JP6013083B2 - Medical image management server - Google Patents

Description

  Embodiments described herein relate generally to a medical image management server performed on a network.

  In recent years, in medical image diagnosis, due to regional medical disparity, shortage of diagnostic doctors, and diversification of diagnostic tools, a network is formed between hospitals, and patients are diagnosed in cooperation with a plurality of hospitals.

  However, this approach is generally a diagnosis within a private network where certain related hospitals are connected, or a remote diagnosis rooted in a specific region. In this remote diagnosis, there is one that presents patient data to a plurality of doctors to obtain a diagnosis result. (For example, refer to Patent Document 1).

  In addition, due to the high functionality of diagnostic imaging apparatuses and the complexity of diagnostic tools, the difference in the technical level of diagnostic doctors has become remarkable, and there has been an increasing demand for obtaining second opinions of other diagnostic doctors from patients. Diagnosis has been made by effectively utilizing global diagnostic resources such as institutions other than related hospitals because of patient demands and lack of diagnostic resources. A typical example is an overseas diagnostic imaging service.

  On the other hand, the number of patients who want to receive advanced medical care in the world is increasing, and there is a problem that there is no effective referral system for such patients.

JP 2006-277559 A

  The problem to be solved by the present invention is to solve the above problems and provide a global medical image management server.

To achieve the above object, a medical image management server according to an embodiment includes a medical information storage unit that stores medical information in which a reference level is set on a medical public cloud, a patient that accesses the medical information storage unit, and an attending physician And account control means for storing the account of the diagnostician and controlling the account level; and a disclosure level determining means for comparing the reference level and the account level for the account to determine the disclosure level of the medical information; Medical information uploading means for uploading the medical information to the medical information storage means, medical information reference means for enabling the diagnostician to refer to medical information whose disclosure information is limited according to the disclosure level, and the disclosure A simple diagnosis report diagnosed using medical information with limited information is uploaded to the medical information storage means. Selection and simplified diagnosis report upload means for loading, into the patient or the attending physician, and simple diagnostic report reference means allowing reference to the simplified diagnosis report, with reference to the plurality of the simplified diagnosis report, the diagnostician to request a second opinion And a referral letter control means for transmitting a referral letter of the attending physician to the selected diagnostic doctor.

The network block diagram of the medical image management server in embodiment. The block block diagram of the access control part in the medical image management server of embodiment. An example of a user account registration screen in the medical image management server of the embodiment. The example of the reference level with respect to the personal information in the medical image diagnostic server of the embodiment. The example of the reference level with respect to the medical image in the medical image diagnostic server of the embodiment. An example of a workflow up to acquisition of a second opinion in the medical image diagnostic server of the embodiment. 6 is a screen example of a diagnostician-side user interface on the medical image diagnostic server of the embodiment. 5 is a user interface screen example of a patient and an attending physician on the medical image diagnostic server of the embodiment.

  Embodiments for carrying out the present invention will be described in detail below with reference to the drawings shown in FIGS.

  As shown in FIG. 1, a medical image management server 1 according to the present embodiment is connected to a public cloud 2 configured by a network such as a WAN (Wide Area Network). Connected to the public cloud 2 are an in-hospital private network 3, a linked hospital private network 4 that links a plurality of hospitals, an image diagnosis service company 5 that undertakes interpretation, a personal hospital 6, and the like. In addition, a patient terminal 7 installed in a patient's home or the like may be connected to the public cloud 2. With this configuration, the medical image management server 1 can be connected from anywhere in the world, and provides a medical public cloud service for a patient to obtain a diagnostic report such as a second opinion. Moreover, the diagnostician connected to the public cloud 2 refers to the patient's medical information and provides the patient with a second opinion.

  In order to provide this medical public cloud service, the medical image management server 1 connected to the public cloud 2 includes an access control unit 11, an account information storage unit 12, a medical information storage unit 13, and a history information storage unit 14. ing.

  The access control unit 11 performs access control according to the account level of the account of the patient, the attending physician, and the diagnostician who performs image diagnosis from the medical information of the patient registered in the medical public cloud service. At this account level, it is possible to perform a public level control of medical information published in the public cloud 2.

  The account information storage unit 12 holds account information of patients, attending physicians, and diagnosticians registered in the medical public cloud service. Details of the account information will be described later.

