病歷室主管對於電子化病歷之認知及預測實施後現有人力運用之研究-以區域醫院及醫學中心為例

The Study of Taiwan Medical Centers and Regional Hospitals Medical Record Administrators’ Perception on Electronic Patient Recording and Manpower Adjustment Forecast

郭啟坤(Chi-Kun Kuo)

指導教授 ： 黃崇謙

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(2004年)

摘要

資訊科技的高度發展，讓許多企業得以透過電子化來提升及強化其競爭力，電子化所帶來的是一項工程浩大的企業重整及人力資源重分配的工作，相同的，在醫療院所面對此一時代步調，已漸將傳統的紙本式病歷朝向電子化病歷發展，而「人」在此走向及趨勢中當如何轉變及調適是本研究之重點，因此本研究初擬嘗試了解病歷主管對電子化病歷之認知程度，及即將被電子化病歷所可能取代的人力，其所可能的因應之道及考量，以作為本研究之目的。 本研究以區域醫院及醫學中心之病歷室主管為研究對象，以郵寄問卷及電子郵件的方式進行調查，總計共發出問卷86份回收58份，經整理扣除填答不全且無法再補答者後，共獲得有效問卷53份，回收率為61.63%，藉由本研究樣本分析結果得知有96.2%的病歷室主管認為電子化病歷後會減少人力，減少人力的百分比平均為46.67%，在人員留任的標準依序為：「學習能力」、「有效證照」、「學經歷」、「抗壓性」、「忠誠度」最後才是「主管個人評定及裁量」；在願意離職的員工會做何處置方面依序為：「轉調其他部門」、「資遣優退」、「依上級安排」及「轉業輔導」；經分析病歷室主管屬性對電子化病歷的認知部份，在「法律面」計有2項有顯著相關，如「醫療糾紛發生時電子化病歷的公信力足夠」等，在「標準面」計有4項有顯著相關，如「目前的網路速度能符合電子化病歷的需求」等，在「技術面」計有7項有顯著相關，如「本院的發展技術已純熟及齊備」及「本院的電腦硬體設備符合未來電子化病歷的需求」等，在「執行面」計有12項有顯著相關，如「導入電子化病歷所獲得的利益大於投入成本」、「電子化病歷是健保局掌控醫療資源的一種手段」及「電子化病歷所需經費應由政府部門支出」等。 藉由本研究樣本分析結果提出建議如下： 一、對主管機關的建議： （1）應儘速立法或修訂有關電子病歷之相關法規，方可協助釐清所衍生之相關性問題。 （2）政府機關應編列預算及提供專人協助各醫療院所建立一套能與世界接軌的軟硬體標準並予技術輔導。 （3）跨院際間的傳輸應設立專有線路以確保網路之穩定性及安全性。 二、對病歷主管的建議： （1）建議成立電子化病歷管理委員會或電子化病歷規劃及推動小組，將所有可能產生的問題列入時間表，以利追蹤處理。 （2）對員工應主動協助生涯規劃，並借助政府或民間的力量協助培養第二專長等技能。 （3）建議配合規劃時間表柔性進行人力重組的工作，以避免可能發生的勞資爭議。

關鍵字

病歷室主管 ； 電子化病歷 ； 人力

並列摘要

Many enterprises use various information technologies to improve their operational efficiency and effectiveness to gain the competition edges. The introductions of electronic commerce such as enterprise resource planning, supply chain management, customer relationship management and mobile computing have fundamentally changed the traditional business operations and management models. This trend relocates the manpower in work placement and subsequently induced enterprise reengineering of human capital structure and integration of business functional resources. Since the electronic revolution, the health care industry has faced new challenges of new business model and information technology to improve its operation and medical services as well as quality of care. The traditional medical records are written or drawn in paper. It will be transformed to electronic media. This situation will save the manpower and improve its efficiency on the medical care and quality. The purpose of this research focuses on electronic medical administrators’ the perception of efficiency and how to utilize the manpower replaced by electronic medical record（EMR）. This study survey is by sampling of the target population from administrators of medical record department from all Taiwanese regional hospitals and medical centers. The survey vehicle collected questionnaire data by posted mail or electronic mail format. The number of population sizes is 86 hospitals. The number of total respondents is 58 samples. However, there are five incomplete returned questionnaires. The number of completed questionnaires is 53. The response rate is 61.63%. From this study, we found that the majority (96.2 %) of medical record department administrators think that the EMR can save manpower cost. The EMR will save 46.67% manpower from the survey targets. How to relocate the manpower will be based upon the evaluation standards such as personnel capability, valid specialty license, work experience, academic degrees, working pressure resistance and loyalty. The decision to keep or let go of the employee will be the least consideration to evaluate the employee. The utilization of manpower will be as follows: transfer to other departments, retirement, and employee assistance program to other career development. From the study data, we found the cognition of EMR will be analyzed from various prospective. From legal perspective, when the malpractice litigation occurs, we have strong evidence that the EMR can be a powerful justification for legal investigation. There are two significant findings from our legal perspectives. First, from defining standard of EMR perspective, there are two significant results, one is the speed of transferring medical data, unparalleled by conventional method, and secondly, it can simultaneously satisfy many requests for the data. From IT perspectives, there are seven significant results finding, such as the hospital IT development capability and hardware equipments supplement, how the web and hardware equipments can enhance EMR capability. From the implementation perspectives, there are 12 significant finding such as the cost benefit and reward of EMR investment, and how the national health insurance bureau to utilize the EMR to control and analyze hospital reimbursement. The cost of developing EMR should be reimbursed from government budget. Policy Implication From our research findings, we have some suggestions to contribute the development of EMR. These recommendations are as follow: 1. The recommendations for the government agency： (1). The legislation agency of government should establish the privacy laws and electronic certification validation act to protect the EMR information security. (2) The government should take the lead and provide budget to support the development of EMR and set national standard to exchange EMR information. (3). The bandwidth management of web system should maintain stability, efficiency and security to process EMR. 2. The recommendations for medical record department directors： (1). To plan the EMR implementation to make sure the project execution and problem-solving techniques as needed to make the EMR project work. (2) To help workers by developing their versatile career skills to adapt to EMR evolution. (3) To avoid the conflict between employer and employees of EMR’s manpower adjustment smoothly and peacefully.

並列關鍵字

medical record administrator ； Electronic Patient Record ； manpower

參考文獻

楊和炳(民90)。e世代人力資源品質。品質管制月刊，頁29-30。

蔡潔娃(民90)。EC對人力資源發展之影響。臺灣經濟研究月刊，頁62-65。

Cartwright, S., & Cooper, C.L.(1993).”The Rule of Culture Compatibility in Successful Organizational Marriage”, Academy of Management Executive, 7(2), 57-76.

Gary Dessler(2002),Human Resources Management(8rd ed.).New Jersey:Prentice Hall. Henry S. B., Douglas K., Galzagorry G., Lahey A., and Holzemer W. L. (1998). “A template-based approach to support utilization of clinical practice guidelines within an electronic health record” Journal of American Medical Informatics Association. 5, 237-244.

Bates D. W., Teich J. M., Lee J., Seger D., Kuperman G. J., Ma''Luf N., Boyle D., and Leape L. (1999). “The impact of computerized physician order entry on medication error prevention” Journal of American Medical Informatics Association. 6, 313-321.