目錄
5 技術(shù)需求分析....................................................................................................482
5.1 概述.............................................................................................................................482
5.2 域的概念......................................................................................................................485
5.3 點(diǎn)（POS），線（專項(xiàng)業(yè)務(wù)活動(dòng)）與平臺(tái)互聯(lián).........................................................486
5.3.1 區(qū)域衛(wèi)生信息系統(tǒng)的基本構(gòu)件.....................................................................487
5.3.2 實(shí)體與活動(dòng)關(guān)聯(lián)矩陣.....................................................................................492
5.3.3 二次應(yīng)用與ODS/數(shù)據(jù)倉庫...........................................................................494
5.3.4 平臺(tái)的角色.....................................................................................................494
5.4 文檔（Document）與消息（Message） ...................................................................495
5.4.1 文檔與消息的不同.........................................................................................495
5.4.2 基于文檔的EHR 結(jié)構(gòu)...................................................................................496
5.4.3 結(jié)構(gòu)化文檔與信息共享的重要意義.............................................................498
5.5 網(wǎng)絡(luò)基礎(chǔ)架構(gòu)需求......................................................................................................498
5.5.1 基于公網(wǎng)的VPN............................................................................................499
5.5.2 專網(wǎng).................................................................................................................499
5.5.3 域間互聯(lián).........................................................................................................499
5.6 應(yīng)用軟件體系架構(gòu)......................................................................................................500
5.6.1 SOA...............................................................................................................500
5.6.2 ASP 與SaaS 模式........................................................................................500
5.7 系統(tǒng)規(guī)模劃分..............................................................................................................501
5.7.1 系統(tǒng)規(guī)模劃分的目的.....................................................................................501
5.7.2 系統(tǒng)規(guī)模劃分可供參考的主要參數(shù).............................................................501
6 區(qū)域衛(wèi)生信息平臺(tái)系統(tǒng)架構(gòu)............................................................................504
6.1 平臺(tái)架構(gòu)分析................................................................................................................504
6.1.1 平臺(tái)系統(tǒng)功能................................................................................................504
6.1.2 數(shù)據(jù)來源模式................................................................................................507
6.1.3 數(shù)據(jù)存儲(chǔ)類型................................................................................................508
6.1.4 系統(tǒng)架構(gòu)類型................................................................................................509
6.1.5 數(shù)據(jù)利用模式................................................................................................510
6.1.6 隱私保護(hù)與信息安全....................................................................................512
6.2 平臺(tái)框架........................................................................................................................512
6.3 平臺(tái)構(gòu)件組成................................................................................................................512
6.3.1 注冊服務(wù)........................................................................................................512
6.3.2 健康檔案存儲(chǔ)服務(wù)........................................................................................515
6.3.3 健康檔案信息共享和業(yè)務(wù)協(xié)同服務(wù)............................................................515
6.3.4 全程健康檔案服務(wù)........................................................................................524
6.3.5 信息接口服務(wù)................................................................................................529
6.3.6 醫(yī)療機(jī)構(gòu)內(nèi)部信息系統(tǒng)數(shù)據(jù)交換................................................................534
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6.3.7 數(shù)據(jù)倉庫........................................................................................................536
6.3.8 健康檔案瀏覽器............................................................................................536
6.4 健康檔案數(shù)據(jù)處理和存儲(chǔ)架構(gòu)....................................................................................545
6.4.1 總體結(jié)構(gòu)........................................................................................................545
6.4.2 業(yè)務(wù)模型........................................................................................................546
6.4.3 病人主索引....................................................................................................548
6.4.4 平臺(tái)存儲(chǔ)構(gòu)成................................................................................................550
6.5 健康檔案管理服務(wù)........................................................................................................561
6.5.1 健康檔案管理模式........................................................................................561
6.5.2 檔案全生命周期管理服務(wù)............................................................................561
6.6 跨平臺(tái)之間互聯(lián)............................................................................................................562
6.6.1 上下級平臺(tái)之間互聯(lián)....................................................................................563
6.6.2 同級平臺(tái)之間互聯(lián)........................................................................................564
6.7 平臺(tái)案例........................................................................................................................566
6.7.1 實(shí)驗(yàn)室檢查結(jié)果共享....................................................................................566
6.7.2 轉(zhuǎn)診................................................................................................................593
7 系統(tǒng)平臺(tái)............................................................................................................628
7.1 整體架構(gòu)......................................................................................................................628
7.1.1 HIAL（區(qū)域衛(wèi)生信息應(yīng)用訪問層）...........................................................628
7.1.2 EHR 數(shù)據(jù)存儲(chǔ)庫和服務(wù)..............................................................................638
7.1.3 數(shù)據(jù)倉庫........................................................................................................642
