David A. Koff MD

1
????????????????

• David A. Koff MD
• McMaster University, Hamilton
• ZHE FENG MD
• Sunnybrook Health Science Centre, Toronto

2
????
????????????????????????????.
??????????. ??????????????????????????????.
gt 100 km
3
??

• Telehealth ??????????. ????, ??,?????????.
• Telemedicine ?????????????????????.
• Teleradiology ?????????????????????.
  ????????/???.
• Teleradiology ???90???????.
• ?????Telehealth???????????.

4
????

• ???????????Telehealth???
• ????100??Telehealth??????.
• ????Telehealth??????????.
• ?????????,??????????????.

5
??

• ???????????
• ??????????????
• ????????????.
• ??????
• ???????80??.
• ??????
• ???????????
• ???PACS??

6
??????(EHR)

• ??????????????????????????????????.

7
???EHR?

• ??????????????????????, ??????????.
• ????????????????????????????????????????.
• ??, ??9????????????.

8
Canada Health Infoway

• Canada Health Infoway
• ????2001?????????????, ?????10???3??????????????.
• ??
• ???????????????????, ???2009???????50???,
  2016????????????????????????.

9
Canada Health Infoway

• Infoway ????????
• ???????50?50???????
• ???????
• ???????????????????

10
Infoway?????
???????????
????? - 6??
??????
???????? - 1?7?5??
???????1?5??
??????1?
??????3?1??
??????1?8?5??
???????
??????1?5??
??????
??, ???, ???? - 1?3?5??
???????
???? - 2?5??
11
????
End-user Adoption and Setting the Future Direction
Innovation Adoption - 60m
The Electronic Health Record
Interoperable EHR - 175m
Laboratory Information Systems150m
Public Health Systems100m
Diagnostic Imaging Systems310
Drug Information Systems185m
Domain Repositories and Healthcare Applications
Telehealth150m
Cross Program Components
Client, Provider and Location Registries - 135m
???????
???? - 2?5??
12
????

• ????????????, ????????????.
• ??????????????????
• ??????????(????,??,??,??,?)
• ?????????????, ?????????????

13
?????

• ????????
• CAR (????)
• ACR (????)
• ????
• IHE (????)
• ????????
• DICOM
• JPEG and JPEG 2000
• TIFF
• BMP
• ????????
• HL7 v3
• CCR (Continuity of Care Record) - ASTM
  International
• ???????
• ITU-T H.323/H.320 ???????
• ITU-T T.120 ????

14
????

• ???2006???????????????????????,??????????????????.
  
• ??Infoway????????????,??, ?????Infoway????????????
  ?.

15
????

• ???????????????????(CIHI)???????.
• - ???????????
• - HL7?????
• DICOM (????????)
• ???????(CSA)--ISO/TC 215.

16
??,???,????
End-user Adoption and Setting the Future Direction
Innovation Adoption - 60m
The Electronic Health Record
Interoperable EHR - 175m
Laboratory Information Systems150m
Public Health Systems100m
Diagnostic Imaging Systems310
Drug Information Systems185m
Domain Repositories and Healthcare Applications
Telehealth150m
??????
??, ???, ???? - 1?3?5??
Architecture and Standards
Infostructure - 25m
17
??, ???, ????

• ??????,????,??????.
• ???? ???????????
• ????? ??ID,???,??,??,?
• ?????? ??,??,?????.

18
??????
End-user Adoption and Setting the Future Direction
Innovation Adoption - 60m
The Electronic Health Record
Interoperable EHR - 175m
Laboratory Information Systems150m
Public Health Systems100m
Diagnostic Imaging Systems310
??????1?8?5??
???????
Telehealth150m
Cross Program Components
Client, Provider and Location Registries - 135m
Architecture and Standards
Infostructure - 25m
19
??????

• ?????? ???, ???, ??????.
• ???????????????????(EHR).
• ????????????.

20
???????
End-user Adoption and Setting the Future Direction
Innovation Adoption - 60m
The Electronic Health Record
Interoperable EHR - 175m
???????1?5??
Public Health Systems100m
Diagnostic Imaging Systems310
Drug Information Systems185m
???????
Telehealth150m
Cross Program Components
Client, Provider and Location Registries - 135m
Architecture and Standards
Infostructure - 25m
21
???????

• ???????????????????.
• ??????????????????( EHR )?.

22
??????
End-user Adoption and Setting the Future Direction
Innovation Adoption - 60m
The Electronic Health Record
Interoperable EHR - 175m
??????3?1??
Laboratory Information Systems150m
Public Health Systems100m
Drug Information Systems185m
???????
Telehealth150m
Cross Program Components
Client, Provider and Location Registries - 135m
Architecture and Standards
Infostructure - 25m
23
??????

• ?????
• ???????????????????? ????, ???????.
• ??????????150????,?IHE-???RIS??.

