Toward to the new generation of intelligent healthcare by combining
the cancer genetic information
結合癌症基因資訊迎向智慧醫療的新世代
Der-Ming Liou
劉德明
Institute of Biomedical Informatics, National Yang-Ming University, Taipei, Taiwan, ROC
國立陽明大學 生物醫學資訊研究所
In Taiwan, the patient's clinical information is mainly stored in hospital information
system. The medical information, biological information and technical information of
the patients are the main components useful for personalized medicine. With an
efficient, complete, and up-to-date patient information system, clinical
decision-making based on the integrated information will be able to support
physicians to help each patient to get the best medical care.
Establishing clinical data repositories (CDR) plays a crucial role in developing
clinical information systems for intelligent healthcare. A well-designed CDR can
promptly provide accurate clinical data for decision support. While collecting and
analyzing clinical data for study purposes, researchers should conform to Personal
Information Protection Act in order to protect patients’ privacy. In Taiwan, some
clinical data repositories had been created. However, these repositories all comprise
homogeneous data, which not only limit statistical inference but also confine the
continuity of the patient’s medical records. To overcome the aforesaid problem,
integrating heterogeneous databases is imperative.
The goal of this study is to collect and integrate the clinical pathology, recurrence
patterns and survival data of the cancer patients. Then we will use these clinical data
and tumor specimens to identify potential biomarkers. Based on these biomarkers, the
clinicians will be able to make better clinical decision and to predict the probability of
metastasis and/or recurrence, which will provide better treatment strategy for
individual gastric cancer patient before surgery or chemotherapy. We will also
develop an ontology extraction, transformation and load module for oncology
mapping and semantic interoperability. Therefore, we can standardize, normalize and
integrate clinical data from electronic health record systems and build a usable and
scalable clinical data repository for intelligent healthcare.
Create standardized integration framework for cancer therapies
建構癌病診療資訊標準化及互通機制
Chia-Hung Hsiao
蕭嘉宏
Department of medical informatics Tzu Chi University
慈濟大學醫學資訊系
This research proposes an integration framework for clinical data sharing in
cancer therapies. The framework utilizes HL7, DICOM, and web services to exchange
clinical information between HIS, PACS, radiotherapy modalities, and EMR systems.
Basing on the framework, orders generated from HIS would be transferred to
departmental systems for cancer therapies. The treatment results can be stored in EMR
or PACS using web services and DICOM standards. And the clinical workflows can be
tracking through the integration framework for caring cancer patients. The framework
indicates the standard communication protocols for order entry, departmental working
list scheduling, imaging acquisitions, therapy planning and simulation, and therapies.
In the integration framework, all cancer therapy related clinical data that stored
in HIS or departmental system databases currently would be accumulated and
transformed as standard medical record and stored in an EMR system. The EMR
system plays a role as document repository in IHE XDS clinical document sharing
profile. Following XDS integration profile, we can query and retrieve all the patients’
clinical documents by standard web services. Consequently, the cancer therapy
information can be reused by other oncology healthcare systems, such as nursing
service system and PHR system for cancer patient. Through the framework, the statics
data can also be extracted automatically form clinical document that stored in the
EMR system. Consequently, this would be convenience for gather clinical data for
clinical trial or surveillance of clinical processes for cancer healthcare, such as IHE
Quality, Research, and Public Health (QRPH) specifications that has been addressed
and used in other healthcare domains.
The Big Data in Oncology
海量資料之應用於癌症研究
Yu-Chuan (Jack) Li
李友專
College of Medical Science and Technology (CoMST)
Taipei Medical University, Taipei, Taiwan, ROC
臺北醫學大學醫學科技學院
The advancement in the Health Sciences and Health Information Systems, has
had dramatically increased the patient level health data accumulated by the health
providers. Health databases are constantly getting increased by 4 V’s (Velocity,
Volume, Variety and Veracity). The number of rows (objects) crossing the order of
N=109 (billions) and the number of columns (attributes to the objects) are growing to
the order of 102 (hundreds). Informaticians are eager to explore methodologies and
techniques that can make ‘meaningful’ use of huge database in order to achieve an
efficient health care.
Oncology represents the top cause of death in Taiwanese population. No matter
what advances there may be in hi-tech medicine for treatments, any major reduction
in deaths, disability and cost of care will come from prevention, not from cure.
Therefore, one of the best strategies to deal with cancer is to focus on prediction,
prevention, personalization and participation (4P) model of healthcare.
The American Society of Clinical Oncology (ASCO) is harnessing big data to
build and mine a database of cancer treatment records to help physicians determine
the best treatments for particular kinds of patients. It is high time to accumulate cancer
care data directly from any EHR system, as well as other sources such as lab data,
genomic profiles and physician notes. Models should be developed in order to provide
clinical decision support to help physicians care for patients. We need to enable
researchers to explore the database to identify real-world trends and associations.
