臺灣博碩士論文加值系統

近年來醫療資源共享已成為重要的議題，而醫療資源共享包含醫院合作、醫院資訊共享和病人轉檢等議題。其中，醫院資訊共享是將醫療訊息資訊化，讓醫院能傳遞醫療資訊給他家醫院。而醫護人員在進行不同的醫療作業時，需利用資訊系統得到所需的醫療訊息。若當病人轉檢時，所需的醫療訊息未完整的傳遞至轉檢醫院，則醫院轉檢流程的順暢性與轉檢病人安全會受到影響。故資訊系統如何達成傳遞訊息的完整性與時效性，則變成一個重要的研究議題。
故本研究針對個案醫院的轉檢作業之電腦斷層檢查作業流程，探討資訊流如何有效的輔助醫療作業流程以達成醫療資訊共享。本研究利用Integration Definition For Function Modeling (IDEF 0)分析醫院門診電腦斷層病人的轉檢作業之作業流與資訊流，另外，本研究以精敏來改善分析後的轉檢作業，其中精敏又分為精實與敏捷，本研究利用精實消除作業流程的浪費以及敏捷提升其資訊的敏捷性以達到醫療資訊共享，使醫院的資訊系統能夠處理多樣性的病人。
本研究針對個案醫院在三家院區進行醫療資源共享的過程，提供一套改善後轉檢作業之電腦斷層檢查作業流程與資訊流流程。透過有效的資訊流交換，在執行作業時可使資訊流能具備其完整性與時效性，並有效執行轉檢作業也可達到醫療資訊共享的目的，進而提升病人的安全。另外，有效的資訊共享與傳遞訊息有利於提升醫院的醫療品質。而本研究提出的架構可使當兩家醫院進行合作時，資訊系統能輔助醫療作業流程，並達成醫療資訊共享。

Recently, medical resource pooling has been an important topic. The types of medical resource pooling consist of hospital collaboration, communication between hospital information systems and patient-referring mechanism. Since patient’s data of hospitals becomes e-processing, hospitals can transmit patient’s electronic medical record (EMR) to other hospitals. If the referring hospital does not receive the referred patient’s EMR, the patient-referring mechanism will be delay and safety of the referred patient will be affected. Therefore, how hospital information systems can transmit patient’s EMR accurately and timely becomes a critical research issue.
The objective of this research is to consider a computed tomography (CT) scan process of the patient-referring mechanism as a case study and to explore how the information flow can support the medical operations in order to accomplish medical resource pooling. This research adopts Integration Definition for Function Modeling (IDEF0) to analyze the operational and information flows of the CT scan of the referred patients. In addition, this research adopts the Leagility concept, which contains lean and agility, to analyze the CT patient-referring mechanism. This study uses the “Lean” concept to remove the non value-added medical operations and also apply the “Agility” concept to improve the feasibility of hospital information systems. As a result, hospital information systems can handle more uncertainty of patients.
This research considers three hospitals and improves their operational flows of the CT scan of the referred patients. Through information sharing between these hospitals, the medical staff can perform medical operations more accuracy and timely. The modified patient-referring mechanism can fulfill medical resource pooling and improve patient safety. Further, effective information sharing and transmission can improve quality of care for patients. The proposed framework by this research can provide hospitals with a reference to achieve their medical resource pooling.

目錄
摘要 I
ABSTRACT II
致謝 III
目錄 IV
圖目錄 VI
表目錄 VII
第一章 緒論 1
1.1 研究背景及動機 1
1.2 研究目的 3
1.3 研究範圍 4
1.4 研究架構 4
第二章 文獻探討 6
2.1 協調工作 6
2.2 醫療資訊系統 9
2.3 IDEF 0 方法論 10
2.3.1 IDEF 來源與發展 11
2.3.2 IDEF 0方法 12
2.4 精敏(LEAGILITY) 15
2.4.1 精實(Lean) 15
2.4.2 Agile 17
2.5 小結 18
第三章 研究方法 19
3.1 問題定義 19
3.2 研究步驟 21
3.3 研究範圍 21
3.4 醫院轉診與轉檢作業 23
3.4.1 轉診 23
3.4.2 轉檢 24
3.5 個案醫院介紹 25
3.5.1 個案醫院資料 25
3.6 IDEF 0 之建立方法與步驟 29
3.7 精敏改善過程 (LEAN & AGILE) 31
3.8 小結 34
第四章 改善結果與分析 35
4.1 個案醫院電腦斷層檢查作業IDEF 0 之AS-IS MODEL 35
4.2 改善後個案醫院電腦斷層檢查作業IDEF 0 之TO-BE MODEL 39
4.3 個案醫院資訊系統輔助電腦斷層檢查作業IDEF 0 之AS-IS MODEL 39
4.4 改善後個案醫院電腦斷層檢查作業IDEF 0 之TO-BE MODEL 43
4.5 小結 45
第五章 討論、結論與未來研究方向 46
5.1 討論 46
5.2 研究結論 48
5.3 未來研究方向 49
參考文獻 50

 
圖目錄
圖1-1 研究架構圖 5
圖2-1 IDEF 0 示意圖 13
圖2-2 IDEF 0 流程分解圖 14
圖3-1 本研究的研究步驟 21
圖3-2　繪製IDEF 0流程之程序圖 30

 
表目錄
表2-1 醫院協調困難相關文獻 7
表2-2 探討醫院資訊系統架構之相關文獻 10
表2-3 IDEF 家族簡介 12

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