國內衛生福利部大規模推動乳癌篩檢，並推行乳房攝影篩檢巡迴車幫民眾服務，民眾除了在乳房篩檢巡迴車檢查外，還會到固定的醫院做更精確的檢查，因此轉介檢查服務的需求即增加，民眾就會需要一個平台來整合這些醫療流程所產生的病歷報告。本研究以台灣某兩家醫院的乳房健檢合作為例，設計資訊互通介面使PHR能夠透過此資訊互通介面調閱分散在不同地方的病歷。為滿足上述需求，本研究依據醫學資訊標準制定標準XML模板設計讓本研究之資訊互通介面能與EMR及PHR結合，並運用IHE(Integrating the Healthcare Enterprise) XDS (Cross-
Enterprise Document Sharing )讓 EMR 與 PHR 有標準的病歷傳輸機制，使資訊互通介面扮演來源端和用戶端角色，將病歷報告轉為HL7 (Health Level Seven) CDA(Clinical Document Architecture)使兩家醫院有醫學資訊標準格式的病歷報告，也方便將轉診單內的重要資訊轉給進階檢查醫院之健檢報告系統，並讓醫生與病人能透過此資訊互通介面檢索到病人的病歷報告，以及結合IHE PDQ(Patient Demographic Query)讓 EMR與 PHR也有個人資訊互通傳輸機制，使PHR的個人基本資料與病史可傳至EMR。透過本研究之資訊互通介面讓醫生及病人在自己使用的系統端可看到分散在不同地方的病歷報告，使醫生可更精確判斷病人的病情，減少重複做相同檢查的機會和重複填寫個人資料，且病人透過自己的健康記錄並結合自身的病歷報告，更有效的長期追蹤健康狀況。

Ministry of Health and Welfare promotes the breast cancer screening and provides the mammography screening touring car service to people. In addition to breast screening, patients will go to hospital to take more precise examination, therefore referral services demand increase. The patients will need a platform to integrate medical report produced by different hospitals for medical processes. In this study, we take two hospitals' breast checkup collaboration for example. The information exchange interface between EMR and PHR is designed to develop a standard XML template based on medical information standards. It helps EMR and PHR data transfer through the interface. The interface transforms the medical records into HL7 CDA and makes the medical records report in medical information standard format. The important information of the referral can transfer conveniently to the checkup report system of the referred hospital. Furthermore, the standard connection of EMR and PHR will play to be document source and consumer by IHE XDS, integrate IHE PDQ for communicating among the general information of patient. Aims to search patient reports between different systems that make the physicians diagnose disease more exactly, patients can track their own records and care themselves health easily.

致謝 I
摘要 II
ABSTRACT III
目錄 IV
圖目錄 VI
表目錄 VIII
第一章 前言 1
1. EMR 與 PHR 資訊互通需求 1
2. 病歷互通所需標準 1
3. 文獻探討 2
4. 動機與目的 4
第二章 研究方法 5
1. EMR與PHR資訊互通介面設計之功能 5
2. 情境模擬 6
3. 開發工具 7
4. 個人基本資料更新 8
5. 病歷報告標準轉換 22
6. 病歷文件分享 26
第三章 研究成果與評估 39
1. EMR與PHR資訊互通介面 39
1.1 資訊互通病人基本資料之更新功能 39
1.2 資訊互通介面扮演Document Source與Consumer角色-上傳病歷與調閱病歷 43
2. 評估本研究之資訊互通介面之傳輸機制 48
2.1EMR及PHR與資訊互通介面介接設計之標準XML模板測試 48
2.2資訊互通介面的個人基本資料更新之傳輸機制驗證 53
2.3資訊互通介面的病歷報告標準轉換功能之驗證 57
2.4資訊互通介面的病歷文件分享之傳輸機制驗證 59
2.5其他廠商之Consumer互通介面調閱本研究架設之Registry與Repository內容之測試 62
第四章 討論與結論 64
1. 討論 64
2. 結論與未來展望 65
參考文獻 67
附錄A：IHE XDS角色說明 69
附錄B：病人文件分享同意書 70
附錄C：轉診單 71
附錄D：乳房健檢報告 72
附錄E：NIST提供PDQ測試之病人基本資料 73
附錄F：轉診單之HL7 CDA 74
附錄G：乳房健檢報告之HL7 CDA 82

