如何将临床决策支持与医疗信息系统的业务流程整合起来

早些年,人工智能专家系统盛行的年代,有很多在临床决策支持方面的尝试和探索,很多机构都使用了一些单机的用以辅助诊断的临床决策支持系统. 现如今,更多的则期望能够将最先进的医学知识,最佳实践集成了医生工作站,电子病历等医疗信息系统内部.本文就是对此主题的一个简单梳理.
1 参考美国卫生部的第一种分类

美国卫生部的网站上对这个问题进行了一个归纳和总结，见Workflow Taxonomy，大致上翻译了一个版本参考附件Reference Taxonomy of Clinical Workflows.xlsx 分别从患者的角度,系统交互的角度,临床医务人员的角度介绍了临床上哪些阶段,哪些步骤涉及了哪些类型的临床决策支持行为.
1.1 患者的角度

以患者的视角,从门诊,急诊,门诊手术,住院的一系列就医的流程中分析可能应用临床决策支持技术的场景和会用到的临床决策支持的类型
1.2 从系统交互的角度

以系统交互的视角,从预约挂号,急诊信息流程,药房消息处理,术前准备,术中等分析可能应用临床决策支持技术的场景和会用到的临床决策支持的类型.
从医务人员的角度

以医务人员的视角,从人员管理,病例管理(病例的寻找,患者的诊断,治疗计划的确定,治疗计划的实现,治疗结果的评估和监管)和病例评估(评审,上报,患者教育,随访)等分析可能应用临床决策支持技术的场景和会用到的临床决策支持的类型.
2 参考论文的第二种分类

《基于临床指南的临床决策支持系统的设计与实现》一文中引用中的如下内容：

1 接诊前临床工作流中的活动包括:

1.1 临床医生回顾患者的健康指标概要

1.2 患者回答医生的问询

1.3 临床医生回顾相关疾病的知识

1.4 提醒患者(例如，保持健康)

1.5 帮助指导患者完成相关信息和决策

2 接诊中临床工作流中的活动包括:

2.1 疾病评估

2.1.1 从患者信息记录中收集数据

2.1.2 通过患者获取疾病史和检查信息

2.2.3 检验

2.1.4 诊断咨询

2.1.5 诊断和鉴别诊断

2.2 安排和执行治疗计划

2.2.1 药物选择(安全性、成本、适用性，等)

2.2.2 非药物治疗的干预

2.2.3 对有效性和副反应的跟踪，进一步的临床评估、测试，必要时调整治疗计划

2.2.4 获得治疗方法

2.2.5 继续安排治疗计划，或者结诊出院

2.3 患者教育

2.3.1 病情交流，包括疾病风险评估、疾病的严重程度、医生与患者共同讨论临床决策建议

2.3.2 患者自我照料

2.3.3 执行说明

3 接诊后临床工作流中的活动包括:

3.1 药物分发

3.2 药物管理(例如，静脉注射相容性，药物存放条件)

3.3 检查检验结果公布

3.3.1 根据患者之前的状况分析结果

3.3.2 将结果、结果的解释以及治疗计划传达给患者

3.4 患者注意事项

3.5 出现新的临床情况(例如，停药)

3.6 临床医生思考患者可能的诊断或处方

3.7 信息系统发送临床数据报告给医生

综上来看，二者在分类上存在一定差异，前者更为详尽，仔细，参考价值更高。

美国卫生部网站上有关CDS的内容

What is Clinical Decision Support (CDS)?

Clinical decision support (CDS) provides clinicians, staff, patients or other individuals with knowledge and person-specific information, intelligently filtered or presented at appropriate times, to enhance health and health care. CDS encompasses a variety of tools to enhance decision-making in the clinical workflow. These tools include computerized alerts and reminders to care providers and patients; clinical guidelines; condition-specific order sets; focused patient data reports and summaries; documentation templates; diagnostic support, and contextually relevant reference information, among other tools. Why CDS?

CDS has a number of important benefits, including:
Increased quality of care and enhanced health outcomesAvoidance of errors and adverse eventsImproved efficiency, cost-benefit, and provider and patient satisfaction

CDS is a sophisticated health IT component. It requires computable biomedical knowledge, person-specific data, and a reasoning or inferencing mechanism that combines knowledge and data to generate and present helpful information to clinicians as care is being delivered. This information must be filtered, organized and presented in a way that supports the current workflow, allowing the user to make an informed decision quickly and take action. Different types of CDS may be ideal for different processes of care in different settings.

Health information technologies designed to improve clinical decision making are particularly attractive for their ability to address the growing information overload clinicians face, and to provide a platform for integrating evidence-based knowledge into care delivery. The majority of CDS applications operate as components of comprehensive EHR systems, although stand-alone CDS systems are also used.
CDS ActivitiesCDS ImplementationCDS Sharing

整理后
CDS入门：
如何利用Clinical Decision Support Starter Kit入门
在哪些临床工作流程中可以使用哪些CDS工具
CDS实施中的经验教训

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第二篇，读< 从业务角度看API >

英文
中文
作者：Matt McLarty

观点1：API是当今信息技术趋势的核心，比如说移动终端、云计算、物联网、大数据、社交网络。涉足各行各业，如能源、汽车、电商等
观点2：虽然和API在整个技术领域应用相比是九牛一毛，在open WEB领域，API俨然已经成为相当重要的创新和收益的业务模式，对比，Kin Lane在API Evangelist网站上撰文进行了详细的阐述, Mehdi Medjaoui也在博文中就此进行了总结 。
事实上，现如今web API是隐藏在解决方案背后的，也就是API的业务模式也就是业务本身
观点3：API的业务价值、商业价值是可以度量的。传统意义上，由于服务器和存储设备成本高昂，他们所拥有的数据一定程度成为自身的债务。现如今，伴随着大数据和物联网、万物互联IoT等技术发展，拥有数据意味着可以将其转换为新的机会和收入来源。
观点4：如何确定那些数据、服务可以通过API暴露，以及如何实现这些API，可以通过如下三个数据的属性来判断：

总结下来，也就是两方面：
1、有用的API“Useful APIs” 能够提供准确适当的数据
2、可用的API “Usable APIs”能够访问到数据

观点5：有用的API
开发API时常见的误区是认为所有数据都是有用的。不是说你开放了数据，开发人员就能从中增加收益、创新、开拓新的业务。API和Open Data本身是远远不够的。
“This “medium is the message” thinking was responsible for many of the failed SOA initiatives that occurred in enterprise integration over the last decade”这句是什么意思，没有搞懂
举出Google Map、Facebook、Twitter的例子说明只有正确的数据结合API才能攫取最大的效益，
观点6：Amazon API的案例
API对于开放API之外的机构而言，在业务上帮助作用拥有巨大潜力。对于Amazon，API是从内部缘起的。
经验教训一：将API定位为产品、解决方案的构建基石。Brad Stone在书中花了一章来阐述API是Amazon整个技术架构的基础，Kin Lane在博文The Secret to Amazons Success Internal APIs中讨论了如何保证程序能够访问这些API接口。
经验教训二：如何使用基于API的方法来采集、分析、改进和分发数据。Jeff Bezos 讲到“We don’t make money when we sell things. We make money when we help customers make purchase decisions.”.只有恰当的、准确的、可用的数据才能帮助用户进行决策，这对于亚马逊来讲至关重要。
“Data-Enabled Disruption (DED)”图示

经验教训三： 战略与战术定位之间的权衡。早期，Jeff Bezos认识到万维网的巨大潜力，随即产生了要创建一个巨大的能够存放任何东西的商店。
在分析了市场之后，以在线图书零售为突破口来优化整个供应链，企业文化(ensuring timely execution while maintaining religious devotion to the future vision—is now a tenet of Amazon’s culture, where solutions must add value both in what they deliver and what they enable)一方面能够实现功能，一方面能够传递价值。
见下图

