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題名:建置符合IHE架構之高安全性雲端電子病歷交換模式之研究
作者:吳建樺
作者(外文):WU,CHIEN-HUA
校院名稱:輔仁大學
系所名稱:商學研究所博士班
指導教授:邱瑞科
葉宏謨
學位類別:博士
出版日期:2016
主題關鍵詞:電子病歷IHERESTFul雲端運算資訊安全WCFElectronic Medical RecordsIHERESTfulCloud ComputingInformation SecurityWCF
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電子病歷交換不僅可以減少紙本病歷的保存與使用等管理的問題。對病人而言醫師可以迅速的調閱其在不同醫院的就診病歷,避免醫療資源的浪費。我國衛生福利部導入並推行電子病歷交換,醫院間透過電子病歷中心在健保VPN的環境內使用EEC 閘道器進行電子病歷交換至今已有相當成效。截至2016年5月已完成EEC建置可以進行電子病歷交換的醫院共計 405 家。目前可以進行跨院交換的電子病歷分別為醫療影像及報告、血液檢驗、出院病摘、門診用藥紀錄及門診病歷等五類單張交換服務。醫師透過自己的醫師卡以及病患的健保卡可以調閱最近六個月內 的電子病歷資料。
本研究基於IHE國際的XDS、ATNA以及CT等整合規範,使用TLS的安全機制於Windows Communication Foundation (WCF)框架上採用RESTFul Service來於建置一套具安全性且適用於雲端運算的電子病歷交換機制。本研究運用數位憑證來進行伺服器端的身分驗證以及電子病歷傳送過程中的加解密來確保其病歷的安全性。本研究並於Microsoft Azure雲端運算平台建置了一套符合IHE且具安全性的電子病歷交換機制,本研究設計了四種實驗情境的模擬與實驗以驗證為了驗證本雛型系統的可行性。從四種實驗情境的實驗結果顯示本研究能成功地於各種應用情境安全地進行電子病歷的上傳與調閱。本研究更進一步分別於Microsoft Azure雲端運算平台進行Web Services與RESTful Services的交換效能比較。四種應用情境的實驗結果SOAP結合Web Services 的總平均花費時間為5.311秒,XML結合RESTful Services 的總平均花費時間為2.612秒,實驗結果顯示本研究所提出的RESTful Services方法優於Web Services方法。驗證結果顯示本研究符合IHE架構,運用RESTful和TLS的安全機制可以有效提升現有電子病歷交換效能並且於電子病歷交換過程中可以達到電子病歷於交換時的機密性、完整性和可驗證性。
The exchange of electronic medical records can not only reduce the paper of the presentation of medical reports but also the management issues of use. For patients, physicians can quickly access to their medical records for treatment resulting to avoid the waste of medical resources. It has been quite effective so far since the Ministry of Health and Welfare established and implemented the exchange of electronic medical records. To the end of May 2016, the hospitals take the exchange of electronic medical records through EEC gateways over the VPN environment has reached the total number of 405. At present, it may proceed to cross-institutional exchange of electronic medical records that include the exchange services of five leaflets, which are medical images and reports, blood tests, the disease summary of discharge, outpatient medication records and patient medical records. Physicians can use their physician cards and a patient’s national health insurance IC Card to access the patient’s recent electronic medical records within last six months.
This study aims to implement a secure but suitable for cloud computing EMR exchange mechanism which is based on the integrated standards of IHE XDS, ATNA, and CT as well as use the TLS security mechanism with the adoption of the framework of RESTFul Service on Windows Communication Foundation. In this study, the digital certificates is used to verify the identity in the server-side and the encryption and decryption of medical records are taken in the process of the the transferring to protect the security of electronic medical records. The study also established a highly secure EHR exchange mechanism on Microsoft Azure cloud computing platformin in conformity with IHE framework. There are four scenerios designed for system simulation and experiment in order to verify the feasibility of the prototyping system. The experimental results show the system can successfully proceed to the upload and retrieval of EMR. The Microsoft Azure is also taken to be the cloud computing platform for the comparison of exchange performance between Web Services and RESTful Services.The results of four experimental scenerios show that RESTful Services (2.612 seconds) are superior to Web Services (5.311 seconds). The results of verification show that the comformity of IHE and the use of RESTful and security mechanism of TLS may effectively enhance the process of existing exchange of electronic medical records as well as may achieve confidentiality, integrity, and verifiability of electronic medical records at the time of the exchange.
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