臺灣博碩士論文加值系統

摘要
中文摘要
本研究主要在於建立一某教學醫院門診系統之智慧型醫囑輔助模擬子系統。主要在現有系統上，加強資料庫輔助模式相關模組，提供適時檢驗醫學資訊給臨床醫師，學習醫師診療行為，協助醫師思考開立診斷相對應檢查，並進行簡易的評估工作，了解此系統未來改善方向。
研究採用系統發展生命週期System Development Life Cycle為主架構並以決策輔助系統Decision Support System開發程序進行系統開發。系統架構主要分成資料庫、模式庫、知識庫及介面四部分。資料庫由病歷資料及前三個月歷史資料組成；模式庫採用資料採礦(Data Mining)方法論中提出記憶基礎理解(MBR)方法搜尋比對近三個月歷史資料及理論疾病診斷檢驗資訊，主動提示醫師常用醫囑開立項目；知識庫分成疾病診斷知識庫及檢驗知識庫，由相關診斷與檢驗書籍、醫學網站等資料彙整而成；介面部分以研究醫院診間醫令系統以VB6.0軟體程式做畫面模擬，並在醫囑開立畫面上重新設計修正及改變畫面配置，適時提供檢驗資訊，如檢驗上升、下降意義及相關疾病關鍵字查詢、動態搜尋等功能。
系統評估以問卷受訪研究醫院家庭醫學科臨床醫師11名醫師基本資料、對於現有診間醫令子系統之滿意度、試用新設計智慧型臨床醫囑輔助系統和現有使用診間醫令子系統作比較後之滿意度。評估結果有效問卷10份，無效問卷1份，大部分醫師對現有系統操作上皆具有一定熟悉程度。而醫師花費於看診的時間最長的為問診，其次為開立醫囑，其次為下處方及下診斷。在現有子系統操作方便性、相關資訊查詢、開立診斷或醫囑方式、輔助性資訊提供方面以及整體系統的滿意度，大多表示不甚滿意。在使用過新設計智慧型臨床醫囑輔助系統後，於操作方便性、醫囑相關資訊查詢、開立診斷或醫囑方式方便性及教學資訊提供上，多認為有所幫助。在新設計的醫囑輔助子系統整體滿意度上，皆認為有幫助。

英文摘要
The purpose of this study is to create an intelligent clinical physician order simulation subsystem of teaching hospital outpatient service system in hospital. The subsystem enhances database support models and provides timely medical order information to clinical doctors, it also could learn to make a diagnosis and give treatment for help doctors to think physician diagnosis corresponding orders. Finally, we precede a simple estimate work to understand the direction to improve the system.
The main frame of the study adopts the way of System Development Life Cycle and Decision Support System. The system could separate to four parts, database, model base, knowledgebase and interface.
The part of database combines with cases history data and history data three months before. And the model base adopts memory based reasoning way of data mining methodology which search to compare with the recent three months history data and theory orders information. The system also prompts in common use physician orders timely. The knowledgebase forms disease diagnosis knowledgebase and orders knowledgebase which from medical books and web sites. The interface adopts Microsoft Visual Basic 6.0 software to simulate outpatient service system.
The system evaluation adopts clinical physicians of department of family medicine questionnaire which include basic information, satisfaction of outpatient service subsystem in existing and the satisfaction of the new simulation subsystem. The result has ten effective questionnaires and one ineffective questionnaire. The greater part of clinical physicians is familiar with the original system. The clinical physicians spend the most time on interrogation enquiry, the next is physician orders, prescriptions and diagnosis. Most of clinical physicians are unsatisfactorily about outpatient service subsystem of operation convenience、information to look up and the way of diagnosis or physician orders in existing. In the other hand, they are satisfactorily about the intelligent clinical physician orders support simulation subsystem of operation convenience, information to look up and the way of diagnosis or physician orders and education information. All of clinical physicians consider the whole system is helpful.

