The Ministry of Health and Welfare started offering subsidies to hospitals in 2010 for Internet development and to promote platforms for digitizing medical records. At present, 2,000 clinics and 142 hospitals in Taiwan have entered the electronic medical record exchange system. Two years from now it is anticipated that Taiwan will become the first nation to have a nationwide medical records system that links every hospital in the country. However, the financial burden on hospitals for setting up an operational electronic medical records system is formidable, and although each hospital might be satisfied with its own Internet connection, there are still complaints about how inconvenient it can be when trying to access medical records from other hospitals.
Taiwan Community Hospital Association and Airen Hospital president Hsieh Wu-chi says that running community hospitals is no easy task, especially as subsidies are being cut year after year, adding that it cost more than NT$3 million (US$101,372) to set up a digital imaging system able to save communications, tests and discharge summaries at Airen Hospital, while accessing the inter-hospital Internet connection also costs hundreds of thousands of NT dollars, he says.
Tri-Service General Hospital receives subsidies from the National Defense Medical Bureau, so it spent only NT$5 million to complete the entire hospital’s electronic system, which can now be utilized at 13 of the National Defense hospitals. The amount of money that each hospital is able to inject varies, while praise for digitization is relatively uniform. Chien Hsu-sheng, head of the IT department at Tri-Service General Hospital, says that in the past when a doctor wrote a prescription for a patient at the hospital it had to be delivered by hand to the pharmacy before the pharmacy would fill the order, which would typically take about an hour, but now that the system is digitized, pharmacies are able to automatically receive prescriptions as soon as a doctor writes them.
Photo courtesy of Tri-Service General Hospital
照片由三軍總醫院提供
With the digitization of medical records, wastewater is no longer being produced from developing photos either. Fan Chung-mei of Chang Gung Memorial Hospital’s Healthcare Management Department says that 60 ping (198.35m2) had to be used every year just to store new medical records at Linkou’s Chang Gung Memorial Hospital, but this has now be been cut by 70 percent. Time previously taken to make copies of paper medical records is now spared as well.
Hsieh says that the inter-hospital platform is sluggish, taking 45 seconds just to access a patient’s medical record from the National Health Insurance Administration on the Internet, adding that reviewing inter-hospital digital images can take several minutes. Hsieh hopes that digital medical records can reduce repeating the same tests, but says that patients will not necessarily be appreciative.
Hsu Ming-hui, head of the ministry’s Department of Information Management, says that since the central government began implementing the “project for expediting the digitalization of medical records at hospitals and clinics” in 2010, it is estimated that 48 health clinics in remote areas and half of all hospitals in Taiwan will be online by the end of the year. Over the next two years, NT$200 million in subsidies will be handed out with the goal of having hospitals in all areas and all of the more than 20,000 clinics online as well, Hsu says, adding that hospitals failing to cooperate will be subject to fines.
(Liberty Times, Translated by Kyle Jeffcoat)
Photo: Wang Hsiu-ting, Liberty Times
照片：自由時報記者王秀亭
衛福部二０一０年起補助醫院網路建設、推動電子病歷平台，全台已有兩千多家診所、一百四十二家醫院加入電子病歷交換系統。兩年後，台灣可望成為全球第一個全國醫院流通電子病歷的國家。不過，醫院要撐起電子病歷運作，財力是項挑戰。此外，雖然各院都對院內網路滿意，但讀取跨院病歷，仍嫌不便。
社區醫院協會理事長、愛仁醫院院長謝武吉感嘆，社區醫院經營不易，補助卻逐年刪減。愛仁建置數位影像儲存通訊、檢驗和出院病摘，成本要三百多萬元，租用跨院網路，一年也要好幾十萬元。
三總則因有軍醫局補助，花不到五百萬元就完成院內電子系統，在十三家國軍醫院通用。醫院投入財力不一，對電子化則一致稱讚。三總資管室主任簡旭生說，醫師為住院病人開處方箋後，以往人工送箋到藥局，再領藥回病房，得花一小時。電子化後，箋開好，藥局馬上收到。
病歷電子化也不再產生洗相片廢水。長庚醫院醫管部范仲玫指出，光收納林口長庚新增病歷，每年得擠六十坪空間，現在減七成，複製病歷也省去調閱紙本時間。
對於跨院平台，謝武吉則抱怨速度太慢，醫院透過健保署網路讀取病人用藥紀錄，要四十五秒，跨院讀取影像檢查，更要好幾分鐘。此外，電子病歷希望減少重複檢查，但病人也未必領情。
衛福部資訊處處長許明暉說明，中央自二０一０年「推動加速醫療院所實施電子病歷計畫」，預計年底全國四十八間偏鄉衛生所、過半醫院上線。未來兩年再補助兩億元，目標所有地區醫院、兩萬多家診所全上線。屆時仍未配合的醫院，將予處罰。
（自由時報記者邱宜君、魏怡嘉）
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