Hệ mã công khai RSA và ứng dụng bảo mật trong trao đổi tài liệu lâm sàng CDA (Luận văn thạc sĩ)

IH
NG

IH C

NGUY N H I NINH

NG D NG B O M T

H

LU

- 2016
S

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ct

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Th

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Em xin g i l i c
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Em xin g i l i c

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iH

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Th

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H

th c hi n

Nguy n H i Ninh

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L
Nguy n H i Ninh

p Cao h c K13C
iH

, hi
u

Qu ng Ninh.

Trong th
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is

n

t nghi
ng d ng b o m

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ng d n khoa h c c a TS. Nguy n H i Minh.

i

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cl

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Nguy n H i Ninh

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M CL C
Trang
L IC

..............................................................................................................i

L

..................................................................................................... iii

M C L C..................................................................................................................iv
DANH M

NG.........................................................................................vi

DANH M

NH ...............................................................................vii

M

U.....................................................................................................................1
1 CHU

...........................................................2

CLINICAL DOCUMENT ARCHITECTURE ............................................................2
1.1. Gi i thi u chung...................................................................................................2
1.1.1. M

t k chu

u CDA [3] .....................................................2

tc am
1.2. C

u CDA ...............................................................3

u CDA .................................................................................4

1.2.1. C

u CDA. ................................................................4

1.2.2 C

u CDA ....................................................................7

1.2.3 C

a m t Entry. ..............................................................................14
u d li u - HL7 Reference Information Model(RIM) .........19

1.3.1. M t s

m quan tr

.............................................19

1.3.2. HL7 V3 Data Types.....................................................................................20
v ng

HL7 Vocbulary Domains ...............................................20

sinh m

u CDA ....................................................................21

1.5. M t s

c s d ng trong vi c g n
u CDA khi duy
2

N TH

u. ...................22

t IE...............................................26
NV H

...................27

2.1. Gi i thi u chung.................................................................................................27
mh m

...................................................................................27

2.1.2. H m
2.2. H
S

.....................................................................29
........................................................................................................30
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ng RSA ...................................................................................30
ng t
2.2.3. M t s

m t RSA. ...........................................31
ng v RSA.................................................................37

mc ah m
3 K T QU

......................................39
.......................................41

c s d ng trong b nh vi n. ........................................41
3.1.1. N i dung h

ng.................................................41
b

................................................................45

ng d ng H
3.2.1.

53

ng d ng thu

A ...................53

ng d ng H
CDA .......................................................................................................................54
u CDA.............................................................................56
3.3.1. D li

...................................................................................................56
.........................................................................................57
u CDA d

.....................................................58

3.3.4. Module gi

u ................................................................................59

3.3.5. Giao di

................................................................................60
n Header ho c Body............................................61

3.4.1. Thu

n Header ho c Body ................................61

3.4.2. Thu

n Header ho c Body ................................62
c Body. ..................................................63

3.5. M t s Modules c

......................................................63

3.5.1. Module RSA ................................................................................................63

3.5.2. Module ReadDOM ......................................................................................63
3.5.3. M t s v
K T LU

qu

...............................................................64

N NGH ...................................................................................65

U THAM KH O.........................................................................................66

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DANH M
B
B ng 1.2: Quan h

NG

a Header..........................................................................6
p trong Header ....................................................................7

B ng 1.3: C

u CDA.................................................................8

B

a Section .........................................................................8

B

ng c a Section..........................................................................9

B

c a Section............................................................................9

B
B

tr

nh d ng.........................................................13

ng tham gia m t Entry ...........................................................15

B ng 1.9: Quan h trong m t Entry ..........................................................................17
B ng 1.10: Quan h entry-Entry Relationships ........................................................18
B

...............................................................................22

B ng 1.12: Di n gi i

B

.........................................................................24
ct

B ng 3.1: C

S

a H RSA.......................34
b

c li u

...................................................................47




DANH M

NH

u CDA [3]............................................................................5
u CDA ............................................................................21
gi

u CDA...........................................22
.....................................................................28
ps d

..........................................29

ps d

i nh n ..........................30

ps d
t S.......................................................................................39
ps d
gi

gi

t S...............................................................................39
thu

...............................................................................54
u CDA .......................................................................55

u CDA d ng XML ..........................................................................56
u CDA...........................................57
....................................................................58
u CDA .........................................59
............................................................................60
n Header ho c Body ......................................61
n Header ho c Body .....................................62
u CDA..............................63