  The medical information storage unit 13 stores medical information such as a medical image uploaded by a patient connected to a medical public cloud service or a doctor, or a diagnostic report created by a diagnostician. Here, the medical information is a collective term for data information used for medical purposes such as medical images, diagnostic reports including medical records, and personal information.

  The history information storage unit 14 stores history information such as the number of times a diagnosis report is accepted, a participation period, and evaluation from a user for a diagnostician participating in a medical public cloud service. As a result, the patient can select a diagnostician who requests a second opinion in consideration of the evaluation for the diagnostician in addition to the actually created simple diagnostic report.

  FIG. 2 is a block configuration diagram showing details of the access control unit 11 indicated by a dotted line frame. In order to show the flow of the control information such as the account indicated by the dotted line arrow and the medical information indicated by the solid line arrow, the public cloud 2, the account information storage unit 12, the medical information storage unit 13, the history information storage unit 14 and the like are described together. 2 shows the overall configuration of the image management server 1.

  The medical information storage unit 13 includes a medical image storage unit 131, a diagnostic report storage unit 132, and a personal information storage unit 133, which classifies and stores medical information. These may be classified by folders in the same storage device, or may be in different locations and connected to the public cloud 2.

  The access control unit 11 includes a registration unit 111, a medical information reference unit 112, a medical information upload unit 113, an introduction letter control unit 114, a history reference unit 115, and a disclosure level determination unit 116. The disclosure level determination unit 116 includes an account level control unit 116a and a medical information reference level control unit 116b.

  The registration unit 111 registers a patient registered in the medical public cloud service, the attending physician of the patient, and a diagnostician who performs image diagnosis using the medical information of the patient. FIG. 3 shows an example of a user account registration screen 31 in a terminal device connected to the public cloud 2. The registration screen 31 includes a patient registration button 32, an attending physician registration button 33, and a diagnostic physician registration button 34, which are appropriately selected depending on the type of user. In addition, although not shown here, registration can be performed for the entire medical organization.

  In patient registration, a patient who wants to receive a medical cloud service inputs a patient ID, a facility ID, an attending physician ID, a disease name ID, a site ID, and the like. As the patient ID, it is preferable to input, for example, an ID number or the like described on a medical examination ticket used in the hospital facility. In addition, the facility ID, the attending physician ID, the disease name ID, and the site ID can be selected from a table value in the account information storage unit 12 in advance using a pull-down menu. Since the actual name is linked to each ID, the actual name is viewed and selected.

  Patient ID is semi-automatically generated from PACS (Picture Archiving and Communication Systems) and electronic medical records by using the identification number specified by the patient within the hospital facility's medical examination ticket. The patient's medical information can be uploaded and transferred to the medical image management server 1 of the present embodiment. By using the patient ID and the facility ID, the patient can be uniquely identified, and a request ID for requesting a second opinion is issued simultaneously with the patient registration. In this embodiment, database management of medical information can be performed using this request ID as a main key. The patient account level given to the patient at the time of registration is “Pat”.

  In the attending physician registration, the attending physician of the patient inputs the attending physician ID, facility ID, specialized ID, and the like. If there is no problem in terms of protection of personal information, the attending doctor ID is input with the attending doctor ID such as the staff number in the hospital facility to which he belongs. Alternatively, the attending physician ID issued by the medical image management server 1 may be used. The facility ID and the specialized ID can be selected from a table value stored in the account information storage unit 12 in advance using a pull-down menu. Since the relationship between the attending physician and the patient is linked at the time of patient registration, the attending physician can be uniquely identified from the request ID. Here, the account level given to the patient's attending physician at the time of registration is “Adm”, which is the account level with the strongest authority.

  In the diagnosis doctor registration, the diagnosis doctor ID, the facility ID, the specialized ID, and the like are input in the same manner as the attending doctor registration. If there is no problem with respect to the protection of personal information, the diagnosis doctor ID is input with the attending doctor ID such as the staff number in the hospital facility to which he belongs. Alternatively, the attending physician ID issued by the medical image management server 1 may be used. The facility ID and the specialized ID can be selected from a table value stored in the account information storage unit 12 in advance using a pull-down menu. Here, the account level given to the diagnostician at the time of registration is “Open”. As will be described later, at this account level “Open”, only anonymous medical information in which the personal information of the patient is protected can be browsed, and the diagnosis doctor receives a request for a second opinion from the patient and performs an official diagnosis. Is accepted, the account level is changed to “Doc”, and the patient's personal information can be browsed.

