I. Project background
In order to solve the problem of unbalanced economic and social development in China, high-quality medical resources are mostly concentrated in developed areas and big cities in the east, while medical resources in central and western regions and rural areas are relatively insufficient, making it difficult for people to see a doctor. The national medical reform plan clearly puts forward to vigorously develop remote consultation for the central and western regions and rural areas, and puts forward the construction principles of resource integration, unification, high efficiency, interconnection and information sharing. In order to make full use of remote consultation to improve the medical service level in the central and western regions and rural areas and facilitate the people to see a doctor, the Ministry of Health proposed the construction project of remote consultation system in the central and western regions.
Establish a grassroots remote system with provincial general hospitals as the core and a high-end remote consultation system with national hospitals as the core. Five county-level people's hospitals carry out remote consultation at the grassroots level.
Second, the construction principles and objectives
1, construction principle, top-level design, unified standard: proceed from the overall situation and promote the construction of grassroots and high-end remote consultation system according to unified design. Based on the current situation, implement it step by step: make full use of existing resources such as network, equipment and personnel, and gradually promote and improve the construction of remote consultation system according to the business needs of primary medical institutions. Mature technology and interconnection: fully consider the development needs of remote consultation, adopt mature and reliable advanced technology, adopt open architecture design, support interconnection, and be easy to expand and upgrade. Ensure safety and pay attention to practicality: Information and system security is an important guarantee for health informatization construction. The construction and application of remote consultation involves the staff and patients of various medical institutions at all levels, and the system must be convenient, practical, safe and reliable, and easy to maintain.
2. The overall goal is to build a grassroots telemedicine consultation platform with the People's Hospital as the provincial telemedicine consultation center, and gradually realize the functions of remote consultation, distance education, remote digital resource sharing, video conference, two-way referral, remote appointment and remote specialist diagnosis. To promote the sharing of high-quality medical resources and the equalization of medical services in our province, effectively strengthen the medical service capacity of primary hospitals in our province, improve the level of treatment for difficult and severe diseases, and alleviate the difficulty of people seeing a doctor. In the future, it will realize the interconnection and resource sharing with the ministerial-level remote consultation platform.
Third, the system architecture of telemedicine consultation platform
The telemedicine consultation platform system adopts B/S architecture and centralized mode, which is extensible. When the time is ripe, regional platforms can be established in various regions. The system consists of a set of software, a website and a data center, and the networking consists of 10MB/4MB fiber dedicated line.
A set of software: design the specific construction scheme according to the technical scheme requirements of the Ministry of Health, and select the software developer development platform through bidding according to the relevant national policies.
Website A: Establish a telemedicine consultation service network, which is used for video-on-demand of distance video teaching, notification of distance video teaching information, inquiry and reading of digital shared resources, etc.
A data center: establish a provincial telemedicine data center to realize centralized storage and management of telemedicine data. As the center of telemedicine management system, telemedicine data center realizes the storage and management of all kinds of telemedicine data, and provides data mining and analysis support for telemedicine application systems such as distance education system and remote digital resource sharing system.
Network: initially, the health information private network was used for networking. The whole system includes remote consultation management, medical record data collection, remote specialist diagnosis, remote monitoring, video conference, distance education, digital resource sharing, two-way referral and remote appointment, data center, electronic authentication, SMS platform, fee settlement and other subsystems.
(1) Remote consultation management subsystem According to the implementation mode, remote consultation includes interactive remote consultation and offline remote consultation.
1, interactive remote consultation: support real-time interactive remote consultation among consultation experts, doctors and patients; Support the clinical needs of patients and realize that patients can receive expert remote consultation service in real time from their beds; Support consultation experts to remotely control video images of patients in different beds; For critically ill patients, it supports the real-time transmission of vital sign data such as bedside monitors, and provides continuous and dynamic diagnosis basis for consultation experts.
