JP2005044321A - Electronic medical record system in wide area network environment - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide an electronic medical record system that enables a terminal device connected via a wide area network such as the Internet to interactively image-process image data associated with an electronic medical record and observe the image-processed image. <P>SOLUTION: A high speed data processing device is installed near the network of a PACS server for saving medical image data. An electronic medical record creation device attaches information and image processing parameters about image data used at an image diagnosis to an electronic medical record. The electronic medical record browsing terminal device uses the information attached to the electronic medical record to send the information for image data acquisition and the image processing parameters to the data processing device near the PACS server saving the image data. The data processing device acquires and image-processes the image data according to the information and parameters, and sends the created image to the terminal device. Related information is likewise acquired and displayed. The terminal device can thus interactively process and display the image and information associated with the electronic medical record. <P>COPYRIGHT: (C)2005,JPO&NCIPI

Description

Detailed Description of the Invention

Technology to which the invention belongs

  The present invention relates to a system for creating and browsing electronic medical records and using medical image data in a wide area network environment such as the Internet.

  Electronic medical records called electronic medical records are being promoted. Usually, not only medical records but also information related to medical care such as diagnostic imaging reports, nursing records, and blood test data are electronically recorded in the electronic medical record. By intensively recording patient medical information such as medical records, diagnostic imaging reports, nursing records, blood test data, etc. in the electronic medical record, access to medical data becomes quicker and double tests occur. It becomes possible to prevent.

  Usually, an electronic medical record is stored as an electronic file in a server of a hospital information system (hereinafter referred to as HIS) of a medical facility where a patient is treated, and is used in the medical facility. In this case, an electronic medical record of a patient exists in each medical facility that the patient visits. Recently, attempts have been made to record an electronic medical record on an offline recording medium having a security function such as an IC card. In this case, by sequentially recording the electronic medical record on the patient's individual IC card, the patient has been to the hospital so far, even if the patient has visited at a different medical facility By browsing electronic medical records created at medical facilities, it is possible to refer to past medical history.

  Important information related to medical treatment of patients is information related to medical image examinations. In general, medical image inspection is performed in an image diagnosis department by a medical image diagnosis apparatus such as an X-ray apparatus, an X-ray CT apparatus, a nuclear medicine diagnosis apparatus, an ultrasonic diagnosis apparatus, or an endoscopy apparatus. In many cases, medical images collected by an image diagnostic apparatus are subjected to image diagnosis called interpretation by an image diagnostician. The result of image diagnosis is described in the image diagnosis report and sent to the requesting department.

  Conventionally, an X-ray image taken by an X-ray apparatus is observed on an X-ray film, and a medical image collected by a digitized medical image diagnostic apparatus such as an X-ray CT apparatus is also printed on the film and observed. However, recently, in order to improve the storage and distribution of medical images, medical images are stored as digital data on a server, delivered to an image display device via a network as needed, and image storage for observation. A communication system (PACS) has been introduced.

  Conventionally, the results of image interpretation performed by an image diagnostician are handwritten on a sheet of an image diagnosis report and delivered to the requesting department. Instead of handwriting, it is also created using a word processor and printed on paper. In these cases, the image information that is the basis of the image diagnosis is transmitted from the image diagnosis doctor to the request department by a handwritten sketch called a schema written in the image diagnosis report. Recently, an increasing number of hospital information systems (hereinafter referred to as HIS) store image diagnostic reports created using personal computers and send them to requesting departments. In this case, the diagnostic imaging report is stored as an electronic file on the personal computer and sent to the terminal computer of the request department or by e-mail. In these cases, in order to reduce the amount of data that passes through the network, the image that is the basis of the image diagnosis is an image that has been reduced in size, reduced in image density resolution, and greatly reduced in the number of images. Attached to the diagnostic report. For example, in recent X-ray CT examinations, one examination may generate hundreds to thousands of image data with a pixel number of 512 × 512 and a depth of 16 bits. The number of pixels is 256 × 256, and an image having a depth of 8 bits is attached to one or two images.

  In recent X-ray CT examinations or MRI examinations, a three-dimensional image is created and image diagnosis is started by observing the three-dimensional image. 3D images can be viewed from multiple perspectives by displaying the object in three dimensions and interactively changing the direction of the line of sight, so that not only diagnostic imaging doctors but also orthopedic surgeons in the request department Very useful information can be provided for the operation plan to be performed. However, since the amount of data passing through the network becomes enormous, it is difficult for doctors in the request department to create 3D images. The image attached to the diagnostic imaging report is only about attaching one or two two-dimensional images obtained by projecting a three-dimensional image at a certain angle, and a three-dimensional image useful for the requesting department is not utilized.

  As described above, the reason why the images that can be used by the requesting department are limited is that the network bandwidth from the image diagnosis department to the requesting department is narrow, and sufficient image data cannot be supplied to the requesting department. In general, hospitals have a large number of request departments and a large number of computer devices for user terminals. For this reason, it is often difficult to construct a high-speed network in all user terminal computer devices.

  This diagnostic imaging report is also recorded in the electronic medical record along with other medical information. When the electronic medical record is distributed via a network, the number of images that can be attached to the electronic medical record is limited by network traffic. In addition, when an offline recording medium having a security function such as an IC card is used as a recording medium for the electronic medical record, the number of images that can be attached to the electronic medical record is limited by the storage capacity of the recording medium. .

  Recently, cooperation between the main hospital and clinics has progressed, and medical image inspection of patients who have come to the clinic has been outsourced to the main hospital. In this case, the patient who visits the clinic will undergo a medical imaging examination at the core hospital. The diagnostic imaging doctor at the main hospital interprets the medical images acquired by the medical imaging examination and creates a diagnostic imaging report. This diagnostic imaging report is sent to the requesting clinic along with the medical image printed on a film or the like. The doctor at the requesting clinic determines the medical condition of the patient from the diagnostic imaging report sent from the basic hospital and the medical image printed on the film.

  With recent advances in wide area networks such as the Internet, it has become possible to connect medical facilities with wide area networks. Therefore, I would like to create and observe images at the clinic using the medical image data stored in the core hospital when the patient visits the clinic by connecting the clinic and the core hospital with a wide area network. There is also a demand to create and observe 3D images. However, at present, the bandwidth of a wide area network such as the Internet is narrow, and it is almost impossible to transfer a large amount of data for medical image inspection from a hospital to a clinic, so these demands have not been realized.