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M

U

ng d
ng r t l

bi n r ng

n di n m o c
th c hi

is

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nh

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c t xa v i s h tr c

ng Internet. T t

c

th ng

m ng. Trong y t , vi c ng d
c kh

ng, r t nhi

d

ng

h tr vi c qu

qu

o hi

a b nh t

th ng h

tr qu
n.

b om

m t vi c c n thi

b

ib

Trong ph

uc

uc

chu

,h
ng d ng trong vi
u CDA

c a b nh nh
hai m c: Ph n Header c a

c

c section

n m trong component thu c ph n Body.
K t qu c
a b nh

us
n

s khoa h

i nh n

u.

a, k t qu

mb

ng t i vi ckhi g i
i nh n m

u

u ra c

i

nc

chu n qu c t

nh b i t ch c
xu t

d ng h
yt

S

, gi

v

c li u

ng Internet.



gi i


1
CHU
CLINICAL DOCUMENT ARCHITECTURE
1.1. Gi i thi u chung.
Chu
chu

ch
yt

n

t k ph m m m, ph n c ng v c
c am

im

yt

tr vi c trao

ch

c thu n ti

ng truy
b n CDA Release
nh

n Qu c t

n CDA Release 2 (CDA
i American National Standards Institute/

Health Level Seven International (ANSI/HL7). V i s
b

i vi c c p nh

n v thi t k c

li u (Data type), lo i b , b sung m t

s thu

g n k t ch t ch v

d
c

i chu n

n LOINC, chu n SMOMED-

v

cb

v ng trong

CNE t
m

t nhi u so v i v

ng th

c th hi n m
1.1.1. M

t k chu

u CDA [3]

nh trong vi

c kh e.

Mang l i hi u qu trong vi c tri

th

s

th
Vi c m
v

S

n th n
n m m hi
c li u

li

m vi l n.
gi i h n b i s

d ng gi


n.


i gian.

h th
th

nt

nt .
c t o ra b

Vi

ng d ng

thu

h t ng ho c h th

tr .
Cung c p m t thi t k h p

i ng d ng.

i nh

ng nhu c

vi

nh trong

u.

1.1.2.

tc am

u CDA

M

c thi t k d

u CDA s

ch t sau:
n - Persistence: M
trong tr

u CDA ti p t

cb ot n

nv c

ng th i gian

u truy v

is d

- Stewardship: M

n ph

li u.

nh t, b

p

n b i m t t ch

th m quy n.
c - Potential for authentication: M
h

t p

ch ng th
i c nh - Context: M

n ph i ch

cb i

c nh v i n i dung c
-

c
ph i ch

ng cho
ng ph n c

li u.

S

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cc

i th
iv

i nh

td

c th hi n c th

li u CDA s d

n th n

c
ch

i nh

t Web.
1.2. C

u CDA

M

chia m

n: C

u file

nn
n thi t ph c v cho vi c chuy

u gi

V i ph n

ch
:D

d ng <StructuredBody> ho
tr n

nh

nh d
uc

i. C

n: thu

trong

th , th c th

gi

c

th
1.2.1. C

u CDA
a m t Header

Ph

c v vi
ch

c ph c v
c p nh

tin cho h

n t su

i cho m t b
u c a ph

th hi n qua kh
ph
thi t k

, ph

c

c th hi n qua kh i n

t gi a 2 ph
u: M

t trong tag g c n n m gi a t tag
n th hi n c

li

i c

u (t

</ClinicalDocument>).

S

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n



ng tham gia c n ph

trong Header

B

a Header

STT

Ch

1

ClinicalDocument.id

2

ClinicalDocument.code

3

ClinicalDocument.title

4

ClinicalDocument.effectiveTime

u
u c
i
nh qua chu n
LOINC

5

6

c

u

Th i gian t

u

o m
ch
c th hi n qua 3 m c:
-N(normal)

(codeSystem
2.16.840.1.113883.5.25);
ClinicalDocument.ConfidentialityCode
-R(restricted)
(codeSystem
2.16.840.1.113883.5.25);
-V(very restricted) (codeSystem
2.16.840.1.113883.5.25);
c th hi
ClinicalDocument.languageCode

nh
qua

chu n:

IETF

(Internet

Engineering Task Force) RFC 3066.

7

ClinicalDocument.setId

i, n

li u n u n i
p nh t, s a

c sinh m i.

8

9

S

ClinicalDocument.versionNumber

n c

u ho c th i

ClinicalDocument.copyTime
(Deprecated)

c g i t
i nh n.

c li u

u



i g i


1.2.1.3. Quan h gi

n trong Header

N i dung trong ph

s

quan h

gi

i l p g c

gi
B ng 1.2: Quan h
STT

p

p trong Header
Ch

quan h
1

ActRelationship

li u v

Ph

ug

ph i tham chi

thu

n
u g c.

v ng

APND,

RPLC, XFRM.
2

ServiceEvent
th

3

t

ngu

Order
a b nh th c t .

