統一台灣電子病歷的策略

Strategy for Unifying Electronic Medical Records in Taiwan

台灣自電子病歷（EMR）實施以來，已經超過20至30年，且大部分醫療機構已開發出自訂化的系統，提升了醫療效率。然而，隨著智慧醫療時代的來臨，電子病歷的角色面臨新的挑戰。在人工智慧（AI）技術的推動下，診斷輔助及臨床決策支持（CDS）等功能已逐步融入醫療系統。為了實現智慧醫療的潛力，醫療系統間的可互操作性（Interoperability）變得至關重要。本文探討了FHIR（快速醫療互通資源）在電子病歷標準化過程中的作用，FHIR的應用簡化了資料交換流程，並利用RESTful API技術，支持不同平台間的資料流通。美國透過《21世紀治療法案》推動FHIR的全國實施，對全球電子病歷發展有深遠影響。台灣也面臨類似挑戰，若未實現電子病歷的可互操作性，智慧醫療將難以發展。本文回顧了醫療資訊標準的發展，並探討LOINC、SNOMED CT及RxNorm等編碼系統對AI的支持。為促進台灣電子病歷的統一，政府提出資料統一、規則統一及應用統一三大策略，將有效提升醫療服務效率，推動智慧醫療生態系建設，並加速臨床試驗及新藥開發。

Taiwan has implemented electronic medical records (EMR) for over 20 years, with most healthcare institutions developing customized systems, significantly improving medical efficiency. However, with the advent of the era of smart healthcare, the role of EMR faces new challenges. Driven by artificial intelligence (AI) technologies, functions like diagnostic assistance and clinical decision support (CDS) have been integrated into medical information systems. To fully harness the potential of smart healthcare, interoperability between healthcare systems has become crucial. This article explores the role of FHIR (Fast Healthcare Interoperability Resources) in the standardization of EMR. The application of FHIR has greatly simplified data exchange processes and, through RESTful API technology, supports data flow between different platforms. The United States has promoted the nationwide implementation of FHIR through the 21st Century Cures Act, significantly impacting global EMR development. Taiwan faces similar challenges; without achieving EMR interoperability, the development of smart healthcare will be hindered. This article reviews the development of healthcare information standards and discusses the support of coding systems like LOINC, SNOMED CT, and RxNorm for AI. To promote the unification of EMR in Taiwan, the government has proposed three major strategies: data standardization, rule standardization, and application standardization. These strategies aim to enhance medical service efficiency, foster the establishment of a smart healthcare ecosystem, and accelerate clinical trials and new drug development.