台湾医院U化经验谈(连载一)

Ubiquitous Healthcare in Taiwan

台湾全民健保自1995年实施至今,其成就已赢得国际的肯定,国际公共卫生学者与健康保险同业纷纷前来观摩。但由于人口老化、医疗科技进步及民众就医需求增加等因素,从2007年即开始出现上百亿元台币的资金缺口,财务压力逐年飙高,若无法提出有效的解决方案,财务状况则会持续恶化,将面临破产的命运。幸赖名闻全球的台湾信息科技,在全民健保实施之际,医疗院所为改善作业流程、提升服务效率与降低人力成本,即开始信息系统的开发与应用,让竞争激烈的医疗院所,得以顺利运作与经营,加上政府全面推动使用健保IC卡,并落实执行《国民健康信息建设计划》,让医疗信息的交换更为便捷,也促成电子病历的实施更为成熟。面对全民健保的财务沉痾,根本解决之道还是在于如何提升预防保健与公卫教育之层面,而非一味寻求增加保费或加税。因此,在二十一世纪初的台湾医疗服务,已从e化朝向m化的行动保健市场发展,除可全民共同解决健保财务问题外,并满足未来高质量生活水平的需求。随着云计算的发展,民众无论身在何处,只要有浏览器就可呈现自己的病历与健康数据,而医疗院所之间的沟通也是利用云架构来共享与提供有限且宝贵的医疗资源,也就是随时随地民众都能享受无所不在的医疗照护与健康管理服务。而以云计算科技所建构的远距医疗防护网,更可改变医院营运获利模式、建构医疗产业生态网络并可让大量信息同时传输与运算,以改善台湾全民健保的信息透明与财务压力等问题,以期能提供健保的财务沉痾一剂救命良方。更期盼藉由《台湾医院u化经验谈》,传承台湾医疗产业如何从e化、m化到u化的渐进发展历程与建置经验,携手两岸四地的医疗信息专家在医护专业主导之下,集思广益发挥良能共同发展健康管理云与医疗照护服务云来提升民众的健康,一起创造未来华人高质量的健康愿景。

Over the past 17 years, the National Health Insurance （NHI） system has successfully provided universal and high-quality healthcare to the people of Taiwan at an affordable cost. Today, Taiwan＇s NHI system has become a role model of a single-payer social insurance and has earned praise in the international society. However, because of rapid increases in NHI medical expenses, the NHI program is facing a financial imbalance. The increases in expenses have been caused by many factors, including rapid population aging, a dramatic increase in the number of patients suffering from catastrophic diseases, and the continuous introduction of new medical technologies, pharmaceutical products and medical devices. Fortunately, by means of Taiwan＇s advantage of information technology, hospitals have begun to develop and apply information system for improving business process, service efficiency and overhead cost when NHI program was implemented. In addition, the government adopted IC card for all individuals enrolled in the program at the beginning of 2004 and executed the National Health Infrastructure Project （NHIP） in 2008, that expedites the exchange of medical data and matures the use of electronic medical record. Facing the NHI＇s financial burdens, the fundamental solution is to enhance the preventive healthcare and public health education but not to increase the tax and premium. Therefore, the system of medical service delivery has changed from electronized to mobilized from the beginning of 21st century in Taiwan. With the incoming of cloud computing era, people can access their medical and health record via web browser anytime and anywhere. Hospitals are also able to share the limited and expensive medical resources under the cloud computing architecture. Nowadays, the ubiquitous healthcare services are more popular for people to utilize the medical care and health management in Taiwan. This paper shares the experience of national healthcare information infrastructure in Taiwan, and hopes all medical and information specialists can join together to develop healthcare cloud applications for China's Mainland to pursuit the vision of high-quality health.