醫師對於個人健康記錄之認知與使用意願初探

Physicians’ Cognition and Willingness to Use on Personal Health Records

李怡萱(Yi-Hsuan Lee)

指導教授 ： 林能白

國立臺灣大學/公共衛生學院/健康政策與管理研究所/碩士(2012年)

https://doi.org/10.6342/NTU.2012.00718

摘要

背景：個人健康記錄（Personal Health Records, PHRs）是一個以電子化方式儲存民眾終生與健康相關之資訊紀錄，藉由資訊化與系統化的方式個人健康紀錄能夠協助民眾管理健康，增進醫病溝通以及病患賦權。近年來PHRs之概念受到美國、英國與澳洲政府的重視，臺灣亦逐步朝建構PHRs邁進。由於過去研究發現民眾認為PHRs系統有價值的功能皆與醫師相關，加上醫療屬於高知識密集的產業，醫師相較於民眾更為瞭解PHRs的定位與系統需求。綜合過往研究並未從醫師之觀點對整體PHRs之系統需求、使用意願、發展議題等面向進行探討，因此探討此一議題為目前PHRs系統發展初期相當重要之課題。
目的：本研究旨在從醫師觀點進行PHRs的初步系統需求分析，內容包含PHRs系統應含括的功能、系統價值與採行障礙。進一步以創新擴散模式探討醫師對於PHRs的使用意願與影響因素。最後，整合醫師對於PHRs發展之觀點，進而提供未來發展之建議。
方法：本研究採質性研究之深度訪談方式，針對家庭醫學科以及內科醫師為對象以立意取樣進行資料蒐集。資料蒐集期間自2011年11月1日至2012年5月15日，共有17位受訪者。訪談過程以半結構式訪談大綱引導並進行錄音，訪談後將錄音檔整理成逐字稿，以內容分析及編輯式編輯分析方式作為資料分析方法。
重要結果：(一)PHRs使用者應為全體民眾，考量回收效益推動可能有所先後，但最終目標應為每個人皆能擁有以達整合照顧與健康資源的全面共享。系統功能面以就診、健康管理及醫病間溝通三大功能為主。PHR系統的採行在民眾面、醫師面或是社會層面皆能產生許多價值，然而由於民眾的教育、相關法律的制定以及系統建置準備尚未就位，可預見PHRs的推行會遇到許多困難。(二)多數醫師表示願意使用PHRs，其所產生的多方價值及合適的健保支付制度為醫師使用PHRs的誘因，相對的系統複雜性與相容性兩面向則是主要影響醫師採取行動的關鍵因素。(三)PHRs的發展建議：標準設置、法律、財務、應用等四個層面是PHRs發展的主要關鍵。政府應確立立場，決定是否由政府統一建置全國性的PHRs，若開放民間企業建置則需考量法律的可行性以及跨醫療機構之間的資訊共通性。應制定PHRs相關法令保障民眾資訊隱私與安全，並避免醫師因所產生之法律責任風險而卻步。而在PHRs推行初期可從「疾病類型」、「世代」、「個人意願」或「健保制度」等四個面向著手逐步推動。最後，為了社會健康的平等，政策面上應針對弱勢族群加以補助與協助。

關鍵字

個人健康紀錄 ； 電子化個人健康紀錄 ； 隨身病歷 ； 創新擴散模式 ； 需求分析

並列摘要

Background
Personal Health Records (PHRs) is an individual electronic record of health-related information and can help an individual to manage their health, improve physician-patient communication and patient empowerment by computerized tools. In recent years, the concept of PHRs has been taken into account in US, UK and Australia. With this trend Taiwan is also stepping toward developing PHRs. According to research studies, people believe the most valuable function of PHRs is related to physician. Aside from that, healthcare is a highly knowledge-intensive industry therefore physicians have more understanding of PHRs orientation and system requirements than public. Past research hardly mentioned physician’s view on PHRs development and willingness to use, therefore this is an important topic to discuss in Taiwan.
Objective
The purpose of this study is to explore physicians’ perspective on the need assessment of, value of, barriers to and use of PHRs. Furthermore, explore factors affecting physicians’ usage intention of PHRs by innovation diffusion theory. Ultimately, provide policy recommendations for developing PHRs.
Method
This qualitative study adopted in-depth interview and purposive sampling. The 17 physicians participated in semistructured interview, which were audiotaped and transcribed verbatim. Data were collected from November 2011 to May 2012. The method of content analysis and editing analysis were employed for analysis.
Findings
1. PHRs should provide services for all people for the goal of integrated care and healthcare resource-sharing. However, there might be a sequence to contain every person when considering recovery benefits. The main function of PHRs is medical treatment, health management and physician-patient communication. There will be many benefits for public, physician, and society; nevertheless, popular education, laws and PHRs systems has not ready for putting PHRs in practice. 2. Participants are willing to use PHRs. Their incentives are benefits of many aspect and proper payment system. On the other hand, system complexity and compatibility are key impact factors of adopting PHRs. 3. Policy Suggestion: There are 4 main issue should be discussed, that is PHRs standard, related laws, finance and application. Besides, government should take a stand on deciding whether to develop nationwide PHRs. If PHRs were set up by enterprise, legal feasibility and interoperability between organizations should be taken in to account. Government need to constitute regulation for protect public privacy and information safety and avoiding physician hang back because of legal risk. At initial stage, government can advance PHRs adoption by 4 ways that is “sickness”, “generation”, “intention” or “NHI institution”. Ultimately, government should subsidize and assist disadvantaged minorities for the goal of health equity and social justice.

並列關鍵字

Personal Health Records ； Electronic personal health records ； Health record to go ； Diffusion of Innovations ； Need assessment

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