每种服务都对应着一个API，每个都是基于早期的解决方案所产生的。

观点6：可用的API以及API设计的重要性
虽然亚马逊很成功，但它们的API设计却不是很好，也不易用。随着API的爆发性增长和其必要性的认可度提高，API的可用性成为众多公司主宰行业或者初创公司试图开拓创新服务的关键。

移动设备和consumerization of IT引发了企业应用开发的模式转变。从一开始的终端到CS架构到现在的分布式网络。在之前的文章the shedding of tiers,为了适应云端和移动端的发展，正在从n层web模型向以API为中心的而转变。
以远程通讯领域为例，多年来大玩家们一方面互相竞争，另一方面寻求能够为用户提供网络之外的增值服务。这个行业在过去15年间经历过很大分裂，如VOIP的出现，业务和服务的整合，以及移动设备服务的改革，在上述环节中，API都发挥了作用，尽管仍然主导着传统的telco服务，但难以维系其优势，在Alan Quayle的文章a-brief-history-of-telco-apis(http://alanquayle.com/2012/06/a-brief-history-of-telco-apis/)中指出在像Parlay X和OneAPI这样的协作项目中这些玩家困难重重。

Twilio公司成立于2007年，旨在提供易用的语音和短信服务，所有应用都部署在云端。他们认识到API是他们最核心的业务渠道，尽管SMS和VOIP服务是恨有用的，但要和大玩家竞争，commoditized telco services是远远不够的。Twilio也意识到他们服务的最初用户并非终端用户，而是调用API构建APP的开发人员，而且发展最快的是移动APP，于是开发了诸多衡量是否能够很好的服务客户的指标。除了像传统的统计数据如端到端的调用响应时间，他们还测量了新上手的开发人员从注册他们的api到开发好应用花多长时间，这极大的提高了易用性，成为了和大公司的主要差异点，当开发人员在选择SMS VOIP服务的时候，优势就显现出来了。

总结：
1、API 与业务策略要统一
2、实现过程中通过API保证数据可用、准确
3、确保API是有用的、可用的
4、像亚马逊一样形成a disciplined culture of iterative Data-Enabled Disruption
5、像Twilio一样形成优质的API开发人员用户体验来差异化和竞争对手的业务

参考资料

Mehdi Medjaoui

如果要解释web API到底是什么，常常会说，“web API代表的是应用程序的借口”，这个答案会让business managers和出租车司机都一脸茫然。如果说“是网站和移动应用程序的基石”，又显得太过于抽象，如果说“你记得Facebook和微信上的点赞按钮么，可用在Facebook之外的任何网站上使用，那么Facebook是如何知道发生了什么 的呢？这一切要归功于Facebook的API使得外部网站和Facebook能够处于连接状态。因此点赞按钮是不属于Facebook本身的Facebook的一块功能，API能够似的应用程序相互连接起来”
如果Twitter不允许收集APP访问Twitter你如何从收集发送tweet，也就是说APP也要用到Twitter的API。
这些说法都没错，我们强调了API是一切事物的基石。但对于CEO和管理层而言，API对于业务有多大价值，如何来介绍呢
“An API is not only a building brick, it is also a projection of a product vision, based on internal assets you can open to the world”
API定义了一种新的数字化的B2B共享的生态圈，各个公司以API的形式将自己的核心资产暴露出去，同时通过API消费其他核心资产。对于管理、业务人员我们要向他们这样解释，将内部资产以web API暴露出去，也就成为了第三方可产品化的资产。这时候，API 就是产品。
那如何从市场、财务、技术、业务拓展和法律五个角度来解释API呢？
第一点：平台式思考。就市场而言，开放API意味着公司转型为一个平台，在传统的B2B或SaaS市场上，你与竞争对手在同一个市场上竞争，很难扩展市场份额。

通过Open API，你占领的是垂直方向的市场，与合作方和第三方以及开发人员形成一个全新的生态圈，蓝海市场。

第二点：现有资产的商品化。从财务的角度来看，API是对现有资产ROI做乘法。在亚马逊形成了一个全球性的零售店之后，才发觉他们自己的云数据服务器架构也可以作为服务来卖，通信行业采用了双面的业务模型，一方面卖自己的语音、短消息和连接服务，另一方面卖自己的网络给第三方公司。最近IBM也开始对外卖自己的Watson大数据处理分析技术。
对于花了重金形成了技术资产的公司，也想通过向第三方开放的形式回收一部分投入。就好像你买了一栋房子，想出租其中一间给外人来用抵房贷一样。

第三点：Composability 从技术的角度而言，API能够让用户把外部的软件适配到自己内部的IT架构上，而不是反过来内部的IT架构适配外部的软件上。
在做B2B集成时，必须考虑尽量避免自己这边的繁重的governance治理工作量。再也没有必要安排一系列的业务上的会议、技术上的会议和技术培训来探讨如何集成。可以在自己的网站上把API放上去，能够极大地帮你减少概念验证所花的时间。客户只需要通过API把你的软件与自己内部的IT架构整合起来，不用说两面都添功能，再改功能。
当然你也可以给客户直接买实现好的服务，虽然大多数长尾客户都会自己实现自己的功能。

第四点：自服务Self-service，从业务拓展的角度而言，API就是一个Self-service自服务的门户，能够让你的业务延伸到全球范围内。潜在的用户能够7*24小时的发现你所提供的服务和特性，使用API来完成集成，letting you contact them later in the customer on-boarding funnel. You are then able to transform better leads into customers in a more qualified approach

越来越多的开发人员代表公司会在查找API，立即进行集成的测试，在评估线上可用的服务之后做出业务上的决策。有人曾说过如果开发人员不能马上开始集成的话，在7分钟内就会转向另一个API服务，作者也听过很多客户讲过如果服务不能在他们所在的时区内启动和运行的话，或者是晚上或是周末，或者说要去解决针对他们自己业务需求的一些问题的话，客户都会直接抛弃这个API。

第五点：从法律的角度而言，API就是供应方和客户之间的一纸合约。这个在API Terms of Service and Business Model Agreement.的里面都说明好了。
API式的业务数据定义了两个机构/实体间的业务和法律关系：它是供应方和客户之间的合同。
This is why an API user and customer community is valuable as a customer portfolio in accounting.
因此，从法律角度来看，API就是合同，但是相对简单，十分钟就可以读完；同样也是7*24小时可用；足够灵活可随生态系统的发展而改变；

总结：
API的出现改变了我们做生意的方式，但很重要的一点是形成一个真正理解API真正价值的业务文化。通过向周围的同事介绍宣讲API到底是什么，鼓励大家实践API。

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第一篇，读< 与Roy Fielding谈论版本化、超媒体以及REST >

全系列Web APIs: From Start to Finish
第一篇，读< 与Roy Fielding谈论版本化、超媒体以及REST >
中文版
英文版
Roy的“Scrambled Eggs • Roy T. Fielding, Ph.D. | Senior Principal Scientist, Adobe”PPT解读
1、什么是作者所说的版本化，怎么理解所说的接口数量限制在某些名称内，什么样的名称，还有一点是这里所说的API版本和资源的版本的区别是什么，各自的设计初衷是什么，适用的场景有哪些？

我所说的版本化，是指将客户端可见的接口数量限定在某些名称内，这样一来客户端就可以对每个操作进行标记，将这些操作归于该API的某一版本。

不幸的是，对接口名称进行版本化，只是从API作者的角度而言实现了对变更的管理。这一点是对接口设计哲学的短视行为：作者渴望对API进行控制，而忽略了客户对于良好的持续性的需求。

查看了 PPT，对于API的版本控制，常见的有如下实现方式(
在stackoverflow上看到一个相关问答，其中详细讨论了下述方法优劣best-practices-for-api-versioning
):

