Foreword
出自医学信息学大百科
March 31, 2006
Dear partners and collaborators:
3月31日, 2006年
亲爱的股东和合作伙伴:
I am pleased to present the revised version of the Electronic Health Record Solution (EHRS) Blueprint, Canada Health Infoway’s road map guiding the sustainable development of the interoperable Electronic Health Record (EHR) for all Canadians.
我很乐意来介绍新版的电子健康记录解决方案(EHRS)蓝图,Canada Health Infoway的路线图是用于指导服务于所有加拿大人的互操作型电子健康记录(EHR)的持续健康发展。
Based on interoperability (the ability of different systems to communicate seamlessly with one another), the Blueprint addresses the challenge of providing healthcare professionals with the patient information they need to support informed decision-making.
基于互操作能力(不同系统之间无缝通讯的能力)的考虑，这份蓝图帮助医疗专业人员解决如下挑战：获取必要的病人信息以支持信息化的决策。
It provides a framework for accessing and consolidating information and presents the information in a way that meets the needs of healthcare professionals. It takes into consideration the fact that tens of thousands of health information systems could be part of the Electronic Health Record across Canada. It supports the sharing of patient health information between health services providers -- including GPs, specialists, nurses and pharmacists -- across care settings, including hospitals, emergency rooms, clinics and homecare settings, and across geographical distances.
它为医疗专业人员用适当的方法访问、合并（consolidating information）以及展现信息提供了一个框架。考虑到加拿大现存的数万信息系统都将成为电子健康记录系统的组成部分，这份蓝图需要支持在不同的健康服务提供者之间共享病人信息--包括全科医生、专科医生、护士以及药剂师—覆盖所有医疗机构（care setting），包括医院、急救室、临床和家庭护理，而且跨越地理位置距离。
The Blueprint guides all of Infoway’s investment decisions. First published in 2003, the Blueprint has recently been enhanced to provide more detail on how standards-based technology can be used to support sharing of EHR information. The current version also integrates elements of the Privacy and Security Architecture, which provides for the private and secure sharing of health information. It shows how Telehealth and Public Health Surveillance fit in with the Electronic Health Record.
这份蓝图指导着Infoway的所有投资决策。在2003年首次出版后，蓝图最近得到细化，着重在标准化为基础的技术如何用来支持共享EHR信息。最新的版本，也整合了隐私和安全框架，在共享健康信息方面提供隐私和安全保护。它还展示了在远程医疗（Teleheath）和公共卫生监督（Public Health Surveillance）这两方面与电子健康记录如何相互适应。
The Blueprint was developed based on extensive consultations with stakeholders. I wish to thank all of the representatives from the jurisdictions and the privacy and security community as well as technology vendors, healthcare professionals and others for the time and energy devoted to enriching the Blueprint. I am pleased to note that many stakeholders who have previewed the enhanced Blueprint refer to it as a detailed, practical and valuable tool to guide EHR planning and implementation.
这份蓝图的开发基于利益相关各方的广泛磋商，我希望感谢所有的人，包括区域医疗管理机构、隐私和安全团体和技术供应商、医疗专业人员以及其他投入时间和精力以丰富这份蓝图的人。我很高兴地注意到很多利益相关者已经预言这份增强的蓝图将作为详细、实用和有价值的工具来指导HER的计划和实施。
The Blueprint is a foundational piece guiding our efforts to ensure that the EHR becomes a standard of care in Canada. The end result will be a renewed, sustainable healthcare system providing improved quality, productivity and access to health care for all Canadians.
在加拿大，我们正努力将EHR纳入医疗保健的标准内容，这份蓝图为此提供了一块基石。最终结果是一个革新的、可持续的卫生保健系统提供高质量、高效、而且人人可以享有的卫生保健服务。
Thank you again to all who have contributed for your continued support. Sincerely,
再一次感谢那些对本蓝图提供支持和帮助的人们。真诚的,
Richard C. Alvarez
President and CEO
Canada Health Infoway
目录 |
FOREWORD
It is my pleasure to introduce the second version of the Electronic Health Record Solution (EHRS) Blueprint. This is a very significant evolution from the first version, and is the result of significant design evaluations and collaborations with many stakeholders and subject matter experts across the country.
