从电子健康记录中获取实时数据:方案和解决方案。

IF 2.2 Q2 HEALTH CARE SCIENCES & SERVICES mHealth Pub Date : 2024-04-03 eCollection Date: 2024-01-01 DOI:10.21037/mhealth-24-2
Nikola Kirilov
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引用次数: 0

摘要

背景:在电子健康记录(EHR)中集成实时数据(RTD)正在改变未来的医疗保健。在这项工作中,研究了从电子病历中获取医疗保健实时数据的常见情况,并调查了实施实时解决方案的方法和工具:方法:通过表征状态传输(REST)应用编程接口(API)提供实时数据通常是通过发布-订阅(Publish-Subscribe)方法完成的。实现订阅的常用技术和协议是 REST 钩子和 WebSockets。轮询是一种获取更新的直接机制,但它可能不是最有效或可扩展的解决方案。在这种情况下,其他方法往往更受欢迎。数据库触发器和反向代理在 RTD 应用场景中可能很有用,但应仔细设计,以避免性能瓶颈和潜在问题:结果:介绍了通过 REST 钩子和 WebSocket 通知(使用快速医疗互操作性资源(FHIR)REST API)实现订阅的方法,以及反向代理和数据库触发器的设计。GitHub 存储库中提供了解决方案的参考实现。反向代理的实现使用了专门用于开发服务器端网络应用程序的 Go 语言(Golang)。对于 FHIR 服务器,我们提供了一个 python 脚本来创建样本订阅资源,以便在为特定患者 ID 创建新的观察资源时发送 RTD。WebSocket 客户端示例是使用 "websocket-client "python 库编写的。示例 RTD 端点使用 "Flask "框架创建。在数据库触发器方面,提供了 Postgres 的结构化查询语言 (SQL) 查询示例,用于在 FHIR 资源表执行 INSERT 或 UPDATE 操作时创建触发器。此外,还提供了一个临床用例,其中的主要参与者包括医疗服务提供者(医院、私人诊所、全科医生和医学实验室)、医疗信息网络和患者。详细介绍了实时数据流和交换,以及如何改善医疗保健:获取 RTD 对于医疗专业人员和成功的数字医疗无疑是至关重要的。但这一主题仍未得到深入探讨,尤其是在电子病历的背景下。在我们的工作中,首次对常见场景和问题进行了研究。此外,我们还提供了解决方案和参考实施方案,可为实时应用程序的开发提供支持和帮助。
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Capture of real-time data from electronic health records: scenarios and solutions.

Background: The integration of real-time data (RTD) in the electronic health records (EHRs) is transforming the healthcare of tomorrow. In this work, the common scenarios of capturing RTD in the healthcare from EHRs are studied and the approaches and tools to implement real-time solutions are investigated.

Methods: Delivering RTD by representational state transfer (REST) application programming interfaces (APIs) is usually accomplished through a Publish-Subscribe approach. Common technologies and protocols used for implementing subscriptions are REST hooks and WebSockets. Polling is a straightforward mechanism for obtaining updates; nevertheless, it may not be the most efficient or scalable solution. In such cases, other approaches are often preferred. Database triggers and reverse proxies can be useful in RTD scenarios; however, they should be designed carefully to avoid performance bottlenecks and potential issues.

Results: The implementation of subscriptions through REST hooks and WebSocket notifications using a Fast Healthcare Interoperability Resources (FHIR) REST API, as well as the design of a reverse proxy and database triggers is described. Reference implementations of the solutions are provided in a GitHub repository. For the reverse proxy implementation, the Go language (Golang) was used, which is specialized for the development of server-side networking applications. For FHIR servers a python script is provided to create a sample Subscription resource to send RTD when a new Observation resource for specific patient id is created. The sample WebSocket client is written using the "websocket-client" python library. The sample RTD endpoint is created using the "Flask" framework. For database triggers a sample structured query language (SQL) query for Postgres to create a trigger when an INSERT or UPDATE operation is executed on the FHIR resource table is available. Furthermore, a use case clinical example, where the main actors are the healthcare providers (hospitals, physician private practices, general practitioners and medical laboratories), health information networks and the patient are drawn. The RTD flow and exchange is shown in detail and how it could improve healthcare.

Conclusions: Capturing RTD is undoubtedly vital for health professionals and successful digital healthcare. The topic remains unexplored especially in the context of EHRs. In our work for the first time the common scenarios and problems are investigated. Furthermore, solutions and reference implementations are provided which could support and contribute to the development of real-time applications.

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