Transcript PowerPoint 簡報

電子病歷推動與美國醫療資訊暨管理系
統協會之電子病歷採用模型
HIMSS EMRAM
Chien-Yeh Hsu 徐建業 PhD
台北護理健康大學資訊管理系所
National Taipei University of Nursing and Health
Sciences
台北醫學大學醫學資訊研究所
Taipei Medical University
台灣醫學資訊學會
Taiwan Association for Medical Informatics
TAMI
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簡報大綱
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電子病歷交換計畫
進行EMRAM目的
HIMSS EMRAM 介紹
◦ HIMSS Analytics Asia 簡介
◦ HIMSS EMRAM 之介紹與探討
◦ HIMSS EMRAM之醫院評價流程
◦ HIMSS EMRAM作為國內電子病歷評價之可行性探討
臺灣醫療機構電子病歷檢查與EMRAM及大陸電子病歷系
統功能與應用水平分級評分標準比較
HIMSS EMRAM與台灣、美國、中國大陸電子病歷評價
體系之比較研究結果
EMRAM Stage 7輔導作業說明
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二代醫療資訊網HIN2.0計畫
國家醫療資訊交換中心
Medical Information Exchange Center - MIEC
CA - Certificate Authority
PRF - Patient Request Form
HRF - Hospital Request Form
HIS - Hospital Information System
RS – Resource Server
Patient
Results (in XML)
Secure e-mail,
Fax, Voice, Mobile phone
MIEC 2.0
SSL
CA
Mail Server
Web Server
Internet
or
HIN 2.0
PRF
HRF
Audit
SSL
Query (in HL7)
Secure e-mail
HIN 2.0 or
Internet
Hospital
HL7
Agent
RS
HL7
Inter
-face
HIS
個人化健康資訊整合架構
TMT File Exchange Pathway
Hospital Information System
Hospital Information System
1
TMT viewer
Laboratory
Information Systems
Data Mapping
Gateway
2
Laboratory
Information Systems
Data Mapping
Gateway
3
Pre-Authorized
TMT File
TMT File
TMT File
TMT PHS
File
TMT PHS
File
Personal Health
Personal Health
Records
Records
Paperless server
TMT mini-server
TMT PHS
File
Personal Health
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Records
TMT mini-server
Internet Health and Life Supporting Data Bank
HIT-Enabled Health Reform
Achieving Meaningful Use of EMR
2009
2011
2012-2013
2015
HIT-Enabled Health Reform
Policies in
Legislation
(法案及規則建
立) National
health
insurance
Stage 1
Meaningful Use
Criteria
(資料取得，決策支
援，品質測量)
Capture/share
data/decision
support/quality
measurement
需要完成的要求criteria
Edward H. Shortliffe, MD, PhD
Stage 2
Meaningful Use
Criteria
(持續醫療品質改善
，結構化的HER交
換) Continuous
quality
improvement,
structured
exchange
Stage 3 Meaningful Use
Criteria
(醫療品質，安全，效率，
自我健康管理) Quality,
safety, efficiency, patient
self-management to
Improve Outcomes
EMR Exchange Center
EMR providing
Hospitals
National EEC Center
EMR Reading Hospitals
Download, Querying,
and Reading
Ministry of Health
Image Exchange Center
Health Insurance Center
Index Server
134 hospitals,
2010-2011
upload index 2,168,063
request: 6,592
download: 81,108
Hospital B
Hospital A
eSignature
Radiology
Image
Report
Database
CPOE
Download image
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Request for image
Image
Report
Database
Radiology
CPOE
Download image
Dual Card system and
Dual Card system and
inform consent
Request for image inform consent
Surveys for Taiwan’s EHR project
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Government should establish software standards for EMR system
Exchange of EMR should contain a serious and dangerous contagious
diseases
Department of Health should establish a secure trust information
center for EMR storage and exchange control.
Hospitals use EMR is the future trend.
Government should set up education and training team to help
hospitals to promote EMR
Healthcare authorities should be more actively involved in funding and
increasing manpower to accelerate the Smart Healthcare Project
Government should be more actively educate the public and promote
the EMR exchange policy.
Regulations should be amended with the implementation of EMR
Healthcare authorities should be more widely to promote the
interpretation and exchange of medical image
The Government should fully promote the implementation of EMR in
hospitals
Score from 1 to 7, all >5.1
Surveys for Taiwan’s EHR project
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Healthcare authorities should be more widely to promote security
RFID systems used in health care facilities
RFID chip technology can be used for hospital safety concern
Use of EMR can promote personal health management
The use of EMR can promote the development of domestic
information industry
Hospital may re-plan their service processes due to the
implementation of EMR
Implementation of EMR can reduce the medical expenses for
national health insurance
EMR should use the new version of ICD-10 (International
Classification of Diseases coding)
Use of EMR can enhance the national competitiveness
In the future, patient’s data can be stored in cloud computing
architecture
Patients should be able to access their own EMR
EMR system should be included in hospital accreditation
EMRAM目的

