全面電子病歷轉診化前如何營造以病患為中心的主動追蹤系統 ---以子宮頸抹片篩檢為例的探討

Abstract

醫療IT化是近十年來醫療界亟欲蛻變的熱門話題。不論從管理的角度、降低人事成本的角度、績效衡量的角度、或是想要更進一步，連通相距甚遠的聯合醫院間的病歷資料（如美國的HMO制度），都非得靠IT化來達成不可。但是，誠如這些年醫療界在IT化的過程中遭受的所有阻撓顯示出的問題癥結，都不在IT技術或IT設備，問題的核心都在使用者的抗拒心態！抱怨使用不方便、抱怨作業流程過於繁雜、抱怨輸入界面不夠人性化、抱怨電子病歷讓他們反而找不到所需的病歷資料，過去醫師順手翻翻病歷便可知病患大致情況的習慣被過分IT化的電腦界面徹底破壞。醫師在繁忙的臨床工作之餘還得花精神學習使用電腦，徒增工作量和工作壓力！於是，過去一向資訊化由IT人員主導的態勢已經在醫療界發生了變革，改由醫療從業人員（如醫師、護理師等）主導界面的設計和流程的制定。唯有消除臨床使用者的抗拒，醫療IT化才有可能繼續進行下去。 對所有的人類而言，醫療資訊化最重要的是要達到醫療資訊「交換」及「可攜性」的目的。因為傳統病歷容易損毀、受潮、遺失、人為篡改、佔據大量空間、長期保存不易、攜帶不便、交換困難等先天條件都可能隨時造成病患、醫師、或其他醫療相關人員的權益受損，甚至造成醫療糾紛。在經過十多年的努力之後，終於有HL7作為全球的交換標準，但是，依然不能解決醫療地區化及醫療IT化進程障礙重重的問題。迄今的經驗顯示，醫療IT化成功的案例，不外乎有以下兩項特質：（１）政府主管機關的政策貫徹，強迫全面IT化的實施。但通常須配合高額的系統建置補助精費；（２）成功的實施經驗讓使用者有非用不可的依賴感。 本研究所提出的架構，在嘗試以一個臨床婦產科醫師的角度，應用最簡單而且最具預防性功效的「子宮頸抹片篩選」檢查，設計一套符合未來架構的暫行性轉診系統，能符合醫療資訊「交換」及「可攜性」的目的；並以臨床醫師的角度設計出流程，符合醫師的醫療行為以及台灣病患的就醫習慣。唯有讓病患和醫師都同受其利，系統的建置才會成功。

EMR (Electronic Medical Record) has been an overwhelmed topic in recent 10 years. It will enhance management, lower cost, boost efficiency, and medical record transmission without any boundary. However, IT still did not prove to be successful in healthcare organization despite all the efforts for so many years. The reasons to be blamed are not technologies or equipments, but the resistance from the user themselves. Users have to change their habits to accommodate to the new working procedures and new interface without the benefits of convenience and quick data collection. The extra workload has become a burden to the clinical medical staff, which is reluctant to learn a new technology that is not much helpful to his/her patients. The situation has no variation until medical staff with IT background come down to lead the design of medical IT system interface. “Data exchange” and “data portability” are the two main goals for a complete electronic medical record system. Alone with security issue and exchange standard protocol, the complete electronic medical record system will only be accomplished under the government full support and some killing applications to the users and clients. Before reaching that, the intermediate model will be a mixed type of both old system and new technology concept. What I am trying to, based on a clinical Obs/Gyn clinical physican’s experience and knowledge, sketch out an infrastructure under the transfer system of Pap smear, the test that detects and prevents the existence of cervical cancer. The infrastructure will not only be bearing the goals of “data exchange” and “data portability” which fit the need for future system construction, but also suit the habits of both physicians and patients here in Taiwan.