区域协同医疗系统模型与机制研究

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区域协同医疗系统模型与机制研究

摘要

区域协同是医疗卫生信息化建设的发展方向，区域协同医疗系统是基于区域

协同医疗模型和数据标准，在一定的行政区域内实现各医疗信息系统间的数据收

集、交换，为临床医疗、公共卫生、医疗保健、医疗急救以及相关科学研究、政府宏

观决策提供服务的一个顶层系统，是建立在原有各级各类应用系统上的复杂系统，

其核心是医疗信息的协同共享和医疗资源科学配置机制。当前社区医院与大医院

之间双向转诊就是一种典型的基于区域协同医疗模式，其通过对区域内的医疗信

息协同共享和资源合理配置，患者就诊的有关数据将在同一区域医院内有效、有

序流动，从而有效地减少重复检查、重复用药的问题，实现医疗信息和技术资源

的共享，提高服务的效率和质量。

本文面向我国医疗信息系统的区域化和协同化发展需求，开展了区域协同医

疗系统理论和方法研究，提出了医疗文档协同共享和医疗资源优化配置是实现区

域医疗协同机制的核心，论文的主要工作包括：

1）总结国外发达国家区域医疗系统的现状、趋势、先进经验，分析我国医疗

信息化发展存在的主要问题，基于“系统的系统”（Systems of Systems, SoS）和

协同学的理论、方法和建设原则，定义了区域协同医疗系统的概念、特征，探讨了

区域协同医疗系统的系统模型和共享数据类型，提出了区域协同医疗系统对相关

标准的选择建议；

2）将协同学（Harmann Haken’s Synergetics）引入区域协同医疗系统，提出

了区域医疗协同理论，建立了区域协同医疗系统模型及协同定理，开展了区域协

同医疗系统的自组织运动、动力机制以及区域医疗系统中的协同工作分析；提出

了区域协同医疗系统的四种协同模式；提出医疗信息的协同共享和医疗资源优化

配置是实现区域医疗协同机制的核心，并进行了对策研究和案例分析；

3）分析了 SOA 和Web Services 技术优势，进行了基于 SOA 的具有互操作

性RCHSIS 平台结构设计，讨论了区域协同医疗系统安全保障面临的问题和解决

技术途径；以上海市医联工程系统为例，进行了区域协同医疗系统顶层（SoS

层）设计、实施的实例分析；以某医院协同医疗系统为例，进行了区域协同医疗

系统的系统层方案设计，实现了系统间的数据共享交互；

4）开展了区域医疗协同体系对策分析，针对本论文提出的区域协同医疗文

档共享和医疗资源科学配置这两个区域协同医疗系统核心问题，提出了区域医疗

区域协同医疗系统模型与机制研究

文档共享和资源科学配置的对策和建议，同时在宏观和系统层面上，提出了区域

医疗协同发展的建议和措施。

区域协同医疗系统是一类面向更广范围内的区域性公共管理、医疗服务和应

用的信息系统，是将现代医学、信息学、管理学、系统工程与计算机科学等学科的

先进理论方法和技术手段进行融合的复杂系统。本文开展的区域协同医疗模型以

及机制研究获得的理论、方法和建议，将为推动我国区域协同医疗系统发展，建

立和健全相应的协同工作机制提供必要的理论参考。

关键词：区域协同；医疗文档共享；医疗资源配置；系统的系统；协同学

ABSTRACT

Regional Cooperative Healthcare Service Information System (RCHSIS) is the

development trend of sanitation information work. RCHSIS system is a top-level

system which is based on the RCHSIS model and data standard. It can implement

online data gathering and exchange among different medical and sanitary information

systems within a certain administrative region, thus provide services for clinic

therapy, public sanitation, medicate, medical first-aid and related scientific research

decisions. It is a kind of complicated systems based on the original medical

information system, with its core of medical information collaboration and sharing.