HIMSS(The Healthcare Information and Management
Systems Society)有一套評價醫療機構實施電子病歷水準
的EMR Adoption Model模型，簡稱為「電子病歷採用
模型」（EMR Adoption Model, EMRAM），分為八個
階段，以瞭解醫院推行電子病歷之狀況。

衛生福利部於101年委託本團隊執行評估計畫，藉由文
獻收集，資料查閱，專家會議，實地訪視探討，並與
HIMSS Analytics Asia 充分合作，進行HIMSS EMRAM
之介紹與探討，評價流程之說明，以及作為國內電子
病歷評價之可行性探討。
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HIMSS EMRAM 介紹




HIMSS Analytics Asia 簡介。
HIMSS EMRAM之介紹與探討。
HIMSS EMRAM之醫院評價流程。
HIMSS EMRAM作為國內電子病歷評價之可行性
探討。
12
HIMSS Analytics Asia
 HIMSS成立於50年前，不以營利為目的的組織，
辦事處在芝加哥，華盛頓，DC，布魯塞爾，新
加坡，萊比錫，和美國各地的其他地點。
Analytics是在 HIMSS 的研究機構，位
於新加坡，負責亞太和中東地區的業務，使用
所建立的亞洲數據庫，對整個亞太，中東，美
國，加拿大，和歐洲的醫院收集數據。
 HIMSS
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HIMSS Analytics Asia(cont.)
 開發出
EMRAM，是一個對於醫院和基層醫療
機構採用電子病歷之水準和階段的追踪及方法。
 目前是採用此方法的唯一機構，衡量電子病歷
之實施與採用基準。
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HIMSS EMRAM 介紹




HIMSS Analytics Asia 簡介。
HIMSS EMRAM之介紹與探討。
HIMSS EMRAM之醫院評價流程。
使用HIMSS EMRAM作為國內電子病歷評價之可
行性探討。
15
EMRAM(EMR adoption model)
 根據
HIMSS 的電子病歷採用模型，主要
評價內容包含：
臨床資料倉庫（CDR）
臨床決策支援系統（CDSS）
受控醫學詞彙表（CMV）
電腦化的醫囑系統（CPOE）
藥品管理系統（eMAR）
臨床文檔應用程式(CDA)
企業級病人主索引（Enterprise Master Patient
Index, EMPI）
。
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EMRAM(EMR adoption model)

將評價的結果分為下列八級，各等級所代表的主要涵義
如下：
•
•
•
•
•
•
•
•
•
0級：尚未完成電子病歷系統。
1級：部門內初步使用電腦做資料登錄。
2級：部門內資料交換。
3級：部門間資料交換，並且初步應用於醫療決策支援。
4級：全院資料共用，並且進階應用於醫療決策支援。
5級：統一資料管理，各部門系統資料集成，基本建立以電子
病歷為基礎的醫院資訊平臺。
6級：全流程醫療資料閉環管理，高級醫療決策支援。
7級：完整電子病歷系統，區域醫療資訊共用。
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HIMSS EMRAM 之介紹與探討

參與 EMRAM 評估的醫院將可獲得：
◦ 該醫院的電子病歷採用模型分數。
◦ 完整而有效的標竿基準（benchmarking），並
有一個路線圖，說明如何實施資訊技術，以
確保病人安全。
◦ 分享HIMSS Analytics Asia 基準測試工具，包
括近似醫院間的比較報告，資訊系統的戰略
發展，找到並確定成本和資源效率使用方式。
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HIMSS EMRAM 之介紹與探討(cont.)

