醫療保健與長照資訊整合系統

Information System Integrated with Healthcare and Long Term Care

1978年Alma-Ata宣言聲明基層醫療保健是達到全民健康的重要關鍵，而健康不僅是沒有疾病，而是一種完全的身體、心理和社會的安適狀態。台灣本土化社區醫療體系之發展，從區域醫療網、衛生所群體醫療執業中心、偏鄉整合式醫療保健服務，到1999年921地震之後的社區醫療群與家庭醫師整合制度，已建立一個結合個人健康紀錄（personal health record，PHR）雛形的社區基層醫療保健資訊整合系統。台灣近年來國家級健康資訊網的發展，從2008年的國民健康資訊建設計畫（National Health Informatics Project，NHIP），到2013年以PHR為核心的台灣健康雲計畫，利用雲端運算與大數據資料庫，連結公部門所有個人健康紀錄，提供健保雲端醫療資訊查詢及健康存摺下載提供個人健康管理，為要落實把健康資訊還給人民之口號，21世紀台灣在進入加速高齡化社會之後，如何整合醫療保健與長照服務，因應醫療費用增加與照護人力不足，已成為當前衛生福利政策最重要的課題。台灣家庭醫學會醫學資訊委員會PHR工作小組於2010發表了PHR指導原則，2016年又發展出多維度PHR內容架構，四個層面包預防醫學的四段七級、健康照護連續性、全人健康照護、生活輔助。以此架構為基礎，與埔里基督教醫院、愚人之友基金會合作，實作發展雲端資訊平台配合個人健康管理行動App之社區醫療保健與長照資訊整合系統。展望未來，2018年衛福部已推動通訊診療辦法，大幅鬆綁對社區基層醫療、長照照護及家庭醫師連續性照護之遠距醫療與遠距健康照護服務，將有助於建構一個無縫隙社區全人健康照護體系，以保障台灣全民健康。

The 1978 Alma-Ata Declaration stated the importance of primary health care to achieving health for all, and that health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. The development of Taiwan community health care system started from the regional medical network, the group practice center in public health station, and integrated delivery system (IDS) in rural area. After the great earthquake on Sep 21, 1999, personal health record (PHR) prototype in an integrated community health care information system was developed as a part of the community medical group and family doctor system. In recent years, Taiwan’s national health information network has grown from 2008 National Health Informatics Project (NHIP) to 2013 Taiwan Healthy Cloud Project with the PHR as core contents for cloud computing and big health data. All personal health records of the public sector can be retrieved during clinical visit and downloaded from health bank for personal health management to realize the slogan of returning health information to the people. In this accelerated aging society in the 21st century, how to integrate health care and long term care services in Taiwan has become the most important issue for the current health and welfare policy in response to the increase in medical costs and the lack of care manpower. In 2010 the PHR Working Group of the Medical Informatics Committee of the Taiwan Family Medical Association released the PHR guidelines. In 2016, it developed a multi-dimensional PHR content structure including four aspects of preventive medicine’s 4 stages 7 levels, health care continuity, holistic health care, and assisted living. Based on this structure and collaborated with the Puli Christian Hospital and Quixotic Foundation, an information system cloud integrated with healthcare and long term care was implemented with a mobile application (App) for personal health management in the community. For future prospect, in 2018, the Ministry of Health and Welfare started new regulation for diagnosis and treatment via telecommunication and greatly loosened the telemedicine and telehealth services for community primary health care, long-term care and continuous care of family doctors, which will help build a seamless community holistic health care system to protect the health of all the people in Taiwan.