There is consensus in Canada and other countries about the value of health information technology in the healthcare industry. Our efforts around the interoperable EHR are about providing each individual in Canada with a secure and private lifetime record of their key health history and care within the health system. The interoperable EHR will ultimately be available electronically to authorized health providers and the individual anywhere, anytime in support of high quality care. Additionally, this record is designed to facilitate the sharing of data – across the continuum of care, across healthcare delivery organizations and across geographies. In order to achieve these objectives, the information technology solutions must be founded on interoperability. This is the fundamental driver for developing and publishing the Blueprint, and associated health information systems standards.
The Blueprint is a set of standards and guidelines for our jurisdictional partners and vendors such that systems will be compatible and interoperable. Interoperability is a critical factor in renewing our healthcare system. Without interoperability, there can be no interoperable Electronic Health Record and information will continue to be trapped in silos, to the detriment of healthcare providers and patients
前言
我很乐意来介绍第二版EHR解决方案蓝图。相对第一个版本，这是一个非常重大的进展，而且它是诸多利益相关者和全国各地各方面专家（subject matter experts）设计评估和协作的重大成果。
加拿大和其他国家关于健康信息技术在医疗行业的价值有一致的理解。我们对具有互操作能力的EHR的努力将在健康系统中给每个在加拿大的个体提供安全而独有的（secure and private）终身的关键性历史健康和护理的记录。具有互操作能力的EHR最终可以经过电子授权的医疗人员和个体在任何地点、任何时间获得用来支持高质量的医疗服务。此外，这些记录设计为容易进行数据共享――贯穿持续医护过程，横跨医疗服务机构（healthcare delivery organizations），跨越地理位置。为了达到这些目的，信息技术解决方案必须建立在具有互操作能力的基础上。这是驱动开发和出版这本蓝图的基本原则，也是整合卫生信息系统的标准。
这份蓝图是给我们区域医疗管理的合伙人和供应商的一系列标准和指导方针，以使得系统将相互兼容和相互操作。互操作能力是复兴我们的卫生保健系统的关键因素。如果没有互操作能力，就不会有能互操作的电子健康记录，而且信息将继续通过烟囱系统进行采集，从而给卫生专业人士和病人造成损害。
Allow me to provide a high level overview of what you will find in this document.
允许我概括一下你能在这份文档中看到的内容：
Objectives of EHRS Blueprint Version 2
While the first version of the Blueprint was helpful in defining the vision for EHR Solutions in Canada, it was understood from the outset that more work would be needed to successfully apply the concepts effectively in real-world solutions. With this in mind, the recent work on extending the Blueprint had the following objectives:
- To improve its breadth and depth in terms of the scope of Infoway investment programs and in the level of detail in expressing architectural components.
- To ensure its relevance and coherence as a vision statement for stakeholders, by furthering the business case for the use of EHR Solutions in health services, and by better illustrating how the EHRS is used in the context of service delivery.
- To provide a fuller specification to guide: solution vendors, service provider organizations, regions, and federal/provincial/territorial jurisdictions in actually building and implementing EHR Solutions and their associated Infostructures (the software services common to and reusable among the diverse set of healthcare point of service systems).
EHRS蓝图第二版的目标
在第一版蓝图帮助定义EHR解决方案在加拿大的远景时，可以理解要成功的将它应用在现实世界中的解决方案还有更多工作需要去做。带着这些想法，最近的工作是按以下目标扩展蓝图：
－根据Infoway投资项目的范围提升广度和深度，明确了体系结构层面的细节。
－通过促进在医疗服务中使用EHR解决方案的商业案例，和更好地例证说明在实际提供医疗服务的语境下（the context of service delivery）如何利用EHRS，来确保蓝图作为远景声明在利益相关者之间保持恰当和一致。
－提供一个完整的规范在建设和贯彻EHR解决方案及其关联信息结构(软件服务在多个医疗服务点通用且可重用)的实践中指导：解决方案供应商、医疗服务组织、地区、联邦/省/地区等区域医疗管理机构
What is New in Blueprint v2
Just after the first version of the EHRS Blueprint was published, Infoway’s mandate was increased to address two additional health domains; Telehealth, and Public Health Surveillance. Given the vast geography of the country and population distribution in Canada, and the sobering lessons learned from public encounters with SARS and West Nile virus, it is easy to understand the importance of these mechanisms for delivery health services and in preserving and promoting the health of Canadians.