使用的方法：
◦ 採用文獻蒐集與整理，針對目前相關的期刊論文、研
討會論文，以及相關的技術文件做完整的蒐集，並比
較出HIMSS EMRAM模型與其他國際上使用模型之異
同。
◦ 並參考中國大陸於2011年公布的電子病歷系統功能應
用水準分級評價方法及標準，該標準建立37個評價指
標分別對電子病歷系統功能、有效應用以及電子病歷
系統應用的基礎環境等三個方面進行評分。
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HIMSS EMRAM 介紹




HIMSS Analytics Asia 簡介。
HIMSS EMRAM之介紹與探討。
HIMSS EMRAM之醫院評價流程。
HIMSS EMRAM作為國內電子病歷評價之可行性
探討。
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HIMSS EMRAM之醫院評價流程
HIMSS EMRAM 利用資料分
析結果，研究改善的方向及基
準，引導醫療服務提供者和政
府機構進行相關的改善，以資
料收集，數據分析，研究討論，
達到醫療品質改善的目的。
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HIMSS EMRAM之醫院評價流程

醫院參與 EMRAM 評估之進行步驟：
(1) 簽訂相關計畫合約
(2) 計畫啟動會議
(3) 收集醫院相關數據
(4) 準備線上分析模式
(5) 進行主要數據分析
(6) 交付分析基準報告
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HIMSS EMRAM之醫院評價流程
HIMSS Analytics Asia EMRAM 證書給與流程及準則：
(1) 有8個（從0-7）階段組成，期望通過技術的運用，實現無
紙化環境，提高照護品質。
(2) 提供醫院和政府機構完全實現電子病歷的技術路線圖，
使一個實際的醫療服務點的到改善，在病人護理，臨床
決策的支持，警報。
(3) EMRAM的分數是保密的，在同業水平基準的分析是去識
別化的，並是在總體水平上再分析的結果。
(4) 欲通過階段6的醫院必須經過電話訪查驗證。(USD 2500)
(5) 欲通過階段7的醫院必須經過到院實地考察。(USD 5000 + 3
個評鑑委員的住宿及機票費用)
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HIMSS EMRAM之醫院評價流程
◦ EMRAM 亞洲地區的評鑑項目： 將“Closed Loop
Medication Administration”從第 5級移到第6級，”Full
Radiology PACS” 從第6級移到第5級。
Stage 6
Complete EMR; CCD transactions to share data; Data
warehousing; Data continuity with ED, ambulatory, OP
Physician documentation (structured templates), full
CDSS (variance & compliance), full R-PACS
Stage 5
Closed loop medication administration
Stage 4
CPOE, Clinical Decision Support (clinical protocols)
Stage 3
Stage 2
Nursing/clinical documentation (flow sheets), CDSS
(error checking), PACS available outside Radiology
CDR, Controlled Medical Vocabulary,
CDS, may have Document Imaging; HIE capable
Stage 1
Ancillaries – Laboratory, Radiology, Pharmacy – All Installed
Stage 0
All Three Ancillaries Not Installed
Stage 7
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United States EMR Adoption Model SM
Stage
Cumulative Capabilities
2013 Q3
2013 Q4
2.2%
2.9%
11.1%
12.5%
20.9%
22.0%
15.1%
15.5%
31.9%
30.3%
8.4%
7.6%
Stage 1 Ancillaries - Lab, Rad, Pharmacy - All Installed
3.5%
3.3%
Stage 0 All Three Ancillaries Not Installed
6.9%
5.8%
Complete EMR; CCD transactions to share data;
Stage 7 Data warehousing; Data continuity with ED,
ambulatory, OP
Physician documentation (structured templates),
Stage 6 full CDSS (variance & compliance), full RPACS
Stage 5 Closed loop medication administration
CPOE, Clinical Decision Support (clinical
protocols)
Nursing/clinical documentation (flow sheets),
Stage 3 CDSS (error checking), PACS available outside
Radiology
CDR, Controlled Medical Vocabulary, CDS,
Stage 2
may have Document Imaging; HIE capable
Stage 4
Data from HIMSS Analytics® Database ©2012
n=5437
n=5458
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EMR Adoption Comparisons
Across Regions
EMRA United
M Stage States Canada Germany Italy
Spain Sweden UAE Singapore
7
1.20%
0.00%
0.87%
0.00%
0.00% 0.00% 0.00%
0.00%
6
5.20%
0.50%
0.00%
1.35%
4.59% 2.94% 0.00%
66.67%
5
8.40%
0.20%
11.30%
2.70% 32.11% 26.47% 16.67%
0.00%
4
13.20% 2.30%
6.96%
5.41% 14.68% 2.94% 2.78%
0.00%
3
44.90% 36.50%
7.83%
8.56%
0.00%
2
12.40% 20.4%
12.17% 15.77% 12.84% 35.29% 33.33% 33.33%
1
5.70% 14.50%
1.74%
6.42% 11.76% 2.78%
30.18% 9.17% 0.00% 30.56%
0.00%
0
9.00% 25.60% 59.13% 36.04% 20.18% 20.59% 13.89%
No. of
Hospitals 5337
641
115
222
109
34
36
0.00%
6
Description of Each Stage of the HIMSS
Analytics Asia EMR Adoption Model
EXPLANATION AND VALUE
From HIMSS Analytics Asia
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Stages 0 and 1