2. Off-line remote consultation: supporting non-real-time off-line remote consultation between consulting experts and applicants; Support application
Doctors submit consultation application information and medical records; Consultation experts browse consultation application information and pathological data in real time according to the actual situation, and compile and publish consultation reports; Ask the doctor to browse the consultation report again. It includes the following functional modules: See Table 3. 1 for the functional modules. Table 3. 1 Function list of remote consultation management system Description of consultation application submitted and modified by the user; Expert information inquiry; Medical record submission and inquiry, as well as consultation management and consultation application management of other provincial, prefectural and county hospitals; Management of medical records; Consultation process records, report browsing, etc. Browse the medical records of expert consultation in tertiary hospitals, county hospitals and provincial health departments (medical images, electrocardiogram, pathological pictures, etc.). ); Compilation, revision and release of the consultation report; Expert information management of expert management in tertiary hospitals, such as template management of consultation report; According to the doctors, hospitals and diseases, the statistical analysis of tertiary hospitals such as authority management is carried out, and the basic data of provincial health departments and hospitals at all levels are maintained; User and authority management; Server information monitoring and other provincial health departments and hospitals at all levels.
(II) Medical record data collection subsystem The medical record data collection subsystem should support the processing of analog signals, digital signals and real-time signals, and its main functions are as follows:
1. Analog signal processing: Digitize the patient's film and paper medical records, laboratory sheets and chart reports through scanning. The system supports the transmission, storage and reading of scanned files and the manual input of medical records. Film data: It is recommended to use a special medical scanner to process the film, which can support the output as DICOM3 image files. Paper materials: Paper materials are processed by ordinary flat scanner, and scanned documents are saved in JPEG format.
2. Digital signal processing: The system should support collecting patient image data from imaging equipment with DICOM3 interface through DICOM gateway and importing DICOM3 images from PACS graphic workstation. The system supports interconnection with electronic health records, electronic medical records, data centers and other systems. Conditional hospitals can export patients' medical records according to the standards and norms of electronic medical records issued by the Ministry of Health, and the remote consultation system supports the import, transmission, storage and reading of the exported information.
3. Real-time vital sign signal processing: The system supports real-time collection and transmission of vital sign data such as bedside ventilator and monitor, and realizes 24-hour continuous dynamic observation of patients.
(3) Remote specialist diagnosis subsystem The remote specialist diagnosis subsystem should support the remote diagnosis functions of images, ECG and pathology.
1. Remote image diagnosis supports obtaining patient image data from standard DICOM 3.0 interface image equipment or PACS system, and storing, reproducing and corresponding post-processing operations. A remote radiation consultation system based on DICOM 3.0 protocol, B/S architecture and WEB browsing mode is established, which supports post-processing of image data, labeling and saving of key images, writing and publishing of image consultation report, and supporting report template function. Support multi-party real-time interactive operation of medical images (including static and dynamic) during remote image consultation. Support remote consultation experts to conduct remote image consultation after passing Internet security certification at any place. Conditional hospitals at higher and lower levels can establish the relationship of remote imaging diagnosis service from department to department.
2. Remote ECG diagnosis supports the acquisition of ECG information from digital electrocardiograph, lossless data transmission, storage and reproduction, and the transmission of static ECG data from primary hospitals to consultation experts in higher hospitals. Support experts to interpret and print ECG, and support the writing and publication of reports. 12 lead digital ECG supports the transmission of ECG data through Internet, GPRS and telephone lines. Digital ECG data can be stored in XML, DICOM and other general data formats. Support the analysis and comparison of different cases and historical data. Conditional hospitals at higher and lower levels can establish diagnostic service relationships between departments.
(IV) Video conference subsystem Video conference subsystem provides audio-video interactive function for remote consultation service, and its main functions are as follows:
1. Remote interactive communication and consultation between medical experts and doctors and patients in the hospital. Support remote camera in different places, and adjust the observation angle in real time; The system supports the bedside needs of critically ill patients, and patients can receive expert remote consultation and remote monitoring services in real time in the hospital bed;
2. The system supports the remote consultation service between the consultation application hospital and different health affiliated hospitals and different provincial tertiary hospitals; Support multi-experts across specialties, institutions and regions to conduct real-time joint consultation with the same grassroots patient at the same time. When applying for consultation in different hospitals, the system should be switched quickly and seamlessly to enhance the response efficiency and expansion ability of the system;
3, to carry out distance education, support the synchronization of audio and video of teaching experts and courseware slides, and support the interaction between the two sides.