7.1.4 客戶端設(shè)備....................................................................................................646
7.2 虛擬化.........................................................................................................................649
7.2.1 虛擬化技術(shù)概述............................................................................................649
7.2.2 服務(wù)器虛擬化................................................................................................650
7.2.3 虛擬化環(huán)境的部署........................................................................................652
7.2.4 虛擬化技術(shù)在平臺(tái)中的應(yīng)用........................................................................655
7.3 基礎(chǔ)設(shè)施管理..............................................................................................................657
7.3.1 基礎(chǔ)設(shè)施管理方面........................................................................................658
7.3.2 基礎(chǔ)設(shè)施管理數(shù)據(jù)庫....................................................................................659
7.4 備份與恢復(fù)..................................................................................................................660
7.4.1 基礎(chǔ)設(shè)施組件的備份與恢復(fù)注意事項(xiàng)........................................................660
7.4.2 虛擬機(jī)備份....................................................................................................661
7.5 災(zāi)難恢復(fù)......................................................................................................................661
7.5.1 組件故障與恢復(fù)............................................................................................662
7.5.2 基于集群和高可用性（HA）的服務(wù)故障與恢復(fù)......................................663
7.5.3 數(shù)據(jù)中心物理訪問失效................................................................................664
7.5.4 數(shù)據(jù)中心失效................................................................................................664
7.6 基礎(chǔ)設(shè)施實(shí)施..............................................................................................................665
8 存儲(chǔ)架構(gòu)............................................................................................................670
8.1 存儲(chǔ)需求分析................................................................................................................670
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8.1.1 存儲(chǔ)的數(shù)據(jù)類型.............................................................................................670
8.1.2 數(shù)據(jù)存儲(chǔ)的模式需求.....................................................................................672
8.1.3 數(shù)據(jù)存儲(chǔ)的安全需求.....................................................................................673
8.1.4 可靠性和可擴(kuò)展性的需求.............................................................................674
8.2 存儲(chǔ)設(shè)計(jì)（數(shù)據(jù)存儲(chǔ)的物理設(shè)計(jì)）............................................................................674
8.2.1 數(shù)據(jù)類型對應(yīng)的存儲(chǔ)模式.............................................................................674
8.2.2 XML 文檔存儲(chǔ)設(shè)計(jì).......................................................................................675
8.2.3 文件的管理和存儲(chǔ)設(shè)計(jì).................................................................................676
8.2.4 數(shù)據(jù)庫存儲(chǔ)設(shè)計(jì).............................................................................................677
8.2.5 數(shù)據(jù)倉庫存儲(chǔ)設(shè)計(jì).........................................................................................680
8.2.6 影像數(shù)據(jù)存儲(chǔ)設(shè)計(jì).........................................................................................682
8.2.7 信息生命周期管理（Information Lifecycle Management , ILM）..............682
8.3 存儲(chǔ)平臺(tái)總體架構(gòu)........................................................................................................684
8.4 存儲(chǔ)管理........................................................................................................................685
8.4.1 分層存儲(chǔ).........................................................................................................685
8.4.2 數(shù)據(jù)備份與歸檔.............................................................................................686
8.5 災(zāi)備建設(shè)........................................................................................................................695
8.5.1 災(zāi)備技術(shù)介紹與選型.....................................................................................695
8.5.2 區(qū)域衛(wèi)生信息平臺(tái)災(zāi)備建設(shè)規(guī)劃.................................................................699
8.6 部署架構(gòu)示例................................................................................................................704
8.6.1 基礎(chǔ)規(guī)模.........................................................................................................704
8.6.2 中級規(guī)模.........................................................................................................706
8.6.3 高級規(guī)模.........................................................................................................708
9 網(wǎng)絡(luò)基礎(chǔ)架構(gòu)...................................................................................................712
9.1 區(qū)域衛(wèi)生信息網(wǎng)絡(luò)體系架構(gòu)......................................................................................712
9.1.1 區(qū)域衛(wèi)生信息網(wǎng)絡(luò)體系架構(gòu)概述................................................................712
9.1.2 設(shè)計(jì)原則........................................................................................................714
9.1.3 網(wǎng)絡(luò)分層、分區(qū)設(shè)計(jì)....................................................................................715
9.1.4 網(wǎng)絡(luò)帶寬設(shè)計(jì)................................................................................................720
9.1.5 區(qū)域衛(wèi)生信息平臺(tái)網(wǎng)絡(luò)架構(gòu)模型................................................................725
9.2 遠(yuǎn)程接入模式..............................................................................................................731
9.2.1 遠(yuǎn)程接入模式分析........................................................................................731
9.2.2 專線接入方式................................................................................................732
9.2.3 大中型醫(yī)療機(jī)構(gòu)基于公網(wǎng)的加密接入（IPSec VPN）..............................733
9.2.4 小型醫(yī)療機(jī)構(gòu)基于公網(wǎng)的加密接入（SSL VPN）.....................................737
9.2.5 遠(yuǎn)程接入的可靠性設(shè)計(jì)................................................................................741
9.3 平臺(tái)架構(gòu)......................................................................................................................744
9.3.1 平臺(tái)架構(gòu)概述................................................................................................744
9.3.2 平臺(tái)整體規(guī)劃................................................................................................744
9.3.3 平臺(tái)架構(gòu)模型................................................................................................745
