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  • 學位論文

影響醫院醫師及資訊主管電子病歷交換意圖及行為之因素

The factors affecting hospital physicians and information officers’ electronic health records exchange intention and behavior

指導教授 : 溫信財

摘要


研究背景與目的:為提升醫療照護品質、減少醫療錯誤及降低醫療成本,近年來,歐美先進國家逐步推行電子病歷的建置及資訊交換。目前國內雖亦藉由國家政策推行電子病歷跨院互通,但各醫院推動互通之時間及執行程度等情形均不相同。再者,醫院醫師與資訊主管在電子病歷交換中是重要成員,但兩者分別扮演使用者及服務提供者不同的角色。因此,本研究之目的在瞭解國內醫院電子病歷互通系統使用情況,並分別探討醫院醫師及資訊主管對電子病歷互通系統的採用意圖及交換行為之影響因素。 方法:本研究為一橫斷性研究,以科技-組織-環境理論為研究架構,發展結構式問卷,以全台468家醫院的電子病歷委員會醫師成員及資訊主管為研究對象,共回收有效問卷醫師樣本235份及資訊主管258份問卷,回收率為50.0%及54.9%,並使用利用SPSS 21.0及AMOS18.0進行描述性及結構方程模式等統計分析。 結果:經結構方程模式之路徑分析結果顯示,醫師在科技構面的「認知利益」(β=0.313, t=3.689, p<0.001)、「易用性」(β=-0.231, t=-2.589, p<0.05)、「相容性」(β=0.211, t=2.561, p<0.05)及「安全性」(β=-0.125, t=-2.312, p<0.05),環境構面的「政府政策」(β=0.304, t=-3.196, p<0.01)及「法令規章」(β=0.231, t=3.209, p<0.01)對電子病歷互通系統的採用意圖呈現顯著影響;資訊主管在科技構面的「認知利益」(β=0.166, t=2.371, p<0.05)及「安全性」(β=-0.094, t=-2.069, p<0.05),組織構面的「上級支持」(β=0.242, t=4.081, p<0.001),以及環境構面的「政府政策」(β=0.185, t=2.123, p<0.05)及「法令規章」(β=0.464, t=5.047, p<0.001)對電子病歷互通系統的採用意圖呈現顯著影響。但醫院醫師及資訊主管是否採用電子病歷互通系統,在科技、組織、環境構面上並未對「採用意圖」產生調節的關係。 結論:電子病歷互通系統的資訊安全、政府相關政策及法規等對醫師及資訊主管的採用意圖有顯著影響,其中醫師較為關切科技層面的系統相容性及功能易用性,而資訊主管則需要上級主管大力支持,以推展電子病歷互通作業。整體而言,本研究建議政府主管機關應適時提供誘因及協助中小型醫院互通系統的建置,以提高醫院使用電子病歷交換的意願,且醫院在推動電子病歷互通系統時,需具備足夠的資訊人員及軟硬體設施等能力,並定期舉辦教育訓練及宣導活動,並提供醫師、資訊人員與上級主管相互溝通的管道。

並列摘要


Background & Object: In recent years, US and some European countries has implemented the Electronic Medical Record (EMR) Exchange system to enhance the quality of care, reduce medical errors and costs of healthcare. Although Taiwan followed advanced countries’ steps to promote EMR exchange by government policies, hospital had different approaches and completions individually due to their strategies and resources. Hence, realise the situations of hospital’s EMR exchange and to explore the factors affecting hospital physicians and information officers’ EMR exchange intention and behaviors is our purpose. Methods: A cross-sectional study conducted which was used structured questionnaire based on the technology-organization-environment theory. The subjects included the in charge physicians and information officers of electronic medical records exchange from 486 hospitals implemented EMR exchange system. 238 hospital physicians and 258 information officers were responded and the response rate was 50.0% and 54.9% respectively. SPSS 21.0 and AMOS 18.0 statistical software was used for subsequent analysis. Results: According to the path analysis of structural equation model, the factors which influenced the hospital physicians’ intention of EMR exchange were “perceived benefit” (β=0.313, t=3.689, p<0.001), “usagility” (β=-0.231, t=-2.589, p<0.05), “compatibilit” (β=0.211, t=2.561, p<0.05), and “security” (β=-0.125, t=-2.312, p<0.05) of technology context and “govermnemt policy” (β=0.304, t=-3.196, p<0.01), and “laws and regulations” (β=0.231, t=3.209, p<0.01) of environment context. For the information offices, the factors which influenced it’s intention of EMR exchange were “perceived benefit” (β=0.166, t=2.371, p<0.05), and “security” (β=-0.094, t=-2.069, p<0.05) of technology context and “top manager support” (β=0.242, t=4.081, p<0.001) of organization context and “govermnemt policy” (β=0.185, t=2.123, p<0.05), and “laws and regulations” (β=0.464, t=5.047, p<0.001) of environment context. , there had no significant difference for the hospital physicians and information officers, whether they have the beviors of EMR exchange or not. But whether hospital physicians and information officers haved “the behavior of using EMR exchange system” or not, it doesn’t produce relations in the thecnology context, organization context, and eviornment context to the intention of EMR exchange system. Conclusion: The information’s security of EMR, relevant government policies, laws and regulations were significant influence the intention of EMR exchange. However, hospital physicians were more concerned about EMR system’s “compatibility” and functional usability and information officers were demanded more “top manager support” from hospital executives that can promote EMR exchange system. So, we suggest that hospital should have adequated IT manpower and euipments and conduct education and training regularly when they promote EMR exchange system. That could provide physicians, information officers, and supervisors a communication channels and support to build up EMR exchange system. Also government should establish policies and provide incentives for hospitals to increase the EMR adoption intention and behaviors.

參考文獻


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被引用紀錄


佘明玲、黃興進、翁儷禎(2019)。影響老年病人就診科別醫師使用電子病歷交換意願因素之初探研究台灣公共衛生雜誌38(4),416-430。https://doi.org/10.6288%2fTJPH.201908_38(4).108025

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