(2007-12-18) 遠距居家照護系統現況與發展

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2Gerontechnology Research Center, YZUGerontechnology Research Center, YZU

EducationEducation

National Taiwan University, Mechanical Engineering, B.S., 1981/0National Taiwan University, Mechanical Engineering, B.S., 1981/099--1985/06.1985/06.

Stanford University, of Mechanical Engineering, M.S., 1987/09Stanford University, of Mechanical Engineering, M.S., 1987/09--1988/06.1988/06.

Stanford University, Mechanical Engineering, Ph.D., 1989/07Stanford University, Mechanical Engineering, Ph.D., 1989/07--1992/06.1992/06.

ExperienceExperience

Professor, Department of Mechanical Engineering, YuanProfessor, Department of Mechanical Engineering, Yuan ZeZe University,University,2001/022001/02--present.present.

Secretary General, YuanSecretary General, Yuan ZeZe University, 2005/08University, 2005/08--present.present.

Chairman, Department of Mechanical Engineering, YuanChairman, Department of Mechanical Engineering, Yuan ZeZe University,University,1999/081999/08--2005/07.2005/07.

Director, Office of Physical Education, YuanDirector, Office of Physical Education, Yuan ZeZe University, 2002/08University, 2002/08--present.present. Director, Gerontechnology Research Center, YuanDirector, Gerontechnology Research Center, Yuan ZeZe University, 2000/08University, 2000/08--

present.present.

Columnist, Car Magazine, 1995/06Columnist, Car Magazine, 1995/06--present.present.

Dean, Office of Information Services, YuanDean, Office of Information Services, Yuan ZeZe University, 1997/08University, 1997/08--1999/07.1999/07.

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Aging SocietyAging Society

Population aged 65 and above, projection in 2020 by WHOPopulation aged 65 and above, projection in 2020 by WHO

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GerontechnologyGerontechnology

How can technology be best used to support the needs of agingHow can technology be best used to support the needs of agingsociety?society?

Gerontechnology includes the research and development of techniqGerontechnology includes the research and development of techniques andues andtechnological products, based on the knowledge of aging processetechnological products, based on the knowledge of aging processes, for thes, for the

benefit of a preferred living and working environment and adaptebenefit of a preferred living and working environment and adapted medicald medical

care for the elderly. [care for the elderly. [GraafmansGraafmans andand BoumaBouma, 1993], 1993]

Although technology can greatly aid older adults, it must firstAlthough technology can greatly aid older adults, it must first be designed tobe designed to

accommodate their needs.accommodate their needs. There is a great need for both basic and appliedThere is a great need for both basic and applied

research to address the usability of devices of the aged.research to address the usability of devices of the aged.

The increasing needs for elderly care cannot be solved by increaThe increasing needs for elderly care cannot be solved by increasing thesing thenumber of carenumber of care--givers.givers.

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Gerontechnology Research Center (GRC)Gerontechnology Research Center (GRC)

Facilities andFacilities and

infrastructureinfrastructure

AcademicAcademic

programsprogramsHumanHuman

resourcesresources

YuanYuan ZeZe UniversityUniversity

GovernmentGovernment

resourcesresources

Older adultsOlder adults

ServiceService

InstitutionsInstitutions

EducationEducation

AcademicAcademic

researchresearch

GRCGRC AcademicAcademicresourcesresources

IndustrialIndustrial

companiescompanies

AdvancedAdvanced

technologiestechnologies

ProductProduct

developmentdevelopment

On the basis of the support from Yuan Ze University,

the Gerontechnology Research Center

further integrates external resources,

to develop technologies,

products, academic research,

and educational programs in

the field of Gerontechnology,

in the aim of improving thequality of life of older adults.

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7/457Gerontechnology Research Center, YZUGerontechnology Research Center, YZU

Telemedicine,Telemedicine, TelehealthTelehealth, e, e--HealthHealth

TelemedicineTelemedicine generally refers to the use of communications and informationgenerally refers to the use of communications and information

technologies for the delivery oftechnologies for the delivery ofclinical careclinical care. It is the use of medical. It is the use of medical

information exchanged from one site to another via electronicinformation exchanged from one site to another via electronic

communications to improve patientscommunications to improve patients health status.health status.

