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首页> 外文会议>Biomedical Science amp; Engineering Conference, 2009. BSEC 2009 >“Defense Health Information System as a case study for national health IT”
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“Defense Health Information System as a case study for national health IT”

机译：“国防卫生信息系统作为国家卫生信息技术的案例研究”

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摘要

The National Forum on the Future of Defense Health Information Systems (National Forum) held in Washington, DC in March 2008 provided a unique opportunity to conduct a case study of developing a large complex health information system. The concept of the health information system has evolved from the days to electronic hospital information system (HIS) to longitudinal health record (LHR) which refers to a complete information system that adequately captures what occurs to service persons from ldquocradle to graverdquo, including but not limited to the clinical record. As originally imagined after the first Gulf War, the LHR is supposed to serve many functions in occupational health, medical logistics, health planning, and medical surveillance as well as clinical care. The LHR has become central to both DoD and VA health systems. As LHR emerges, the interoperable national health information system is becoming critical for the future. DoD and VA collaboration has accelerated in the last two years as exemplified by current efforts to exchange information between AHLTA (DoD Health IT system) and VistA (VA health IT system). With almost 70% of defense and veteran healthcare happening outside of the DoD/VA system, the LHR must accept information from the private sector not only Government sources. Given their size and position, DoD and VA have the potential to lead the nation in supporting standards for national health information network (NHIN). With that in mind, the VA and DoD are coordinating their efforts with the Office of the National Coordinator Health Information Technology (ONCHIT) that is leading the nation's interoperability and information exchange effort. Knowledge discovery and management is vital to bringing benefits of data repository to the clinicians and researchers. The growth of clinical data, image files, physiologic data, and omic data among others has produced an information explosion in healthcare and forced successful organizations to become kno-nwledge-driven enterprises. Moreover, the recent IOM Roundtable on ldquoData for the Public Goodrdquo discussed the current challenges of aggregating large sets of data while taking the position that exploiting large databases would significantly accelerate science. Although DoD and VA have numerous databases and two of the largest growing clinical data tissue repositories in the world, they lack a common healthcare data model to link the databases together and sponsor no significant effort to create an infrastructure to make this data available for research. The MHS currently also lacks a strategy for managing its growing amount of data. Recently, MHS has worked with TATRC and IBM to develop a roadmap for developing a strategy but much more work remains. There are increasing needs for efficient software engineering and ability to integrate innovations in IT development process. Many participants expressed dissatisfaction with the current performance of AHLTA. Slow and awkward to use, AHLTA delays clinical work at a time when maximizing physician throughput really matters. The IT development occurred in a closed environment, insulated from evolving new ideas and best practices outside the DoD. As a result, while the previous efforts developed and implemented software for health care applications, global advances in information technology render it obsolete by the time it becomes available for use. With these problems and consequences in mind, participants in the National Forum consistently called for more open process of software engineering, program management and knowledge sharing to allow lessons learned to flow freely among government, academic and industrial partners in the software development process. As the health IT and personal health records (PHR) have become important national agenda, the experiences gained from the development and deployment of health IT systems in DoD and VA should provide important lessons for the national community.
机译：2008年3月在华盛顿特区举行的国防健康信息系统的未来全国论坛（全国论坛）为开展开发大型复杂卫生信息系统的案例研究提供了难得的机会。健康信息系统的概念已经从几天发展到电子医院信息系统（HIS）到纵向健康记录（LHR），后者指的是一个完整的信息系统，可以充分捕获从“摇篮”到“坟墓”的服务人员所发生的一切，包括但不限于限于临床记录。正如第一次海湾战争后最初想象的那样，LHR应该在职业健康，医疗后勤，健康计划，医疗监视以及临床护理中发挥许多作用。 LHR已成为国防部和弗吉尼亚州卫生系统的中心。随着LHR的出现，可互操作的国家卫生信息系统对未来变得至关重要。在过去的两年中，DoD和VA的合作加速了，目前正在努力在AHLTA（DoD健康IT系统）和VistA（VA健康IT系统）之间交换信息。由于国防部和退伍军人医疗系统中近70％的国防和退伍军人医疗工作发生在国防部/弗吉尼亚州系统之外，因此LHR必须不仅接受政府来源，还接受私营部门的信息。鉴于其规模和位置，国防部和弗吉尼亚州有潜力在支持国家健康信息网络（NHIN）的标准方面领先于美国。考虑到这一点，弗吉尼亚州和国防部正在与负责协调国家互操作性和信息交换工作的国家健康信息技术国家协调局（ONCHIT）协调努力。知识发现和管理对于将数据存储库的好处带给临床医生和研究人员至关重要。临床数据，图像文件，生理数据和听觉数据等的增长，已在医疗保健领域引起了信息爆炸，并迫使成功的组织成为知识驱动型企业。此外，最近的IOM面向“公众利益”的ldquoData圆桌会议讨论了汇总大型数据集的当前挑战，同时认为利用大型数据库将大大促进科学发展。尽管DoD和VA拥有众多数据库和世界上最大的两个增长中的临床数据组织存储库，但它们缺乏将数据库链接在一起的通用医疗数据模型，也没有为创建可用于研究的基础设施而投入大量精力。 MHS当前还缺乏管理其不断增长的数据量的策略。最近，MHS与TATRC和IBM合作制定了制定战略的路线图，但还有更多工作要做。对高效软件工程和在IT开发流程中集成创新的能力的需求不断增长。许多参与者对AHLTA的当前表现不满意。使用AHLTA的步骤缓慢且笨拙，而这在使医生吞吐量最大化至关重要的时候会延迟临床工作。 IT开发发生在封闭的环境中，与国防部外部不断发展的新思想和最佳实践保持隔离。结果，尽管先前的努力开发并实现了用于医疗保健应用程序的软件，但随着信息技术的全球进步，信息技术在可用时已过时。考虑到这些问题和后果，全国论坛的参与者始终呼吁软件工程，程序管理和知识共享的过程更加开放，以使所学课程可以在软件开发过程中自由地在政府，学术和行业合作伙伴之间传播。随着健康信息技术和个人健康记录（PHR）成为重要的国家议程，在国防部和弗吉尼亚州从健康信息技术系统的开发和部署中获得的经验应该为国家社会提供重要的经验教训。

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