北部某醫學中心電子病歷創新應用及無紙化推展探討

A Study on Our Innovative Uses of EHR and Approach to the Paperless Goal

北部某醫學中心在實施電子病歷之前，因病歷紀錄資訊化仍須列印，造成紙本病歷單張倍數成長。於98年起配合衛生政策積極推動實施電子病歷，初期優先推動實施四大類單張電子病歷上線，而後逐步推動影響範圍大與耗紙量多的病歷表單資訊化，至今共實施139張電子病歷。在推動電子病歷後跨入病歷無紙化階段，因資訊系統資訊孤島問題，以致推動病歷無紙化及不送紙本病歷造成極大考驗。故開發整合提供以病人為中心完整電子病歷調閱程式，提供友善又快速的查詢病歷介面，以替代紙本病歷調閱流程。且在門診醫囑系統開發雙畫面功能，看診時可調閱本院電子病歷外，另一畫面亦可同時調閱外院電子病歷，提供醫師完整評估病人病史。104年9月起門診全面不列印門診病歷紀錄，病歷無紙化也推展至院外公文醫療查詢，檢附病歷資料改採燒錄光碟加密回覆。估算病歷紙張每年減少約367萬張用紙，累積高度約101大樓2/3，約減少4.6公噸二氧化碳排放量。又於105年4月起全面不送門診紙本病歷，因工作量下降後改採完全排班制，至106年9月病歷課實際人力由33人降為24人，大幅降低事務成本及人力成本。

Before implementing the changeover to electronic health records (EHR), or electronic medical records as we used to call them, at a certain medical center in Northern Taiwan where we are employed, the number of pages in each and every paper medical record created there had grown up by multiple folds because of these essential informative records needing to be printed. Ever since 2007, we have been actively promoting the shift to EHR to be in line with the government health policy. Initially, we gave priority to promoting an online, single-leaflet EHR registration system for each of four categories we roughly divided our entire business into, which was followed by a step by step gradual informatisalion of the records themselves harboring a wild range of influences and enormous paper consumption. So far, a total of 139 different sorts of EHR forms have been created and put into use. In the phase of pushing EHR into the paperless finale, due to that the island problems of the information system are causing tremendous hardships to the paperless version promotion itself and to avoid further circulation of the old paper records, we were forced to develop, integrate and sum up a complete patient-centered program for accessing EHR, which provided us a friendly and fast query EHR interface to replace the conventional paper medical records retrieval process, and the program turned out to be very important. In the outpatient order system we also added a new dual-screen function, during visiting hours the physician can read the hospital’s own EHR on one screen, and external ones on the other simultaneously, providing him/her a complete assessment of the patient’s medical history. Since September 2015, outpatient clinics have completely stopped printing outpatient medical records. This paperless endeavor was also extended to the medical documents outside the hospital with some modified checking and replying medical record data attachments to use CD-ROM and encrypted. We estimate that our annual medical record cost would be reduced by about 3.67 million sheets of paper, with a cumulative height of about two-thirds of that of Building 101, and about 4.6 metric tons of carbon dioxide emissions. In addition, since April 2016, we have also stopped sending paper records to our outpatient clinics, which enabled us to adopt a completely shift scheduling system due to the decline in workload. Up to September 2017, the number of staff working at the medical record management department actual manpower total decreased from 33 to 24.