24
?????
22 ??? PACS/Archive Solutions (DI-r)
??
??
??
??
25
????????

• ????
• ????????
• ??????. (??1?3?2??/?)
• ??????
• ????
• ???????????25-28
• ??????????10-12
• ???????????

26
????????

• ????
• ??????(32-40?)
• ??PACS ?? ?????40.
• ????????
• ??10???74?, ???91?.

27
??????

• ?????? (CT, MR, X-Ray, ultra-sound, etc.)
• ?? IHE ?EHR(HL7/DICOM ?????????????)
• ??????????????.

28
?????XDS??????????? IHE-Canada??XDS-I????????.
IHE

• ????????????
• ??????
• ???????

??
PACS Y
????
??---????
PACS Z
????
?????
29
????

• ???
• ???????????, ???????????.
• ??????????.
• ???????4?????????
• ???????????7?.
• ??101??????????????????.

30
????

• ????
• ???????????????????, ?????????100
  mbps?????????????
• EHR ???????????????,?????????????????????

31
????

• ?????????, PACS/Teleradiology ????????DICOM JPEG
  ? JPEG-2000??????????????????.
• ????????????????????.

32
????

• ????????????Infoway??, ?Sunnybrook ????.
• ????, CHI ?????2 ??????2?????.
• 9???????????????

33
??

• ??????,???????????????
• ?ROC???????????
• ?JND????

34
??

• 3???, 23??, ??????100???????.
• ?????????DICOM??????????.
• ??????????.
• ???????,???????.

35
?????
???????
36
????
JPEG 2000 151 ORIGINAL
37
??
JPEG 2000 201 ORIGINAL
PNEUMOTHORAX
38
Examples
JPEG 2000 251 ORIGINAL
CALCIFICATIONS
39
??
?18 ????/????????, ??3?????.
40
??
41
??
42
??
43
J2K ? JPG ??
J2K 151
JPEG 151
???????
???????
JPEG 2000 ?????????,????????????????
44
??

• ?????????????????.???????????????.
• ????????,????JPEG ? JPEG 2000 ????

45
?? ???
CR/DR CT US MR NM MG
??? 10-15 16-24
?? 20-30 JPEG 10-15 J2K 10 8-12 16-24 9-11
?? 8-12 16-24 15-25
?? 20-30 10-15
???? JPEG 20-30 J2K 20 10-15 8-12 16-24
?? JPEG 8-12 J2K 8 16-24
?? 20-30 10-15 8-12 16-24 9-11
46
??????
End-user Adoption and Setting the Future Direction
Innovation Adoption - 60m
The Electronic Health Record
Interoperable EHR - 175m
Laboratory Information Systems150m
??????1?
Diagnostic Imaging Systems310
Drug Information Systems185m
???????
Telehealth150m
Cross Program Components
Client, Provider and Location Registries - 135m
Architecture and Standards
Infostructure - 25m
47
??????

• ?????????????????????, ??, ??.
• 2004?3?,??SARS???????????????????????????????????,
  ??????Infoway????????????????????.

48
????????
End-user Adoption and Setting the Future Direction
Innovation Adoption - 60m
The Electronic Health Record
Interoperable EHR - 175m
Laboratory Information Systems150m
Public Health Systems100m
Diagnostic Imaging Systems310
Drug Information Systems185m
???????
??????1?5??
Cross Program Components
Client, Provider and Location Registries - 135m
Architecture and Standards
Infostructure - 25m
49
??????

• ??????????????????????????.
• ??????
• -???(????,????,)
• -???(????,??????)
• ???(?????,????,???????
• ???????????

50
????????
End-user Adoption and Setting the Future Direction
Innovation Adoption - 60m
??????
???????? - 1?7?5??
Laboratory Information Systems150m
Public Health Systems100m
Diagnostic Imaging Systems310
Drug Information Systems185m
Domain Repositories and Healthcare Applications
Telehealth150m
Cross Program Components
Client, Provider and Location Registries - 135m
Architecture and Standards
Infostructure - 25m
51
?????????

• ????????????????????????????.
• ???, ??????HER????????????, ??HER ????.
• ????HER??????????, ????????,?????????.

52
?????
???????????
????? - 6??
The Electronic Health Record
Interoperable EHR - 175m
Laboratory Information Systems150m
Public Health Systems100m
Diagnostic Imaging Systems310
Drug Information Systems185m
Domain Repositories and Healthcare Applications
Telehealth150m
Cross Program Components
Client, Provider and Location Registries - 135m
Architecture and Standards
Infostructure - 25m
53
?????

• Infoway ??EHR???????
• ????
• ?????
• ?????????????????.
• ??????.

54
??

• ??????????????????????, ?????????. ?2010??,
  ????Infoway ?????50??????.
• ??????????????.

55
??

• ? ? !