目錄
摘要1
中文摘要1
英文摘要2
1.緒論3
1.1研究動機及背景3
1.2研究目的4
2.文獻回顧5
2.1醫學檢驗5
2.1.1臨床檢驗分類6
2.1.2臨床診斷與檢驗的關係7
2.1.3目前檢驗發展挑戰10
2.2檢驗資訊系統10
2.2.1國內檢驗資訊系統現況11
2.2.2檢驗資訊系統架構說明11
2.2.3檢驗資訊系統發展方向13
2.3診斷輔助系統14
2.3.1國內診斷輔助系統應用15
2.3.2國外診斷輔助系統應用16
2.4診斷輔助系統應用方法17
2.5名詞解釋18
3.研究方法20
3.1系統設計20
3.1.1系統流程20
3.1.2研究方法21
3.1.3研究工具23
3.1.4系統架構25
3.2系統評估29
3.2.1研究樣本29
3.2.2研究範圍35
3.2.3問卷評估36
4.結果38
4.1.系統流程說明38
4.2系統展開圖38
4.3系統展示40
4.4問卷評估結果50
5.討論及建議53
5.1討論53
5.2未來研究方向54
參考文獻55
附錄59
圖目錄
圖2-1治療臨界模式圖8
圖2-2檢驗資訊系統作業流程圖11
圖2-3台北榮總檢驗資訊系統架構概念圖13
圖2-4決策輔助系統概觀圖14
圖3-1系統開發流程比較圖20
圖3-2醫師看診流程圖22
圖3-3系統架構圖25
圖3-4主程式系統說明圖28
圖3-5實際與理論關係圖34
圖4-1智慧型臨床醫囑輔助系統流程圖38
圖4-2系統展開圖39
圖4-3系統首頁畫面40
圖4-4診間登入畫面41
圖4-5點選病人畫面42
圖4-6系統主畫面42
圖4-7開立診斷畫面43
圖4-8開立醫囑畫面44
圖4-9開立其他醫囑畫面44
圖4-10以部科別開立其他醫囑畫面45
圖4-11以比對搜尋方式開立其他醫囑畫面46
圖4-12輸入開立其他醫囑之理由畫面46
圖4-13檢驗查詢功能畫面47
圖4-14查詢檢驗上升意義、下降意義、相關疾病畫面48
圖4-15檢驗相關資訊查詢畫面48
圖4-16動態查詢檢驗相關資訊畫面49
圖4-17系統結束畫面49
表目錄
表2-1臨床檢驗科別項目說明表6
表2-2檢驗測試結果2*2說明表9
表2-3國內醫醫令系統架構比較表11
表3-1檢驗知識庫欄位說明表27
表3-2家醫科13項常見疾病診斷29
表3-3研究醫院門診資訊系統說明36
表4-1看診花費時間長短50
表4-2現有醫囑輔助子系統評估51
表4-3新設計之醫囑輔助子系統評估52
附錄
附錄一 常見20項診斷碼59
附錄二 13項診斷碼最常開立檢驗60
附錄三 常見診斷疾病定義62
附錄四 13項診斷理論上建議開立檢查65
附錄五 問卷內容67
附錄六 榮總網路示意圖70
附錄七 榮總資訊系統圖71
附錄八 榮總資訊室門診資訊系統流程圖72
附錄九 榮總門診展開圖73
附錄十 程式原始碼74

參考文獻
1.Butter worth:Medical Decision Making.230-233 ,1998.
2.Federspil G,Vettor R: Clinical and laboratory logic. Clinica Chimica Acta. 280(1-2):25-34,1999 Feb.
3.Gonzalez-Vallejo C,Sorum PC,Stewart TR,Chessare JB: Mumpower JL, Physicians'''''''' diagnostic judgments and treatment decisions for acute otitis media in children. Medical Decision Making.18(2):149-62,1998 Apr-Jun.
4.Heckerling PS,Verp MS. Albert N: Patient or physician preferences for decisionanalysis:the prenatal genetic testing decision. Medical Decision Making.19(1):66-77,1999.
5.Helfer D, Marsh K, Sorensen M:Developing an integrated computer system for cardiac catheterization laboratories. Journal of Cardiovascular Management. 8(1):21-6, 1997 Jan-Feb.
6.Interpretation of Diagnostic Tests, 1992 Little, Brown and Company。
7.http://www.labwise.com.tw/
8.JAMA,280(15),October 21,1998.
9.Keri E,Pearlson:Managing AND Using Information Systems.250-252.1999.
10.Kimble,Young,Kradjan,Gugllelmo：Handbook of Applied Therapeutics應用治療學手冊.合記出版社.1994.
11.Kokkotos S, Ioannidis EV,Spyropoulos CD：A system for efficient scheduling of patient tests in hospitals. Medical Informatics. 22(2):179-90, 1997 Apr-Jun.
12.Markin RS：Recent trends in clinical laboratory automation. Clinical Laboratory Management Review.12(3);176-80,1998 May-Jun.
13.Michael J.A.Berry,Gordon S.Linoff,Dr.彭文正：資料採礦顧客關係管理暨電子行銷之應用.樹博網資訊公股份有限公司.2000.
14.Plebani M:The clinical importance of laboratory reasoning. Clinica Chimica Acta. 280(1-2):35-45, 1999 Feb.
15.Richardson H：Laboratory medicine in Ontario: its downsizing and the consequences on quality. Clinica Chimica Acta. 290(1):57-72, 1999 Dec.
16.Stair TO：Reduction of redundant laboratory orders by access to computerized patient records:Journal of Emergency Medicine. 16(6):895-7, 1998 Nov-Dec.
