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首页> 美国卫生研究院文献>AMIA Annual Symposium Proceedings >A distributed scalable community care network architecture for wide-area electronic patient records: modeling and simulation.
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A distributed scalable community care network architecture for wide-area electronic patient records: modeling and simulation.

机译：用于广域电子病历的分布式可扩展社区护理网络体系结构：建模和仿真。

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Principal systems issues relative to computerizing patient medical records that are yet to be addressed in the scientific literature include (1) the characteristics of networks, i.e. bandwidth and capacity, and their impact on the performance of the system, (2) the architecture and the underlying algorithm of the system, (3) the location and migration of medical records, (4) scalability of the system, and (5) the nature of the performance variation under heavy and light use of the network. Key parameters that affect performance include the number of patients, doctors, frequency of patient visits, and the number of electronic queries and record entries initiated during a patient-doctor interaction episode. This paper presents AMPReD, a Distributed, Scalable, Community Care Network Architecture that aims to provide Real-Time Access to Geographically-Dispersed Patient Medical Records. The AMPReD model includes stationary hospitals and medical clinics, mobile clinics, migrating doctors as well as patients, the communications network, and the patient medical record database. AMPReD's goals include (1) the accurate modeling of the propagation of medical records and (2) providing real-time access to patient medical records from anywhere in the system. To achieve these goals, an asynchronous, distributed algorithm must be developed that achieves concurrent access of multiple, autonomous databases. AMPReD is modeled and simulated for a representative community care network on a network of workstations configured as a loosely-coupled parallel processor, for different parametric combinations of number of doctors, patients, and number of queries or record entries generated corresponding to every patient-doctor interaction episode. AMPReD defines and obtains key performance measures including the idle times of the doctors, patient waiting times, the access times of queries as functions of their sizes, and the growth of the databases. In addition, AMPReD also measures the deviation of the actual time required for a patient-doctor interaction episode from the scheduled interaction interval, as a function of the network load. For the representative system selected, performance measures indicate that the network, utilizing 1/2T1 links, and the database system poses no bottleneck to the system even where the number of doctors and patients within a 30 minute interval are chosen at 192 and 200 respectively. A T1 is a standard, digital, transmission link that is rated at 1.44Mbits/sec.
机译：与将患者病历计算机化有关的主要系统问题尚待解决，科学文献包括（1）网络的特性，即带宽和容量，及其对系统性能的影响，（2）体系结构和系统的基本算法，（3）病历的位置和迁移，（4）系统的可伸缩性，以及（5）在网络的大量使用和轻度使用下性能变化的性质。影响性能的关键参数包括患者数量，医生，患者就诊频率以及在患者与医生互动期间启动的电子查询和记录条目的数量。本文介绍了AMPReD，这是一种分布式，可扩展的社区护理网络体系结构，旨在提供对地理上分散的患者病历的实时访问。 AMPReD模型包括固定医院和医疗诊所，移动诊所，移居医生以及患者，通信网络和患者病历数据库。 AMPReD的目标包括（1）对病历传播进行精确建模，以及（2）从系统中的任何位置实时访问患者病历。为了实现这些目标，必须开发一种异步的分布式算法，该算法可以实现对多个自治数据库的并发访问。在配置为松耦合并行处理器的工作站网络上，针对代表性的社区护理网络对AMPReD进行建模和仿真，以针对医生，患者数量以及与每个患者医生对应生成的查询或记录条目数量进行不同的参数组合互动情节。 AMPReD定义并获取关键绩效指标，包括医生的空闲时间，患者的等待时间，作为其大小函数的查询的访问时间以及数据库的增长。此外，AMPReD还根据网络负载来测量患者-医生互动事件所需的实际时间与计划的互动间隔之间的偏差。对于所选择的代表性系统，性能指标表明该网络利用1 / 2T1链接，并且即使在30分钟间隔内分别选择192和200的医生和患者数量，数据库系统也不会对该系统造成瓶颈。 T1是标准的数字传输链路，额定值为1.44Mbits / sec。

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