統的發展趨勢與應用實例 …. and some Philosophy

醫療影像資訊系統的發展趨勢與應用實例 …. and some Philosophy. 高雄大學資訊工程學系數位科技與生活應用 ( 大學部科技類通識課程 ). @ NUK 2007.12.19 A New Spawning Ground for I nterdisciplinary M edical F ieldwork D evelopment ( IMFD Project ). Tsung-lung, Yang , M.D Section Chief in Tele Radiology

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醫療影像資訊系統的發展趨勢與應用實例 …. and some Philosophy

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  1. 醫療影像資訊系統的發展趨勢與應用實例….and some Philosophy 高雄大學資訊工程學系數位科技與生活應用 (大學部科技類通識課程) @ NUK 2007.12.19 A New Spawning Ground for Interdisciplinary Medical Fieldwork Development( IMFD Project ) Tsung-lung, Yang , M.D Section Chief in TeleRadiology Department of Radiology, Kaohsiung Veterans General Hospital

  2. The PACS recess I indulge….. Ugly duckling … Dark Room

  3. Crash Course for 1-hour Speech • Medical Modality Revolution • 9.4 Tesla MR, 320 MDCT, Elastography, PET….. • Nanowire-based Electronic Nose, Photoacoustic tomography • Medical Ethics • Medical Platform • Medical Information Technology: 躍躍欲試 • Service, Administration, Research, Teaching • Medical IT standards • MIRC, DICOM, HL7, IHE, EPR, EHR, EMR, SNOMED, CPT, ICD, RFID and many more….

  4. IT all began with the hurtful remarks 10 years ago… 小孩玩大車 資訊大玩具 用一根針造一口井!!!!! 10 years later, 那根針已經變成大型營造廠!

  5. Kernel Logics underpinning KSVGH PACS toward EPR • How to reach concept of Sustainability? • Philosophical approach • Designer PACS • Web-based enterprise PACS Solutions • Briefing on current PACS status at KSVGH • The Revolution • Is ubiquitous-paperless environment a dream? • A better tomorrow 幸福的老年社會

  6. 夫天地者 萬物之逆旅光陰者 百代之過客

  7. HOW TO REACH SUSTAINABILITY?

  8. Sustainability永續發展

  9. SPARC See, Plan, Act, Refine, and Communicate 硬體與軟體

  10. Designer Building 弱建築 柔弱中見剛強的哲學 隈研吾

  11. 像蓋房子一樣, 哪一種房子, 適合人來住呢? 軟體所營造的平台, 如何像空氣一般, 不著痕跡, 卻又柔中帶強, 帶給人無比的信任!!

  12. 生活的目的：在增進人類全體之生活；生命的意義：在創造宇宙繼起之生命。生活的目的：在增進人類全體之生活；生命的意義：在創造宇宙繼起之生命。 病歷的本質何在? 在於反映生活, 反射生命!

  13. Virtual Medical Civility 虛擬醫療公民素質

  14. 虛擬醫療公民素質 • 過程: progress to fight the disease or be compliant with the disease • 內容: the content from medicare consumer and provider • 形成 healthcare2.0 的核心: 良性的醫病互動. • 讓病人有思考, 表達的機會 • 也讓醫師有驗證, 論述, 論辯與溝通的能力

  15. 虛擬醫療公民素質 • Healthcare 2.0 漸進的以Web 2.0, Web 3.0 為工具或平台, 將身心靈的弱建築完整的呈現 • 人與自然合而為一的電子病歷 • 關心大宇宙與小宇宙 • 形成共識後, 讓更多的證據浮現出來, 身心靈一起獲得醫治 • 降低醫病緊張關係

  16. Essence of Patient Record • Medical Record • 主觀病歷 • 客觀病歷 • Billing Record • 醫療經濟學

  17. 柔弱中見剛強的哲學 Like learning to play a musical instrument, you learn technique first and after then, the artfulness flows. CONCEPT OF DESIGNER PACS/EPR From Learning Pieces to Masterpieces!

  18. 優質無片, 智慧無紙 H.E.L.P.HEALTHCARE ENHANCEMENT AND LEVERAGE PLATFORM

  19. 蘇格拉底問答? 病( DISEASE) 是敵人, 或是夥伴!?

  20. Web 3.0 vs. Healthcare 2.0 • Healthcare 2.0: user-generated Healthcare • Web 3.0: intelligent, economic web • Tele-Radiology, Tele-Storage • Tele-Consultation • Tele-Management • Medical IT in Home • Medical consumer electronics • EHR, EPR, EMR…..

  21. 反對的聲音?

  22. An EMR isn’t nearly as good as a paper chart, because I can’t draw my cute male and female symbols.

  23. A car isn’t as good as a horse, because a horse can go into tight places. 錯誤 /鄭愁予  我打江南走過那等在季節裡的容顏如蓮花般開落... 東風不來，三月的柳絮不飛你的心如小小的寂寞的城恰若青石的街道向晚 跫音不響，三月的春帷不揭你底心是小小的窗扉緊掩 我達達的馬蹄是美麗的錯誤 我不是歸人，是個過客

  24. The Ultimate Goal 用最少的時間,營造最大的功 犯最少的錯!

  25. “One of the things we’re going to see in the next five to 10 years is the first and second generation of PACS, that were departmental and closed in their design for use by radiologists, replaced with Web-based enterprise PACS solutions that converge with the entire hospital’s digital system,” said Dr. Thrall. “This is a 20-year revolution, and we’re now about three-quarters of the way through it.”

