醫學影像儲傳系統(PACS)建置之績效評估---以高屏區某區域教學醫院為例

Evaluating the Efficiency of Picture Archiving and Communication System (PACS) Installation and Clinic- al Implementation---A Regional Hospital in Kaohsiu- ng - Pingtung Area Experience

王宗揚(Tsung-Yang Wang)

指導教授 ： 邱亨嘉

高雄醫學大學/健康科學院/公共衛生學研究所碩士在職專班/碩士(2004年)

摘要

研究目的：使用平衡計分卡的財務、顧客、流程、學習與成長四個構面評估PACS設置之績效，並探討PACS設置對流程縮減之效果與PACS設置投資之回收期。
研究方法：研究對象為99名員工(醫院管理層、醫師、放射技術師)、91名患者、放射科三大流程(拍照、調片、歸片)調查資料、前後各7個月的放射科財務支出，詢問傳統X光片方式(PACS前)與PACS方式(PACS後)四個構面的滿意度分數，與比對放射科流程步驟數及時間，與放射科的片庫人力與耗材資料，使用MS SPSS 10.0統計軟體進行統計分析與計算。
研究結果：員工問卷的傳統X光方式構面平均值為(2.14±0.65、2.40±0.60、1.94 ±0.54、2.14±0.58)，PACS方式構面平均值為(3.99±0.68、3.91±0.70、4.04±0.65、3.89±0.58)，患者滿意度平均值為4.10±0.72，放射科門診三大流程(拍照、調片、歸片)步驟數，傳統X光方式為(11、10、10) ，PACS方式為(9、1、0)，PACS前與PACS後財務支出，人力與耗材及各依變項統計檢定皆呈顯著性差異，PACS設置使用回收期限法計算出來的回收期是在第五年。
討論：由研究結果得知員工問卷在平衡計分卡的財務、顧客、流程、學習與成長四構面，PACS比傳統X光片表現更佳，且未偏頗一構面，患者滿意度也呈現肯定，對放射科三大流程在門診區、住院區、急診區有很大縮減效果，其中調片與歸片方面的速度PACS比傳統X光快甚多，因而也對相關人力的產生節省的效果，並對醫師臨床使用的提供較佳的便利性，與減少患者等候調片的時間，另外PACS對放射科的人力與底片耗材與片庫儲存空間亦有節省效果，投資的回收期是第五年開始回收。由此研究四構面的績效探討得知，PACS對醫院的財務、顧客、流程、學習與成長構面的皆有很好的績效表現，對於品質與可近性有很好的提升，對成本支出有很好的節省效果，是值得醫療院所投資的。
建議：未來研究者可投入研究PACS應用軟體WEB版本與主從架構版本之差異與比較，與不同科別間對PACS之滿意度差異探討。

關鍵字

平衡計分卡 ； 回收期限法 ； PACS

並列摘要

Objectives: Using 4 factors of the Balanced Scorecard: finance, customer, procedure, learning and growing, to evaluate the benefits of installation of PACS, besides investigate how the PACS installation would shorten the procedure and the investing refund period of the PACS installation.
Methods: The subjects of this study were 99 employees (administrators, doctors, radio-technicians), 91 patients, the 3 major procedures of radiology department (photographing, delivery of the films, returning of the films) data investigation, financial expenditure for 7 months before and after, enquiring the satisfactory score of the 4 factors concerning using the conventional X-ray (before using PACS) versus PACS (after using PACS), compare the number of the steps used by the radiology procedure and time consuming, the manpower working at the radiology department and the materials consumed. The results were statistically analyzed and calculated with the MS SPSS 10.0 statistic software.
Results: The staff questionnaire survey of conventional X-ray method factors mean value were (2.14 ±0.65, 2.40 ±0.60, 1.94 ±0.54, 2.14 ±0.58), of PACS method factors mean value were ( 3.99±0.68, 3.91±0.70, 4.04±0.65, 3.98±0.58).Patients satisfactory mean value was 4.10±0.72. The number of steps of the 3 major procedures (photographing, films delivery, films returning) at the radiology out-patient department, of conventional X-ray method was (11,10,10), of PACS method was (9,1,0). There were significant differences revealed from the analysis of financial expenditure pre-PACS and post-PACS, manpower and materials consumed. PACS installation refund period is in the fifth year, calculated with Payback method.
Discussion: From the results of the staff questionnaire survey the 4 factors of the Balanced Scorecard : financial, customer, procedure, learning and growing, PACS has better performance than the conventional X-ray, and do not bias to any single one factor. Patients’ satisfaction reveal the positive outcome, time consuming of the 3 major procedures of radiology department in out-patient department, admission, emergency department was shortened, the speed for films delivery and returning of the PACS was faster than the conventional X-ray, leading to the effects of saving more manpower. For the doctors, it provides better facilities of bed-side utility. It shortens the time for patient to wait for the films delivery. Additionally PACS has saving effect concerning manpower of the radiology department and space for storing the films. Investing refund period is from the 5th year. From study these 4 factors concerning their contributions, PACS establishes excellent outcome in the aspect of financial, customer, procedure, learning and growing of a hospital. It promotes better quality and increases availability. Additionally it saves the cost expenditure. Beyond these benefits, it is worthy for the hospital to invest in this installation.
Suggestion: The future research could involve into studying the PACS application software WEB edition, study the differences and the comparisons from the structural edition, investigate the satisfactory of the PACS between the different departments of a hospital.

並列關鍵字

PACS ； Payback method ； Balanced Scorecard

參考文獻

英文

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