Live broadcast and video recording of the training process;
4. Support high-definition video conferencing among medical institutions to meet the business needs of academic exchange, case discussion and experience sharing among medical institutions;
5. Audio and video recording/playback, supporting the recording and video playback of consultation, meeting and teaching process;
6. It can be interconnected with the video platform of emergency command system to support the submission of audio and video information.
7. Basic configuration of the system:
① Full HD video conference system based on IP network is adopted.
② H.323 protocol framework technology is adopted to support mainstream audio and video protocols such as H.264
③ Resolution: Resolution ≥ 1280×720P.
④ Frame rate: 30 frames per second.
⑤ Double stream: H.239 standard is supported, and the resolution of the second video stream is ≥ 1280×720P.
⑥ Support dual-screen display applications.
⑦ Interconnect with emergency command video exchange platform. Conditional can be remote consultation video conference system and national and provincial emergency command video exchange platform interconnection, realize the emergency consultation and emergency related image information submitted.
(5) The distance education subsystem supports two training modes: real-time interaction and courseware on demand. Real-time interactive training should ensure the synchronization of audio and video of teaching experts and courseware playback; Support real-time interaction of training participants; Support the video recording of the training process, save it as a common file format and store it in the remote consultation center, and support the production, sorting and classification of streaming media courseware. Real-time interactive training should include supporting remote surgical observation, remote nursing teaching and remote teaching rounds. Support courseware on-demand service, with courseware management functions such as adding, deleting, uploading and querying.
(6) Remote digital resource sharing subsystem supports primary medical institutions to share medical books and information resources, provides convenience for them to consult medical literature, and improves the professional level of primary medical staff. At the same time, support superior hospitals to share typical medical records, case analysis, surgical videos and other materials to lower hospitals for reference and study by medical staff in primary hospitals.
(VII) Two-way referral and remote appointment subsystem supports two-way referral and remote appointment between primary medical institutions and superior hospitals. Support the information of discharged patients from superior hospitals to be automatically transferred to the primary medical institutions to which the patients belong, and the primary medical institutions will track and manage the patients after discharge, and guide the patients to review and see a doctor locally. Support grass-roots hospitals to complete appointment registration, appointment inspection, transfer application and other operations; Support superior hospitals to complete relevant application acceptance and information feedback.
(8) The electronic authentication subsystem is connected to the soon-to-be-built unified identity authentication system to realize cross-system unified identity authentication and data encryption authentication for units and individuals, so as to ensure the safety of system operation and data security.
(9) SMS platform subsystem supports SMS notification in the station and SMS notification by mobile phone. Users in the system can send one-to-one or one-to-many notifications through the SMS function in the station, and can also notify things manually or automatically through the SMS platform. It is convenient to handle the consultation application in time and effectively, and realize the consultation time reminder.
(10) The expense settlement subsystem supports the setting of telemedicine consultation expense standards, and is used for the inquiry, settlement and summary of telemedicine consultation expenses.
(eleven) remote consultation communication network and data center.
Communication Network The remote consultation communication network all adopts optical fiber dedicated line, that is, it is connected to the private network of health information (formed by mobile network), and the bandwidth allocation of each node is as follows:
Remote consultation center: 100MB mobile optical fiber network exit, with standby line and fixed IP address. Primary medical institutions: 4MB mobile optical fiber access, fixed IP address. Data Center Provincial telemedicine data center adopts dual-machine hot standby and optical fiber storage, makes full use of existing resources, and makes unified planning for the health information platform under construction. Realize the storage and management of all kinds of telemedicine data, and provide data mining and analysis support for telemedicine application systems such as distance education system and remote digital resource sharing system.