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題名 運用創新科技提昇病人安全之研究以台灣醫院為例
Improving Patient Safety Using Emerging Information Technology based on Taiwan Hospital Cases Research
作者 趙嘉成
Chao，Victor
貢獻者 季延平
Chi，YanPing
趙嘉成
Chao，Victor
關鍵詞 病人安全
創新科技
patient safety, mobile, RFID, Emerging Technology
日期 2006
上傳時間 14-Sep-2009 09:12:47 (UTC+8)
摘要 Applying information technology (IT) to support or magnify a competitive business strategy has been recognized which IT had adopted by enterprises. Many examples of various enterprises illustrate applying IT to create and sustain competitive advantage. Applying information strategy is becoming a trend for success and also for coping with dramatic environmental changing.The Institute of Medicine (IOM) brought patient safety issue into the public attention in its 1999 report “To Err is Human”. It is estimated those medical errors responsible for 44,000 and 98,000 deaths in the United States per year. Medical errors are causing patient’s death, permanent loss of health functions, etc.. Facing on these errors, main strategy for preventing errors is applying IT strategy. Many studies and surveys show that information technology can effectively reduce the rate of medical care errors and adverse events, up to 50%.Thus, information technology plays the role as a gatekeeper for promoting and protecting patient safety in various fields of medical care.
      The object of this thesis is from historical review to explore various IT strategies adopted by hospitals to improve patient safety and to explore of Taiwan hospitals applying patient safety information technologies to pursue patient safety and its contribution. We are designing this research by three phases. Phase I study, various of SCI literature review from 1990 to 2005 and in-depth interview with physicians, administrators from hospital was used to collect the data. Phase II study; from previous literature reviewed, the model and comments will gather from Phase I interviews to develop a structured questionnaire. Phase III study, In order to reduce the probability of misinterpretation, a Delphi approach was used to further revise and validate the extended framework, which has been synthesized from Phase I and Phase II study. Patient safety has become an important trend and international health facilities operation guidelines. Therefore, hospitals need a well-developed plan to implement in the near future by steps to achieve risk free hospital for patient treatment. We are happy to share our findings to hospitals and learn more on what we can do to make the hospital a safer place for all type of errors.Hospitals not only pursuing a patient safety goal by innovative information technologies but also diffusing, assiminating as a trend of enhance patient safety era.
     Key Words: Patient Safety, Medical Error, RFID, Electronic Medical Record.
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描述 博士
國立政治大學
資訊管理研究所
92356509
95
資料來源 http://thesis.lib.nccu.edu.tw/record/#G0092356509
資料類型 thesis
dc.contributor.advisor 季延平zh_TW
dc.contributor.advisor Chi，YanPingen_US
dc.contributor.author (Authors) 趙嘉成zh_TW
dc.contributor.author (Authors) Chao，Victoren_US
dc.creator (作者) 趙嘉成zh_TW
dc.creator (作者) Chao，Victoren_US
dc.date (日期) 2006en_US
dc.date.accessioned 14-Sep-2009 09:12:47 (UTC+8)-
dc.date.available 14-Sep-2009 09:12:47 (UTC+8)-
dc.date.issued (上傳時間) 14-Sep-2009 09:12:47 (UTC+8)-
dc.identifier (Other Identifiers) G0092356509en_US
dc.identifier.uri (URI) https://nccur.lib.nccu.edu.tw/handle/140.119/31078-
dc.description (描述) 博士zh_TW
dc.description (描述) 國立政治大學zh_TW
dc.description (描述) 資訊管理研究所zh_TW
dc.description (描述) 92356509zh_TW
dc.description (描述) 95zh_TW
dc.description.abstract (摘要) Applying information technology (IT) to support or magnify a competitive business strategy has been recognized which IT had adopted by enterprises. Many examples of various enterprises illustrate applying IT to create and sustain competitive advantage. Applying information strategy is becoming a trend for success and also for coping with dramatic environmental changing.The Institute of Medicine (IOM) brought patient safety issue into the public attention in its 1999 report “To Err is Human”. It is estimated those medical errors responsible for 44,000 and 98,000 deaths in the United States per year. Medical errors are causing patient’s death, permanent loss of health functions, etc.. Facing on these errors, main strategy for preventing errors is applying IT strategy. Many studies and surveys show that information technology can effectively reduce the rate of medical care errors and adverse events, up to 50%.Thus, information technology plays the role as a gatekeeper for promoting and protecting patient safety in various fields of medical care.
      The object of this thesis is from historical review to explore various IT strategies adopted by hospitals to improve patient safety and to explore of Taiwan hospitals applying patient safety information technologies to pursue patient safety and its contribution. We are designing this research by three phases. Phase I study, various of SCI literature review from 1990 to 2005 and in-depth interview with physicians, administrators from hospital was used to collect the data. Phase II study; from previous literature reviewed, the model and comments will gather from Phase I interviews to develop a structured questionnaire. Phase III study, In order to reduce the probability of misinterpretation, a Delphi approach was used to further revise and validate the extended framework, which has been synthesized from Phase I and Phase II study. Patient safety has become an important trend and international health facilities operation guidelines. Therefore, hospitals need a well-developed plan to implement in the near future by steps to achieve risk free hospital for patient treatment. We are happy to share our findings to hospitals and learn more on what we can do to make the hospital a safer place for all type of errors.Hospitals not only pursuing a patient safety goal by innovative information technologies but also diffusing, assiminating as a trend of enhance patient safety era.
     Key Words: Patient Safety, Medical Error, RFID, Electronic Medical Record.		en_US
dc.description.tableofcontents Chapter 1
     