  FIG. 1 is a block diagram showing a conventional image diagnosis apparatus, data storage apparatus, image processing display apparatus and network environment in a basic hospital and clinic. Reference numeral 101 denotes a wide area network such as the Internet. 111, 112, 113, and 114 are basic hospitals, and 115 is a clinic. Reference numeral 116 denotes an image data storage center such as a data center. The basic hospitals 111, 112, 113, 114, the clinic 115, and the image data storage center 116 are connected to the wide area network 101. A connection device 131 connects the wide area network and the network in the hospital / clinic / image data storage center, and 132 indicates a network in the hospital / clinic / image data storage center. 133 is a data storage device for storing medical image data such as an image storage communication system (PACS), and 134 is an image network. Reference numerals 141 and 142 are examples of diagnostic imaging apparatuses. 151 and 152 are examples of the image processing display device. An X-ray CT apparatus 141, which is an example of an image diagnostic apparatus, collects X-ray projection data of a plurality of cross sections of a subject, and performs image reconstruction processing on the projection data to create multi-section image data. A data storage device 133 as a PACS server stores image data created by collecting and reconstructing images with a plurality of diagnostic imaging apparatuses such as an X-ray CT apparatus 141, and transfers it to a user as necessary. The network 134 is a high-capacity and high-speed network that transfers a large amount of image data from the X-ray CT apparatus 141 to the PACS server 133. The image processing display device 151 acquires the image data stored in the X-ray CT device 141 or the PACS server 133 via the network 132, and uses this image data to create a two-dimensional, three-dimensional, and four-dimensional image. An image diagnostician who performs image diagnosis uses the image processing display device 151 to acquire image data from the X-ray CT apparatus 141 or the PACS server 133 via the network 132, and uses this data to generate a two-dimensional image. Image processing and observation, 3D and 4D image creation and observation.

  The image diagnostician uses the image processing display device 151 to perform image processing and observation of 2D images, creation and observation of 3D and 4D images, and create an image diagnosis report based on the findings obtained thereby. To do. At this time, the image that is the basis of the findings of the diagnostic imaging report is attached to the diagnostic imaging report. As described above, the image diagnosis report includes only one or two images of 256 × 256 pixels and a depth of 8 bits. Even when a three-dimensional image is created and image diagnosis is performed, the image data that can be attached to an image report is only one or two two-dimensional images obtained by projecting the three-dimensional image onto a certain surface. When the requester is in the same hospital, the image diagnosis report created by the image diagnosis doctor is delivered to the requesting department via the hospital network or printed on paper. If the client is another medical facility, it is delivered to the requesting facility via a wide area network such as the Internet, or printed on paper and mailed.

  In FIG. 1, if the request source facility is 115, the doctor in charge of the request source facility 115 desires to access the image data stored in the data storage device 133 of the basic hospital 111 to which the image inspection is entrusted. May attempt to access the PACS server 133 of the requesting hospital 111 via the wide area network 101 such as the Internet by operating the image processing display device 151 of the requesting facility 115, or using an e-mail or a letter. The person in charge at the requesting hospital 111 is requested to transfer the image data from the PACS server 133 of the requesting hospital 111 to the requesting facility 115.

  In either case, there are security and privacy protection problems, and access is often not permitted. Also, transferring a large amount of image data via the wide area network 101 such as the Internet greatly increases network traffic, which is technically difficult and is not preferred.

  In order to cope with these problems, it is considered to install an image data storage center 116 that sufficiently considers security and privacy protection on a wide area network and store image data collected in a medical facility. However, in this case as well, it is difficult to solve the problem of an increase in network traffic caused by transferring a large amount of image data via the wide area network 101 such as the Internet. In addition, the cost of constructing and operating the image data storage center is enormous.

  In the past, attempts have been made to record all medical image examination image data received at all medical facilities visited by patients on portable recording media of individual patients. Is enormous and can quickly fill up with some patients, even with large storage media. Although it is possible to sequentially record on a plurality of portable recording media, if there are a large number of portable recording media that should be protected for privacy, a security problem occurs, so this attempt has not been successful so far.

Problems to be solved by the invention

  The cooperation between hospitals and clinics has progressed, and outsourced medical image inspections of patients who have come to the clinic to a core hospital. In addition, it is desired to use data of medical image inspections performed in a plurality of medical facilities in the past by introducing electronic medical records. Thus, there is a strong demand for using medical image data not only within the same medical facility but also across medical facilities. Since the number of images that can be recorded in an electronic medical record is limited, it is impossible to store a large number of images from a medical image examination of a patient in an electronic medical record, so another means for acquiring image data is required. . However, patient visit schedules are not always planned, and unplanned patient visits often occur. In such a case, there may be a request to immediately obtain the medical image data of the patient stored in another medical facility, but the medical image data of the patient is stored online on a PACS server or the like. However, it is difficult to acquire the data via a wide area network such as the Internet due to the long time required for the transfer and the increase in network traffic. It is also possible to record the patient's image examination data in a large-capacity storage medium and mail it, but it takes time. Attempts to acquire medical image data from other medical facilities in real time have not been realized in accordance with the patient's sudden visit.

Means for solving the problem

  In order to solve the above problems, the present invention installs a high-speed data processing device in the network vicinity of the PACS server. This data processing device acquires image data from a PACS server based on an instruction from a personal computer for viewing and creating an electronic medical record, and creates an image by performing two-dimensional image processing and three-dimensional image processing on the image data. , This image is sent to a personal computer for browsing and creating electronic medical records. The personal computer for viewing and creating the electronic medical chart displays this image, adds a key image as a key for diagnostic imaging to the electronic medical chart, and makes it possible to recreate the key image later. Information and a set of image processing parameters are added to the key image. The created electronic medical record is sent to the requesting facility that requested the medical image inspection online, such as online or via mail. The doctor at the requesting facility uses an electronic medical chart viewing / creating personal computer connected to a wide area network such as the Internet to view the electronic medical chart and store the patient's medical image data in the vicinity of the PACS server. Information regarding image data attached to the electronic medical record and a set of image processing parameters are transmitted to the data processing apparatus. The data processing device reads the designated image data from the PACS server based on the information about the designated image data, and the 2D, 3D, and 3D specified in the image data based on the designated set of image processing parameters. Four-dimensional image processing is performed to create an image, and the created image is sent to an electronic medical chart viewing / creating personal computer. A personal computer for viewing and creating electronic medical charts displays images sent from the data processing server together with the electronic medical charts, which is useful for understanding the electronic medical charts. If necessary, the personal computer for the user terminal changes the image processing parameters and sends them to the data processing server, and the data processing server performs image processing with the changed image processing parameters, and the result is electronic medical chart. Send to a personal computer for viewing and creation.

