探討運用IDEF 0與精敏對病人轉檢作業與醫院資訊系統之影響

Translated Titles

Exploring the Effects of IDEF 0 and Leagility Analysis on Patient-referral Operations of Hospital Information Systems



Key Words

電腦斷層掃描 ; IDEF 0 ; 精敏 ; 醫院資訊系統 ; Leagility ; Computed tomography ; IDEF 0 ; Hospital information system



Volume or Term/Year and Month of Publication


Academic Degree Category




Content Language


Chinese Abstract

近年來醫療資源共享已成為重要的議題,而醫療資源共享包含醫院合作、醫院資訊共享和病人轉檢等議題。其中,醫院資訊共享是將醫療訊息資訊化,讓醫院能傳遞醫療資訊給他家醫院。而醫護人員在進行不同的醫療作業時,需利用資訊系統得到所需的醫療訊息。若當病人轉檢時,所需的醫療訊息未完整的傳遞至轉檢醫院,則醫院轉檢流程的順暢性與轉檢病人安全會受到影響。故資訊系統如何達成傳遞訊息的完整性與時效性,則變成一個重要的研究議題。 故本研究針對個案醫院的轉檢作業之電腦斷層檢查作業流程,探討資訊流如何有效的輔助醫療作業流程以達成醫療資訊共享。本研究利用Integration Definition For Function Modeling (IDEF 0)分析醫院門診電腦斷層病人的轉檢作業之作業流與資訊流,另外,本研究以精敏來改善分析後的轉檢作業,其中精敏又分為精實與敏捷,本研究利用精實消除作業流程的浪費以及敏捷提升其資訊的敏捷性以達到醫療資訊共享,使醫院的資訊系統能夠處理多樣性的病人。 本研究針對個案醫院在三家院區進行醫療資源共享的過程,提供一套改善後轉檢作業之電腦斷層檢查作業流程與資訊流流程。透過有效的資訊流交換,在執行作業時可使資訊流能具備其完整性與時效性,並有效執行轉檢作業也可達到醫療資訊共享的目的,進而提升病人的安全。另外,有效的資訊共享與傳遞訊息有利於提升醫院的醫療品質。而本研究提出的架構可使當兩家醫院進行合作時,資訊系統能輔助醫療作業流程,並達成醫療資訊共享。

English Abstract

Recently, medical resource pooling has been an important topic. The types of medical resource pooling consist of hospital collaboration, communication between hospital information systems and patient-referring mechanism. Since patient’s data of hospitals becomes e-processing, hospitals can transmit patient’s electronic medical record (EMR) to other hospitals. If the referring hospital does not receive the referred patient’s EMR, the patient-referring mechanism will be delay and safety of the referred patient will be affected. Therefore, how hospital information systems can transmit patient’s EMR accurately and timely becomes a critical research issue. The objective of this research is to consider a computed tomography (CT) scan process of the patient-referring mechanism as a case study and to explore how the information flow can support the medical operations in order to accomplish medical resource pooling. This research adopts Integration Definition for Function Modeling (IDEF0) to analyze the operational and information flows of the CT scan of the referred patients. In addition, this research adopts the Leagility concept, which contains lean and agility, to analyze the CT patient-referring mechanism. This study uses the “Lean” concept to remove the non value-added medical operations and also apply the “Agility” concept to improve the feasibility of hospital information systems. As a result, hospital information systems can handle more uncertainty of patients. This research considers three hospitals and improves their operational flows of the CT scan of the referred patients. Through information sharing between these hospitals, the medical staff can perform medical operations more accuracy and timely. The modified patient-referring mechanism can fulfill medical resource pooling and improve patient safety. Further, effective information sharing and transmission can improve quality of care for patients. The proposed framework by this research can provide hospitals with a reference to achieve their medical resource pooling.