      Introduction…………………………………………………………………...1
     1.1. Rationale and motivation……………………………………………………...1
     1.2. Research purpose….………………………………………………………….1
     1.3. Research scope…….………………………………………………………….2
     1.4. Theoretical fundation……………..……………………………………………3
     1.5. Research Method…..………………………………………………………….4
     1.5.1. Phase I study…….…………………………………………………………..4
     1.5.2. PhaseII study…..………………………………………………………….....4
     1.5.3. Phase III study….…………………………………………………………….4
     1.6.Research limitation….. ……………………………………………………………6
     Chapter II
     Literature review …...........……………………………………………….....7
     2.1. Diffusion of Innovation Theory ……………..…………………………………....7
     2.2. Health service management …………………….……………………………….7
     2.3. IT strategy……………………………………………….………………………….8
     2.4. Apply IT strategy promote organizations’ competitive advantage………........10
      2.4.1. RFID IT strategy adopted by health care provider….……………..………...11
      2.4.2. Enterprises applying advanced information systems to strengthen
      managerial power……………………………….………..…………………….12 2.4.3. Technology innovation of RFID, 1990 to 2000……..………………………..13
      2.4.4. Organization adoption of RFID, 1990 to 2000……………………………….13
      2.4.5. New Challenges, and Organization Diffusion, 2001 to 2005………….......14
      2.4.6. Organizational Diffusion, Supply Chain management, Health,
      Privacy and Others, 2001 to 2005……..………………..…………………….15
      2.4.7. Health Organization Adoption, 2000 to 2005……..………………………….18
      2.4.8. Privacy and Security………………………………………..……………........19
      2.4.9. Trends and Forecasts………………………..…………………………………20
      2.4.10. Enterprise Adoption of RFID………………..………………………………..20
      2.4.11. RFID Applied in the Health Industry…………………………………….22
      2.4.12. New Challenges of RFID promotion and adoption by enterprises…..24
      2.5. Mobile Technology…………..….……………………………………………25
      2.6. Patient safety………………………………………………………………….26
      2.7. Health Care management core issue: Patient safety……………………..27
     2.8. FIT: threaten patient safety of human errors ………………………………27
     2.9. Apply IT for patient safety strategy………………………………………….28
     2.10. Kinds of IT systems …………………………………………………………29
     2.11.Patient safety………………………………………………………………….30
     
     Chapter III
      Methodology……..…………………………………………………………..31
     
     3.1.Research Model...………………………………………………………………31
     3.2.Research scope…………………………………………………………………32
     3.3.Research design ………………………….……………………………………33
      3.3.1. Evaluation Hospitals IT strategy level…………………..…………....33
     3.4. Data collection Methods……..………………………………………………..35
     3.5.Evaluation Hospitals IT capability……….…………………..………………..35
     3.6. Evaluation of hospital applying IT patient safety and service systems…..36
     3.7. Phase I study………..………………………………………………………….36
      3.7.1 In-depth interview…..………….…………………………………….37
     3.8. Phase II study…..…………..…………….…………………………………….37
      3.8.1.Case study..………………….……………………………………...37
      3.8.2. Survey in a case study……..…..…………………………………...38
     3.9. Phase III study….…………………………………………………………........38
      3.9.1. Delphi method………………………………………………………………….39
     
     3.10. Data Analysis Method…..…………………..………………..………………39
      3.10.1. Thematic analysis………………….…………………….………….40
     
     
     
     Chapter. IV.
     Phase I Study
     
      4.1. Research Method for Phase I study…………………………………………42
      4.2. Results and Discussion for Phase I study…………………………………..43
      4.2.1. Respondent profile………………………………………………………………….....43
      4.3. Adopted IT strategy for patient safety and service…………………………43
      4.4. Evaluation Hospitals IT capability…………………………………………....44
      4.5. Evaluation of hospital applying IT patient safety and service systems…..44
      4.5.1. Improving Medication Safety: MSIS (Medication Safety Information System)…..45
      4.5.2. Improving Communication: HRRS (High Risk Reminder System)………………..47
      4.5.3. Improving monitoring: ER RFID (Emergency Room RFID )……………………….50
      4.5.4. Improve Identification: SPSS (Surgical Patient Safety System) ………………….54
      4.4.5. Rapid response to and tracking of Adverse Events : AERS ………………………55
      (Adverse Event Reporting System)
      4.4.6. Mobile Outpatient Service System (MOSS) : Solve outpatient service problem…55
      4.6. Patient Safety IT Communication Infrastructure …………………………….56
     
