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

本論文研究專注於研究穿戴科技對於銀髮族遠距照護服務創新的可能性，利用系統思維與設計思維的研究方法來進行服務設計。研究問題設定為”一個罹患慢性病並獨自在家生活的銀髮族,如何自主健康生活，並能讓家人感到安心呢” 。透過顧客驅動價值共創的服務設計模型，確認利害關係人，並實際訪談利害關係人後深入分析使用者潛在問題及需求，以不同視角來找出創新的洞見。依據此洞見來發展可行的方案，並展開成為完整的服務系統，再將此服務系統雛型具體化產出後進行風險分析。最終的研究結果以商業模式草圖來呈現完整的商業模式。 / The aim of this thesis is to study the possibility of the wearable technology and to create a service innovation toward the tele-health for elders. The research method of the service design is based on the design thinking and the system thinking.We set up a hypothetical situation as follows: A solitary elder who has chronic diseases knows to how to manage her/ his life well without making the family worry. Through the service design models from the co-creation of the customer empowerment, we affirm the stakeholder at the beginning and then interview her/ him to get to know more about the needs and some main details. The purpose is to look for the insight into the innovation in different aspects. Based on this insight, we start a feasible plan and develop the integrity of the service design. Next thing we externalize the service design prototype and provide the follow-up risk assessment.As the final result, we use business model canvas to bring out the coherence and the integrity to our business models.