远程重症系统建设的探索与实践

Exploration and practice of building tele-critical care system

目的查找远程重症系统建设中面临的问题,探索构建远程重症系统架构,验证已建成的远程重症系统的应用效果。方法以青岛大学附属医院为牵头单位,青岛大学医疗集团为依托,建设以集团核心医院为中心、集团内成员单位为节点医院重症监护病房(ICU)的远程重症系统。通过查阅文献及现场调研论证,查找影响远程重症系统建设的原因。现场调研相关医院重症医学科实际情况,论证选择有意向的ICU以及合作第三方通讯和设备公司,通过物联网及5G通信技术建成远程重症系统。通过实际开展远程监护、可视化查房、会诊、教学等活动,验证其系统功能。结果相关人员认知不足、远程医疗执业认证要求、信息安全问题和设备信息集成障碍是影响远程重症系统建设的主要原因。远程重症系统架构包含床单元设备及音视频信息物联采集、采集信息无损安全传输、信息在远程中心实时显示、中心与各节点医院ICU工作人员实时互动、诊疗信息云端储存5个部分。经验证患者诊疗数据信息可通过5G网络专线实时、安全、无损传输。通过该系统可实现患者监护、呼吸机、输液工作站应用信息及音视频监控信息实时、稳定上传;结合远程会议连线与当地医务人员进行双向交流,可实现实时远程监护、可视化远程查房、远程会诊、远程教学等功能。结论远程重症系统在医疗集团内部建设是可行的,可以安全有效地实现实时远程监护、可视化远程查房、远程会诊、远程教学等功能。

Objective To look for the problems faced in the construction of the tele-critical care system,explore the framework of construction of the tele-critical care system,and verify the application effects of the established tele-critical care system.Methods Through literature review and on-site investigation and demonstration,the causes affecting the construction of the tele-critical care system were explored.Through on-site investigation of the actual situation of the critical care department in relevant hospitals,arguing and choosing intended intensive care unit(ICU)and cooperative third-party communication and equipment companies,and through the Internet of Things and 5G communication technology,a tele-critical care system with the core hospital of the group as the center and the member institutes within the group as the nodes was built.Via the established tele-critical care system,activities such as tele-monitoring,visual remote ward rounds,remote consultation,remote teaching were carried out to verify the functions of the system.Results The insufficient cognition of relevant personnel,tele-medicine practice certification requirements,information security issues and the barriers of equipment information integration were the main causes affecting the construction of tele-critical care system.There were five parts in the tele-critical care system architecture foundations,including bed unit equipment and audio and video information collection system,lossless and secure transmission of collected information,real-time display of information in the remote center,real-time staff interaction between the centre and the nodal hospitals,and information cloud storage.It has been verified that patients'diagnostic and treatment information can be transmitted safely,losslessly and in real-time by a special line through private 5G network.Through this system,real-time and stable upload of audio and video information of patients and application information of monitors,ventilators and infusion work stations can be achieved;combined with tele-conference connections to conduct two-way communication with local medical staff,real-time tele-monitoring,visual remote ward rounds,remote consultation,remote teaching and other functions can be achieved.Conclusion The tele-critical care system we established is feasible to construct within the medical group and can safely and effectively realize the functions of real-time tele-monitoring,visual remote ward rounds,remote consultation,and remote teaching.