• URL里带版本号
  http://www.host.com/v1/users
• 资源名称里带版本号
  • http://example.com/users.v1
• 查询参数里带版本号
  • http://example.com/users?api=v1
• 在HTTP头中制定版本信息
  • Content-Type: application/vnd.myname.v1+json

2、

Hypertext as the Engine of Application State
http://stackoverflow.com/questions/717851/can-someone-explain-hypertext-as-engine-of-application-state-in-simple-terms

也就是说在web的世界里，事物的状态变化是通过link来实现的，你浏览网页，看到了一些内容，点击了其中一些链接跳转到其他的页面上，获取更多的内容
Darrel Miller在stackoverflow上的回答

1

When attempting to explain hypermedia, I like to use the example of navigating in a car via signposts versus a map. I realize it doesn't directly answer you question but it may help.
When driving a car and you reach a particular intersection you are provided signposts to indicate where you can go from that point. Similarly, hypermedia provides you with a set of options based on your current state.
A traditional RPC based API is more like a map. With a map you tend to plan your route out based on a static set of road data. One problem with maps is that they can become out of date and they provide no information about traffic or other dynamic factors.
The advantage of signposts is that they can be changed on the fly to detour traffic due to construction or to control traffic flow.
I'm not suggesting that signposts are always a better option than a map. Obviously there are pros and cons but it is valuable to be aware of both options. It is the same with hypermedia. It is a valuable alternative to the traditional RPC interface.

作者强调Rest是一个可Evolvability演化的架构方式，他说不应该对API打上版本号标签，紧接着他抛出REST API版本控制的最佳实践也应该是怎么样的问题？
他把RESTAPI比喻成机器与机器交互的website，接着反问谁在网站的地址上看到过版本号这些玩意儿(对于网站而言，向后的兼容性简直是生命线，如果baidu哪天域名换成bidu呢 google换成bidu呢)，紧接着又引用了Paul在“ALWAYS SHIP TRUNK”PPT中的结论，web应用程序都没能很好的解决版本控制的问题，你自己怎么可能搞的定这难题。 接着便引出了Paul在ppt中的观点，如果要给web应用程序设计一个revision control system 版本控制系统，应该是什么样的呢？
随即引出了根据feature flag和具体情况激活不同的功能，给出了一种全局配置文件的例子

1

if (frags(“saml_auth”)) {
  credentials = saml.authenticate(user);
}
else {
  credentials = httpAuth.check(user);
}
• testable for conditional content (i.e., everything) • readable via all development interfaces
• writable with ops authority

后面就是广告时间了，展示了一下他的产品FRAGS的情况，去twitter上搜了一下，说这个产品的点子来源于Paul Hammond
using version control to manage web services.，在这个长达96页的PPT里Paul介绍到：
要实现软件的 revision control，既有的分支、分布式分支的方法实现起来问题多多。接着指出现有的revision control的方案是面向可安装的软件这一种软件类型所设计的，他提出软件可以分为三种(要安装的软件、开源的要安装的软件、web应用程序或软件即服务)，考虑到我们不是所有服务器上的管理员，无法保证在公开测试、beta环境、QA环境和AB测试环境下同时发布更新，那么要怎么解决呢？(第39页开始)提出三种思路

• 第一种：基础架构和功能代码启动的分离，二者都可以单独部署，不会影响

• 第二种：同时运行多个版本的代码，来回切换，不论是后台还是UI(这里就需要一个revision control系统来解决代码运行时的动态切换并行存在的多个版本的代码)

• 传统的分支本身不能帮你解决运行时不同版本间的切换；

• 传统的分支不能帮你解决一次性多个版本的依赖关系变化的管理
  到底怎么样才能解决不同版本切换时的revision control呢？考虑在应用程序内部，也就是代码层面控制不同的版本，换句话说，就是要在代码里利用分支来实现不同版本的控制。
  紧接着从550-72利用大量的代码演示了如何利用配置文件来设置标记，实现不同功能(功能的切换、功能的启动与否、不同环境下的配置、不同比例的用户使用那些功能、生产环境下的功能测试等)的切换，74页总结了三类feature flag 功能标记
• 1、Development on user facing features UI界面的
• 2、Development on infrastructure 后台功能的
• 3、 Kill-switches

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# killswitch
if ($cfg['disable_login']) {
  error('Sorry, login is unavailable');
  exit;
}

通常而言，需要将三者混合使用，如下

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# for development
$cfg['disable_search_tests_all'] = false;
$cfg['disable_search_ui_beta_test'] = false;
$cfg['disable_search_darklaunch'] = false;
# for post launch
$cfg['disable_search'] = false;

作者对于使用分支和feature flag的结论

为了进一步了解feature flag究竟为何物，google一把，定位了几个不错的资源
1、stackoverflow上关于feature-flag的讨论
2、看起来是百度前端团队某大神整理的feature-flag的材料
3、概念的对比和介绍Feature Toggles (Feature Switches or Feature Flags) vs Feature Branches
4、
6、java代码示例
7、仍然是matrin大神的博文

infoQ上另外一篇文章不同api版本控制策略的成本分析则指出
对于如下三种策略：

• 1、只有一个版本，所有消费端使用同一个版本，当API发生变更，消费端也要跟着变。
• 2、每个服务的版本都可以在生产环境中使用，客户端按需来就行
• 3、有多个版本存在，所有消费端都使用最新的一个版本，版本是向后兼容的

显示向后兼容的版本策略最划算

综上所述：
feature flag指的是将功能发布与代码部署分离feature release and code deployment,对于rest API 或者HTTP API 而言，完全没搞懂ROY大神推荐的是那种套路，是说并存多个向后兼容的版本，以feature flag的形式来配置，客户端只访问最新的版本？对于URL和http header 大神似乎不推荐使用任意带版本号的方法。

本人正在致力于FHIR(FHIR is a new emerging and appealing healthcare exchange standards, with the all difficulty embedded,through the off the shelf Web standards,you can flood health information anywhere on the web 2.0.)技术的翻译、推广和传播，希望能切实的推动整个行业的发展，尤其是移动互联的这个时代，让天朝所有爸爸麻麻老婆孩子的医疗数据流动起来，光是想想就很美。
目前在做的工作主要是两块，一是标准原文及其网络上一些博文、涉及到的相关技术点的翻译和推广，另一块是与之相关的开源项目的跟踪和研究。
标准的翻译见此:https://github.com/wanghaisheng/fhir-cn
一些博文的介绍见此:https://github.com/wanghaisheng/fhir-in-action

如果你在从事移动医疗相关的开发和产品设计，走过路过千万不要错过~~

记在这个浮躁的时代。
2015年2月4日

原文标题：REST APIs
原文作者：Twitter Inc
原文来源：Twitter Inc
译者： edwin_uestc

版权声明：
欢迎转载本站的所有内容，本站的所有文章使用知识共享署名-非商业性使用-相同方式共享 3.0 Unported许可协议，唯一的要求就是保留署名权，请在转载时注明出处。

REST APIs

这样就能够以编程的方式读写Twitter数据。发一条推或者读取某个人的资料和他的粉丝信息等。通过OAuth来识别twitter应用程序和用户，返回的数据是JSON格式。

entities(实体)
retweets(转发)
Tweet objects微博对象

概述

在1.1版本之中我们做了如下重大变化，在此列出 希望所有的开发人员不会错过这些重要信息。

1、Default entities and retweets

在一定的情况下，V1.1版本的接口中默认会返回 entities(实体) 和 retweets(转发)。 entities(实体) 是作为Tweet objects微博对象的一部分返回的，除非你将include_entities变量的值设为false。其中会包含时间流顺序组织的转发信息，除非include_rts参数的值为false

