台灣微生物檢驗資訊標準導入研究

A Unified Approach to Adoption of LOINC for Microorganism tests in Taiwan

陳佳苹(Chia-Ping Chen)

指導教授 ： 劉建財

臺北醫學大學/醫學院/醫學資訊研究所/碩士(2007年)

摘要

隨著資訊科技發展與檢驗技術的進步，目前大部份醫療院所的實驗室都建置有自己的檢驗資訊系統(Laboratory information system, 簡稱：LIS)，使用自行定義的院內檢驗碼開立檢驗單、檢驗結果確認以及檢驗資料的交換，當醫療院所間使用院內碼進行檢驗資料交換時，會因檢驗編碼的不一致，導致需要花費人力解析詮釋所交換的檢驗資料，也因此院內檢驗碼只適合在同一體系的醫療院所間流通，雖然中央健康保險局針對實驗室作業編列有檢驗項目編碼，但健保碼係以計價為出發點，對於檢驗項目分類原則以成本為考量，在施作成本類似下便不再加以細分，因此健保碼很難用來識檢驗項目資訊，也無法記錄臨床醫師診療處置，很難滿足臨床工作的需要，所以為讓檢驗項目資訊能具有臨床意義，採用檢驗資訊標準是必要的。

過去台灣有許多先進對於檢驗資訊標準化有相當的研究，其重點在於資料庫的自動化對應及如何將專家知識加以擷取，呂新傑在「建構Taiwan-LOINC 知識庫」研究中，引進了國際廣為採用的LOINC(Logical Observation Identifer Names and Codes)做為國內檢驗資訊標準，建立健保碼與LOINC碼對應的NHI-LOINC資料庫，讓有意願導入LOINC 的醫療院所透過健保碼將院內碼正確轉換成LOINC碼，雖然NHI-LOINC資料庫提供了健保碼與LOINC資料庫簡便的對應資訊，但對於微生物檢驗方法定義不完整，因此在微生物檢驗LOINC碼的對應幫助稍有不足，而各醫療院所作業環境不同，對於檢驗項目命名與健保支付標準也有所差異，除了健保支付項目外，也有非健保檢驗項目，像這類的檢驗項目無法透過NHI-LOINC資料庫對應LOINC。

本研究為改善微生物檢驗與LOINC的對應上不足，強化微生物檢驗項目與LOINC碼的對應系統，擴充微生物健保檢驗項目與NHI-LOINC對應資料庫並且提出非健保支付項目與LOINC對應方法，建立微生物檢驗名詞相關字資料庫，所建立的資料庫涵蓋了微生物檢驗使用的學名、慣用名稱、別名、縮寫、同義字詞等，因此具有相當的完整性，解決了非健保檢驗項目與LOINC對應問題，並設計線上對照輔助系統，提供醫療院所簡便轉換院內微生物檢驗項目與LOINC碼的方法，協助各醫療院所順利完成院內碼與 LOINC碼對應工作，進而促使各醫療院所、衛生主管機關及防疫中心間能彼此分享微生物檢驗資訊，達到傳染病通報與公共衛生組織溝通的目的。

關鍵字

健保碼 ； LOINC ； NHI-LOINC ； 微生物檢驗 ； 健康資訊交換第七層協定 ； HL7

並列摘要

With the diversified development and rapid growing of the information systems, compatibility of different medical information systems between hospitals become a critical issue for exchange of medical information. The compatibility issue results in ineffective data exchange and integration. Statistical analysis of such examination data can’t be complete in-situ, and has to be adjusted from one to another depending on exchanging content. In Taiwan, Most hospitals use local codes to report their Microbiology tests data. Using the local codes for exchanging the laboratory data makes different system unable to understand and reuse. Therefore, a standard for laboratory data exchange is very important for establishing a common interface and decreasing the complexity of medical records exchange.

Many researches have been conducted in the standardization of laboratory tests and clinical observations. Most of them focus upon automatic data recognition to the database and also adoption of expert’s knowledge. LOINC(Logical Observation Identifier Names and Codes) has been developed to facilitate the transmission and storing of clinical laboratory results among different sources of clinical laboratories since 1995. LOINC has been widely adopted internationally. Since NHI(National Health Insurance) codes have been used for insurance claim, they are adopted by most hospitals in Taiwan. In order to solve the difficulty in mapping of local code and LONIC in laboratory, Mr. Chi-Chieh Lu built up a NHI-LONIC database in his research “Build of Taiwan LONIC database”. This database allows each hospital who are willing to convert their local code to LOINC codes through NHI code. However, microbiology tests is usually very complicated and available for multiple choices. Somehow, it is still not fully satisfied for the mapping of microbiological tests and LONIC codes.

The purpose of this research is to use an extensively recognized LONIC code in laboratory information system, and have built up a microbiology LOINC mapping database. Therefore, it is necessary to collect the need of clinical data and result of laboratory tests in each hospital and expand the corresponding information of microbiological item and LONIC code in NHI-LONIC database through comparison of local code, NHI codes, and LONIC codes. In This paper, we present methods to create a microbiology related name database and develop a web-base assistant system for mapping local code of microbiology tests to corresponding LOINC. Our approach can reduce the learning curve and required domain knowledge for the LOINC. Hopefully, a common data exchanging system that can meaningfully differentiate laboratory tests and report can be established to assist laboratory data exchange in different hospitals and laboratory centers. In addition, methodology of converting local code to LONIC will be built up to improve the information sharing between hospitals, DOH(Department of Health), and CDC(Centers for Disease Control).

並列關鍵字

NHI ； National Health Insurance ； LOINC ； Microbiology test ； NHI-LONIC ； HL7

參考文獻

劉建財，王亮雯，溫立力，羅友聲，<建構國內檢驗院內碼與LOINC碼對應輔助系統>，醫療資訊雜誌，民95.09，15(3):29-40。

劉建財，呂新傑，王亮雯，陸偉輝，<建立健保碼與LOINC碼檢驗對應資料庫之研究>，醫療資訊雜誌，民94，14(3):63-78。

呂新傑，<建構 Taiwan-LOINC 知識庫>，臺北醫學大學醫學資訊研究所，碩士論文，民93.07。

Xiaoping Zhang, M.D., M.Sci, Soft Search and Stepwise Selection, A New Strategy for Loinc Mapping

Charles D. Hawker and Marc R. Schlank. Development of Standards for Laboratory Automation. Clinical Chemistry. 2000;46:746-750.