醫療影像資訊系統的發展趨勢與應用實例….and some Philosophy 高雄大學資訊工程學系數位科技與生活應用 (大學部科技類通識課程) @ NUK 2007.12.19 A New Spawning Ground for Interdisciplinary Medical Fieldwork Development ( IMFD Project ) Tsung-lung, Yang , M.D Section Chief in TeleRadiology Department of Radiology, Kaohsiung Veterans General Hospital

The PACS recess I indulge….. Ugly duckling … Dark Room 暗房變研發中心 醜小鴨變天鵝

Crash Course for 1-hour Speech Medical Modality Revolution 9.4 Tesla MR, 320 MDCT, Elastography, PET….. Nanowire-based Electronic Nose, Photoacoustic tomography Medical Ethics Medical Platform Medical Information Technology: 躍躍欲試 Service, Administration, Research, Teaching Medical IT standards MIRC, DICOM, HL7, IHE, EPR, EHR, EMR, SNOMED, CPT, ICD, RFID and many more…. 一個小時的課程只能帶大家到機場, 吃吃當地小吃, 呼吸當地空氣, 看看當地來來往往的人

IT all began with the hurtful remarks 10 years ago… 小孩玩大車 資訊大玩具 用一根針造一口井!!!!! 話說從前 一個住院醫師的心路歷程 10 years later, 那根針已經變成 大型營造廠!

Kernel Logics underpinning KSVGH PACS toward EPR How to reach concept of Sustainability? Philosophical approach Designer PACS Web-based enterprise PACS Solutions Briefing on current PACS status at KSVGH The Revolution Is ubiquitous-paperless environment a dream? A better tomorrow 幸福的老年社會 核心理念 這個小時想帶給大家的東西

夫天地者 萬物之逆旅 光陰者 百代之過客 出自 : 李白 人很偉大, 於天地間, 像一粒沙 百年壽命, 於光陰如一剎那 談出永續的觀念

HOW TO REACH SUSTAINABILITY? 永續是甚麼?

Web-based Enterprise PACS Solution Platform service oriented Sustainability 永續發展 Web-based Enterprise PACS Solution Ubiquitous On-the-alert Connectivity Platform service oriented 從2002 年起發展資訊系統的四個柱子

See, Plan, Act, Refine, and Communicate SPARC See, Plan, Act, Refine, and Communicate 哲學觀念, 如何落實, 從策略面談資訊軟硬體 硬體與軟體

Designer Building 弱建築 柔弱中見剛強的哲學 隈研吾 像蓋房子一樣, 哪一種房子, 適合人來住呢? 像蓋房子一樣, 哪一種房子, 適合人來住呢? 軟體所營造的平台, 如何像空氣一般, 不著痕跡, 卻又柔中帶強, 帶給人無比的信任!! 弱建築 柔弱中見剛強的哲學 隈研吾

像蓋房子一樣, 哪一種房子, 適合人來住呢? 軟體所營造的平台, 如何像空氣一般, 不著痕跡, 卻又柔中帶強, 帶給人無比的信任!! 像蓋房子一樣, 哪一種房子, 適合人來住呢? 軟體所營造的平台, 如何像空氣一般, 不著痕跡, 卻又柔中帶強, 帶給人無比的信任!!

病歷的本質何在? 在於反映生活, 反射生命! 生活的目的：在增進人類全體之生活； 生命的意義：在創造宇宙繼起之生命。 病歷的本質何在? 生活的目的：在增進人類全體之生活； 生命的意義：在創造宇宙繼起之生命。 病歷的本質何在? 在於反映生活, 反射生命! 病歷的本質何在? 在於反映生活, 反射生命!

Virtual Medical Civility 虛擬醫療公民素質

虛擬醫療公民素質 過程: progress to fight the disease or be compliant with the disease 內容: the content from medicare consumer and provider 形成 healthcare 2.0 的核心: 良性的醫病互動. 讓病人有思考, 表達的機會 也讓醫師有驗證, 論述, 論辯與溝通的能力

虛擬醫療公民素質 Healthcare 2.0 漸進的以Web 2.0, Web 3.0 為工具或平台, 將身心靈的弱建築完整的呈現 人與自然合而為一的電子病歷 關心大宇宙與小宇宙 形成共識後, 讓更多的證據浮現出來, 身心靈一起獲得醫治 降低醫病緊張關係

Essence of Patient Record Medical Record 主觀病歷 客觀病歷 Billing Record 醫療經濟學

CONCEPT OF DESIGNER PACS/EPR 柔弱中見剛強的哲學 Like learning to play a musical instrument, you learn technique first and after then, the artfulness flows. CONCEPT OF DESIGNER PACS/EPR From Learning Pieces to Masterpieces!

