Recently, a company in the United States used Google Glass to record the process of doctors' medical practice in clinics as a protection for doctors. The plan successfully raised $20 million in investment. The news was sent back to Taiwan. Many doctors said that they would like to buy Google Glass, because it is best to complete the record for the patient. The patient and the family can read it on their own, so that if there is a medical dispute in the future, the patient says that he wants to report it, and the doctor even protects himself. There is no evidence...
The endless stream of medical disputes has become the focus of recent news. The confrontation between doctors and patients is becoming increasingly tense. The Medical Disputes Treatment and Medical Accident Compensation Act, promoted by the Ministry of Health and Welfare in Taiwan, has been reviewed and may be completed in recent days. Although this law claims to compensate patients, it is necessary to promote the harmony of medical care, but from the point of view of physicians, it is necessary to use medical corrections to improve medical disputes. (Note 1)
"Medical accidents" are unpredictable or changeable by human resources, but medical disputes must be prevented from "medical errors" such as misplaced needles, wrong knives, and wrong medicines. Taking the error of administration as an example, according to the statistics of the Taiwan Patient Safety Notification System, the drug incident has jumped to the first place in the notified case since 2008, with about 19,000 cases each year, of which more than 560 patients suffered moderate or above. Injury, more than 900 patients suffered mild injuries. Further analysis revealed that 43% of errors in drug events occurred during the medical order opening period, 27% occurred in the dosing phase, and 16% occurred in the drug administration. (Note 2)
Further analysis of the drug events notified in the fourth quarter of 2014, at most, the error occurred when the doctor opened the doctor's order, and then the mistake was made during the administration. In hospitals and psychiatric hospitals, the cause of drug incidents is highest by human factors, followed by system factors such as work status/process design factors (re-checkable).
Figure 1. The stage of the hospital drug incident error
Figure 2, the breakdown of the wrong items in the drug administration error phase of the hospital
How serious is the nursing shortage in Taiwan?
According to statistics from the "Weifu Department" test evaluation data in Taiwan, the failure rate of 200 medical institutions is as high as 75%! In the past, in the clinic, a nursing class in the small night shift had to take care of 15 to 20 patients. One night, one person had to take care of 20 to 30 people. It is not too much to say that it is a “sweatshopâ€. According to foreign research, it is the limit for a nurse to take care of six patients. If added to eight, the mortality rate will increase by 30%. The serious lack of nursing manpower in Taiwan is of course the key to affecting the quality of medical care.
In the past, when Taiwan was conducting a evaluation hospital, only the day-to-day class care ratio was included in the appraisal project. Until this year, the three classes of nursing care were officially included in the hospital evaluation, but the goal of the medical reform was 1:7. There is a big gap, and the nursing director can also be included in the calculation of nursing quota irrigation. The regional hospitals are allowed to reach 1:15, and there is still much room for improvement.
Table 1, the hospital evaluation benchmark "all-day average care ratio of acute wards"
Su Huairen: Promoting smart medical care to surround the city with the countryside
From the perspective of the medical care environment in Taiwan, it is still highly dependent on the nursing manpower, so the introduction of intelligence and automation is an important task to reduce human dependency. Shao Yaohua, director of the Institute of Biomedical and Medical Materials of the Industrial Research Institute in Taiwan, revealed that Su Huairen, the former chief consultant of the Taiwan Biotechnology Integration and Breeding Center, was also very interested in promoting smart medical care during his lifetime. Su Huairen once told him that the hospital system is conservative. If Taiwan wants to promote smart medical care, it must adopt the "village surrounding the city" and let the patients tell the doctor, "Why do people have you?" Many hospitals in the United States are because of patients. Reaction, "The next-door hospital has equipment that you don't have, so I have to go to the next-door hospital", which has become the power to promote the hospital to update equipment. If there is a need between customers, the hospital will naturally improve.
