Web-based PACS管理系統之研究與建置：以某醫學中心為例

A Study and Realization of a Web-based PACS Management System

蔡興國(Sinkuo Chai) ； 陳政男(Cheng-Nan Chen) ； 黃少美(Shao-Mei Huang) ； 施志融(Chih-Jung Shih) ； 李覃(Tain Lee)

《中華放射線醫學雜誌》 32卷1期 (2007/03) Pp. 17-26

摘要

醫學影像儲傳系統(PACS)的建置，已成為國內區域級以上醫院資訊化的主要目標之一，各級醫院先後導入使用PACS系統進而進入無片化環境。然而，大部分的醫院著眼於耗材、人力、儲存空間等成本之降低，而攸關醫療品質的管理功能普遍缺乏，一般PACS的缺失為，(1)影像遺失或漏照(2)病人影像方位標示方位標示錯置(3)資料錯誤或品質不良的影像無法立即刪除(4)廢片分析機制缺乏(5)放射線醫師中改報告內容，無紀錄可供查詢(6)外院提供的軟片與數位光碟無法有效提供醫師會診參考使用。另外，RIS相關管理亦為一般醫院所疏忽。
本論文以個人電腦建置一套於網基(WEB-based)環境下的PACS管理系統，採用雛型法(Prototype)進行系統設計，並整合現有PACS/RIS資料庫，除PACS管理部分外，並將放射線部門原先管理不足部分及新增業務一併列入，包含服務中心、病人安全、初階主管決策、系統基本資料維護，再以知識管理理論加以整理分析問題原因，希望達到主動管理、問題改善、避免醫療糾紛、提升品質、提高競爭力。
本研究達成的功能為：(1)異常報告追蹤主動通知臨床醫師及病人(2)主動式管理影像，影像不遺失，資料正確(3)特殊攝影排程、病人候檢時間、影像傳輸時間管理，締造以病人為中心的放射線部門服務(4)提升PACS/RIS系統穩定度(5)提升影像品質(6)提升使用者信賴及滿意(7)病人安全加強(s)提供主管及時性資料，做為主管決策。本研究亦設定了放射線部門與資訊室良性合作的模式，系統完成後，一般維護由使用單位管理者自行處理，肇因於程式設計良好的動態性及延展性。

並列摘要

Constructing a picture archiving and communication system (PACS) is becoming one of the major strategies of hospitals. In Taiwan, a number of hospitals have successively implemented PACS over the past decade in order to have a filmless environment. However, most of them are focused on the cost reduction that a PACS can bring about, while the necessity of a good PACS management is ignored. Without management, PACS may fail to handle problems such as: (1) image missing, (2) images associated with wrong patient names, (3) the need of deleting erroneous images or images with poor quality, (4) lack of scrapped film analysis mechanism, (5) lack of tracing of report modification, (6) films or CDs from other hospitals not meeting the diagnosis requirements. In addition, the management of a radiology information system (RIS) is often overlooked by the average hospitals.
In this thesis, we developed a web-based PACS management system to solve the problems described above. The system, designed by the method of prototype, also integrated the current PACS/RIS databases so as to develop related management functions for RIS, including the call center services, patient safety mechanism, executive information providing, and data maintenance. Furthermore, concept of knowledge management was introduced for problem analysis. The system was expected to help the hospital in various aspects such as active managing, problem improving, medical controversy avoiding, medical quality enhancing, and competition ability elevating.
The developed system has achieved several functions. (1) It automatically traces exceptional reports and informs doctors and patients. (2) It actively manages the image transmission and solves the image missing problem. (3) It provides patient-centered services that efficiently schedule the examinations and reduce waiting time. (4) It improves the stability of PACS/RIS systems. (5) The image quality is also enhanced by using the system. (6) System reliability and user satisfaction of PACS are increased. (7) The patient safety is improved. (8) The system also provides immediate information to department supervisors for decision-making. Basic maintenance of this system can be performed by the departments that operate it due to its dynamic property. This study is also a model of well-cooperation between radiology department and information center.