建置無縫接軌癌症多專科團隊臨床資訊系統-以癌症多專科會議系統為例

Establishing a Seamless Integrated Cancer Clinical Information Platform for Cancer Multidisciplinary Team: Illustrated by the Case of Multidisciplinary Cancer Conference

朱原嘉(Yuan-Chia Chu) ； 蕭正英(Cheng-Ying Shiau) ； 姜崇信(Chung-Hsin Chiang) ； 李中原(Chung-Yuan Lee) ； 賴飛羆(Fei-Pi Lai) ； 廖振毅(Jhen-Yi Liao) ； 歐家維(Jia Wei Ou) ； 簡伶怡(Ling-I Chien)

《醫療資訊雜誌》 24卷4期 (2015/12) Pp. 27-38

摘要

目的：自西元2008 年第一屆癌症診療品質認證，臺灣各家參與此認證的醫院都認知到癌症資訊系統(Cancer Information System, CIS)的必要性。一個完善的癌診療系統必須能夠支援服務所有癌症多專科團隊，兼顧各癌特異性與全癌共通性，以無縫串接整合至醫院資訊系統(Hospital Information System，HIS)，即時分享資訊，降低醫療行政成本，同時提昇臨床照護品質，並能協助臨床癌症研究及教學。本研究主題是建置教學醫院之臨床癌症多專科臨床會議系統，以系統取代傳統紙本人工作業，軟體建置上使用服務導向架構(SOA)及Web Service 技術無縫整合HIS、CIS、癌症個案管理系統(Cancer Case Management System, CMC) 與醫療影像儲傳系統(Pictures Archiving and Communication System , PACS)。本系統協助多專科團隊照護病人，不論是在診斷期、治療期或是追蹤期，適時地提供相關適切的資訊內容，除了可以減少資料整理與會議結論文件製作的時間，亦使團隊成員能以最短時間了解病人現況，縮短臨床決策時間，減少資訊散落、人工作業繁複等問題。透過實作服務導向架構後，軟體工程師能專注開發核心功能與流程，除避重複撰寫已有的功能，且導入擴充式性，以滿足所有癌症現今與未來之臨床需求。結果：在服務質量上，本院所有19 個癌症多專科團隊皆使用本系統，普及率高達100%；在服務效益，每個案討論約節省醫護人員時間28 分，上線後實際討論個案數1,715 個案計算，約可節省處理時間33.35 天（如以1 天8 小時計算，約100.05 工作天）。結論：癌症病患接受多專科團隊照護的盛行率有逐年增加的趨勢，本研究成果可提供政策、實務及未來研究之參考。多專科團隊會議照護模式之成效可推廣至其他醫院以提升癌症照護品質。

關鍵字

癌症多專科會議系統 ； 服務導向架構(SOA) ； 網頁服務(Web service) ； J2EE ； RESTful

並列摘要

Every hospital has implemented the first accreditation program for cancer care quality since 2008. The participating accreditation program recognizes the importance of cancer information system (CIS). A comprehensive CIS should serve all cancer multidisciplinary teams (CMDT), managing not only common requirements of all cancers but also specific needs of individual cancer, and seamlessly integrate with the hospital information system (HIS) in order to share information, lower administrative costs, improve quality of clinical care, and facilitate research and teaching. Objective: The objective of this study is to create a clinical cancer multidisciplinary conference system (CMDTC) for a teaching hospital. Replacing traditional paper work and manual operation, the system adopts service-oriented architecture (SOA) and Web Service technology to seamlessly integrate HIS, CIS, Cancer Case Management System (CMC), and Pictures Archiving and Communication System (PACS). The CMDTC provides timely pertinent and specific information, before diagnosis, during treatment or at follow-up period, to assist CMDT in providing high quality cancer care. In addition, it shortens time for information collation and documentation, helps team members in prompt understanding of patients’ status, abridges time for clinical decision making, as well as resolves issues such as scattered information and cumbersome manual operation. Through SOA, the software engineers of CMDTC focus on developing core functions and procedures, avoid remaking / porting existing functions, and incorporate extendibility to meet the present and future needs of all cancers. Results: The CMDTC has been introduced and used by all the existing 19 multidisciplinary cancer teams in this hospital. On service efficiency and effectiveness, it saves 1,680 seconds on average per case for a medical staff every time when using the system. With total of 1,715 cases, this seamlessly integrated system would be able to reduce 33.35 days of operation time. In another word, if calculated with 8 hours of working hour each day, 100.05 working days would be saved. Conclusions: The prevalence of cancer patients received multidisciplinary team care increased gradually. The result can be the reference for policy making, practice and future studies. The multidisciplinary team care model can be applied to other cancers for improving the quality of cancer care.

並列關鍵字

Clinical multidisciplinary conferencing systems ； paperless ； seamless integration