臺灣博碩士論文加值系統

隨著網路科技的發展，醫院的作業、資料處理及病歷都朝向電子化發展。醫學是很複雜的，特別是對於住院的病患，醫師需要將病患的所有資料，包括本次就醫的處方資料、檢驗資料、病理資料及護理資料等，甚至必須將同一病患的所有病史資料全部整合在一起，才能對病情有深入的瞭解，進而依病情需求開立處方。由於住院病人的病歷資料繁多，醫院為了醫師診斷的需求而必須運用很多人力來紀錄以及整理這些資料。基於這些原因，我們想要建構一個應用於醫師查房之個人數位助理（Personal Digital Assistant，PDA）雛形系統，輔助醫師管理查房所需的資料，用以節省人力資源、減少人為疏失，並掌握時效，以提昇醫療照護的品質。
本研究在發展以個人數位助理為基礎之雛形系統，將醫師巡房時所需要之病歷資料，透過無線網路的方式傳送到個人數位助理之嵌入式資料庫中，醫師可以直接由個人數位助理的嵌入式資料庫瀏覽所需的相關病歷資料，同時亦可直接在個人數位助理上新增及修改資料，再經由無線網路與醫院資料庫做同步的動作，以維持資料庫之資料一致性。
本系統以Client/Server方式建構，Client端以Microsoft eMbedded Visual C++ 3.0開發應用程式，並採用Sybase SQL Anywhere Studio 6.0.3之UltraLite行動資料庫﹔Server端則包含以Sybase Adaptive Server Anywhere建構之醫院資訊系統資料庫，以及進行同步控制的Sybase MobiLink Server。本系統的主要功能包含：病患資料檢視、病患資料新增及修改、資料同步等。
個人數位助理配合無線網路所架構之應用於醫師查房雛形系統，可協助醫師進行查房工作時的資料攜帶，不但能減少醫師查房的人力需求，為醫師查房所需的資料提供高度可攜性的解決方案，並且節省資料存取所需時間，可以掌握醫療時效，以提供高品質、高效率的醫療照護。

According to the development of network technology, the daily works, such as data processing and medical record storage, in the hospital are transition to a digital style. Medicine is complex, especially for inpatient. The physicians need a lot of data of patients to make diagnosis, such as prescriptions, testing data, pathology data, and nursing charts, to help them make diagnosis. It’s necessary to combine all information of patients to make accurate diagnoses. But inpatients’ medical records are more and more; need a lot of efforts to collation and management. Due to these reasons, we propose a personal digital assistant prototype for clinical ward rounds in this thesis in order to save medical manpower, reduce artificial errors, and improve the quality of medical care.
The development of the prototype is base on PDA. Though the wireless network, data can be transmit to an embedded database on a PDA. Physicians can insert and update data on PDAs directly and synchronize with database server through wireless network again to maintain data consistency.
The system was implemented as a client/server framework. The client side adopted Microsoft eMbedded Visual C++ 3.0 as development tool and Sybase UltraLite database as embedded database. The mainly functions are viewing data, insert a new row of data, and update data.
This prototype combines PDA and wireless network. Not only reduce the manpower of clinical ward rounds but also provide mobility solution of data that are used in clinical ward rounds. It accelerates medical treatment efficiently and promotes a high quality medical care in hospital.

