title: Grid-based implementation of XDS-I as part of image-enabled EHR for regional healthcare in Shanghai.
abstract: OBJECTIVE
  Due to the rapid growth of Shanghai city to 20 million residents, the balance between healthcare supply and demand has become an important issue. The local government hopes to ameliorate this problem by developing an image-enabled electronic healthcare record (EHR) sharing mechanism between certain hospitals. This system is designed to enable healthcare collaboration and reduce healthcare costs by allowing review of prior examination data obtained at other hospitals. Here, we present a design method and implementation solution of image-enabled EHRs (i-EHRs) and describe the implementation of i-EHRs in four hospitals and one regional healthcare information center, as well as their preliminary operating results.
  
  
  METHODS
  We designed the i-EHRs with service-oriented architecture (SOA) and combined the grid-based image management and distribution capability, which are compliant with IHE XDS-I integration profile. There are seven major components and common services included in the i-EHRs. In order to achieve quick response for image retrieving in low-bandwidth network environments, we use a JPEG2000 interactive protocol and progressive display technique to transmit images from a Grid Agent as Imaging Source Actor to the PACS workstation as Imaging Consumer Actor.
  
  
  RESULTS
  The first phase of pilot testing of our image-enabled EHR was implemented in the Zhabei district of Shanghai for imaging document sharing and collaborative diagnostic purposes. The pilot testing began in October 2009; there have been more than 50 examinations daily transferred between the City North Hospital and the three community hospitals for collaborative diagnosis. The feedback from users at all hospitals is very positive, with respondents stating the system to be easy to use and reporting no interference with their normal radiology diagnostic operation.
  
  
  CONCLUSIONS
  The i-EHR system can provide event-driven automatic image delivery for collaborative imaging diagnosis across multiple hospitals based on work flow requirements. This project demonstrated that the grid-based implementation of IHE XDS-I for image-enabled EHR could scale effectively to serve a regional healthcare solution with collaborative imaging services. The feedback from users of community hospitals and large hospital is very positive.
authors.affiliation: Laboratory for Medical Imaging Informatics, Shanghai Institute of Technical Physics, Shanghai, China. jgzhang62@yahoo.com
authors.forename: Jianguo
authors.initials: J
authors.lastname: Zhang
authors.forename: Kai
authors.initials: K
authors.lastname: Zhang
authors.forename: Yuanyuan
authors.initials: Y
authors.lastname: Yang
authors.forename: Jianyong
authors.initials: J
authors.lastname: Sun
authors.forename: Tonghui
authors.initials: T
authors.lastname: Ling
authors.forename: Guangrong
authors.initials: G
authors.lastname: Wang
authors.forename: Yun
authors.initials: Y
authors.lastname: Ling
authors.forename: Derong
authors.initials: D
authors.lastname: Peng
mesh_terms: D002681:China; D003195:Computer Communication Networks; D003363:Cost Control; D057286:Electronic Health Records / Q000458:organization & administration*; D017048:Health Care Costs; D006801:Humans; D011873:Radiology Information Systems; D018511:Systems Integration