基于B/S结构的电子病历管理系统的开发

电子病例系统研究是医院信息系统和建立数字化医院的关键课题。首先,讨论了作为医院管理系统实现信息化的重要环节——电子病例管理系统的定义和作用。由于B/S结构具有伸缩性、维护性和扩展性等多方面的优势,因此系统开发采用B/S结构;其次,对电子病历管理系统的系统功能进行分析和功能模块划分;再次,进行数据库的需求分析、概念结构分析以及逻辑结构分析,并对数据库进行实现和连接;最后,利用Dreamweaver实现JSP页面。     

The relationship between usage intention and adoption of electronic health records at primary care clinics

Objective

Despite of emerging evidence that electronic health records (EHRs) can improve the clinical quality, enhances patient safety and efficiency. Most physicians in primary health care clinics in the Taiwan do not currently adopt EHR at their clinic practices. We aim to measure the relationship between usage intention and adoption behavior.

Study design and methods

We used structured questionnaires distributed both EHRs adopter and non-adopter group to the primary health care physicians which participated in the DOH project to establish the information exchange environment across Taiwan. The response rate of adopter and non-adopter is 54.7% and 55.0% respectively.

Measurements

EHRs adoption behavior.

Results

The EHRs adopter group has higher intention than non-adopter (p = 0.003). From the result of logistic regression analyses, we found the key factors affecting physicians’ adoption pattern were intention to use (OR: 2.85; 95% CI: 2.30–3.54). In addition, higher perceived usefulness (OR: 1.29; 95% CI: 1.06–1.56) and perceived ease to use (OR: 1.48; 95% CI: 1.22–1.79) increase adoption of EHR found.

Conclusion

The intention to use EHR, perceived usefulness and ease to use of primary care physicians were found as key factors influencing EHRs adoption. Thus, we suggest that government should promote the potential benefits of EHR and enhance physicians’ willingness to adopt the EHRs at their clinic practices.     

基于Web的RBAC权限机制在电子病历系统的研究

首先分析了电子病历系统安全验证的必要性,着重研究了Cookie技术,探讨了安全Cookie的应用机制,并且通过使用PKI数字认证技术,分析了安全Cookie的安全特性。进一步通过对基于角色的访问控制的深入研究,提出了一种基于Web高效安全机制。该机制在利用安全Cookie保证安全性的前提下,引入缓存机制来提高权限获取效率。通过实际数据模拟实验,结果表明该机制在效率上有一定程度的提高。最后,针对电子病历系统的特点分析了该机制在其中的应用。     

云计算中基于属性的可搜索加密电子病历系统

电子病历是医学报告在云计算技术迅速发展下的一个重要产物,它的出现方便了医院和患者对病历的管理。然而, 患者的相关隐私数据存储在云上,就必然面临着隐私泄露、非法访问等隐患。为保护存储在云端的电子病历数据的私密性,提出了一个基于属性的可搜索加密方案,并给出了它在电子病历系统中的重要应用。与传统的可搜索加密方案相比,本方案降低了多用户环境下密钥管理的难度,且方案中的陷门可以在非安全信道上传输。此外,该方案可隐藏访问结构,具有细粒度访问控制,可根据数据拥有者的请求增加或撤销用户的访问权限。安全性分析表明,该方案保护了关键词的隐私性,可抵抗关键词猜测攻击,能有效防止隐私数据的泄露。关键词陷门匹配算法仅需一次双线性对运算,大大提高了搜索效率。     

Balancing documentation and direct patient care activities: A study of a mature electronic health record system

US hospitals now fully embrace electronic documentation systems as a way to reduce medical errors and improve patient safety outcomes. Whether spending time on electronic documentation detracts from the time available for direct patient care, however, is still unresolved. There is no knowledge on the permanent effects of documenting electronically and whether it takes away significant time from patient care when the healthcare information system is mature. To understand the time spent on documentation, direct patient care tasks, and other clinical tasks in a mature information system, we conducted an observational and interview study in a midwestern academic hospital. The hospital implemented an electronic medical record system 11 years ago. We observed 22 health care workers across intensive care units, inpatient floors, and an outpatient clinic in the hospital. Results show that healthcare workers spend more time on documentation activities compared to patient care activities. Clinical roles have no influence on the time spent on documentation. This paper describes results on the time spent between documentation and patient care tasks, and discusses implications for future practice.Relevance to industryThe study applies to healthcare industry that faces immense challenges in balancing documentation activities and patient care activities.     

