雲端藥歷對藥品醫囑行為改變及品質成效之研究

為提升民眾用藥品質，健保署結合雲端科技技術建置，以病人為中心的「健保雲端藥歷系統」，提供醫師於臨床處置、開立處方，及藥師用藥諮詢時即時查詢病人用藥明細紀錄。於104年起，中山醫學大學附設醫院將健保雲端藥歷系統，導入醫院HIS電子病歷跟醫院內病歷系統連結後，開始推動執行雲端藥歷系統輔助醫療決策。因此，本研究分析透過醫師或藥師在查詢雲端藥歷統，是否作業上可行？是否可以避免重複開藥用藥，提升用藥品質。研究分析時間為 104年第一季起至107年第四季。結果呈現，中山醫學大學整合式的雲端藥歷上線，執行成效佳，尤其是高血壓藥、降血糖、降血脂藥、抗思覺失調藥、安眠鎮靜藥及抗憂鬱藥物等，在將雲端藥歷系統跟醫院內病歷系統連結後，一旦跨院診療時，有重複開藥或藥物有交互作用時，系統就會主動跳出警示視窗，讓民眾用藥更安全，也可避免浪費健保資源。對重複處方或調劑用藥之改善、多重用藥合理管理、每張處方單藥品數量節約、避免藥品不良反應、避免藥品不良交叉作用、減少慢性病患者處方藥品開立數與多重用藥風險、合理藥費管控等，均有很大助益，可保障民眾用藥安全及避免健保浪費，確保病人高品質醫療照護。 106、107年中山醫學大學附設醫院各季重複用藥與前1、2年同期比較，均呈現降低情形，比較104年高血壓、高血脂、糖尿病、抗憂鬱症及安眠鎮靜等類藥品用藥日數重疊率，與後期（106-107年）比較，均呈現顯著下降情形。顯示雲端藥歷對避免重複開藥，精神疾病患者的抗憂鬱症及安眠鎮靜等類藥品用藥較多與頻繁，過去重複開藥與多重用藥最為嚴重，但導入「雲端藥歷系統」之後，該類藥物下降幅度也最為明顯，106-107年數據呈現，抗憂鬱症及安眠鎮靜等類藥品重複用藥下降率最高。中山醫學大學附設醫院將健保雲端藥歷系統，導入醫院HIS 電子病歷大資料庫，跟醫院內病歷系統連結，可以整合病人在不同醫療院所診療的以往用藥紀錄。讓醫師在診療過程中，可查詢病患近期內使用過或正在使用的藥品，在開立新的藥物處方時，可依此審視是否有與既有藥物重複使用或交互作用的問題，明確知道開立藥囑應注意事項，除此之外，針對事前已經完成簽署同意書的病人，可以執行預先下載病人過往醫療資料，因為健保雲端藥歷資料已完成崁入中山醫學大學的病人就醫電子病歷資料庫中，HIS更可以主動監控醫師開立藥囑行為，如有重複開藥、藥物過敏、藥物交叉反應等，會警示醫師，保障民眾用藥安全。雲端藥歷導入醫療藥囑開立，可達到藥囑資料分享，輔助醫師藥師臨床決策，加速檢裡以病人為中心的診療決策，提昇醫療品質，促進病人安全，減少醫療資源浪費。中央健保署建置健保雲端藥歷系統提供病人歸戶用藥明細，建置目的為降低跨院重複開藥用藥問題，由結果亦得到印證。

關鍵字

雲端藥歷系統；重複開藥；用藥安全；藥物浪費；醫療品質

並列摘要

In order to improve the quality of medicine used by the public, the Health Insurance Department has built a patient-centered “Health Insurance Cloud Medicine System” with the help of cloud technology. It is called the PharmaCloud System. It provides doctors with instant patient medication records in regards to their dealings with pharmacists. When a person call on clinics , the physician can immediately check the last three months of records. The doctor first checks the patient's medication record through the PharmaCloud System, to avoid redundant medication or medication interaction, and improving healthcare safety. Since 2015, the Chung Shang Medical University Hospital has integrated the PharmaCloud System into hospital information system (HIS)，and connected into the hospital medical records system (EMR), and that the implementation of the PharmaCloud System with the clinical decision-making, especially focus on the drug prescriptions. Therefore, the study analyzes whether or not it is feasible for doctors and pharmacists to use the PharmaCloud System. The duration of this study was from January 2015 to December 2017. The results are excellent for the implementation of the PharmaCloud System into Chung Shang Medical University Hospital, especially for the prescription of hypertension’ diabetes’ hypolipidemic, sleeping pills ’ and anti-depression medications. If repeated or redundant taking of drugs or drugs interaction during prescription, the Chung Shang PharmaCloud system would automatically display a warning message to physician, this was beneficial for the safety of patients and avoid of redundant prescription or healthcare resources wasting, and rational drug control. These are all great benefits for safety, avoiding health insurance waste, and ensuring high-quality medical care. In 2018, the drug redundant rate in Chung Shang Medical University Hospital, compared with the same periods in 2014 and 2015, showed a specific reduction, especially for the prescriptions for hypertension, hyperlipidemia, diabetes, anti-depression‘ and sleeping sedation. This shows that the PharmaCloud System can avoid the redundant prescriptions. In the past, redundant drug and unnecessary prescriptions were serious problems, but after the introduction of the PharmaCloud System, there was a clear decline in these cases. Loading the patient's medication history through the PharmaCloud System also helps the pharmacist to explain the drug's function and characteristics, increase the patient's medication compliance, and helps the drug treatment achieve the maximum effect. The introduction of the PharmaCloud System helped with drug information sharing, assisted physicians and pharmacists with clinical decision-making, sped up patient-centered diagnosis and treatment decisions, improved the quality of medication, promoted patient safety, and reduced medical resource waste across multiple hospitals. Positive results for this were also confirmed.