電子病歷的推動與實施，可以提高醫療照護的品質，提供病患完整的持續性照護，在會診各專科醫生時，使用電子病歷更增加醫療診斷的正確性。為了讓病患可以得到更好的醫療照護，透過電子病歷系統的建置，可以建構出一套以電子病歷系統為中心的全新醫療資訊系統，並進一步架構出無紙化、無片化的醫療資訊環境。資訊技術的日新月異，資訊設備的效能亦隨之提升，更加速了病歷電子化的推動。電子病歷的推動，延續了醫療照護，提升了醫療照護的品質，進一步提升醫療診斷的正確性與醫療處置的精確性。若能將電子病歷進一步應用在遠距醫療與居家照護上，則偏遠地區與重症病患舟車勞頓的辛苦將獲得大幅的改善。 而為了因應未來電子病歷系統的規劃與建置，本研究提出了一個電子病歷釋出的方案，讓病患個人（或其代理人）、保險公司、司法機構、其他相關的自然人或法人、醫療院所等都可以經由網際網路存取所需要存取的病歷。而為了讓電子病歷檔案在傳輸的過程中都可以達到資訊安全的四大議題：認證（Authentication）、私密性（Confidentiality）、完整性（Integrity）、可用性（Availability），本研究運用公開金鑰基礎建設（Public Key Infrastructure, PKI）技術、HCA所核發之醫事人員憑證的認證機制、對稱加解密、非對稱加解密、數位簽章、數位憑證等技術，讓電子病歷檔案在傳輸的過程中不會有被竄改或盜取的風險。 本研究所規劃設計的電子病歷釋出方案，除了可以達到上述的資訊安全四大議題外，更可以達到下述的目的： (1) 解決紙本病歷不具有即時性的問題。 (2) 藉由電子病歷的提供，提高醫療診斷的正確性與醫療照護持續性，以提高醫療品質。 (3) 讓病患或其他醫療院所可以更方便的取得病患之個人病歷資料。 (4) 增加個案醫院的財務收入。 The promotion and implementation of the electronic medical records (EMR) greatly enhances quality of care. It provides easy access to share a patient’s medical records among the providers’ groups and thus eliminates unnecessary exams and tests. EMR, when integrated with picture archiving and communication systems (PACS), has proven to have many benefits such as elimination of radiological films and reduction of paper usage. As more health information technologies (HITs) are introduced and implemented in the patient care, the roles of EMR are becoming increasingly important in many areas such as remote medicine for people living in the remote areas where healthcare resources are scarce. Thus, the availability of EMR to authorized providers when needed and the protection of confidentiality of EMR are critical to the success of EMR adoption. This research provided a technical mechanism that allows authorized parties including patients, insurance companies, government authority, and hospitals to access patients’ medical records without sacrificing the confidentiality and the integrity of the medical records. The adoption of public key infrastructure (PKI), healthcare certification authority (HCA), cryptography such as encryption, digital signature, and digital certificate in the protection of EMR were studied. The authentication, confidentiality, integrity, and availability of EMR were discussed. This research further discuss the resulting benefits of EMR which is believed to be phenomenal.
