衛生署推電子病歷計畫延宕落後

[newshine]

衛生署推電子病歷計畫延宕落後

【聯合報╱記者李順德／即時報導】

2013.04.16 11:45 pm



行政院衛生署推動「電子病歷計畫」遲未定案，自民國99年起至101年止，總經費原規劃60.4億元，之後卻大幅縮水為10.5億元，至今不只未兌現，也失信於民，延宕改革契機，有違失，監院16日通過糾正衛生署。

監察院指出，目前全國醫療院所共500多家醫院、300多家衛生所及2萬多家診所，在衛生署推動電子病歷計畫後，全國已連結上電子病歷交換中心的醫院僅有142家，病歷交換數量仍低，尚不足以呈現應有的效果。


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[李誠民]

Try out the paperless NHS when doctors change jobs in the NHS
BMJ2013;346doi: http://dx.doi.org/10.1136/bmj.f946(Published 19 February 2013)
Cite this as:BMJ2013;346:f946

Every August, thousands of junior doctors rotate jobs. For some of us it occurs even more often. Usually, it involves a change of hospital, colleagues, job description, commute, and even accommodation, all of which is stressful. It also brings a mountain of paperwork, which is sent out 7-10 days before starting the job and requires urgent completion, despite the placement having been confirmed months before.

Today, in between night shifts, I filled in 15 different forms for my new employer, all of which I completed in different guises six months ago for a different trust. I also have to provide numerous documents to back up the data on the forms, all while surviving a relentless run of night shifts on intensive care.

I have had an NHS smartcard for four years and an NHS data card for six, but neither has ever been used by trusts to transfer my personal or professional data. Why can’t we sign a single form each time we are due to change jobs, under proof of identity, which allows our former NHS trust to electronically share our payroll details, occupational health details, and security checks? The saving of time, money, and paper would be enormous.

The aim of a paperless NHS by 2015 is an admirable goal.1 However, if NHS trusts cannot go paperless for the thousands of junior doctors in training jobs that rotate in a predictable way each year, how will it cope with the millions of unpredictable patients?

Doctors and politicians call for tighter rules on commissioners’ conflicts of interest, after BMJ investigation
BMJ2013;346doi: http://dx.doi.org/10.1136/bmj.f1810(Published 19 March 2013)
Cite this as:BMJ2013;346:f1810

Should the NHS work at weekends as it does in the week? Yes
BMJ2013;346doi: http://dx.doi.org/10.1136/bmj.f621(Published 21 February 2013)
Cite this as:BMJ2013;346

NHS will be paperless by 2015, says commissioning board
BMJ2012;345doi: http://dx.doi.org/10.1136/bmj.e6888(Published 12 October 2012)
Cite this as:BMJ2012;345:e6888
Paper records should be “eradicated” from the NHS as early as 2015, the NHS Commissioning Board’s national director for patients and information has said


Should the NHS work at weekends as it does in the week? No
BMJ2013;346doi: http://dx.doi.org/10.1136/bmj.f622(Published 21 February 2013)
Cite this as:BMJ2013

Should the NHS work at weekends as it does in the week? Yes
BMJ2013;346doi: http://dx.doi.org/10.1136/bmj.f621(Published 21 February 2013)
Cite this as:BMJ2013;346
...................

[李誠民]

Electronic Health Records and National Patient-Safety Goals
Dean F. Sittig, Ph.D., and Hardeep Singh, M.D., M.P.H.
N Engl J Med 2012; 367:1854-1860November 8, 2012DOI: 10.1056/NEJMsb1205420
.....Phase 1: Address Safety Concerns Unique to EHR Technology
.....Phase 2: Mitigate Safety Concerns Arising from Failure to Use EHRs Appropriately
.....Phase 3: Use EHRs to Monitor and Improve Patient Safety
/....Application of the Three-Phase e-PSG Framework
.....Summary
To create a coordinated, consistent, national strategy that will address the safety issues posed by EHRs, we propose that a concerted effort be made to improve health care safety in the context of technology use. This effort should address preventable risks that may hamper endeavors to create a safer EHR-enabled health care system. Further discussion and consensus among national agencies (e.g., the Office of the National Coordinator for Health Information Technology [ONC], the AHRQ, the Joint Commission, the Centers for Medicare and Medicaid Services) is clearly necessary for the adoption of future national patient-safety goals specific to EHR use. However, this approach must be given immediate priority considering the rapid pace of EHR adoption and the resulting changes in our nation's health care system. National EHR-related patient-safety goals are needed to address current problems with existing EHR implementations and failures to leverage current EHR capabilities. For instance, the ONC has recently taken several important steps in this direction with release of the revised 2014 EHR certification criteria (e.g., emphasis on user-centered design and application of quality management systems in the EHR design and development process58). Such efforts should be expanded in the future. Goals must be technically feasible, financially prudent, and practically achievable within current constraints and be accompanied by specific guidance on achieving them. Input on these goals must be sought not only from EHR developers and clinical end users but also from cognitive scientists, human-factors engineers, graphic designers, and informaticians with expertise in patient safety in complex health care environments. Creating unique EHR-related national patient-safety goals will provide new momentum for patient-safety initiatives in an EHR-enabled health system......