The Blueprint incorporates the requirements for these domains into the evolving EHRS architecture, in support of the respective investment program strategies and with an objective of leveraging the EHR Infostructure to support real world projects in these domains.
第二版蓝图进行了哪些更新
在第一版蓝图发布后，Infoway要求增加两个额外的健康域：远程医疗和公共健康监督。由于加拿大幅员辽阔和人口分布广泛，从公众遭遇SARS和西尼罗病毒的清醒教训中，我们可以很容易理解这些机制对于医疗服务以及保护和提升加拿大人健康的重要性。
这份蓝图将这些域的需求纳入了EHRS发展的体系结构中，用来支持各自的项目投资策略，并且调整EHR信息结构以支持这些领域在现实世界中的项目。
Telehealth
For Telehealth, the key requirement is the ability to share consistent and comprehensive EHR information to health service providers and their patients at distances from each other. The essence of the Blueprint is enabling this sharing of information wherever it is required, and in the ability to see a consistent view of that information, regardless of the viewer’s location and in addition to the abilities of local applications and the information they hold.
For this reason, Telehealth requirements were met in the Blueprint by extending the representation of how the EHRS would meet these needs for different purposes. The EHRS architecture was already well suited for supporting this program as we already had a key requirement of sharing clinical information across geographies.
远程医疗
对于远程医疗，关键要求是能够分享一致和全面的EHR信息给相距甚远的卫生服务提供者和病人。蓝图的本质是使得信息在所有需要的情况下能够进行共享，并有能力看到一个一致的信息视图，而不用管浏览者的地理位置、以及本地应用程序的能力和它们保存的信息。
为了满足远程医疗的需求，蓝图扩展了EHR满足不同的目的的表现方法（representation）。EHRS体系已适用于支持这项计划，因为我们已经有了一个横跨地域分享临床资料的关键性要求。
Public Health Surveillance
In the case of Public Health Surveillance (PHS), the impact to the Blueprint was much more far reaching. When considering the needs of PHS, it became clear that the concept of EHR infostructure was much more than a convenience, it could and should be an integral component of a set of applications that are being developed in conjunction with the development of a consistent set of standards for capture and use of information for PHS purposes. As a result, PHS introduced the concept of value-add “Ancillary” services that take advantage of the infostructure to leverage EHR data for health surveillance purposes. For example, public health provides rely heavily on information that is core to the EHR, such as immunization history and laboratory test results.
In addition, the PHS program brings to the Blueprint the need to represent the use of Data Warehousing in a secure context for analysis.
公共卫生监督
公共卫生监督(PHS)方面，对蓝图的影响更为深远。当考虑PHS的需要时，EHR信息结构的概念变得十分清晰的是：它应该更为通用。它可以而且应该是一套正在研制与开发的完整的应用和一套正在发展的一致性标准组成，用来捕捉和利用信息以达到PHS的目标。作为一个结果，PHS采用增值"辅助"服务的概念来利用信息结构的优势，用EHR数据达到卫生监督的目的。举例来说，公共卫生预防依赖HER核心的大量的信息，诸如免疫史和实验室测试结果。
此外，PHS项目向蓝图提出了在安全的环境下将数据仓库用于分析的需求。
Privacy Security Architecture
This version of the Blueprint is also aligned with the Privacy and Security Architecture (PSA), another project funded and led by Infoway. The PSA is a Canadian first, developed with the collaboration of all Canadian jurisdictions, in consultation with numerous other stakeholders, and with the privacy and security subject matter experts. It addresses the requirements for protecting the confidentiality and privacy of personal health information in the EHR on a pan-Canadian basis.
