- 學位論文
醫學量表電子化之研究—以醫師用來詢問思覺失調症患者功能進步之功能量表電子化之執行計畫為例
Research on the Digitalization of Medical Chart – Digitalize SRG-PSP Scale for Schizophrenia Patients
摘要
根據文獻，目前醫學上將「功能」之恢復視為對思覺失調症患者治療之最終結果，因此治療過程需仰賴持續且有系統的診斷，才能有效評估功能恢復之成效，因此功能量表之設計與開發極為重要。而圖像化之個人與社會功能自我評估量表（SRG-PSP）在許多層面皆優於以往所開發之功能量表，最重要的點在於作答能更快速，且內容更簡單易懂，並能作為醫療人員、患者與家屬三方的溝通工具。 而本研究電子化SRG-PSP功能量表之計畫則為了解決以下其紙本量表使用上之問題：(1)紙本量表整理排序不易、(2)紙本量表記錄之資訊無法做有效率且有系統之分析、(3)就算紙本資料整理妥當後，仍有可能因當初漏題而分析困難、(4)紙本量表之使用難以有系統性的與患者一起的長期進步，達成功能康復之願景、(5)紙本量表無法加入產業界之幫忙於治療體系中。 本研究之計畫執行，首先透過與醫師們之專家訪談，來深入了解醫師們使用紙本之SRG-PSP功能量表之習慣、所遇之困難及其他未被滿足之需求等。分析訪談結果後，透過科技之幫忙，來打造電子化之SRG-PSP功能量表，使電子化後之系統能儲存不同時間所累積之患者診斷資料，並透過網頁快速分析多筆資料，建立患者功能分數折線圖、住出院資訊、用藥資訊及量表筆記等，這些自動累積下來之資訊，能協助醫師更有效率的進行分析與診斷，而與患者溝通量表之內容時，更能協助提升醫病關係，完整一系統之架構。而最後專案執行之結果也符合創新循環（VPS）與價值創造循環（VCC）之概念。 最後透過電子化計畫之執行提供解決方案於以上紙本使用上之問題，針對問題(1)至(4)之解決，本研究以所設計之電子化SRG-PSP功能量表系統，完善了資料庫分析、醫病共享與其價值創造循環。而針對問題(5)則結合產業鏈之運作，解決法律層面、技術層面及行銷層面之問題，而往後更能以各方醫師有系統性整合之資訊，來舉辦研討會，分享彼此之經驗，朝患者功能之康復願景邁進。 而電子化量表計畫之執行僅是精神疾病治療之起步，未來仍需許多計畫之執行來滿足創新循環中之願景、定位及情境之循環。透過持續的與各方產業鍊之運作，來持續動態之創新循環。
關鍵字
醫學量表電子化 ； 思覺失調症 ； 圖像化之個人與社會功能自我評估量表 ； SRG-PSP ； 電子化 SRG-PSP ； eSRG-PSP ； 創新循環 ； 價值創造循環 ； VPS ； Value Creation Cycle ； VCC並列摘要
According to literature review, psychosocial functioning is recognized as a necessary outcome for therapeutic success in schizophrenia. In order to assess the improvement of functionality of patients, the therapeutic process relies on continuous and systematic diagnosis, which makes the design and development of functionality scale important. The medical chart, Self-reported Graphic version of the Personal and Social Performance Scale (SRG-PSP), has several advantages over other scales developed before it. Most important of all, the content is more comprehensible and faster to answer, and it also serves as a communication tool between doctors, patients, and the family members of the patients. The research on the digitalization of the SRG-PSP scale is to solve the following problems when paper version of SRG-PSP scale is used. (1) Paper scales are disorganized and difficult to sort. (2) Information collected by paper scales is not capable of doing efficient and systematic analysis. (3) Even after the paper scales are organized, some of the answers to the questions on the scale may still be missing due to human errors and can cause the specific scale to be invalid. (4) Unsystematic paper version of the scale is hard to have long-term improvement with patients to achieve the vision of improving functionality. (5) Paper scale cannot gain value-added advantages in the therapeutic process from different industries. The research started with in-depth interview with the doctors to understand their habits, problems, and unmet needs when using paper SRG-PSP scales. After analyzing the conclusion of the interviews, the research gains help with technologies to build the digitalized system of SRG-PSP scale. The system stores the information of diagnosis from different patients from different periods, and through the computing of the website, the information could be transformed into line charts, summary table of medication used, daily total doze, periods in hospital, and notes taken. The accumulated information could make the diagnosis more efficient and could improve physician-patient relationship through communications in therapeutic processes. In the end, the whole digitalization system matches the Value, Positioning, Scenario (VPS), and Value Creation Cycle (VCC) as well. In conclusion, the digitalization project solved the problem when paper version of SRG-PSP scale is used mentioned above. To question (1) to (4), the designed digitalization system of SRG-PSP scale completed the data-computing, shared decision making, and the Value Creation Cycle. To question (5), the system cooperates with different industries to solve problems from legal, technical, to marketing level. Afterward, with systematic information collected from the doctors, seminars could be held to share experiences to help patients improve their functionality. However, the digitalization of medical chart is just the beginning of improvement of therapeutic process in schizophrenia. More projects need to be executed to fulfill the vision, positioning, and scenario when treating schizophrenia patients in the future. Then the dynamic cycle of VPS could be continued through cooperation with different industries.