Azure Stack HCI混合雲? 電子病歷上雲並接軌FHIR國際資料交換標準
疫情加速醫療院所數位轉型，為因應醫療產業邁向智慧醫療面臨的法規、國際標準、遠距醫療及病患就診行為的改變，台灣微軟與社團法人台灣醫學資訊學會，於日前共同舉辦「2022微軟智慧醫療高峰會」，邀請產官學專家共同針對電子病歷新法實施後，針對電子病歷上雲、資料安全、資料交換與共享、資料分析與 AI 應用、及醫療影像 MR 元宇宙創新應用等議題進行討論。微軟 Azure Stack HCI 混合雲能夠兼顧地端建置的需求與雲端服務的連結，快速落實以混合雲漸進改造醫療業 IT 基礎架構、及以混合雲接軌FHIR國際資料交換標準，推動電子病歷上雲及合規目標。
In response to changes in the laws, international standards, long-distance medical treatment, and patient behaviour in response to the health-care industry’s demands for intelligent medical care, Taiwan Microsoft and the corporate Taiwan Medical Information Society co-sponsored the 2022 Microsoft Smart Medical Summit, which invited industry experts to work together on new methods of electronic medical records, data security, data exchange and sharing, data analysis and an AI application, and medical imaging of the MR meta-cosmography.
「 2022 微軟智慧醫療高峰會」吸引包括臺大醫院、新光吳火獅紀念醫院、台中榮民總醫院、中國醫藥大學附設醫院、中山醫療大學附設醫院、林口長庚紀念醫院、馬偕紀念醫院、彰化基督教醫院、奇美醫院、花蓮慈濟醫院等 10 家醫學中心及 16 家醫院資訊室主任以上層級參加，其中臺大醫院新竹分院、花蓮慈濟醫院、衛生福利部桃園醫院、中國醫藥大學附設醫院、台南市立醫院、竹銘醫院、奇美醫院、屏東榮民總醫院、馬偕紀念醫院、高雄市立聯合醫院、高雄榮民總醫院、童綜合醫院、衛生福利部雙和醫院、及聯新國際醫院更是由副院長以上層級參加，足見各大醫院對於電子病歷上雲及符合國際資料交換標準 HL7 FHIR 的重視。
The 2022 Microsoft Smart Medical Summit attracted the participation of 10 medical centres and 16 levels above the head of the hospital's information room, including the main hospital's new bamboo branch, the Huai Chik Hospital, the Peach Park Hospital of the Ministry of Health and Welfare, the Chinese Medical University's auxiliary hospital, the Chinese Medical University Hospital, the Chinese Medical Hospital, the Chinese Medical University's annex hospital, the Limongh Memorial Hospital, the Mapang Memorial Hospital, the Christian Hospital, the Chimmy Hospital, the Huamei Hospital, the Hua Lien Tzu Hospital, the Hong Kong General Hospital, the Mahachi Memorial Hospital, the Gao Yung City Joint Hospital, the High Honorary People's General Hospital, the Kindergarten Hospital, the two hospitals of the Ministry of Health and Welfare, and the United International Hospital, which were attended more than one level by the deputy head of the hospital.
電子病歷管理辦法新版7/18正式上路 資料交換與共享是邁向智慧醫療的關鍵
醫療機構電子病歷製作及管理辦法新版於 2022 年 7 月 18 日正式實施，包括了資料安全、雲端服務、資料管理與資料應用四大重點，其中開放電子病歷系統可委託使用雲端服務及允許公私立機構建置電子病歷交換平臺，不僅打破了各醫療院所電子病歷的藩籬，更打通醫院全面無紙化的最後一哩，然而大多數醫療院所使用多年的 HIS 醫院核心系統仍建置在大型主機上，不僅既有的架構無法讓電子病歷上雲，資料的交換格式仍採用 CDA 醫療資料標準，要符合新法勢必要從 IT 的基礎建設開始翻新，將為醫療院所帶來 IT 預算增加及欠缺 IT 專業人員的雙重挑戰。
The new version of the medical facility's electronic records production and management methods was officially implemented on July 18, 2022, and included four major points, including data security, cloud-end services, data management and data applications, in which the open electronic records system was commissioned to use cloud-based services and to allow public and private institutions to exchange electronic records, not only to break the final mile of the hospital's full paperless medical records, but the HIS hospital core system, which has been in use in most medical institutions for many years, is still being built on large mainframes, and not only has the existing structure to allow electron records to be clouded, but the format of the data is still subject to the CDA standards of medical data, in keeping with the need to renovate the infrastructure of the new system from which IT is built, and will generate a two-fold challenge for the Academy of Medicine, which is expected to increase IT and to lack IT specialists.