2、Authentication on all endpoints

我们使用OAuth1.0a或者Application-only authentication对来自应用程序的所有请求消息进行鉴权。
这种透明化的方式避免了滥用行为，也能够让我们对使用API的应用程序更好的分类。
这样我们就能对平台持续演进以更好的满足开发者的需求

3、Rate Limiting

对于每个endpoint，我们将频率限制划分为15分钟一段，在每段当中，单个应用调用的请求的上限为15次。
与V1版本的API相比，每个endpoint的调用次数都变多了，有些特殊的节点在一段内甚至可以达到180次，尤其有利于使用了GET statuses / show / :id, GET users / lookup, GET search / tweets 等接口的APP。详细信息请阅读API V1.1Rate Limiting相关文档和每个方法中具体对于调用上限的描述

4、Twitter client policies

所有再造了Twitter核心功能的应用斗称之为client客户端，都必须遵循某些约束，包括100，000用户令牌的限制。这点也仅仅适用于小型的客户端，并不适用于生态系统中的大多数应用程序。详情请查看开发者守则

#

版权声明：
欢迎转载本站的所有内容，本站的所有文章使用知识共享署名-非商业性使用-相同方式共享 3.0 Unported许可协议，唯一的要求就是保留署名权，请在转载时注明出处。

Docker 玩转 RHadoop

网络上已经有了太多的 RHadoop 的安装使用的教程，鉴于其中的配置配置繁复，对软件版本的要求又极其苛刻，故笔者想用时下热门的 docker 来尝尝鲜，以下是心路历程，供看客参考，希望能给大家一些帮助。

1、软硬件环境

操作系统：OXS 10.10.1

docker安装版本：boot2docker(推荐大家使用https://github.com/unixorn/docker-helpers.zshplugin该插件可以省去大家不少功夫)

Hadoop镜像：sequenceiq/hadoop-ubuntu:2.6.0

2、事前准备

1、考虑到GFW的因素，拟将 sequenceiq/hadoop-ubuntu:2.6.0 镜像中的源替换成163的,顺便添加R语言安装的source
新建source.list

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deb http://mirrors.163.com/ubuntu/ trusty main restricted universe multiverse
deb http://mirrors.163.com/ubuntu/ trusty-security main restricted universe multiverse
deb http://mirrors.163.com/ubuntu/ trusty-updates main restricted universe multiverse
deb http://mirrors.163.com/ubuntu/ trusty-proposed main restricted universe multiverse
deb http://mirrors.163.com/ubuntu/ trusty-backports main restricted universe multiverse
deb-src http://mirrors.163.com/ubuntu/ trusty main restricted universe multiverse
deb-src http://mirrors.163.com/ubuntu/ trusty-security main restricted universe multiverse
deb-src http://mirrors.163.com/ubuntu/ trusty-updates main restricted universe multiverse
deb-src http://mirrors.163.com/ubuntu/ trusty-proposed main restricted universe multiverse
deb-src http://mirrors.163.com/ubuntu/ trusty-backports main restricted universe multiverse
deb http://cran.r-project.org/bin/linux/ubuntu trusty/

2、下载好RHadoop的几个 tar.gz 安装包，版本以自己安装日期的最新版本号为准

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rmr-2.3.3
rhdfs-1.0.8
rhbase-1.2.1

3、测试过程中会用到的测试数据 主要是wordcount程序中

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subl  part-m-00000

数据内容如下所示

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10,3,tsinghua university,2004-05-26 15:21:00.0
23,4007,北京第一七一中学,2004-05-31 06:51:53.0
51,4016,大连理工大学,2004-05-27 09:38:31.0
89,4017,Amherst College,2004-06-01 16:18:56.0
92,4017,斯坦福大学,2012-11-28 10:33:25.0
99,4017,Stanford University Graduate School of Business,2013-02-19 12:17:15.0
113,4017,Stanford University,2013-02-19 12:17:15.0
123,4019,St Paul's Co-educational College - Hong Kong,2004-05-27 18:04:17.0
138,4019,香港苏浙小学,2004-05-27 18:59:58.0
172,4020,University,2004-05-27 19:14:34.0
182,4026,ff,2004-05-28 04:42:37.0
183,4026,ff,2004-05-28 04:42:37.0
189,4033,tsinghua,2011-09-14 12:00:38.0
195,4035,ba,2004-05-31 07:10:24.0
196,4035,ma,2004-05-31 07:10:24.0
197,4035,southampton university,2013-01-07 15:35:18.0
246,4067,美国史丹佛大学,2004-06-12 10:42:10.0
254,4067,美国史丹佛大学,2004-06-12 10:42:10.0
255,4067,美国休士顿大学,2004-06-12 10:42:10.0
257,4068,清华大学,2004-06-12 10:42:10.0
258,4068,北京八中,2004-06-12 17:34:02.0
262,4068,香港中文大学,2004-06-12 17:34:02.0
310,4070,首都师范大学初等教育学院,2004-06-14 15:35:52.0
312,4070,北京师范大学经济学院,2004-06-14 15:35:52.0

4、这些文件准备好了之后，最好放置在宿主机的某个文件夹下，比如我这里放在

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/Users/wanghaisheng/docker

5、请确保docker成功安装，不同操作系统的安装教程请前往国内docker中文社区寻找答案
docker中文社区站
docker.cn
DockerPool

3、Hadoop 单机环境

1、从远端服务器拉取Hadoop镜像文件 由于GFW和网络原因，可能耗时较长 请耐心等待

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~ docker pull sequenceiq/hadoop-ubuntu:2.6.0

2、把之前准备好的文件夹挂载到我们要启动的单机 Hadoop 容器中去，这里笔者比较懒，各位可以自行用喜欢的目录替换容器中的挂载目录(冒号后面的部分/Users/wanghaisheng/docker)

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~ docker run -i -t  -v  /Users/wanghaisheng/docker:/Users/wanghaisheng/docker sequenceiq/hadoop-ubuntu:2.6.0 /etc/bootstrap.sh -bash

4、R的安装

1、修改源文件

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cp /etc/apt/sources.list /etc/apt/sources.list_backup
rm /etc/apt/sources.list
cp /Users/wanghaisheng/docker/source.list /etc/apt/sources.list

2、从CRAN安装R
CRAN中具有最新的R版本，所以一般建议利用CRAN进行R的安装。其基本步骤为：

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~ sudo apt-key adv --keyserver keyserver.ubuntu.com --recv-keys E084DAB9

然后需要添加CRAN源到/etc/apt/sources.list:

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deb http://cran.r-project.org/bin/linux/ubuntu xxx/

其中xxx为你的Ubuntu版本,这里的话就是trusty。同时CRAN的地址可以用任意你喜欢的镜像替换。这里我们在source.list中已经事先准备好了，直接进入下一步

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~ sudo apt-get update
~ sudo apt-get install r-base r-base-dev

5、R的配置

1、需要运行如下命令，让R与系统中安装好得jdk环境关联起来

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~ R CMD javareconf

2、启动启动R程序

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~ R

3、安装RHadoop会使用到的依赖包

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install.packages("rJava")
install.packages("reshape2")
install.packages("Rcpp")
install.packages("iterators")
install.packages("itertools")
install.packages("digest")
install.packages("RJSONIO")
install.packages("functional")
install.packages("caTools")

6、rhdfs和rmr2的安装

1、配置环境变量，网络上大量的例子使用的是hadoop1.0.3，我们使用的是Apache2.6，这里的HADOOP_STREAMING路径可能大不一样，/hadoop-1.0.3/contrib/streaming/hadoop-streaming-1.0.3.jar)，PATH这里要添加hadoop的安装路径的bin目录，否则后续使用hadoop命令会出现not found

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~ vi /etc/environment

    HADOOP_CMD=/usr/local/hadoop/bin/hadoop
    HADOOP_STREAMING=/usr/local/hadoop/share/hadoop/tools/lib/hadoop-streaming-2.6.0.jar
	PATH=$PATH:/usr/local/hadoop/bin


