講題：智慧健康照護–由AI醫院擴展至健康生活圈 Smart Healthcare

生技醫療與智慧化醫療之產業趨勢與商機

主題：打造全人照護目標的智慧醫院

講題：智慧健康照護–由AI醫院擴展至健康生活圈 Smart Healthcare

–

臺北醫學大學附設醫院

院長 陳瑞杰教授

智慧健康照護–由AI醫院擴展至健康生活圈

⊙ 照護制度轉型

⊙ AI醫院

⊙ 健康生活圈

全球人口改變與健康照護趨勢

Global Trends in Healthcare

Rapid Ageing Threatens

(2050, ↑60y) 快速老化

2 billions

(21.5%)

Higher Health Expenditure

高耗醫療

10.5 %

Global GDP (2020, OECD) Lower Fertility

低生育率

(Caregivers for age 80+)

Today 7 2030 4 2050 3

Chronic care

Healthcare Demand Increases with Age

供需失衡

>60 y

75%=1 disease 50%≥2 disease

Critical care shortfall in US

22 % (2020) 35 % (2030)

3

Affordability (可負擔)

Continuity (連續性)

Digital (數位化)

Engagement (認同感)

Four Themes

• Healthcare Expense:

72% are concerned

• Most wanted plan: IPD, ED & dental care

• Retail clinic: growing

• Primary care: dropping

• Digital Solutions: 70%

preferred, eg, digital appointment reminders

• Behaviors change to reduce cost ….

• Better incentives for

• 5000 steps/day

• weight reduction

• regular exercise

健康照護的消費觀

Healthcare Consumerism

醫療照護產業數位轉型

Digital Transformation in Healthcare

Reactive vs. Proactive & Predictive

One Size Fits All vs. Personalized

Institution Centered vs. Decentralized

Paternalistic vs. Empowered

Volume Based vs. Value Based

5

精準醫學

Precision Medicine - P4 Medicine

P4

–預測

–預防

–參與

–個人

何謂健康？

Determinants of Health and Contribution to Premature Death

(Steven A. Schroeder, M.D, NEJM 2007)

Source: Schroeder, SA. (2007). We Can Do Better – Improving the Health of the American People.

NEJM. 357:1221-8.

From Clinic to Community:

A Holistic Approach to Health Care

7

Precision Medicine

(醫學是精準化或大眾化?)

• Medicine

– “one-size-fits-all” approach

• Precision Medicine

– takes into account “individual differences”

• genes, environments, and lifestyles

The Health Care Industry

• Complex, Comprehensive and Expensive

• Too slow to embrace the digital technology

• But recognize the data could improve outcomes

智慧健康照護–由AI醫院擴展至健康生活圈

⊙ 照護制度轉型

⊙ AI醫院

⊙ 健康生活圈

建構智慧醫院之關鍵

To build a future-proofed facility that uniquely balances

three key aspects

– excellence in clinical outcome (卓越) – efficiency in the supply chain (效率)

– enhancement of the patient experience (有感)

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智慧醫院

SMART-AI HOSPITAL

Health

Checkup Smart

Pharma

cy Smart

Laboratory Smart

Scheduling

Smart Station, Wards, ICUs, and OP Room Smart OPD

Smart Radiolog

y Robotic Service

Counter

Tele-care & Long-term Care Service

Smart Auxiliary Smart ER

• Hospital info (Website)

• Patient Service (App)

• Structured Orders &

Reports

• Structured EMRs

• Data & Seamless Care Workflow

• Scheduling &

Reports

• Tele-care Service

• Long-term Care Service

• CRM Management

• Logistic Supply Chain

• Smart Building

全球健康照護現況與未來發展

Global Healthcare (Economist, March 4th, 2017)

The “Healthcare Value Chain”

(健康照護價值鏈)

– care: continuous & proactive – incentives shifting:

“outcomes are the new incomes”

“Health on Demand ( ^隨需而醫 )”

