美國醫療資訊暨管理系統協會（Healthcare Information and Management Systems Society，簡稱為HIMSS）是全球醫療機構智慧醫療的高品質指標，中國醫藥大學附設醫院歷經努力，今年初榮獲HIMSS「數位健康指標（Digital Health Indicator, DHI）」評鑑成績優異，獲選為評鑑全球智慧醫院的前三強，並連續獲得許多重要認證包括INFRAM 第七級、EMFRAM第七級，以及AMAM第六級，被HIMMS譽為「全球智慧醫院新興模範（emerging as a global model smart hospital）」。中醫大附醫由周德陽院長領導的AI智慧醫療團隊，登上2023年12月HIMSS《INSIGHTS》雜誌亞太版封面，深感榮幸，讓我們為病患的努力與轉變被世界看見。
When the AlphaGo software beat a nine-dan professional and champion in a game of Go in 2016, CMUH chairman Chung-Hai Tsai and superintendent Der-Yang Cho immediately realised AI’s sweeping impact on human life and healthcare. “AI may not replace doctors but doctors who don’t know AI will be replaced,” they said.
Now, it is one of CMUH’s goals to become a smart AI hospital by 2030. It aspires to be a smart hospital that provides “humane, intelligent, and effective care.” Critical to achieving this vision is the integration of data and AI to improve healthcare delivery and enable providers’ efficiency.
With no local role models and examples to follow, CMUH sought guidance from globally acclaimed models and standards to measure its efforts toward digital transformation. In recent years, underwent validations for the HIMSS Electronic Medical Record Adoption Model (EMRAM), Infrastructure Adoption Model (INFRAM), and Adoption Model for Analytics Maturity (AMAM).
The EMRAM measures an organisation’s clinical outcomes, patient engagement and clinician use of EMR technology while the INFRAM measures their maturity in infrastructure and associated technology capabilities. Meanwhile, the AMAM gauges the analytics capabilities that an organisation gains from its analytics strategy and competency.'
Stage 7 INFRAM
CMUH is the first healthcare provider in Taiwan to be validated for Stage 7 INFRAM. A hospital at this level has achieved high data, voice, and location grades for all internal and specified external on-campus areas; implemented a high-availability wireless identity and access management solution, as well as a high-availability wireless enterprise mobile management solution on-premise and in the cloud; enforced well-defined bring-your-own-device network access policies for both staff-owned and guest-owned devices; and provided advanced security and automated access policy enforcement through identity, access and mobile device management solutions that uses a software-defined networking controller.
Just four months after its Stage 6 INFRAM validation, CMUH was validated for Stage 7. It is now working to fulfil some of HIMSS’ recommendations for improvement in its IT infrastructure.
One of them is aligning its governance structure, emphasising the synergy between its IT solutions and services and business requirements. The hospital is crafting mechanisms to meticulously track and realise the benefits of its IT capital fund initiatives.
Alongside actively updating transport and wireless components beyond their end-of-support dates, CMUH is fortifying its systems to proactively monitor potential firmware vulnerabilities. It is also exploring advanced location service technologies like Bluetooth Low Energy.
In cybersecurity, CMUH is currently considering the most suitable configurations for establishing a Governance, Risk, and Compliance entity that is independent of its IT team. It is also assessing the integration of a Privileged Access Management solution, targeting the supervision of critical access accounts to mitigate potential risks.
Regarding its data centre, CMUH is now crafting plans to improve its disaster recovery strategies, including the establishment of a backup mechanism located at a remote site at least 150 kilometres away from the hospital. It also continues to harness the High Availability feature of its data centre to ensure seamless continuity and resilience in operations.
STAGE 7 EMRAM
CMUH has also been validated for Stage 7 EMRAM. Hospitals validated at this stage have proven to improve safety by optimising their EMR implementation and allowing clinicians to access critical information anytime, anywhere; increase patient satisfaction by reducing time and errors in care delivery; support clinicians by designing the EMR to their distinct uses; and secure data by having effective data policies and governance.
Prior to the validation, CMUH made some adjustments and implementations within its systems to meet the EMRAM standards. These include the implementation of the Electronic Medication Administration Record that logs all records of medications ordered and administered and ensures that a patient’s medical history is accessible throughout the hospital network.
It also integrated records from multidisciplinary teams to enhance medical collaboration. Medical professionals from different specialties have been able to share patient information and access their examination reports and medical images via the viewing function.
Moreover, CMUH clinicians now also have authorised access to the Med-cloud database of Taiwan’s National Health Insurance (NHI), allowing them to query a patient’s medical information. CMUH has also established a mechanism for uploading patient’s medical information to the NHI.
CMUH has the following systems and tools that support various aspects of healthcare delivery and data management:
•Laboratory Information System
•Radiology Information System
•Pharmacy Information System
•Cardiology Information System
•Various medical systems
•Clinical Data Repository (CDR)
The aforementioned systems have been connected to facilitate efficient access to patient information and ensure seamless operations and patient safety. Most data within these systems are stored as structured and discrete data that enables trending analysis and clinical decision support.
A notable demonstration during the EMRAM validation was CMUH’s comprehensive antimicrobial AI platform – the Intelligent Anti-Microbial System (i.A.M.S.). It features a four-in-one function which is driven by AI to identify drug-resistant strains and predict and monitor the risk of infectious sepsis and mortality. It can also make smart drug dosage recommendations and automatic comparisons of drug-drug interactions and allergy history.
STAGE 6 AMAM
CMUH also became the first hospital in Taiwan to be validated for Stage 6 AMAM. At this level, CMUH has demonstrated maturity in the use of predictive analytics and expanded focus on advanced data content and clinical support.
Its analytics strategies consist of:
•Gathering data from various sources while ensuring data integrity, accuracy, and consistency
•Storing data in appropriate locations while ensuring data security, scalability, and usability
•Extracting valuable information or features from the data while maintaining data quality and consistency
•Providing patient-centric descriptive, diagnostic, predictive, and prescriptive healthcare services
The establishment of a Big Data Center, AI Center for Medical Applications, and the Digital Transformation Technology Office has been essential in achieving these strategies. So far, CMUH has developed 16 AI-driven services and 50 dashboards based on the Microsoft Power Business Intelligence platform. These AI and BI applications are covered broadly in clinical and operational areas.
CMUH has also made strategic investments in human capital to prepare staff to take on the challenges of the hospital’s ongoing digital transformation. It has conducted training in AI and related fields, with more than 250 hospital staff taking one-month AI training courses.
“The ultimate goal is to use technology to elevate the quality of healthcare and patient safety within the hospital. By achieving the HIMSS AMAM validation, CMUH not only demonstrates its commitment to data-driven healthcare but also showcases its dedication to continuously improving patient care through the integration of technology and analytics.”
WHO THEY ARE
In 1980, China Medical University Hospital (CMUH) was established as a regional hospital in Taichung, Taiwan. Affiliated with China Medical University, it later became a medical centre and the second-largest healthcare system in the country with over 2,000 beds and more than 6,000 employees. Each month, CMUH receives around 200,000 outpatients, sees about 13,000 emergency patients, admits 7,900 inpatients, and conducts over 5,500 surgeries.
The hospital is said to be the first in Taiwan to offer and integrate Western and Chinese medicine. It runs eight medical units, namely Cancer Center, Cerebral Stroke Center, Cardiovascular Center, Organ Transplantation Center, Trauma and Emergency Center, Preventive Medicine Center, Renal Care Center, and International Medical Service Center. It also runs nine disease-focused research institutes, such as the Center for Molecular Medicine, the Biomedical Technology Research Center, and the Translational Medicine Research Center.