目錄
5 技術需求分析....................................................................................................482
5.1 概述.............................................................................................................................482
5.2 域的概念......................................................................................................................485
5.3 點（POS），線（專項業(yè)務活動）與平臺互聯(lián).........................................................486
5.3.1 區(qū)域衛(wèi)生信息系統(tǒng)的基本構件.....................................................................487
5.3.2 實體與活動關聯(lián)矩陣.....................................................................................492
5.3.3 二次應用與ODS/數(shù)據(jù)倉庫...........................................................................494
5.3.4 平臺的角色.....................................................................................................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 結構...................................................................................496
5.4.3 結構化文檔與信息共享的重要意義.............................................................498
5.5 網(wǎng)絡基礎架構需求......................................................................................................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 應用軟件體系架構......................................................................................................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)生信息平臺系統(tǒng)架構............................................................................504
6.1 平臺架構分析................................................................................................................504
6.1.1 平臺系統(tǒng)功能................................................................................................504
6.1.2 數(shù)據(jù)來源模式................................................................................................507
6.1.3 數(shù)據(jù)存儲類型................................................................................................508
6.1.4 系統(tǒng)架構類型................................................................................................509
6.1.5 數(shù)據(jù)利用模式................................................................................................510
6.1.6 隱私保護與信息安全....................................................................................512
6.2 平臺框架........................................................................................................................512
6.3 平臺構件組成................................................................................................................512
6.3.1 注冊服務........................................................................................................512
6.3.2 健康檔案存儲服務........................................................................................515
6.3.3 健康檔案信息共享和業(yè)務協(xié)同服務............................................................515
6.3.4 全程健康檔案服務........................................................................................524
6.3.5 信息接口服務................................................................................................529
6.3.6 醫(yī)療機構內部信息系統(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)處理和存儲架構....................................................................................545
6.4.1 總體結構........................................................................................................545
6.4.2 業(yè)務模型........................................................................................................546
6.4.3 病人主索引....................................................................................................548
6.4.4 平臺存儲構成................................................................................................550
6.5 健康檔案管理服務........................................................................................................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............................................................................561
6.6 跨平臺之間互聯(lián)............................................................................................................562
6.6.1 上下級平臺之間互聯(lián)....................................................................................563
6.6.2 同級平臺之間互聯(lián)........................................................................................564
6.7 平臺案例........................................................................................................................566
6.7.1 實驗室檢查結果共享....................................................................................566
6.7.2 轉診................................................................................................................593
7 系統(tǒng)平臺............................................................................................................628
7.1 整體架構......................................................................................................................628
7.1.1 HIAL（區(qū)域衛(wèi)生信息應用訪問層）...........................................................628
7.1.2 EHR 數(shù)據(jù)存儲庫和服務..............................................................................638
7.1.3 數(shù)據(jù)倉庫........................................................................................................642
7.1.4 客戶端設備....................................................................................................646
7.2 虛擬化.........................................................................................................................649
7.2.1 虛擬化技術概述............................................................................................649
7.2.2 服務器虛擬化................................................................................................650
7.2.3 虛擬化環(huán)境的部署........................................................................................652
7.2.4 虛擬化技術在平臺中的應用........................................................................655
7.3 基礎設施管理..............................................................................................................657
7.3.1 基礎設施管理方面........................................................................................658
7.3.2 基礎設施管理數(shù)據(jù)庫....................................................................................659
7.4 備份與恢復..................................................................................................................660
7.4.1 基礎設施組件的備份與恢復注意事項........................................................660
7.4.2 虛擬機備份....................................................................................................661
7.5 災難恢復......................................................................................................................661
7.5.1 組件故障與恢復............................................................................................662
7.5.2 基于集群和高可用性（HA）的服務故障與恢復......................................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 基礎設施實施..............................................................................................................665
8 存儲架構............................................................................................................670
8.1 存儲需求分析................................................................................................................670
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8.1.1 存儲的數(shù)據(jù)類型.............................................................................................670
8.1.2 數(shù)據(jù)存儲的模式需求.....................................................................................672