Stage 0 – Laboratory, Pharmacy, or Radiology are
not installed.
◦ The patient record is paper based
◦ There may be some departmental systems, but they are not
integrated
◦ Value: Departmental process improvement

Stage 1 – The core ancillary systems are automated –
Laboratory, Pharmacy, and Radiology
◦
◦
◦
◦
◦
The patient record is still primarily paper based
Core clinical departmental systems are installed
Systems not yet integrated
Data is not yet being stored in a central database
Value – Core clinical data related to results and medications are
stored electronically
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Stages 2 and 3

Stage 2 – A Clinical Data Repository is installed
◦ A central database containing core clinical data from the core
ancillary departments
◦ The ancillary systems (laboratory, radiology, and pharmacy) are
integrated through the clinical data repository
◦ Value: provides the platform for allowing access to key clinical
data through one user interface. Creates the foundation for a
patient centric electronic medical record

Stage 3 – Order Entry, Nursing Documentation, and
Electronic Medication Administration Record
(EMAR) Installed
◦ Further capture of core clinical data
◦ Value: Allows for basic clinical decision support including
duplicate order checking, order sequencing, microbiology and
pharmacy communication (e.g. antibiotic appropriateness)
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Stages 4 and 5

Stage 4 – Computerized Practitioner Order Entry in
at least one inpatient unit
◦ Physicians are entering their own orders
◦ Clinical Protocols available
◦ Value: Standardized and improved care delivery. Intermediate
clinical decision support available to physicians thereby reducing
the potential for medical errors.