  Conventionally, only one or two images attached to the electronic medical chart can be viewed at the requesting facility, and it is practically impossible to acquire the data of medical image inspection performed at the requesting facility in real time. However, according to the present invention, when the requesting facility browses the electronic medical record, the information processing apparatus sets a set of information and image processing parameters related to the image data attached to the electronic medical record from the electronic medical record viewing / creation personal computer. Send to. Upon receiving this, the data processing apparatus acquires image data from the PACS server, performs image processing on the image data, creates an image, and transmits the image to the electronic medical chart viewing / creating personal computer at the requesting facility. . The personal computer for viewing / creating the electronic medical record at the requesting facility receives the image obtained as a result of the image processing and displays it. In addition, by transmitting the changed image processing parameters to the data processing apparatus of the requested facility, it is possible to interactively receive images processed with different image processing parameters. Therefore, it becomes possible to deepen the understanding of the contents of the diagnostic imaging report.

  Thus, conventionally, when it is desired to perform image processing of image inspection data at the requesting facility, it is necessary to acquire all the image inspection data from the requesting facility. Using a wide area network such as the Internet, it is virtually impossible to transfer image inspection data between the requested facility storing the image inspection data and the external requesting facility due to network traffic problems. there were. In the present invention, it is not necessary to transfer the image inspection data between the request destination facility storing the image inspection data and the external request source facility, and information and image processing parameters for specifying the image data are not required. And receiving only the image of the result of image processing, medical use with a huge amount of data such as 3D and 4D image processing using image data collected by a multi-slice X-ray CT apparatus Image processing using image data can be easily realized using a wide area network such as the Internet.

  Conventionally, there are few image processing workstations that can perform 3D image processing in facilities such as clinics, and the creation of 3D images requires specialized know-how. 3D images that can be expected to have a great effect on explanations to patients are only used in the diagnostic imaging department of large hospitals and are rarely used in clinics. The present invention can be expected to promote the application of three-dimensional images.

  The user of the requesting facility clicks on the key image attached to the electronic medical record, and the information regarding the image data and the image processing parameter set are transferred from the personal computer for viewing / creating the electronic medical record to the data processing device of the requesting facility. Send. For example, when viewing a three-dimensional image of X-ray CT image data, specification of X-ray CT data used to create the three-dimensional image and specification of parameters such as a spatial region of the object and a CT value range And projection processing parameters for displaying a three-dimensional image. The data processing apparatus acquires the designated image data from the PACS server, performs a 3D image processing on the image data using the designated set of image processing parameters, creates a 3D image, Transfer to the requesting personal computer. The requesting user displays the image on the personal computer for viewing and creating the electronic medical record. When the image processing parameters are interactively changed while viewing the image on a personal computer for viewing and creating an electronic medical record and transmitted to the data processing device, the data processing device uses the changed image processing parameters to perform image processing. Since the image is created and transmitted to the user terminal, the user of the requesting facility can use the personal computer to perform image processing as if the image processing workstation is at hand. it can.

  For example, the process of creating a 3D image performed by a radiologist can be included in the image processing parameter set, so the referring doctor at the requesting facility reproduces the process of creating a 3D image performed by the radiologist. Compared to the case where a scene of a 3D image created by a radiologist is attached to an electronic medical record and sent to the requesting facility, the radiologist and the requesting facility are inquired. Doctors' communication can be greatly improved, and the understanding of referring physicians can be improved.

  In the present invention, the personal computer for viewing and creating the electronic medical record is information useful for the client in related image examinations and past image examinations, physiological examinations, medical history information, etc. used by doctors for image diagnosis. Is attached to the report as a key image and key information, and information, image processing parameters, and information processing parameters that enable acquisition of the image data and medical information data are added to the key image and key information of the electronic medical record. With the function to do. A personal computer for viewing and creating electronic medical records is a parameter set for acquiring image data and medical information data attached to a key image and key information and image processing and information processing when a user views a report. It has a function to send a parameter set for image processing and information processing in which some of the constituent parameters are changed to the data processing device. The data processing apparatus acquires image data from the PACS server based on the received image data acquisition information and the image processing parameter set, performs image processing on the image data, creates an image, and converts the image into an electronic medical chart. The medical information data is acquired from the HIS based on the function to send to the personal computer for browsing and creation, the received information for acquiring medical information data, and the information processing parameter set, and the user is added with the specified processing. And a function for sending to a terminal device. This makes it possible to interactively display the image related to the key image pasted on the report and the medical information related to the key information on the personal computer for viewing and creating the electronic medical record.

  In the present invention, image data and medical information data such as an image examination, a past image examination, a physiological examination, and medical history information by other types of diagnostic imaging apparatuses besides the key image which is a key for the image diagnosis are obtained by an electronic medical record. It became possible to get. These medical image data and medical information data are collected with great effort during image diagnosis. For example, in a hospital that does not have a complete image management system, each image data is acquired from each image storage system that manages, for example, CT examination, MR examination, and DSA examination. Acquired from the warehouse and acquired physiological examination data from the HIS to interpret image examinations. However, the accumulation of these images has been dissipated once the interpretation has been completed. In the present invention, means for enabling later acquisition of information that the image diagnostician has determined to be important in the accumulation can be integrated in the electronic medical record. By browsing the electronic medical record according to the present invention, not only the user of the requesting facility but also other diagnostic imaging doctors and the diagnostic imaging doctor who created the diagnostic imaging report at any time receive important information about the patient. But it became possible to obtain it immediately. In addition, in the future image examination of the patient, this image diagnosis report can be used to collect past image examination, physiological examination, and medical history information necessary for image interpretation in a short time. It is very useful from the aspect of management and economics.

  In the case of an electronic medical record that records medical records sequentially at a medical facility where the patient consulted on a portable medium such as an IC card owned by the individual patient, when the patient had previously consulted at another medical facility at the patient's visit The electronic medical record can be referred to. In a medical facility that employs the present invention, the patient can click on a key image or key information attached to an electronic medical record when the patient has visited the other medical facility that employs the present invention. In addition, it is possible to access data of examinations received at other medical facilities adopting the present invention and display the images and medical information. This eliminates the need to undergo imaging and physiology every time a medical facility is transferred, helping to reduce patient exposure and improve the medical economy.