  26. 您期待醫師如下所示嗎? 必須熟悉ㄧ萬多種疾病 必須熟悉三千多種藥方 在醫院所做的TEST可以馬上知道判讀結果，並且加以臨床應用 必須熟讀很多文獻

  27. “Digital Medical Practice” Medical institutes today have entered an era of high-stake accountability and standards-bases medical management.高風險醫療責任,證據醫學趨勢 Flooding of medical data, information results in more time-consuming on screen, more error-making unconsciously.醫療資訊爆炸 用最少的時間營造最大的功!

  28. 用最少的時間營造最大的功犯最少的錯 Concept from single sign-on • Web-based enterprise PACS solution • Patient link:病歷號同步連結 • User link:使用者帳號同步連結 • Encounter link:查房清單同步連結 • Conference link:開會清單同步連結

  29. 高雄榮總PACS發展里程碑 Interdisciplinary cooperation 大型營造廠 用一根針造一口井??

  30. Brief History of PACS development at KSVGH(高雄榮總) • Partnership with TEDPC(臺灣電腦) since 1997 • Ultrasound Filmless Environment in 1998 • Enterprise Filmless in 2002 End • Transforming Client-server into Web-based enterprise solution in 2006 • Future projects: • Secured EMR in 2008 • Electronic Display Record in 2008 • Nursing informatics in 2009

  31. Some Statistics about KSVGH • Near-online image available since1998 • Online image available since 2000 • Total Study Number:1759081 • Total Series Number:2919765 • Total Instance Number:29679901 • Radiology Studies per months:29000 • Total Workstations at KSVGH: over 1414sets( client-server: 633 AETs ) • Total Employees: 3512(醫師: 927名 ) DATA Collected: 2007.09.01

  32. DrYang’s Definition ofWeb-based Enterprise PACSSolutions More than image storage and retrieval More IHE-compliant workflows integration HIPAA compliant environment Enterprise-wide deployment of Standard Display Systems Quality Management Human Resource management Ubiquitous Assess Solution

  33. Future Projects • Secured,Kerberosized Medical Platform安全醫資平臺 • Medical IT in Home:數位居家照護 • XDS: Cross enterprise document sharing • Nursing informatics:數位護理資訊 • Electronic display record:螢幕電子病歷 • Timeline-based, patient-centered semantic paperless medical record:無紙環境 • eMPI, eReferral, ePrescription:數位病患資料索引,數位轉診,數位處方

  34. IHE IT Infrastructure Technical Framework IHE IT Infrastructure Technical Framework 在高榮的 blueprint

  35. Why?Cross-Enterprise Document Sharing (XDS) 藉由標準查詢與檔案取回機轉，建立多層級醫事機構間分享管道，在病患同意下，分享標準醫學檔案與影像 分享檔案影像 建立分享管道 多層級醫事機構分享 標準查詢與檔案取回機轉

  36. Cross-Enterprise Document Sharing (XDS) • XDS-Image ( RSNA 2006, 2007 demonstration) • XDS-Medical Summary • Online solution即時線上安全医資交換 • Offline solution • XDMedia 可攜式媒体醫資交換 • XDReliable interchange 安全電子郵件醫資交換

  37. Virtual Touring at KSVGH Web-Access DICOM object (WADO) 網基影像取回機轉 LIS Retrieve information display實驗室動態資料取回展示 On-line WADO-based Consultation即時線上會診 Study Protocol Management貴重檢查程式審核管理 Adaptive Report Key Words PHS Notification即時報告關鍵字通報系統 Web-based Image Deletion QC Management網基影像刪除管理作業 OLAP for performance measurement即時線上效能分析暨關鍵效能指標展示 HIPAA 完整系統日誌記錄查詢作業 ECG/PDF Integration Many more profiles…….( KIN, CPI, Help desk, MIRC, Patient tracking etc)

  38. Smartwonder

  39. 網基影像取回機轉 URL:http://192.168.195.26:8080/SmartWonder/servlet/dcmWADOResponseFile?contentType=application/dicom;text/plain&DicomServer=SK&requestType=WADO&studyUID=1.2.840.113817.886.602030026.0.2078446.953945141&seriesUID=1.3.12.2.1107.5.1.4.43094.4.0.17748351826461681&objectUID=1.3.12.2.1107.5.1.4.43094.4.0.17748648210981388

  40. 完整系統日誌記錄查詢作業

  41. 實驗室動態資料取回展示 只要1秒

  42. 即時線上會診

  43. 貴重檢查程式審核管理 最後以SR/PR之DICOM格式存入系統 檢查室與報告醫師均可參考此檢查步驟

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