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

@ NUK 2007.12.19A New Spawning Ground for

Interdisciplinary Medical Fieldwork Development

( IMFD Project ) Tsung-lung, Yang , M.D

Section Chief in TeleRadiologyDepartment of Radiology, Kaohsiung Veterans General Hospital

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 )

The PACS recess I indulge…..

Ugly duckling … Dark Room

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….

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 !

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

夫天地者

萬物之逆旅

光陰者

百代之過客

HOW TO REACH

SUSTAINABILITY?

SustainabilitySustainability 永續發展永續發展

SPARCSee, Plan, Act,

Refine, and Communicate硬體與軟體

Designer Building

弱建築柔弱中見剛強的哲學

隈研吾

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 !!

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 !

Virtual Medical Civility虛擬醫療公民素質

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 healthcare 2.0 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

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

Essence of Patient Record

Medical Record 主觀病歷 客觀病歷

Billing Record 醫療經濟學

CONCEPT OF DESIGNER PACS/EPR

Like learning to play a musical instrument, you learn technique first and after then, the

artfulness flows.

From Learning Pieces to Masterpieces!

柔弱中見剛強的哲學

H.E.L.P.HEALTHCARE ENHANCEMENT AND LEVERAGE PLATFORM

優質無片 , 智慧無紙

病 ( DISEASE) 是敵人 , 或是夥伴 !?

蘇格拉底問答 ?

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…..

反對的聲音 ?

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

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

The Ultimate Goal

用最少的時間 , 營造最大的功犯最少的錯 !

“One of the things we’re going tosee in the next five to 10 years is thefirst and second generation of PACS,that were departmental and closed intheir design for use by radiologists,replaced with Web-based enterprisePACS solutions that converge with theentire hospital’s digital system,” saidDr. Thrall. “This is a 20-year revolution,and we’re now about three-quartersof the way through it.”

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

“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 !

用最少的時間營造最大的功犯最少的錯

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

Concept from single sign-on

高雄榮總 PACS 發展里程碑

用一根針造一口井 ?? 大型營造廠Interdisciplinary cooperation

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

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 1414

sets( client-server: 633 AETs )

Total Employees: 3512( 醫師 : 927 名 )

DATA Collected: 2007.09.01

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

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

IHE IT Infrastructure Technical Framework在高榮的 blueprint

Why?Cross-Enterprise Document

Sharing (XDS)

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

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

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

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)

Smartwonder

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

完整系統日誌記錄查詢作業

實驗室動態資料取回展示

只要 1秒

即時線上會診

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

即時報告關鍵字通報系統

網基影像刪除管理作業

若刪除影像時 , 報告已完成 , 將根據HIPAA 計錄 , 自動或人工通知所有相關醫師修改報告或重新審視影像 !

即時線上效能分析暨關鍵效能指標展示

DICOM ECG Waveform 動態波型瀏覽

Applications of RFID-based Remote Care onWeb-based Enterprise PACS Solution

心臟病糖尿病

Patient exclusiveMedical IT in Home…..

Norway 100 % PACS ready…..

Patient Delivery System

術後回家

調整劑量 EKGRFID+ 指紋

結構性報告 / 證據DICOM SR/PDF/SVG

B.P.R

B.P.R

血糖儀RFID+ 指紋

Patient Delivery System

術後回家

調整劑量

血糖值

結構性報告 / 證據DICOM SR/SC/VL

血糖值

Healthcare Anywhere: ubiquitous

Streaming Technologyfor medical industry, now and

tomorrow Static Images 3D reconstructed Images Waveform-based vital sign

monitoring Tele_monitoring video streaming Tele_management decisive panel 天蒼蒼地茫茫 風吹草低見牛羊

謝謝歡迎到高雄榮民總醫院來參觀

MIRC

Live Connection to KSVGHH.E.L.P.

Thin Client 3DMIRC