總額預算下電子病歷系統動態模擬之研究

A Simulation Study on Dictation with Speech Recognition Applied to the Electronic Medical Records under Global Budgeting

醫院總額於七月起實施，知己知彼的零和資訊競賽，必為垂直整合策略聯盟的利器。而提昇電子病歷之「完整性」及「詳實性」才是因應用儕制約的客觀事務。因此，本研究目的在探討音辨聽打提昇醫師病歷輸入電腦的品質和效率、建置因果基模關係、模疑病歷電子化政策以為總額預算前瞻性的參考。本研究以美國M.I.T.發展出來的系統動力學，對模式中之參數（總額預算、病歷電子化程度、及導入語音聽打等）作可行性政策的模擬與分析。以某醫院三年的資產負債表為基礎，探討該醫院財務報表的流動性、安全性、收益性、營運槓桿度、及提供病歷分享的共異性等指標。先模擬電子病歷投入程度為30時的論量計酬、總額預算、及自主管理的100個月走勢情形。再就總額預算下，模擬電子病歷強化及導入音辨聽打系統之情境，觀察其100個月後的走勢差異。研究以系統動態模擬討論垂直策略聯盟是醫院總額互助合作的必要策略、引進音辨聽打以為病歷傳送及重覆檢查降低的同儕制的客觀依據。並建議政府協助引進國外高科技音辨聽打ASP系統，甚或低利貸款給醫院。同時建議醫院經營者，關注『病患為中心』的醫院評鑑，病歷書寫內容完整性，是醫療治療團隊更應及早因應的課題。

The purpose of this paper is to explore a possible suggestion for hospitals under blobal budgeting for the taiwanese health care system to implement the patient records digitalized. After building a model of system dynamics by composing several archetypes, such as ”Limits to Success, ””Growth and Underinvestment, ””Escalation, ””Success to the Successful, ”and ”Shifting the Burden”, 　consisting of causal loop diagrams depicting typical and problematic systemic sturctures to simulate the scenario of a Medical center to test any possible strategies to the situation of the health care. The paper suggests to utilize the Wed-based speech recognition and dictation system to help physicians dictate their unstructured patients’ records to be transcribed as text files and even if be automatically coded ICD in order to make the patient records shared possibly by the other medical ones, and then the hospital will be got more profits form global budgeting. As global budgeting is meant the entirety of the information systems used to monitor the performance of the health care financing and delivery system, and the associated regulatory processes by which health spending si controlled and allocated. We urgently recommend that a fully computerized patient records system should be comped with the function of “VIOCE…to TEXT…to DATA…to KNOWLEDGE”. If so, the ideal of “The electronic medical record. Good-bye paper chars, hello better patient care.” Could be realized completely.