「電子病歷上雲及符合國際資料交換標準是不可逆的趨勢，微軟提供的雲端服務不僅符合國際資安及資料交換標準，更滿足醫療院所快速開發及彈性佈署的需求，」台灣微軟總經理卞志祥表示：「微軟承諾提供一個專為醫療產業需求建構的智慧醫療雲端服務，不僅結合 Office 365、Dynamic 365 及 Power Platform，同時通過 ISO 27001、ISO 27018、CSA 金級認證及國際資料交換標準 HL7 FHIR、HIPPA 和HITRUST 等各項國際資安法規與認證，可同時滿足醫療機構在合規與安全性的雙重需求。」
"The cloud on the history of electrons and compliance with international data exchange standards is an irreversible trend, and Microsoft provides cloud services that meet not only international standards for security and data exchange, but also meet the needs of the rapid development and broadcasting of health facilities." "The Taiwan Microsoft Managing Director, Zhixiang, said that "Microsoft promises to provide an intelligent medical cloud service designed specifically for medical industry needs, not only to combine Office 365, Dynamic 365 and Power Platform, but also to match the dual needs of medical facilities with those of safety through international safety laws and certifications such as ISO 27001, ISO 27018, CSA gold accreditation and international data exchange standards such as HL7 FHIR, HIPPA and HITRUST."
社團法人國家生技醫療產業策進會副會長楊泮池強調：「智慧醫療的” I ”不是智慧 ( Intelligent )，而是可相互操作 ( Interoperable ) 與可相互交換 ( Interexchageable )，資料是智慧醫療的關鍵，要達成目標首先需要將舊有的大型主機及使用 20 多年的 HIS 系統更新，並將健保資料庫與國建署資料進行整合，此外，醫療產業還要與 ICT 產業密切合作，才能建構資料可交換、安全的醫療次世代系統。」
The corporate entity, the Vice-President of the National Council for the Development of Biomedical Industries, has stressed that "Intelligent I" is not "intelligent," but is interoperable and interchangeable, and that data is the key to intelligent medicine, and that achieving the goal requires, first and foremost, updating the existing large mainframe and HIS systems that have been in use for more than 20 years, and integrating the health database with the National Agency's data. In addition, the medical industry is working closely with the ICT industry to build a secure medical sub-generational system where data can be exchanged.
社團法人台灣醫學資訊學會理事長徐建業指出：「國際資料交換標準已經從 HL7 改為HL7 FHIR，唯有資料共享才能讓醫療產業邁向智慧醫療，台灣的健保資料多年來累積了數量龐大的病歷資料，這些龐大的數據資料透過整合與AI分析後才能成為醫療洞察，微軟提供的 Azure Stack HCI 不僅能夠讓資料留在地端，同時還可透過 Azure 雲端上提供的各項服務，達成流程自動化及各種 AI 分析服務。」
"The international data exchange standard has been changed from HL7 to HL7 FHIR, and only data sharing can enable the medical industry to move to intelligent medicine, and Taiwan's health data have accumulated a large number of medical records over the years, which can only become medical insight through integration and analysis by AI, and AzureStack HCI from Microsoft can not only leave the data on the ground, but also through the services provided on the Azure cloud.
衛生福利部資訊處處長龐一鳴表示，醫院醫療資系統的趨勢是朝平台化發展。 20多年前我們以健保申報為目的，開始建立了一個中央統一管理並以醫療給付為目標的數位化體系。現在衛福部要推動的次世代數位醫療平台，需要可相互操作、資料可共享且符合國際資料交換標準，同時採用容器化 ( Container ) 和微服務 ( Micro Service ) 的概念去建立平台架構，讓應用系統及新的服務可以自由在雲端或是地端系統移動並即時融入服務流程。
More than 20 years ago, with the aim of health insurance, we began to build a centralized digital system with the aim of providing medical treatment. Now, the sub-generational medical platform that the Department of Health is moving forward requires interoperable, shared, and international data exchange standards, using the Container and Microservice concepts to build the platform so that applications and new services can move freely and immediately into the service process at cloud or ground levels.