  Here, a sequence of account registration performed through the registration unit 111 is referred to as a user registration sequence. The registered user account is stored in the account information storage unit 12 and is accessed for account authentication and determination of the disclosure level. The authority level at the account level is “Adm”> “Doc”> “Pat”> “Open”, and as the authority increases, more medical information can be viewed.

  The medical information reference unit 112 controls the reference contents of the medical information stored in the medical information storage unit 13 according to the public level determined by the user type connected to the public cloud 2, the account level, the medical information reference level, and the like. In the case of mainly a diagnostician, this is a reference control of medical information of a patient for preparing a diagnostic report, and in the case of a patient or an attending physician, a reference control of a diagnostic report made by a diagnostician. Here, the sequence performed through the medical information reference unit 112 is referred to as a medical information reference sequence. The disclosure level is controlled by the disclosure level determination unit 116 as described later.

  The medical information upload unit 113 uploads medical information to the medical information storage unit 13 connected to the public cloud 2 according to the user type and the like. In the case of a diagnostician, it is medical information of a patient. In the case of a diagnostician, the diagnostic report is created by browsing the medical information of a patient.

  The attending physician obtains medical information from a system such as a PACS and an electronic medical record of the hospital facility to which he belongs, using the patient ID as a key, and uploads it to the medical information storage unit 13 on the public cloud 2. Due to the nature of the public cloud, it is necessary to anonymize the personal information protection. Therefore, a reference level is set for the medical information to be uploaded to the medical information storage unit 13. For example, the reference level is set in the patient personal information such as the medical image shown in FIG. For example, the reference level that can specify the patient such as the patient ID, the patient name, and the date of birth shown in the tags T1 to T3 is “Pat”, and the reference level that cannot specify the individual such as the age and sex shown in the tags T4 and T5 is “ Open ". The reference level that can be referred to when the diagnostician officially receives a second opinion request is “Doc”.

  The reference level is set to “Adm” so that only the attending physician can refer to information that is not desired to be disclosed to diagnostic doctors at other facilities, such as treatment plan information of the tag T15.

  As shown in FIG. 5, the reference level is similarly set for the medical image. For example, reference levels such as those in which a marker is described in a lesion in a medical image and personal information such as a name are referred to the reference level “Pat” in order to allow reference to the patient. The account level “Open” cannot be referred to by a user. In addition, the reference level is set to “Doc” or the like for medical images such as those in which abnormalities in a lesion such as a disease that needs to be notified can be clearly confirmed by the patient, which are inappropriate for the patient to view. In this way, the medical information for which the reference level is set is stored in the medical information storage unit 13 via the medical information reference level control unit 116b. Here, the sequence performed via the medical information upload unit 113 is referred to as a medical information upload sequence.

  The referral letter control unit 114 browses one or more simple reports performed on anonymous medical information in which personal information is protected, and a selection operation for selecting a diagnostician to request a second opinion from among the reports. An introduction request operation for sending an introduction letter with the signature of the attending physician to the diagnostician and an acceptance operation for receiving from the diagnostician that the formal diagnostic report has been accepted are performed. A sequence performed via the referral letter control unit 114 is referred to as a referral letter control sequence.

  The history reference unit 115 makes it possible to collect and refer to acceptance results of second opinions, evaluations from patients, and the like performed by a diagnostician. This history information is stored in the history information storage unit 14. A sequence performed through the history reference unit 115 is referred to as a history reference sequence.

  The disclosure level determination unit 116 compares the above-described user account level with the reference level attached to the medical information to determine the disclosure level of the medical information. Then, medical information corresponding to the disclosure level is disclosed on the public cloud 2.

  The account level control unit 116a changes the account level when the diagnostician accepts the second opinion. For example, the level is changed from the “Open” level to the “Doc” level. In the medical information reference level control unit 116b, the attending doctor changes the reference level of the medical information from the terminal as necessary. This change is made with the “Adm” authority given to the attending physician or the like.

  The flow until the patient acquires the second opinion of the diagnostician who connects to the public cloud 2 by the medical image management server 1 having the above configuration will be described with reference to the flowchart of FIG. In addition, it is assumed that diagnostic doctors are registered in advance in the medical image management server 1.