Stage 5 – Full Radiology Picture Archiving
Computerized System
◦ All images are available for review in the Electronic Medical
Record environment
◦ Value: Improved diagnostic efficiency and further elimination of
paper
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Stages 6

Stage 6 – Physician Documentation installed with
structured templates in at least one inpatient unit, Full
CDSS, and Closed Loop Medication Administration is
being practiced
◦ Capture of structured data through the use of templates
◦ Physician Documentation with underlying clinical decision support
(e.g. evidenced based clinical advice triggered from
documentation)
◦ Use of bar coding at the point of care in the administration of
medication – the patient and medication (unit dose) must be bar
coded
◦ 5 Rights of closed loop medication administration – the right
patient, right drug, the right dose, the right route, and the right time
◦ Value: Eliminates medication errors and improves patient safety
and patient and family confidence. Structured data allows for data
31
sharing and sophisticated analytics
Closed Loop Medication Administration –
Biggest Challenge to achieving Stage 6
eMAR (Electronic
Medication Administration
Record) is updated and
available for review and
CDSS interactions
Medication
orders that
pass CDSS
flow to
Pharmacy
CPOE
eMAR
Nurse scans
patient and
medication after
logging onto
scanner for five
rights CDSS –
“Passed”
POC(Point of Care)
medications are
Administration
administered
Pharmacy
Nurse
retrieves
medication
from ADM
and takes it
to patient
Pharmacy
validates order
and dispenses
medication to
ADM or floor
ADM
Ward-based automated dispensing
Nurse selecting stock medication from drawer in automated cabinet.
The patient-specific drawers can be seen below the open drawer,
and the screen to the right.
-- in a 28-bed general surgery ward of a London teaching hospital.
Franklin, B. D., O’Grady, K., Donyai, P., Jacklin, A., & Barber, N. (2007). The impact of a closed-loop electronic prescribing and
33
administration system on prescribing errors, administration errors and staff time: a before-and-after study. Qual Saf Health Care, 16, 279–284.
Electronic drug trolleys
One drawer is allocated to each
patient for whom medication is
due and their name shown on the
liquid crystal display.
The barcode scanner is on the top
of the trolley.
-- in a 28-bed general surgery ward of
a London teaching hospital.
Franklin, B. D., O’Grady, K., Donyai, P., Jacklin, A., & Barber, N. (2007). The impact of a closed-loop electronic prescribing and
34
administration system on prescribing errors, administration errors and staff time: a before-and-after study. Qual Saf Health Care, 16, 279–284.
Stages 7

Stage 7 – Complete EMR, Continuum of Care
Document (CCD) transactions for the sharing of
data, Data Warehousing, Data Continuity, and
Health Information Exchange
◦ No paper charts used for patient care throughout the hospital
◦ 90 percent of all medical orders entered by physicians in CPOE
◦ Use of discrete data in business intelligence and clinical data
warehouses to analyze outcomes, protocols, and care delivery
processes
◦ Use of CCD transactions to share data with other organizations
◦ Interoperability of data flows between inpatient, emergency
department and outpatient
◦ No film in radiology
◦ Value: discrete data supports sharing with all stakeholders;
market efficiency
35
HIMSS EMRAM之醫院評價流程

確保結構的客觀性，EMRAM亦於標準中加註以
下項目：
(1) 每個階段內的所有應用能力項目必須達成才能取得該階段
之認證。
(2) 在通過更高階段的認證前必須通過較低階段的認證。
(3) 在認證階段3~6中，醫院只要符合對於單一病患的應
用能力即可通過。(e.g.single nursing floor, cardiology
service）
(4) 使用上述規則，若醫療院所必須達到的標準外能提供
額外附加的應用(e.g. correlation with quality and
financial research)則可獲得加分。
36
HIMSS EMRAM之醫院評價流程

HIMSS EMRAM 的導入標準作業程序：
(1) 醫院的資料蒐集是透過 HIMSS Analytics EMRAM 線上問卷
調查系統來完成的。
(2) 當線上資料蒐集完成後，將進行一個質量審查程序(QC)，以
確保所有必要的問題都已回答，異常值將會被找出並且追蹤
以確保資料之正確性。
(3) 質量審核完成後，EMRAM會透過演算法來進行計算。
(4) 計算完成後會得到每家醫院的 EMRAM 得分，這個分數反
應每家醫院的電子病歷無紙化的實施階段。
37
HIMSS EMRAM 介紹




