基于世界卫生组织全球数字健康战略架构的数字康复的政策、标准和技术模式研究

doi:10.3969/j.issn.1006-9771.2025.02.001

Abstract

Abstract:

Objective To systematically analyze the global policy framework, standard systems and application technology models of digital rehabilitation within the framework of the World Health Organization (WHO) Global Digital Health Strategy and propose policy recommendations for the future development of digital rehabilitation.

Methods Based on the policies on digital health and rehabilitation development issued by the WHO, focusing on the Global Digital Health Strategy, Rehabilitation 2030 Initiative, Rehabilitation in Health Systems, Rehabilitation in Health Systems: A Guide for Action, and World Report on Disability,a systematic review was conducted, to explore the policy architecture and core content of digital rehabilitation, the standard system for digitalizing rehabilitation, and key technological models for the development of digital rehabilitation.

Results In the context of global health and digital transformation, the development of digital rehabilitation services was an essential component of the global digital health strategy. Building a comprehensive policy framework and content system for digital rehabilitation was critical for strengthening rehabilitation data governance, enhancing data utilization efficiency, and ensuring data privacy and security. Empowering rehabilitation with digital technology was vital for improving the standardization, effectiveness, coverage, quality and safety of rehabilitation services. International digital rehabilitation policies primarily involved the following areas: policy and governance, digital standard systems, data privacy, security and ethics, digital talent cultivation and capacity building, and monitoring, evaluation and continuous improvement of digitally empowered rehabilitation services. The standard system for rehabilitation digitization covered the three major reference classifications of the WHO Family of International Classifications, including International Classification of Diseases Eleventh Revision (ICD-11), International Classification of Functioning, Disability and Health (ICF), and International Classification of Health Interventions (ICHI), especially ICF. It also included international data interoperability standards, data security and privacy protection standards, data quality and certification standards, and health information standards, etc. The application technology models of digital rehabilitation primarily included data-driven service models, artificial intelligence -enabled models, and remote rehabilitation models combined with virtual reality, augmented reality technologies, and Internet of Things support.

Conclusion The establishment and implementation of comprehensive policies, standards and technological models for digital rehabilitation are crucial for driving the digital transformation and development of global rehabilitation services. Under the framework of the WHO Global Digital Health Strategy, it is necessary to build adaptive digital rehabilitation policy frameworks, and enhance digital governance capabilities and levels, establishing and improving digital rehabilitation standard systems, and promoting the interoperability and integration of rehabilitation data with other health big data. Meanwhile, it is essential to actively develop data-driven technological models for rehabilitation services to comprehensively improve the accessibility, availability, quality and safety of rehabilitation services.

Key words: digital rehabilitation, digital rehabilitation standard system, digital rehabilitation technology models, global digital health strategy

CLC Number:

YANG Yaru, QIU Zhuoying, CHEN Di, WANG Zhongyan, ZHANG Meng, JING Qi, ZHANG Yaoguang. Policies, standards and technological models of digital rehabilitation aligned with the framework of WHO's global digital health strategy[J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(2): 125-135.

Figures/Tables 4

Table 1

Framework and content of digital rehabilitation policy based on WHO Global Digital Health Strategy"

政策核心支柱	政策内容	政策目标	优先领域	数字康复的政策架构和内容	实现数字康复的技术路径
政策和治理	制定并完善数字康复的法律法规，确保技术标准的一致性和合规性；建立数字治理体制并提升治理能力，推动康复服务的现代化	建立健全数字健康法律法规框架，确保技术合规性和治理能力提升	数据隐私保护、法律合规、政策标准化	强化数字赋能路径，结合健康服务体系中的康复政策，重点推进康复监测和研究能力建设；支持国际合作框架下的政策共享	通过构建数字化监测和研究工具、区块链技术的数据透明化管理系统和健康服务整合平台，提升治理能力和服务效率
健康系统整合	通过数字技术提升康复服务的系统整合度，包括数据共享、EHR/EMR系统标准化和优化患者管理路径	提高服务效率和医疗质量，推动多系统协同	数据互操作性、信息共享、系统整合	推进康复路径优化，强化健康数据整合和共享，通过系统性数据支持改善个性化康复方案实施	应用互操作性标准(如HL7 FHIR)；开发结合AI和大数据的康复预测模型，支持临床决策和资源分配优化
数字健康工具和创新	推动基于AI的康复优化、远程康复和个性化移动健康方案，扩展康复服务技术能力	提升康复服务的覆盖率和精准性	远程康复、AI支持、健康功能监测	开发个性化康复管理工具；推广基于数据分析的健康功能评估方案；制定康复技术应用的标准化指南	集成AI驱动的康复平台、移动健康设备和远程健康支持工具；开发AR和VR辅助的康复训练系统
与可持续发展目标的协同发展	数字健康促进实现可持续发展目标，促进健康福祉、减贫、教育和性别平等，提升弱势群体的健康服务可及性	提高全球健康服务的公平性和可及性	健康福祉、教育平等、贫困减轻	推动跨领域协作，在康复服务中融入社会经济支持措施；面向偏远地区人群的康复技术	多功能健康管理平台、支持偏远地区的数字健康服务系统
合作和伙伴关系	强化国际合作和区域协作，推动全球康复数据共享和技术标准一致性	实现全球数字健康标准化和数据协作	数据共享、标准制定、国际合作	构建区域和全球协作框架，推动基于国际标准的康复数据共享和政策协调；支持多边平台下的康复研究和应用推广	应用国际互操作性标准(如ICD-11、SNOMED CT)；开发跨国协作数据平台，促进实时共享和大规模数据比较研究

Table 1

Table 2

Table 3

Core standard systems for rehabilitation data and information"

