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Grid-based implementation of XDS-I as part of image-enabled EHR for regional healthcare in Shanghai

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International Journal of Computer Assisted Radiology and Surgery Aims and scope Submit manuscript

Abstract

Purpose

Due to the rapid growth of Shanghai city to 20 million residents, the balance between healthcare supply and demand has become an important issue. The local government hopes to ameliorate this problem by developing an image-enabled electronic healthcare record (EHR) sharing mechanism between certain hospitals. This system is designed to enable healthcare collaboration and reduce healthcare costs by allowing review of prior examination data obtained at other hospitals. Here, we present a design method and implementation solution of image-enabled EHRs (i-EHRs) and describe the implementation of i-EHRs in four hospitals and one regional healthcare information center, as well as their preliminary operating results.

Methods

We designed the i-EHRs with service-oriented architecture (SOA) and combined the grid-based image management and distribution capability, which are compliant with IHE XDS-I integration profile. There are seven major components and common services included in the i-EHRs. In order to achieve quick response for image retrieving in low-bandwidth network environments, we use a JPEG2000 interactive protocol and progressive display technique to transmit images from a Grid Agent as Imaging Source Actor to the PACS workstation as Imaging Consumer Actor.

Results

The first phase of pilot testing of our image-enabled EHR was implemented in the Zhabei district of Shanghai for imaging document sharing and collaborative diagnostic purposes. The pilot testing began in October 2009; there have been more than 50 examinations daily transferred between the City North Hospital and the three community hospitals for collaborative diagnosis. The feedback from users at all hospitals is very positive, with respondents stating the system to be easy to use and reporting no interference with their normal radiology diagnostic operation.

Conclusions

The i-EHR system can provide event-driven automatic image delivery for collaborative imaging diagnosis across multiple hospitals based on work flow requirements. This project demonstrated that the grid-based implementation of IHE XDS-I for image-enabled EHR could scale effectively to serve a regional healthcare solution with collaborative imaging services. The feedback from users of community hospitals and large hospital is very positive.

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Abbreviations

ASP:

Application service provider

CDA R2:

Clinical document architecture, release 2

caBIG:

Cancer Biomedical Informatics Grid

DICOM:

Digital imaging communication in medicine

ebXML:

eXtensible markup language used for electronic business

EHR:

Electronic Healthcare record

EHRs:

Electronic Healthcare record solution

EMR:

Electronic medical record

GID:

Global identifier

Grid_FTP File:

Transfer protocol used in grid computing

GUI:

Graphical user interface

GW:

Gateway

HL7:

Health Level Seven

ICD:

Intelligent content delivery

i-EHRs:

Image-enabled EHRs

IHE:

The Integrating Healthcare Enterprise

ITI:

Information technology infrastructure

JPIP:

JPEG 2000 interactive protocol

KOS:

Key Object Selection

MSG:

Message

NCI:

Network communication interfaces

NPfIT:

National Program for IT

OID:

Object identifier

PHI:

Protected Health Information

PIX:

Patient Identifier Cross-Referencing

PACS:

Picture Archiving and Communication System

RIS:

Radiological information system

SAAS:

Software as a service

SAN:

Storage Area Network

SOA:

Service-oriented architecture

UID:

Unique identifier

VPN:

Virtual private network

WADO:

Web access to DICOM persistent object

WS:

Workstation

XACML:

eXtensible Access Control Markup Language

XCA:

Cross-community access

XDS:

Cross-Enterprise Document Sharing

XDS-I:

Cross-Enterprise Document Sharing for Imaging

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Authors and Affiliations

  1. Laboratory for Medical Imaging Informatics, Shanghai Institute of Technical Physics, Shanghai, China

    Jianguo Zhang, Kai Zhang, Yuanyuan Yang, Jianyong Sun & Tonghui Ling

  2. Healthcare Information Center of Zabei District, Shanghai, China

    Guangrong Wang, Yun Ling & Derong Peng

Authors
  1. Jianguo Zhang
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  2. Kai Zhang
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  3. Yuanyuan Yang
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  4. Jianyong Sun
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  5. Tonghui Ling
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  6. Guangrong Wang
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  7. Yun Ling
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  8. Derong Peng
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Corresponding author

Correspondence to Jianguo Zhang.

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Zhang, J., Zhang, K., Yang, Y. et al. Grid-based implementation of XDS-I as part of image-enabled EHR for regional healthcare in Shanghai. Int J CARS 6, 273–284 (2011). https://doi.org/10.1007/s11548-010-0522-8

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  • DOI: https://doi.org/10.1007/s11548-010-0522-8

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