HIMSS Analytics Asia 簡介。
HIMSS EMRAM之介紹與探討。
HIMSS EMRAM之醫院評價流程。
HIMSS EMRAM作為國內電子病歷評價之可行性
探討。
38
HIMSS EMRAM作為國內電子病歷評價
之可行性探討

衛生福利部於民國94年11月公告施行《醫療機構電子病
歷製作及管理辦法》，凡符合規定之醫療機構，得免另
以書面方式製作病歷。

於100年，制定醫院電子病歷檢查案，電子病歷驗證準則
(草案)，至目前為止，已有318家醫院宣告實施電子病歷，
191家醫院通過電子病歷查驗。

同時實施新版醫院評鑑基準，納入電子病歷品質要求，
正式列入評鑑範圍。
39
HIMSS EMRAM作為國內電子病歷評價
之可行性探討
衛生福利部未來可以預期的成果：
得到參與醫院的正確資訊技術發展。
獲得電子病歷採用模式(EMRAM)的發展趨勢及數據收集
經驗。
若未來需要收集醫院資料，將由
HIMSS Analytics 派出亞
洲代表，與相關醫療機構聯繫，完成醫院利用資訊技術程
度的問卷，這些數據將被輸入到HIMSS Analytics Asia數據
庫。
40
HIMSS EMRAM作為國內電子病歷評價
之可行性探討

HIMSS Analytics 對受評醫院的產出：
◦ 參與的醫院可以得到自己醫院的 EMRAM 分數，同時
也可分享 HIMSS Analytics 的完整分析結果。
◦ 提供一個成果基準報告，概述研究的結果，趨勢和分
析數據收集項目。基準報告將聯同衛生福利部公佈，
並可於 HIMSS Analytics Asia 網站上張貼。
◦ HIMSS Analytics Asia 也可與衛生福利部共同發布有關
研究工作於相關媒體。
41
臺灣醫療機構電子病歷檢查
與EMRAM及大陸電子病歷系統功能與
應用水平分級評分標準比較

HIMSS EMRAM 評估項目與台灣的電子病歷檢查案重複性相當少。

在檢查表九個項目中大約只有部分: (第3條第3款(3.1,3.2,3.3)，第3條第
5款(5.1,5.2,5.3) ，第5條(7.1,7.2) ，包含在EMRAM裡面。

目前台灣的電子病歷檢查項目無法用於驗證HIMSS EMRAM。

台灣的電子病歷檢查項目著重於:
◦
電子病歷之操作，使用權限內容完整，緊急應變、資料安全、時間正確、
簽章、保存期限、醫事憑證、與實施公告。對於電子病歷本身之系統建置
與臨床應用較少且並無明確之規範。

大陸: 把醫療過程劃分爲9個工作角色和37個考察項目，對每個項目都
進行0—7共8級的功能等級劃分。37個項目劃分爲基本項目與選擇項
目。通過對醫院獲得的總分，實現基本項目、選擇項目的數量，各個
項目達到的等級進行統計分析，就能够得到醫院整體電子病歷應用水
平的評價。