Empowering village doctors and enhancing rural healthcare using cloud computing in a rural area of mainland China

Background

China's healthcare system often struggles to meet the needs of its 900 million people living in rural areas due to major challenges in preventive medicine and management of chronic diseases. Here we address some of these challenges by equipping village doctors (ViDs) with Health Information Technology and developing an electronic health record (EHR) system which collects individual patient information electronically to aid with implementation of chronic disease management programs.

Methods

An EHR system based on a cloud-computing architecture was developed and deployed in Xilingol county of Inner Mongolia using various computing resources (hardware and software) to deliver services over the health network using Internet when available. The system supports the work at all levels of the healthcare system, including the work of ViDs in rural areas. An analysis done on 291,087 EHRs created from November 2008 to June 2011 evaluated the impact the EHR system has on preventive medicine and chronic disease management programs in rural China.

Results

From 2008 to 2011 health records were created for 291,087 (26.25%) from 1,108,951 total Xilingol residents with 10,240 cases of hypertension and 1152 cases of diabetes diagnosed and registered. Furthermore, 2945 hypertensive and 305 diabetic patients enrolled in follow-up. Implementing the EHR system revealed a high rate of cholecystectomies leading to investigations and findings of drinking water contaminated with metals. Measures were taken to inform the population and clean drinking water was supplied.

Conclusions

The cloud-based EHR approach improved the care provision for ViDs in rural China and increased the efficiency of the healthcare system to monitor the health status of the population and to manage preventive care efforts. It also helped discover contaminated water in one of the project areas revealing further benefits if the system is expanded and improved.     

Making a Case in Medical Work: Implications for the Electronic Medical Record

The introduction of theelectronic medical record (EMR) is widely seenby healthcare policy makers and servicemanagers alike as a key step in the achievementof more efficient and integrated healthcareservices. However, our study of inter-servicework practices reveals important discrepanciesbetween the presumptions of the role of the EMRin achieving service integration and the waysin which medical workers actually use andcommunicate patient information. These lead usto doubt that technologies like the EMR candeliver their promised benefits unless there isa better understanding of the work they areintended to support and the processes used inits development and deployment becomesignificantly more user-led.     

智慧医疗环境下支持属性更新的加解密外包方案

为了共享患者数据,更便捷地查询患者情况,电子病历成为目前医疗系统中不可或缺的数据资料。为解决医患之间细粒度的访问控制和患者隐私保护问题,提出了智慧医疗环境下的支持属性更新的加解密外包方案。该方案通过将加解密运算外包给雾节点,有效地降低了数据拥有者和数据用户的计算负担,同时提高了效率。另外,该方案支持更新患者病历,更符合实际应用情况。同时,在密文更新时,授权机构将属性相关的哈希值传输给医疗云服务器,有效地保护了用户的隐私。最后,基于DBDH困难问题证明该方案是安全的,同时实验数据分析表明,该方案在计算效率上也具有一定优势。     

Perceived risks, counter-beliefs, and intentions to use anti-/counter-terrorism websites: An exploratory study of government–citizens online interactions in a turbulent environment

This study examines the relationships between various risks, beliefs, and behavioral intentions that are related to citizens' use of anti-/counter-terrorism e-Government websites. The data was collected through two surveys within a one-year interval — before and after the Iraqi regime was expelled by the US coalition army. The results suggest that perceived privacy risk from an anti/counter-terrorism authority is the major obstacle in citizen-to-government anti/counter-terrorism information flow, while citizens' belief in the authority's domain competence greatly influences citizens' dependence on anti/counter-terrorism website information. Other findings and implications are discussed, and directions for future research are suggested.