~ source /etc/environment

2、安装rhdfs

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~ R CMD INSTALL /Users/wanghaisheng/docker/rhdfs_1.0.8.tar.gz

3、安装rmr2

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~  R CMD INSTALL /Users/wanghaisheng/docker/rmr2_3.3.0.tar.gz

7、测试rmr2-wordcount

1、启动R
2、载入rmr2包

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library(rmr2)

3、执行如下命令

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> small.ints = to.dfs(1:10)
> mapreduce(input = small.ints, map = function(k, v) cbind(v, v^2))
> from.dfs("/tmp/file1ea36ae45f9f")

这里要注意的是 这个临时文件的名字是变化的 请自己根据上一条命令的返回信息进行替换

8、测试rmr2-MapReduce的R语言程序

1、首先，是基本的hdfs的文件操作。查看hdfs文件目录

hadoop的命令：hadoop fs -ls /usr
R语言函数：hdfs.ls(“/usr/“)

你会发现什么数据都没有，这时候把事先准备好的测试数据拿进来好了

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hadoop fs -mkdir /user/hdfs

hadoop fs -mkdir /user/hdfs/o_same_school/  
hadoop  fs  -rm /user/hdfs/o_same_school/part-m-00000

hadoop fs -put  /Users/wanghaisheng/docker/part-m-00000  /user/hdfs/o_same_school/
hadoop fs -cat /user/hdfs/o_same_school/part-m-00000
看到了一堆数据了把！

2、启动R程序

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> library(rhdfs)
Loading required package: rJava
HADOOP_CMD=/root/hadoop/hadoop-1.0.3/bin/hadoop
Be sure to run hdfs.init()

> hdfs.init()
hdfs.ls("/user/")

library(rmr2)
> input<- '/user/hdfs/o_same_school/part-m-00000'
> wordcount = function(input, output = NULL, pattern = " "){

  wc.map = function(., lines) {
            keyval(unlist( strsplit( x = lines,split = pattern)),1)
    }

    wc.reduce =function(word, counts ) {
            keyval(word, sum(counts))
    }

    mapreduce(input = input ,output = output, input.format = "text",
        map = wc.map, reduce = wc.reduce,combine = T)
}

> wordcount(input)
> from.dfs("/tmp/file24053f4a0d65")

这里要注意的是 这个临时文件的名字是变化的 请自己根据上一条命令的返回信息进行替换

参考文献

1.Linux环境下RHadoop配置笔记
2.RHadoop实践系列文章

HL7 Domain Analysis Model: Health Quality Improvement, Release 1 September 2014 US Realm Informative Specification文档 9/16/14

Introduction简介

目前在美国，电子化的医疗质量测度eCQM和临床决策支持CDS是采用不同的数据模型来表达的。eCQM用的是QDM(Quality Data Model质量数据模型)，CDS是使用vMR(Virtual Medical Record虚拟病历)。而二者之间又存在紧密的关联，eCQM度量医疗服务的质量，CDS为改进以来质量通过干预措施，二者存在共通的需求，即如何标识某种eCQM或CDS知识/规则所应用的患者。
举例说明，在CDS中常常会用到怀孕的概念，我们可以将其映射到eCQM目前所使用的vMR模型中，在vMR中 如果Problem中给类的problemCode使用了特殊的字典(2.16.840.1.113883.3.600.1622 怀孕)，我们就认为这个Pbolem类它表示的是怀孕的概念。如下所示：

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<def name="Pregnancy">
   <expression xsi:type="ClinicalRequest" cardinality="Multiple"
       dataType="vmr:Problem" codeProperty="problemCode"  
      dateProperty="problemEffectiveTime.low"
        useValueSets="true" subjectProperty="evaluatedPersonId">
       <codes xsi:type="ValueSet" id="2.16.840.1.113883.3.600.1622"
           authority="Quality Insights of Pennsylvania"
               version="20130614" />
   </expression>
</def>

反过来 我们也可以用QDM(eCQM)模型来表达vMR(CDS)中的概念，比如eCQM中使用“Diagnosis, Active: Pregnancy” 的术语来表示怀孕，对于CDS而言，我们可以用字典为(2.16.840.1.113883.3.600.1622 怀孕)的Diagnosis类同样来表示怀孕。

目标

这份文档也就是QIDAM(Health Quality Improvement Domain Analysis Model 医疗质量改进领域分析模型)是一个概念层面数据模型(其实应该是概念模型就对了)，可以作为这个域的任何一种逻辑数据模型的基础。
这个模型分析了逻辑数据模型的需求，也就是说应该包含哪些元素。这个逻辑数据模型是用来表达医疗质量改进领域知识中的逻辑条件、总体条件、公式和其他表达的临床数据模型。这样子就确保了CDS和eCQM知识之间的一致性。

受众

包括医疗知识质量的测度、管理和上报的工作人员，知识的编辑和使用人员，标准分析和开发人员，工具开发人员以及系统集成商。
最好熟悉OO的设计原则和UML知识。

大背景介绍

MU第二阶段中要求通过认证的EHR系统实现CDS来支撑eCQM的改进。eCQM和CDS知识采用了不同的数据模型则1)阻碍了二者之间患者数据需求的共享;2)要求软件供应商在不同的格式间进行映射3)阻碍了二者之间共享模块开发
vMR是HL7的一种逻辑模型，2014年发布了第二版。使用UML来定义，其中的概念沿用了HL7 CLinical Statement 模型中的概念，使用了简化版的HL7 V3数据类型第二版。该模型的核心类是ClinicalStatement，该类可以具体化成ProcedureEvent，其中也包含了proposals的类，用以表示医嘱套餐中的一项或者一些规则中的建议。
QDM模型是基于components的，规定了如何将这些components组合成一种数据映射的表达方式。其中包括了：

• Category (e.g., Procedure, Medication, Communication)
• State (e.g., Active, Administered)
• Attribute (e.g., Dosage, Frequency, Admission Date Time)
• Timing Operators (e.g., Starts Before or During)
  QIDAM对两种模型进行了整合

方法学

QIDAM旨在确定医疗质量改进的应用程序的数据需求，它整合了vMR和QDM的功能点。除此之外，还考虑了Quality Reporting Document Architecture (QRDA) Category 1 Templates 、vMR Templates 、Consolidated Clinical Document Architecture (CCDA) Templates 中的模板来分析QIDAM中要对哪些概念建模，概念的结构。另外还尽可能的复用了HL7 Fast Healthcare Interoperability Resources (FHIR) Specification 和Federal Health Information Model (FHIM) Specification 的元素。
附件中的QDM-vMR-cross-map.xlsx中提供了QIDAM、QDM、VMR之间的映射关系。
由于QIDAM是概念模型，使用VMR和QDM表达的数据完全没必要转换成QIDAM。你可以通过将自己的数据模型与QIDAM映射的方式来分析数据模型是否有能力提供实现医疗质量改进目标所需的数据。

范围

仅适用于US的eCQM和CDS制品中所需的临床数据元的表达。目前涵盖的概念包括：

• Communication
• Care goals
• Diet and nutrition
• Participation in care plans and protocols
• Use of devices
• Encounters
• Immunization
• Medication treatments
• Procedures
• Allergies, intolerances, and adverse reactions
• Conditions including findings, diagnoses, symptoms
• Contraindications
• Care experience
• Family history
• Observation results
• Predictions such as risks and prognoses