8.1.3 數(shù)據(jù)存儲的安全需求.....................................................................................673
8.1.4 可靠性和可擴展性的需求.............................................................................674
8.2 存儲設計（數(shù)據(jù)存儲的物理設計）............................................................................674
8.2.1 數(shù)據(jù)類型對應的存儲模式.............................................................................674
8.2.2 XML 文檔存儲設計.......................................................................................675
8.2.3 文件的管理和存儲設計.................................................................................676
8.2.4 數(shù)據(jù)庫存儲設計.............................................................................................677
8.2.5 數(shù)據(jù)倉庫存儲設計.........................................................................................680
8.2.6 影像數(shù)據(jù)存儲設計.........................................................................................682
8.2.7 信息生命周期管理（Information Lifecycle Management , ILM）..............682
8.3 存儲平臺總體架構........................................................................................................684
8.4 存儲管理........................................................................................................................685
8.4.1 分層存儲.........................................................................................................685
8.4.2 數(shù)據(jù)備份與歸檔.............................................................................................686
8.5 災備建設........................................................................................................................695
8.5.1 災備技術介紹與選型.....................................................................................695
8.5.2 區(qū)域衛(wèi)生信息平臺災備建設規(guī)劃.................................................................699
8.6 部署架構示例................................................................................................................704
8.6.1 基礎規(guī)模.........................................................................................................704
8.6.2 中級規(guī)模.........................................................................................................706
8.6.3 高級規(guī)模.........................................................................................................708
9 網(wǎng)絡基礎架構...................................................................................................712
9.1 區(qū)域衛(wèi)生信息網(wǎng)絡體系架構......................................................................................712
9.1.1 區(qū)域衛(wèi)生信息網(wǎng)絡體系架構概述................................................................712
9.1.2 設計原則........................................................................................................714
9.1.3 網(wǎng)絡分層、分區(qū)設計....................................................................................715
9.1.4 網(wǎng)絡帶寬設計................................................................................................720
9.1.5 區(qū)域衛(wèi)生信息平臺網(wǎng)絡架構模型................................................................725
9.2 遠程接入模式..............................................................................................................731
9.2.1 遠程接入模式分析........................................................................................731
9.2.2 專線接入方式................................................................................................732
9.2.3 大中型醫(yī)療機構基于公網(wǎng)的加密接入（IPSec VPN）..............................733
9.2.4 小型醫(yī)療機構基于公網(wǎng)的加密接入（SSL VPN）.....................................737
9.2.5 遠程接入的可靠性設計................................................................................741
9.3 平臺架構......................................................................................................................744
9.3.1 平臺架構概述................................................................................................744
9.3.2 平臺整體規(guī)劃................................................................................................744
9.3.3 平臺架構模型................................................................................................745
9.4 網(wǎng)絡安全可用性設計..................................................................................................747
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9.5 網(wǎng)絡管理......................................................................................................................755
9.5.1 IP 地址規(guī)劃...................................................................................................755
9.5.2 路由選擇與設計............................................................................................760
9.5.3 QoS 設計........................................................................................................761
9.5.4 網(wǎng)絡設備管理................................................................................................767
9.5.5 IT 服務管理...................................................................................................772
10 安全...………………………………………………………………………….777
10.1 前提假設......................................................................................................................777
10.2 安全方案目標..............................................................................................................777
10.3 安全等級需求..............................................................................................................777
10.4 系統(tǒng)風險分析..............................................................................................................779
10.4.1 信息和信息系統(tǒng)分析...................................................................................779
10.4.2 安全風險分析...............................................................................................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險管理..................................................................................784
10.7 HIAL 中提供的安全和隱私服務說明........................................................................788
10.8 安全技術建設方案......................................................................................................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)絡安全.......................................................................................................796
10.8.5 系統(tǒng)安全.......................................................................................................800
10.8.6 應用安全.......................................................................................................803
10.8.7 數(shù)據(jù)安全.......................................................................................................809
10.8.8 安全層次關聯(lián)和全面風險管理...................................................................811
10.9 安全技術實現(xiàn)..............................................................................................................812
11 服務點應用系統(tǒng)POS........................................................................................814
11.1 醫(yī)院..............................................................................................................................814
11.1.1 目標...............................................................................................................814
11.1.2 需求分析.......................................................................................................814
11.1.3 功能模型.......................................................................................................814
