結合資通訊科技與創新服務以提升偏鄉醫療之策略佈局：以「安心雲林e院聯防」為例

Abstract

我國健康保險制度與醫療可近性享譽國際，然而仍然存在明顯的城鄉差距。人口老化，低家戶所得，醫療人力與資源不足等現實環境，帶來了醫療公平性，可近性與醫療品質的種種挑戰。臺大醫院雲林分院掌握雲林得天獨厚的遠距醫療發展契機，在2017年4月成立了遠距醫療中心，實現「打造雲林成為遠距醫療區域合作的示範縣市」的願景。從2018年以來，在「安心雲林e院聯防」的大架構下，以雲林縣為場域，逐步連結起區域內外十家不同層級醫院與基層診所，以及數十家長照機構，結合資通訊科技與創新服務，發展出一系列偏鄉地區急重症資源整合與創新服務的模式。其中「斗六雙星區域聯防」打破醫界藩籬，建立人力資源大水庫，透過聯合排班與遠距醫療，完成急重症資源共享；「智慧遠距傷口照護」由傷口專科護理師訪視，結合智能判斷與遠距醫療清創，讓就醫困難的機構居民複雜的壓傷傷口終得痊癒;「高危新生兒外接即時監測」對照顧高危新生兒的婦產科診所，提供即時生理資訊監視傳輸與遠距線上指導，讓他們沒有後顧之憂。「偏鄉兒童心臟篩檢遠距群助」則透過心電圖與心音訊號的數位擷取，遠距傳輸，醫師群助與雲端判讀等創意作為，讓雲林的學童，也可以得到像都會區一樣高水準的心臟病篩檢服務。 藉由「政策，醫療，產業」鐵三角的形成，在雲林打造出綿密完整的遠距醫療生態系。「安心雲林e院聯防」傾聽民眾和醫療人員的需求，從滿足缺口出發，成功結合資通訊科技應用與創新醫療服務，為偏鄉醫療面臨的資源缺乏與就醫困難等挑戰，提出令人驚艷的解決方案。臺大醫院雲林分院遠距醫療模式成為全國資源不足地區，透過資通訊科技，弭平健康不平等，提升全民健康覆蓋的典範。 本研究以個案研究法，對[安心雲林e院聯防]之策略佈局與創新動能脈絡進行深入剖析，先以TIES架構分析臺大醫院雲林分院發展遠距醫療的兢爭策略，再以C-SOP架構探討臺大醫院雲林分院近年醫療創新的發展脈絡。在「安心雲林e院聯防」的策略佈局方面，臺大醫院雲林分院掌握雲林發展遠距醫療的天時地利與人和，定下明確的三階段發展目標。關鍵產品「安心雲林e院聯防」的數項痛點解方，緊密結合資通訊科技應用與創新服務，突破法規和現狀，解決偏鄉面臨的種種障礙。策略上從B2B服務開始，減少阻力，次第開發B2B2C網絡，又充分掌握COVID19帶來的機會，持續創新力道。團隊掌握雲林的主導優勢，打造「全方位全病程」的多重樣態與差異化內容的遠距醫療服務，形成難以模仿的遠距醫療生態系。透過政策、產業與醫療的三角聯盟，增加了自身政策影響力，跨大產業研發能力，也大幅擴大服務的版圖。其整體競爭策略，可謂有略有術。 綜觀臺大醫院雲林分院創新動能的情境脈絡，可以看到在策略佈局上，臺大醫院雲林分院切合時地需求的使命、願景、和策略地圖，以及詳細闡述企業文化內涵的「我們的宣言」，讓上下聚焦，轉身成為創新的搖籃。在文化形塑上，重視社會責任與永續、強調當責文化、公開透明、與關懷同理的組織文化，讓打破傳統藩籬的創新能夠誕生。在興業領導方面，領導者培育人才，知人善任且信任授權，營造出組織心理安全氛圍，讓人才產生創新動力。在組織協同方面，積極推動跨領域的功能性特色醫學中心，打破了穀倉效應，善用策略與與OKR來凝聚集體共識，並且推動社團與體育藝文活動，增加員工社交連結與組織向心力，降低了部門鴻溝，激發跨領域的創新力。 「安心雲林e院聯防」個案來自一個台灣醫療不足，人口老化，經濟弱勢的農業縣份。團隊不被外在的困難和現狀而限制，洞悉內外部的環境，掌握自我資源的優勢，進而化劣勢為優勢，主動出擊，並且結合政策、醫療與產業共同創造價值。「安心雲林e院聯防」彰顯的價值是連結，不只是把東西連起來(Internet of Things- IoT)，更要把資源連起來（Internet of Resources- IoR），把服務連起來(Internet of Services- IoS)，最重要的，是把眾人的專業和愛心連結起來（Internet of Love- IoL）。 本研究對於未來發展資通訊遠距醫療的建議包括，持續營造數位遠距醫療的永續經營模式，建立數位健康系統與平台之間的互通性(Interoperability)，弭平資源不足地區與弱勢族群數位落差並建立數位包容政策，佈建資源不足地區數位醫療的最後一哩，以及掌握COVID-19帶來的遠距醫療新動能。