Topic Category 電機資訊學院 > 工業與系統工程研究所
工程學 > 工程學總論
  1. Abraham, J., & Reddy, M. C. (2010). Challenges to inter-departmental coordination of patient transfers: A workflow perspective. International Journal of Medical Informatics, 79(2), 112-122.
  2. Berg, M. (1999). Patient care information systems and health care work: A sociotechnical approach. International Journal of Medical Informatics, 55(2), 87-101.
  3. Beuscart-Zephir, M. C., Pelayo, S., Anceaux, F., Meaux, J. J., Degroisse, M., & Degoulet, P. (2005). Impact of CPOE on doctor-nurse cooperation for the medication ordering and administration process. International Journal of Medical Informatics, 74(7-8), 629-641.
  4. Bhakoo, V., & Chan, C. (2011). Collaborative implementation of e-business processes within the health-care supply chain: The Monash Pharmacy Project. Supply Chain Management An International Journal, 16(3), 184-193.
  5. Blobel, B., & Pharow, P. (2007). A model driven approach for the German health telematics architectural framework and security infrastructure. International Journal of Medical Informatics, 76(2-3), 169-175.
  6. Chang, Z., Mei, S., Gu, Z., Gu, J., Xia, L., Liang, S., & Lin, J. (2003). Realization of integration and working procedure on digital hospital information system. Computer Standards & Interfaces, 25(5), 529-537.
  7. Feufel, M. A., Robinson, F. E., & Shalin, V. L. (2011). The impact of medical record technologies on collaboration in emergency medicine. International Journal of Medical Informatics, 80(8), 85-95.
  8. Hendrich, A., Chow, M. P., Skierczynski, B. A., & Lu, Z. (2008). A 36-hospital time and motion study: How do medical-surgical nurses spend their time? Permanente Journal, 12(3), 25-34.
  9. Iversen, T. B., Melby, L., Landmark, A. D., & Toussaint, P. (2013). Managing variations from surgical care plans: Challenges for coordination. International Journal of Medical Informatics, 82(1), 47-57.
  10. Johannessen, L. K., & Ellingsen, G. (2009). Integration and generification-agile software development in the healthcare market. Computer Supported Cooperative Work-the Journal of Collaborative Computing, 18(5-6), 607-634.
  11. Kuo, T. C., Hsu, C. W., Ku, K. C., Chen, P.-S., & Lin, C. H. (2012). A collaborative model for controlling the green supply network in the motorcycle industry. Advanced Engineering Informatics, 26(4), 941-950.
  12. Naylor, J. B., Naim, M. M., & Berry, D. (1999). Leagility: Integrating the lean and agile manufacturing paradigms in the total supply chain. International Journal of Production Economics, 62(1-2), 107-118.
  13. Niazkhani, Z., Pirnejad, H., van der Sijs, H., & Aarts, J. (2011). Evaluating the medication process in the context of CPOE use: The significance of working around the system. International Journal of Medical Informatics, 80(7), 490-506.
  14. Ohno, T. (1988). Toyota Production System: Beyond Large-Scale Production. Cambridge, Mass: Productivity Press.
  15. Raghupathi, W., & Umar, A. (2008). Exploring a model-driven architecture (MDA) approach to health care information systems development. International Journal of Medical Informatics, 77(5), 305-314.
  16. Rahimnia, F., & Moghadasian, M. (2010). Supply chain leagility in professional services: How to apply decoupling point concept in healthcare delivery system. Supply Chain Management-an International Journal, 15(1), 80-91.
  17. Ren, Y. Q., Kiesler, S., & Fussell, S. R. (2008). Multiple group coordination in complex and dynamic task environments: Interruptions, coping mechanisms, and technology recommendations. Journal of Management Information Systems, 25(1), 105-130.
  18. Sambamurthy, V., Bharadwaj, A., & Grover, V. (2003). Shaping agility through digital options: Reconceptualizing the role of information technology in contemporary firms. MIS Quarterly, 27(2), 237-263.
  19. Sheikhtaheri, A., Sadoughi, F., Ahmadi, M., & Moghaddasi, H. (2013). A framework of a patient safety information system for Iranian hospitals: Lessons learned from Australia, England and the US. International Journal of Medical Informatics, 82(5), 335-344.
  20. Tucker, A. L. (2004). The impact of operational failures on hospital nurses and their patients. Journal of Operations Management(22), 151-169.
  21. 參考文獻
  22. Gardner, R. M., Pryor, T. A., & Warner, H. R. (1999). The HELP hospital information system: Update 1998. International Journal of Medical Informatics, 54(3), 169-182.
  23. Iacocca Institute. (1992). 21st Century Manufacturing Enterprise Strategy. Paper presented at the An Industry-Led View 1 and 2, Iacocca Institute (PA, Bethlehem).
  24. Mayer, R. J., Painter, M. K., & DeWitte, P. S.,IDEF Family of Methods for Concurrent Engineering and Business Re-engineering Application. ,Knowledge Based System Inc.,(1994)。
  25. Ouellette-Piazzo, K., Asfaw, B., & Cowen, J. (2007). CT healthcare failure mode effect analysis (HFMEA): the misadministration of IV contrast in outpatients. Radiology Management, 29(1), 36-44; quiz 45-37.
  26. Sahin, F. (2000). Manufacturing competitiveness: Different systems to achieve the same results. Production and Inventory Management Journal, 41(1), 56-65.
  27. Shortell, S. M., & Anderson, O. W. (1971). The physician referral process: A theoretical perspective. Health Services Research, 6(1), 39-48.
  28. Spahni, S., Lovis, C., Mercille, R., Verdel, H., Cotten, M., & Geissbuhler, A. (2007). Implementing a new ADT based on the HL7 version 3 RIM. International Journal of Medical Informatics, 76(2-3), 190-194.
  29. Victor, C. R. (1998). Pensioned off: Retirement and income examined. Ageing and Society, 18, 119-120.
  30. 中央健保局: 中央健保局轉診、轉檢作業規範. 2006. Source: www.kmuh.org.tw/www/pastsrv/s4.htm
  31. 王嘉玲,CALS 之模型方法分析---IDEF,ARIS 與OOA/OOD,中崗科技,(2006)。
  32. 行政院衛生署: 醫療糾紛鑑定案件. 2007. Source: http://www.mohw.gov.tw/cht/DOMA/DM1_P.aspx?f_list_no=608&fod_list_no=762&doc_no=1791
  33. 林成志,應用流程模式化支援企業再造工程,成功大學工業管理研究所,1996。
  34. 張淑真,急診病患轉診機制之研究:城鄉差異之研究,國立東華大學公共行行政研究所, 碩士論文,2008。
  35. 管孟忠, & 劉璧如,應用IDEF 於系統運維期之軟體支援流程建模,2010 年資訊科技國際研討會,(2010)。