| Abstract: | 大家幾乎普遍同意實施電子病歷系統之好處，然而成功的實施是很少的。當今電子 病歷系統集中於功能性，互通性和安全性，而使用性(Usability)的領域經常被忽略。一 個系統不考慮使用性，成功之機會是很小，即沒有電子病歷系統很難成功除非它考慮使 用性。 目前文獻對於在資源有限之環境下如何來改善電子病歷實施，尚未有相關研究。另 一方面，在資源有限之環境下，用來改善服務品質的方法有決策實驗室法、重要度-績 效分析法及貝氏網路等方法，因此本研究欲結合使用者評估、決策實驗室法、重要度- 績效分析法和貝氏網路來解決此問題。進而提升整體醫療照護品質，促進整個醫療院所 病歷的流通與整合，提升醫療資源運用效能。 本研究首先是觀察中區某一家醫院在電子病歷推行過程為整個任務(Task)目標，將 整個作業過程所發生錯誤與困難點記錄下來。並且對常發生錯誤與困難點分群，找出隱 藏之問題。並深入探討解決問題方法，設計相對應題目。第二步驟從文獻收集題目，訪 談醫護團隊相關領域專家進行滿意度調查，透過重要度-績效分析法分析得到急需改善 題目。並且應用在解決電子病歷實施所發生錯誤或困難點之方法編成題目加上滿意度問 卷所得急需改善項目，形成一個績效評估表。利用此績效評估表進行問卷發放，問卷內 容以評估每一問題之重要度為主，在訪談相同醫護團隊相關領域專家進行第二次調查， 得到最重要項目；並且在進行決策實驗室法針對電子病歷歷使用者進行相關問卷調查， 將相關資料進行困果關係探討，找出整個關鍵因素。最後建立錯誤模式、臭蟲(Bug)、任 務(Task)、績效評估表與績效指標之貝氏網路，估計貝氏網路所有參數，對電子病歷使 用者進行適性化評估，診斷出使用電子病歷所遇到可能之臭蟲或原因，再針對相對應績 效評估表之項目進行輔導補救，以達到醫院使用電子病歷具有效能、有效率及高滿意 度。並且提昇醫院整體服務品質與市場競爭力。
There is almost universal agreement on the benefits of an Electronic Medical Records (EMR) System, yet successful implementations are few. While EMR systems focus on the important areas of functionality, interoperability and security, the area of usability has been overlooked. No electronic medical records system can be viable unless it addresses usability. In the literature, it is difficult to find any paper, concerned about how to improve the performance of EMR implementation. On the other hand, DEMATEL, importance-performance analysis (IPA) and Bayesian network are the methods for improving service quality under resource limited environment. Therefore, we want to apply usability evaluation, DEMATEL, IPA and Bayesian network to deal with this issue. And then improve whole medical treatment care quality, promote the circulation and integration of the whole medical institutes' EMR, and improve the use of medical resources and use efficiency. A case study of EMR implementation was conducted in a hospital located in central Taiwan. First, define the whole tasks in EMR implementation. Then, observe the process of RMR implementation. Find all frequent mistakes and find out the hidden cause of each corresponding frequent mistakes. This can be done by expert opions or data mining. Finding remedial measures for each hidden cause which we called bug, we get performance questionnaire items. On the other hand, conduct a satisfaction questionnaire with importance information. Using IPA method to find the items needed to be improved immediately. Joint the items from the performance questionnaire items and items needed to be improved immediately together to get a whole performance questionnaire items. Conduct this questionnaire with the evaluation importance of each item. Design DEMATEL questionnaire by finding the important items. By DEMATEL method, we can identify the key factors of EMR implementation. Set up a Bayesian network among frequent mistakes, bugs, tasks and performance index. Estimate the parameters of the Bayesian network. Then, we have a system to evaluate and improve the performance of EMR implementation system for a personal EMR user. From the mistakes made by a personal EMR user, we can infer the bugs made by the user from Bayesian network. Then, find the remedial measures corresponding to these bugs. After taking remedial measures, the user can use the EMR to have efficiency, efficient and high satisfaction. And then improve whole medical treatment care quality, promote the circulation and integration of the whole medical institutes' EMR, and improve the use of medical resources and use efficiency. |