This is a complex and critically important component of the Blueprint. While each jurisdiction has its own policy related to securing personal health information, every jurisdiction and its stakeholders must be able to trust that their requirements are satisfied with the most appropriate privacy enhancing strategies and technologies when placing or accessing information in the EHR.
The Privacy and Security Architecture has been available publicly for some time now, and it is being formally published in concert with the Blueprint v2 as it has shaped many aspects of the architecture, particularly in the Common Services section.
隐私安全体系
这个版本的蓝图，也符合隐私和安全架构(PSA)，PSA是另一个由Infoway投资和领导的项目。PSA是加拿大人的首要关注，所有加拿大区域医疗管理机构合作进行开发，请教了众多其他利益相关者和隐私安全方面的专家。它注重在全加拿大人EHR的基础上保护个人健康资料的机密性和隐私性的需求。
这是蓝图中一个复杂而重要的组成部分。每个区域医疗管理机构都有自己的相关政策来获取个人的健康信息，因此每个区域医疗管理机构及其利益相关者都需要确认，通过最合适的增强的隐私策略和技术，在存入和获取EHR信息时，，他们的要求能够得到满意的解决。
隐私安全体系现在已公开一段时间，在正式出版时，它将与第二版蓝图保持一致，因为它已在多个方面形成了体系结构，特别是在公共服务方面。
EHRS Reference Architecture
Another major addition to the Blueprint in this version is the EHRS Reference Architecture (ERA). TheReference Architecture defines the set of formalisms, or documentation patterns, which express in a structured manner both the requirements for the interoperable EHR and the components and mechanisms to meet those requirements. The ERA includes:
o Clinical Reference Framework or the “Life of the Lamberts”. This is the set of use cases developed by Infoway to document our assumptions about the context for use of the interoperable EHR and the clinical requirements for communicating information. These use cases are not intended to represent every possible process in health care, but rather to focus on how EHR information is to be collected, shared and used in clinical decision making.
o EHRi Conceptual Data Model. This model provides a representation of how the Shared Health Record component of the EHR should be structured to flexibly support information collected and used in many different care settings and disciplines.
o EHR Interoperability Profiles. These are high level specifications of the mechanisms used by Point of Service applications to interact with the EHR infostructure.
o Infostructure Interoperability Profiles. These are high level specifications of how requests for placing or accessing data in the EHR are handled within the EHR infostructure.
All of the information in the ERA has been represented using Unified Modeling Language representations and captured in an automated tool that has resulted in a repository of specifications that can be reused by projects with UML capable software engineering tools.
EHRS参考架构
蓝图的另一个重大变化是EHRS参考架构（ERA）。该参考架构定义一套形式，或是文件模版，它们以结构化的方式既表达了互操作性EHR及组件的需求也表达了满足这些需求的机制。ERA包括：
临床参考框架或"兰贝茨的一生"（Life of the Lamberts）。这是一套Infoway使用用例（use case）开发的文档，我们假设背景使用的互操作的EHR和临床所需传递信息。这些用例无意表达一切诊疗过程，而只是把重点放在EHR信息在临床决策中是如何收集、共享和使用。
EHRi概念数据模型。这一模型描述了HER的共享健康记录部分如何实现结构化以应灵活地支持在大量不同的医疗环境和学科中进行信息收集和使用。
EHR互操作性规范。这些是高层次机制的规格说明，用于医疗服务点与EHR信息结构互动。
信息结构互操作规范。这些是高层次的规格说明，用来说明在HER信息架构内存储或访问EHR数据的请求如何处理。 ERA中的所有信息使用统一建模语言表达，被一个自动化工具管理，作为一个规格知识库存放，任何项目均可以通过UML软件工程工具重复使用它们。
Functioning Principles
As Blueprint v2 evolved, there were many assumptions made that, once implemented in the architecture, can no longer be considered assumptions anymore: they are now principles about the function of EHR Infostructures and EHR Solutions that need to guide detailed design and development of solutions.
功能法则（Functioning Principles）
随着蓝图第二版的进展，原存的许多假设，随着这个体系的实施，就再也不能被视为假设：现在它们成为HER信息架构和HER解决方案的法则，这些法则将指导HER解决方案的详细设计与开发。
What is Different in Blueprint v2
The current version of the Blueprint expresses many aspects of the architecture in more detail, expanding on the previous work and providing additional information.