A system for creating and viewing electronic medical records and using medical image data in a wide area network environment according to the present invention will be described below. FIG. 2 is a block diagram showing a network environment of a personal computer for an image diagnosis apparatus, a data storage apparatus, a data processing apparatus, and an electronic medical chart browsing / creation terminal apparatus in a basic hospital and clinic according to the present invention.
Reference numeral 201 denotes a wide area network such as the Internet. 211, 212, 213, 214, and 215 are medical facilities, 211, 212, 213, and 214 are basic hospitals, and 215 is a clinic. The medical facilities 211, 212, 213, 214, and 215 are connected to the wide area network 201. Reference numeral 231 denotes a connection device that connects the wide area network and the network in the medical facility, and reference numeral 232 denotes the network inside the medical facility. 233 is a data processing device, 234 is a data storage device for medical image data which is a PACS server, 235 is a medical information server (hereinafter referred to as HIS server) for storing medical information such as an image diagnosis report, and 236 is a data processing device and data. A high-speed network 237 for connecting the storage devices is a high-speed network for image data. Reference numerals 241 and 242 are examples of diagnostic imaging apparatuses. Reference numerals 251 and 252 exemplify a personal computer for an electronic medical chart viewing / creating terminal device used for image display and electronic medical chart creation / display.
An X-ray CT apparatus 241, which is an example of an image diagnostic apparatus, collects X-ray projection data of a plurality of cross sections of a subject, and performs image reconstruction processing on the X-ray projection data to generate image data of a plurality of cross sections. The PACS server 234 stores image data collected and reconstructed by a plurality of diagnostic imaging apparatuses such as the X-ray CT apparatus 241 and transfers it to the user as necessary. The network 237 is a large-capacity and high-speed network that transfers a large amount of image data from the X-ray CT apparatus 241 to the PACS server 234. The data processing device 233 acquires the image data stored in the PACS server 234 and performs image processing on the image data to create a two-dimensional, three-dimensional, and four-dimensional image. An image diagnostician who performs image diagnosis uses the personal computers 251 and 252 to specify medical image data and image processing parameters to the data processing device 233. The data processing device 233 acquires designated image data from the PACS server 234, performs image processing instructed on the image data to create an image, and transfers the created image to the personal computers 251 and 252. In this way, the image diagnostician uses the personal computers 251 and 252 to specify image data, create and observe a two-dimensional image using the image data, and create and observe a three-dimensional / four-dimensional image. be able to.

  In FIG. 2, a case where an image diagnostician performs image diagnosis at a medical facility 211 will be described as an example. The same applies to the medical facility 212, the medical facility 213, and the medical facility 214. X-ray CT image data of the patient imaged by the X-ray CT apparatus 241 is stored in the data storage apparatus 234 that is a PACS server via the network 237. An image diagnostician who performs image diagnosis uses the personal computer 251 to send the patient's X-rays to a data processing device 233 installed in the network vicinity of the PACS server 234 that stores the X-ray CT image data of the patient. Information that can specify CT image data is transmitted. The data processing device 233 that has received the information related to the patient's X-ray CT image data acquires the X-ray CT image data from the PACS server based on the information, and the image diagnostician transmits the image using the personal computer 25. Image processing is performed based on an instruction regarding processing to generate an image, and the generated image is transmitted to the personal computer 251. The personal computer 251 receives this image and displays it. The image diagnostician observes the image displayed on the personal computer 251, changes the image processing parameter if desired, and transmits the change to the data processing device 233 to change the image processing parameter interactively. However, it is possible to receive an image created by image processing with new image processing parameters.

  As an example of image data and image processing, and an image obtained as a result of image processing, for example, in image processing to X-ray CT image data, as an example of two-dimensional image processing, to 16-bit X-ray CT image data Examples of window processing and the resulting 256-level grayscale image, and three-dimensional image processing include volume rendering processing to a plurality of 16-bit X-ray CT image data and the resulting RGB 256-level color image There is.

  The image diagnostician performs image processing and observation of a two-dimensional image, creation and observation of a three-dimensional image, and creates an image diagnosis report of an electronic medical record using a personal computer 251 based on the findings obtained thereby. At this time, a key image that is the basis of the findings of the electronic medical record image diagnosis report is attached to the electronic medical record. In addition, a set of image processing parameters used to create an image that is the basis for the findings of the electronic medical record image diagnosis report is attached to the electronic medical record. This includes a parameter for designating a key image selected from a large amount of image data, an image processing parameter for displaying the key image in an optimum state, a parameter for creating a three-dimensional image, and the like.

  Electronic medical records created by diagnostic imaging doctors are stored in a medical information server (HIS server) 235 that stores medical information such as electronic medical records, and if the requester is in the same hospital, requests are made via the hospital network. It is delivered first or recorded on an offline medium such as an IC card and delivered. When the requester is another medical facility, the encrypted electronic medical record is delivered to a personal computer for browsing and creating electronic charts connected via a wide area network such as the Internet, or is sent to an offline medium such as an IC card. Record and mail the encrypted electronic medical record.

  In FIG. 2, a case where the request source facility is 215 will be described. The same applies to the medical facility 211, the medical facility 212, the medical facility 213, and the medical facility 214. The doctor in charge browses the electronic medical record delivered using the personal computer 251 or 252. In order to access the electronic medical record from this personal computer, it is necessary to be authenticated by an authentication system using an IC card or the like.

  When viewing the electronic medical chart using the personal computer 251, the doctor in charge at the requesting facility clicks on the key image attached to the electronic medical chart to obtain information on image data attached to the electronic medical chart and image processing parameters. The set is transmitted from the personal computer 251 to the data processing device 233 of the requested facility 211. Upon receiving this, the data processing device 233 obtains image data from the PACS server 234, performs image processing on this image data to create an image, encrypts this image, and encrypts this image to the electronic medical record of the requesting facility 215. The data is transmitted to the browsing / creation personal computer 251. The personal computer 251 for browsing / creating the electronic medical chart of the request source facility 215 receives the encrypted image, decodes it, and displays it. Further, by transmitting the changed image processing parameters to the data processing device 233 of the requested facility 211, it is possible to receive an image processed with the new image processing parameters while interactively changing the image processing parameters. Therefore, it becomes possible to deepen the understanding of the contents of the diagnostic imaging report.

  In the present invention, two-dimensional, three-dimensional, and four-dimensional image processing that requires a large amount of image data is performed centrally by a data processing device in the vicinity of the PACS server that stores the data. Since it is distributed via the wide area network to the personal computer for viewing and creating the electronic medical records at the requesting facility, the traffic on the wide area network does not increase so much.

  The requesting facility and the requesting facility are included even if they are the same medical facility. In this case, a network in a medical facility is generally used instead of a wide area network such as the Internet. In this case, the traffic in the medical facility network can be greatly reduced.

The following parameters are included in the set of information regarding image data attached to the report and image processing parameters.
1) Parameters for specifying patients,
2) Parameters for specifying image data,
3) Parameters for image processing,
4) Parameters for image display.
Of these, 1) may be omitted because of privacy protection. In this case, the image data is specified only by the information of 2).