H.E.L.P. HEALTHCARE ENHANCEMENT AND LEVERAGE PLATFORM 優質無片, 智慧無紙 H.E.L.P. HEALTHCARE ENHANCEMENT AND LEVERAGE PLATFORM

蘇格拉底問答? 病( DISEASE) 是敵人, 或是夥伴!?

Web 3.0 vs. Healthcare 2.0 Healthcare 2.0: user-generated Healthcare Web 3.0: intelligent, economic web Tele-Radiology, Tele-Storage Tele-Consultation Tele-Management Medical IT in Home Medical consumer electronics EHR, EPR, EMR…..

反對的聲音?

An EMR isn’t nearly as good as a paper chart, because I can’t draw my cute male and female symbols.

A car isn’t as good as a horse, because a horse can go into tight places. 錯誤      /鄭愁予  我打江南走過 那等在季節裡的容顏如蓮花般開落... 東風不來，三月的柳絮不飛 你的心如小小的寂寞的城 恰若青石的街道向晚 跫音不響，三月的春帷不揭 你底心是小小的窗扉緊掩 我達達的馬蹄是美麗的錯誤 我不是歸人，是個過客

The Ultimate Goal 用最少的時間,營造最大的功 犯最少的錯!

“One of the things we’re going to see in the next five to 10 years is the first and second generation of PACS, that were departmental and closed in their design for use by radiologists, replaced with Web-based enterprise PACS solutions that converge with the entire hospital’s digital system,” said Dr. Thrall. “This is a 20-year revolution, and we’re now about three-quarters of the way through it.”

Web-based PACS Solution Client Server Browser Server Web-based PACS Solution thin client device => IE-on-chip panel communicator Hybrid client Fat client System-on-a-chip

您期待醫師如下所示嗎? 必須熟悉ㄧ萬多種疾病 必須熟悉三千多種藥方 在醫院所做的TEST可以馬上知道判讀結果，並且加以臨床應用 必須熟讀很多文獻

“Digital Medical Practice” Medical institutes today have entered an era of high-stake accountability and standards-bases medical management. 高風險醫療責任,證據醫學趨勢 Flooding of medical data, information results in more time-consuming on screen, more error-making unconsciously. 醫療資訊爆炸 用最少的時間營造最大的功!

Web-based enterprise PACS solution 用最少的時間營造最大的功 犯最少的錯 Web-based enterprise PACS solution Patient link:病歷號同步連結 User link:使用者帳號同步連結 Encounter link:查房清單同步連結 Conference link:開會清單同步連結 Concept from single sign-on

高雄榮總PACS發展里程碑 Interdisciplinary cooperation 大型營造廠 用一根針造一口井?? 1998 超音波斷片 Client Server 2002 全院無片 2006 Web-based Platform Tele-diagnosis 遠距診斷 Tele-consultation 遠距會診 2008 Secured Platform 2008 Medical IT in home 數位居家照護 2008 Tele-Management 遠距處置 2008 Electronic Display Record 螢幕的電子病歷 2009 Nursing Informatics 營造無紙環境 Interdisciplinary cooperation 大型營造廠 用一根針造一口井??