Despite the implementation of National Health Insurance in the 1990s, there are still significant urban-rural disparities among equality, acess and quality of health care in Taiwan. Recognizing the unique environment and opportunities of developing digital and tele-health in Yunlin County, National Taiwan University Hospital Yunlin Branch established its ‘Center of Telemedicine’ in April 2017 to achieve the goal of developiong Yunlin into the model city of telemedicine implementation in Taiwan. Since 2018, the ‘Safe-Yunlin’ Digital Health Network has been initiated that successfully connected dozens of hospitals, clinics, and long-term care facilities. Novel pilot projects that combined information communication technology (ICT) and service innovation were proposed and implemented to address the unmet healthcare needs from the low-resourced areas. The revolutionary ‘Twin-Star Regional Collaboration’ program broke the silos between different under-staffed hospitals, and created joint acute care digital services via telemedicine. The ‘Smart Tele-wound’ program combined onsite visits by trained wound nursing specialists with plastic surgeon telemedicine, and was able to treat those patients with difficult wounds. The ‘High-Risk Neonatal Retrieval’ Program reassured local obstetric clinics experiencing unoforseen high risk neonate delivery by streaming realtime videos and vital signs to the retrieval team. The ‘School Children Heart Screening through Crowd-sourced Telemedicine’ utilized dital acquisition of heart sounds and 12-lead electrocardiograms, and crowd-sourced pediatric cardiologists to interpret these digital signas on a cloud-based platform to enable heart diseases screening in a county with no access to pediatric cardiologists. The ‘Safe-Yunlin’ Digital Health Network addressed the unmet health needs, and liaised with key policy, industry and healthcare stakeholders. The innovative approaches implemented by the ‘Safe-Yunlin’ Digital Health Network have made Yunlin the model city that deployed ICT to address health inequality and to improve universal health coverage. In this case study, the strategies of telemedicine development and implementation by the ‘Safe-Yunlin’ Digital Health Network are closely examined by the TIES (Target, Internal, External, Strategy) model, together with an in-depth exploration of the contexts that could explain the recent innovation momentum that was observed from the National Taiwan University Hospital Yunlin Branch through the C-SOP (Culture, Strategy, Organization, People) structure. A detail strategic analysis showed that National Taiwan University Hospital Yunlin Branch was able to recognize the unique telemedicine opportunities and resourced enjoyed by Yunlin, and launched the ‘Safe-Yunlin’ Digital Health Network at a critical timing and with very clear objectives. The digital health services were truly novel and were able to address the challenges experienced by the low-resources areas. The team alleviated potential resistance by starting with B2B services, inching into B2B2C and fully leveraged the new opportunities from the COVID-19 pandemic. Dominance of the Policy-Healthcare-Industry strategic alliance allows ‘Safe-Yunlin’ Digital Health Network a formidable lead. An in-depth exploration of the context leading to the the recent innovation momemtum enjoyed by the National Taiwan University Hospital Yunlin Branch identified several key factors. Updated and timely vision and mission statement, along with the Credo statement that addresses the commitments to the patients, the staff, the community, and the environment were key to align the whole organization from a strategic height. The foster of social responsibility and sustainability, accountability, transparentcy, compassion and empathy in corporate culture enabled innovations that transecend traditional values. The leadership of the organization were keen to cultivate all levels of staff, treated them with trust and due authorizaion, and most importantly, have created a psychological safe environment, so the staff can truly express, explore and innovate. Finally, the leadership aggressively promoted functional, cross-department medical specialy units the that responded to burgeoning patient needs and technololgy, fostered common goals through strategy maps and OKR, and improved staff social connection and engagement by social clubs and hospital-wide arts and sports events. These measures broke department silos, nourished teamwork and fostered multi-disciplinary innovations. The fact that ‘Safe-Yunlin’ Digital Health Network originated from a low-resourced, aging and poor community is in fact encouraging to communities, companies, and organizations with similar daunting challenges. If one entity is not limited by difficulties and status-quo, is able to see through the internal and external environment, and to seize the strength and uniqueness of oneself, it is always possible to transform a seeming weakness into strength, and to lead policy and industry innovations. The key value of ‘Safe-Yunlin’ Digital Health Network is ‘CONNETION’. The goal is not merely connecting stuff and things, (Internet of Things- IoT), but more aggressively, connecting resources (Internet of Resources- IoR), connecting services (Internet of Services- IoS), and most importantly, connecting all the passion and love for the needed (Internet of Love- IoL). The case study of ‘Safe-Yunlin’ Digital Health Network identifies several areas for future contemplations. First, innovative digital health services need to creat values to key stakeholders to be truly sustainable. Second, the policymakers should spare no efforts in making multiple digital health services and platforms ‘interoperable’. Third, digital divide among low-resourced areas and underserved population could be damaging, so a digtal inclusion policy should be formulated. Fourth, similar to the last mile delivery in e-commerce, the last-mile of digital health delivery should be designed. Finally, despite the pandemic could wean, we should continue leverage and capitalize the digital health momentum brought by COVID-19.