Remote consultation implementation plan
1. Project background
In order to solve the imbalance of economic and social development in my country, high-quality medical resources are mostly concentrated in developed eastern regions and large cities. , the central and western regions and rural areas have relatively insufficient medical resources, and it is difficult for the masses to see a doctor. The national medical reform plan clearly proposes to vigorously develop remote consultation for the central and western regions and rural areas, and proposes resource integration, unification and efficiency, interconnection, and information security. *Shared construction principles. In order to make full use of remote consultation to improve the level of medical services in the central and western regions and rural areas and facilitate people's medical treatment, the Ministry of Health proposed a remote consultation system construction project in the central and western regions.
Establish a grassroots remote consultation system with provincial general hospitals as the core and a high-end remote consultation system with national hospitals as the core. Five county-level people's hospitals carry out grassroots remote consultation.
2. Construction principles and goals
1. Construction principles Top-level design, unified standards: starting from the overall situation and following unified design, promote the construction of grassroots and high-end remote consultation systems. Based on the current situation, implement it step by step: make full use of existing network, equipment, personnel and other resources, and prioritize based on the business needs of primary medical institutions to gradually promote and improve the construction of the remote consultation system. Mature technology and interconnection: Fully consider the development needs of remote consultation, adopt mature and reliable advanced technology, adopt an open architecture design, support interconnection, and be easy to expand and upgrade. Ensure security and focus on practicality: Information and system security are important guarantees for health informatization construction. The construction and application of remote consultation involves staff and patients in various types of medical institutions at all levels. The system must be convenient, practical, safe, reliable, and easy to maintain.
2. The overall goal is to build a grassroots telemedicine consultation platform with the People's Hospital as the provincial remote consultation center, and gradually realize remote consultation, distance education, remote digital resource sharing, video conferencing, and two-way transfer. It provides functions such as consultation, remote appointment, and remote specialist diagnosis to promote the full sharing of high-quality medical resources and the equalization of medical services in our province, effectively strengthen the medical service capabilities of primary hospitals in our province, improve the treatment level of difficult and severe diseases, and alleviate the difficulty of medical treatment for the masses. In the future, interconnection and resource sharing with the ministerial-level remote consultation platform will be realized.
3. Telemedicine consultation platform system architecture
The telemedicine consultation platform system adopts B/S architecture, a large centralized model, and is scalable. It can be established in various regions when the time is right. Regional level platform. The system consists of a set of software, a website, and a data center, and the network is composed of 10MB/4MB optical fiber dedicated lines.
A set of software: Design a specific construction plan in accordance with the technical plan requirements of the Ministry of Health, and select software developers for platform development through bidding in accordance with relevant national policies.
A website: Establish a telemedicine consultation service network for on-demand remote video teaching recordings, notification of remote video teaching information, query and reading of digital shared resources, etc.
A data center: A telemedicine data center is established at the provincial level to realize centralized storage and management of telemedicine data. As the hub of the telemedicine management system, the telemedicine data center realizes the storage and management of various telemedicine data, and provides data mining and analysis for various telemedicine application systems, such as distance education systems, remote digital resource sharing systems, etc. support.
Network: The initially built health information private network will be used for networking. The entire system includes remote consultation management, medical record data collection, remote specialist diagnosis, remote monitoring, video conferencing, distance education, digital resource sharing, two-way referral and remote appointment, data center, electronic identity authentication, SMS platform, and fee settlement. and other subsystems.
(1) Remote consultation management subsystem According to the implementation method, remote consultation includes interactive remote consultation and offline remote consultation.
1. Interactive remote consultation: Support real-time interactive remote consultation between consulting experts, applying doctors, and patients; support the clinical needs of patients, and enable patients to receive expert remote consultation services in real time in their beds; Support consultation experts to remotely control the video images of patients in remote hospital beds; for critically ill patients, support real-time transmission of vital sign data such as bedside monitors, providing continuous and dynamic diagnosis basis for consultation experts.
