1918西班牙流感花了一年的時間才成為國際間的流行病,武漢肺炎在幾天內即席捲全球,癱瘓醫療系統檢測、追蹤、及圍堵疑似病例的能力。為維持運作,私人公司及教育機構已採取視訊或其他通訊方式,僅醫療系統仍以高風險的傳統方式面對這項危機。美國醫療系統仍採取病人與醫師面對面的傳統互動方式,但這樣可能會造成疾病的傳染,高風險族群如慢性病患或免疫功能失調者面臨感染風險或延誤治療的選擇。遠距醫療已存在很久,但因法令及給付的問題,在醫療市場使用率不高。為加強這項科技的使用,the Department of Health and Human Service (HHS)已宣布不會對使用沒有符合Health Insurance Probability and Accountability Act(HIPPA)的通訊技術執行遠距醫療的行為開罰,但這項措施仍有三個層面需要注意:新服務模式的給付、法規的鬆綁、及評估。

遠距醫療的模式,除了視訊,還包括簡訊、電郵、及手機應用程式,甚至是穿戴裝置及”聊天機器人”,給付設計為計次(time-based)或論量計酬(fee-for-service);付費原則應放寬至其他新技術,如,聲控系統或移動式感測器,如智慧錶、血氧計、體溫計等。第二個需要發展的服務是照顧模式,如在宅醫療(hospital-at-home)。第三個服務是居家檢疫者的監測系統;但這些服務應有給付機制的支持。

HIPPA嚴格及過時的規定及模糊的指引嚴重影響資通科技在醫療市場的應用;允許使用最先進的安全技術,而非HIPAA在1996年通過時的技術,應可在提供服務時確保隱私。

最後一個層面,評估。我們必須了解這些新的措施是否被適當的使用,並評估醫療照顧的品質。我們也必須評估這些新的措施是否在武漢肺炎流行時提高臨床生產力。這些資訊將提供決策者決定,在疫情結束後,是否將這些緊急措施常態化。

(財團法人國家衛生研究院 莊淑鈞博士摘要整理)

In the face of the Covid-19 outbreak, Americans are waking up to the limitations of their analogue health care system. It seems clear that we need an immediate digital revolution to face this crisis.

In a very real sense, the spread of Covid-19 is a product of the digital and technological revolution that has transformed our world over the past century. Unlike the “Spanish flu” of 1918, which became an international epidemic over the course of a year, Covid-19 has spread to every inhabitable continent within weeks, outpacing our health system’s ability to test, track, and contain people with suspected infection. To continue functioning, private companies and institutions of higher education have made an abrupt transition to remote videoconferencing and other digital solutions, while the health care system is still managing this crisis largely through risky brick-and-mortar visits.

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Author:Sirina Keesara, Andrea Jonas
原文連結:https://www.nejm.org/doi/full/10.1056/NEJMp2005835?query=featured_coronavirus