标准/框架	适用范围	功能与特点
ICF	人体功能、活动、参与及环境因素的多维描述	为康复数据提供统一的编码与分类框架，以多维度刻画健康与功能状况；支持跨专业、跨机构的数据对比与研究，可与ICD-11、SNOMED CT整合应用
ICD-11	疾病和相关健康问题的国际标准分类	为基础疾病、并发症和相关健康状态提供标准化编码；与ICF整合可更全面描述康复对象的健康状态，为康复干预重点与策略制定提供依据
ICHI β-3	临床和统计目的报告和分析健康干预	涵盖由广泛的提供者在整个卫生系统范围内进行的干预措施，包括诊断、医疗、手术、心理健康、初级保健、联合健康、功能支持、康复、传统医学和公共卫生
SNOMED CT	临床诊断、干预措施和结果的精确描述	为康复诊断、治疗措施及结果指标提供统一的临床术语，使EHR和CDS中的康复信息更加标准化、可计算和可分析
数据可操作性与交换标准(HL7 FHIR、HL7 V2/V3、IHE)	健康数据的互操作、可交换与整合	HL7系列标准(包括V2/V3消息格式、FHIR资源模型)与IHE框架为康复数据在不同信息系统间的无缝共享提供基础，实现跨平台、跨机构的高效数据交换和集成
DICOM	医学影像数据的标准格式与传输协议	适用于康复相关的影像学数据处理与传输(如MRI、超声)，确保不同设备与软件间的图像信息互操作与兼容性，以辅助康复评估与干预决策
卫生信息标准(OpenEHR、CEN/ISO)	医疗数据模型、信息结构与安全标准	OpenEHR提供可扩展的信息模型与临床知识库结构；CEN/ISO标准(如EN 13606、ISO/IEC 27799)为信息安全、隐私保护和数据结构规范提供参考，确保康复数据的长期可用性与合规性
数据安全与隐私保护标准(参考ISO/IEC 27002、ISO/IEC 27799、GDPR、HIPAA)	健康数据的隐私、安全和合规性	ISO/IEC 27001与ISO/IEC 27799为医疗数据的安全管理与隐私保护提供国际公认的标准框架；GDPR与HIPAA为康复数据跨境传输与使用，确保患者隐私与数据安全提供参考
数据质量与认证标准(ISO 13131、IEEE医疗信息标准)	数据质量控制、系统与软件认证	确立数据质量评价指标、审核机制和软件系统认证流程；对康复信息系统和应用程序进行独立认证与审查，提升数据可信度、安全性和用户信任度

Table 3

Table 4

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政策领域	主要政策内容	政策导向和原则
数据治理和框架^{[4,16⇓⇓-19]}	在全球数字健康战略下制定康复数字化相关政策架构强调以患者为中心的数据治理倡导国际标准和统一术语的应用	以患者为中心促进数据标准化鼓励国际合作和可持续发展
数据收集和信息标准化^{[4,6,11,16,20]}	建立统一数据要素标准和指标体系(包括功能改善、活动能力、康复绩效指标) 广泛采用ICF、ICD-11、SNOMED CT等国际标准运用HL7 FHIR等互操作性标准	数据标准化和国际通用健康分类体系互操作和跨系统数据共享增强数据比较性和可用性
数据隐私、安全和伦理合规^[4,21-22]	明确患者数据保护与隐私权建立访问控制、加密传输和符合国际数据保护条例(如欧盟的GDPR)机制强调伦理审查和法律合规	确保数据安全和隐私法律和伦理合规性增强患者对数据处理的信任度
人才培训和能力建设^[4-5,16]	将数字康复和信息管理技能纳入教育培训促进跨学科团队协作(医疗、信息、康复、工程) 提供持续职业发展和在线培训资源	加强人才队伍建设促进信息素养和专业技能提升实现跨领域协作
监测、评估和持续改进^[21,23-24]	建立实施康复数据政策的指标与考核机制利用数据评估康复服务质量、资源分配与政策执行的效果借助国际平台分享经验和最佳实践	强调循证决策和质量改进持续监测和动态评估加强国际合作和经验交流

应用场景/领域	主要技术模式	功能与特点
数据采集与输入	可穿戴设备、mHealth应用、物联网智能设备	实时监测患者生理和活动数据(如心率、步态、肌电信号)、收集自报症状和主观感受；利用ICF/SNOMED CT对数据进行结构化编码，为康复过程中的客观评估和个体化方案制定奠定基础
数据传输与互操作	FHIR标准、HL7消息、IHE集成、中间件与API网关	利用国际互操作标准将多源异构数据(医院信息系统、远程康复平台、可穿戴数据)整合与共享；通过安全的API和消息格式，实现数据在各平台的无缝交换与灵活调用
数据存储与管理	云计算、分布式数据库、数据湖/仓库、ETL流程、元数据管理	在云平台或本地数据中心存储和管理结构化和非结构化康复数据；通过分布式数据库、数据湖与数据仓库处理海量数据，并运用ETL工具进行数据清洗、转换和融合，利用ICF、ICD-11等标准化元数据模型，确保数据质量和可用性
数据分析与决策支持	统计分析、机器学习/深度学习、CDS系统、可视化工具	利用统计模型和AI技术对康复数据进行预测分析(如康复进度、跌倒风险)、模式识别和个性化推荐；将分析结果嵌入CDS中，为康复治疗师和医生提供智能辅助决策和可视化界面
服务应用与监管	远程康复平台、康复训练系统、区块链数据共享与审计	通过远程视频、实时数据共享和VR/AR技术，提供个性化、交互式的康复训练和指导；使用区块链技术保障数据可追溯和可信共享；引入认证和审计机制，确保服务合规性和患者数据安全

Policies, standards and technological models of digital rehabilitation aligned with the framework of WHO's global digital health strategy

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