In recent years, the rapid development and wide application of information technologies such as cloud computing and big data have put forward higher and higher requirements for the construction of regional health information platforms, so that if the above technologies are not introduced into the regional health information platform under construction, it will become outdated, let alone have real practical value. However, the application of new information technology is definitely not a simple technical problem, but involves many aspects such as management concept, organizational structure, business process, values and so on, which must be dealt with seriously.
The application demand is urgent.
Although this does not belong to the category of technological progress, it is the fundamental driving force to promote regional health informatization. The construction of regional platform must closely follow the theme of providing information service for medical and health reform and improving service quality, and the application of information should be fully considered at the beginning of platform construction.
1. New technologies bring new challenges.
The contradiction between public cloud and private cloud is prominent. In the regional medical cloud, hospitals always occupy an important position. In essence, the construction of hospital private cloud competes with the public cloud of regional health cloud platform, including financial data and information. With the birth of regional public health cloud platform, the scale or necessity of hospital private cloud is increasingly questioned. Whether this contradiction can be properly handled will directly affect the development of regional health cloud platforms.
Telemedical monitoring and wearable devices. The adoption of these technologies faces the contradiction between individuals and groups, short-term and long-term in the process of data collection and processing. The application of Internet of Things technology in medical activities and health maintenance practice is mainly reflected in remote medical monitoring and wearable health maintenance equipment. At present, it is mainly reflected in the measurement and analysis of individuals at a certain point in time, lacking comprehensive, continuous and long-term statistical analysis, and even lacking macro analysis and processing of group data.
The contradiction between data collection, storage and mining. In the papers or introductions about the construction and development of regional health information platforms, it is very common for regional health information centers to collect tens of thousands of articles (millions, tens of millions, billions ...) every day, and to store many TB, PB and even EB articles. However, there are few reports about how this information is used and what effects and achievements it has produced. The application of big data in the health field is more limited to a few very "high-end" cases such as Google flu prediction. There are many reasons for this situation, such as few people know (information professionals collect and manage data but don't know its clinical research value and processing methods, while clinical researchers know little about the existence, connotation and application value of regional health information platform data), high data processing cost and inconsistent data collection quality standards. The latter is one of the main obstacles that affect the full use of data.
2. Standardization issues
In fact, there are many standard systems related to regional health information platforms, mainly including information engineering, communication engineering, construction standards, data exchange standards, storage standards, medical and health business and management standards coding and terminology. The construction of most regional health information platforms basically follows the standards of information engineering and communication engineering construction, so many interconnected and urban-rural integrated regional health information basic network facilities have been born. The implementation of data exchange and storage standards is basically satisfactory, because most regional health information platforms have also built centralized and distributed storage modes, which have achieved the basic requirements of information sharing in the region.
However, due to the disconnection between information engineering and medical and health service management, the application of medical service and management codes and terms has been ignored. The purpose of constructing regional health information platform is to apply, not to complete performance engineering. Information engineering construction is essentially a revolution in business process, management concept and practice. This disconnect essentially reflects that the current medical and health industry has not been fully prepared for the arrival of the information age. But it is more prominent in the hospital industry. Therefore, the regional health information platform that insists on adopting various standards still faces different data collection and information standards, and it is difficult to carry out effective data mining and utilization.
3. The hospital was brought into the regional health information network.
Hospitals are the giants of the whole health industry, occupying more than 70% of the personnel and assets in the health industry, and are also the main source of big data for health care, and their data quality directly affects the availability of data. The main energy of the hospital is focused on saving lives. Its supporting systems, such as information system construction, coding, terminology, etc., mostly revolve around this goal. This is natural and understandable, and it is also the most economical and effective for a single hospital. However, there is a potential conflict between the hospital's self-centered operation mode and the construction of regional health information platform:
Private cloud and public cloud. As discussed in the last article, it needs to be explained again that in the cloud era, it is necessary to improve the planning level and technology application level, so that cloud technology can really play its role as soon as possible. Otherwise, countless resources will be consumed in our discussion, and more information chimneys will be produced at the same time.
Adoption of coding terms. If it is a single hospital information system, the use of coding terms is not a problem, at most, it can be solved with a little coordination. However, it is a very difficult problem for the construction of regional health information platform. Different coding terms make it impossible to count, analyze and process the information of different medical institutions, and even simple statistics are easy to produce wrong results. For big cities that accommodate various medical institutions at all levels, such as countries, provinces, cities, districts, and the military, the difficulty of coordination can be imagined.
Maintenance of coding terms. Even if the use of coding terms is agreed, there are still problems in the maintenance of coding terms, especially who is responsible for the overall maintenance of the area. But if this problem is not solved, the communication and sharing of information, statistics and analysis, and the mining and utilization of big data will be difficult to achieve. At present, the software and hardware maintenance of regional platforms has been included in budget management, but the maintenance of business management coding terms has been ignored.