17.smi-web.stanford.edu/projects/eon/.
18.Simon Haykin, Neural Networks: A Comprehensive.
19.Tafeit E,Reibnegger G：Artificial neural networks in laboratory medicine and medical outcome prediction. [Review] [35 refs]. Clinical Chemistry & Laboratory Medicine. 37(9):845-53, 1999 Sep.
20.Tierny WM,McDonald CJ,Martin DK：Computerized display of past test results:effects on outpatient testing.Ann Intern Med .107:569-74.1987.
21.Tierny WM,McDonald CJ,Martin DK：Computerized Predictions of abnormal test results:effects on outpatient testing. J Am Med Assoc.259:1194-8.1988.
22.Tierny WM,Miller ME,Overhange Jm：Order-writing on microcomputer workstations:effects on resocurce utilization. J Am Med Assoc.269:379-83.1993.
23.Turban Aronson：Decision Support System and Interllgent systems.269-274.1998.
24.Waise A：Clinical audit and the contribution of the laboratory to clinical outcome. Clinica Chimica Acta. 280(1-2):47-57, 1999 Feb.
25.Whiting-O’Keefe QE,Simbord DW,Epstein WV：A computerized summary medical record system can provide more in formation than the standard medical record. J Am Med Assoc.254：1185-92.1985.
26.Wilkinson DS：The role of technology in the clinical laboratory of the future. Clinical Laboratory Management Review. 11(5):322-30, 1997 Sep-Oct.
27.Wilkinson GA,McDonald CJ,McCabe GP：The effect of immediate access to acomputerizated medical record on physician test ordering a controlled clinical trial in emergency room.Am J Public Health.72：698-92.1982 .
28.Wu AH：Improving the utilization of clinical laboratory tests. [Review] [43 refs] Journal of Evaluation in Clinical Practice. 4(3):171-81,1998 Aug.
29.www.acl.icnet.uk/
30.www.cpmc.columbia.edu /arden/.
31.www.dsg.harvard.edu網站.
32.ycmi.med.yale.edu /gem/.
33.Zinder O：New directions in laboratory-clinician communications: Clinica Chimica Acta. 278(2):83-94, 1998 Dec.
34.王景弘：設計一個具有學習能力的腦瘤診斷專家系統. 國立交通大學碩士論文.1990.
35.吳坤祥：以個人電腦為基礎的醫用專家系統建構工具之設計與應用.國立成功大學碩士論文.1990.
36.李秉穎醫師：檢驗結果的不一致造成檢驗錯誤‧台大醫院.1999.10.
37.林等義：全方位的檢驗資訊系統.慈濟綜合醫院之發展與應用研討會.1999.
38.長庚醫院廖順奎:全民健保叢書健康檢查指引.鍾郡出版.1998.
39.長庚醫院網站。
40.翁心華,潘孝彰:名醫談百病-肝炎。南粵出版社.2000.
41.張顯洋,蔡俊榮,林俊龍：跨世紀新醫療資訊系統慈濟綜合醫院之發展與應用.1998.
42.許昭仁：整合知識庫品管決策輔助系統之研究.國立交通大學碩士論文.1989.
43.郭振邦：急性腹症的電腦諮詢系統.國立成功大學碩士論文.1994.
44.陳秋宏：神經網路專家系統之設計與製作. 國立交通大學碩士論文.1989.
45.陳銘泉：醫院管理資訊系統規劃之研究.中國醫藥學院碩士論文.1988.
46.惠汝太,彰麟:名醫談百病-高血壓.南粵出版社.2000.
47.榮總資訊室.
48.謝逸中：以World Wide Web為基礎之臨床資訊站對使用者之衝擊. 台北醫學院論文.1988.
49.當代內科診斷與治療Diagnosis & Treatment.附錄Current Medical第卅五版.1996.
50.檢驗醫學Merck Manual默克診療手冊.第十五版.第268節.
51.葉東波：永大簡明道氏醫學辭典.1996.
52.葉怡成：應用類神經網路.儒林圖書公司.1997.
53.蘇木春,張孝德：機械學習、類神經網路、模糊系統以及基因演算法則.全華科技圖書股份有限公司，1999.
54.郭振宗;微生物類別診斷與抗生素用藥決策支援系統. 國立屏東科技大學碩士論文.2000.
55.薛洪昇：皮膚病理非感染性全身性水泡診斷決策支援系統.台北醫學院碩士論文.2000.
56.賴燕賢：醫學診斷輔助護理過程支援系統. 台北醫學院碩士論文.2000.
57.余儀呈：常見門診判讀之原則.台北榮民總醫院家庭醫學專題演講.2000.
58.檢驗資訊網.http://www.super MT.com.tw.
59.台大醫學網站.http://ntuh.mc.ntu.edu.tw.