什么是第二版蓝图的不同点
目前版本的蓝图明确了更为详细的体系结构，扩展了以往的工作，并提供更多的附加信息。
Longitudinal Record Services (LRS)
The Blueprint diagram exposes the concept of Longitudinal Record Services (LRS). The LRS is responsible for all the business services (e.g. rules, data quality, normalization) and data access services (e.g. find, read and write a person’s personal health information) that are required at the heart of an EHR solution. None of the services represented within this concept are really new, however it was realized that specifying these services separately from the Common Services greatly facilitated understanding of how the multiple repositories and registries are managed in the EHR infostructure.
纵向记录服务（LRS）
蓝图的图表展示了纵向记录服务（LRS）的概念。LRS负责所有事务服务（如规则，数据质量，规范）和数据访问服务（例如查询，阅读和记录某个人的健康资料），是EHR解决方案必需的核心。没有哪个服务概念上有真正的更新，但人们认识到，这些从公共服务（Common Services）中分离出来的特殊服务大大便利了理解在EHR的信息结构中多存储库和多地点注册如何被管理。
Extended Services Description
This version of the Blueprint provides additional detail on the many services expressed in the original version. Basic execution patterns for invoking Infostructure services have been provided and more detailed descriptions of the various functions within the services are provided.
扩展服务描述
这个版本的蓝图在原版本基础上提供了许多服务更多细节上的体现。提供了调用信息结构服务的基本执行模式，而且对在服务中的各项功能提供了更详细的说明。
Infostructure Configurations and Potential Interim States
The Blueprint now more fully expresses the possible deployment models for Blueprint based architectures in small, medium-sized, and large jurisdictions.
信息结构配置和潜在过渡状态
蓝图现在更充分的说明了在小型、中型、大型的区域医疗管理机构中以蓝图为基础架构的可能部署模式。
Proposed COTS Configurations
The use of Commercial-Off-The-Shelf (COTS) products as components of a functioning EHR infostructure is also addressed at a high level, providing various configurations for the use of currently available commercial products that would meet the requirements expressed in the Blueprint.
COTS配置建议
利用商业现成（COTS）的产品组成EHR信息结构的功能也在高层次中描述。，在蓝图中提供利用现有的商业产品满足需求的各种配置方案。
New and Extended Value of the Blueprint
The new version of the Blueprint is expressed in terms that should allow vendors and service provider organizations to more confidently engage in high level component and systems design. The Blueprint provides more information on how the various architectural elements must work together as a coherent set of EHR services.
The UML modeling in the EHRS Reference Architecture can be reused by design and development projects, providing a quick start for solutions based around a shared perspective on the high-level requirements.
The “Life of the Lamberts” has been very well received by many audiences, and will serve as a powerful baseline for continuing to refine and express requirements for EHR Solutions.
蓝图新的和扩展的价值
新版本的蓝图是让厂商和医疗服务提供组织更有信心从事高层次组件和系统设计。蓝图就各种体系元素如何一起作为一个连贯完整的EHR服务提供更多信息。
EHRS参考架构中的UML建模在项目设计和开发中可以重用，提供了基于共享视图的高层次需求的解决方案的快速启动。
"兰贝茨的一生"已经成为许多拥护者认可的标准，而且将会成为一个强大基线进行持续改进，并体现EHR解决方案的需求。
How the Blueprint is Applied Today
In the course of creating version 2 of the Blueprint, Infoway shared much of the work-in-process with our jurisdictions. Working closely with Infoway, some jurisdictions have already used the Blueprint v2 materials in their tendering processes for EHR related products and services.
In addition, the early EHR projects across Canada have been relying upon the new representation for their planning and EHR Solutions design.
The Blueprint is actively being used by the all of our standards projects, which were underway at the time of this publication. This project is tasked with the core set of messages for Point of Service applications to interface with the EHR infostructure. The message and terminology specifications produced by these projects are a direct extension of the Blueprint.
