| 摘要: | 以往重視醫師個人的專精醫療已不敷現今病患需求，當病情嚴重複雜時，患者及家屬迫切希望得到專精醫術照護與資訊科技的輔助醫療支援資訊系統協助，而這些醫療及管理制度的建立需仰賴醫院各資訊系統，其中與醫病關係密切相關的因素之一即為會診諮詢資訊系統。會診諮詢資訊系統，可促使開單醫師適時獲得專家諮詢與病患及早獲得正確治療。早期會診諮詢以人工作業處理，造成效率低落及治療時效性延誤，因此藉由資訊科技做整體改善會診諮詢作業流程。 本研究旨在：1)探討不同屬性醫學中心之基本資料，及其會診諮詢資訊系統各評估項目的差異。2)分析影響醫院會診諮詢資訊系統成效因素與會診諮詢系統各評估項目之相關性，並探討其在不同屬性醫學中心間之差異。以及3)分析醫院會診諮詢資訊系統各評估項目：系統品質、使用者滿意、對個人影響及對醫院影響之間的相關，並探討在不同屬性醫學中心間之差異。4)分析會診諮詢資訊系統實施成效與實施年數，在不同屬性醫學中心間相關。 本研究母群體以中部三家不同屬性的醫學中心，研究對象為會診諮詢資訊系統使用者，使用者是醫師、資訊人員、護理人員等，並以醫院別進行分層抽樣比率方式進行郵寄問卷調查，資料收集期間為民國九十二年十一月和十二月，共發出450份問卷，回收有效問卷388份。 研究結果初步發現：由於醫療經濟規模較大之故，三家醫院都聘僱資訊人員自行開發及維護醫院的會診諮詢資訊系統。在會診資訊系統評估的構面中，『系統品質』、『使用者滿意』、『對個人的影響』、『對醫院的影響』三家醫院間均有顯著差異；其中上線時間進入成熟時期的醫學中心，使用者在各項滿意度平均分數均優於其他二家。本研究亦發現評估『系統品質』項目-當機問題因應作法，三家醫院作法無顯著性差異。會診資訊系統使用年限與採用軟體作業系統有關。受測者的年齡及不同屬性醫學中心在使用者滿意程度有顯著差異。會診資訊系統評估指標，丙醫院在『系統品質』、『使用者滿意』、『對個人的影響』、『對醫院的影響』各項平均值均優於其他二家。本研究得知影響會診資訊系統實施成效因素，『對電腦瞭解』、『資訊化改變』、『教育訓練』、『醫院時機』三家醫院間均有顯著差異；其中丙醫院『對電腦瞭解』、『資訊化改變』、『教育訓練』、『醫院時機』各項平均分數均優於其他二家；而甲醫院『對資訊系統的態度』各項平均分數均優於其他二家。 透過會診資訊系統的應用，將會診的記錄併於病歷資訊管理，讓醫護人員隨時掌握病人現況，以提昇醫療團隊服務品質。藉由本研究對會診資訊系統評估，更瞭解現有系統現況與問題，可提供醫院改進或未來引進新系統的評估原則及參考依據。
The physician’s own expertise in clinical treatment for patients does not meet the need in modern medicine. When patient’s condition is at critical, the patient and his (her) family need more expertise for treatment. This can be achieved through computerized medical information, as well as support from other physicians. It needs some control mechanisms to manage all these information. One of them which is closely related to patient treatment is a consultation system. Through this system, the physician ordering the consultation will obtain a proper and on-time information to treat the patient. Early consultation operation was handled by hand resulting in poor efficiency, it may be so slow that the treatment could not be handled on time. By current computerized information system, the consultation can be handled quickly, so to improve the quality of patient management. This study aimed at: (1) comparing the different consultation information systems in hospitals of various scales, (2) analyzing the performance of consultation systems of different hospitals, (3) analyzing the consultation systems in its quality, users satisfaction, and the effects of the consultation systems on users and hospitals, (4) the relationship between system duration and impacts among various hospitals. The preliminary results indicated all three hospitals were big enough to develope the computerized consultation systems by themselves. There were quite different in three hospitals on quality of the consultation systems, users satisfaction, and their effects on users and on hospitals. Among the three hospitals, one was a medical center, and its computerized consultation system, after reaching a maturity, was superior to the other two hospitals. However, some indicators including the quality of the system, the problems of computer shutdown and its arrangement, were not different in three hospitals. The period using the computerized systems in various hospitals is related to the software system that they used. The age of users and their satisfaction to the system were related to the levels of the hospitals. This each concludes that the factors affecting the performance of the systems were quite different in (1) users’ understanding of the computers, (2) the development of computerized system, (3) the training in using the consultation system, and (4) the timing of the hospital to develop the consultation system. Through the use of computerized consultation system, the records of consultation can be stored into medical record, also medical personals can instantly understand patients’ condition, so to improve the quality of patient care. The study on computerized consultation system enables one to understand its current status and problems. The results of this study may provide a useful information for hospital authority to develop a better system and to evaluate the system. |
