The reporter recently learned from the National Health and Family Planning Commission that in order to ensure the legitimate rights and interests of both doctors and patients, the new electronic medical record will be implemented on April 1. This indicates that China has taken another step in the integration of medical information .
However, the book " Digital Medical " published recently has talked about some of the obstacles that people encountered in the past on medical informationization. The author of the book is known as the "father of hospital doctors", Robert Wacht, dean of the University of California, San Francisco School of Medicine, in which he exposed a number of medical incidents: a Benoco at the University of California, San Francisco Medical Center A rare genetic disease juvenile patient who was treated at the Children's Hospital, he should take 1 antibiotic according to the doctor's advice, but the nurse asked him to eat 38.5! Part of the reason for this outrageous error is that the information system is involved in the medical process: the measurement unit in the system is inconsistent with the doctor's familiarity, the robotic drug collection system is not questioned, and the system warning is ignored because of too many false alarms...
Digital medicine, a small mistake in a unit of measurement, can be life-threatening. When the proportion of informationization in the whole world is getting bigger and bigger, and everyone's life can even be divided into "physical dimension" and "binary dimension", the informationization of medical care is progressing slowly. Although various robots are running between the pharmacy and the ward, although the diagnostic error rate of the AI ​​diagnostic tool is greatly reduced, the intuitive feeling of the patient is not in the fields of finance, communication, etc. Do not hesitate to put "five stars".
Despite the difficult pace, medical care is the most influential area of ​​informationization. What are the difficulties in the process of medical informationization? How to crack? How to get the most convenience for the people quickly and safely? Zheng Jie, president of Shulan Medical Group and the translator of the book, said that “the marriage of medical and information technology is indeed a global issue, especially as a superpower, China and the United States have certain comparabilityâ€.
Standard non-uniform medical information big data is difficult to share
Before the medical information system, the Mayo Medical Center in the United States transmitted the patient's paper medical records and X-ray film through a pneumatic pipe transmission system. More than 10,000 pneumatic pipes with a total length of 16 kilometers were on the ground, and the patient's information was transmitted. Come and change. Until 2004, the United States clearly stated that every American had an electronic health record within ten years.
The digitalization process in China started a little later. According to the data, in the second half of 2009, the Ministry of Health began to implement the electronic file of health records. In the past six months, it issued the "Basic Framework and Data Standards for Electronic Medical Records (Draft for Comment)" and issued A number of documents and standards such as the Notice on the Construction of Technical Solutions for Regional Health Information Platforms Based on Health Archives (Trial).
If there is no health record, the doctor's understanding of the patient will start from “zero†every time, and the accumulation of files allows the information to be connected into a continuous “health lineâ€. In the process of data accumulation, China and the United States have encountered similar technical problems unique to medicine. "For example, low potassium levels in blood may be recorded as 'low potassium' 'hypokalemia' 'low K ion' '↓K', etc." Wacht wrote in the book that these various medical terms are in The electronicization must be unified, otherwise the seamless connection between medical systems cannot be achieved.
In a paper published in the "China Health Industry" in 2011, entitled "On the History of Electronic Medical Records and Electronic Health Archives", the current data resources are limited to a certain department or a certain business system, and the construction standards are not uniform. It is difficult to exchange data and share information between various systems, resulting in a large number of "information islands."
Over the years, with the upgrade of hardware and algorithms, information “islands†have gradually become adjacent, computers can not only recognize text information, but also identify image information. In the virtual world, “structured data and unstructured data†can be “digested†at the same time. The era is like the "global integration" in reality. Information exchange is no longer a problem in technology. It is quickly applied at the grassroots level.
“In order to build a close-knit medical association, we link the information of the community to the tertiary hospital.†Gu Gang, dean of the Shougang Hospital of Peking University, said that they spontaneously tried information sharing based on the dockable information system, but other hospitals Modeling may also require a push from the institutional system.
Beijing Fangzhuang Community Health Service Center is one of the active community hospitals. Wu Hao, director of the center, said, “We have networked with Tiantan Hospital (one of the four tertiary hospitals in the United). The information of all patients in Fangzhuang has to interact with Tiantan Hospital every night. The medical records of our contracted patients at Tiantan Hospital The hospitalization information will be synchronized to his health record database and the management platform of the contracted doctor." According to this, people's complete "health line" gradually emerges, the health of different stages of community signing patients can be "traceable", and medical staff to follow up and health management.