11.1.4 服務模型.......................................................................................................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...............................................................................................................838
11.2.2 需求分析.......................................................................................................838
11.2.3 功能模型.......................................................................................................851
11.2.4 服務模型.......................................................................................................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)和農村基層醫(yī)療機構..........................................................................................873
11.3.1 目標...............................................................................................................873
11.3.2 需求分析.......................................................................................................873
11.3.3 功能模型.......................................................................................................874
11.3.4 服務模型.......................................................................................................876
11.3.5 服務，角色與交易組合流程圖...................................................................877
11.3.6 案例（兒童體檢、計劃免疫、診療服務場景描述） ...............................952
11.3.7 系統(tǒng)實施的約束條件...................................................................................953
11.3.8 典型系統(tǒng)支撐環(huán)境.......................................................................................953
11.4 婦幼保健服務機構.......................................................................................................966
11.4.1 建設目標.........................................................................................................966
11.4.2 需求分析.........................................................................................................969
11.4.3 服務模型.........................................................................................................975
11.4.4 服務，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.................................................................................................................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)實施的約束條件...................................................................................1017
11.5.6 典型系統(tǒng)支撐環(huán)境.......................................................................................1017
11.6 遠程醫(yī)療....................................................................................................................1022
11.6.1 目標..............................................................................................................1022
11.6.2 需求分析......................................................................................................1023
11.6.3 功能模型......................................................................................................1028
11.6.4 服務模型......................................................................................................1030
11.6.5 案例..............................................................................................................1032
11.6.6 系統(tǒng)實施約束..............................................................................................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.............................................................................................................1042
11.7.2 需求分析.....................................................................................................1042
11.7.3 功能模型.....................................................................................................1046
11.7.4 服務模型.....................................................................................................1049
11.7.5 服務，角色與交易組合流程圖.................................................................1050
11.7.6 案例.............................................................................................................1051
11.7.7 系統(tǒng)實施的約束條件.................................................................................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 設計的原則......................................................................................1056
12.2 需求分析....................................................................................................................1057
12.2.1 醫(yī)務人員門戶..............................................................................................1058
12.2.2 公眾門戶......................................................................................................1060
12.2.3 衛(wèi)生管理者門戶..........................................................................................1061
12.3 門戶的技術解決方案................................................................................................1062
12.3.1 服務模型和技術要求..................................................................................1062
12.3.2 門戶的業(yè)務邏輯架構..................................................................................1064
12.3.3 系統(tǒng)實施的約束條件..................................................................................1065
12.3.4 典型系統(tǒng)支撐環(huán)境......................................................................................1065
12.3.5 軟件架構......................................................................................................1068
12.3.6 軟件平臺選擇案例......................................................................................1069
12.3.7 服務，角色與交易組合流程圖..................................................................1069
13 區(qū)域衛(wèi)生信息平臺建設項目的管理..............................................................1070
13.1 區(qū)域衛(wèi)生信息化項目過程........................................................................................1070
13.2 整體規(guī)劃階段............................................................................................................1071
13.2.1 主要工作內容..............................................................................................1072
13.2.2 主要工作要點..............................................................................................1076
13.3 可研/立項階段..........................................................................................................1077
13.3.1 主要工作內容..............................................................................................1077
13.3.2 主要工作難點..............................................................................................1077
13.4 設計/開發(fā)/實施階段.................................................................................................1077
13.4.1 主要工作內容..............................................................................................1077
13.4.2 主要工作難點..............................................................................................1082
13.5 運營維護階段............................................................................................................1091
13.6 區(qū)域衛(wèi)生信息平臺的持續(xù)平穩(wěn)運營........................................................................1093
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5 技術需求分析
5.1 概述
本節(jié)概要論述以居民電子健康檔案為基礎的區(qū)域衛(wèi)生信息平臺的技術需求。前
面章節(jié)的業(yè)務需求以終端用戶的視角，從用例出發(fā)，仔細、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。技術需求則以
IT 技術的視角，從業(yè)務需求的分析結果出發(fā)，用信息技術的語言重新梳理和歸納這
些需求，并給出達到這些需求的技術方案，這包括：
系統(tǒng)的體系架構
軟件的體系架構
數(shù)據(jù)的存儲架構
信息 |
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資源大�。�2.93 MB 
