http://www.libertytimes.com.tw/2009/new ... day-o5.htm
◎ 李友專
美國歐巴瑪政府之振興經濟方案中預計編列一九○億美金（相當於六四二六億台幣）提升健康資訊技術特別是電子病歷，其中八十九％的經費是用於獎勵醫院及醫師採用電子病歷，並強調符合獎勵辦法之電子病歷系統必須是「經過驗證」、「有意義的運用」以及「可以做病歷資訊交換分享」。繼布希總統之後，歐巴瑪總統也再度宣示：二○一四年每位美國公民都將擁有個人之電子病歷。另外中國也宣布將於二○○九年至二○一一年投入人民幣八五○○億元改革醫療體系的計畫，而投資於健康資訊技術，協助醫院建立電子病歷，將包括實現病歷數位化，以及建立區域性的病歷網路等為其重點項目。美、中分別投入龐大之經費於電子病歷之發展，其主要意義不外為利用病歷資訊之跨院交換，防止醫療浪費，減少醫療疏失，並提升整體醫療品質。而其電子病歷之相關技術（例如與臨床試驗系統之整合）亦可加速醫療生技產業之發展。
反觀國內，政府相關單位雖然近年來在經費上稍有投入，但電子病歷發展之核心一直圍繞於法規及褊狹的標準訂定問題上打轉，致使電子病歷推動近十年仍然發展遲緩且障礙重重。
電子病歷之推行是時勢所趨，正確的建置將對醫療院所、民眾及醫療照護產業帶來莫大的效益，日前其主要法規「醫療機構電子病歷製作及管理辦法」已適度放寬對於電子病歷時戳之認定，以便加速電子病歷之實行，實甚為可喜。如政府主管當局不再拘泥於電子病歷標準、法規之爭，以電子病歷真正之核心價值為推動藍圖，將法令之障礙排除、提出有效之誘因、並且在考量台灣民眾之需求、醫院流程及病歷資訊交換等需求的前提下建立標準，相信台灣全國人民擁有電子病歷之日亦不遠矣！（作者為陽明大學生物醫學資訊研究所教授兼所長，台灣醫療機構電子病歷推動聯盟召集人）
電子病歷 打鐵趁熱
版主: 版主021
Re: 電子病歷 打鐵趁熱
時勢所趨嗎？懷疑！MK 寫:http://www.libertytimes.com.tw/2009/new ... day-o5.htm
◎ 李友專
美國歐巴瑪政府之振興經濟方案中預計編列一九○億美金（相當於六四二六億台幣）提升健康資訊技術特別是電子病歷，其中八十九％的經費是用於獎勵醫院及醫師採用電子病歷，並強調符合獎勵辦法之電子病歷系統必須是「經過驗證」、「有意義的運用」以及「可以做病歷資訊交換分享」。繼布希總統之後，歐巴瑪總統也再度宣示：二○一四年每位美國公民都將擁有個人之電子病歷。另外中國也宣布將於二○○九年至二○一一年投入人民幣八五○○億元改革醫療體系的計畫，而投資於健康資訊技術，協助醫院建立電子病歷，將包括實現病歷數位化，以及建立區域性的病歷網路等為其重點項目。美、中分別投入龐大之經費於電子病歷之發展，其主要意義不外為利用病歷資訊之跨院交換，防止醫療浪費，減少醫療疏失，並提升整體醫療品質。而其電子病歷之相關技術（例如與臨床試驗系統之整合）亦可加速醫療生技產業之發展。
反觀國內，政府相關單位雖然近年來在經費上稍有投入，但電子病歷發展之核心一直圍繞於法規及褊狹的標準訂定問題上打轉，致使電子病歷推動近十年仍然發展遲緩且障礙重重。
電子病歷之推行是時勢所趨，正確的建置將對醫療院所、民眾及醫療照護產業帶來莫大的效益，日前其主要法規「醫療機構電子病歷製作及管理辦法」已適度放寬對於電子病歷時戳之認定，以便加速電子病歷之實行，實甚為可喜。如政府主管當局不再拘泥於電子病歷標準、法規之爭，以電子病歷真正之核心價值為推動藍圖，將法令之障礙排除、提出有效之誘因、並且在考量台灣民眾之需求、醫院流程及病歷資訊交換等需求的前提下建立標準，相信台灣全國人民擁有電子病歷之日亦不遠矣！（作者為陽明大學生物醫學資訊研究所教授兼所長，台灣醫療機構電子病歷推動聯盟召集人）
莫大的效益？請詳細說明！
當你要毀掉目前花大錢所建立的基礎，重新建構所謂新的東西，當然會有莫大的商機！但是對醫療好嗎？
私人小診所看一堆小病，這些紀錄對於病人萬一生大病，幫助有限，卻要花大錢去維護。真正有關係的訊息，早已記錄在轉診單內了，為何多此一舉？大醫院間檢驗資料（如CT,MRI等）早已數位化，只要將這些資料改成可在院所間交換就好，花小錢就可以，為何要大興土木？
如果病人隨便拿個USB隨身碟就可以copy病歷，請問如何確保資料庫不被病毒感染？
有沒有考慮到C/P值問題？
公家機構重要的資料庫可以花大錢來做維護、備份工作
私人小診所可能花大錢做備份維護工作嗎？
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herotopone
- V3
- 文章: 3600
- 註冊時間: 週三 2月 18, 2009 1:13 am
- 來自: 天王星
Re: 電子病歷 打鐵趁熱
空空空寫:
時勢所趨嗎？懷疑！
莫大的效益？請詳細說明！
當你要毀掉目前花大錢所建立的基礎，重新建構所謂新的東西，當然會有莫大的商機！但是對醫療好嗎？
私人小診所看一堆小病，這些紀錄對於病人萬一生大病，幫助有限，卻要花大錢去維護。真正有關係的訊息，早已記錄在轉診單內了，為何多此一舉？大醫院間檢驗資料（如CT,MRI等）早已數位化，只要將這些資料改成可在院所間交換就好，花小錢就可以，為何要大興土木？
如果病人隨便拿個USB隨身碟就可以copy病歷，請問如何確保資料庫不被病毒感染？
有沒有考慮到C/P值問題？
公家機構重要的資料庫可以花大錢來做維護、備份工作
私人小診所可能花大錢做備份維護工作嗎？
開業
醫學學識是基本功，嘴巴甜，身段軟才是真功夫
當病患在你面前批評其他醫師時，請不要太高興，同時有可能其他病患在另一位醫師面前批評你
醫學學識是基本功，嘴巴甜，身段軟才是真功夫
當病患在你面前批評其他醫師時，請不要太高興，同時有可能其他病患在另一位醫師面前批評你
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baleno
- R3
- 文章: 344
- 註冊時間: 週四 9月 20, 2007 10:09 pm
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delirium
- CR
- 文章: 647
- 註冊時間: 週六 12月 02, 2006 11:48 am
Re: 電子病歷 打鐵趁熱
剛出刊的 NEJM, April 16, 2009
Use of Electronic Health Records in U.S. Hospitals
ABSTRACT
Background: Despite a consensus that the use of health information technology should lead to more efficient, safer, and higher-quality care, there are no reliable estimates of the prevalence of adoption of electronic health records in U.S. hospitals.
Methods: We surveyed all acute care hospitals that are members of the American Hospital Association for the presence of specific electronic-record functionalities. Using a definition of electronic health records based on expert consensus, we determined the proportion of hospitals that had such systems in their clinical areas. We also examined the relationship of adoption of electronic health records to specific hospital characteristics and factors that were reported to be barriers to or facilitators of adoption.