臺灣的項目與其第九個工作角色(電子病歷基礎)類似: 病歷資料存儲，
電子認證與簽章，病歷資料存取控制，系統災難恢復體系。
Developmental goals of different EMRs evaluation systems
Patient
Patient
Healthcare Providers
1.Safer treatment
2.More conerning on
patient safety
1. Faster and more
efficient workflow
2. Reduce medical errors
and adverse events
1.Reduce barriers of
medical access
2.Equally and easily
access of healthcare
HIMSS
EMRAM
1. Standardize
medical behavior
2. Reduce healthcare
costs
3. Consider the
economic benefits
of the payer
Payer
Healthcare Providers
1.Prevent medical errors
2.Implement state-ofthe-art information
technology
3.Enhance information
exchange in public
health system
Meaningful
Use of EMRs
1.Patient-centered
healthcare approach
2.Costing improves
the operational
efficiency
3.Enhance the core
competitiveness
1
Patient-centered
healthcare approach
Hospital Managers
Payer
Hospital Managers
H. I. Liu, Comparison and analysis of different Evaluation
Models for Hospital Information System, 2012.
Patient
Patient
Healthcare Providers
1.Computerized medical
records and
information sharing
2.Clinical Knowledge
Base, clinical decision
support application
3.Medical records
quality control
PRC’s EHR
evaluation
standard
1.Patient-centered
healthcare approach
2.Use cost accounting as
a mean
3.Improve the core
competitiveness of the
medical institutions
Payer
Hospital Managers
Healthcare Providers
1.Security of EMRs
2.Sharing and exchange
of EMRs
Taiwan EMRs
audit program
1
1.Developing an EMRs
that follows
regulation
2.Implement EMRs
management and
improve the
specifications
continuously
Payer
Hospital Managers
H. I. Liu, Comparison and analysis of different Evaluation
Models for Hospital Information System, 2012.
[1]陳正美、徐建業(2012)：美、台、中電子病歷評價體系之比較研究，病歷資訊管理期刊，第11 卷第2 期。
[2] Chen CM, Hsu CY, J Andrew Worley. Evaluation Systems of the Electronic Medical Records: A Comparative
Study. In: Proceedings of 4 th IEEE International Conference on Software Engineering and Service Sciences. 43
China:Beijing, 2013.
[1]陳正美、徐建業(2012)：美、台、中電子病歷評價體系之比較研究，病歷資訊管理期刊，第11 卷第2 期。
[2] Chen CM, Hsu CY, J Andrew Worley. Evaluation Systems of the Electronic Medical Records: A Comparative Study. In: Proceedings of 4 th IEEE International Conference on Software Engineering and Service
44
Sciences. China:Beijing, 2013.
[1]陳正美、徐建業(2012)：美、台、中電子病歷評價體系之比較研究，病歷資訊管理期刊，第11 卷第2 期。
[2] Chen CM, Hsu CY, J Andrew Worley. Evaluation Systems of the Electronic Medical Records: A Comparative Study. In: Proceedings of 4 th IEEE International Conference on Software Engineering and Service
45
Sciences. China:Beijing, 2013.
[1]陳正美、徐建業(2012)：美、台、中電子病歷評價體系之比較研究，病歷資訊管理期刊，第11 卷第2 期。
[2] Chen CM, Hsu CY, J Andrew Worley. Evaluation Systems of the Electronic Medical Records: A Comparative Study. In: Proceedings of 4 th IEEE International Conference on Software Engineering and Service
46
Sciences. China:Beijing, 2013.
HIMSS EMRAM與台灣、美國、中國大陸
電子病歷評價體系之比較研究結果
(一) 主要的差異:


發展目標的不同
HIMSS EMRAM 主要目標是通過分析收集的數據得出電子病歷應用等級與醫院的經濟
投入、人員投入等方面的比較，同時也能産生許多有價值的市場分析研究報告。

美國 MU的評價目標以「clinical workflow tasks」臨床應用為主，除病人安全外，更著
重審查是否可提供病人預防、教育的照護以及公衛體系醫療資訊的能力。