  The case of an electronic medical record in which medical records are sequentially recorded in a medical facility where a patient has been examined on a portable medium such as an IC card owned by an individual patient will be described. In FIG. 2, if the requested medical facility is 211, the medical facility that has been visited in the past is 212, the medical facility that has been visited in the past is 213, the medical facility that has been visited in the past is 214, and the requesting facility is 215, The doctor in charge of the facility 215 browses the electronic medical record delivered from the requested medical facility 211 using the personal computer 251 or 252. At that time, by clicking the key image and key information attached to the electronic medical record when the patient has visited the medical facility 212 in the past, the image data of the image examination that the patient has received at the medical facility 212 in the past. Can be accessed and the image can be displayed. In addition, by clicking the key image and key information attached to the electronic medical record when the patient has visited the medical facility 213 in the past, the image data of the image examination that the patient has received at the medical facility 213 in the past can be obtained. It is possible to access and display the image. In addition, by clicking the key image and key information attached to the electronic medical record when the patient has visited the medical facility 214 in the past, the image data of the image examination that the patient has received at the medical facility 214 in the past can be obtained. It is possible to access and display the image. This makes it possible to use medical image examination data received in the past even when patients visit different medical facilities, eliminating the need for another image examination, reducing patient exposure and improving the medical economy. Helps improve.

  In the above description, the case where an image processing parameter set used for creating an image that is the basis of the findings of image diagnosis is attached to the electronic medical record has been described. In other embodiments, the electronic medical record includes image processing. A parameter set identifier is attached, and an image processing parameter set corresponding to the identifier is stored in the PACS server 234 or the HIS server 235. In this case, only the identifier of the image processing parameter set is attached to the electronic medical record. The PACS server 234 or the HIS server 235 accumulates the electronic medical record and the identifier of the image processing parameter set attached thereto and the image processing parameter set corresponding to the identifier, and stores the electronic medical record and the image processing parameter attached thereto in the requesting facility. The set identifier is recorded online via the wide area network 201 or on an IC card and distributed offline.

  The user of the requesting facility browses the electronic medical record using the electronic medical chart viewing / creating personal computer 251 or 252 and transmits the identifier of the image processing parameter set attached thereto to the data processing device 233 of the requesting facility. . The data processing apparatus that has received the identifier of the image processing parameter set transmits this identifier to the PACS server 234 or the HIS server 235, and acquires the image processing parameter corresponding to this identifier from the PACS server or the HIS server. The data processing device reads the image data specified based on the image processing parameters from the PACS server, and performs 2D, 3D, and 4D image processing on the image processing parameters to create an image. The sent image is sent to a personal computer for viewing and creating the electronic medical chart at the requesting facility.

  In a personal computer for viewing and creating an electronic medical chart, an image sent from the data processing apparatus is displayed together with the electronic medical chart. As necessary, the electronic medical chart viewing / creating personal computer acquires parameters for image processing and parameters for image display via the data processing device, changes them, and sends them to the data processing device. The data processing apparatus performs image processing using the changed image processing parameters, and sends the result to a personal computer for viewing and creating an electronic medical record. This operation can be repeated interactively. The changed parameters can be stored in the PACS server or HIS server.

  An image diagnostician who performs image diagnosis performs image interpretation by referring not only to the image inspection performed this time but also to other image inspections. For example, when an image diagnosis of an angiographic examination is performed, the diagnosis is comprehensively performed with reference to images of an X-ray CT examination and an MRI examination performed at the same time. Such related image examination information is important data for the doctor of the requesting facility. In the present invention, not only the current image inspection but also other image inspection key images and image data information and an image processing parameter set that allow an image to be created by accessing the image inspection are attached to the electronic medical record. Is possible. Image data information and image processing parameter sets that allow image diagnosticians to access and create images by using related mechanisms that were referenced during image diagnosis by using the mechanism described so far Is attached to the electronic medical chart, and the doctor of the requesting facility viewing the electronic medical chart transmits the image data information and the image processing parameter set of the related image examination desired from the information described in the report to the data processing apparatus. Thus, it is possible to view an image of a desired image inspection.

  An image diagnostician who performs image diagnosis reads an image by referring not only to the data of the current image examination but also to the past image examination of the patient. For example, when an image diagnostic report for an angiographic examination is created, an image of an X-ray CT examination or an MRI examination performed in the past as well as an angiographic examination performed in the past is referred to. Such past image inspection information may be important data for the doctor of the requesting facility. In the present invention, image data information and an image processing parameter set that make it possible to create an image by accessing a key image of past image inspection and its image data as well as the current image inspection that is the main body of image diagnosis are provided. It is possible to attach it to an electronic medical record. The doctor at the requesting facility transmits the image data information of the past image examination and the image processing parameter set attached to the electronic medical chart to the data processing device, so that the desired image can be viewed.

  An image diagnostician who performs image diagnosis performs image interpretation by referring to not only image examination data but also examination data such as physiological data of the patient and medical history data of the patient. In the present invention, not only image examination data but also examination data such as related physiological examination data and medical history data can be accessed and visualized and displayed. The set can be attached to an electronic medical record. In medical facilities, HIS is generally in charge of distribution of examination data such as physiological examination data and medical history data. However, in order to view desired data, it is necessary to perform a search using an HIS terminal. In the present invention, the doctor of the requesting facility viewing the electronic medical record transmits the access information of the medical information data described in the electronic medical record and the information processing parameter set to the data processing apparatus of the requesting facility. The data processing device is used for browsing / creating electronic medical records that are browsing the electronic medical record by acquiring test data such as physiological test data and medical history data from the HIS etc. according to the access information of the medical information data and performing information processing for visualization Send to a personal computer. This makes it possible to view desired test data such as physiological test data and medical history data.

  In the present invention, a personal computer for viewing and creating an electronic medical chart uses key image information useful for a requesting facility user in the current image examination, past image examination, recent and past physiological examinations, medical history information, etc. As well as pasting it as key information to the electronic medical record, the electronic medical record includes information that enables acquisition of image data and medical information data of image examination, physiological examination, and medical history information, and parameter sets for image processing and information processing. The function to add to the key information of. The requesting facility electronic medical chart viewing / creating personal computer uses the key image and the data acquisition information added to the key information and the data processing parameter set or some of the parameters constituting it when the user views the electronic medical chart. The data processing parameter set in which the data is changed is transmitted to the data processing apparatus in the facility where the server storing the data exists. The data processing apparatus acquires image data from the PACS server based on the received image data information and a set of image processing parameters, performs image processing on the image data, creates an image, and views the electronic chart A function for sending to a personal computer for creation and a function for obtaining data from the HIS based on the received information acquisition information, adding the specified processing to the data and sending it to the personal computer for viewing and creating the electronic medical record . This makes it possible to interactively display an image related to the key image pasted on the electronic medical record and information related to the key information in a personal computer for viewing and creating the electronic medical record.