攜手醫療產業夥伴 協助醫療院所以混合雲建構智慧醫療數位平台與應用
微軟攜手寬橋、智捷生醫、台灣思杰、台灣戴爾、智齡科技、及慧與科技分享 Azure 混合雲建構次世代醫療數位平台及相關的應用，包括資料分析、資料安全、雲端醫院、數位病理、雲端智慧長照、醫療影像 MR 元宇宙臨床應用，協助醫療院所建置以人為本的智慧醫療。
Microsoft carries a wide-handed bridge, an intelligent life doctor, Taiwan Shije, Taiwan Dale, age science and technology, and the Azure hybrid cloud-building digital platform and related applications, including data analysis, data security, cloud-end hospitals, digital pathology, cloud-side wisdom, medical imaging of the MR meta-cosmos, and assistance with people-centred mental health care at medical hospitals.
Azure Stack HCI 是以 Azure 服務形式提供的超融合式（HCI）基礎結構作業系統，可運行在通過微軟驗證的 20 多家合作夥伴的硬體平台，以開放系統的多元選擇，避免被綁定在專屬硬體架構的風險。此外， Azure Stack HCI 還具備下列特色：
Azure Stack HCI is an ultra-integrated (HCI) infrastructure system in the form of an Azure service that operates a hard-forming platform of more than 20 partners with microsoft testing to open the system's multiple options and avoids the risks of being tied to a dedicated hard-structured structure. In addition, Azure Stack HCI has the following features:
- Azure 混合雲原生設計：可將Azure 公有雲服務打包至地端運行，亦可將資料中心延伸至雲端，在Azure 入口網站的單一介面同時管理地端和雲端的Azure Stack HCI 主機、虛擬機器（VM）及Azure 資源。
- 企業級規模和性價比優勢：運用軟體定義的運算、儲存體和網路功能，快速將基礎架構現代化，以內部部署展現雲端效益。此外，醫療機構部分既有系統仍運行於已終止支援的Windows Server 和 SQL Server 2008 及2012 版本，無需額外付費即可取得安全性更新。
- 熟悉的管理和作業環境：IT 團隊利用原有在Windows Server 及Hyper-V 的技能結合Windows Admin Center 及內建的部署 GUI，就能建置超融合式基礎結構，並將管理工作大幅自動化。
- 部署彈性：發揮微軟生態圈在軟硬體夥伴的多元性，自由選擇最符合需求的部署情境及最佳化解決方案。
為了更貼近醫療業的應用場景與需求，微軟專門為醫療產業設計高效且安全的智慧雲端平台，串連微軟旗下產品與醫療產業夥伴生態系的客製化解決方案，建構三大醫療目標及實作場景，包括：
In order to be more relevant to medical applications and needs, Microsoft specializes in the design of an efficient and safe intelligent cloud platform for the medical industry, a series of customized solutions for products under the microsoft flag and the partnership of the medical industry, and the construction of three major medical goals and implementation scenarios, including:
- 提升與病患的互動：以數據分析進行全方位患者洞察，建立個人化護理，強化遠距醫療服務，進而優化醫病關係。
- 賦能醫療同仁的協作：以智慧化流程串連新一代 HIS 系統，加速醫療團隊協同合作流程，提高醫療團隊資源協調效率，亦可應用於患者長期監測。
- 優化醫資洞察：整合分散於各系統的數據並建立相互關聯性，進而產生可預測風險、提升病患照護品質和營運效率的數據洞察，增進營運分析和臨床分析。
衛福部開放電子病歷上雲及採用 FHIR 架構的政策，勢必深刻影響醫療業未來的營運管理模式，善用混合雲模式來改造關鍵的底層技術，不僅可加速接軌國際標準，還能成為發展智慧醫療服務的最佳基石。
The policies of the Ministry of Health to release electrical records and use FHIR structures will have a profound impact on the future operating management model of the medical sector, and the use of hybrid cloud models to transform critical sub-level technologies will not only speed up compliance with international standards, but will also be the best building block for the development of intelligent medical services.
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