Emerging Healthcare Information Technologies and the Future of Privacy 2008. 6. 25. 김일곤 경북대학교 IHIS 연구소장, 전자전기컴퓨터학부교수 Copyright, 2008, IHIS. 1
목차 구글헬스서비스 Healthcare Services Specification Project 국내문제점과국제표준 2
Definitions EMR, EHR, PHR Electronic Medical Record An electronic record of health-related information on an individual that can be created, gathered, managed, and consulted by authorized clinicians and staff within one health care organization Electronic Health Record An electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be created, managed, and consulted by authorized clinicians and staff across more than one health care organization Personal Health Record An electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be drawn from multiple sources while being managed, shared, and controlled by the individual. 3
Definitions HIE, HIO, RHIO Health Information Exchange The electronic movement of health-related information among organizations according to nationally recognized standards Health Information Organization An organization that oversees and governs the exchange of health related information among organizations according to nationally recognized standards Regional Health Information Organization A health information organization that bring together health care stakeholders within a defined geographic area and governs health information exchange among them for the purpose of improving health and care in that community 4
http://www.google.com/health 5
사용자온라인헬스프로파일생성 Personal Health Record ( 평생전자개인건강진료기록 ) Personal Health Task Force - ISO/TC215/WG1/WG7/WG8 and CEN/TC251/WG1/WG3/WG4 - Personal Health Record(PHR) 에대한 ISO 차원에서의대응을위한 Task Force 로보완된보고서를제출하고논의 IHE PHRX Health Summary ( 건강진료기록요약 ) ISO/CD TR 12773 Business requirements for health summary records 복지부 EHR 연구사업단 Health Summary 구현가이드라인 이슈기관내, 기관간서비스주체 Privacy 침해? 참고 : 건강기록시장구글 MS 박빙, 국내는먼산? 메디컬투데이이동근기자 6
진료요약정보 - 구현가이드라인 ( 진료요약정보 ) Health Summary data element CDA template 헤더정보템플릿 바디정보템플릿 Document Code Medication Surgery Allergies History Immunizatio Diagnosis ns /problem 스타일시트템플릿 1.1.1. Document Code Health Summary CDA 가대표하는문서코드를표시한다. CONF-4 : ClinicalDocument 는정확히한개의 code 를가진다. CONF-5 :"ClinicalDocument/code" 의값은 2.16.410.1.113883.6.1- 복지부검사용어의 34133-9 "Summarization of episode note" 을갖는다. Vital sign Lab test result Plan of care 예제임상문서렌더링 모듈데이터항목과 CDA 매핑 77
Add to this Google Health Profile 8
의료기관으로부터메디컬기록다운로드 다운로드 전자정부가해줘야할일 의료기관간정보교류 기록 : 서명을갖춘것, 상호운용성고려 ISO/HL7 DIS 27932 Health Informatics -- Clinical document architecture, release 2 이슈누가? 메디컬기록범위는? 매체? Privacy 9
진료요약정보 CDA 예제 10
진료요약정보 스타일시트적용 11
Import medical records 12
개인화된건강가이드와관련뉴스제공 정확한정보생성과필터링 지식사전, 영상서비스각광 병실 IPTV 이슈개인적특성고려 Privacy 13
Explore health services 14
질높은의사를찾아주고, 시간을절약하는서비스에접속질높은의사찾기? 방법 근거자료 : 기관평가시간을절약하는서비스? 예약, 상담이슈 Privacy 15
Find a doctor 16
가족이나보호자간에선택된건강정보공유 공유 = 등록? 등록저장소 (Registry/Repository) ISO/NP TS 27790 Health informatics -- Document registry framework IHE XDS 이슈정보소통, 흐름, 요약의중요성 Privacy 17
DRF: DRF Functional Model Other Registries Provider Registry Patient Registry Client Registry Resource Registry Document Provider DRF Repository Register Documents Query Documents DRF Registry Document Consumer User System Provide Documents DRF Repository Register Documents based on ebxml 3.O RIM/RS User System Retrieve Documents 18
Healthcare Services Specification Project Collaborative effort betw. HL7 and OMG www.hl7.org, www.omg.org Identify and document service specifications, functionality, and conformance supportive and relevant to healthcare IT stakeholders and resulting in real-world implementations. 참조 http://hssp.wikispaces.com/ 20
HSSP Projects 21
HSSP - Functional Specification Work 22
HSSP Technical Specification Work 23