Who is the owner of the information? Legally speaking, personal health information belongs to individuals, and the medical institutions that produce it only keep it for them according to law. The reality is that most medical institutions consider themselves the owners of this information and take full responsibility for its use and security. Therefore, they are unwilling to "hand over" or share the information they control with the outside world, which seriously affects the information collection and sharing of regional health information platforms.
An important opportunity
The above challenges do not mean that the construction of regional health informatization is stagnant or in trouble. On the contrary, the existence of challenges shows that all parties have higher requirements and greater hopes for the construction of regional health information platforms. Challenges and opportunities coexist, and difficulties and hopes coexist. In order to make the regional health informatization construction out of the predicament, we must find the answer in the challenge. 1. touchstone
Meeting the demand is the touchstone to measure the effectiveness of platform construction. The application of big data in regional health information platform is the requirement of medical and health system reform, improving medical and health service level and improving medical and health management level, and also the requirement of people's medical treatment and self-care. Application degree is the touchstone to test the effectiveness of regional health informatization construction. If the regional platform has been built for many years, but it is still unable to provide the main health and disease diagnosis and treatment data of residents in the region and make relevant statistical analysis, its role and existence value will cause many doubts.
2. New technologies bring new opportunities.
Cloud computing brings new hope for improving efficiency and reducing repeated investment. Cloud computing forces us to re-examine the technical scheme of regional health information platform planning and construction, and ensure that it must be built on a higher technical level. Today, if we see that the primary medical institutions in the regional platform still set up their own information centers, we will definitely feel that the system design has room for improvement. The correct application of cloud computing technology provides credible theoretical and technical support for the construction of regional health information platform to some extent, so as to reduce repeated investment and achieve high integration. The application of cloud computing reflects the planning level, integration level and system efficiency of regional health platform construction to a certain extent.
The application of data mining puts forward clear requirements for the seamless connection between regional platform construction and medical and health business management. In the past, the platform construction paid more attention to the realization of information engineering and communication network technology, but neglected the supporting promotion of medical and health business management. The data mining and utilization of the regional health information platform started hard with cheers, which in turn requires the health management department to improve the standardization and standardized management level while establishing the regional information platform, and actively connect with the application of information technology. In a word, the development and availability of big data is the touchstone to measure the effectiveness of platform construction. Xiamen citizen health information system has made some attempts in this respect, and has produced application effects, which will be briefly introduced in the next section.
3. The application of standards has expanded from information engineering to medical and health services and management.
Due to the increasing demand and practice of data analysis and utilization, the understanding of the importance of medical and health services and management standards is becoming more and more clear. With the expected improvement and extensive application of regional health information platform, it has become a knowledge to expand the standard from pure information engineering field to medical and health business and management field.
4. More and more deans advocate that hospital information system should be actively integrated into regional health information network.
In recent years, many well-known and far-sighted deans have actively advocated bringing hospital informatization into the regional health information network on different occasions to realize the real enjoyment of big data and big information. This kind of foresight is actually produced through years of practical experience and painful exploration, and it is a sublimation on the accumulation of profound medical management and information construction, which indicates that the hospital's active and deep integration into the regional health information network has gradually become a * * * knowledge. With such a profound understanding, hospital managers have seen the new hope of data source and quality improvement of regional health information platform.
Enlightenment from Xiamen's practical experience
As the earliest regional health information platform covering the whole jurisdiction in China, Xiamen Citizen Health Information System has carried out the practice of regional health information data mining, analysis and utilization in recent years. On this basis, the "20 13 Xiamen Health Report" comprehensively adopted the data of Xiamen Citizen Health Information System, a regional health information platform, for the first time.
The data of Xiamen regional health information platform are provided by medical and health institutions that account for more than 90% of the resources in the jurisdiction. Compared with the traditional health statistics, in 20 12 years, the workload statistics included in the system accounted for more than 95% of the city. Therefore, it is basically the full sample data of Xiamen residents seeking medical treatment. Based on this, the statistical analysis can basically reflect the health level, main health problems, causes, frequency and expenses of Xiamen residents.
The construction of Xiamen regional health information platform is also from top-level design, step-by-step implementation to full regional coverage, and then gradually to the cloud. From the establishment of regional health information network platform to the application of health big data, it has gone through a process of gradual standardization. The most important part is not only the application of information engineering standards, but also the "three unifications" of medical and health business and management norms and terms, that is, the unification of versions, standards and maintenance. To achieve these three unifications, it is inseparable from the forward-looking planning and vigorous promotion of the health administrative department.