  As a method of distributing electronic medical records to the requesting facility, a personal computer for viewing and creating electronic medical records or a server storing electronic medical records encrypts the electronic medical records and connects them via a wide area network such as the Internet. A personal computer for browsing and creating medical records, which has a function of distributing encrypted electronic medical records to a personal computer for viewing and creating medical charts, is received by the personal computer for browsing and creating electronic charts connected via a wide area network. As explained in the example with the function of decrypting medical charts, a personal computer for browsing and creating electronic medical charts connected via a wide area network such as the Internet creates an electronic medical chart from an encrypted electronic medical chart. A personal computer or electronic It has a function to obtain and decrypt a medical record from a server storing medical records, and a personal computer for browsing and creating electronic medical records or a server storing electronic medical records has a function to encrypt and provide electronic medical records. The case works as well.

  A personal computer for viewing and creating electronic medical records or a server storing electronic medical records has a function of encrypting electronic medical records and recording them on a recording medium such as an IC card via a wide area network such as the Internet. The connected electronic medical chart browsing / creating personal computer includes a case in which an encrypted electronic medical chart is read from a recording medium such as an IC card and decrypted.

  When delivering information related to the patient such as electronic medical records, medical images, and examination information created by the requested medical facility to the requesting medical facility that requested this image inspection, the requesting medical facility is used to protect the privacy of the patient. There is a need for a mechanism that prevents access to this patient information by anyone other than those who are required to access this patient information at the facility and the requested medical facility. In the embodiment of the present invention, an access control system based on user identification using an IC card or the like is provided in the personal computers 251 and 252 so that only a designated doctor can access the patient information of the patient. The case where other privacy protection mechanisms are used is also included in the present invention.

  A connection device 231 is provided between the wide area network 201 and the network in the medical facility, and access is restricted so that access through the network is not possible unless the medical facility is planned in advance.

  When sending patient information from the requesting medical facility to the requesting medical facility, the patient information is encrypted, and a mechanism to prevent so-called “spoofing” of the requesting medical facility is provided. There is a mechanism that prevents patient information from being sent.

  When sending patient information from the requesting medical facility to the requesting medical facility, the data is encrypted and a mechanism is installed to prevent so-called “spoofing” from the requesting medical facility to the third party. There is a mechanism to prevent information from being sent.

  Multiple users can hold a conference using an electronic medical record. The electronic medical record created by the personal computer for viewing and creating the electronic medical record includes address information that can be accessed by related persons such as the created diagnostic physician and the doctor at the requesting facility that distributes the electronic medical record, and the created image Schedule information indicating the date and time when a diagnostician or the like can participate in the conference can be attached. The doctor at the requesting facility who views the electronic medical record can know the names and schedules of the parties concerned by clicking on, for example, icons linked to the address information and schedule information included in the electronic medical records. It becomes possible to plan a conference. Once the schedule is decided, the conference leader will convene participants based on the address information of the electronic medical record. Participants of the conference hold conferences using telephone conference systems and video conference systems, and use multiple user terminal devices based on image examination data, physiological examination data, and medical history information related to electronic medical records. Proceed with the conference.

  A personal computer for browsing and creating an electronic medical chart selects image examination data, physiological examination data, and medical history data attached to the electronic medical chart, and transmits a parameter set to the data processing device. The data processing apparatus acquires and processes related data based on the parameter set, and transmits the result to a plurality of electronic medical chart viewing / creating personal computers participating in the conference. A conference participant browses these data, and transmits parameters changed as necessary to the data processing device, so that a plurality of users can proceed with the conference interactively. For example, by using the present invention, an image diagnosis specialist and a plurality of users can share one 3D image processing. The personal computer for viewing and creating electronic medical charts specifies the X-ray CT image data used to create a 3D image using the parameter set attached to the electronic medical chart, and the spatial area and CT value range of the object. Parameters and projection processing parameters for 3D image display are specified, and the data processing device acquires related data and creates 3D images based on this parameter set. A plurality of users can share 3D image processing by transferring it to a personal computer for viewing and creating electronic medical records.

  The data processor performs image compression when sending the created 2D, 3D, and 4D images, and the personal computer for viewing and creating electronic medical charts receives the 2D, 3D, and 4D images when receiving the compressed images. Even if a wide area network such as the Internet is used as a network for connecting the data processing device and the electronic medical chart viewing / creating personal computer, the 2D / 3D / four It is now possible to interactively display the dimensional image and respond to the operation.

  In another embodiment, a user interface for changing image processing parameters is displayed on the screen by clicking a thumbnail image attached to the electronic medical record, and the changed image processing parameters are processed by data processing. The function to transmit to the device was provided.

  In another embodiment, a user interface for changing image processing parameters is displayed in a separate window from the report by clicking on a thumbnail image attached to the electronic medical record, and the changed image is manipulated. A function of transmitting processing parameters to the data processing device is provided.

  In the embodiments described so far, the X-ray CT apparatus and the X-ray CT image data obtained from the X-ray CT apparatus have been described as examples. However, medical image apparatuses such as MR apparatus, nuclear medicine apparatus, and ultrasonic apparatus, and image data obtained therefrom The same applies to the case of. Further, the same function is performed when these medical image devices and image data obtained from them are used at the same time.

  In the explanation so far, the term electronic medical record was used, but the electronic medical record includes all documents related to the patient prepared by the doctor such as diagnostic imaging reports.

The invention's effect

  There is a system that browses medical images stored in a web server using a wide area network such as the Internet. In this case, the medical images stored in the web server are medical image diagnostics such as an X-ray CT device. This is an image created by performing image processing in advance on image data collected by the apparatus. That is, an image created by performing image processing in advance is stored in a web server, and the client personal computer acquires and displays it. In this case, since the user acquires the image-processed image, the image processing parameters cannot be freely changed. In the present invention, image data collected by a medical diagnostic apparatus such as an X-ray CT apparatus designated from a client personal computer is used as data instead of browsing an image created by performing image processing in advance stored in a web server. The processing apparatus acquires the data, and the data processing apparatus performs data processing on the basis of the image processing parameters designated from the client personal computer, and creates an image. The newly created image is sent to the client personal computer. The personal computer of the client receives this image and displays it. Therefore, the user can interactively change the image processing parameters by using the client personal computer, and can display the image processed by the image processing parameters.