Medical resources (MR) optimization deployment is anther key problem. A typical

medical treatment pattern based on RCHSIS is the bi-directional cooperative medical

treatment between community hospitals and comprehensive hospitals, which will

contribute to sufficient sharing of medical resources in a certain area. The related data

of patients will be exchanged effectively among hospitals of the same area, thus

effectively reduce the repetition of examining and medicine using, implement the

sharing of medical technology resources and improve the efficiency and quality of

services.

The theory and method were studied for the development of Chinese RCHSIS in

this paper. Sharing Electronic Health Record (EHR) and optimized MR configuration

were proposed as two key mechanisms in planning and building RCHSIS. The main

achievements of this dissertation are summarized as follows:

(1) This paper introduces the history and present situation of medical information

systems in China, and analyzes some major problems in the medical treatment

information development. Based on the analysis of present situation and future trend

of medical treatment systems in developed countries, it defines the concept of

RCHSIS from the theory of ‘the system of systems’ (SoS) and raises the urgency and

significance for the construction and top-level layout of RCHSIS systems in our

country. The suggestion for research on RCHSIS model and data standard

were proposed too；

(2) The theory of regional cooperative healthcare service was proposed based on

Harmann Haken’s Synergetics. It focuses on the following points: The research of

III

区域协同医疗系统模型与机制研究

RCHSIS mechanism from collaboration viewpoint, including related concepts

comparison and analysis ；The theory of RCHSIS ；RCHSIS four models and

collaboration theorem ；Collaboration analysis for the self-organizing movement,

driving mechanism and RCHSIS ；Sharing Electronic Health Record (EHR) and

optimized MR configuration were proposed as two key mechanisms to implement

RCHSIS mechanism, as well as policy research and case analysis.

(3) The advantages of SOA and Web Services were analyzed. The RCHISIS’s

architecture and platform with interoperability was design in this paper. It puts

forward the proposal of Web Services area medical treatment information system

based on SOA, and performs a real case analysis and design of a hypothetic hospital’s

RCHSIS system under the background of Shanghai Hospital Association Project. In

the end, it gives the strategic analysis of RCHSIS system, measures and advices for

the medical resources scientific development, as well as advices of

developing and upgrading such kind of systems.

(4) The strategy analysis of developing RCHSIS was given in detailed. The

strategy and suggestion for Sharing HER and optimized MR configuration were

proposed too, which were solve these two key problems and mechanisms. It also gave

four suggestions to developing RCHSIS in regional and system level.

RCHSIS is a kind of public information management system which orients

hospitals in all levels from much wider areas. It is a complicated system that

integrates advanced theories and technological methods of medical informatics,

management, system engineering and information science, etc. The preliminary

conclusion of this paper upon the RCHSIS model and mechanism research will

provide necessary theoretic reference for boosting the development of RCHSIS and

establishing and improving the corresponding collaboration mechanism.

Keywords: Regional Cooperative, Sharing HER, Medical resources configuration,

System of Systems, Synergetics

目  录
目 录
摘 要................................................................I
ABSTRACT...........................................................III
目 录................................................................I
第一章　绪　论.......................................................1
1 医疗卫生信息化与医疗信息系统.................................1
2 区域医疗信息系统形成背景.....................................2
2.1 医疗信息系统发展过程...................................2
2.2 医疗资源合理配置需求...................................4
2.3 区域医疗信息平台形成环境...............................4
3 区域医疗卫生信息化现状.......................................5
3.1国外区域医疗信息化现状分析..............................5
3.2国内区域医疗信息化现状分析..............................6
4我国发展区域卫生信息化面临的主要问题..........................7
5我国医疗资源配置主要矛盾......................................9
6选题的意义....................................................9
7论文主要内容.................................................12
第二章 区域协同医疗系统与我国医疗信息化建设.........................14
1 区域医疗信息系统平台分析....................................14
1.1区域医疗系统平台分类...................................15
1.3区域协同医疗系统信息平台实现价值.......................16
1.4区域协同医疗系统信息平台的发展方向.....................17
2我国目前医院信息化建设情况分析...............................18
2.1 医院信息化现状........................................18
2.2 区域间发展不平衡......................................21
2.3 应用深度广度有差异....................................22
2.4 医院信息化投资规模较低................................22
2.5 医院信息化人力资源严重不足............................23
2.6 信息技术应用滞后......................................24
3 区域协同医疗系统平台用户分析................................25
4区域协同医疗系统平台主要业务分析.............................26
5区域协同医疗系统的提出和需求分析.............................28
6本章小结.....................................................30
第三章 区域协同医疗系统的系统模型和数据标准.........................31
1区域医疗信息共享的内容.......................................31
2区域医疗协同信息类型.........................................32
2.1 孤岛数据..............................................32
2.2 烟囱数据..............................................33
2.3 无系统数据............................................33
3区域协同医疗系统模型.........................................34
3.1分布式模型.............................................34
V