[1] D. Garets and M. Davis, "Electronic Medical Records vs. Electronic Health
Records: Yes, There Is a Difference " in HIMSS, 2006.
[2] F. J. Burrington-Brown J, Fox L, Friedman B, Giannangelo K, Jacobs E, Lang
D, Lemery C, Malchetske B, Morgan J, Murphy K, Okamoto C, Peterson
R,Robin D, Smith C, Sweet D, Thomas M, Wolter J, Zallar B, "Defining the
personal health record. AHIMA releases definition, attributes of consumer
health record.," AHIMA, vol. 76, pp. 24-25, 2005.
[3] G. J. Kuperman, "Health-information exchange: why are we doing it, and
what are we doing?," J Am Med Inform Assoc, vol. 18, pp. 678-682, 2011.
[4] 衛生福利部資訊處. (January 20). 行政院衛生署電子病歷推動專區.
Available: http://emr.mohw.gov.tw/news.aspx
[5] A. Sunyaev, D. Chornyi, C. Mauro, and H. Krcmar, "Evaluation framework
for personal health records: Microsoft Healthvault vs. Google Health,"
presented at the 43rd Hawaii International Conference, 2010.
[6] 台大遠距照護中心. (January 20). Available:
http://www.ntuh.gov.tw/telehealth/default.aspx
[7] A. Arbor and Michigan, "Health Level Seven Version 2.5 Application
Protocol for Electronic Data Exchange in Healthcare Environments
Becomes an International Standard " Health Level Seven, Inc., September
21 2009.
[8] D. Rajeev, C. J. Staes, R. S. Evans, S. Mottice, R. Rolfs, M. H. Samore, et al.,
"Development of an electronic public health case report using HL7 v2.5 to
meet public health needs," J Am Med Inform Assoc, vol. 17, pp. 34-41, 2010.
[9] R. H. Dolin, L. Alschuler, C. Beebe, P. V. Biron, S. L. Boyer, D. Essin, et al.,
"The HL7 Clinical Document Architecture," J Am Med Inform Assoc, vol. 8,
pp. 552-569, 2001.
[10] I. IHE International. (2013, 20 January). IHE IT Infrastructure Technical
Framework, Volume 2b (ITI TF-2b): Transactions Part B. Available:
http://www.ihe.net/Technical_Framework/upload/IHE_ITI_TF_Vol2b.pdf
[11] I. IHE International. (2013, 20 January). IHE IT Infrastructure Technical
Framework, Volume 2a (ITI TF-2a): Transactions Part A. Available:
http://www.ihe.net/uploadedFiles/Documents/ITI/IHE_ITI_TF_Vol2a.pdf
[12] A. O. Orlova, M. Dunnagan, T. Finitzo, M. Higgins, T. Watkins, A. Tien, et al.,
"An Electronic Health Record - Public Health (EHR-PH) System Prototype
for Interoperability in 21st Century Healthcare Systems," in AMIA Annu
Symp Proc., 2005, pp. 575-579. [13] X.-W. Huang and D.-M. Liou, "Implementation of an Electronic Emergency
Referral Document System," presented at the 2nd International
Conference on Education Technology and Computer (ICETC), 2010.
[14] "建構以病人為中心之電子病歷跨院資訊交換環境案期末成果報告," 台灣
醫學資訊學會 2008.
[15] O. Heinze*†, M. Birkle†, L. Köster, and B. Bergh, "Architecture of a consent
management suit and integration into IHE-based regional health
information networks," BMC Medical Informatics and Decision Making, vol.
11, 2011.
[16] A. H. Association. (1992, January 27). Management Advisory: A Patient's
Bill of Rights. Available:
http://www.healthsourceglobal.com/docs/Patient%20Bill%20of%20Rig
hts_merged.pdf
[17] C. Balleyguie, S. Ayadi, K. V. Nguyen, D. Vanel, C. Dromain, and R. Sigal,
"BIRADS™ classification in mammography," European Journal of Radiology,
vol. 61, pp. 192-194, 2007.
[18] B. J. Moore, S. Gaehde, and C. Curtis, "Architectural Choices and Challenges
of Integrating Electronic Patient Questionnaires into the Electronic
Medical Record to Support Patient-Centered Care," in AMIA Annu Symp
Proc., 2008, pp. 490–494.