在现在如何应用蓝图
在创作第二版蓝图的过程中，Infoway已经与区域医疗管理机构分享了许多工作过程（work-in-process）。在与Infoway紧密的工作联系中，一些地方已经在他们EHR相关产品和服务招标过程采用第二版蓝图的材料。
此外，在加拿大各地（across Canada）较快的EHR项目已经在他们的规划与EHR解决方案设计中依赖蓝图新的陈述说明。 我们所有的标准项目（这些项目在本书出版过程中已在实施中）均实际使用了蓝图。。这个项目是负责一套核心消息机制服务于医疗点应用与EHR信息结构的接口。这些项目所产出的消息和术语规格是蓝图的直接扩展。
How the Blueprint Will Be Maintained and Extended
Looking to the Future (Near and Far)
Infoway fully understands that we have a responsibility to our jurisdictional partners to sustain and continue to evolve the Blueprint as the roadmap for interoperable EHR solutions.
The EHRS Blueprint v2 is the last planned major revision. From this point forward the Blueprint will be decomposed into its various logical sections and the resulting documents will be loaded into the Infoway Artefacts Repository (AR) where they will be managed and new releases version controlled.
The Artefacts Repository is a tool that includes a web-enabled database that holds many knowledge artefacts from the Blueprint, as well as from Infoway’s standards projects, and the projects in each investment program. The AR categorizes the content and provides information on each artefact stored in it. It is publicly accessible, and can accept submission of artefacts from external sources as well.
将如何维护和扩展蓝图
展望未来（近期和远期）
Infoway充分理解，我们对区域医疗管理伙伴的责任，维护和持续发展蓝图作为互操作EHR解决方案的路标
第二版EHRS蓝图是计划中的最后的主要版本。以后蓝图将分解成各种逻辑片段，形成的结果文件将装入Infoway的构件库（Artefacets Repository，AR），这样它们就能被管理并在发布新版本时得以控制。
构件库是一个工具，包括一个基于Web的数据库，其中保存着许多来源于蓝图、Infoway的标准化项目及其他每个投资项目的知识构件。AR对储存的每个构件内容进行分类，并提供资料。这个数据库是公开的，并能接受从外部来源提交的构件。
In Conclusion: Many Thanks
Infoway is both inspired and humbled by the incredible energy, passion, and dedication to this work shown by our collaborators and stakeholders across the country. We understand that adherence to a higher level architectural framework means that EHR project teams must think beyond their local requirements. With many pressing issues needing to be addressed, thinking on a pan-Canadian scale is not easy. Yet we have seen a willingness to embrace the Blueprint concepts and embed them in planning and actions that go beyond the imperative of Blueprint conformance as eligibility criteria for Infoway investments. Our team at Infoway hopes this document reflects those contributions.
As jurisdictions invest in implementing the Blueprint, it has become much more than an Infoway artefact. This belongs to the Federal / Provincial / Territorial jurisdictions, it belongs to the country. All Canadians should be proud of the commitment and passion that their health community has for realizing the benefits that Electronic Health Record Solutions can bring. The Blueprint is one component of “bringing the vision of the EHR to life” for the benefit of all Canadians.
结论：非常感谢
Infoway是充满灵感和谦卑的，我们全国各地的合作者和利益相关者在这项工作中展示了不可思议的活力、激情和奉献。我们了解到坚持更高层次的体系框架意味着EHR项目团队必须考虑超越他们自己本地的需求。许多迫切的问题需要解决，考虑到整个加拿大的范围是不容易。然而，我们看到了愿意接受蓝图概念并将其嵌入在规划和行动中，已经超越了与蓝图一致作为Infoway投资合格标准的强制要求。我们Infoway的团队希望这份文件反映了这些贡献。
区域医疗管理机构投资实施蓝图，已远远超过Infoway的范围（an Infoway artefact）。它属于联邦/省/地区区域医疗管理机构，它属于国家。所有加拿大人应为这个承诺而感到自豪和为他们的健康社区已认识到电子健康记录可以带来的好处而激动。蓝图是"bringing the vision of the HER to life"的一个组成部分，将造福所有加拿大人。
Santé !
Dennis Giokas Chief Technology Officer Canada Health Infoway Inc.
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