  A user at a network location away from a PACS server storing image data collected by a medical image diagnostic apparatus such as an X-ray CT apparatus can interact with the image data stored in the PACS server, for example, interactively. If a user wishes to observe a 3D image by performing 3D image processing while changing the 3D image processing parameters, the user is now working on an image processing work. It is necessary to prepare a station and transfer related image data from a PACS server storing image data using a wide area network such as the Internet to an image processing workstation prepared by a user. For example, a recent X-ray CT apparatus sometimes collects as many as 2000 pieces of tomographic image data in one examination. In this case, it is necessary to transfer 1000 MB of data. The use of a wide area network such as the Internet is almost impossible to realize because the data transfer speed is slow and the data transfer time becomes long and the network traffic becomes excessive and occupies the network. For this reason, image data is recorded on a CD-R, etc., which is mailed by mail, etc., so it is virtually impossible to create a 3D image as needed in front of a patient who has visited without reservation. It is. It also costs money to prepare an image processing workstation. In the present invention, image processing on image data is performed by a data processing apparatus installed in the vicinity of the network of the PACS server storing the image data, so that no network traffic problem occurs. Also, since this data processing apparatus performs image processing intensively, the user does not need to prepare an expensive image processing workstation, and can be sufficiently handled by a personal computer used for browsing electronic medical records.

  In the present invention, the image data acquired by the medical image inspection is not transferred on the network connecting the request source facility and the request destination facility, and only the information for specifying the image data and the image processing parameters are flowed. Conventionally, a high-speed network such as a dedicated line was required to use medical image data taken at the requested facility at the requested facility, but in the present invention, a wide-area network such as the Internet can be used. Became.

  When an electronic medical record system with a wide-area network environment according to the present invention is constructed in two or more medical facilities including a medical facility that requests medical image inspection and a medical facility that entrusts medical image inspection, the requested medical care that has performed medical image inspection The doctor of the requesting medical facility requests the medical request from the requesting medical facility without transferring the huge amount of medical image data stored in the facility from the requesting medical facility to the requesting medical facility. It is possible to perform image diagnosis by using the huge amount of medical image data stored in the medical facility, applying the desired image processing, and observing the resulting image . That is, even if the image data for medical image examination with a huge amount of data is not moved, the image processing is performed as if the image data for medical image examination with a huge amount of data is at hand, and the result of the image processing is obtained. Can be displayed. This eliminates the time required to obtain image data for a medical image examination with a huge amount of data, and can greatly reduce network traffic. In addition, since the data processing device in the medical facility storing medical image data performs image processing, there is no need to install an image processing workstation in the requesting medical facility, and it is used for browsing electronic medical records. It is now possible to display images while interactively processing images on a personal computer.

  A doctor at a medical facility such as a clinic who requested medical image inspection browses an electronic medical record created by an image diagnostician at a medical facility such as a basic hospital that has been entrusted with the medical image inspection, It is now possible to perform the same image processing using the image data stored in the requested medical facility used at the time of diagnosis, and display and observe the results of the image processing. This greatly facilitates understanding of electronic medical records.

  In the present invention, it is possible to acquire data and information such as an image examination based on other modalities other than a key image that is a key for image diagnosis, past image examination, physiological examination, and medical history information by the electronic medical record. It was. At the time of image diagnosis, these data and information are collected with great effort. In the present invention, all means and routes necessary for accessing such information are collected in the electronic medical record. Even in hospitals where a complete image management system is not in place, each image storage system that manages important data from, for example, CT, MR, and DSA image data accumulated at the time of image diagnosis. The information that is judged to be important by the diagnostic imaging doctor can be acquired later by an electronic medical record. By browsing the electronic medical record according to the present invention, not only the user of the requesting facility but also other diagnostic imaging doctors and the diagnostic imaging doctor who performed the diagnostic imaging can obtain important information about the patient at any time. Is possible. In addition, when the patient performs an image examination again, this electronic medical record can be used to quickly access information such as past image examinations, physiological examinations, and medical history information necessary for image interpretation. It is very useful from an economic point of view.

  Diagnostic imaging specialists and multiple users can share one 3D image processing. Specification of X-ray CT image data used by a specialist to create a 3D image, specification of parameters such as the spatial region and CT value range of an object, and specification of projection processing parameters for 3D image display The data processing server transfers the result of creating the 3D image to a plurality of personal computers, so that a plurality of users can share one 3D image processing.

  The data processing device compresses and encrypts the image data when transmitting the created 2D, 3D, and 4D images, and the user terminal computer device receives the 2D, 3D, and 4D images. Even if a wide area network such as the Internet is used as a network for connecting the data processing device and the user terminal computer device by performing the decryption and decompression of the data, the two-dimensional, three-dimensional, four-dimensional data in the user terminal computer device is used. It has become possible to interact interactively with manipulation and display response of dimensional images.

  FIG. 3 is a block diagram showing an operation when the doctor of the requesting facility browses the electronic medical record in the conventional case and when the present invention is used. Conventionally, in order for a doctor at a requesting facility to perform image processing using image data stored at a requested medical facility, the image data stored at the requested medical facility is stored via a network or stored. It was necessary to record and obtain the data on a medium, and to prepare an image processing workstation, and to perform image processing on the image data at the image processing workstation. Since the computer used to view and create electronic medical records is usually a personal computer, when a doctor at the requesting facility performs image processing on image data, the personal computer lacks data processing capabilities. Therefore, it was necessary to purchase a dedicated workstation for image processing. According to the present invention, the doctor of the requesting facility uses the data processing device installed in the requested medical facility for the image data stored in the requested medical facility when necessary. Image processing can be performed with image processing parameters. According to the present invention, it is possible to greatly reduce the amount of data transmitted over a wide area network, and it becomes unnecessary to install a workstation dedicated to image processing.

  In the case of an electronic medical record that records medical records sequentially at a medical facility where the patient consulted on a portable medium such as an IC card owned by the individual patient, when the patient had previously consulted at another medical facility at the patient's visit The electronic medical record can be referred to. When a plurality of medical facilities adopt the present invention, the patient can click on the key image or key information attached to the electronic medical record when the patient has visited the other medical facility. It is possible to access image data of an image examination received at another medical facility and display the image. Conventionally, even if such an IC card system is used, it is practically impossible to access a large amount of data such as image inspection data stored in another medical facility. By adopting the present invention by a plurality of medical facilities, a system that uses and uses large-capacity data such as image inspection data stored in other medical facilities using an IC card system is used for the first time. It became possible to build. As a result, even if a patient visits a different medical facility, it is possible to use test data received in the past, eliminating the need for another test, which helps reduce patient exposure and improve the medical economy.