[空空空]

根本的問題在電子簽章
診所電子病歷要用電子簽證
就有無窮無盡的費用 → 無底洞啊

依衛生署的眼光來看
國外的「電子病歷」充其量只是衛生署的「病歷電子化」
因為人家不搞電子簽章這套東西

[amin30]

出張嘴巴說一說,沒經費,就叫診所自己出
可以請官員免費幫全台診所員工買1000台飛機專用嗎
何況電子病歷是一個無底洞,永遠在更新,病毒一來就毀了,可以靠那克流感嗎

[polo]

台灣民主國家卻老是在搞共產極權的勾檔 (打小人)

[李誠民]

...總經費原規劃60.4億元，之後卻大幅縮水為10.5億元，至今不只未兌現，也失信於民，延宕改革契機，有違失，監院16日通過糾正衛生署。....還好只花了10.5憶元!!!

ERH 無關病人安全(?!),所以電子簽章不是重點.....(N Engl J Med 2012; 367:1854-1860November 8, 2012)....美國推行的比我們要久,也要到2014年revise 才會公佈?!

....EHR design and development process58). Such efforts should be expanded in the future. Goals must be technically feasible, financially prudent, and practically achievable within current constraints and be accompanied by specific guidance on achieving them. Input on these goals must be sought not only from EHR developers and clinical end users but also from cognitive scientists, human-factors engineers, graphic designers, and informaticians with expertise in patient safety in complex health care environments(

[half8121]

[quote="李誠民"]...總經費原規劃60.4億元，之後卻大幅縮水為10.5億元，至今不只未兌現，也失信於民，延宕改革契機，有違失，監院16日通過糾正衛生署。....還好只花了10.5憶元!!!

ERH 無關病人安全(?!),所以電子簽章不是重點.....(N Engl J Med 2012; 367:1854-1860November 8, 2012)....美國推行的比我們要久,也要到2014年revise 才會公佈?!

quote]

所以到底要不要採用電子病歷呢?

最近新診所要成立, 展望號稱他們是第一家已經成功用電子病歷完成抽審作業的軟體商........

優點是以後不用再有實體病歷, 只要病歷頁就可以了, 也不用看完診貼病歷的動作, 以後抽審也是直接電子病歷送審.....

但是加裝電子病歷的電腦設備要4萬多!!......
還有以後病歷存檔的安全問題..(電腦中毒!??)

有沒有大大可comment 一下????

[chichang]

所以到底要不要採用電子病歷呢?

最近新診所要成立, 展望號稱他們是第一家已經成功用電子病歷完成抽審作業的軟體商........

優點是以後不用再有實體病歷, 只要病歷頁就可以了, 也不用看完診貼病歷的動作, 以後抽審也是直接電子病歷送審.....

但是加裝電子病歷的電腦設備要4萬多!!......
還有以後病歷存檔的安全問題..(電腦中毒!??)

有沒有大大可comment 一下????

沒地方放病歷的時候，再來安裝電子病歷。這就是我的考量

[空空空]

所以到底要不要採用電子病歷呢?

最近新診所要成立, 展望號稱他們是第一家已經成功用電子病歷完成抽審作業的軟體商........

優點是以後不用再有實體病歷, 只要病歷頁就可以了, 也不用看完診貼病歷的動作, 以後抽審也是直接電子病歷送審.....

但是加裝電子病歷的電腦設備要4萬多!!......
還有以後病歷存檔的安全問題..(電腦中毒!??)

有沒有大大可comment 一下????

先了解一下什麼是電子簽章
再決定要不要用
之前有討論過一大串
爬文找一下吧

[min]

官方盡推一些勞民傷財的措施。

[李誠民]

Electronic health record(EHRs)
American Recovery and Reinvestment Act of 2009.
computer-based provider order entry (CPOE)
Agency for Healthcare Research and Quality (AHRQ),
Centers for Medicare and Medicaid Services (CMS)
Office of the National Coordinator for Health Information Technology [ONC]
.........
都是要參院預算中心通過預算來執行!!!
反觀台灣立法院自柑成為行政院的立法局(???)
規劃的電子醫療系統,當然就是財團的利益,出錢的就事醫師與全民了!!! 10.5億買個經驗,值得嗎?!這可是美國要到2014年才有revise報告!!!......
監院真的有深入這問題何心嗎?

[李誠民]

Electronic health record(EHRs)
American Recovery and Reinvestment Act of 2009.
computer-based provider order entry (CPOE)
Agency for Healthcare Research and Quality (AHRQ),
Centers for Medicare and Medicaid Services (CMS)
Office of the National Coordinator for Health Information Technology [ONC]
.........
都是要參院預算中心通過預算來執行!!!
反觀台灣立法院自柑成為行政院的立法局(???)
規劃的電子醫療系統,當然就是財團的利益,出錢的就事醫師與全民了!!! 10.5億買個經驗,值得嗎?!這可是美國要到2014年才有revise報告!!!......
監院真的有深入這問題核心嗎?

[李誠民]

不知各位醫師大大!!您有看Chanel 45(?)的實習醫師影集嗎?!
有個住院醫師(?)急著 看球賽!可是要把病例一個 個簽好名! 主任過來說.:先簽好名 看球賽!可是要把病例一個 個簽好名! 主任過來說.:先簽好名再說!...
台灣病例是影印下來,...貼好,...醫師再需簽名的地方簽好!!!......
既不環保,也是病力一大疊!!---好難翻看!!!

[wipten]

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