資訊化程度的不同

台灣因醫療機構等級不同，資訊系統發展不一，所以電子病歷檢查與查驗不審查其系
統的建置與應用，而定位在審查醫療機構是否有製作電子病歷的能力及符合規範。

大陸電子病歷的評價標準則是根據其醫院資訊化發展的現狀而制定，重心仍在於醫療
記錄的電子化，與歐美各國之資訊化程度還存在相當的差距，大陸之評價項目較細
(針對單一之資訊系統)。
- 陳正美、徐建業(2012)：美、台、中電子病歷評價體系之比較研究，病歷資訊管理期刊，第11 卷第2 期。
- Chen CM, Hsu CY, J Andrew Worley. Evaluation Systems of the Electronic Medical Records: A Comparative Study. In: Proceedings of 4 th IEEE International
Conference on Software Engineering and Service Sciences. China:Beijing, 2013.
47
H IMSS EMRAM與台灣、美國、中國大陸
電子病歷評價體系之比較研究結果
(二) 使用HIMSS EMRAM 作為國內電子病歷的評價是可行的。
利用問卷中廣泛的醫院基礎數據，産生大量有商業價值的各種
市場情况分析報告，提供醫院持續發展路綫圖；也爲主管機關
提供統計報告，瞭解、掌握轄區內醫療建設現狀，制定未來發
展規劃。
(三) 建議-可考慮納入Meaningful Use之評價特性(ex.交換、提供病人
預防、教育的照護及公衛體系醫療資訊能力)。
- 陳正美、徐建業(2012)：美、台、中電子病歷評價體系之比較研究，病歷資訊管理期刊，第11 卷第2 期。
- Chen CM, Hsu CY, J Andrew Worley. Evaluation Systems of the Electronic Medical Records: A Comparative Study. In: Proceedings of 4 th IEEE International
Conference on Software Engineering and Service Sciences. China:Beijing, 2013.
48
近期工作事項

2012年5月完成HIMSS EMRAM 教育訓練-種子教練。

HIMSS 專人來台教育訓練1小時專題演講+3小時演練操作
示範，包括：
◦
◦
◦
◦

Method of filling in data+Things-to-note
Essential and additional questions to answer
Study Walkthrough
Section-by-section walkthrough
2012年5月底完成HIMSS EMRAM 翻譯，包括問卷及說
明
，繁體中文版已經架設在HIMSS EMRAM網站上。
49
05/2012 HIMSS EMRAM教育訓練
HIMSS Analytic Asia主席 Dr. Steven 與學員進行討論
Day 2學員上機操作情形
HIMSS Analytic Asia工程師說明HIMSS EMRAM調查內容
學員聽講情形
50
近期工作事項(cont.)

文獻及相關實作技術探討。

綜合整理，文獻管理及綜合報告。

2012年5月雙和醫院測試與 7/17 訪查。

2012年8月專家座談會議。

2012年9月HIMSS AsiaPac 2012 會議研習與新加坡醫院
參訪：

陳篤生醫院 Tan Tock Seng Hospital

新加坡國立大學醫院 National University Hospital
51
近期工作事項(cont.)


輔導三家醫院取得 HIMSS EMRAM Stage6認證 :

2013年04月雙和醫院。(已完成)

2013年12月萬芳醫院。(已完成)

2014年02月北醫附設醫院。(已完成)
輔導參與認證中的醫院 :

高雄醫學大學中和附設醫院(2014已經取得Stage 6)

蕭中正醫院，

國立陽明大學附設醫院。
52
HIMSS EMRAM in Taiwan
署立雙和醫院於04/01/2013 通過電子病歷採納模式第6級的認證，成為全亞
洲第十一家(新加坡4家、大陸3家、印度2家，馬來西亞1家) ，台灣第一家
取得第6級認證的醫院，HIMSS 協會102年8月2日在香港舉行的 年度大會中
頒發證書。More第6級: 萬芳醫院，北醫附醫，高醫大中和紀念醫院
53
Benchmarking Reports
與同為第6級之其他醫院，在 operating revenue 上做比較
5億美元
54
Benchmarking Reports
與同為第6級之其他醫院，在 operating expense上做比較
5億美元
55
Benchmarking Reports
42,651,000 NTD
56
58
歡迎 各醫療機構參與認證
 聯絡人姓名
徐建業 : [email protected]
陳正美 : [email protected]
饒孝先 : [email protected]
 電話
02-27361661 #3349
 電話
02-28227101 #2210, 3921, 3924
 0939193212
59
謝謝聆聽
Chien-Yeh Hsu 徐建業教授
台北護理健康大學
臺北醫學大學
臺灣醫學資訊學會
National Taipei University of Nursing and Health
Sciences
Taipei Medical University
Taiwan Association for Medical Informatics, TAMI
http://gimi.tmu.edu.tw/Prof. 0939193212
e-mail:[email protected], [email protected]
60