台灣大型醫院醫令資訊系統介面使用性評估之研究

An Interface Usability Evaluation of Physician Order Entry System on Large Hospitals in Taiwan

臺灣醫療體系日益重視病患安全議題，均期望運用資訊科技降低人為醫療疏失之可能。以開立處方為例，各大型醫院均建置醫令資訊系統(Physician Order Entry System, POES)，確實大為降低許多人為疏失問題的發生，但卻也因運用資料輸入方式取代傳統手寫方式，而衍生出人機介面(Human-Computer Interface)溝通失誤的來源。當系統設計師依據傳統設計理論與主觀認知進行醫令資訊系統介面設計時，極可能設計出具有使用性(usability)問題的介面設計。當醫師在操作介面後，可能因不當的設計而引起誤解或誤判，造成處方輸入錯誤，若藥師未善加把關，則用藥疏失將因而產生。本研究以介面使用性為主軸進行醫令資訊系統介面設計之探討，以期了解介面設計應考量的使用性問題與原則，並提供改善之建議。本研究主要以台北榮民總醫院、彰化基督教醫院以及楊梅天成醫院等三家醫院的POES為研究對象，進行醫令資訊系統介面使用性評估，研究執行共分為「釐清」、「採證」以及「確認」三階段，釐清階段主要執行前測及問卷調查法，獲取使用者端之介面使用性問題；採證階段則運用放聲思考法 (Thinking Aloud Method)，以錄影、音及筆記方式，採擷與收集醫師於實驗診間看診之操作介面狀況；於確認階段邀請使用性專家，在瀏覽錄影記錄後表述介面使用性問題，並連同使用者端之介面使用性問題一併提出修正建議。本研究之成果包括：(1)釐出醫師與使用性專家對醫令資訊系統介面使用性問題之認知共識與差異，並提出POES介面修正建議。(2)提出能確保安全性與可信賴的醫令資訊系統之介面設計原則。

As observing the trend of medical treatment system in Taiwan values the subject of the patient safety increasingly. All expect to reduce the possibility of medical errors using Information Technology. For example on patient's prescribe, most large hospitals develop the Physician Order Entry System (POES) by themselves to decrease man-made medical error, although computerized POES made great assistance on physician's prescriptions, but it is still far from perfect control system as we usually expected. On the case of keyboarded prescription which has replaced handwritten process, it is cause of the communication errors from HCI (Human-Computer Interface). While the inadequate user interface of POES derived from the traditional design methods and designers' subjective recognition, it may be raised the medication errors. By the point of view, the purpose of this study is to survey the interface design problems of POES at present. Moreover, to bring up the principles of the POES interface design and references for the health care system to prevent medication errors. The research of interface usability evaluation is targeted to three POES subjects from Veterans General Hospitals Taipei (VGHTPE), Changhua Christian Hospital, and Ten-Chen General Hospital. Totally studies are carried on three study stages: 'distinguishing stage', 'collect as evidence stage' and 'confirm stage'. The distinguishing stage is focused on implementations of pre-testing and questionnaire to obtain the interface usability problems from clients. On the collect as evidence stage, it apply Thinking Aloud Method using video/audio recording and hand-written note to collect the real users' operating records from the system interface. On the confirm stage, the usability experts state themselves views of interface usability problem and put forward amendments. The achievement of this research includes: (1) To distinguish the consensus and differences of the POES interface usability subjection between physicians and usability experts; (2) To bring out the design principles of the POES user interface to ensure patient's safeness and trustiness.