  First, in step ST601, the patient consults with the attending physician about a second opinion. In step ST <b> 602, the patient and the attending physician perform user account registration with the medical image management server 1. User registration is as described in FIG. This user registration uses the user registration sequence shown in FIG.

  In step ST603, the attending physician uploads the patient's medical information to the medical image management server 1 in order to share the patient's medical information on the public cloud 2. At this time, as shown in FIGS. 4 and 5, the medical information of the patient is uploaded after setting the reference level of the medical information so that the patient is not specified in consideration of at least personal information. The medical information is transmitted using the upload sequence shown in FIG.

  In step ST604, the diagnostician registered in the medical image management server 1 can browse the medical information uploaded in step ST603. FIG. 7 is an example of a diagnostic physician-side user interface screen 71 for referring to medical information and the like. When the diagnostician first inputs the diagnostician ID and presses the “OK” button 72, a medical information list 73 that is being opened to the public is displayed. In the medical information list 73, a list of patients who are requesting a specialist department of a diagnostician is searched using a specialized ID linked to the diagnostician ID as a search key. The diagnostician can browse the patient's medical information by selecting an interested patient from the medical information list 73 and pressing the “browse” button 74. At this time, since the account level of the diagnostic doctor is “Open”, only medical information whose reference level is “Open” can be viewed. The medical information reference sequence in FIG. 2 is used for referring to this medical information.

  The diagnostician creates a diagnostic report with reference to the medical information. The diagnosis report at this time is a diagnosis based on medical information in which browsing information is restricted in consideration of personal information. Here, it is referred to as a simple diagnosis report. A file of this simple report is designated by a “file designation” button 75, and a simple report is sent to the medical image management server 1 by a “send diagnosis report” button 76. The simple report is transmitted using the upload sequence shown in FIG.

  In step ST605, the patient or the attending physician confirms the simple diagnosis report uploaded to the medical image management server 1 in step ST604. FIG. 8 shows an example of a patient / primary physician-side user interface screen 81 used for browsing a diagnosis report or the like. Although the request ID is input here, the patient ID and the attending physician ID may be input to distinguish whether the patient or the attending physician is browsing. When the request ID is input and the “OK” button 82 is pressed, a diagnosis report list 83 is displayed. The patient or attending physician can browse the simple diagnosis report by designating a diagnostician and pressing the “Browse” button 84.

  In step ST606, a diagnostician who requests a second opinion is selected with reference to the contents of the simple report, the evaluation column, and the like. A request for a second opinion requires a referral letter from a diagnostician, and a “Create a referral letter” button 85 is pressed to display a referral letter creation screen. Since an electronic signature is attached to the referral letter, the electronic signature of the diagnostician registered in advance linked to the diagnostician ID is attached to the referral letter by pressing the “attach signature” button 86. Then, by pressing a “Send” button 87, an introduction letter with an electronic signature is sent to the selected diagnostician. The referral letter is sent to the selected diagnostician in the referral letter control sequence of FIG. The evaluation displayed in the diagnosis report list 83 is performed by a history reference sequence.

  In step ST607, a letter of introduction is sent to the selected diagnostician, and the diagnostician accepts the second opinion. The diagnostician can find the patient ID for which the referral letter is received from the medical information list 73 that is being disclosed to the public in FIG. Alternatively, by setting the “status” pull-down box 77 of the referral letter status to “received”, it is possible to search for a referral letter reception status from the patient (in FIG. 7, “accepted” is displayed). . If the diagnostician receives the referral letter and accepts the creation of a formal diagnostic report for the second opinion, he selects the patient ID to accept and presses the “accept” button 78 to enter the referral letter status. Changes to "accept".

  As shown in FIG. 7, by setting the “status” pull-down box 77 to “accepted”, a list 79 of patients who have accepted the creation of a formal diagnostic report for the second opinion is displayed.

  In step ST608, only for the request ID of the patient who accepted the second opinion, the account level of the diagnostician's account is increased. That is, for the request ID that is not accepted, the account level remains “Open”, and for the accepted request ID, the account level is changed to “Doc”. The signal that accepted the referral letter in the referral letter control unit 114 is sent to the disclosure level determination part 116, and the reference level of the medical image of the request ID that accepted the second opinion can be browsed up to “Doc”. As a result, it is possible to browse medical information for which release restrictions on personal information and the like have been released. The account level change information is stored in the account information storage unit 12. The referral letter acceptance by the diagnostician is performed in the referral letter control sequence of FIG.

