臺灣博碩士論文加值系統

急診室的主要功能在於搶救生命及提供緊急救護，急診病患和醫護人員之間的關係通常出於偶然，醫護人員面對病史不明、病情不可預測的急診患者，有必要針對病患身體系統再進行完整檢查，由於急診病患的病因多樣化以及病情的緩急不一，所進行之醫療作業流程也各不相同，形成急診作業流程上的複雜。
從病患進入急診室，經掛號、檢傷分類、醫師診療、檢驗或檢查、觀察、批價、領藥、離院、或需要進行手術、辦理住院等，這一系列的急診醫療作業流程，都必須緊密且有效率的結合在一起運作。而這一連串的醫療資訊相關功能分散在多個不同的系統中，要完成一組完整的醫療資訊服務工作，需要整合多個分散的功能。
IHE 根據醫院作業流程並結合國際通用的醫療資訊標準訂定出流程規範，透過標準整合院內各項資訊系統可達到資料存取方便、減少錯誤率等優點，由於流程和資料格式的標準化，更可加速跨院間整合以及資料共享。
本研究主要目的在於藉由 IHE 技術架構中所定義之規範，依照急診流程所對應的作業機制設計急診資訊系統，透過病歷文件跨部門的正確、即時交換，協助醫護人員掌握完整的病患資訊及醫囑執行狀況，以減少錯誤發生及提升效率，縮短病患等候時間，讓急診流程更臻於完美。

The main functions of an emergency ward were to rescue live and provide emergency treatment. The relationship between emergency patients and doctors usually occurred fortuitously. Medical staffs had to do a complete inspection to patient’s body system because they were not acquainted with the patient’s history and condition. However, due to the variety of pathogen and urgency, the medical procedures were different, which result in the complexity of emergency medical treatment procedure.
Since the patient went into the emergency ward, there was a series procedure from did a register, assigned a triage category, got a medical treatment, checking and inspection, be observed, paid the medical fare, receive medicine, to leave hospital or had to conduct a operation and hospitalization. This series of emergency medical procedure had to work together closely and effectively. This series function about the medical information was in different systems. It had to integrate several functions which were in different systems in order to complete a set of medical information service work.
IHE developed stander operation procedure, which was made on the basis of the hospital operation procedure and the standard of international general medical information. By integrating the standards of every information system, there would be some advantages such as easy to access the information and prevent mistakes. In addition, because of the standardization of the procedure and information format, it could accelerate the integration between hospitals and information sharing.
The main purpose of this research is to design Emergency Information System according to the operation method of the emergency medical treatment procedure by the standard of IHE technical framework. Via the correctness and real time information exchanging of the clinical record document across departments, the medical staffs could handle the entire information about the patient information and the accomplishment of doctor’s advice, and could have reduction of medical errors, increase the effectiveness, cut down the waiting time of patient and make a perfect emergency medical treatment procedure.

目錄
長庚大學碩士學位論文指導教授推薦書 I
長庚大學碩士學位論文口試委員會審定書 II
長庚大學碩士論文著作授權書 III
誌謝 IV
摘要 V
ABSTRACT VI
圖目錄 X
表目錄 XII
第一章 序論 1
1.1 研究背景 1
1.2 研究動機與目的 2
1.3 研究步驟 4
第二章 文獻探討 5
2.1 急診作業流程 5
2.2 企業醫療整合（INTEGRATING THE HEALTHCARE ENTERPRISE, IHE） 8
2.2.1 IHE 發展背景與現況 8
2.2.2 IHE 技術架構 9
2.2.3 IHE 流程整合規範 12
2.2.4 IHE 病患資料查詢整合規範 15
2.3 國內醫療資訊系統整合現況 16
2.4 文獻小結 19
第三章 研究方法 20
3.1 物件導向方法 20
3.2 UNIFIED MODELING LANGUAGE（UML） 22
3.3.1 UML 的五個觀點 23
3.3.2 UML 模式圖 25
3.3 WEB SERVICES 26
3.3.1 SOAP（Simple Object Access Protocol） 28
3.3.2 WSDL（Web Services Description Language） 29
3.3.3 UDDI（Universal Description Discovery and Integration） 30
3.4 開發工具 31
第四章 系統設計與實作 32
4.1 系統塑模與分析 32
4.1.1系統功能塑模 32
4.1.2 系統流程塑模 35
4.1.3 物件互動行為塑模 36
4.1.4 物件資料結構塑模 39
4.1.5 Web Services 運作模式分析 41
4.2 系統建置 45
4.3 情境方案 51
第五章 結論與未來研究方向 62
5.1 研究貢獻 62
5.2 未來研究方向 62
參考文獻 64


