臺灣博碩士論文加值系統

檢驗資料的處理一直是醫院中極為重要的部分之一。在現行的架構下，各醫院為了健保申報，均各自訂定了本身院內使用的院內碼和健保碼的對應項目表。然而，各醫院在進行檢驗時多採用本身制訂之院內碼系統來進行檢驗。這種方式在實施上雖然沒有不妥當之處，但是當資料需要進行交換的時候，各醫院間不同的編碼標準除了造成資料溝通的困難外，也使各醫院的臨床診斷和檢驗結果的比對產生極大的困難，這對整體來說是一個浪費許多人力物力的情況。

由於建構新的系統需要花費大量的人力和物力，因此能夠直接將現有使用的檢驗碼轉換為LOINC碼作為標準，將是較佳的選擇。本研究的目的，並不在於建構一個可以取代國外目前現行的RELMA的系統，而是在建構一個適合國內醫療院所和檢驗中心使用的查詢平台，使各醫療院所能夠在自己較熟悉的環境中進行檢驗碼轉換的工作。對國內各醫院來說，最為熟悉的就是健保碼和院內碼。因此，架構一個可以利用健保碼和院內碼檢驗名稱查詢到相關LOINC碼的檢驗名詞系統，是本研究最主要的工作。

本系統透過Taiwan-LOINC知識庫，建構一個Web-based的線上輔助查詢系統，提供使用者單筆健保碼、健保碼分類和利用檢驗名詞來進行查詢。利用收集到的檢驗名詞Term加以重整後建立的Keyword-LOINC對應資料，讓檢驗人員能夠以自身所掌握的知識來進行查詢，進而找到正確的LOINC碼，完成院內碼對應的工作。當各醫院的院內碼-LOINC碼對照表都建立的時候，即可讓各院能夠透過檢驗代碼的交換，使不同的檢驗系統能彼此溝通、交換和分析的目的，進而使健保能夠達成節省成本的目的。

Handling to the medical examination data is an important issue in the hospital. Under current administrative structure, each hospital has its own local codes to perform the examinations and management the laboratory data. These codes may suit for internal use, but may cause the great difficulties in data communication, clinical diagnosis, and comparison of the examination data between hospitals. Thus this system caused a serious waste, in global situation.

To construct a new communication system for exchange the laboratory data between hospitals will cost large amount resources. An alternative choice is setting the logical observation identifier names and codes (LOINC) as standard, and directly converting the local code to LOINC. The main purpose of this study is to construct an information inquiry platform which is suitable for domestic hospital and examination center to communicate with each other using their familiar internal-used code, but not to construct a new system to replace the Regenstrief LOINC Mapping Assistant (RELMA) system which is widely-used in foreign area. The most familiar coding systems for the domestic hospital are their local code and national health insurance (NHI) standard code. Each hospital already established corresponding sheet between local examination code and the NHI standard code to declare the NHI payment. Thus, the main work in this study is concentrating to construct a platform which can directly inquire the LOINC information using local laboratory name or NHI laboratory name.

This system will construct a web-based mapping assist system. Using Taiwan-LOINC knowledgebase, user can inquire the information with single NHI standard code, category of the NHI standard codes, and examination term. After arrange the collected examination term, a keyword-LOINC database has been build up. The user can also inquire the LOINC code by these keywords which are not standard keywords in LONIC but are familiar to the laboratory technician. When the corresponding sheet between local codes and LOINC code has been established in each hospital, the different coding system in different hospital can be easily communicated, and data can also be easily exchanged and analyzed. Thus, the cost of NHI can be reduced.