9.4 網(wǎng)絡(luò)安全可用性設(shè)計(jì)..................................................................................................747
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9.5 網(wǎng)絡(luò)管理......................................................................................................................755
9.5.1 IP 地址規(guī)劃...................................................................................................755
9.5.2 路由選擇與設(shè)計(jì)............................................................................................760
9.5.3 QoS 設(shè)計(jì)........................................................................................................761
9.5.4 網(wǎng)絡(luò)設(shè)備管理................................................................................................767
9.5.5 IT 服務(wù)管理...................................................................................................772
10 安全...………………………………………………………………………….777
10.1 前提假設(shè)......................................................................................................................777
10.2 安全方案目標(biāo)..............................................................................................................777
10.3 安全等級需求..............................................................................................................777
10.4 系統(tǒng)風(fēng)險(xiǎn)分析..............................................................................................................779
10.4.1 信息和信息系統(tǒng)分析...................................................................................779
10.4.2 安全風(fēng)險(xiǎn)分析...............................................................................................780
10.4.3 資產(chǎn)分析.......................................................................................................781
10.4.4 威脅分析.......................................................................................................781
10.5 安全需求......................................................................................................................784
10.6 安全方案框架和安全風(fēng)險(xiǎn)管理..................................................................................784
10.7 HIAL 中提供的安全和隱私服務(wù)說明........................................................................788
10.8 安全技術(shù)建設(shè)方案......................................................................................................791
10.8.1 安全域劃分...................................................................................................791
10.8.2 安全區(qū)域的等級劃分...................................................................................794
10.8.3 物理安全.......................................................................................................794
10.8.4 網(wǎng)絡(luò)安全.......................................................................................................796
10.8.5 系統(tǒng)安全.......................................................................................................800
10.8.6 應(yīng)用安全.......................................................................................................803
10.8.7 數(shù)據(jù)安全.......................................................................................................809
10.8.8 安全層次關(guān)聯(lián)和全面風(fēng)險(xiǎn)管理...................................................................811
10.9 安全技術(shù)實(shí)現(xiàn)..............................................................................................................812
11 服務(wù)點(diǎn)應(yīng)用系統(tǒng)POS........................................................................................814
11.1 醫(yī)院..............................................................................................................................814
11.1.1 目標(biāo)...............................................................................................................814
11.1.2 需求分析.......................................................................................................814
11.1.3 功能模型.......................................................................................................814
11.1.4 服務(wù)模型.......................................................................................................820
11.1.5 案例...............................................................................................................826
11.1.6 系統(tǒng)支撐環(huán)境...............................................................................................833
11.2 CDC(疾病控制中心)...................................................................................................838
11.2.1 目標(biāo)...............................................................................................................838
11.2.2 需求分析.......................................................................................................838
11.2.3 功能模型.......................................................................................................851
11.2.4 服務(wù)模型.......................................................................................................860
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11.2.5 糖尿病管理案例...........................................................................................861
11.2.6 系統(tǒng)實(shí)施的約束條件...................................................................................869
11.2.7 典型系統(tǒng)支撐環(huán)境.......................................................................................869
11.3 社區(qū)和農(nóng)村基層醫(yī)療機(jī)構(gòu)..........................................................................................873
11.3.1 目標(biāo)...............................................................................................................873
11.3.2 需求分析.......................................................................................................873
11.3.3 功能模型.......................................................................................................874
11.3.4 服務(wù)模型.......................................................................................................876
11.3.5 服務(wù)，角色與交易組合流程圖...................................................................877
11.3.6 案例（兒童體檢、計(jì)劃免疫、診療服務(wù)場景描述） ...............................952
11.3.7 系統(tǒng)實(shí)施的約束條件...................................................................................953
11.3.8 典型系統(tǒng)支撐環(huán)境.......................................................................................953
11.4 婦幼保健服務(wù)機(jī)構(gòu).......................................................................................................966
11.4.1 建設(shè)目標(biāo).........................................................................................................966
11.4.2 需求分析.........................................................................................................969
11.4.3 服務(wù)模型.........................................................................................................975
