血糖監測系統上市計畫書 / This new product will target on those insulin patients who requires more frequent of SMBG. We will be positioning this product as high accuracy with least interference tool to help insulin patients adjust their daily insulin dosages for better treatment results. The meter price will be between NTD3,500~3,900 at consumer price and NTD2,000 for retailer price. As for test trip price, a box of 50 test strips will be NTD900~1,000 at consumer price and NTD 800 for retailer price. We estimate a 5% market share will be gained in 2009 year and estimate 15% share in the 2013. This launch will generate NTD 25 million sales revenue in 2009 and expected to reach NTD100 million revenue in 2013. Since this product is to focus on insulin patients, strong recommendations from HCPs such as Endocrinologists and Diabetes Educators will be our winning strategy. Moreover, partnership with insulin companies will also accelerate product penetration among insulin patients.

隨著少子化、老年化的時代來臨，以「銀髮族」為目標客戶的產業前景看好。全世界已開發國家人口老化日趨嚴重，社會醫療成為各國財政越來越沈重的包袱，於是以提升高齡者自立能力、降低醫療負擔，提高生活品質為目的的「遠距照護產業」備受重視。相較於其它先進國家，我國遠距照護產業發展較晚。衛生署主導的「遠距照護試辦計畫」第一階試辦已完成，目前進入第二階段擴大推廣。因而，本論文探討的核心問題，在於如何建立成功的遠距照護產業營運模式。 本論文選擇遠距照護應用中的「遠距心電圖監測」作為研究標的，乃因心電圖監測技術已有成熟發展，且全世界心臟病人口日益增加，值得投資。本論文修改技術與市場二分法的研究模式，除了「產業環境」與「營運模式分析」，更將「專利」與「查驗登記制度」納入研究環節。技術、專利與查驗登記制度雖非傳統營運模式分析的重要核心，但對於發展此產品、服務，有一定的影響。由於美國遠距心電圖產監測業發展較我國成熟，本論文比較美國與台灣發展現況，並選擇兩家於美國提供遠距心電圖監測服務的LifeWatch AG與CardioNet, Inc.作為個案研究的對象。 研究結果發現，遠距心電圖監測服務在美國主要用於輔助醫師診斷心臟疾病。不受限於環境，長期連續不間斷監測心電圖的特性，使其市場表現快速成長。美國成功建構產業的關鍵在於完善的商業機制。此外，亦發現美國針對六十五歲以上高齡人口的政府保險Medicare，其給付金額對市場發產有舉足輕重的影響，值得我國政府借鏡。建議台灣應該在保護民眾生命財產安全，以及發展產業之間取得平衡，建構一個適合發展創新技術、創新服務的產業環境。 此外，研究結果發現，台灣尚未能成功發展遠距心電圖監測服務的關鍵，並非技術，而是商業模式。台灣以保守的醫院為服務窗口的營運策略，是衛生署比擬全民健保機制，推動年長者長期健康照護制度的產物，屬於社會福利的性質，與發展產業的概念背道而馳，而且成本過高。另一方面，民眾沒有長期測量生理參數的習慣，拓展市場不易，此二者為台灣長期推動服務失敗的主要原因。因此，本研究最後建議，應捨棄以醫院為中心的服務模式，設計一套能夠被民眾廣為接受的營運模式，提供彈性的價格與服務，搭配適當的宣傳，方能突破現狀。 / Population aging is getting more and more serious among developed countries, as well as the extremely heavy medical treatment budgets. Consequently, governments start to think about how to make medical service more efficient by means of information technology; businessmen start to provide telemedicine service, in order to let the elder live more independently and healthier. A pilot remote health care project, held by the Department of Health, is moving to the second stage this year. Many telemedicine service centers had been built in the hospitals at the first stage, and now government is seeking for more hospitals and companies setting up more service centers in Taiwan. This is time to check weather it is a good business model worthy of working on, or there is a better way to develop telemedicine business. Remote ECG monitoring is one of the typical telemedicine services. Many people are suffering from cardiac disease in developed countries, and there are already some successful business models in the U.S. This is the reason why this studies focuses on remote ECG monitoring. This study takes into account technology, patent, FDA regulations, markets, and industrial environment aspects. Usually, only markets and industrial environment would be taken into account in this kinds of theses. Technology, patents, and FDA regulations, however, may have significant impact on business. The purpose of this essay is to advice to Taiwan, by comparing the difference between the U.S. model and Taiwan model, and analyzing two cases, LifeWatch AG and CardioNet, Inc.. According to the above surveys, remote ECG monitoring is mostly used for diagnosis. The key factor is the well-built U.S. medical system. The U.S. governmental health insurance, the Medicare, has huge influence on remote the ECG monitoring industry. The medical treatment system is open and well-governed, and suits for incubating new products. Although the medical system is relatively conservative in Taiwan, it is recommended that the Taiwan government should create some mechanisms that will encourage innovative telemedicine services. There are two reasons that make remote ECG monitoring services in Taiwan is not as successful as those in the U.S. Firstly, the services are provided by hospitals. Hospitals are conservative, and services doctors are expensive. So, there are less innovative business models, and the costs rocket high. Monitoring centers should be set outside the hospitals. Secondly, patients don’t “feel” the benefit from monitoring ECG constantly, so usually they quit the services in the second month. Therefore, marketing and promotion should be taking place. Services and prices should be more flexible and cost-effective as well. At this moment, the biggest challenge of remote ECG monitoring is business model, not technology, FDA regulations, or even patents

