運用安全憑證建構糖尿病人自主管理之網路健康服務系統

Building a Certificate-Based Secure Telemedical Health-Care and Self-Management System for Diabetic Patients

21 世紀的今天，糖尿病儼然已成為國人的最主要慢性病之一，其佔十大 死因排行榜為第四位。雖然我們已知道使用飲食、運動及藥物療法可以控制 糖尿病，並且有許多新藥被研發出來，但在台灣卻仍有許多病患因糖尿病合 併症如視網膜或腎病變，而導致死亡或殘障。這不禁讓人要問「是否現行 的治療模式，還隱藏著甚麼樣的缺失？」再者，現行健保政策為簡化民眾看 門診次數及就醫方便性，鼓勵慢性病患者，使用長達二至三個月的慢性病處 方簽。其立意甚佳，然而，在國人普遍對健康自主管理和糖尿病正確照護的 觀念不足峙，若沒有一個叮嚀機制時時提醒病患做好血糖控制峙，不免讓人 憂心其令併症發生率及死亡率是否又要向上攀升？有鑑於此，我們乃運用目 前的資訊科技及遠距醫療觀念，設計一套新的糖尿病照護模式，提供醫病之 間更密切互動的血糖監測控制系統，以填補因門診就醫問隔拉長而產生可能 延君診治的漏洞，並且在確定網路安全與病人隱私保護優先的前提下，協助 病患降低今併症發生的機會。若以經濟觀點來看，如果能夠建立國人自我對 糖尿病正確的照護觀念、掌握即時有效的治療，同時建構以安全遐證為基礎 的網路健康服務及自主管理在統，當可為政府節省不少醫療開銷，消5耳健保 赤字，同時也提昇了病患生活品質。

The prevalence of diabetes continues to rise worldwide. It is the 4th leading cause of death in Taiwan. Persons with diabetes often struggle to keep their blood glucose level in a normal range or close to normal to prevent or delay complications caused by the disease. Though we realize to treat diabetes with diet, exercise, and medicine control, and there have been many update methods to upgrade our ability, there are still many patients suffered from diabetic complications resulting into mortality or disability. The epidemiological burden of diabetes is changing the classical model of diabetes management, in which a specialist center delivers care based on registration, recall and regular review. The internet is used worldwide as a communication tool. To improve the quality of diabetes control, we show a program which allows patients with diabetes to transmit their self-monitored blood glucose data directly from their personal glucometer device to their diabetes care provider over the internet. No customized software is necessary on the patient's computer, only a web browser, MOICA and active Internet connection. We use this example to highlight public key infrastructure and security measures that should be considered for devices that transmit healthcare data to remote locations. The Internet continues to grow at an accelerating pace, and it is clear that it will serve as an increasingly central role in the healthcare process. With these advances, authentication, non-repudiation, security, confidentiality, and data integrity concerns have been raised.