具即時健康資訊與診斷輔助之遠距健康照護系統

Abstract

我國老年人口數量與比例在民國95年底已高過總人口之10%，達到聯合國所界定之「高齡化」水準，推估至民國101年時將為14%，民國120年時則將超過20%。中老年慢性病及相關的併發症、身心障礙、重症末期帶來龐大的醫療需求，甚至獨居、失智老人衍生的照護問題，已經成為社會沈重的負擔。因此我們藉著結合無線通訊網路、生醫感測器與醫療資訊系統，發展一個能解決緊急照護、長期照護，及預防性照護等各種遠距與行動照護問題及具即時健康資訊與診斷輔助能力之遠距健康照顧系統。此系統為結合遠距照護資訊網路、遠距醫療、與生醫感測技術提供病患個人化、可近性、即時的遠距與行動醫療照護服務，以減輕長期照護體系醫療人員與家屬的負擔，改善醫療服務品質並進而降低醫療成本。 本論文提出一模組化的遠距健康照護系統架構，以利往後相關的系統設計。此架構具功能再用(Function reuse)、元件再用(Component reuse)、模組再用(Module reuse)等功能，可清楚定義每個子系統之下的功能單元，其模組化設計可讓未來之系統在發展與擴張上更為容易。另透過導入適當XML (eXtensible Markup Language)與Web Service技術來解決異質資訊系統之建置，可達到加速整合系統建置的時程。此系統架構包括使用者端系統、行動服務端系統、健康照護中心資訊系統、醫院端系統、緊急醫療端系統。 我們所發展的行動醫院緊急醫療系統(MHEMS, Mobile Hospital Emergency Medical System) 結合遠距超音波診斷系統與外傷重點腹部超音波(FAST, Focused Assessment with Sonography for Trauma)，提供目前緊急醫療系統無法達到的預診與診斷評估，並且提供救護車預計到達時間 (ETA, Estimated Time of Arrival)，因此改進了緊急照護的品質進而提高存活率。 為解決居家訪視師出勤時常常得攜帶厚重病患紙本病歷的困擾，本論文提出一結合居家訪視師使用的電子病歷及可攜帶式生理量測儀之電子護理包(Nurse’s e-Bag)。同時病患家中的遠距健康系統，不只提供病患之遠距健康記錄，並可讓訪視師在做家訪時可得到遠端醫師的諮詢支援，加強病患病情的控制進而減少病情復發的機率。因此病患的健康照護品質將提升，醫療成本亦可降低。 另外本論文以資通訊技術建構之電子化個人健康紀錄，可提供一個民眾自我健康管理，以及專業健康管理師進行個案管理的共通資訊平台系統，以創新服務模式提升目前預防性照護效率。首先我們以臨床實驗探討遠距健康照護的系統與服務模式，再針對個別系統將遭遇的問題加以探討，嘗試作為標準化架構模式，以使系統更佳模組化，最後對遠距健康照護作服務模式的探討。 本論文所提出的具即時健康資訊與診斷輔助之遠距健康照顧系統，其整合與建置皆使用嵌入式系統與標準訊息架構發展，未來將可使用相同架構模式延伸發展至預防醫學之三段五級的預防性照護、亞急性照護、急性照護、長期照護、甚至末期照護，以提供一週全、持續性的健康照護(Continuum healthcare)。未來可結合軟硬體共同設計 (Hardware/Software Co-design) 或超大型積體電路系統晶片(System-on-Chip)的規劃與設計，即可改善生理訊號之偵測與回饋途徑、系統資料之傳送、轉換與接收速度等，以因應不同科別與疾病之照護需求，進而使日後健康照護系統之整合與應用更能迅速。

By the end of 2006, the number of senior citizens in Taiwan had already exceeded 10% of the entire population and reaching the level of the 'aging society'. Chronic diseases and complications, mental and physical handicaps, and terminal illnesses of elderly people have also created a huge medical need. These are all becoming heavy burdens of the society. In view of this, we have developed a Real-Time health information and Diagnosis Assistance System for Telehealthcare, which combines a radio communication network, biomedical sensors, and a medical information system to address the needs for emergency care, long term care, and preventive care. First, we propose a modular Telehealthcare framework that supports function reuse, component reuse, and module reuse. We define each sub-system clearly during the design of a Telehealthcare system. Through the import of Web Service technology and XML (Extensible Markup Language), we can integrate heterogeneous information systems into a framework and accelerate the establishment of our Telehealthcare system. For emergency care, our proposed Mobile Hospital Emergency Medical System (MHEMS) combines Tele-ultrasound and Focused Assessment with Sonography for Trauma (FAST) to provide pre-diagnosis and diagnosis assistance and ETA (Estimated Time of Arrival) of Ambulance, which cannot be done with current emergency care technology. With MHEMS, when patients are carried into the ambulance, the emergency medical technician can ask a doctor to make proper diagnosis for subsequent medical preparation, operations and/or sickbed assignment. Moreover, to improve the inconvenience of carrying paper patient records when a visiting nurse makes a visiting, we provide a home care record system integrated with portable bio-measurements as a Nurse’s e-Bag. Also, to let the patients record their health records, a tele-homecare system is installed at their home. Therefore, the visiting nurse can make healthcare service and obtain tele-consultation via such system. Based on the system that we provide, morbidity and medicine cost will be reduced. For preventive care, we have run a clinical trial for a Pilot Study on Community-Based Ubiquitous Healthcare for Current and Retired University Employees. Equipped with information and communications technologies, the system provides to the general public a different healthcare customized by changing the concept from receiving a medical staff’s service only in hospital to obtaining a medical group’s identical daily service outside a hospital, and without doctors or nurses around. The core technology of this Dissertation is to propose a systematic framework and functional units for Telehealthcare, then to develop a Telehealthcare system supporting emergency care, long-term care, and preventive care. The system framework complies with the standard embedded system and information system, and can be extended to include preventive healthcare, subacute care, acute care, long-term healthcare, and terminal healthcare. In the future, hardware/software co-design or VLSI chip design can also be adopted to improve the detection and feedback of physiological signals, system data transmission, conversion, and reception rate, so as to meet the needs of different medical departments, and facilitate a quicker integration and development of future healthcare systems.