  Configuration diagram of a conventional system for viewing medical images   Configuration diagram of a system for creating and viewing electronic medical records and using medical image data in a wide area network environment according to the present invention   A block diagram showing operations at the time of browsing an electronic medical record of a requesting user according to the prior art and the present invention

Explanation of symbols

101 Wide-area network such as the Internet 111, 112, 113, 114 Core hospital 115 Clinic 116 Image data storage center 131 Connection device 132 In-hospital network 133 PACS server (data storage device)
134 Network for image data 141, 142 Image diagnostic device 151, 152 Image processing display device 201 Wide area network 211, 212, 213, 214, 215 such as the Internet Medical facility 231 Connection device 232 Hospital network 233 Data processing device 234 Data storage device 235 HIS server 236 High-speed network for image data 237 High-speed network for image data 241 and 242 Diagnostic imaging apparatus 251 and 252 Personal computer

Claims (8)

For browsing and creating electronic medical records, and a medical image archiving communication system (hereinafter referred to as PACS) server for storing and transferring medical image data created by an image diagnostic device, and a data processing device installed in the network vicinity of the PACS server A plurality of medical facility information system terminals including an electronic medical chart viewing / creating terminal device to be used and a user authentication system, an electronic medical chart viewing / creating terminal device used for viewing and creating electronic medical records, and a user In an information system in which zero or more medical facility information systems having an authentication system are distributed and connected to each other on a wide area network such as the Internet,
The data processing device has a function for acquiring image data instructed from the electronic medical chart viewing / creating terminal device from the PACS server as a function at the time of creating the electronic medical record, and an image in the image data based on the instructed image processing parameter. A function to process and create an image to be used for diagnostic imaging, and a function to send the image to a terminal device for viewing and creating an electronic medical record,
The data processing apparatus acquires image data from the PACS server based on information instructed from the electronic medical chart browsing / creation terminal device as a function at the time of browsing the electronic medical chart, and converts the image data based on the instructed image processing parameters. A function to create an image by performing image processing, and a function to perform data compression and encryption on the image and send it to a terminal device for viewing and creating an electronic medical record,
The electronic medical chart browsing / creating terminal device has a function for designating image data acquired from the PACS server and a parameter for image processing applied to the image data as a function at the time of creating the electronic medical chart, A function for displaying an image transmitted from a data processing device, a function for recording a result of an image diagnosis performed based on the image in an electronic medical record, and a function for attaching a key image used as a key for image diagnosis to the electronic medical record And a function of adding access information to related image data and a set of image processing parameters to the key image in order to make it possible to reproduce the image used at the time of image diagnosis when browsing the electronic medical chart,
The electronic medical chart browsing / creating terminal device stores the image data as a function when browsing the electronic medical chart based on the access information to the related image data added to the key image of the electronic medical chart and the set of image processing parameters. A function to access the data processing device installed in the vicinity of the PACS server and instruct the acquisition of image data and the image processing to the image data, and the image transmitted from the data processing device are received and displayed. And a function to
The user authentication system has a function to perform mutual authentication of information systems of medical facilities connected via a wide area network.
An image related to the key image attached to the electronic medical record at the time of electronic medical chart preparation at the medical facility where the patient has received an image examination at the time of electronic medical chart inspection at the terminal device for electronic medical chart browsing / creation at the medical facility visited by the patient Wide area that enables interactive display of data created by 2D, 3D, and 4D image processing by a data processing device near the PACS server of the medical facility that stores the image data A system for creating and viewing electronic medical records and using medical image data in a network environment. 2. The data processing apparatus according to claim 1, wherein the data processing apparatus acquires image data designated from the PACS server based on a parameter set received from the electronic medical chart browsing / creation terminal apparatus as a function when creating the electronic medical chart, and is designated by this. A function to send images created by performing image processing to a terminal device for browsing and creating electronic medical records, and acquiring specified information data from the hospital information system (hereinafter referred to as HIS), and adding the specified processing to this A function to send the information visualized in this way to a terminal device for viewing and creating an electronic medical record,
The electronic medical chart browsing / creating terminal device is a function for creating an electronic medical chart. It is a key image, a key image, and a key image and information that are used for image diagnosis and related image examinations, past image examinations, physiological examinations, and medical history information. A function to attach to the electronic medical chart as information and a set of parameters for enabling acquisition and processing of image data and information data related to the electronic medical chart when browsing the electronic medical chart are added to the key image and key information of the electronic medical chart With functions,
The electronic medical chart viewing / creating terminal device functions as a function for viewing the electronic medical chart, and is a parameter set added to the key image and key information attached to the electronic medical chart or some of the parameters constituting the parameter set. Terminal for viewing and creating electronic medical records in a medical facility visited by a patient, having a function of transmitting an image to a data processing device and a function of receiving an image and information transmitted from the data processing device and displaying the image and information When viewing the electronic medical record on the device, the image data related to the key image / key information attached to the electronic medical record at the time of preparation of the electronic medical record at the medical facility that the patient has visited so far, the past image inspection, physiological examination, and medical history data , Interactively processing results processed by a data processing device near the medical facility server storing the data System for electronic charting and browse in the wide area network environment that made it possible to display.   3. The electronic medical chart browsing / creating terminal apparatus or the server storing the electronic medical chart according to claim 1 or claim 2 is encrypted in the electronic medical chart viewing / creating terminal apparatus connected via a wide area network such as the Internet. The electronic medical chart browsing / creating terminal device provided with the function of distributing the digitized electronic medical chart and connected via the wide area network has the function of receiving this.   3. The electronic medical chart viewing / creating terminal device connected via a wide area network such as the Internet is encrypted from the electronic medical chart viewing / creating terminal apparatus or the server storing the electronic medical chart according to claim 1 and claim 2. The electronic medical chart viewing / creating terminal device or the server storing the electronic medical chart has a function of providing the electronic medical chart.   3. The electronic medical chart browsing / creating terminal device or the server storing the electronic medical chart according to claim 1 or 2, wherein the server storing the electronic medical chart has a function of recording the electronic medical chart in which privacy is protected by encryption or the like on a recording medium such as an IC card. The terminal device for browsing / creating electronic medical charts connected via a wide area network such as the Internet has a function of reading the electronic medical chart whose privacy is protected by encryption or the like from a recording medium such as an IC card.   6. The electronic medical record screen according to claim 1, wherein the user interface for changing the image processing parameter by clicking the key image added to the electronic medical record is a screen of the electronic medical record. A system having a function of transmitting an image processing parameter set displayed on and changed by operating the data processing apparatus to the data processing apparatus.   A user interface for changing an image processing parameter by clicking a key image pasted on an electronic medical chart according to claim 1 and claim 2, claim 3, claim 4, claim 5, and claim 5 A system that has a function of displaying image processing parameters that are displayed in a separate window from the chart and that are changed by operating the chart to the data processing apparatus.   In claim 1 and claim 2, claim 3, claim 4, claim 5, claim 6, and claim 7, the electronic medical record includes an electronic diagnostic report.

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