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智能藥局 - 精準.即時.安全

Automation Pharmacy

自動包藥

VBM 藥師確認 適用族群

慢簽.多重

OPD 智慧藥盒

IPD (Automation Pharmacy)

Prescription

Order check

UD藥囑

QR code

Stat / Return

Confirmation

Decentralized Centralized

Automated Dispensing Cabinets (ADC)

安全分裝

清楚標示

Carousel + Tosho餐包

即時取藥(2-5mins)

Traditional (開放式)護理站 New (隱藏式)護理站

智慧病房- 護理站進化

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護理白板

床頭卡

(即時互動)

巡房系統

住 (出)院

IPD & Discharge

跨單位 / ISBAR系統

無出院櫃檯

(病房完成結帳

)

電子藥櫃 (ADC)

護理師候藥時間 0.5-2時  2-5分

使用率:日均 7次 (最高達37次)

團隊交班全院無紙化

Key Drivers in the Healthcare AI

To solve key problems :

• Reducing

workload (降低工作負荷)

– time and costs

• Reducing errors (減少人為錯誤)

– Improve service quality

• Providing virtual assistance

– to patients and providers

• Improving accuracy of diagnosis (改善診斷正確率)

– with imaging and procedures

17

No Data, No AI

The Process

DataGenerated Data

Stored Data

Processing Actionable Insights

Big Data Artificial Intelligence

行動化應用

巡房系統/交班系統

生理量測 檢驗資料(趨勢圖)

影像/超音波檢查 用藥紀錄(院內外) 會診紀錄 Note紀錄系統 ISBAR交接班

病歷結構化 照護自動化 & 行動化

Structured EMR & Mobile HIS

 VS/R/NP：309台

 PGY：15台

 護理單位： 206台

 行政單位 : 100台

普及率

跨單位(高危)運送交接班

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重症照護 -臨床決策系統

Ted-ICU & Decision Support System (DSS)

• ICU 70 床

全面使用

作業，

同步上線

•自動上傳：

-生理指標：血壓、脈搏、血氧、呼吸 -檢查數值：心電圖、超音波

•顏色區分檢傷級數

Auto-Transmission 自動化拋轉

Auto-Integration 自動化整合

Auto-Calculating &

Warning

自動化計算與警示

Auto-Transformation 自動化醫療記錄整合

 AI-Assisted 3-hour Sepsis Bundle Care

降低死亡率：10%

 LOS: 縮短 25%

AI

核心技術 具體成果 專業團隊

智慧醫療影像

智慧睡眠醫學

李信謙

及科技輔具 智慧復健

陳適卿 康峻宏 彭志維

智慧醫院

資料可視化 區塊鏈技術 癌症智慧系統 NLP深度學習 陳瑞杰

羅友聲 袁國慶 陳俊佑

智慧病理

智慧病患安全

智慧胸腔醫學

智慧氣喘監測 智慧肺結核診斷

手機智慧回饋 結核菌智慧診斷 郭漢彬周俊良

余明治

智慧骨鬆預測

Actionable Insights

(北醫大人工智慧團隊,

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智慧健康照護–由AI醫院擴展至健康生活圈

⊙ 照護制度轉型

⊙ AI醫院

⊙ 健康生活圈

TMU Healthcare Ecosystem

23

健康照護系統-未來挑戰與機會

Challenges & Opportunities

ACCELERATED AGING POPULATION

RISING OF NCD BURDEN

SHORTAGE OF DOCTORS, NURSES &

CARETAKERS

ABSENT LONG-TERM CARE

INFRASTRUCTURE

“Decentralization” of healthcare system to tackle many issues afflicting developed countries

Personal Health Records (PHRs)

PHRs have the potential

– to give patients or healthy people

• fine-grained (精釀)

• personalized (個人)

• secure (安全)

– to access & control their own medical data – to enable self-management of care

A Ledger of Me: Personalizing Healthcare Using Blockchain Technology (Gary Leeming*, James Cunningham and John Ainsworth, Frontiers in Medicine | July 2019 | Volume 6 | Article 171)