誌 謝 ii
目錄 iii
表目錄 v
圖目錄 vi
論文摘要 vii
Abstract ix
第一章 緒論 1
1.1前言 1
1.2 研究動機 2
1.3 研究目的 4
第二章 文獻查證 7
2.1 Web-based分享式平台 7
2.2 Logical Observation Identifiers Names and Codes（LOINC） 7
2.3 健保碼 12
2.3.1 單一檢驗項目 12
2.3.2 組套式檢驗項目介紹 13
2.4 Taiwan LOINC Knowledge Base 17
2.5 Relam 18
2.6 全文檢索 19
第三章 研究材料與方法 21
3.1 系统架構 21
3.2 LOINC資料庫 23
3.2.1 LOINC資料庫的建立 24
3.3 NHI健保碼資料庫 25
3.3.1 NHI健保碼資料庫的建立 25
3.4 NHI-LOINC對應資料庫 27
3.4.1 NHI-LOINC對應資料庫的建立 27
3.5 NHI-LOINC Mapping Assistant 健保碼查詢系統架構 28
3.5.1單筆健保碼搜尋 29
3.5.2 健保碼群組搜尋 31
3.5.3 全部健保碼查詢 35
3.6 Term和Keyword 35
第四章 檢驗名詞查詢系統 38
4.1檢驗名詞查詢系統資料庫 38
4.1.1驗慣用名稱資料庫 39
4.1.2 檢驗名詞(Keyword)資料庫 40
4.2 檢驗名詞(Keyword)重整 42
4.3.1 LOINC資料庫檢驗名稱(Term)重整 42
4.2.2 NHI健保碼資料庫英文檢驗名稱(Term)重整 46
4.2.3 各院檢驗名稱和檢驗慣用名稱重整 49
4.3 檢驗名詞查詢 53
4.3.1 檢驗名詞英文查詢 53
4.3.1.1 檢驗名詞英文查詢欄位 54
4.3.1.2 檢驗單位(Property)欄位查詢 58
4.3.1.3 採檢時間(Time Aspect)查詢欄位 63
4.3.1.4 檢體（System）查詢欄位 66
4.3.1.5 綜合查詢 70
4.3.2 檢驗名稱中文查詢欄位 72
4.4 更新資料庫 74
4.4.1 LOINC資料庫更新 75
4.4.2 NHI健保碼資料庫更新 77
4.4.3 NHI-LOINC對應資料庫更新 79
4.4.4 檢驗慣用名稱資料庫更新 81
第五章 討論 84
5.1 研究發現和探討 84
5.2 RELAM和本系統的比較 85
5.3 系統Keyword的建立問題和探討 86
第六章結論與建議 88
6.1 結論 88
6.2 展望 89
參考文獻 90
附錄一：LOINC Data Base Structure 94

專書

[1]林秀貞等，《醫療資訊管理學》，台北：華杏出版社，民90，頁393-397。
[2]中央健康保險局編，《全民健康保險醫療費用支付標準(上冊) 》，台北：中央健康保險局，2002。

論文

[3]陳勇國、李友專、劉建財、林秀貞、蔣以仁，〈台灣醫療檢驗檢查數位化標準訂定與評估〉，《1999國際醫學資訊研討會論文集》，民88，頁49。
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[5]臺北醫學大學醫學資訊研究所碩士論文; 研究生：陸偉輝撰; Building Knowledge bases and Mapping Framework for Taiwan LOINC. June，2002。
[6]臺北醫學大學醫學資訊研究所碩士論文; 研究生：黃崇益撰; 建構健保藥品給付規定本體論知識庫之研究-以降血脂用藥為例。
[7]呂新傑、羅文慈、陸偉輝、劉建財：健保檢驗診療項目編碼與LOINC編碼轉換之研究Proceedings of The 2nd Asia-Pacific and Cross-Strait HL7 Conference on 6.Healthcare Information Standard.頁123-133.August 21-23,2003。

英文文獻

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[16]Lau, L.M., Johnson, K., Monson, K., Lam, S.H., &Huff, S.M. (2000). A method for the automated mapping of laboratory results to LOINC. Journal of Proceedings/AMIA Annual Symposium.p.472-6
[17]Lee Min Lau MD PhD, Kate Johnson MT (ASCP) MHR,Kent Monson MS MT (ASCP) CLS, Siew Hong Lam MD, Stanley M. Huff MD 3M Health Care, Murray, Utah and Intermountain Health Care, Salt Lake City, Utah，A Method for the Automated Mapping of Laboratory Results to LOINC
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[19]Forrey, A. W., McDonald, C.J., DeMoor, G., Huff, S.M., Leavelle, D., Leland, D., Fiers, T., Charles, L., Stalling, F., & Tullis, A. et al. (1996). The logical observation identifier names and codes (LOINC) database: A public use set of codes and names for electronic reporting of clinical laboratory results. Clinical Chemistry, 42, p.81-90.
[20]Henry, J.B. (1994). Clinical Diagnosis and Management by Laboratory Methods. Philadelphia: W.B. Saunders.
[21]ASTM E1238-94 (1994). Standard Specification for Transferring Clinical Observations Between Independent Computer Systems. Philadelphia: American Society for Testing Materials.
[22]Burtis, C.A. & Ashwood, E.R. (1994). Tietz Textbook of Clinical Chemistry, 2nd ed. Philadelphia: W.B. Saunders.
[23]McDonald, C.J. & Tierney, W.M. (1988). Computer-stored medical records. JAMA, 259, p.3433-40.
[24]Health Level Seven (1997). An application protocol for electronic data exchange in healthcare environments. Version 2.3. Ann Arbor, MI: Health Level Seven, Inc..

電子資料

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