  In step ST609, the medical information whose release restriction such as personal information is released is browsed, and a formal diagnosis report made based on the medical information is uploaded to the medical image management server 1. For uploading, the file storage location of the official diagnostic report is designated by the “file designation” button 75 in FIG. 7, the “diagnosis report transmission” button 76 is pressed, and the diagnostic report is uploaded to the medical image management server 1. The official diagnostic report is uploaded in the medical information upload sequence shown in FIG.

  In step ST610, the patient or the attending physician confirms that a formal diagnostic report can be received in the diagnostic report list 83 in FIG. Then, a second opinion can be acquired by pressing the “browse” button 84.

  In addition, after acquiring the second opinion, the user selects how to handle the patient's own medical information that is disclosed on the public cloud 2. In order to delete all of the patient's own medical information from the public cloud 2, the “delete” button 89 is pressed, and the “public” button 90 is pressed when it can be widely used for future clinical / research. In this case, the information that identifies the individual is deleted, stored, and released. At this time, the link relationship between the request ID and the patient ID is also released.

  According to this embodiment, medical information including medical images can be shared on a public cloud for the purpose of requesting and selecting a second opinion, and diagnosis can be performed by many diagnostic doctors. In addition, a patient who requests a second opinion and an attending physician can request a formal diagnosis by referring to the reports of many diagnostic doctors and taking into account the results of the diagnostic doctor and user evaluation. In addition, by sending a letter of introduction from the attending physician to the diagnostician, medical cooperation with enhanced trust can be performed. In addition, advanced diagnosis by doctors from all over the world is available regardless of the country. Furthermore, since the personal information of the patient is protected in the simple diagnosis, the second opinion can be requested with peace of mind.

  In the present embodiment, the case of acquiring a second opinion has been described as an example, but the present invention is not limited to this. It can function as a global referral system to receive medical care for people who want to receive advanced medical care around the world.

  Although several embodiments of the present invention have been described, these embodiments are presented by way of example and are not intended to limit the scope of the invention. These novel embodiments can be implemented in various other forms, and various omissions, replacements, and changes can be made without departing from the scope of the invention. These embodiments and modifications thereof are included in the scope and gist of the invention, and are included in the invention described in the claims and the equivalents thereof.

1 ... Medical image management server,
2. Public cloud,
11 ... access control unit,
12 ... Account information control unit,
13 ... Medical information storage unit,
14 ... history information storage unit,
111 ... Registration part,
112 ... Medical information reference part,
113 ... Medical information upload section,
114. Referral letter control unit,
115 ... History control unit,
116: Public level control unit.

Claims (4)

Medical information storage means for storing medical information with a reference level set on a medical public cloud;
Account control means for storing the account of the patient, the attending physician, and the diagnostician accessing the medical information storage means and controlling the account level;
A disclosure level determination means for comparing a reference level and an account level for the account to determine a disclosure level of the medical information;
Medical information uploading means for uploading the medical information to the medical information storage means;
Medical information reference means for enabling the diagnostician to refer to medical information whose disclosure information is limited according to the disclosure level;
A simple diagnostic report upload means for uploading a simple diagnostic report diagnosed using medical information with limited disclosure information to the medical information storage means;
Simple diagnostic report reference means for enabling the patient or attending physician to refer to the simple diagnostic report;
Referring to the plurality of simplified diagnosis report, and the diagnostician selecting means for selecting a diagnostician to request a second opinion,
A referral letter control means for sending a referral letter of the attending physician to the selected diagnostician;
A medical image management server. The account control means changes the account level of the diagnostician when the diagnostician who requested the second opinion accepts the creation of a formal diagnostic report, and discloses medical information whose release level has been relaxed to the diagnostician The medical image management server according to claim 1. A formal diagnostic report uploading unit for uploading a formal diagnostic report diagnosed using medical information whose release level is relaxed to the medical information storage unit;
Formal diagnostic report reference means for allowing the patient or attending physician to refer to the formal diagnostic report;
The medical image management server according to claim 2, further comprising: History information storage means for storing history information including acceptance results of the second opinion of the diagnostician;
The medical image management server according to claim 3, further comprising history information reference means for enabling reference to the history information.

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