台灣正逐步邁向高齡化社會，慢性疾病的人口增加，連帶著醫療費用高漲，導致全民健保財務收支失衡，可預見健保制度必須在未來有所改變，並且逐漸以品質及預防為重。由於疾病型態逐漸由「急性」轉為「慢性」。國民對醫療照護之需求將由「治療」轉為「治療與照護並重」。整體醫療型態的改變，加上國內資訊通訊產業發達，醫療器材產業的發展，遠端醫療照護的前景十分看好。國內過去遠距醫療服務的研究，多著重於趨勢與未來商機，較少有臨床效果的研究，且多闡述技術發展，對服務系統的建置與運作較少著墨。本研究提出國內一家遠距居家照護的營運個案，由醫院、資通訊業者以及醫療器材廠商合作共同發展的「高齡者照護服務平台」。此服務平台整合了醫療服務端、設備端以及系統端，且以醫院服務端為主導，對生理訊號進行監測。個案可於家中自行依據醫師建議量測生理訊號，或是於安養中心由照護人員量測，由量測器材經RFID手環身分辨識後透過網路，自動將生理訊號，傳遞至「照護服務平台」資訊系統，並由醫院Call center做生理資訊之監控及異常事件回應。資訊分析結果，可提供醫院醫療團隊或在地開業醫師，作為醫療照護服務之參考。在一年的期間，有287位個案安裝遠距居家照護系統，包含長照機構50位住民與家居使用者237位，續監測血壓及血糖變化。使用成效上，健康常事件發生率從第一個月的36.6%下降至第六個月的32.2%；糖尿病患的平均血糖值，由159mg/dl降至151mg/dl；糖化血色素HbA1C由8.36％下降至8.05％；平均血壓值的波動減少漸趨穩定。半年內平均住院天數由1.23天下降至0.97天，降幅達21%；平均每人每半年醫療費用支出減少3,514元；使用者滿意度調查結果滿意與非常滿意的達81%。至於建置及使用成本，若能達每月6000人的使用人數，每月之器材及資通訊系統成本約650元。使用的醫師認為遠距居家照護所帶來的益處為：1.對慢性病照護有實質幫助，2.醫師可以隨時關懷病患，3.更良好的醫病關係，4.提升門診品質。至於使用本服務平台的費用，72%的使用者傾向支付小於500元的月費。使用者期望付最低的費用而享有遠距居家照護服務是可預期的結果。但也使得長期營運維持不易。可能的解決方案有：1.開發新的使用情境，在原有基礎上產生更大的服務價值，2. 以創新的應用情境，導入「家庭病房，遠端管理」的服務概念，讓留院觀察的時間縮短，縮短總住院天數。不僅減少健保醫療費用支出，也增加醫院收入的雙贏局面。未來長期照護保險納入遠距照護並實施，將可帶動整體產業的發展。政府也應鼓勵長期、大型的遠距照護服務計畫，讓國人享有更好的健康照護。

台灣地區地層下陷問題肇始於六十年代迄今已逾三十餘載，持續下陷面積已達1,194平方公里，最大累積下陷量達到三公尺以上。而目前地層下陷地表監測所採用的傳統水準測量耗費人力、時間較多，且不易獲得連續和全面性之地層下陷資料，目前國內水利單位限於人力時間，無法針對所有監測區域每年皆施測一次。近年來由於空載光達測量技術興起，其具有短時間內獲取大區域高密度、高精度高程資料的特性，因此本研究之目的在探討如何利用空載光達測量技術快速獲取高精度之三維點雲資訊，進行大區域的地層下陷監測及其成效。 研究方法係首先將監測區內掃瞄的光達點雲資料進行網格化分群；接著，計算網格區域內所有光達點擬合平面的中心高程；然後，以人工或自動方法萃取出平坦、穩固的網格區域做為監測面；最後，進行不同時期網格監測面高程差異之統計測試分析，以求出地層下陷量。 實驗結果顯示改善點雲高程精度至5公分以內後，經由網格監測面的精度、坡度、坡向、反射強度、道路範圍等為門檻值，可萃取出80%以上正確率的穩固監測面，且其高差成果與長期監測成果的平均值差異在1.3公分至2.9公分之間，由此成果可以說明本研究成果對建立一套省時省力的監測模式，進而達到地層下陷監測自動化的目的有相當幫助。 / The issue of land subsidence in Taiwan has been concerned for over 30 years since 1970. Land subsidence area has been already over 1194 km2, the maximum amount of accumulative subsidence is more than 3 meters. The conventional leveling for the land subsidence monitoring is labor-intensive and time-consuming, so that the Water Resources Agency could not monitor all the subsidence area every year. Airborne LIDAR technology was developed in recent years, it has the characteristics of collecting 3-D point data at the high density and high elevation accuracy in short time. The purpose of this study, therefore, is to discuss how to utilize the airborne LIDAR technology to monitor the land subsidence. The proposed approach, therefore, is first to divide the collecting DSM points in the monitor area into regular grids. Secondly, all the points in the regular grids are fitted to one set planar parameters by least squares principle and the centric elevation of each grid is calculated. Third, the flatness and well-defined planar grids are selected as the monitoring surfaces with the manual or automatic method. Finally, the difference of centric elevation in each monitoring surfaces at different period is calculated and analyzed with statistical approach. This study shows that after refining the elevation accuracy of point clouds within 5 cm, our approach can extract stable monitoring surfaces by limiting planar fitting accuracy, flatness, slope, intensity, or by using road information. The extracted correct rate can be more than 80%. The discrepancy of elevation difference between this study and long-term monitoring result is between 1.3 cm and 2.9 cm. It proves the proposed approach is helpful on constructing the monitoring model in timesaving and efficient way, and our proposed approach has the potential for developing automatic land subsidence monitoring method.