開發線上新型冠狀病毒防疫供需儀表板

Development of Web-Based Dashboards for Demand and Capacity During COVID-19 Pandemic

台灣北部一2,600床教學醫院，在2020年1月23日成立COVID-19疫情指揮中心，負責人主持每日簡報會，有效地制定了跨部門政策。本研究團隊開發線上的COVID-19儀表板，為醫療管理提供視覺化和即時更新的數據，以精準迅速掌握疫情／醫療量能，適時機動地因應。本研究描述系統的開發架構，設計可供使用者點選，即時呈現圖表、數據的儀表板。每日午夜、每小時透過線上醫療資訊系統、實驗室資訊系統資料庫相互連結，將防疫相關的重要訊息，即時更新在院內網路的商業軟體儀表板，供疫情主管決策參考；包括SARS CoV-2 RT-PCR陽性結果的事件病例數、在該院診斷的確診病例數以及從其他醫院或社區隔離轉診的病例數、採取COVID-19隔離預防措施的病例數，專責病房或重症加護病房的床位數量，患有COVID-19的醫護人員數量，COVID-19相關的檢驗數量，以及社區監測警訊指標等。藉由實測各主題資料人工作業彙算和使用系統自動產生數據所花費時間，人工彙算所有項目每次需8.4小時方能完成，而系統最多只需要16分鐘點選和資料載入。疫情高峰期經常需要更新數據，人工作業根本不足以應付實際需求。另外，監測社區持續性指標，透過要因分析有效率地進行plan-do-check-act（PDCA）循環式品質改善措施，以確保達成目標。並在臨床端電子白板進行病人提醒註記，協助同仁能清楚病人分布及其隔離防護等級。運用資訊優勢，藉由精準快速、穩定一致、全方位的監測系統，事半功倍地爭取到更多時間，使感染管制在因應疫情、品質改善活動上有更多著力，間接提昇醫療品質與病人就醫的安全。

The Incident Command Center for COVID-19 pandemic has established since January 23, 2020 at this 2600-bed teaching hospital in Northern Taiwan. Superintendent chaired daily briefing and multidisciplinary or cross sector policies were made efficiently. This study aimed to develop web-based COVID-19 dashboards which report data visually and dynamically for healthcare system management. This article described the development framework of this information system, the design of the actionable layout for data presentation and evaluation of performance. Data were extracted automatically from web-based health information system and laboratory information system in the midnight at the development stage and later, renewed hourly during the peak of the epidemic. Data included number of incident cases with positive results of SARS CoV-2 RT-PCR and antigen assay, number of confirmed cases diagnosed in this hospital and those referred from other hospitals or community-based quarantine settings, active cases who receive COVID-19-specific isolation precaution, numbers of beds in dedicated wards or ICUs taking care of COVID-19 patients, and number of healthcare personnel with COVID-19. Infection control personnel took 8.4 hours to collect these data and summarize data for the report manually, while it took only 16 minutes by using selection screen in data processing and upload function of this system. Information technology also facilitated collecting mandated indicators for assurance of adequate implementation of SARS CoV-2 testing of this hospital during fall and winter. Indicators were generated efficiently and timely, thus, infection control personnel performed root-cause analysis, provided feedback to physicians, and achieved the target through the Plan-Do-Check-Act (PDCA) cycle. Besides, the notifiable COVID-19 cases were labelled on the web-based dashboard of the ward automatically while they remained in special isolation. Thus, the staff (including cleaning personnel) prepare in advance regarding personal protective equipment and other precaution accordingly before leaving the station and heading to patient unit. In conclusion, information technology facilitates infection prevention and control program to assure patient and occupation safety in the healthcare setting in the context of COVID-19 pandemic.