Taichung Veterans General Hospital is the first hospital in Taiwan to implement electronic medical records, including records of care, administration and execution of treatment records. Taking the patient's respiratory monitoring as an example, Taichung Rong will connect the instruments of the respiratory therapy department and generate an electronic form to improve the lack of traditional hand-filled respiratory monitoring records, which can reduce the chance of human error. In addition, Taichung Rong has also introduced the Wireless Transmission Physiology Measurement System (WiDAS), which can be connected with most medical instruments at this stage. Through data transmission, the time spent by the nurses in copying data can be greatly reduced, and the efficiency of nursing work can be improved. And correctness, reducing the work input that the nurse is not necessarily necessary.
Figure 3. Schematic diagram of wireless transmission physiological measurement system (WiDAS) operation
Improve medical efficiency, hospitals are becoming smarter
The most common way to promote smart hospitals is to start with improving the basic equipment of medical care. The Medication Cart integrates the in-hospital medical information system (HIS) through a wireless technology environment to realize a modular touch interface, allowing the caregiver to confirm the patient's vital signs by simply using the touch point selection query. And the status of administration, and the exchange of real-time data in the hospital to achieve automatic drug delivery; and the physician can also log in to inquire various test orders or images and medical orders, prescription modifications, disease picks, etc., to facilitate the physician to complete the medical work, and Further combined with the application of electronic medical records.
Figure 4. Intelligent mobile medical cart launched by ADLINK.
To improve the hospitalization environment, intelligent bed care system is also the focus of smart medical development. For example, Quanta Computer's "QOCA spt smart bedside care system" can be integrated with the hospital's medical information system. Physicians can directly access the inspection report and X-ray film at the bedside to explain the condition to the patient. Patients can also make calls through QOCA spt and call for dedicated caregivers to check hospitalization information, medical orders and watch educational videos, and use personalized entertainment services such as TV, radio, games, video calls, and social networks to improve Satisfaction during patient hospitalization. The QOCA spt smart care device used by the caregiver provides an overview of the patient's condition and communicates with the patient in real time over the phone or video. In an emergency, the system's group broadcast feature can send text or voice messages and contact the relevant health care provider.
Figure 5. The “QOCA spt smart bedside care system†jointly launched by Cisco and Quanta Computer emphasizes the patient-centered healthcare environment.
The third hand of Google Glass avatar doctor
Among the wearable devices, Google Glass, which can help doctors obtain real-time information without using both hands, has practical applications in many fields such as surgery and medical teaching. For example, the Department of Cardiothoracic and Lung Surgery at Stanford University School of Medicine in the United States has used Google Glass technology to exercise the surgeon's technique in complex surgery. As long as the doctor who wears the knife wears Google Glass, he can convey the sight to others. Google Glass users. (Note 3) The Beth Israel Medical Center in Boston, USA, used Google Glass to create an emergency patient database. In the past, doctors had to log in to the patient information system to view patient information. Now, when an emergency is needed, doctors can scan the ward door. The QR code is used to obtain information about each patient. This method can reform the emergency room diagnosis and treatment and reduce the waste of time. (Note 4) In India, there are also orthopedic surgeons who use Google Glass to assist with foot surgery. They can also simultaneously view X-ray and MRI images and use the network to broadcast the surgery in real time. (Note 5)
Figure 6. In the United States, hospitals have introduced Google Glass into the emergency room to build a patient database.
2017 mobile medical output value will reach 26.56 billion US dollars
In 2013, mobile medical revenues reached US$2.45 billion. The Turkmenistan Industrial Research Institute (TRI) estimates that it will grow to US$26.56 billion by 2017. The EU estimates that by 2017, 3.4 billion people worldwide will have smart phones. The Mobile Health App for smartphones will save the EU about €99 billion in health costs.
Today, more than 40,000 health-related apps are available for download in the smart phone market. Wearable devices and mobile mobile health apps undoubtedly play the link of smart healthcare. The future health management has broken through traditional time and place. Restriction, but the difficulty is the combination of the user and the hospital, the data collected from the wearable device, can the doctor really use it, how can it be used? If the general public does not have a medical profession, will it cause misjudgment when used? It is a new topic that needs to be paid attention to by current smart medical care.
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