场景分析

能够使用到 QIDAM的场景有三：

• artifacts的开发
  • 描述：eCQM和CDS artifacts的作者创建数据标准或动作/行为标准
  • 标识符：M1
  • 角色：eCQM author or CDS artifact author
  • 前置条件：数据标准以描述性的形式(指南中或指标中的文字)已经有了；对于CDS而言，建议或其他动作的标准以描述性的形式存在(临床指南中的文本 检查或处方)
  • 动作：作者确定了选取哪个QIDAM概念来表示数据标准或动作/行为标准;作者确定了数据标准或动作/行为标准的语境，使用语境来选择QIDAM中的概念类;作者确定具体的属性，使用QIDAM属性来完成数据或行为标准
  • 后置条件：通过QIDAM就可以实现完整准确的数据标准或动作/行为标准的定义，标准中会包含一些诸如剂量、时间，字典中的属性来表达数据元(如诊断、用药、手术)
  • 备注：如果QIDAM用到了一些属性，它们的值来自其他受控术语中编码值，QIDAM中并未对编码进行限制
• artifacts的实现
  • 描述：eCQM和CDS artifact实现人员将采用QIDAM定义的数据标准和动作/行为标准对应到自己系统中
  • 标识：M2
  • 角色：eCQM implementer or CDS artifact implementer
  • 前置条件：eCQM or CDS artifact 中已经定义好了数据标准，数据标准中将artifact中的用到的标记或名称映射到QIDAM中的定义 比如Last LDL result到an observation result with the specified LOINC codes and date selection criteria;
    CDS artifact 包含了行为/动作标准(prescription of statins)
  • 动作：实施人员确定与用QIDAM定义的数据标准或动作标准中等同的目标系统中的元素 一张表或一个类;实施人员使用这个定义在目标环境下来构建数据或动作的定义;如果QIDAM的元素属性存在不明确的地方，实施人员对模型标准文档进行咨询; 重复此任务
  • 后置条件：实施人员成功的将eCQM和CDS制品中的数据标准、动作行为标准全部映射到自己的系统当中。
  • 备注：如果数据标准、动作行为标准中的一些项在目标系统中找不到对应的元素，根据实际情况可以不处理
• artifacts的评估
  • 描述：指标评估系统或者CDS系统来评估eCQM或者是CDS。用QIDAM来表示数据标准、动作/行为标准
  • 标识符：M3
  • 角色：A measure calculation system or a CDS system
  • 前置条件：eCQM CDS制品中存在数据标准，数据标准将制品中的符合映射到QIDAM的定义中;
    CDS制品包含了行为动作标准；
    制品中的所有标准都已经映射到自己系统的数据模型中或者是系统可以执行的动作
  • 动作：系统评估CDS制品和eCQM;当系统遇到数据标准，能够将其无歧义的转换成一个检索/查询数据的请求;CDS系统可以决定应用某个行为标准是由于评估逻辑，系统将标准转换成可执行的动作;动作分两种，一种是展现给用户的proposal，一种是系统自动执行的;
  • 后置条件：eCQM评估的结果是可计算机化的质量指标的效果，CDS制品评估的结果是从动作集合中选一个或者执行一些动作
  • 备注

artifacts在HL7中用的很多，比如像每个域对应的类图、excel、xsd等等，这里我们就理解成CDS的知识/规则。
这里我们描述时是将QIDAM作为数据模型来使用的，实际应用中，我们只需要用我们自己的数据模型将其替换即可。

Courera上新一轮的SongWriting又开课了，去年就跟了一些，这次争取能把全部跟完，不求拿证，只为开心。

第一篇

Donny和Donna的故事

I have to leave you.
What?
Donny, I feel like I’ve lost myself. I, I don’t know who I am. I don’t know where I am. I think, I might be in Marrakesh and I need to go there and find myself, because
you can’t truly love anyone unless you know who and where you are. I’ve lost myself. I need to find myself. I’m sorry. I’m sorry. And especially I’m sorry about the wedding next week, But I need to go.
Goodbye. Don’t wait for me, I may never be back. And she picks up her suitcases, then turns to go.
At which point, Donny who has been sitting at the writing table in stunned silence, rises from the writing table and bursts into song.
记录灵感的小本本
And I put it in my little file of possible song ideas, which I’d really encourage you to take. you know just a little book or perhaps on
your computer, just have this little list. Of of potential song ideas. Of things that will take you someplace. What what could this mean?
What kind of idea will this song be? so that keeping, keeping a little list of songs. and then you can start thinking about them.
演唱者和听众的关系
第一人称、第二人称、第三人称
歌曲发展
盒子理论 三段式 层层升华 可以是时间为主线 也可以是事情发展的动机
经典故事 老情人见面

• hi, how are things going? You look really happy, are you, are you as happy as you look? I’d just like to know.
• Did you cheat on me? When you left me, did you know that, that you’re going to move in with him and, and do it so fast. When, when I was out on the road, did,
  did you invite him over to your place? So, what’s up, did you cheat? I’d just like to know.
• I said it to you. I said, I just want to be able to tell you everything. And I want you to tell me everything.
  I really want this to be an open and honest relationship. You could told me about him, it’s, it’s not like I would have tried to stop you,
  I’d just like to know.
  歌曲内容的填充 有了大体框架之后
  借助你的six friends
  who what why when where how
  歌曲的组织 前面讲的都是idea是如何发展的 歌曲大致上可以按照功能不同分成不同的section
  verse 主歌 基本信息
  chorus 副歌 大家一起唱的部分 简单易记 强调主题
  bridge 间奏
  pre-chorus

有爱的故事The story of Bernice

Let’s talk a little bit about the relationship of, all of the various song sections to the central idea. Whether that central idea, the statement of the central idea, the statement of the title of the song is a chorus, or whether it’s, as in The Great Pretender, the opening of a verse, or as in Still Crazy After All These Years, the closing of a verse where we’ll call it a refrain. But the diff-, the, the relationship between the, basic information of the song, given by the verses and the statement of the central idea. Bernice, went through preschool, grammar school, high school, and college With her best friends, Ashley, Brittany, Nicole, Caitlin, and Samantha.
They were best friends, 6, best friends. Now, it has to be said that, Bernice, was not the brightest light on the Christmas
tree, Bernice was not, the funniest, not the smartest, not the most athletic, not the best personality, not the prettiest, but she was a good and loyal friend. And as they grew and grew together,
everyone loved Bernice for her quality as a great listener. And someone who would always be supportive.
The girls all loved her. Things started getting a little complicated in high school when boys started coming around. Because the boys seemed to gather primarily around Katlin and Samantha.
And the other girls too, but Bernice was always left in the shadows. And when they started actually dating, she was often home alone on Friday night,
or in the group where all of the other girls had somebody they were with, and then Bernice didn’t, Bernice was the one who would always get fixed up with the
second cousin from Milwaukee. So that, as they went into college and started getting into serious relationships, Bernice felt a little more
and a little more Out of the loop and the girls were so hopeful that some time, some, some way, Bernice would find someone.
And then, in physical health class, Bernice found Edwin, Edwin thought that Bernice hung the moon and the girls were all so excited and it got deeper and it got deeper and they went everywhere
together until, on Christmas that year Edwin gave Bernice an engagement ring. And Bernice called the girls, and they
did the girl squeal, they were all so happy, and, and then, the date was set. And Bernice’s mom, who was no fool, took Bernice to the wedding dress store.
They looked, and they tried, they looked and tried another one on and tried another one on and an another one and an another when it was for such along time
till finally, Bernice’s mom found the dress. And in the dress Bernice looked better than she had ever looked in her entire life. All of the great qualities that Bernice
had were highlighted by the dress and those that she wasn’t sure about were all diminished by the dress.
So she looked fabulous, she said, Oh mom. I love you so much. This is so wonderful. The mom said, thank you honey, it’s so, you look so beautiful.
And Bernice said, thanks mom. Okay, let’s, let’s now get some dresses, pick out some dresses for the girls. She said there’s some really great
dresses over here, come on mom. And her mom said come back here darling. And led her over to a rack on which hung five purple taffeta sacks.
And Bernice said, oh Mom, I don’t know, I don’t know. And her mother said, Bernice, trust me. She said, okay mom, said, the girls will love them, they’ll wear them everywhere. And so it was done. Ashley, Brittany, Nicole, Katelyn and
Samantha in purple taffeta sacks, and the day of the wedding, the music begins, and down the aisle one by one. Ashley, Brittany, Nicole, Katelyn and
Samantha. All walking down the aisle, slightly uncomfortable in their purple taffeta sacks and the congregation turns to look, oh I always thought she was better
looking than that. And as they paraded one by one, the boyfriends and the husbands of these girls was like[NOISE] oh. They were slightly embarrassed because
they didn’t look that good. And then, the doors flung open[NOISE][SOUND] and here comes Bernice in the dress. And everybody goes[NOISE] shes’ so
gorgeous, and all of the husbands and boyfriends[NOISE] I could have had her, I could have had her, she’s gorgeous.
And there is Bernese in the dress, looking great for two reasons, number 1 because she’s wearing, the dress, and number 2, because everything around her
has been diminished in order to highlight her. That is the relationship between the secondary sections of your song, the development sections of your song and the
chorus. And what you need to do is try to put your chorus in the dress. But then be quite careful not to diminish that dress by anything that happens
before it. So, for example, if the dress has to do with a really special chord or a really high note, that that chord or that note probably should not appear, before it appears in the chorus. So that is the verse, walks down the
aisle. It should interest people to some degree, it should invite them in but it’s not the dress, the dress is Bernice’s sole property.
The story of Bernice, the end.