区域协同医疗系统模型与机制研究
3.2集中式模型.............................................35
3.3 混合式模型.............................................36
4区域协同医疗系统的数据标准...................................36
4.1相关的医疗信息标准.....................................37
4.2区域协同医疗系统标准选择建议...........................41
5本章小结.....................................................42
第四章 系统的系统－区域协同医疗系统.................................43
1系统的系统...................................................43
1.1定义及特征.............................................43
1.2实例及分类.............................................44
2区域协同医疗系统的概念.......................................46
3区域协同医疗系统面临的问题和对策.............................47
4基于 SoS 理论的区域协同医疗系统规划...........................50
4.1 区域协同医疗系统的目标及总体功能结构分析..............50
4.2区域协同医疗系统互联互通性.............................52
4.3区域协同医疗系统对数据利用模式.........................52
4.4区域协同医疗系统应用平台规划...........................53
4.5区域协同医疗系统架构模式...............................55
5本章小结.....................................................57
第五章 协同学及区域医疗协同理论.....................................58
1协同学及协同理论.............................................58
1.1协同学基本理论.........................................58
1.2协同学两个基本原理.....................................60
2区域医疗引入协同学的必要性...................................61
2.1协同是现代医院管理发展的必然要求.......................61
2.2 医疗资源是区域协同医疗系统核心因素....................62
2.3自组织是协同系统的理想模式.............................62
3区域医疗协同模型.............................................63
4区域医疗协同定理.............................................64
4.1 不稳定性分析和序参量选取..............................64
4.2 区域医疗协同定理......................................66
5本章小结.....................................................67
第六章 区域协同医疗系统的协同模式及动力机制.........................68
1区域协同医疗系统的协同模式...................................68
1.1共享协作模式...........................................69
1.2同步优化模式...........................................69
1.3协调发展模式...........................................70
1.4互补协同模式...........................................70
2 区域协同医疗系统的自组织运动及动力机制......................70
2.1区域协同医疗系统的受力分析.............................71
2.2区域协同医疗系统的自组织运动方程.......................72
2.3区域协同医疗系统中的竞争与共存.........................72
3 资源优化配置模式分析........................................74
VI

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摘要：

目录区域协同医疗系统模型与机制研究摘要区域协同是医疗卫生信息化建设的发展方向，区域协同医疗系统是基于区域协同医疗模型和数据标准，在一定的行政区域内实现各医疗信息系统间的数据收集、交换，为临床医疗、公共卫生、医疗保健、医疗急救以及相关科学研究、政府宏观决策提供服务的一个顶层系统，是建立在原有各级各类应用系统上的复杂系统，其核心是医疗信息的协同共享和医疗资源科学配置机制。当前社区医院与大医院之间双向转诊就是一种典型的基于区域协同医疗模式，其通过对区域内的医疗信息协同共享和资源合理配置，患者就诊的有关数据将在同一区域医院内有效、有序流动，从而有效地减少重复检查、重复用药的问题，实现医疗信息和技术资源...

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