4

Consent

Tham chi u t
kh o c

1.2.2 C

i dung tham
u.

u CDA

V

tri n khai bi u di n

(StructuredBody). M

u CDA s

t m
t component, ch

c di n gi

S

c li u

t v i


B ng 1.3: C
STT

u CDA

p

1

Ch

NonXMLBody

c
nh d ng

nh d
XML.

2

StructuredBody

n body, bao g m
i 1 hay

nh
nhi

XML.
1.2.2.1 C

a Section.

a. Thu
B

a Section

STT

Ch

1

Section.id

bi t gi
u

2

Section.code

gi

n trong
t
i dung trong

t
3

Section.title

u

cho section
tin s
chuy n t i t
id

4

Section.text

5

Section.confidentialityCode

6

Section.languageCode

c
i nh n

n text
khi h
ib
ho c k t qu h i ch n.
o m t
p

th

hi n S d
t

Web
S

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b.

ng tham gia trong m t section
B

STT

1

2

ng c a Section

ng

Ch
n

Author

u

c

tham chi u t i author c a
ph n header

i cung c p

Informant

N i

N

c

tham chi u t i informant
c a ph n header

3

Subject

th

trong 2 n i dung c

u

u

c. Quan h trong m t section
B

c a Section

STT

Ch
L

1

Component

c

xen nhau

2

gi a d ng thu t ng CDA level 3

Entry

ch
li u CDA

d. Kh

u

Section Narrative Block
ng text c a section (Section.text field)

c chuy n t
S

c li u

i nh

um




v

u. Th c ch

c n ph

hi n th ph

h tr c a m
n thi t t

li u MIME

i nh

cd

ud

chu

bao g

i dung sau:
N i dung

tag <content>

tn
ph

t trong kh

id

c bao trong c

iv in
a ch n vi
tham chi u t i n

m t kh

:
<section>
codeSystem="2.16.840.1.113883.6.1"
codeSystemName="LOINC"/>
<title>Past Medical History</title>
<text>
There is a history of<content ID="a1"> Asthma</content>
</text>\
<entry>
<observation classCode="OBS"moodCode="EVN">
codeSystem="2.16.840.1.113883.6.96"
codeSystemName="SNOMED CT"
displayName="Asthma">
<originalText>
<reference value="#a1"/>
</originalText>
S

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u c n.


</code>
<statusCode code="completed"/>
</observation>
</entry>
</section>
H tr

tag <linkHtml>

S d

th c hi n tham chi

n m trong n i t
d

u CDA ho c m

tham chi

c: N u ph n n i dung tham

chi

u hi n th
tham chi

ng h

tag<linkHtml>.
Ch s

i, ch s

t trang-

h tr hi n th n
u v ch s

cho ch

<sup> ch s

i,

c ng t trang, n u c n.
i trang tag <footnote> and <footnoteRef>
ch

iv

nm t

nh

n ph

a

m t<footnote>.
Tham chi

n m t d li u multimedia-tag <renderMultiMedia>.

S d ng ch

i thi t k tham chi

hi n th n i dung c a m

c bi
t thi t v

thu

S

u CDA hi n th

ch n <caption>, n i dung c

c li u

t
nh danh




c

d
t os

t tham chi u ng

u.

n-tag
N i dung trong ph

uc

iv

t l a ch n <caption>, khi hi n th
c hi n th
trong m t paragraph.
-tag<list>
V

n ch

a HTML,
ch

t ho c nhi

ig i
a thu c

p x p theo th t hi n th
ng-tag<table>

ng HTML. M

iv ib

trong b

t (fileds)

cv im

n d li

c

ab

u

ng vi
and table.cellspadding.
L

-tag<caption>
iv i

paragraph, lits, lits item, table ho
gi

t links ho

S

c li u

i c tham chi u c

t footnotes.




tr

nh d ng-styleCoda attribute.

B
-

tr cho

nh d ng

nh d ng font

Code

Definition

Font style (Defines font rendering characteristics.)
Bold

Render with a bold font.

Underline

Render with an underlines font.

Italics

Render italicized.

Emphasis

Render with some type of emphasis.

-

nh d ng b ng

Lrule

Render cell with left-sided rule.

Rrule

Render cell with right-side rule.

Toprule

Render cell with rule on top.