圖目錄
圖1.3-1 研究步驟 4
圖2.1-1 急診部門作業流程分析 5
圖2.2-1 IHE 技術架構[20] 10
圖2.2-2 IHE 技術架構範圍及整合規範數 11
圖2.2-3 IHE 整合規範之相互關係[49] 11
圖2.2-4 IHE 檢驗流程整合規範[19] 14
圖2.2-5 IHE 流程整合規範（ORDER PLACER、ORDER FILLER） 14
圖2.2-6 QUERY FOR EXISTING DATA PROFILE INTEGRATION PROFILE 16
圖2.3-1 現行國內醫院 HIS 與 PACS 系統整合方式[49] 18
圖3.2-1 UML 4 + 1 觀點 24
圖3.3-1 WEB SERVICES 運作方式[36] 27
圖3.3-2 SOAP 訊息格式 29
圖3.3-3 WSDL 文件架構 29
圖4.1-1 急診資訊系統之使用案例圖 33
圖4.1-2 急診資訊系統之活動圖 35
圖4.1-3 病患急診進行檢驗循序圖 38
圖4.1-4 病患離院循序圖 39
圖4.1-5 急診資訊系統類別圖 40
圖4.1-6 病患檢傷 WEB SERVICES 示意圖 41
圖4.1-7 病患掛號 WEB SERVICES 示意圖 42
圖4.1-8 新增病患追蹤 WEB SERVICES 示意圖 42
圖4.1-9 查詢病患生命徵象 WEB SERVICES 示意圖 42
圖4.1-10 新增檢驗醫囑 WEB SERVICES 示意圖 43
圖4.1-11 更新病患追蹤 WEB SERVICES 示意圖 43
圖4.1-12 傳送病患檢驗結果 WEB SERVICES 示意圖 43
圖4.1-13 病患離院 WEB SERVICES 示意圖 44
圖4.1-14 結束病患追蹤 WEB SERVICES 示意圖 44
圖4.1-15 系統 WEB SERVICES 運作模式 45
圖4.2-1 VITALSSIGNSDATAREPOSITORY WEB SERVICES 46
圖4.2-2 ADTPATIENTREGISTRATION WEB SERVICES 47
圖4.2-3 ORDERPLACER WEB SERVICES 48
圖4.2-4 ORDERRESULTTRACKER WEB SERVICES 49
圖4.2-5 ORDERFILLER WEB SERVICES 50
圖4.3-1 病患檢傷執行過程 52
圖4.3-2 病患掛號執行過程 53
圖4.3-4 INVOKE CARERECORDPROFILEQUERY 54
圖4.3-5 急診醫師看診並開立檢驗醫囑 56
圖4.3-6 急診病患追蹤畫面 57
圖4.3-7 檢驗部門回傳病患檢驗結果 58
圖4.3-8 病患追蹤 - 檢驗結果檢視 59
圖4.3-9 病患離院系統執行過程 60
圖4.3-10 病患追蹤畫面 61

表目錄
表2.2-1 IHE 流程整合規範 13
表3.2-1 常用 UML 模式圖及用途說明 25
表3.3-1 WSDL 元素說明 30
表3.4-1 開發工具 31
表4.1-1 使用案例簡述 34
表4.1-2 使用案例參與者實際角色 34
表4.2-1 系統 WEB SERVICES 所提供之服務 50

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