TelehealthTelehealth is often used to encompass a broader definition of remoteis often used to encompass a broader definition of remote

healthcare that does not always involve clinical services [ATA].healthcare that does not always involve clinical services [ATA].

ee--HealthHealth is a term used particularly in the UK and Europe for healthcareis a term used particularly in the UK and Europe for healthcare

practice which is supported by electronic processes and communicpractice which is supported by electronic processes and communication.ation.

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TeleTele--homecare, Homehomecare, Home telehealthtelehealth

TeleTele--homecarehomecare ++ TelehomecareTelehomecare 54,300 hits in Google;54,300 hits in Google; HomeHome

telehealthtelehealth 48,200 hits in Google;48,200 hits in Google;

Definition:Definition: TeleTele--homecare can be defined as the use of information andhomecare can be defined as the use of information and

communication technologies to enable effective delivery and manacommunication technologies to enable effective delivery and management ofgement of

health services at a patienthealth services at a patients residence. [Office of Health and Informations residence. [Office of Health and Information

Highway, Canada, 1998]Highway, Canada, 1998]

Users:Users:

TeleTele

--homecare differs from telemedicine in the sense thathomecare differs from telemedicine in the sense that

peoplepeople

who transmit and receive medical information are not medical docwho transmit and receive medical information are not medical doctors buttors but

the patients themselves and their families, nurses, carethe patients themselves and their families, nurses, care--givers, homegivers, home--helpershelpers

and medical technical expertsand medical technical experts, etc. [, etc. [MasatsuguMasatsugu, 2002], 2002]

Goal:Goal: HomeHome telehealthtelehealth allows the patient the dignity of remaining in theirallows the patient the dignity of remaining in their

own home for as long as possible and by providing care that is eown home for as long as possible and by providing care that is equal to orqual to or

superior than approaches that rely solely on health providers cosuperior than approaches that rely solely on health providers coming into theming into thehome for scheduled visits. [ATA]home for scheduled visits. [ATA]

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Philips Lifeline Service (http://Philips Lifeline Service (http://www.lifelinesys.comwww.lifelinesys.com/)/)

Lifeline is the first and most establishedLifeline is the first and most establishedPersonal Emergency Response SystemPersonal Emergency Response System

(PERS). It was developed in 1974 by(PERS). It was developed in 1974 by

Lifeline System, Inc., which wasLifeline System, Inc., which was

recently acquired by Philips (2006/01).recently acquired by Philips (2006/01).

Story of a lifeline call.Story of a lifeline call.

On average, Lifeline costs a little moreOn average, Lifeline costs a little more

than a dollar a day, depending uponthan a dollar a day, depending upon

where you live.where you live.

No longNo long--term service contracts or needterm service contracts or need

to purchase equipment.to purchase equipment.

Over 500,000 subscribers continuouslyOver 500,000 subscribers continuouslymonitored.monitored.
http://www.lifelinesys.com/flash/story.htmlhttp://www.lifelinesys.com/flash/story.htmlhttp://www.lifelinesys.com/flash/story.html

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Lifeline Service in TaiwanLifeline Service in Taiwan

65

1500

Lifeline SystemsCall Center

200649,7284,622

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TunstallTunstallss Lifeline 4000+ (http://Lifeline 4000+ (http://www.tunstall.co.ukwww.tunstall.co.uk/)/)

50 years in50 years in telecaretelecare andand telehealthtelehealth (started in UK, 1957), over 2.5 million users(started in UK, 1957), over 2.5 million users

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TunstallTunstall: Activities of Daily Living Monitoring: Activities of Daily Living Monitoring

Activities of Daily LivingActivities of Daily Living

(ADL) Monitoring: To(ADL) Monitoring: To

provide an unobtrusiveprovide an unobtrusive

method of capturing amethod of capturing a

personpersonss behaviourbehaviour

patterns so if a deviationpatterns so if a deviation

from the norm occurs, itfrom the norm occurs, itcan be identified, thecan be identified, the

cause investigated andcause investigated and

preventative action taken.preventative action taken.

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TunstallTunstall TaiwanTaiwan (http://(http://www.tunstall.com.twwww.tunstall.com.tw/)/)

Lifeline 400 + Trigger + 12 months monitoring free:Lifeline 400 + Trigger + 12 months monitoring free: 299299

Monthly Service Charge:Monthly Service Charge: 1212

15001500 30003000

13001300 15001500

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Health Hero Network (http://Health Hero Network (http://www.healthhero.comwww.healthhero.com/)/)

Health BuddyHealth Buddy Appliance : USD 99Appliance : USD 99

Monthly Service Charge: USD 49.99Monthly Service Charge: USD 49.99

Health Hero Network has received 57 U.S. patents.Health Hero Network has received 57 U.S. patents.