2. Offline remote consultation: Support non-real-time offline remote consultation between consultation experts and applying doctors; support application
Doctors submit consultation application information and medical records; consultation experts submit In actual situations, the consultation application information and pathological data are not browsed in real time, and the consultation report is compiled and published; the applying doctor then browses the consultation report. Contains the following functional modules: See Table 3.1 for details of functional modules. Table 3.1 Remote consultation management system function list Function module function description Use unit consultation application Consultation application submission and modification; expert information query; medical record data submission and query, etc. Provincial, prefecture-level, county-level hospital consultation management Consultation application management; medical record data Management; consultation process recording, report browsing, etc.
Browse medical records of expert consultations in tertiary hospitals, county-level hospitals, and provincial health departments (medical images, electrocardiograms, pathological pictures, etc.); write, modify and publish consultation reports; manage consultation report templates and other tertiary hospital expert information management; permissions Management and other tertiary hospitals statistical analysis by doctor, hospital, disease type, etc. Provincial health department, hospital at all levels system management basic data maintenance; user and authority management; server information monitoring, etc. Provincial health department, hospitals at all levels
(2) Medical record data collection subsystem The medical record data collection subsystem should support the processing of analog signals, digital signals, and real-time signals. The main functions are as follows:
1. Analog signal processing: patient’s film And paper medical records, laboratory test orders, graphic reports, etc. are digitized through scanning. The system supports the transmission, storage and reading of scanned files, and supports the manual entry of medical records. Film data: It is recommended that the film be processed using a medical scanner that can support output as DICOM3 image files. Paper materials: Paper materials are processed using ordinary flatbed scanners, and scanned files are saved in JPEG format.
2. Digital signal processing: The system should support obtaining patient imaging data from imaging equipment with a DICOM3 interface through a DICOM gateway, and should also support importing DICOM3 images from a PACS graphic workstation. The system supports interconnection with electronic health records, electronic medical records, data centers and other systems. Qualified hospitals can export patient medical record information in accordance with the standards and specifications for electronic medical records promulgated by the Ministry of Health. The remote consultation system supports the import, transmission, storage and reading of exported information.
3. Real-time vital sign signal processing: The system supports the real-time collection and transmission of vital sign data from bedside ventilators, monitors, etc., enabling 24-hour continuous and dynamic observation of patients.
(3) Remote specialist diagnosis subsystem The remote specialist diagnosis subsystem should support the remote diagnosis functions of imaging, ECG and pathology.
1. Remote imaging diagnosis supports obtaining patient imaging data from imaging equipment or PACS systems with standard DICOM 3.0 interface, and performs storage, reproduction and corresponding post-processing operations. Establish a remote radiology consultation system based on DICOM 3.0 protocol, B/S architecture, and WEB browsing mode. It supports the post-processing of image data, key image annotation, and storage, supports the writing and publishing of imaging consultation reports, and supports the report template function. Supports real-time interactive operation of medical images (including static and dynamic) by multiple parties during remote imaging consultation. Support remote consultation experts to conduct remote imaging consultation at any location after passing Internet security authentication. Higher-level and lower-level hospitals that have the conditions can establish a department-to-department remote imaging diagnosis service relationship.
2. Remote ECG diagnosis supports the collection of ECG information from digital ECG machines, lossless data transmission, storage and reproduction, and transmits static ECG data from grassroots hospitals to consultation experts at higher-level hospitals. Support experts' interpretation and printing of electrocardiograms, and support the writing and publishing of reports. The 12-lead digital electrocardiogram supports the transmission of electrocardiogram data through the Internet, GPRS, telephone lines, etc. Digital ECG data can be stored in common data formats such as XML and DICOM. Supports analysis and comparison of different cases and historical data. Higher-level and lower-level hospitals where conditions permit can establish department-to-department diagnostic service relationships.
