由醫院資訊系統及放射醫學數位化之演進探討IHE之未來發展

Evolving from Hospital Information Systems and Digitalized Radiology to ward Integrating Healthcare Enterprise

本文由醫院資訊系統(Hospital Information System; HIS)與放射醫學數位化的演進，探討醫療企業整合(Integrating the Healthcare Enterprise; IHE)的未來發展，並對醫療資訊發展之典範轉移(Paradigm shift)過程作一完整論述。放射醫學起源於X射線的發現（醫療影像的產生），爾後因放射醫學資訊學的興起，漸進式透過放射科資訊系統(Radiology Information System; RIS)輔助放射科部門之經營管理，直到醫療影像傳輸系統(Picture Archiving and Communication Systems; PACS)的問世促進放射醫學進入數位化的時代，為進一步使放射科部門各種特殊昂貴造影儀器效率效果最大化與工作流程的順暢，因而有系統整合的需求，而促使IHE的興起，IHE遵循既有的標準，如健康七層協定標準(HealthLevel Seven; HL7)、 醫療影像傳輸標準(Digital Imaging and Communications in Medicine; DICOM)，提供PACS/RIS/HIS系統的整合的技術架構，透過IHE的技術架構與流程最佳化設計，使放射科的RIS/PACS/造影儀器(modality)與HIS系統之間完成無縫式接合。本文有系統地論述醫院資訊系統與放射醫學數位化之發展歷程與意涵，並結合醫療資訊學術界與實務界專家之見解，提出以下之研究論點：一、醫院資訊系統已積極創造組織之價值。二、整合內外部資源之醫療資訊環境漸成發展趨勢。三、下一代的醫院資訊系統發展方向亟待確立。本文亦認為，未來IHE的發展建議遵循以下原則。(1).建立IHE之商業模式(Business Model)，其中透過相關領域的參與者（產、官、學界）的加入，結合多元領域知識，經由充分的溝通、協調，具體定義各項任務運作的機制。(2).採用Top-Down Model的方法，由上而下分層規劃，由下而上分層執行。(3).尊重市場機制，宣揚共同願景與目標，藉由標準的遵循徹底解決異質系統帶來的問題，以促成電子病歷之發展。然而，PACS之建置在我國仍屬起步階段，IHE之研究更屬初探性研究。因此，針對我國國情之特性，研擬下一代醫療資訊系統之願景及範圍，發展屬於我國醫療產業之IHE Business Model，著實是刻不容緩的任務，亟待國內醫療資訊界專家學者共同來努力。

In this paper, we introduce the evolution of Hospital Information Systems (HIS) and Radiology Information Systems (RIS) from various viewpoints and propose strategies for further Integrating the Healthcare Enterprise (IHE). That is, we make a complete discussion about the paradigm shift of medical informatics. We specially put emphasis on the radiology department where the need of IHE originated. The radiology came from the discovery of X-ray (so called medical images). Later, with the rise of medical informatics, the RIS was adopted to improve the management performance. The Picture Archiving and Communication Systems (PACS) facilitate the revolution of digital images processing and declare the age of entirely hospital digital images. To make the best cost/effectiveness of those expensive hospital modalities and achieve the seamless workflow, the IHE was proposed to provide a total solution for the integration of systems involved in the patient healthcare delivery of hospital. Based on a flexible integrated technical framework, the IHE utilizes the existing medical standards such as Health Level seven (HL7) and Digital Imaging and Communications in Medicine (DICOM) to achieve the optimized workflow designs and the seamless system integration among different systems such as HIS/RIS/PACS and various medical modalities. We discuss the evolution of HIS and Digitalized Radiology, and combine several opinions of medical informatics academic and practitioner to offer three arguments: (1) Hospital Information system has created values for organization. (2) Integrating with internal and external resources has become trend in the medical environment. (3) what is the issue of the next generation of HIS should be confirmed as soon as possible. We also propose three major recommendations or guidelines for development of IHE. (1) Development of IHE business model: invite multidiscipline experts through well cooperation, coordination and communication to discuss the definition, development and working mechanisms of IHE. (2) Clarification of IHE development strategies: we should follow the guidelines of system concept by utilizing the top-down model to decrease the complexity and obstacle of IHE development. (3) Adoption of market mechanisms: to achieve the ultimate purposes of the Electronic Medical Record (EMR) such as patient-oriented healthcare delivery and better healthcare quality, the integration of HIS/RIS/PACS and modalities will highly rely on the success of IHE which provides a flexible and well-designed mechanism adopting the existing standards to meet the needs of healthcare industry. However, in Taiwan, it is not popular for the adopting of PACS and IHE is still an exploration study so it is very important for us to build an IHE Business Model for Taiwan and figure out the major research issues for next generation of HIS as soon as possible.