Health BuddyHealth Buddy

SystemSystem

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Health BuddyHealth Buddy

ApplianceAppliance

Interactive interface forInteractive interface for

diabetic patientsdiabetic patients

Health Hero NetworkHealth Hero Networksshealth managementhealth management

programs cover over 30programs cover over 30

health conditions.health conditions.

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MediCompassMediCompass (http://(http://www.medicompass.comwww.medicompass.com/)/)

Monthly Subscription Plan: $4.95; Annual Subscription Plan: 39.9Monthly Subscription Plan: $4.95; Annual Subscription Plan: 39.955

MetriklinkMetriklink, one time cost: $79.95;, one time cost: $79.95; 20032003

Connecting Patients, Care Professionals, and Health PlansConnecting Patients, Care Professionals, and Health Plans

PHR: Personal Health RecordPHR: Personal Health Record

Our site is an online resource that allowsOur site is an online resource that allows

you to store and track all of your healthyou to store and track all of your health

related data in a completely secure andrelated data in a completely secure and

private environment. Monitoring thisprivate environment. Monitoring this

information keeps you informed of yourinformation keeps you informed of your

progress. You are also able to shareprogress. You are also able to share

information online with your healthcareinformation online with your healthcare

teamteam

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(Fujitsu Taiwan, http://(Fujitsu Taiwan, http://www.fujitsu.com/twwww.fujitsu.com/tw/)/)

(The

Ministry of Health and

Welfare, MHW)199712

2000

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(http://(http://www.netown.net.twwww.netown.net.tw))

BMI

e-mail

25,000

999

(2007/05)(2007/05)

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20

2,50035,0001,500200

10~20/20~30/ 70002000

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Card Guard (http://http://Card Guard (http://http://www.cardguard.comwww.cardguard.com/)/)

Card Guard Wireless inCard Guard Wireless in

MotionMotion

The PMP4 wirelessThe PMP4 wireless

medical monitorsmedical monitorscommunicate with a PDAcommunicate with a PDA

or cellular phone, thusor cellular phone, thus

allowing acquisition andallowing acquisition andtransmission of data fromtransmission of data from

the patient to the PMP4the patient to the PMP4

webbasedwebbased medical center.medical center.

Physicians and patientsPhysicians and patients

alike can access this webalike can access this web

center using a PC basedcenter using a PC based

browser.browser.
http://ecg%20final%20with%20cwim.wmv/http://ecg%20final%20with%20cwim.wmv/http://ecg%20final%20with%20cwim.wmv/

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WHO

2993,588

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Mini Bond (http://Mini Bond (http://www.minibond.twwww.minibond.tw))

AGPS

MiniBond18,0006,999)699

3,000

1,000
http://minibond_scene4old.wmv/http://lifeline%20service/minibond_scene4old.wmvhttp://minibond_scene4old.wmv/

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e-mail

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Personal Emergency Response System (PERS): Lifeline,Personal Emergency Response System (PERS): Lifeline, TunstallTunstallss telecaretelecare,,

Card Guard, Mini Bond.Card Guard, Mini Bond.

Long term wellness monitoring:Long term wellness monitoring: TunstallTunstallss ADL monitoring, Health BuddyADL monitoring, Health Buddy

System,System, MediCompassMediCompass, Fujitsu,, Fujitsu,

Home Health Care ProviderHome Health Care Provider

Lifeline service,Lifeline service, TunstallTunstall, Health Hero, Health Hero

Network,Network, MediComapssMediComapss, Card Guard, Fujitsu,, Card Guard, Fujitsu,

(I)(I)

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Home Health Care ProviderHome Health Care Provider

(PHR)(PHR)

Brand and TrustBrand and Trust

(II)(II)

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Individual needs and perceived benefitsIndividual needs and perceived benefits

A study by Teasdale and Roush [2001] used Lifeline to see if useA study by Teasdale and Roush [2001] used Lifeline to see if users felt morers felt more

secure with the technology. All users reported a greater sense osecure with the technology. All users reported a greater sense of security duringf security during

their PERS use.their PERS use.