EHR Architecture and Design

by Jerome Carter on March 25, 2013

Updated August 26, 2014 (Page is updated monthly on

the 26th. For more frequent resource alerts, follow** EHR Science on

Twitter:@ehrscience**.)

_The Architecture and Design page has been created to serve as a resource for those who are interested in building EHR

systems and/or understanding how they work. To that end, I have included links to EHR standards, open source projects,

and programming/technology information. Data exchange, decision support, and content-related materials (e.g. SNOMED,

LOINC) are included only if they directly address issues encountered when designing and building systems._

General

Books

Freeman E, Freeman E, Bates B, Sierra K, Robson E. _[Head First Design Patterns](http://www.amazon.com/First-Design-

Patterns-Elisabeth-Freeman/dp/0596007124)_. 2004

McLaughlin BD, Pollice G, West D. _[Head First Object-Oriented Analysis and Design](http://www.amazon.com/Head-First-

Object-Oriented-Analysis-Design/dp/0596008678/ref=sr_1_1?s=books&ie=UTF8&qid=1364182297&sr=1-

1&keywords=head+first+object+oriented+analysis+and+design)_. 2006

Microsoft Application Architecture Guide, Second Edition. 2009

Bass L, Clements P, Kazman R. _[Software Architecture in Practice](http://www.amazon.com/Software-Architecture-Practice-

3rd-Engineering/dp/0321815734/ref=sr_1_1?s=books&ie=UTF8&qid=1364182541&sr=1-1&keywords=software

+architecture+in+practice+3rd+edition)_, Third Edition. 2012

**Resource Pages

** EHR Data Quality

NoSQL and Relational Databases <span

style=”color: #ff0000;”>**

**

Websites

Object Mentor Resources - Great information on object-

oriented programminf and software design

Software Engineering Institute - Among other things, offers a range of resources on software

architecture

The Guide to the Software Engineering Body of Knowledge (SWEBOK) - Provides a

great overview of the main issues/areas of software engineering

**Reports

**AHRQ

A Robust Health Data Infrastructure, 2014 **<span

style=”color: #ff0000;”>

**

EHR Architecture and Design

EHR Standards

AHRQ

[Clinical Decision Support Initiative](http://healthit.ahrq.gov/portal/server.pt/community/ahrq-

funded_projects/654/clinical_decision_support_initiative/13665)

[Children’s Electronic Health Record Format]

(http://healthit.ahrq.gov/portal/server.pt/community/health_it_tools_and_resources/919/children

%92selectronic_health_record(ehr)_format/31456)

American Society of Testing Materials

E31 Standards

Food and Drug Administration

[Mobile Medical Applications – Guidance for Industry and Food and Drug Administration Staff]

(http://www.fda.gov/downloads/MedicalDevices/DeviceRegulationandGuidance/GuidanceDocuments/UCM263366.pdf), 2013 <span

style=”color: #ff0000;”>**

**

Health Level Seven

EHR Functional Profiles

International Standards Organization (ISO)

TC 25 Health Informatics Standards

ONC

[Health information technology: certification criteria, 2014 edition

](http://www.gpo.gov/fdsys/pkg/FR-2012-09-04/pdf/2012-20982.pdf)[2014 Certification Test Methods]

(http://www.healthit.gov/policy-researchers-implementers/2014-edition-final-test-method)

OpenEHR

Specification documents

Open Source Projects

FreeMED

GnuMED

Open EMR

Open MRS

Tutorials

Audit trails and data access – these posts discuss MU audit requirements and audit trail design.

[EHR Design, Timelines, and Audit Trails: Getting a Sense of What Has Happened

](http://ehrscience.com/2013/01/14/ehr-design-timelines-and-audit-trails-getting-a-sense-of-what-has-happened/ “EHR Design,

Timelines, and Audit Trails: Getting a Sense of What Has Happened”)[EHR Design Basics: Tracking Data Changes and Accesses]

(http://ehrscience.com/2013/01/28/ehr-design-basics-tracking-data-changes-and-accesses/ “EHR Design Basics: Tracking Data

Changes and Accesses”)

Representational State Transfer – the basics of REST

[Coming to REST, Part I: Complexity in EHR Systems

](http://ehrscience.com/2013/07/08/coming-to-rest-part-i-complexity-in-ehr-systems/ “Coming to REST, Part I: Complexity in

EHR Systems”)[Coming to REST, Part II: It’s All About Resources](http://ehrscience.com/2013/07/15/coming-to-rest-part-ii-

its-all-about-resources/ “Coming to REST, Part II: It’s All About Resources”)

**Posts

**General

[From Idea to System: A Story of Architecture and Design

](http://ehrscience.com/2013/02/18/from-idea-to-system-a-story-of-architecture-and-design/ “From Idea to System: A Story of

Architecture and Design”)[Coupling and Cohesion: A View of Software Design from the Inside Out

](http://ehrscience.com/2012/11/12/coupling-and-cohesion-a-view-of-software-design-from-the-inside-out-2/ “Coupling and

Cohesion: A View of Software Design from the Inside Out”)[Software Architecture and Design, First Steps

](http://ehrscience.com/2012/02/29/software-architecture-and-design-first-steps/ “Software Architecture and Design, First

Steps”)[Rethinking the Design of Electronic Health Record Systems

](http://ehrscience.com/2012/04/18/rethinking-the-design-of-electronic-health-record-systems/ “Rethinking the Design of

Electronic Health Record Systems”)[What If EHRs Were More Like Content Management Systems?

