雖然隨著健保制度的實施，國內民眾可以得到較好的醫療照顧，但醫療資源分配並不平均，大都市裡有分門別類的專科醫師，而偏遠地區往往是一位全能醫師，近幾年來各級醫院之間相互合作的情形越來越頻繁，醫師間會有醫療照會需要，傳統的醫療照會在受距離和時間的限制時，醫師們要相互約定照會安排不易，利用寬頻的網際網路建立起醫療照會的管道，不僅增加醫療照會的效率，更進而讓醫療資源更充分利用。

　　本研究將建立一套同步/非同步醫療照會系統之雛型，利用H.323的通訊標準建立同步的通訊架構，使用即時視訊的對談來縮短照會時空間上的不便，並且增加同步DICOM影像連線，加強同步連線時研究病歷的重要參考；在不同步醫療照會方面，利用同步多媒體整合語言（SMIL，Synchronized Multimedia Integration Language）來整合多媒體資料，讓照會醫師能更清楚的表達病患狀況，在無法及時對談時將病況做最詳盡的展現與解釋，以彌補時間上的差距。

　　無論同步或非同步醫療照會，照會醫師之間交換的文件依據臨床文件架構（CDA，Clinical Document Architecture）之架構標準，建立醫療照會時的醫療臨床紀錄，將醫療照會相關資料轉成XML 格式，透過XML 跨平台的特性來完成照會文件的交換，並且搭配近年來日益重要的醫療影像，將DICOM影像加入成為重要的參考依據，使整份醫療照會電子病歷更趨完整。

　After Implementing the National Health Insurance System , people have been care with better medical quality from healthcare organizations. Unfortunately, most of medical resources are placed in metropolis, and countries only hold the unsound medical infrastructure. In order to balance the medical resource allocation between cities and countries, we propose a Web-based Medical Consultation System. It is designed to construct the communication channel between hospitals for doctors running video conference on internet without time-space limit.

　This paper based on H.323 communication protocol to propose a prototype system for Synchronous/Asynchronous Medical Consultation. For synchronous situation, the system can shorten the space gap with real time video conference. Meanwhile, the DICOM (Digital Imaging and Communications in Medicine) image objects and cases can deliver to any where as well. In asynchronous medical consultation, we integrate the medical multimedia data into SMIL (Synchronized Multimedia Integration Language) format document. Then, the SMIL commands and the corresponding Medical Consultation documents are stored into server for sharing application. One doctor can choose the needed cases from the server or web-based interface to support the patient's diagnosis. Each Medical Consultation document is based on CDA (Clinical Document Architecture) description with medical consultation results. The proposed Medical Consultation System has overcome the space-time limit and provides a flexible medical consultation environment for consulting. Moreover, the Web-based consultation channel enhances the consulting efficiency, and balances the medical resources allocation.

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