Brief History of PACS development at KSVGH(高雄榮總) Partnership with TEDPC(臺灣電腦) since 1997 Ultrasound Filmless Environment in 1998 Enterprise Filmless in 2002 End Transforming Client-server into Web-based enterprise solution in 2006 Future projects: Secured EMR in 2008 Electronic Display Record in 2008 Nursing informatics in 2009

Some Statistics about KSVGH Near-online image available since1998 Online image available since 2000 Total Study Number:1759081 Total Series Number:2919765 Total Instance Number:29679901 Radiology Studies per months:29000 Total Workstations at KSVGH: over 1414 sets ( client-server: 633 AETs ) Total Employees: 3512(醫師: 927名 ) DATA Collected: 2007.09.01

DrYang’s Definition of Web-based Enterprise PACSSolutions More than image storage and retrieval More IHE-compliant workflows integration HIPAA compliant environment Enterprise-wide deployment of Standard Display Systems Quality Management Human Resource management Ubiquitous Assess Solution

Future Projects Secured,Kerberosized Medical Platform 安全醫資平臺 Medical IT in Home:數位居家照護 XDS: Cross enterprise document sharing Nursing informatics: 數位護理資訊 Electronic display record: 螢幕電子病歷 Timeline-based, patient-centered semantic paperless medical record: 無紙環境 eMPI, eReferral, ePrescription: 數位病患資料索引,數位轉診,數位處方

IHE IT Infrastructure Technical Framework 在高榮的 blueprint

Why? Cross-Enterprise Document Sharing (XDS) 分享檔案影像 建立分享管道 多層級醫事機構分享 標準查詢與檔案 取回機轉 藉由標準查詢與檔案取回機轉，建立多層級醫事機構間分享管道，在病患同意下，分享標準醫學檔案與影像

Cross-Enterprise Document Sharing (XDS) XDS-Image ( RSNA 2006, 2007 demonstration) XDS-Medical Summary Online solution 即時線上安全医資交換 Offline solution XDMedia 可攜式媒体醫資交換 XDReliable interchange 安全電子郵件醫資交換

Virtual Touring at KSVGH Web-Access DICOM object (WADO) 網基影像取回機轉 LIS Retrieve information display 實驗室動態資料取回展示 On-line WADO-based Consultation 即時線上會診 Study Protocol Management 貴重檢查程式審核管理 Adaptive Report Key Words PHS Notification 即時報告關鍵字通報系統 Web-based Image Deletion QC Management 網基影像刪除管理作業 OLAP for performance measurement 即時線上效能分析暨關鍵效能指標展示 HIPAA 完整系統日誌記錄查詢作業 ECG/PDF Integration Many more profiles…….( KIN, CPI, Help desk, MIRC, Patient tracking etc)

Smartwonder

網基影像取回機轉 URL:http://192.168.195.26:8080/SmartWonder/servlet/dcmWADOResponseFile?contentType=application/dicom;text/plain&DicomServer=SK&requestType=WADO&studyUID=1.2.840.113817.886.602030026.0.2078446.953945141&seriesUID=1.3.12.2.1107.5.1.4.43094.4.0.17748351826461681&objectUID=1.3.12.2.1107.5.1.4.43094.4.0.17748648210981388

完整系統日誌記錄查詢作業

實驗室動態資料取回展示 只要1秒

即時線上會診

貴重檢查程式審核管理 最後以SR/PR之DICOM格式存入系統 檢查室與報告醫師均可參考此檢查步驟

即時報告關鍵字通報系統

網基影像刪除管理作業 若刪除影像時,報告已完成,將根據HIPAA計錄,自動或人工通知所有相關醫師修改報告或重新審視影像!

即時線上效能分析暨關鍵效能指標展示

DICOM ECG Waveform 動態波型瀏覽

心臟病 糖尿病 Applications of RFID-based Remote Care on Web-based Enterprise PACS Solution 心臟病 糖尿病

Patient exclusive Medical IT in Home….. Norway 100 % PACS ready…..

Patient Delivery System 術後回家 調整劑量 EKG RFID+指紋 Patient Delivery System 結構性報告/證據 DICOM SR/PDF/SVG B.P.R B.P.R

Patient Delivery System 血糖值 血糖儀 RFID+指紋 術後回家 調整劑量 Patient Delivery System 結構性報告/證據 DICOM SR/SC/VL 血糖值 血糖值

Healthcare Anywhere: ubiquitous

Streaming Technology for medical industry, now and tomorrow Static Images 3D reconstructed Images Waveform-based vital sign monitoring Tele_monitoring video streaming Tele_management decisive panel 天蒼蒼地茫茫 風吹草低見牛羊

MIRC 謝謝 歡迎到高雄榮民總醫院來參觀

Live Connection to KSVGH H.E.L.P. Thin Client 3D MIRC