](http://ehrscience.com/2011/11/16/what-if-ehrs-were-more-like-content-management-systems/ “What If EHRs Were More Like

Content Management Systems?”)[Moving Beyond Paper-based Thinking in EHR Design

](http://ehrscience.com/2013/02/11/moving-beyond-paper-based-thinking-in-ehr-design/ “Moving Beyond Paper-based Thinking in

EHR Design”)[Requirements, Usability, and Petri Nets](http://ehrscience.com/2013/03/04/requirements-usability-and-petri-

nets/ “Requirements, Usability, and Petri Nets”)

Architecture and Design

Motifs in EHR Research

[The EHR As an Object Worthy of Study](http://ehrscience.com/2012/10/08/the-ehr-as-an-object-worthy-of-study/ “The EHR As

an Object Worthy of Study”)

[EHRs and Architectural Styles, Peeking Under the Hood](http://ehrscience.com/2012/06/27/ehrs-and-architectural-styles-

peeking-under-the-hood/ “EHRs and Architectural Styles, Peeking Under the Hood”)

[Investigating NoSQL for EHR Systems: MongoDB](http://ehrscience.com/2013/04/15/investigating-nosql-for-ehr-systems-

mongodb/ “Investigating NoSQL for EHR Systems: MongoDB”)

Exchanging Data with JSON

[SaaS EHRs, MVC, Flexibility and Innovation](http://ehrscience.com/2013/04/01/saas-ehrs-mvc-flexibility-and-innovation/

“SaaS EHRs, MVC, Flexibility and Innovation”)

Data Quality

[Wrestling with EHR Data Quality](http://ehrscience.com/2012/11/26/wrestling-with-ehr-data-quality/ “Wrestling with EHR

Data Quality”)

[EHR Data Accuracy—Should You Be Concerned?](http://ehrscience.com/2012/04/09/ehr-data-accuracy%e2%80%94should-you-be-

concerned/ “EHR Data Accuracy—Should You Be Concerned?”)

Clinical Algorithms and Data Structures

[From Data to Data + Processes: A Different Way of Thinking about EHR Software Design]

(http://ehrscience.com/2012/09/24/from-data-to-data-processes-a-different-way-of-thinking-about-ehr-design/ “From Data to

Data + Processes: A Different Way of Thinking about EHR Software Design”)

[The Informaticist-Programmer Interface: What Do You Mean By That…?](http://ehrscience.com/2012/07/30/the-informaticist-

programmer-interface-what-do-you-mean-by-that%e2%80%a6/ “The Informaticist-Programmer Interface: What Do You Mean By That…

?”)

[Making Clinical Concepts Computable](http://ehrscience.com/2012/05/16/making-clinical-concepts-computable/ “Making

Clinical Concepts Computable”)

[The Nuances of Clinical Data

](http://ehrscience.com/2012/01/30/the-nuances-of-clinical-data/ “The Nuances of Clinical Data”)[Null Codes: A Mechanism

for Understanding the Reasons for Missing EHR Data Values](http://ehrscience.com/2013/07/22/null-codes-a-mechanism-for-

understanding-the-reasons-for-missing-ehr-data-values/ “Null Codes: A Mechanism for Understanding the Reasons for Missing

EHR Data Values”)

**Key Articles

**Sinsky CA, Beasley JW, Simmons GE, Baron RJ. [Electronic health records: design, implementation, and policy for higher-

value primary care.](http://annals.org/article.aspx?articleid=1872852) Ann Intern Med. 2014 May 20;160(10):727-8.**

**

Krist AH, Beasley JW, Crosson JC, Kibbe DC, et al. [Electronic health record functionality needed to better support primary

care.](http://www.ncbi.nlm.nih.gov/pubmed/24431335?dopt=Abstract) J Am Med Inform Assoc. 2014 Jan 15. [E] <span

style=”color: #ff0000;”>**

**

Hypp?nen H, Saranto K, Vuokko R, M?kel?-Bengs P, Doupi P, Lindqvist M, M?kel? M. [Impacts of structuring the electronic

health record: A systematic review protocol and results of previous reviews]

(http://www.sciencedirect.com/science/article/pii/S1386505613002475). Int J Med Inform. 2013 Dec 8. [E] <span

style=”color: #ff0000;”>**

**

Xiaomu Zhou, Kai Zheng, Mark Ackerman, and David Hanauer. 2012. [Cooperative documentation: the patient problem list as a

nexus in electronic health records.](http://web.eecs.umich.edu/~ackerm/pub/12b69/CSCW12-352-ProblemList.inpress.pdf) In

Proceedings of the ACM 2012 conference on Computer Supported Cooperative Work (CSCW ’12). ACM, New York, NY, USA,

911-920.

Bisbal J, Berry D. [An analysis framework for electronic health record systems. Interoperation and collaboration in shared

healthcare](http://www.dtic.upf.edu/~jbisbal/publications/me09-01-0002_Bisbal.pdf). Methods Inf Med. 2011;50

(2):1809.

Blobel B, Pharow P. [Analysis and evaluation of EHR approaches]

(http://person.hst.aau.dk/ska/MIE2008/ParalleSessions/PapersForDownloads/06.HIS&EHR/SHTI136-0359.pdf). Methods Inf Med.

2009;48(2):162-9. **

**

Greenhalgh T, Potts HW, Wong G et al. (2009) . [Tensions and paradoxes in electronic patient record research: a systematic

literature review using the meta-narrative method](http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2888022/)**.** Milbank Q

vol. 87, (4) 729-788. **

**

Miller J. Cohesion and Coupling. MSDN Magazine. October 2008.**

**

H?yrinen K, Saranto K, Nyk?nen P. [Definition, structure, content, use and impacts of electronic health records: a review

of the research literature.](http://www.ijmijournal.com/article/S1386-5056(07)00168-2/abstract) Int J Med Inform. 2008

May;77(5):291-304. **

**

**Articles

**[New July 29 - August 26, 2014] [<span style=”color:

ff0000;”>E**] = e-pub date

2014

**Bouaud J, Lamy JB. A 2014 medical informatics perspective on clinical decision support systems: do we hit the

ceiling of effectiveness? Yearb Med Inform. 2014 Aug 15;9(1):163-6.

Braun M, Brandt AU, Schulz S, Boeker M. Validating archetypes for the Multiple Sclerosis Functional Composite. BMC Med

Inform Decis Mak. 2014 Aug 3;14:64. 6.

Tastan S, Linch GC, Keenan GM, Stifter J, McKinney D, Fahey L, Lopez KD, Yao Y, Wilkie DJ. Evidence for the existing

American Nurses Association-recognized standardized nursing terminologies: a systematic review. Int J Nurs Stud. 2014

Aug;51(8):1160-70.

Liaw ST, Taggart J, Yu H, Lusignan SD, Kuziemsky C, Hayen A. Integrating electronic health record information to support

integrated care: Practical application of ontologies to improve the accuracy of diabetes disease registers. J Biomed

Inform. 2014 Aug 1. [E]

Kiah ML, Haiqi A, Zaidan BB, Zaidan AA. Open source EMR software: Profiling, insights and hands-on analysis. Comput Methods

Programs Biomed. 2014 Jul 17. [E]

Forrest CB, Margolis PA, Bailey LC, Marsolo K, Del Beccaro MA, Finkelstein JA, Milov DE, Vieland VJ, Wolf BA, Yu FB, Kahn

MG. PEDSnet: a National Pediatric Learning Health System. J Am Med Inform Assoc. 2014 Jul-Aug;21(4):602-6.

Yao Q, Han X, Ma XK, Xue YF, Chen YJ, Li JS. Cloud-based hospital information system as a service for grassroots

healthcare institutions. J Med Syst. 2014 Sep;38(9):104.

Jing X, Kay S, Marley T, Hardiker NR. Integration of an OWL-DL Knowledge Base with an EHR Prototype and Providing

Customized Information. J Med Syst. 2014 Sep;38(9):75.

Gazzarata R, Vergari F, Salmon Cinotti T, Giacomini M. A standardized SOA for clinical data interchange in a cardiac

telemonitoring environment. IEEE J Biomed Health Inform. 2014 Jul 1. [E]

Abbas A, Khan SU. A Review on the State-of-the-Art Privacy-Preserving Approaches in the e-Health Clouds. IEEE J Biomed

Health Inform. 2014 Jul;18(4):1431-41.

D’Amore JD, Mandel JC, Kreda DA, Swain A, Koromia GA, Sundareswaran S, Alschuler L, Dolin RH, Mandl KD, Kohane IS,

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