病歷資訊管理時代的來臨,象徵一個嶄新時代的開始。然而在醫院進行資訊化過程中仍保有大量的紙本病歷運行著,面對電子病歷新時代,過去的紙本病歷包袱沉重,這些紙本病歷佔用龐大空間、耗費人力並且無法永久保存,要如何進行大量紙本病歷轉換成為一大課題。 目前國內對於電子病歷相關的研究議題,著重於電子病歷導入後所衍生的隱私權、資訊技術、共享效益、滿意度之影響因素等進行探討,尚未對於過去紙本病歷永久保存問題進行討論,故本研究目的在於瞭解紙本病歷保存各項決策因子,制定決策流程,並輔以成本差異分析方式探討不同保存策略之間成本差異,並建立決策系統工具輔助醫院進行決策。 本研究以回溯性個案研究法蒐集個案醫院相關資訊進行分析。為協助成本模型之建構,透過「損益平衡點」、「作業基礎成本制」、「院內自行掃描產能估計」、「不同方案間之成本分析」等方式綜合考量,建立成本分析模型。 結果發現個案醫院損益平衡點為9年,亦即紙本病歷透過外包倉儲方式保存只要到達9年則成本大於掃描成本;透過作業基礎成本制度分析醫院自行掃描成本資料,得知以目前作業效率下,平均每100萬頁掃描成本為84.8萬元,其中直接人員費用佔總費用支出高達57%,直接人員的作業效率將是自行掃描成本的關鍵影響因子;院內自行掃描產量估計方面,運用高低數平均法得知個案醫院年掃描量最高將可以達到167.2萬頁,最低為142.4萬頁;比較不同策略之投入成本,成本最低為方案一(超過法定保存年限之病歷立即銷毀);若要永久保存病歷資訊,成本最低為方案四(超過法定保存年限之病歷全數自行掃描),該方案個案醫院需加強資源投入,折衷之法為方案二(超過法定保存年限之病歷部分自行掃描,部分委外掃描)。 隨著電子病歷的導入,各醫院也同時面臨過去紙本包袱轉換的問題,本研究的結果及成本分析模型應可供醫院管理者及未來相關研究之參考。
The coming of information management of medical record signifies the beginning of a new era. However, before completely transforming into electronic health record, there still exist a huge amount of paper medical records in the hospital. The major defects of paper medical records include needing huge storing space, more staffing, and cannot be retained permanently. Therefore, choosing an appropriate strategy to transform traditional paper medical records becomes a vital issue. The purpose of this study was to construct a decision process by decomposing the cost of digitalizing traditional paper medical records, comparing the cost differences between outsourcing and home-made strategy, and developing a decision support system to assist managers in decision process. Applying the method of retrospective case study, this study conducted a cost analysis by using data of the hospital’s management cost, equipment items, medical record volume, manpower etc. To establish the cost analysis model, different methods, included break even point, activity-based costing, estimated the quantity of output and differential cost analysis of strategies, were considered. The results of cost analysis model in this study would be helpful to readers when making decisions to deal with the growing problems of medical records transformation.