Exchange Center Research Articles

Implementation of a cloud-based electronic medical record exchange system in compliance with the integrating healthcare enterprise’s cross-enterprise document sharing integration profile

In 2011, the Ministry of Health and Welfare of Taiwan established the National Electronic Medical Record Exchange Center (EEC) to permit the sharing of medical resources among hospitals. This system can presently exchange electronic medical records (EMRs) among hospitals, in the form of medical imaging reports, laboratory test reports, discharge summaries, outpatient records, and outpatient medication records. Hospitals can send or retrieve EMRs over the virtual private network by connecting to the EEC through a gateway. International standards should be adopted in the EEC to allow users with those standards to take advantage of this exchange service.In this study, a cloud-based EMR-exchange prototyping system was implemented on the basis of the Integrating the Healthcare Enterprise’s Cross-Enterprise Document Sharing integration profile and the existing EMR exchange system. RESTful services were used to implement the proposed prototyping system on the Microsoft Azure cloud-computing platform. Four scenarios were created in Microsoft Azure to determine the feasibility and effectiveness of the proposed system.The experimental results demonstrated that the proposed system successfully completed EMR exchange under the four scenarios created in Microsoft Azure. Additional experiments were conducted to compare the efficiency of the EMR-exchanging mechanisms of the proposed system with those of the existing EEC system.The experimental results suggest that the proposed RESTful service approach is superior to the Simple Object Access Protocol method currently implemented in the EEC system, according to the irrespective response times under the four experimental scenarios.

Building a National Electronic Medical Record Exchange System – Experiences in Taiwan

There are currently 501 hospitals and about 20,000 clinics in Taiwan. The National Health Insurance (NHI) system, which is operated by the NHI Administration, uses a single-payer system and covers 99.9% of the nation's total population of 23,000,000. Taiwan's NHI provides people with a high degree of freedom in choosing their medical care options. However, there is the potential concern that the available medical resources will be overused. The number of doctor consultations per person per year is about 15. Duplication of laboratory tests and prescriptions are not rare either. Building an electronic medical record exchange system is a good method of solving these problems and of improving continuity in health care.In November 2009, Taiwan's Executive Yuan passed the ‘Plan for accelerating the implementation of electronic medical record systems in medical institutions’ (2010–2012; a 3-year plan). According to this plan, a patient can, at any hospital in Taiwan, by using his/her health insurance IC card and physician's medical professional IC card, upon signing a written agreement, retrieve all important medical records for the past 6 months from other participating hospitals. The focus of this plan is to establish the National Electronic Medical Record Exchange Centre (EEC). A hospital's information system will be connected to the EEC through an electronic medical record (EMR) gateway. The hospital will convert the medical records for the past 6 months in its EMR system into standardized files and save them on the EMR gateway. The most important functions of the EEC are to generate an index of all the XML files on the EMR gateways of all hospitals, and to provide search and retrieval services for hospitals and clinics. The EEC provides four standard inter-institution EMR retrieval services covering medical imaging reports, laboratory test reports, discharge summaries, and outpatient records. In this system, we adopted the Health Level 7 (HL7) Clinical Document Architecture (CDA) standards to generate clinical documents and Integrating the Healthcare Enterprise (IHE) Cross-enterprise Document Sharing (XDS) profile for the communication infrastructure.By December of 2014, the number of hospitals that provide an inter-institution EMR exchange service had reached 321. Hospitals that had not joined the service were all smaller ones with less than 100 beds.Inter-institution EMR exchange can make it much easier for people to access their own medical records, reduce the waste of medical resources, and improve the quality of medical care. The implementation of an inter-institution EMR exchange system faces many challenges. This article provides Taiwan's experiences as a reference.

A hybrid hub-and-spoke postal logistics network with realistic restrictions: A case study of Korea Post

Postal logistics has a complex transportation network for efficient mail delivery. Therefore, a postal logistics network consists of various functional sites with a hybrid hub-and-spoke structure. More specifically, there are multiple Delivery & Pickup Stations (D&PSs), multiple Mail Processing Centers (MPCs), and one Exchange Center (EC). In this paper, we develop two mathematical models with realistic restrictions for Korea Post for the current postal logistics network by simultaneously considering locations and allocations. We propose an Integer Linear Programming (ILP) model for transportation network organization and vehicle operation and a Mixed Integer Linear Programming (MILP) model that considers potential ECs for decision making while simultaneously regarding the EC location, transportation network organization, and vehicle operation. We use modified real data from Korea Post. Additionally, we consider several scenarios for supporting EC decision makers. The proposed models and scenarios are very useful in decision making for postal logistics network designers and operators.

Performance Evaluation of Different QoS Models for Connecting Telephone Exchange Centers over Metro Ethernet Networks

Recent large deployment of high-speed metro Ethernet networks creates opportunity to connect legacy telephone exchange centers and cellular telephone base stations to the core telephony network. The success of data and legacy voice services convergence shall depend on whether it can provide the customer with the required QoS or not. Packet-base telephony service requires stringent bounds on end-to-end packet delay, jitter, and loss. New protocols such as MPLS and Diffserv are realized due to the major advantages associated with them such as QoS. This paper studies the performance of connecting telephone exchange centers over a metro Ethernet network using MPLS and DiffServ QoS model. We will implement some simulations to evaluate the performance in terms of delay, jitter and loss.