25

Challenges after Digitized Healthcare

• Challenges

– enable data sharing ^(共享), or interoperability (共通), between data sources and systems

• Governance (治理)

– Protect the personal and private data (PHR) – need for more “Trust”

• transparency of consent ^{(同意書透明化)}

• anonymization

• data ownership

• “No Trust, No Data”

A Ledger of Me: Personalizing Healthcare Using Blockchain Technology (Gary Leeming*, James Cunningham and John Ainsworth, Frontiers in Medicine | July 2019 | Volume 6 | Article 171)

Fundamentals of Blockchain Technology

(區塊鏈技術基礎)

1. Distributed Network (分散式網路): decentralized

P2P architecture

2. Shared Ledger (共享式帳本):

no

or alter data

3. Digital Transactions

(數位交換)

• encrypted and digitally signed to guarantee authenticity

• Blocks are added in a linear, chronological order

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No Blockchain, No Trust

- Adoption of Blockchain-based PHR

• Solutions of Challenges ?

– Smart contract-based permit

• Event-driven Consent (項目導向同意書)

• Self-governance (自主管理)

– Ledger-based distributed network

• Trust (互信): immutability (零竄改)

• Transparency (透明): no arbitration (仲裁) or authenticate (認證)

• Traceability (可追溯): drug/food logistic

• Dis-intermediation (去中介)

29

HEALTHCARE DATA SHARING

From institution-centric

via Blockchain

to patient-centric

(patient-mediated and

patient-driven)

31

BLOCKCHAIN AT TMUH

Since Nov. 2017, we have expanded the function of our blockchain-based app, iWellChain:

HIGH-END

HEALTH EXAM REPORTS

IT Pass +

NHI Health Account PATIENT SUPPORT PROGRAM

(CLINICAL TRIALS)

HEALTH ACCOUNT

& INTER- HOSPITAL REFERRALS

健保醫療資訊雲端查詢系統

-資訊共享與節制浪費

雲端藥歷系統(西醫用藥) (3個月)

手術紀錄

(6個月)

中醫用藥紀錄 (3個月)

(12個月)

(永久)

特定藥品用藥紀錄

(特定管制藥品&特定凝血因子用藥)

(6個月)

檢查檢驗紀錄

(6個月)

牙科處置及手術

(24個月)

檢查檢驗結果

(Report & Lab Data)

(6個月)

(6個月)

Patients

分類 資料類型 資料說明 SDK釋出 醫院上傳時

效 開放查詢區間

個人資料 生理量測 ※自行輸入資料

輸入維護 自費健檢資料登錄 ※自行輸入資料

健保申報 資料

就醫資料

西醫門診資料 V

<24小時

近3年~前2日 中醫門診資料 V

牙醫門診資料 V

住院資料 V

用藥資料 同門牙住資料 手術資料 同門牙住資料

過敏資料 V 104年1月1日起

出院病歷 X 104年1月1日起

檢驗檢查結果

血糖、血脂檢驗資料 V

近3年~前2日 其他檢驗資料 V

影像或病理檢查資料 V

預防與保健

成人預防保健結果 V

於國民健康署登錄/上傳時間

癌症篩檢結果 V

預防接種資料 V 依檢送疾管署預防接種資料

器捐或安寧緩和醫療意願 V 依檢送衛福部醫事司資料

保險計費 健保卡狀況及領卡紀錄

保費計費明細 ※個人負擔部份

保險繳納 保險費繳納明細 ※雇主+個人明細

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健康醫療資料交換與臺灣機會

Health Data Interoperability & Taiwan’s Opportunity

TAKEAWAYS

• No data, No AI

• No Trust, No Data (interoperability & sharing)

• No Blockchain, No Trust (smart contract & ledger-based distributed network)

• Big Data Data Economy

• AI Hospital Healthcare Ecosystem AI

Blockchain

35

Thank you. Questions?

rayjchen@tmu.edu.tw