Botrule

Render cell with rule on buttom.

-

nh d

Arabic

List is ordered using arabic numerals : 1,2,3.

LittleRoman

List is ordered using little Roman numerals: i, ii, iii.

BigRoman

List is ordered using big Roman numerals: I, II, III.

LittleAlpha

List is ordered using little alpha characters: a, b, c.

BigAlpha

List is ordered using big alpha characters:A, B, C.

Unordered list style (defines rendering characterristics for unordered listS)
Dics

List bullets are simple soild discs.

Circle

List bullets are hollow discs.

Square

List bullets are soild squares

S

c li u

-

:

<sestion>
<text><content styleCode="bold">This is rendered bold,
<content styleCode="Italics">this is rendered bold and
Italicized, </content>thi si rendered bold .</content>
<content styleCode="Bold Italics">This is also rendered
Bold and italicized</content>
</test>
</section>
Tham chi

i
iv

-

t n m trong kh i narrative block

tham chi

n tag<content> c a kh i narriative

block.
-

tham chi

-

ng ho c clas n m trong ho c

tham chi

n th m

m trong

<footnote>.
-

t o ra m t CDA observationMedia and

regionOflnterest n
1.2.3 C

i li u CDA
a m t Entry.

ng tham gia trong m t Entry
Ch

c

th c thi b

u entries

u CDA. V

S

c li u

pc




B

ng tham gia m t Entry

STT

Ch
M t d n xu t t

c nh n
cs

1

Act

ts

d

a Act s
p v

: Act.id,Act.moodCode

c d n xu t t
Encounter

u

l c.

tr ng hi n t i

2

c

PatientEncounter

RIM
class

pb
c d n

xu t t

RIM Khi

Observation.negationInd

nh
di n t
3

u
l

Observation

ng th i m t s thu
h y

hi u l c theo.
: Observation.id,
Observation.moodCode
c d n xu t t

4

Observation
Media

RIM D li
logic v i

di n t

u hi n th i
iv

u d li u

Multimedia
c d n xu t t RIM Act

5

Organizer

t

t

c

u CDA, ph c v

cho vi c chia s
S

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t ng c nh
c d n xu t t

RIM Khi

Procedure.negationInd

nh
t c trong x
6

nh

a th

u tr b nh hi

Procedure

t c s

ng th i m t s

thu
u l c theo
:Procedure.id,
Procedure.moodCode
c d n xu t t

7

Region

RIM M t

RegionOfInterest

thham chi

Of

m

Interest

i m t

c ObservationMedia

c bi

ph i

ho c

nh ExternalObservation.

yt
c d n xu t t RIM Khi SubstanceAdministration.
SubstanceAdministrationcl Negationind nh

8

quan h v s d ng thu c hi u l c.
Substance
cho b
ng th i m t s
Administration

thu

:
SubstanceAdministration.id,
SubstanceAdministration.mood
Code
c d n xu t t

RIM

t v s cung c p v
9

Supply

t , bao g m thu
v
u tr b nh

S

c li u

1.3.2.2. Quan h trong m t Entry
Trong CDA gi
c th
ph

u quan h v ch th
ng l n nhau gi

n trong c

b

u, n i dung

trong ph n body.
B ng 1.9: Quan h trong m t Entry

STT

Ch
cho ph n entry,
n m
qua author c a section, trong h th c th header, section

1

Author

ph n body c

ghi
inh t section
S h y m t entry
2

Khi h y m t entry ta s

Consumable

thi t l p Act.negationInd
true
i cung c
th nh

3

Informant

tin t

section khi b

CDA m

i

CDA cung c

t i

CDA section
m t th c th
4

Participant

Th c th

c

c th
th

i m t th c sinh l ng nhau trong CDA

th

c

entry

i th c hi n ho c, M
5

Performer

tham gia s ki
b nh.

S

c li u

a

ho t
cl

ph


n
m v i


c th
b nh ph m (m

B nh ph

nghi m)
6

t ph n

quan tr ng trong m t s
ng

Specimen

trong vi
t nghi

t qu
u thu t

thu t
y
7

u CDA

Subject

i
subject trong CDA entry khi
b

CDA

section

1.3.2.3. Quan h entry-Entry Relationships
B ng 1.10: Quan h entry-Entry Relationships
STT

Ch
Ch

hi n quan

h gi
1

Component

c

t o ra m
n vi c cung c p

c

d n

xu t

t
c

2

Precondition

di n t

m

u ki n ch c

ch
ki
3
S

ReferenceRange

i xu t hi n

Quan h
n Observation
c li u