11.4.4 服務(wù)，角色與交易組合流程圖.....................................................................977
11.4.5 典型系統(tǒng)支撐環(huán)境.........................................................................................986
11.5 醫(yī)療急救......................................................................................................................993
11.5.1 目標(biāo).................................................................................................................993
11.5.2 需求分析.........................................................................................................993
11.5.3 功能模型.......................................................................................................1004
11.5.4 案例...............................................................................................................1010
11.5.5 系統(tǒng)實(shí)施的約束條件...................................................................................1017
11.5.6 典型系統(tǒng)支撐環(huán)境.......................................................................................1017
11.6 遠(yuǎn)程醫(yī)療....................................................................................................................1022
11.6.1 目標(biāo)..............................................................................................................1022
11.6.2 需求分析......................................................................................................1023
11.6.3 功能模型......................................................................................................1028
11.6.4 服務(wù)模型......................................................................................................1030
11.6.5 案例..............................................................................................................1032
11.6.6 系統(tǒng)實(shí)施約束..............................................................................................1033
11.6.7 典型系統(tǒng)支撐環(huán)境......................................................................................1034
11.6.8 資源分析......................................................................................................1039
11.7 影像中心....................................................................................................................1042
11.7.1 目標(biāo).............................................................................................................1042
11.7.2 需求分析.....................................................................................................1042
11.7.3 功能模型.....................................................................................................1046
11.7.4 服務(wù)模型.....................................................................................................1049
11.7.5 服務(wù)，角色與交易組合流程圖.................................................................1050
11.7.6 案例.............................................................................................................1051
11.7.7 系統(tǒng)實(shí)施的約束條件.................................................................................1052
11.7.8 典型系統(tǒng)支撐環(huán)境.....................................................................................1052
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12 門戶 Portal......................................................................................................1055
12.1 概述...........................................................................................................................1055
12.1.1 Portal 的概念..............................................................................................1055
12.1.2 Portal 設(shè)計(jì)的原則......................................................................................1056
12.2 需求分析....................................................................................................................1057
12.2.1 醫(yī)務(wù)人員門戶..............................................................................................1058
12.2.2 公眾門戶......................................................................................................1060
12.2.3 衛(wèi)生管理者門戶..........................................................................................1061
12.3 門戶的技術(shù)解決方案................................................................................................1062
12.3.1 服務(wù)模型和技術(shù)要求..................................................................................1062
12.3.2 門戶的業(yè)務(wù)邏輯架構(gòu)..................................................................................1064
12.3.3 系統(tǒng)實(shí)施的約束條件..................................................................................1065
12.3.4 典型系統(tǒng)支撐環(huán)境......................................................................................1065
12.3.5 軟件架構(gòu)......................................................................................................1068
12.3.6 軟件平臺(tái)選擇案例......................................................................................1069
12.3.7 服務(wù)，角色與交易組合流程圖..................................................................1069
13 區(qū)域衛(wèi)生信息平臺(tái)建設(shè)項(xiàng)目的管理..............................................................1070
13.1 區(qū)域衛(wèi)生信息化項(xiàng)目過程........................................................................................1070
13.2 整體規(guī)劃階段............................................................................................................1071
13.2.1 主要工作內(nèi)容..............................................................................................1072
13.2.2 主要工作要點(diǎn)..............................................................................................1076
13.3 可研/立項(xiàng)階段..........................................................................................................1077
13.3.1 主要工作內(nèi)容..............................................................................................1077
13.3.2 主要工作難點(diǎn)..............................................................................................1077
13.4 設(shè)計(jì)/開發(fā)/實(shí)施階段.................................................................................................1077
13.4.1 主要工作內(nèi)容..............................................................................................1077
13.4.2 主要工作難點(diǎn)..............................................................................................1082
13.5 運(yùn)營維護(hù)階段............................................................................................................1091
13.6 區(qū)域衛(wèi)生信息平臺(tái)的持續(xù)平穩(wěn)運(yùn)營........................................................................1093
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5 技術(shù)需求分析
5.1 概述
本節(jié)概要論述以居民電子健康檔案為基礎(chǔ)的區(qū)域衛(wèi)生信息平臺(tái)的技術(shù)需求。前
面章節(jié)的業(yè)務(wù)需求以終端用戶的視角，從用例出發(fā)，仔細(xì)、系統(tǒng)地分析了用戶的需
求與流程，以信息交互共享的需求為核心，得到了抽象的信息模型。技術(shù)需求則以
IT 技術(shù)的視角，從業(yè)務(wù)需求的分析結(jié)果出發(fā)，用信息技術(shù)的語言重新梳理和歸納這
些需求，并給出達(dá)到這些需求的技術(shù)方案，這包括：
系統(tǒng)的體系架構(gòu)
軟件的體系架構(gòu)
數(shù)據(jù)的存儲(chǔ)架構(gòu)
信息 |
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