建構跨院區之醫療查詢系統－以接種肺炎鏈球菌疫苗為例

Development of the Cross-branches Innoculation Search System-A Study of Pneumococcal Vaccination

張偉斌(Wei-Pin Chang) ； 吳振龍(Chen-Long Wu) ； 紀櫻珍(Ying-Chen Chi) ； 蔡婷婷(Tin-Tin Tsai) ； 何思慧(Szu-Hui Ho) ； 林均怡(Chun-Yi Lin) ； 梁元瑞(Yuan-Rui Liang) ； 柳景豑(Ching-Chih Liu) ； 劉德明(Der-Ming Liou)

《北市醫學雜誌》 3卷1期 (2006/01) Pp. 41-46

https://doi.org/10.6200/TCMJ.2006.3.1.06

摘要

目的：根據美國流行病學統計，每年有上千萬人罹患中耳炎與鼻竇炎，大約有50%是由肺炎鏈球菌感染引起，另外約有數十萬肺炎病例也都與肺炎鏈球菌有關，因感染肺炎鏈球菌而死亡的人數超過四萬人以上；對於肺炎鏈球菌所引發之相關疾病，又比起其他細菌常有更高比率的死亡率和併發症。根據研究臺灣社區感染肺炎約20%~22%是由肺炎鏈球菌引起，65歲以上老人感染此菌的死亡率高達42.5%，可見肺炎鏈球菌對於世人的健康是一大威脅。有鑑於此，臺北市衛生局與臺北市立聯合醫院為加強老人醫療保健服務，針對六十五歲以上之族群，於94年辦理「臺北市老人肺炎鏈球菌疫苗免費接種服務」，以降低老人因罹患肺炎導致嚴重併發症或死亡之機率，積極維護老人健康，減少醫療費用支出暨社會成本；不過由於注射此疫苗仍有其限制在，若在五年內重複接種此疫苗則容易造成身體不適之情形，且造成醫療資源浪費。故若在施打前得知病人之前接種記錄與接種時間，則可降低醫療資源浪費。方法：臺北市立聯合醫院雖然可透過資料交換平台查詢病人在各院區接種記錄，但因各醫療資料庫(HIS Database)仍歸屬各院區，故使用上仍需至各院區醫療資料庫中查詢，較為不便，且需花費較多之人力與時間。結果：因此本研究將透過SQL-SERVER上所提供DTS(Data Transform Service)服務，每天晚上定時自動將各院區之醫療資料庫下載並且彙整，提供單一查詢介面。結論：由於各院區病歷號目前並無統一，故需透過病人身份字號即可查詢出此民眾在任何一家市立醫院是否曾經接種過此疫苗以及詳細之接種時間，以達到「一家就診、十家市醫服務」的便利性與優勢。

關鍵字

肺炎鏈球菌疫苗 ； 跨院區查詢服務 ； 資料轉換服務

並列摘要

Background and Purpose: Streptococcus pneumoniae is a major cause of death in infants, children and the elderly. In spite of the availability of excellent drug therapies and health care, respiratory disease caused by Streptococcus pneumoniae is still a major health problem. In order to reduce the resources due to Streptococcus pneumoniae and hospital expenditures, the Taipei Department of Health collaborated with Taipei hospitals to implement a free vaccination policy for those over the age of 65 years. However, the vaccine inoculation still had limits, for example it has been associated with significant morbidity and death if repeat vaccine inoculations were given to patients within 5 years. Although all of the records in the 10 different branches of the Taipei hospitals were collected through medical data exchange platform, this sorting process was very time-consuming and inconvenient. Therefore, there is need for a tool to help maintain complete, accurate, and up-to-date inoculation records for patients. Methods: In this study, we applied the Data Transform Service (DTS) through SQL-SERVER to automatically download and gather all of the inoculation records of patients from the 10 different Taipei hospital branches every night. Results: We also developed a program which is able to execute data cleaning and data screening. The main advantage of this approach is to increase the server's efficiency and stability. The database index created automatically by DTS has been proven to be acceptably accurate so that medical researchers are able to finish the searching process in 1 second. Conclusion: Thus, before doing immunization with pneumococcal capsular polysaccharide vaccines, the inoculation records of patients can be checked carefully and quickly in each Taipei hospital branch by simply typing the patient's ID number to prevent the mistakes of repeat vaccine inoculations. This work is to provide a transparent and open infrastructure among the 10 Taipei hospital branches that can be used to monitor the safety of vaccine inoculations and to develop further medical information exchange applications.

並列關鍵字

Pneumococcal capsular polysaccharide vaccine ； cross-branches search service ； data transform service