中文摘要 ------------------------------------------------------------------------ i
英文摘要（Abstract） -------------------------------------------------------iii
目錄 ------------------------------------------------------------------------------v
圖表目錄 ------------------------------------------------------------------------vii
縮寫對照表 ---------------------------------------------------------------------ix
第一章緒論 ------------------------------------------------------------------- 1
第一節研究動機 ---------------------------------------------------------- 1
第二節研究目的 ---------------------------------------------------------- 4
第三節論文架構 ---------------------------------------------------------- 5
第二章文獻探討 ------------------------------------------------------------- 6
第一節電子病歷 ---------------------------------------------------------- 6
第二節資料庫 ------------------------------------------------------------- 8
第三節個人數位助理 ---------------------------------------------------10
第四節無線網路 ---------------------------------------------------------14
第三章系統設計 ------------------------------------------------------------17
第一節研究範圍 ---------------------------------------------------------17
第二節系統架構 ---------------------------------------------------------17
第三節系統設計 ---------------------------------------------------------31
第四章系統實作與展示 ---------------------------------------------------38
第一節系統實作流程 ---------------------------------------------------38
第二節系統實作結果 ---------------------------------------------------40
第五章　討論與結論 ---------------------------------------------------------45
第一節　即時連線與非即時同步 ---------------------------------------45
第二節系統限制 ---------------------------------------------------------47
第三節結論 ---------------------------------------------------------------48
第四節未來研究建議 ---------------------------------------------------49
參考文獻 ------------------------------------------------------------------------51
附錄一　HIS資料庫表格配置 ---------------------------------------------55
附錄二　Reference資料庫表格配置 -------------------------------------60
附錄三　預儲程序 ------------------------------------------------------------63
附錄四　Synchronization Scripts -----------------------------------------66
附錄五　Embedded SQL原始碼 -----------------------------------------74
附錄六　應用程式原始碼 ---------------------------------------------------96
圖表目錄
表2-1　PDA在美國各醫院之發展應用 ---------------------------------12
表2-2　無線網路連接方式比較表 ----------------------------------------16
圖3-1　系統架構圖 ----------------------------------------------------------17
圖3-2　MobiLink Server同步示意圖 ------------------------------------22
圖3-3　系統設計圖 ----------------------------------------------------------31
圖3-4　HIS資料庫架構圖 --------------------------------------------------33
圖3-5　Reference資料庫架構圖 -----------------------------------------35
圖4-1　系統開發流程示意圖 ----------------------------------------------39
圖4-2　啟動MobiLink Server 準備提供同步服務 --------------------40
圖4-3　醫師查房隨身系統登入畫面 -------------------------------------41
圖4-4　MobiLink Server紀錄同步軌跡 ---------------------------------41
圖4-5　病患資料清單 -------------------------------------------------------42
圖4-6　病患基本資料內容 -------------------------------------------------42
圖4-7　病患醫令資料清單 -------------------------------------------------43
圖4-8　病患醫令資料內容 -------------------------------------------------43
圖4-9　病患藥囑資料清單 -------------------------------------------------43
圖4-10　病患詳細藥囑資料內 --------------------------------------------43
圖4-11　病患檢驗報告資料清單 ------------------------------------------44
圖4-12　病患檢驗報告資料內容 -----------------------------------------44
圖4-13　新增醫令資料 -----------------------------------------------------44
圖4-14　病患藥囑資料 -----------------------------------------------------44

[ 1 ] Mary Carmen Cupito : Wireless LAN : Emerging to maturing technology. Health Mangement Technology, 1998 Mar; 19(3); p.15
[ 2 ] J Reponen, E Ilkko, L Jyrkinen, O Tervonen, J Niinimäki, V Karhula and A Koivula : Initial experience with a wireless personal digital assistant as a teleradiology terminal for reporting emergency computerized tomography scans. Jounal of Telemedicine and Telecare, 2000; 6; p.45-49
[ 3 ] Roth AC., Leon MA., Milner SM., Herting RL Jr., and Hahn AW : A personal digital assistant for determination of fluid needs for burn patients. Biomedical Sciences Instrumentation, 1997; 34; p.186-190