Cost: device cost and monthly fee, health insurance and governmeCost: device cost and monthly fee, health insurance and government subsidynt subsidy

User friendliness: installation and operationUser friendliness: installation and operation

Data security and issues on privacy, control, choice, and dignitData security and issues on privacy, control, choice, and dignityy

Whether people want their entire house wired and monitored,Whether people want their entire house wired and monitored,

What activities are monitored and how,What activities are monitored and how, Where the information gathered goes and who sees it or has accesWhere the information gathered goes and who sees it or has access to it,s to it,

Whether the consumer has the choice to turn it off when privacyWhether the consumer has the choice to turn it off when privacy is desired,is desired,

What happens to it in relation to decisions about whether a persWhat happens to it in relation to decisions about whether a person can stay in theon can stay in thehome or not.home or not.

Evaluation of HomeEvaluation of Home TelehealthTelehealth Systems: User AcceptanceSystems: User Acceptance

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Through proactive monitoring, selfThrough proactive monitoring, self

--care education, medication managementcare education, medication management

and behavior modification to improve clinical outcome.and behavior modification to improve clinical outcome.

System reliability and accuracy of the measurements at home.System reliability and accuracy of the measurements at home.

Who will receive and review the data, human or computer algorithWho will receive and review the data, human or computer algorithm? Whom? Who

will take action?will take action?

Will the users change their health management attitudes and behaWill the users change their health management attitudes and behaviors?viors?

In 2002, a VA analysis of those participating in its home healthIn 2002, a VA analysis of those participating in its home health--monitoringmonitoring

program, similar to Health Buddy, showed a 63 percent drop in hoprogram, similar to Health Buddy, showed a 63 percent drop in hospitalspital

admissions, a 40 percent drop in emergency room visits, a 60 peradmissions, a 40 percent drop in emergency room visits, a 60 percent declinecent decline

in bed days of care, a 64 percent drop in nursing home admissionin bed days of care, a 64 percent drop in nursing home admissions, and an 88s, and an 88

percent reduction in nursing home bed days of care. Patient satipercent reduction in nursing home bed days of care. Patient satisfaction ratessfaction ratesexceeded 90 percent.exceeded 90 percent.

Evaluation of HomeEvaluation of Home TelehealthTelehealth Systems: Clinical OutcomeSystems: Clinical Outcome

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20062006 Innovative Approach to the Delivery of HealthcareInnovative Approach to the Delivery of Healthcare ABBY AwardABBY AwardWinner: Health Hero Network, honored for itsWinner: Health Hero Network, honored for its Health BuddyHealth Buddy telehealthtelehealth

interface between patients at home and their providers.interface between patients at home and their providers.

Health Buddy is currently in use by over 12,000 patients and hasHealth Buddy is currently in use by over 12,000 patients and has proven itsproven its

worth in clinical trials: reduced hospital admissions by 63%; reworth in clinical trials: reduced hospital admissions by 63%; reducedduced

congested heart failure (congested heart failure (CHFCHF)) hospitalizations by 72%; reduced CHF inpatienthospitalizations by 72%; reduced CHF inpatient

bed days from 8.6 to 1.7; increased medication compliance from 3bed days from 8.6 to 1.7; increased medication compliance from 34% to 94%;4% to 94%;

reduced CHF costs/patient/year from $25.0K to $11.8K.reduced CHF costs/patient/year from $25.0K to $11.8K.

Evaluation of HomeEvaluation of Home TelehealthTelehealth Systems: Economic AnalysisSystems: Economic Analysis

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COMCOM--COMCOM COMplexCOMplex

COstCOst MotivationMotivation

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What is theWhat is the smallest possiblesmallest possible homehome teletele--health system?health system?

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The Decentralized HomeThe Decentralized Home TelehealthTelehealth SystemSystem Information StructureInformation Structure

Sensor 1

Cable/wireless

transmitter

Cable/wireless

receiverPIC Server

MMC

Distributed Data ServerDistributed Data Server

HouseholdHousehold

E-mail server/SMS

Java applet server

Application serverApplication server

CareCare--giver/Client usergiver/Client user

Browser

E-Mail box/

Mobile phone

EventEvent

alertalert

Request/DataRequest/Data

VB program

AppletApplet

RegularRegular

reportreport

EventEvent

messagemessage

Sensor 2

Sensor 3

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Advantages of the Decentralized HomeAdvantages of the Decentralized Home TelehealthTelehealth System StructureSystem Structure

This system is aThis system is a useruser--centered, productcentered, product--oriented systemoriented system instead of a serviceinstead of a service--oriented system.oriented system.