     Chapter V.
     Phase II study
     
     5.1. Research method for phase II study……………………………………………..59
      5.1.1. Case selection…………………………………………………………………………..59
      5.1.2. Taipei Medical University Wan Fang Hospital (description)………………………..59
      5.1.3. Departments of medicine and their characteristics …………………………………60
      5.1.4. Quality Policy…………………………………………………………………………....61
      5.1.5. Sampling of the survey…………………………………………………………………62
      5.1.5.1. The Study design of Mobile outpatient service system (MOSS)………….62
     5.2. Results and Discussions for phase II study……………………………………..63
      5.2.1. HRRS sample characteristics analysis……………………………………………….63
      5.2.2. Introduction of High Risk Reminder System (HRRS)……………………………….63
      5.2.3. The HRRS system and research model……………………………………………...65
      5.2.4.The HRRS system……………………………………………………………………….66
      5.2.5.The D & M model and hypotheses……………………………………………………..68
      5.2.6. Research methodology…………………………………………………………………69
      5.2.7. Subjects………………………………………………………………………………….70
      5.2.8. Data analysis and results………………………………………………………………70
      5.2.9. The measurement model………………………………………………………………71
     
     5.3. Mobile Outpatient Service System ( MOSS)………………………………………72
      5.3.1. Study Aims……………………………………………………………………………….72
      5.3.2. Mobile technology applied in medical care…………..…………………………….…73
      5.3.3. The description of MOSS…………………………………………………………….…73
      5.3.4. The architecture of the MOSS……………………………………………………….…73
      5.3.5. Study design of MOSS……………………………………………………………….…74
      5.3.5.1. Procedures………………………………………………………………………76
      5.3.6. Course of the study………………………………………………………………….…..77
     
     5.4. Research finding of Mobile Outpatient Service System (MOSS)………………..84
     
      5.4.1. High Risk Reminder System ( HRRS )………………………………………………...84
     
      5.4.2. Research finding of Mobile Outpatient Service System (MOSS)…………………...85
     
     Chapter VI.
     Phase III study……………………………………………………………………... 87
     
     6.1. Research Method for Phase III study……………………………………………….87
     
      6.1.1. Panel profile………………………………………………………………………………..88
     
     6.2. Results and discussions for Phase III study………………………………………..88
     
      6.2.1. High Risk Reminder System (HRRS)……………………………………………………88
     
      Research proposition 1: ............................................................................................88
     
      Research proposition 2: ……………………………………………………………………88
     
      Research proposition 3: ………………………………………………………………….. 88
     
      Research proposition 4: ……………………………………………………………………88
     
      Research proposition 5: ……………………………………………………………………88
     
      6.2.2. Mobile Outpatient System (MOSS) ………………………………………………………89
      Research proposition 6: …………………………………………………………………….89
     
      Research proposition 7:……………………………………………………………………..89
     
      Research proposition 8:……………………………………………………………………..89
     
     
     Chapter VII.
     Final conclusions and managerial implications…………………………………90
     
     7.1. Discussion and conclusion……………………………………………………………..90
      Contribution of Adopted IT strategy for patient safety and service
     
      7.1.1. Contribution of medication safety information system (MSIS)……………………..90
     
      7.1.2. Contribution of high risk reminder system (HRRS)………………………………….90
     
      7.1.3. Contribution of surgical patient safety system (SPSS)…………………………..….91
     
      7.1.4. Contribution of emergency room of RFID system (ER RFID)………………………92
     
      7.1.5. Contribution of adverse event reminder system (AERS)……………………………93
     
      7.1.6. Contribution of Mobile Outpatient service…………………………………………….94
     
      7.1.6.1. Result of survey one – outpatient’s attitudes…………………………………….94
      7.1.6.2. Result of survey two – outpatient satisfaction……………………………………94
     
     7.2. Information technology in Surveillance………………………………………………95
     7.3. Types of patient safety Errors…………………………………………………………95
     7.4. Managerial implication…………………………………………………………………98
     7.5.Research limitation and recommendation…………………………………………..100
     Reference………………………………………………………………………………102
      Appendix………………………………………………………………………………119
      Appendix 1 Interview guide for Phase I study.,……………………………………….119
      Appendix 2 Questionnaire and Literature review for Phase II study ………………130
      Appendix 3 Invitation letter & answering instructions for Delphi investigation
      Phase III study …………………………………………………………...188		zh_TW
dc.language.iso en_US-
dc.source.uri (資料來源) http://thesis.lib.nccu.edu.tw/record/#G0092356509en_US
dc.subject (關鍵詞) 病人安全zh_TW
dc.subject (關鍵詞) 創新科技zh_TW
dc.subject (關鍵詞) patient safety, mobile, RFID, Emerging Technologyen_US
dc.title (題名) 運用創新科技提昇病人安全之研究以台灣醫院為例zh_TW
dc.title (題名) Improving Patient Safety Using Emerging Information Technology based on Taiwan Hospital Cases Researchen_US
dc.type (資料類型) thesisen
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