建置多重使用者之TW-DRGs臨床編碼系統

Developing a TW- DRGs Coding System for Multiple Users

本專案以中央健康保險局公告TW-DRGs第三版為範本，建置臨床醫護人員及行政人員可使用之TW-DRGs臨床編碼系統，協助使用者獲得正確疾病診斷編碼，以降低醫療成本浪費、兼顧醫療品質的維持。目前各家醫院建置的DRGs編碼系統使用對象大多為疾病分類人員，甚少由臨床醫護人員使用，基於個案醫院希望藉由資訊科技的輔助以因應政策的實施，因此本專案主要目的在發展可供醫護人員使用之事前編碼「TW-DRGs臨床編碼系統」系統，並評估使用者對該系統之滿意程度。本專案中所建置之多重使用者之TW-DRGs臨床編碼系統，其系統功能除原編碼功能外，並結合醫療資訊系統之臨床路徑、歷史編碼資料、疾病碼的搜尋提示、編碼異常提示、醫療費用落點區域之費用管理、合併症／併發症診斷提示等，以因應TW-DRGs支付制度的實施。從使用者滿意度結果來看，使用者在系統使用方面均具有高度滿意度。因此，個案醫院推行TW-DRGs臨床編碼系統期能將醫療費用管控機制由過去疾分人員事後編碼申報，轉由臨床醫師事前控管為主，疾分人員為輔應屬可行。

This project was based on the TW-DRGs 3rd version announced by the Bureau of National Health Insurance and developed a TW-DRGs coding system (TW-DRGs-CS) for medical and administrative staff to help them get correct DRG codes of their diagnosis to further reduce the waste of medical resources and maintain the medical quality. Nowadays, most hospitals built the DRG coding systems for their coding specialist, few for physicians and nurses. Since the case hospital expected that information technology can help them cope with the policy changing, therefore the purposes of this project were to develop an innovative system-TW-DRGs- CS for their physicians and nurses, and evaluate users’ satisfaction of the system. The TW-DRGs-CS is for multiple users, therefore except the main function of DRG coding, the TW-DRGs-CS integrates the clinical path system in health information system, provides past coding records, searches the DRG code of disease, alters wrong DRG code, manages the medical expenditures, and reminds DRG codes of complications / comorbidities for physicians to cope with the policy change of TW-DRGs payment system. The result of users’ satisfaction showed users had high satisfaction about TW-DRGs-CS. That means, this project which case hospital changes the coding operation from post-discharge coding by coding specialists solely to mainly instant coding by physicians or nurses and partial by coding specialists when patients were diagnosed is practicable.