AI joins technology giants to put "big move"
"Watson is clear that it needs to interact with doctors and be part of their ecosystem." IBM's Director of Global Healthcare Reform told author Wacht. IBM's Watson is one of the artificial intelligence (AI) that enters the medical industry . It has a large number of medical records and can even diagnose it. Although many media use Dr. Watson to report it, its creators actually think hard. To clarify this title.
In China, capital investment in AI Healthcare accounts for about half of the total AI investment. China also has its own version of Watson. In November 2017, the “Intelligence Assistant†robot of the University of Science and Technology passed the examination of clinical practitioners with a score of 456 points, and its professional knowledge has been able to take up the work of practicing doctors.
Image recognition systems such as lung nodules developed independently by China have also been among the best in international competitions. The most intuitive of the public is the humanoid medical robot equipped in the large local hospitals to answer questions, preliminary triage, and guide patients. AI Landing is currently reducing labor intensity for front-line doctors and helping medical resources reach remote areas.
More sophisticated algorithms are used to develop diagnostic methods that did not exist before, and to enhance the overall strength of medicine. Especially in the near future, technology giants have frequently released “big movesâ€: in February, Google’s brain can predict the risk of cardiovascular disease from retinal images, supplemented by various factors such as age, gender, smoking history, blood pressure and other data. The constructed system used 130,000 retinal images for training with a success rate of around 70%. On March 15th, Nature published the AI ​​tool for brain tumor diagnosis at the German Cancer Center to make up for the shortcomings of neurological tumor diagnosis.
China's progress in expanding medical capabilities in AI is rarely seen in the public. The reporter learned in several interviews that many colleges and universities have subordinates in the AI ​​medical field. For example, under the support of the national key research and development program, the Chinese Academy of Sciences software field The Fung research team worked with Concord Hospital to try to predict the risk of neurodegenerative diseases such as Parkinson's disease by using the tiny jitters of patients.
Collecting data, digital medical care needs to be step by step
China has a large patient population and can provide valuable research data. “ Given 10,000 genomes and efficacy cases, we can predict the possible efficacy of 10,000+1 patients through data mining.†Wang Xiaoning, deputy head of the National Key Research and Development Program Stem Cell Specialist Group, recommended the establishment of a national biotherapeutic efficacy database, mandatory for biological The therapeutic clinical research reporting unit concentrates the data to solve the problem of the inability to determine the indications for the therapeutic indications.
The collection of data is still a work that China needs to further improve. "What we need to improve is the standardization of medical information. At present, most of the mainstream medical information standards come from the standardization organizations in the United States, and the progress of the United States in the 'interoperability' of medical systems. It is also worth our attention and learning." Zheng Jie said that from the examples of trains and rails, light bulbs and lamp holders, and the Internet TCP/IP protocol, in a complex information ecosystem, standards can greatly improve efficiency and obtain data value.
“The health data of one person's life will be scattered in different medical and health service organizations, and it will inevitably face the problem of data sharing across medical institutions and trans-health medical terminals.†Zheng Jie reminded that relevant supporting laws, regulations, and data are traced to tamper-proof. The technical mechanism must also be continuously improved.
Where have we been? In the book Digital Health, the current predictable medical informatization process is divided into four development stages. One stage: digitalization of the entire health care service system; second stage: interconnection between different medical information systems; three stages: giving full play to the value of medical big data ; four stages: creating technical tools, improving medical systems, building medical institutions, Improve hospital culture and improve public health and improve medical quality based on the first three stages. If it is highly summarized, it can be summarized as "building, interconnection, AI and landing." These four stages are not clearly defined. Wacht believes that the United States is about to complete a phase, is unlocking the second phase, laying the foundation for the three phases, and initially involves four phases.
“In the future, we can simulate a series of clinical medical problems through 'digital patients' and make better clinical decisions by analyzing big data, but in the end, only real patients need us to pay attention to them.†Wacht Say. In contrast to China, it is also explored at the same stage. The presentation of the “holographic digital person†for comprehensive nutrition and health at the national level is also a manifestation of the consistency of the future direction of medical informationization. (Technology Daily)
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