The system can be easily adapted and implemented in a home envirThe system can be easily adapted and implemented in a home environmentonment

at a very low cost. The user does not have to subscribe to serviat a very low cost. The user does not have to subscribe to service from thece from the

home healthcare provider.home healthcare provider.

Health monitoring data is stored within the household. Only authHealth monitoring data is stored within the household. Only authorizedorized

caregivers can access the data. Privacy is more greatly protectecaregivers can access the data. Privacy is more greatly protected.d.

The route from the sensor to server is much shorter. Data transmThe route from the sensor to server is much shorter. Data transmission isission is

easier and more reliable. Data integrity will be better preserveeasier and more reliable. Data integrity will be better preserve

d.d.

The distributed structure of the system can be adapted to integrThe distributed structure of the system can be adapted to integrate with aate with a

centralized database and the home healthcare provider.centralized database and the home healthcare provider.

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Applications:Applications:Environment Monitoring SystemEnvironment Monitoring System

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Applications:Applications:Monitoring of Activities of Daily Living (ADL)Monitoring of Activities of Daily Living (ADL)

A i i Sl Q li i i S ( )

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Cable PIC Server

MMC


HouseholdHousehold

E-mail server/SMS

Java applet server



Browser

E-Mail box/

Mobile phone

EventEvent

alertalert


VB program

AppletApplet

RegularRegular

reportreport

EventEvent

messagemessage

Upper LimbConductiveMat

BodyConductiveMat

LegConductiveMat

Applications:Applications: Sleep Quality Monitoring System (I)Sleep Quality Monitoring System (I)

A li i Sl Q li M i i S (II)

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Applications:Applications: Sleep Quality Monitoring System (II)Sleep Quality Monitoring System (II)

A B

BedBed ActigraphyActigraphy ------Physical Activity Detecting MatPhysical Activity Detecting Mat

A i iA li i Sl Q li i i S ( )Sl Q li M i i S (III)

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Applications:Applications: Sleep Quality Monitoring System (III)Sleep Quality Monitoring System (III)

Normal

Arousal

Sensitivity 89.5%, PPV 94.8%, Specificity 84.3%

TRICTRIC Telepresence Robot for Interpersonal CommunicationTelepresence Robot for Interpersonal Communication

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TRICTRIC Telepresence Robot for Interpersonal CommunicationTelepresence Robot for Interpersonal Communication

Aging is associated with an increased risk for isolation.Aging is associated with an increased risk for isolation.

The main aim behindThe main aim behind TRICTRICss development is to allow elderly populations todevelopment is to allow elderly populations to

remain in their home environments, while loved ones and caregiveremain in their home environments, while loved ones and caregivers are able tors are able to

maintain a higher level of communication than via traditional memaintain a higher level of communication than via traditional methods.thods.

TRICTRIC aims to be a lowaims to be a low--cost, lightweight robot, which can be easily implementedcost, lightweight robot, which can be easily implementedin the home environment.in the home environment.

A li tiA li ti

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Sensor 1

Cable/wireless

transmitter

Cable/wireless

receiverPIC Server

MMC


HouseholdHousehold

E-mail server/SMS

Java applet server



Browser

E-Mail box/

Mobile phone

EventEvent

alertalert


VB program

AppletApplet

RegularRegular

reportreport

EventEvent

messagemessage

Sensor 2

Sensor 3

1

2

3

5 4

6

1. BP/BG Meter2. Pressure Cuff3. Lancet Device

4. Lancets5. Test Strips6. Strips Box

Applications:Applications:

ThTh Di tDi t tt C A hC A h

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$$

TheThe DirectDirect--toto--Consumer ApproachConsumer Approach

PP

PP

ii$$ SSCash flow Product flow Information flow Service flowPP

ii

ii

SS

iiDDSDDS

SS

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ii$$ SSCash flow Product flow Information flow Service flowPP

$$PP PP

ii

ii

SS

iiDDSDDS

SS

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Thank YouThank You

Home healthcare research in Gerontechnology Research CenterHome healthcare research in Gerontechnology Research CenterYuanYuan ZeZe UniversityUniversity

YehYeh--Liang HsuLiang Hsu

[email protected]@saturn.yzu.edu.tw

http://http://GRC.yzu.edu.twGRC.yzu.edu.tw//

http://http://designer.mech.yzu.edu.twdesigner.mech.yzu.edu.tw//

(2007-12-18) 遠距居家照護系統現況與發展

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