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探索全民健保環境下使用電腦化之醫令輸入血統產生的非預期結果

Explore Unanticipated Consequences from Adoption of Computerized Provider Order Entry in Hospital under National Healthcare Insurance

摘要


背景:在美國越來越多醫療院所己採用醫令輸入系統(Computerized Provider Order Entry; CPOE)來改善醫療安全與降低健康照護成本。在台灣,為了因應全民健保制度,大多數的醫院採用CPOE來自應健保制度的變革。目前,三級醫療院所多數已採用CPOE做為健康照護的工具。CPOE的執行與整合,促進了健康照護,然而,也因此產生了一些意想不到的結果,在們稱之為非預期結果(Unanticipated Consequences)。先前的研究關於CPOE系統,指出COPE的應用產生錯誤藥物事件(Adverse Drug Events; ADE),與系統錯誤的結果,相對的CPOE也產生了潛在的正面意外結果,兩者都引起我們進一步討論的興趣。 目的:本研究參照之前的研究,主要在探索全民健保制度下醫療院所使用CPOE產生的正面或負面的結果。 方法:本研究以深度訪談法當成探索性研究的工具。訪談問題的來源是收集一所區域醫院的次級資料,與及期刊文獻做為依據。訪談以CPOE為中心的三種角色:主治醫師、資訊人員與健保申報人員,並由相關的專家進行資料編碼和分類。 結論:這份研究找出了全部178條非預期結果的描述,其中158條關鍵的結果由專家會議討論得到,集中在CPOE的使用、醫師行為、健保的合理性和病人安全。結論:這些結果根據創新擴散的分類加以編碼,並加以討論,得到51條(32%)的想要的結果,107條(68%)是不想要的結果,而有65%是直接關於醫師使用CPOE的非預期結果。

並列摘要


The more healthcare industries apply computerized provider order entry (CPOE) to reduce cost and risk of patient safety in United States. Mostly three-level hospitals have adopted CPOE for health care to cope with regulation of national health insurance, and arising healthcare services quality in Taiwan. CPOE promote healthcare, however, produces some unanticipated consequences. Prior researches argued some unintended consequences of CPOE such as adverse drug events and system errors. Some positive consequences accompanied with adverse consequences too, both elicited our interesting to study the further. This research explored both the desirable and undesirable consequences produced from usage of CPOE, and applied depth-interview method to interview three roles of the medical administration, physicians and information staffs. These identified consequences discussed detailed by categories of functionality of CPOE. Total 178 consequences were extracted from transcribed document of recording interviews, and identified 158 critical consequences through the panel rating. We coded these consequences based on stakeholders, functionality and categorization of Rogers' Diffusion of Innovation to understand insight of physician using CPOE. At result, these consequences classified desirable consequences of 5l (32%), undesirable consequences of 107(68%) and direct consequences of 102(65%).

被引用紀錄


李嘉龍(2012)。醫院建置電子化住院醫囑系統的影響因素- 以北台灣某醫療網為例〔碩士論文,國立臺灣大學〕。華藝線上圖書館。https://doi.org/10.6342/NTU.2012.02317

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