臺灣博碩士論文加值系統

本論文主要在探討如何在醫院的醫學工程部門建立一套有效率並完整的管理系統，來確保醫療設備的安全、有效、品質及效益。而論文特點在於利用生命週期模型的管理架構，藉以低開發成本的網頁資訊技術，系統性收集及呈現各階段的營運資料，並透過指標的監控與異常事件的分析，來持續改善、控制與預防相關問題，以確保整個設備管理的完整與妥善運行及降低可能的風險危害。
此論文所提出的生命週期模型是以醫院管理的角度，從設備的預算訂定、採購評估、驗收安裝、保固到期、儀器壽年到期及報廢等時間點來曲分不同階段的管理區間，而各階段佐以不同的管理策略並透過相關資訊系統來達成管理目標。而這些資訊系統主要是以簡易的動態網頁開發技術並結合醫院行政與臨床資訊資料庫及醫工部門的作業資料庫，整合成一完整生命週期的醫療設備資訊管理系統。
在論文結果中，我們舉出四個醫療設備管理子系統，其包括維護品質監督管理、儀器使用效益分析、老舊堪用設備集中調度管理及大量受損設備緊急應變機制。此四個子系統為醫療設備生命週期中所衍生的重要管理議題，而其中最後一項緊急應變機制為一災後大量受損設備緊急應變的特殊案例應用。所有系統目前都正常使用於台大醫院中，而相關產出的資訊也都用於實際醫療設備管理措施中，相關呈現的結果已證明此架構的可行性及其效益。
目前醫院中的醫學工程部門正面臨醫療設備數量持續增加、醫療設備軟硬體技術的變革及功能的複雜化、相關法規評鑑及品質系統的要求、人員安全及風險管理、成本效益的管控及內部人員老化的問題。為了使醫療設備管理更為有效率並能從容面對上述問題，相信透過本論文所提供的管理策略及架構，能有效提升醫工部門的運作品質及效益。

In the hospital, management of medical equipments is a series of activities from budget planning to equipment disposing. The overall activities focus on issues such as quality, safety, performance, cost, and profit. An efficient and effective management system is necessary for supervising these goals.
In this study, we show how to use a low cost web-based information model based on equipment life-cycle to finish the job. The operations information of medical equipment can be systematic collected and revealed at different life-cycle stages. Audit indicators are used to continually monitoring real operation conditions and improve related adverse events. Through this mechanism, the management integrity, medical care quality, and patient’s safety will be improved. This system consists of four sections namely; the surveillance of maintenance quality, the central regulatory, the utilization benefit, and its emergency response.
Quick and effective decision marking becomes possible by useful operating status from the analysis and supervising of quality control, user satisfaction survey, utilization rate, and revenue contribution provided by the system. The framework of this model has worked well in the NTUH by the increase in availability and efficiency of equipments used.

誌謝 I
中文摘要 II
Abstract III
Content IV
List of Figures VI
List of Abbreviations VIII
1. Introduction 1
1.1. Medical Equipment Management System (MEMS) 3
1.2. Utilization benefit administrative system (UBAS) 5
1.3. Regulatory Management System (RMS) 7
1.4. Emergency Management System (EMS) 8
2. Methods 11
2.1. Equipment Service Life-cycle 11
2.2. Web Based Information System (WBIS) 14
2.3. The Database Systems 14
2.3.1. Database of Hospital Information System (HIS) 14
2.3.2. Database of Biomedical Engineering Department (BMED) 15
2.3.3 Database of Clinical Information System (CIS) 15
2.4. System Users 15
2.5. Information Sub-systems 17
2.5.1. Medical Equipment Management System (MEMS) 17
2.5.1.1 The network architecture of MEMS 18
2.5.1.2. The architecture of MEMS 19
2.5.2. Utilization Benefit Administrative System (UBAS) 22
2.5.2.1. The work flow of UBAS 23
2.5.3 Regulatory Management System (RMS) 26
2.5.3.1. The architecture of RMS 26
2.5.3.2. Functions for administrator in RMS 28
2.5.3.3. Functions for general user in RMS 29
2.5.4 Emergency Management System (EMS) 30
2.5.4.1. Development Flow of EMS 31
2.5.4.2. Pre-processing in EMS 32
2.5.4.3. Building the database in EMS 33
2.5.4.4. The architecture of EMS 34
2.5.4.5. The operational databases of EMS 35
2.5.4.6. The system web pages in EMS 36
2.6. Network system 38
2.6.1. Intranet in hospital 38
2.6.2. Intranet in biomedical engineering department 38
2.5. Developing tools 39
3. Results 40
3.1 An example for EMES: A framework of medical equipment management system for in-house BMED 42
3.2 An example for UBAS: A Web-based Information System Applied on Utilization Benefit Management of Medical Equipment in the Hospital 47
3.3 An example for RMS: Using web technique in the managing regulatory requirements of medical equipment for the nursing department 52
3.4 An example for EMS: An efficient framework of emergency response to facilitate disaster recovery for fire-damaged medical equipment –Case study at a large medical centre after a fire accident 54
4. Discussion 60
5. Conclusion 70
Reference 72

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