影響病患對隨身碟電子病歷使用意願與行為之相關因素

The Factors Affecting Patients’ Usage Intention and Adoption Behavior of Portable Electronic Health Record

陳筱如(Hsiao-Ju Chen)

指導教授 ： 溫信財

臺北醫學大學/公共衛生暨營養學院/醫務管理學研究所/碩士(2009年)

摘要

研究背景與目的：使用電子病歷可增加病患資料正確性，有效提升醫療品質，實現以病人為中心之理念，於是各國以電子病歷可交換性與增加可近性為發展重心，並開始重視病患的授權問題。行政院衛生署為了順應電子病歷的發展趨勢，於2008年5月執行「建構以病人為中心之電子病歷跨院資訊交換環境計畫」，除了建置院際間的電子病歷交換環境外，更讓病患擁有病歷，回歸其病歷資訊保管權，希望提供連續性的照護、減低醫病資訊不平等與自我健康管理。故本研究欲了解隨身碟電子病歷推廣現況、影響病患對其使用意願與行為之相關因素，並比較有無申請兩類病患於自變項上的差異。

方法：研究對象為10家自願參與試辦計畫的醫學中心，採用定額抽樣方式，受試樣本為申請與無申請電子病歷兩類病患。研究工具為以科技接受模式為基礎之結構式問卷，問卷共發放3000份，回收總計1549份，有效問卷為1465份，有效回收率48.83%，並利用SPSS 12.0軟體進行統計分析。

結果：申請電子病歷之病患個人特質分別以女性、30-39歲與大學程度為最多，就醫經驗與自覺身體較差的比例較高，其認知有用性、認知易用性、社會規範與隱私安全性認知程度顯著高於無申請者(p<0.001)。羅吉斯迴歸分析結果顯示，影響申請行為之因素為40-49歲(OR=1.516)、高中職(OR=0.303)、專科(OR=0.339)、大學(OR=0.363)、研究所(OR=0.378)、紙本病歷申請經驗(OR=1.498)、半年內兩家醫院以上就醫經驗(OR=0.739)、認知有用性(OR=1.596)、社會規範(OR=1.469)、電腦自我效能(OR=0.769)與使用意願(OR=9.431)。

結論：申請電子病歷的病患其使用意願顯著高於無申請者，因此建議政府宣導電子病歷有用性與易用性，加強與升級醫院資訊系統的安全、隱私，以降低病患疑慮，提升電子病歷的申請行為。

關鍵字

隨身碟電子病歷 ； 科技接受模式 ； 使用意願 ； 申請行為

並列摘要

Background: Electronic health records (EHR) can provide accuracy of health information which also enhances the quality of medical treatment, and achieves the goal of patient-centered care. With the emerging of information technologies, many countries have focused on data interoperability, access, and patient’s authorization. Taiwan Department of Health (DOH) has carried out “Building of an Information Exchange Environment for Cross-Hospital Digital Medical Record project” in May, 2008. DOH’s project tried to build the portable data exchange environment, and empowered people to own their health records to provide the continuum care, self-health management and reduced the information asymmetry. Thus, this study aimed to understand the status quo of portable EHR in Taiwan, explored the factors affecting patients’ usage intention and adoption behavior, and compared the patients apply the portable EHR with the others.

Methods: This study used quota sampling, and the subjects were patients selected from 10 medical centers which volunteered to participate in the DOH project. The subjects can be divided into two groups, one group requested the flash drive with portable data and the other group did not. The structured questionnaire base on the Technology Acceptance Model (TAM) to conduct the survey which was distributed to 3000 respondents.1549 were returned and 1465 were valid from the returned answer sheets, so the valid rate was 48.83%. The SPSS 12.0 statistics software was used for analyzing data.

Results: The results showed the majority of adopt group, whose demographics were female, age between 30 to 39 years old, and university-educated. They had more experiences of medical treatment, but less self-perception of health. And their recognitions of perceived usefulness, perceived ease of use, subjective norms, privacy and safety were higher than non-adopt group (p<0.001). From the results of logistic regression, we found the factors affecting patients’ adoption behavior were age between 40 to 49 years old(OR=1.516), high school-educated(OR=0.303), college-educated(OR=0.339), university-educated(OR=0.363), graduate school-educated(OR=0.378), paper-based medical record release(OR=1.498), medical care seeking over two hospitals in a half year(OR=0.739), perceived usefulness(OR=1.596), subjective norm(OR=1.469), computer self-efficacy(OR=0.769) and usage intention(OR=9.431).

Conclusions: The usage intention of EHR adopters was significantly higher than non-adopters. Therefore, we suggest that government should popularize the perceived usefulness and ease of use of portable HER. Hospitals must upgrade the safety and privacy of EHR system. Thus, patients’ doubts would be reduced and the behavior of applying portable EHR would be effectively increased.

並列關鍵字

portable electronic health record ； Technology Acceptance Model (TAM) ； usage intention ； adoption behavior

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