Taiwan Medical Services’ Journey to the Cloud and Big Data
雲端運算在創新醫療服務之應用
Tschai, Huei-Jane
柴惠珍
Director of IT-enabled Division, Board of Science & Technology, Executive Yuan
行政院科技會報辦公室科技服務組主任
Cloud computing are growing more pervasive, and will re-shape ICT industry value
chain to an era of software and services. Taiwan’s government made an initiative to
transform her ICT industry into an advanced developer of cloud computing
technology. Last year, the initiative was re-adjusted into a new vision and goals, and
put emphases on “value for civilians” and “profitability for industry”. Five strategies
are “Promote valuable applications that touch hearts”, “Build innovative software
development capability”, “Develop cloud system kernel”, “Leverage home-made
infrastructure”, and “Be green”.
The initiative will build ten exquisite government clouds. Each government cloud was
asked to focus on application development rather then hardware and infrastructure to
buy. The main concern is to make more sophisticated software which not only let
government provide better services but also let ICT industry generate an innovative
product sold to worldwide. Of course, to corporate green IT to create a green and
sustainable environment, including computer room consolidation of government
agencies and public schools, is also requested. According to cloud assessment rules,
each cloud can be planned and executed in keeping with large scale, information
sharing, big data analysis, and open data. Recent highlights include food traceability
cloud, health cloud, GIS cloud, environment cloud.
As cloud computing makes its way to create opportunities for both new applications
and innovative business model, the challenge is how to handle big data, the waves of
information generated and stored in the cloud. According to Gartner, big data’s
influence will only amplify in 2013. The power of big data and the competitive
advantages it can bring are so incredible. Enterprises need to find unusual ways to
integrate digital information which from internal, external, social networking, sensors
etc. to create more tremendous commercial value. Government clouds should also dig
out the new business model through big data analysis to get civilian’s more
satisfaction and then to be a smart government.
To construct innovative and good practice government clouds, a high-quality software
development capability is critical. Therefore, a solution-neutral platform for cloud
application development and testing, known as “cloud open lab” is created to
encourage both public and private sectors to match each other's needs. Through this
lab, public sector can get one-stop shopping service and reduce implementation costs;
private sector can also enlarge their business channel, try and strengthen its cloud
solutions and technology, so that the local industrial R&D efforts can be practiced
through government clouds to create a win-win situation.
雲端運算在創新醫療服務之應用
柴惠珍
行政院科技會報辦公室科技服務組主任
雲端運算應用讓電腦運算資源改以服務形式，經由網際網路直接取得，將
重新塑造資訊產業價值鏈新樣貌，開啟以軟體及服務為主的競爭時代。我
國政府也適時推動雲端運算產業發展方案，並於去年重新調整方向，改以
「應用推動」與「產業發展」並重，定名為「雲端運算應用與產業發展方
案」
。從推動民眾有感應用、建構創新應用之開發能量、奠定系統軟體基
礎、落實雲端基礎建設、發揮綠色節能效率等五個面向制定策略。
民眾有感的雲端應用將打造十朵精緻的政府雲，從民眾角度，讓政府相關
部會的資訊能相互共享，發揮創新的服務應用；原則上不再投入硬體設備
之購置，同時推動機房整併及綠色節能，以期健全民間業者機房之營運品
質。另外，訂定政府雲端計畫評估原則，讓政府雲能從資訊共享、巨量資
料分析、開放資料等面向規劃與執行。近期已有食品雲、健康雲、圖資雲、
環境雲等數個亮點露出。
雲端運算的變革帶來巨量資料分析以創新商業模式的可行性，其背後隱藏
的龐大商機令各方垂涎。過去企業專注內部資料的管理，試圖從資料中找
出應用價值；近年來雲端運算、開放資料與社群網路的快速發展，企業更
注意外部資料所能發揮的商業價值。政府雲端計畫若能挖掘出資料背後的
商業價值，掌握潛在需求，開創新的服務模式，提供民眾更滿意的應用價
值，必能創造新一波的成長動能。
要建構創新亮麗的政府雲端應用，一定要有優質的軟體開發能量；因此也
特別建立雲端應用開發測試平台，鼓勵政府部會及民間企業透過雲端開發
測試平台媒合彼此需求；從政府端可滿足一次購足的服務，降低雲端應用
建置成本；亦從民間業者端提供接觸商機管道，試煉雲端解決方案，讓產
業研發成果落實到政府雲的各種應用，奠基本土雲端研發成果，創造雙贏
的局面。
整個雲端推動將以三年為目標，期望透過十朵民眾有感的政府雲端應用，
帶動台灣資通訊產業轉型升級為雲端運算產業，讓我國成為具技術自主能
力，可提供雲端系統、應用軟體、系統整合與服務營運之技術先進國家。
最後期能普及雲端運算應用，發展台灣成為政府、企業與個人高度使用雲
端服務之先進雲端應用典範輸出國。
Mobile Medical Solutions: How it aids in cancer diagnosis, treatment
and post-treatment.
