微軟小畫家應用在手術紀錄電子設計與介紹

Microsoft Paint Software Applied to Digital Graphics Painting on Operation Notes of a Hospital: Prototype and Introduction

推動病歷電子化面臨著手術紀錄圖檔處理的困難，以致醫院仍以手繪的紙張作業，無法臻及電子病歷無紙化之目的。本研究以微軟小畫家軟體搭配觸控式螢幕，傳遞圖檔參數的技術與醫院資訊系統相結合的設計實體，對外科系醫師進行可行性評估與調查，發出問卷109份，回收87份，回收率79.8％，主治醫師佔61％，住院醫師39％。利用Ferguson鑑別係數(Delta)檢定醫師在各題看法上的意見是否一致。拔靴抽樣方法進行Delta係數95％信賴區間的估計。研究結果顯示，四個問項題目：(1)我具能力操作小畫家的介面；(2)我能接受手術圖檔之存取流程及回應速度；(3)手術圖檔電子化是簡易可行的方式；(4)手術圖檔電子化對門診減送病歷具正面的意義，皆呈統計顯著性持正面可行性的看法，主治醫師與住院醫師間在各題項上，皆未呈統計顯著性差異，研究結果作為醫院進行推展手術紀錄圖檔電子化決策的依據參考。

Hospitals encounter problems with graphics on operation notes when implementing electronic patient medical records. The aim of this study was to apply Microsoft paint software (or simply MP) onto graphics painting on operation notes of a hospital. A prototype of digital OP note graphics was designed and demonstrated to 109 surgeons. A questionnaire with a 5-point (from extreme agree to disagree) categories regarding opinions on OP note graphics via MP was designed and required to response from surgeons who attended a morning meeting in March of 2009 and participated in the demonstration of MP applied to OP notes. A total of 87 surgeons had responded to questionnaires (recovery rate=79.8%), of them visiting physician accounted for 61%, resident 39%. Ferguson's Delta (1949) ranged from 0 to 1 was used to judge opinion consistence, the lower value with the high consistence in opinion judgment. Bootstrap sampling approach was used to estimate 95% confidence interval of Delta coefficient. Results showed that those four questions, including (1) agree to own a competent skill of painting OP notes with MP; (2) agree to the designed flow of digital graphical OP notes retrieved and saved as well as their response time; (3) agree to digital graphical OP notes feasible and applicable; (4) agree to the meaning and contribution of reduction in transmitting and turning around patient charts with digital graphical OP notes applied in outpatient department, earned significantly and highly consistent in opinion agreement. No differences across all questions were exhibited between visiting physicians and residents. The findings could provide hospital managers with references in a decision making on digital graphical OP notes implemented in future.