HSSP - PASS PASS: Privacy, Access and Security Services Joint project between the HL7-SOA and HL7-Security technical committees Define a suite of services that will document all privacy, access control, consent, identity management and other security services that are needed in a service-oriented health information architecture http://hsspsecurity.wikispaces.com/space/showimage/pass %20Concept%20Diagram%20090607.pdf 24
PASS 25
Identification 표준안 - 정의 식별 (Identification) EHR 환경에서액터 (Actor) 들을인식하기위해필요한정보의요소와구조에대한정의, 그리고그액터들을정확하게인식하는것그자체를의미 식별자 (Identifier) 액터를구성하는다양한요소들을해당액터에게올바르게연결할수있도록하는대표요소 EHR(Electronic Health Record) 환경에서식별이필요한액터들 환자 (Subject of care), 의료인 (Individual Provider), 의료기관 (Provider Organization) ID 등록서비스 환자, 의료인, 의료기관을식별하기위한정보들을담고있으며, 여러곳에산재해있는각액터들의정보를올바르게연계하도록지원해주는시스템. 26
Identification 표준안개괄 27
Identification 표준안개괄 ISO 18232(Messages and communication Length limited globally unique string identifiers - Format) 표준기반 환자, 의료인, 의료기관을유일하게인식하는식별자정의. ISO 22220(Health informatics Subject of Care Identification) 표준기반 환자에대한식별정보들정의. ISO 27527(Health informatics Provider identification) 표준기반 의료인, 의료기관에대한식별정보들정의. HL7/OMG EIS(Entity Identification Service) 표준기반 액터식별과관련된대표시나리오들을정의. 각시나리오에서고려되는요소들에대해본표준안에서정의한환자정보를구성하는요소들대응. 28
보건의료정보시스템구축기술 비즈니스 Logic, 프로세스 User Interface UML Model 데이터흐름도 Data Dictionary Code System 데이타베이스모델링 Basic Structure Extension 구현 Specification 프로그램인력 29
Reference Information Model ISO/HL7 21731:2006 Health informatics -- HL7 version 3 -- Reference information model -- Release 1 30
Reference Model ISO 13606-1:2008 Health informatics -- Electronic health record communication -- Part 1: Reference model 31
Fuctional Model ISO/HL7 DIS 10781 Health informatics -- HL7 Electronic health record system functional model, release 1 32
Service Architecture ISO/DIS 12967-1 Health informatics -- Service Architecture -- Part 1: Enterprise viewpoint ISO/DIS 12967-2 Health informatics -- Service architecture -- Part 2: Information viewpoint ISO/DIS 12967-3 Health informatics -- Service architecture -- Part 3: Computational viewpoint 33
Service Architecture 34
Messaging V2.5 ISO/HL7 DIS 27931 Health Informatics -- HL7 Messaging Standard Version 2.5 -- An application protocol for electronic data exchange in healthcare environments 35
Exchange of Clinical Documents ISO/HL7 DIS 27932 Health Informatics -- Clinical document architecture, release 2 36
Registry of Clinical Documents ISO/NP TS 27790 Health informatics -- Document registry framework What could be the solution? Basic Idea Header Document Information Encounter Service Actors Service Targets Provider s Information Patient Identification data, etc Doesn t know what kind of treatment has be done patient treatment and care information Body Structured (Narrrative) Text, Coded Entries Never know whose clinical data is 37
Scenario for CDA Separation :User System :DRF Repository :DRF Repository :DRF Registry Document Provider Document Consumer 1: Request Registration 2: Separate Header & Body 3: Provide Documents (Encrypted CDA Header) 6: Provide Documents (Encrypted CDA Body) 7: Register Documents (CDA Body) 4: Register Documents (CDA Header) 5: Create CDRObjectEntry 8: Update CDRObjectEntry 9: Request CDA 10: Query Documents (CDA) 11: Retrieve Documents (CDA Header) CDA Header 12: Retrieve Documents (CDA Body) CDA CDA Body 38
Terminology Service ISO/HL7 DIS 27951 Health informatics -- Common terminology services, release 1 39
Terminology Service ISO/HL7 DIS 27951 Health informatics -- Common terminology services, release 1 40
Data Type ISO/DIS 21090 Health Informatics -- Harmonized data types for information interchange 41
Pseudonymisation ISO/NP TS 25237 Health informatics -- Pseudonymisation Partial Information Recovery Full re-identification No Information Recovered No records could be marked as belonging to, or certainly not belonging to the subject Targeted Person? Targeted Anonymous Database All records linked to the subject were found 42
Individual case safety report ISO/NP 27953 Health informatics -- Pharmacovigilance Individual case safety report 43
Q&A Thank you ikkim@knu.ac.kr 44