行動化數位醫療--癌症之應用
William Pan
盤龍
EBM Technologies Inc.
商之器科技股份有限公司
Cancer treatment is known as a complex and long process that involves a team
including oncologists, surgeons, radiologists, other related specialists and medical
staffs who are in charge mental care and caregivers or primary physicians of the
patient for post-treatment. Hence, timely access to a patient-centric medical
information and efficient communication for all the stakeholders is essential.
Medical Cloud centralizes images and reports of radiology exams but also other
exams data and other related patient’s medical information. Even the printed reports
or Non-DICOM exam data can be converted into DICOM format and stored. All these
patient data will be shared and reviewed by any clinician who is involved in the
treatment process. Given the mobility, medical staff can access patient data at anytime
and anywhere on mobile DICOM viewer: iDO Viewer. For example, doctors who are
away from their workstations or out of the hospital, can access patients’ data for
emergency needs.
iDO Viewer aids communication between all stakeholders during the treatment
and post-treatment:
1. In the hospital, clinicians can discuss patient’s case with colleagues and
review the images and reports under conference mode of iDO Viewer. EBM’s
viewing tool will help communicating with patients with our interactive tool.
2. During post-treatment, patients’ primary physicians or their caregivers at
home can also be able to have enough understanding of patients’ status with
authorized access to the data and communication to the treatment team. Any
abnormal symptom will be faster notified to the hospital or be treated.
Radiation oncology: DICOM RT communications in Taiwan
放射腫瘤：DICOM RT 的應用
Yu-Wen Hu
胡育文
Cancer Center, Taipei Veterans General Hospital, Taipei, Taiwan
台北榮民總醫院癌病中心 放射腫瘤科
The Digital Imaging and Communications in Medicine (DICOM) standard is
widely implemented in radiology and various subspecialties, including radiation
oncology. Currently, nine ICOM-RT objects have been defined: RT Image (Images
relevant to RT acquired using conical geometry, Generated images: DRR, DCR, BEV,
etc, Other RT images: Simulator, portal images, etc.), RT Structure Set (Patient-related
structures, Outlined target volumes, organs at risk), RT Plan (Geometric and
dosimetric data relating to treatment plan, External Beam: treatment unit, isocentre,
gantry/couch/collimator angles, Collimation, Provision for brachytherapy), RT Dose
(Dose distributions calculated by planning system, 2D / 3D dose matrix and groups of
point doses, Isodose curves, Dose-volume histograms (DVHs)), RT Beams Treatment
Record, RT Brachy Treatment Record, RT Treatment
Summary Record, RT Ion Plan and RT Ion Beams Treatment Record.
The benefits of using DICOM-RT include: (1) Transmission of information
regarding radiotherapy between information system of different vendors with minimal
effort; (2) Integration of the treatment process into an electronic patient record; (3)
Monitoring and analysis of the RT workflow; (4) A platform for information sharing
with hospital information systems and other institutions; (5) A platform for future
medical imaging informatics research and outcome analysis of standardized data.
Effective digital content enhance service quality of cancer patient
有效數位內容增強癌患服務品質
Chao, Liang-Hsiao
趙良曉
Cancer Center, Taipei Veterans General Hospital
臺北榮民總醫院癌病中心
Cancer diagnosis and treatment are highly specialized medical practices. Due to
the rapid development of digital network, an excess of medical knowledge and rapid
transmission of information make cancer patients suffer information anxiety. Effective
integration of resources to improve service quality and to promote better
doctor-patient relationship is what we would like to see.
Anyone who was diagnosed as having cancer must undergo a series of medical
procedures and decision making, for example, What kind of treatment is best for me?
What is the treatment program? I need to comply with what care and guidance, How
to take care of my nutrition status during the course of treatment? How long can I
know the effect after treatment? What is and how often should I receive the follow-up
examinations? The various problems can be solved with the use of a variety of
multi-media material via cloud technology to reach a variety of handheld devices.
CTCA (Cancer Treatment Centers of American) endorses a model of treatment
that integrates traditional therapies with alternative ones. Traditional cancer treatments
approved by the U.S. Food and Drug Administration (FDA)—such as surgery,
radiation, chemotherapy ,thermotherapy and stem cell transplants—are provided.
Nutritional support, naturopathic programs, spiritual counseling, relaxation therapies
and other alternative treatments are also available. We may learn the successful
experience of CTCA in the United States.
Constructing effective digital content and timely provision to cancer patients not
only improve service quality, but also effectively improve the doctor-patient
relationship. Creating a win-win situation and a better medical environment is our
goal.