現今的醫療環境中，醫療文件已經漸漸走向數位化，相關醫療儀器也逐步採用自動化作業。縱使如此，有部分的醫療作業仍使用紙本作業。以醫學檢驗為例，當院內沒有相關儀器可提供病患作檢查時，醫生就需要向委外的檢驗中心申請提出檢驗需求，但委外檢驗的資訊作業程序中許多步驟都需以書陎方式進行，但手寫開單耗費較多的時間，另外也可能發生資料填寫錯誤、紙張遺失等風險，在執行上造成許多不便。本論文希望可以透過Web相關技術，提供檢驗委外標準之資訊整合架構，來進行線上醫學檢驗開單、結果報告回傳、檢查狀態查詢等作業。將分析委外檢驗資訊傳輸的需求，並參照IHE所提供之跨院病歷文件分享架構(Cross Enterprise Document Sharing; XDS)以病歷索引中心搭配病歷文件庫結合，進一步探討委外檢驗之資訊流程與傳輸協定。調閱報告再以HL7提出的臨床文件架構(Clinical Document Architecture; CDA)方式呈現，檢查開單及狀態資訊是以 HL7 V2現有訊息封包於CDA的文件當中，形成醫院處方報告文件以及檢驗所狀態回應文件，便於我們利用相同的XDS文件註冊與查詢機制達到資訊跨機構的互通。利用Web方式檢視報告結果，相信可以節省相當多的人力與時間，相較之下也可以解決醫院對於醫學檢驗委外的不方便。

Because of cost and efficiency, lots of hospitals outsource their laboratory examinations currently. But there has no standards information sharing infrastructure for the outsourcing processes. This paper addresses a web solution for exchanging clinical data, such as prescribed examination orders, examination results, and the processing status of the orders, in the outsourcing processes,. The wed solution for information exchange in outsourcing processes is basing on IHE Cross Enterprise Document Sharing (XDS). XDS registry and repositories with corresponding standard web services would be used for sharing laboratory orders and results. And we would use HL7 Clinical Document Architecture (CDA) to deal with examination results. We would use standard HL7 messages to handle exam orders and processing status. However, the messages of exam orders generated by hospitals and messages for processing status in external laboratory would be further packaged as CDA documents also. Consequently, we can utilize the same XDS document registry and sharing infrastructure for handling both orders, processing status, and exam results. The infrastructure for outsourcing of laboratory examinations is a web solution with standard HL7 messages and documents. Using the web solution and information system integration architecture can save much manpower and time than that would be required with traditional outsourcing processes.

致謝 ........................................................................................................................................ III
摘要 ........................................................................................................................................... I
Abstract .................................................................................................................................... II
第一章、緒論 ........................................................................................................................... 1
1.1 研究背景 ........................................................................................................................ 1
1.2 研究目的 ........................................................................................................................ 5
第二章、文獻探討 ................................................................................................................... 6
2.1 檢驗資訊管理系統 ........................................................................................................ 6
2.1.1 檢驗部門電腦化與自動化 ..................................................................................... 7
2.1.2 LIS追求的目標 ....................................................................................................... 7
2.2 醫療資源系統整合主要的標準 .................................................................................... 8
2.2.1 IHE的簡介 .............................................................................................................. 9
2.2.2 IHE XDS的介紹 ..................................................................................................... 9
2.2.3 IHE LTW介紹 ....................................................................................................... 11
2.2.4 醫療資源交換標準HL7 ....................................................................................... 13
2.2.5 IHE 提出的委外檢驗流程 ................................................................................... 16
第三章、研究方法、步驟和程序 ......................................................................................... 22
3.1 系統架構 ...................................................................................................................... 24
3.1.1 架構流程圖簡易說明 ........................................................................................... 25
3.1.2 醫師利用HIS開立處方 ....................................................................................... 27
3.1.3 HIS通知檢體中心取得檢體 ................................................................................. 27
3.1.4 利用Register Server建置處方文件 .................................................................... 28
3.1.5 檢驗所透過Register Server查詢處方文件 ........................................................ 29
3.1.6 檢驗所作業方式 ................................................................................................... 30
3.1.7 透過Register Server調閱檢驗報告 .................................................................... 30
3.1.8 報告查詢流程說明 ............................................................................................... 31
3.1.9 醫師報告查詢 ....................................................................................................... 32
3.1.10 病患報告查詢 ..................................................................................................... 33
3.2 安全防護機制 .............................................................................................................. 33
3.2.1 加密傳輸 ............................................................................................................... 34
3.2.2 權限控管 ............................................................................................................... 35
3.3 處方檢驗單格式標準化 .............................................................................................. 38
3.4 檢驗報告格式 .............................................................................................................. 41
3.5 XDS Metadata ............................................................................................................... 47
第四章、研究成果 ................................................................................................................. 49
4.1 權限管控 ...................................................................................................................... 49
4.2 開立處方與查詢 .......................................................................................................... 54
4.3 報告調閱 ...................................................................................................................... 58
4.4 結果說明 ...................................................................................................................... 63
第五章、討論 ......................................................................................................................... 66
5.1 院內檢驗系統標準化之要求 ...................................................................................... 66
5.2 跨院交換之資訊安全 .................................................................................................. 70
第六章、結論與未來展望 ..................................................................................................... 73
6.1 未來展望 ...................................................................................................................... 74
6.1.1 透過一套系統完成所有程序 ............................................................................... 74
6.1.2 委外檢驗單標準的制定 ....................................................................................... 74
6.1.3 資訊安全管控 ....................................................................................................... 75
6.1.4 索引中心的管理 ................................................................................................... 75
6.1.5 系統普及化 ........................................................................................................... 75
參考文獻 ................................................................................................................................ 77

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