提升診間免送紙本病歷成效之分析：以南部某區域醫院為例

An Effectiveness Analysis of Improvement Projects for Saving Outpatient Clinics from Delivery of Paper Medical Records: Using a Regional Hospital in Southern Taiwan as an Example

目的：免送紙本病歷措施的推動初期，未能達到普及的狀態，藉由針對未加入措施的醫師進行原因分析後，進行專案改善措施，以提升免送紙本病歷措施之成效。方法：本研究採用個案醫院醫師填寫開放式「診間免送紙本病歷原因調查」，分析出醫師未加入免送紙本病歷措施的原因有：軟硬體功能不足與操作不熟練等兩大原因。訂定開發與電子病歷相關繪圖與影像結合之軟硬體及個別指導醫師操作等因應對策，以提升醫師加入本院免送紙本病歷之意願。結果：2012年6月至2013年5月全院門診看診醫師共132位，改善措施前加入免送紙本病歷共67位醫師（50.8%），經2013年6月改善實施後提升至112位醫師（84.9%）加入措施。其他附加效益成效有：免調閱病歷由實施前之8,445本，提升至實施後41,852本，平均病歷單張節省免送紙本病歷總耗費節省59,797元（節省15倍）；免送紙本病歷工時，由實施前之1,008小時∕月改善至實施後608小時∕月，總節省之工時費用43,600元∕月；大夜班值班津貼費用每月節省8,800元；病歷儲存空間一年約節省病歷儲存空間1.63座。結論：透過以電子病歷取代實體病歷，可以達到節省病歷儲存空間、改善病歷存取時效、降低病歷管理與製作成本。因此對於目前現狀病歷管理之問題，以專案的手法提升本個案醫院全院診間免送紙本病歷，以達成健康資訊的串聯與整合。

Objective: Shortly after launching the policy of no paper medical record delivery at many hospitals, they generally failed to reach a satisfying coverage level. We pinpointed and analyzed on those physicians who did not join the effort in the first place to find out why, and conducted some improvement projects accordingly. The ultimate goal is to enhance the effectiveness of the campaign. Methods: In this study we employed an open-style inquiring form entitled “A survey on reasons behind for not taking part in the no-paper-medical-record policy,” which is to be filled by all physicians of the case hospital. From the answers we found two major causes, i.e. insufficient computer functions, both software- and hardware-wise, and being unfamiliar with the practice. To solve the problems, we made go some improvement projects including developing electronic medical records related software to combine drawings and photos with the text, and practicing one to one teaching to increase the physicians’ participating willingness in the policy. Results: There were only 67 physicians (50.8% of the total) joined the policy during the year of 2012.06 – 2013.05 at the case hospital. After the improvement projects were done, the number of participating physicians increased to 112 physicians (84.9%). Additional benefits includes: an immediate cost saving of NT$59,797 due to the numbers of not delivered paper records increased from 8,445 to 41,825, a work time cost saving of NT$43,600/month due to the reduction from 1,008hr/month to 608 hr/month, the overnight duty fee is estimated to save the hospital NT$8,800 per month, and the medical record storage space will bring about a saving of 1.63 units a year. Conclusion: Through using electronic medical records to replace the traditional ones, we can achieve several purposes: including saving space for medical records, improving the access time of them, and cutting down the cost of their making and management. From this study we’ve found that health and information can be linked and integrated much better by using improvement projects at the outpatient clinics of the case hospital.