(4) Video conferencing subsystem The video conferencing subsystem provides audio and video interaction functions for remote consultation services. Its main functions are as follows:
1. Medical experts and applying hospital doctors and patients Remote interactive communication and consultation. Supports remote control of remote cameras and real-time adjustment of observation angles; the system supports the bedside needs of critically ill patients, and patients can receive expert remote consultation and remote monitoring services in real time while in bed;
2. System Support the remote consultation services between hospitals applying for consultation and different hospitals affiliated with (managed by) the Ministry of Health and different provincial tertiary-level hospitals; support multi-experts across specialties, across institutions, and across regions to conduct real-time joint consultations on the same grassroots patients at the same time. When applying for consultation from different hospitals, the system should switch quickly and seamlessly to enhance system response efficiency and scalability;
3. Carry out distance education, support the synchronization of lecture expert audio and video and courseware slideshows, and support interaction between both parties Communication, support
Live broadcast and video recording of the training process;
4. Support high-definition video conferences between medical institutions to meet academic exchanges, case discussions, and experience sharing between medical institutions and other business needs;
5. Audio and video recording/playback, supporting the recording and video playback of consultations, meetings, and teaching processes;
6. Can be interconnected with the emergency command system video platform , supports the submission of audio and video information.
7. Basic system configuration:
① Adopt full HD video conferencing system based on IP network
② Adopt H.323 protocol framework technology and support H .264 and other mainstream audio and video protocols
③Resolution: resolution ≥1280×720P
④Frame rate: 30 frames/second
⑤Dual stream: supports H .239 standard, the resolution of the second video stream is ≥1280×720P
⑥Supports dual-screen display applications
⑦Interconnected with the emergency command video exchange platform. When conditions permit, the remote consultation video conference system can be interconnected with the national and provincial emergency command video exchange platforms to realize the submission of emergency consultation and emergency-related image information.
(5) Distance education subsystem supports two training modes: real-time interaction and courseware on demand. Real-time interactive training should be able to ensure that the audio and video of teaching experts are synchronized with courseware playback; support real-time interaction between training participants; support recording of the training process and save it in a common file format and store it in the remote consultation center, and support the production of streaming courseware. Organize and categorize. Real-time interactive training should include support for remote surgical observation, remote nursing teaching, and remote teaching ward rounds. Supports courseware on-demand services and has courseware management functions such as adding, deleting, uploading, and querying.
(6) Remote digital resource sharing subsystem supports primary medical institutions to share medical library and information resources, provides convenience for them to access medical literature, and improves the professional level of primary medical staff. At the same time, higher-level hospitals are supported to share typical medical records, case analyses, surgical videos and other materials to lower-level hospitals for reference and learning by medical staff in grassroots hospitals.
(7) Two-way referral and remote appointment subsystem supports two-way referral and remote appointment between primary medical institutions and higher-level hospitals. Support the automatic transfer of discharged patient information from higher-level hospitals to the primary medical institutions where the patients belong, and the primary medical institutions will conduct follow-up and post-hospital management of the patients, and guide the patients to local review and reexamination. Support grassroots hospitals in completing operations such as appointment registration, appointment examinations, and transfer applications; support higher-level hospitals in completing relevant application acceptance and information feedback.
(8) Electronic identity authentication subsystem is connected to the unified identity authentication system to be built to achieve cross-system unified identity authentication and data encryption authentication for units and individuals, ensuring system operation safety and data security.
(9) The SMS platform subsystem supports in-site short message notifications and mobile phone SMS notifications. Users within the system can send one-to-one or one-to-many notifications through the in-site short message function, or manually through the mobile phone SMS platform. Or automate transaction notifications. It facilitates timely and effective processing of consultation applications and enables consultation time reminders, etc.
(10) Fee settlement subsystem supports the setting of remote consultation fee standards and is used for query, settlement, and summary of telemedicine consultation fees.
(11) Remote consultation communication network and data center
The communication network remote consultation communication network all adopts optical fiber dedicated line networking, that is, access to the health information private network (established by the mobile network ), the bandwidth allocation of each node is as follows:
Remote consultation center: using 100MB mobile optical fiber network outlet, with backup line and fixed IP address. Primary medical institutions: adopt 4MB mobile optical fiber access and have fixed IP addresses. Data Center The provincial telemedicine data center adopts dual-machine hot backup and fiber optic storage, makes full use of existing resources, and plans them uniformly into the large health information platform under construction. Realize the storage and management of various telemedicine data, and provide data mining and analysis support for various telemedicine application systems, such as distance education systems, remote digital resource sharing systems, etc.