加護病房之病患通常為重症、需特殊照護者，因此病床邊都會需要接上各式各樣的監測儀器，用來維持病患的生命及監測病患的生命徵象，而病患的生命參數必須由護理師定時記錄；觀察發現，護理人員在床邊以紙本方式記錄病患生命參數後，必須再返回護理站或至行動護理車旁，將抄寫的資料逐一輸入病患照護系統，導致醫護人員重複輸入文書工作，尤其對於站在第一線工作照顧急重症加護病房的醫護人員，造成不必要的工作負擔。
    隨著資訊技術的進步及環保提倡，病歷資料漸趨電子化，本研究於心臟血管外科加護病房建構一套臨床資訊系統，以HL7與院內系統及監測病人資訊的床邊儀器進行資料交換，並建立電子化的表單減少人工書寫作業，原本需手寫的裝置監測數值與參數改善成直接從儀器上傳到臨床資訊系統零錯誤率，成功幫臨床護理人員每日節省約76.8分鐘，讓臨床人員有更多時間專注於照護病患，並提昇醫師診斷的效率，更能保障病人的安全。

Patients in intensive care units are usually critically ill in need of special care, and there are many device and vital signs monitors to help clinical personal care them at bedside. The ICU nurse has to record these device parameters and vital signs by order. With the progress of information technology, medical records data gradually electronic, nurses in the bedside by way of paper to record the patient's life parameters must be back to the nursing station or nursing car, the copy of the data entered into the patient care system, resulting in more clinical staff clerical workload especially in Intensive Care Unit (ICU). In this study, a clinical information system was constructed in the ICU of Cardiovascular Surgery. The Clinical Information System exchange data with the Hospital Information System and patient bedside equipment through Health Level Seven (HL7). In addition, we create electronic forms to reduce manual writing and successfully help clinical therapists save 76.8 minutes to key in these dates into NIS per day. The original device was wrote to monitor the value and parameters into a direct upload from the instrument to the clinical information system zero error rate.

Chapter 1	Introduction	1
1.1 Background and Motivation	1
1.2 Purpose of the Research	2
1.3 Research Structure	4
Chapter 2	Related Research	6
2.1 Clinical Information System	6
2.2 Health Level Seven (HL7)	7
2.3 Severity Assessment Score for Patient in ICU	8
2.4 Healthcare 4.0	35
Chapter 3	System Architecture and Design	43
3.1Clinical Information System Architecture	45
3.2 Clinical Information System and Medical Information System Data Exchange Planning	47
3.3 Form design tools	48
3.4 Integration planning of medical equipment’s connection	49
Chapter 4	Implementation results and analysis	52
4.1 Patient List Management	52
4.2 Clinical record form of ICU	53
4.3 Clinical advice and alarm	56
4.4 Nutritional Assessment Record	57
4.5 Digital Picture	57
4.6 Statistical report	58
4.7 Disease severity assessment system	59
4.8 Statically table / Report printing	61
4.9 Clinical performance improvement	62
Chapter 5	Conclusion and Future Research	68
5.1 Conclusion	68
5.2 Future Research	70
Reference	72
Attachment	75


List of Tables
Table 1 Factors for SAPS II	9
Table 2 Killip’s Classification	11
Table 3 GCS Scale	12
Table 4 NYHA FC List	13
Table 5 AHA Grades of Congestive Heart Failure	13
Table 6 UA TIMI score	15
Table 7 RASS Assessment Form	16
Table 8 MODS Assessment Form	18
Table 9 MODS Death Predict Rate	19
Table 10 SOFA	20
Table 11 ISS Assessment (Health and Welfare Department)	24
Table 12 NIH stroke scale	32
Table 13 TRISS Parameters	35
Table 14 RTS Parameters	35


List of Figures 
Figure 1 Research Structure	4
Figure 2 HL7 standardized format	8
Figure 3 OR .NET [30]	37
Figure 4 Structure for Integration of Assistant Healthcare Information System and Internet for Things	38
Figure 5 Changes of Senior Population	39
Figure 6 Structure for System of Tele-care and Alert with Wireless Mini-Sensor	40
Figure 7 ICE Functional Architecture {International, 2009 #53}	41
Figure 8 the Clinical Information System Architecture	45
Figure 9 Data exchange diagram	48
Figure 10 Monitoring instrument information delivery order	50
Figure 11 Monitoring instrument connection architecture in ICU	51
Figure 12 Movable monitoring instrument connection architecture	51
Figure 13 the patient list manage function	53
Figure 14 record sheet in the user interface	54
Figure 15 The window of event notification	56
Figure 16 Nutrition assessment example screen	57
Figure 17 The image is embedded in the form	58
Figure 18Various types of statistics	59
Figure 19 various reports (dashboard form)	59
Figure 20 Scoring System - One-time integration presents patient assessment scores	61
Figure 21 select the recording interval to print	61
Figure 22 Preview the report page	62
Figure 23 IV PUMP	64
Figure 24 Bedside hemodialysis machine	64
Figure 25 the system uses the device connector	65
Figure 26 Respiratory therapy machine with gas cylinder	65
Figure 27 Respiratory therapy machine	66
Figure 28 Portable ECG machine	66
Figure 29 Clinical Patient Use Device Connection Status	67
Figure 30 Numerical Value and Chart Presented in Same Timeline	69

List of Attachment
Attachment 1 Original Vital Signs………………………………………..75
Attachment 2 Original Nursing Assessment……………………………...77
Attachment 3 Original Nursing Progressing Note………………………..80
Attachment 4 Original hypodermic injection record……………………..81
Attachment 5 Original muscle power record……………………………..82
Attachment 6 Original Glasgow Coma Scale…………………………….83
Attachment 7 Original Risk Assessment: Braden………………………...84
Attachment 8 Original Input and Output Record…………………………85

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