[ 4 ] Sotiris Pavlopoulos, Efthyvoulos Kyriacou, Alexis Berler, Spyros Dembeyiotis, and Dimitris Koutsouris : A Novel Emergency Telemedicine System Based on Wireless Communication Technology─AMBULANCE. IEEE Transactions on information technology in biomedicine, 1998 Dec; 4(2); p.261-267
[ 5 ] Hripcsak G., Knirsch CA., Jain NL., Stazesky RCJr., Pablos-Mendez A., and Fulmer T. : A health information network for managing innercity tuberculosis: bridging clinical care, public health, and home care. Computers & Biomedical Research, 1999 Feb; 32(1); p.67-76
[ 6 ] Finkelstein J., Hriocsak G. and Cabrera M. : Telematic system for monitoring of asthma severity in patients’ homes. Medinfo 1998; 9 pt 1; p.272-276
[ 7 ] 李作英、王如華、徐姍姍、陳麗芳、張雪吟：護理資訊化──個人數位處理器（PDA）在臨床護理之應用。護理雜誌，1998.2，69-76頁。
[ 8 ] 畢莉莉：PDA暨行動電話應用於緊急救護資料管理技術可行性探討。 陽明大學碩士論文，2000。
[ 9 ] Huibert J. Tang, Arie Hasman, Pieter F. de Vries Robbé, Harry C. Schouten : Medical narratives in electronic medical records. Yearbook of Medical Informatics, 1998, p.230-252
[10] 游其易：實用資料庫管理系統指引。松崗電腦圖書資料股份有限公司，1998.11。
[11] Michael A. Olson : Selecting and implementing an embedded database system. Comuter; 2000 Sep; p.27-34
[12] Yongning Zou and Zhenyu Guo : A palm pilot based pocket ECG recorder. Proc. IEEE Symp.; 2000; p.110-112
[13] Cornelia M. Ruland : Clinicians’ use of a palm-top base system to elicit patient preferences at the bedside: a feasible technique to improve patient outcomes. Proc. Amia Symp.; 2000; p.739-743
[14] Jon Blackman, Paul Gorman, Richard Lohensohn, Dale Kraemer, Scott Svingen : The Usefulness of handheld computers in a surgical group practice. Proc. Amia Symp.; 1999; p.686-690
[15] G Arnone, A Bianchi, B Della Pietra, R Sernicola, E Sparacino and R Vitolo : Easy Medic: an Internet appliction for the general practitioner. Jounal of Telemedicine and Telecare, 1998; 4; p.93-94
[16] Elske Ammenwerth, Anke Buchauer, Bernd Bludau, Reinhold Haux : Mobile information and communication tools in the hospital. International Journal of Medical Informatics, 2000; 57; p.21-40
[17] Laura K. Heermann, Thomas D. East, Richard L. Bradshaw, and Alejandra M. Lugo : Prototype system for handheld, problem oriented, interdisciplinary charting in the emergency department. Proc. Amia Symp.; 1999; p.1077
[18] Glenn M Parker : Easing workflow in the palm of physician’s hands. Health Mangement Technology, 1999 Oct; 20(10); p.48-19
[19] M. Micheal Shabot and Jeannie Chen : Wireless clinical alerts for physiologic, laboratory and medication data. Proc. Amia Symp.; 2000; p.789-793
[20] Raymond G. Duncan, and M. Micheal Shabot : Secure remote access to a clinical data repository using a wireless personal digital assistant (PDA). Proc. Amia Symp.; 2000; p.210-214
[21] Kevin Hung and Y. T. Zhang : On the feasibility of the usge of WAP devices in telemedicine. Proc. IEEE Symp.; 2000; p.28-31
[22] Lawrence A. Dworkin, Michael Krall, Homer Chin, Nan Robertson, Juline Harris, Jonathon Hughes : Experience using radio frequency laptops to access the electronic medical record in exam rooms. Proc. Amia Symp.; 1999; p.741-744
[23] Andrew Gettinger, Joshua Lee, Debra Dulc, Edward Turpin and Peter Johnson : WorkFlow improvements from use of wireless technology: the Dartmouth- Hitchcock Experience. Proc. Amia Symp.; 2000; p.1017
[24] Kok-Swang Tan, Irwin Hinberg : Effects of a wireless local area network (LAN) system , and electrosurgical devices on medical devices in a hospital environment. Biomedical Instrumentation & Technology, 2000 Mar-Apr; 34(2); p.115-118
[25] Sybase官方網站，http://www.Sybase.com。
[26] Oracle官方網站，http://www.oracle.com。
[27] IBM官方網站，http://www.ibm.com。
[28] Microsoft官方網站，http://www.microsoft.com。
[29] 英國電機工程師協會網站，http://www.iee.org.uk。
[30] Psion官方網站，http://www.psion.com。
[31] Penbex官方網站，http://www.penbex.com.tw。
[32] 楊先民：實戰Pocket PC程式設計。學冠行銷股份有限公司，2001.3。
[33] 英瑞得官方網站，http://www.gismosoft.com。
[34] Eija Kaasimen, Matti Aaltonen, Juha Kolari, Suvi Melakoski, Timo Laakko : Two approaches to bringing Internet services to WAP devices. Computer Networks; 2000; 33;p.231-246
[35] Eric Giguère : Palm™ database programming: the complete developer’s guide. Wiley Computer Publishing; 1999
[36] Charles Petzold原著，余孟學編譯：Windows®程式開發設計指南。華彩軟體股份有限公司，2000.6。
[37] Douglas Boling : Programming Microsoft® Windows® CE. Microsoft® Press.; 1998.
[38] Terence A. Goggin原著，韓丹譯：Windows CE開發寶典。 儒林圖書有限公司﹔2000.1