長庚醫院實施門診醫囑電腦化管理實證研究

The Development and Implementation of a Computerized Operation System for Ambulatory Service in Chang-Gung Memorial Hospital

莊逸洲(Yi-Chou Chuang) ； 郭煇煌(Huei-Huang Kuo) ； 楊雯媛(Wen-Yuan Yang)

《中華公共衛生雜誌》 14卷1期 (1995/02) Pp. 88-102

https://doi.org/10.6288/CJPH1995-14-01-09

摘要

在醫療環境快速變化與同業競爭日益急劇的狀況下，有效率的醫療管理，必須以病患為中心，針對病患的需要，將有限的醫療資源作最有效的分配運用。近年來，由於電腦資訊系統與人工智慧的發展，輔助行政及醫療人員的工作，對醫院之經營管理帶來了重大影響。除行政人員外，醫療人員亦可透過診療行為的改變，採用更具效率之作業方式，達到品質與成本持續性的改善目標。本研究係從病患在診室看診開始，將醫師看診、醫囑輸入、檢驗（查）、回診預約、批價收費、配藥領藥等均納入電腦管理系統，其中最重要的改變是醫師亦加入管理改善的行列。為協助醫師能更有效、方便地使用電腦輸入醫囑，除在制度及軟、硬體方面依其需求規劃設計外，並建議醫師訂定標準診療計劃以輔助看診，據以執行。研究結果，比較醫囑電腦作業實施前後之效益，實施前批價作業人員每日服務208人次，實施後增加為364人次，藥品處方錯誤率由0.60%降低為0.07%，而病患對等候繳費時間之滿意度，採用電腦醫囑作業為47.5%，採用手寫作業為29.0%；對等候領藥時間之滿意度，採用電腦醫囑作業為56.2%，採用手寫作業為30.0%：統計均有顯著差異。

關鍵字

管理系統 ； 門診 ； 電腦化 ； 效率 ； 效益

並列摘要

The health care environment is under drastic changes with a lot of competitions within the business. A pre-requisite for effective and efficient management is that health care providers must be aware of the needs of their patients; and that limited resources have to be distributed efficiently. In order to minimize cost and at the same time maintaining good quality of medical care, a variety of strategies have to be adopted. In recent years, the impact of rapid development of computer information and artificial intelligence systems on hospital administration has been enormous. It is worth bearing in mind that behavioral habits of both administrative personnel and medical specialists could also be changed. This study aims to evaluate the effect of implementing a complete computerized system from registration to the collection of medicine. The most important point is that medical doctors are also involved in management improvement.
In order to assist medical doctors in using the system, they were invited to participate in development all the way, from choice of hardware and software, to the design of standard diagnostic procedures. Complete implememtation was carried out only when medical doctors were satisfied with the system. Results show that the mean number of persontimes served per day per service person increased from before 208 to 364 after the implemention of the computer system. On the other hand, rate of incorrect medicines discovered by pharmacists dropped from 0.6% to .07%. In addition, degree of satisfaction of patients is 47.5% by computerization and 29.0% by writing on waiting to pay for fees. On wainting for medicines, degree of satisfaction of patient is 56.2% by computerization and 30.0% by writing.

並列關鍵字

Management System ； Ambulatory ； Computerized ； Efficiency ； Effectiveness