Results: On the basis of responses from 63.1% of hospitals surveyed, only 1.5% of U.S. hospitals have a comprehensive electronic-records system (i.e., present in all clinical units), and an additional 7.6% have a basic system (i.e., present in at least one clinical unit). Computerized provider-order entry for medications has been implemented in only 17% of hospitals. Larger hospitals, those located in urban areas, and teaching hospitals were more likely to have electronic-records systems. Respondents cited capital requirements and high maintenance costs as the primary barriers to implementation, although hospitals with electronic-records systems were less likely to cite these barriers than hospitals without such systems.
Conclusions: The very low levels of adoption of electronic health records in U.S. hospitals suggest that policymakers face substantial obstacles to the achievement of health care performance goals that depend on health information technology. A policy strategy focused on financial support, interoperability, and training of technical support staff may be necessary to spur adoption of electronic-records systems in U.S. hospitals.
Use of Electronic Health Records in U.S. Hospitals
ABSTRACT
Background: Despite a consensus that the use of health information technology should lead to more efficient, safer, and higher-quality care, there are no reliable estimates of the prevalence of adoption of electronic health records in U.S. hospitals.
Methods: We surveyed all acute care hospitals that are members of the American Hospital Association for the presence of specific electronic-record functionalities. Using a definition of electronic health records based on expert consensus, we determined the proportion of hospitals that had such systems in their clinical areas. We also examined the relationship of adoption of electronic health records to specific hospital characteristics and factors that were reported to be barriers to or facilitators of adoption.
Results: On the basis of responses from 63.1% of hospitals surveyed, only 1.5% of U.S. hospitals have a comprehensive electronic-records system (i.e., present in all clinical units), and an additional 7.6% have a basic system (i.e., present in at least one clinical unit). Computerized provider-order entry for medications has been implemented in only 17% of hospitals. Larger hospitals, those located in urban areas, and teaching hospitals were more likely to have electronic-records systems. Respondents cited capital requirements and high maintenance costs as the primary barriers to implementation, although hospitals with electronic-records systems were less likely to cite these barriers than hospitals without such systems.
Conclusions: The very low levels of adoption of electronic health records in U.S. hospitals suggest that policymakers face substantial obstacles to the achievement of health care performance goals that depend on health information technology. A policy strategy focused on financial support, interoperability, and training of technical support staff may be necessary to spur adoption of electronic-records systems in U.S. hospitals.