建構適用於台灣醫療環境之「醫院資訊系統使用者滿意度評估模式」

研究目的:1. 探討同一醫療體系二家醫院之醫院資訊系統使用者的人口學特性。2. 探討同一醫療體系二家醫院之醫院資訊系統使用者對科技、人性、淨效益等構面之滿意度。3. 探討同一醫療體系二家醫院之醫院資訊系統使用者不同職級間對科技、人性、淨效益等構面之滿意度。4. 探討同一醫療體系二家醫院影響醫院資訊系統使用者滿意度及組織淨效益之重要影響因子。研究方法:本研究所採用之評估工具將包含七大評估構面： (1)科技構面：系統品質、醫療資料品質、服務品質、安全品質；(2)人性構面：系統使用情形、使用者滿意度；(3)機構淨效益：醫療機構淨利益。樣本醫院：本研究以同一醫療體系二家醫院為研究的樣本醫院進行問卷訪視。樣本對象：本研究所欲評估之醫院資訊系統的使用者，將包含醫師、醫師助理、護理人員、病歷管理人員、醫務行政管理人員等相關使用人員作為本研究的研究對象。資料統計分析包括：卡方檢定、變異數分析及複迴歸分析。研究結果:本研究計回收問卷:甲醫院有效問卷349份問卷；乙醫院有效問卷回收259份問卷；研究結果發現: 1. 就醫院資訊系統運用在科技構面的滿意度而言，兩院有顯著性差異；但兩院同樣對於醫療資料品質滿意度最高；對服務品質的滿意度最低。而就醫院資訊系統之運用在人性構面的滿意度而言，兩院同樣有顯著性差異；但兩院同樣的是使用者滿意度的構面滿意度最高，系統使用構面的滿意度次之。就淨效益構面而言兩院在滿意度有顯著性差異。 2. 就醫院資訊系統運用在不同職級使用者間，在科技構面的滿意度而言，兩院有顯著性差異；但兩院同樣是醫事行政人員滿意度最高；護理人員的滿意度最低。在人性構面的滿意度而言，兩院同樣有顯著性差異；但兩院同樣的是行政人員的滿意度最高，護理人員的滿意度的滿意度最低。就淨效益構面兩院有顯著性差異；但兩院同樣的是行政人員的滿意度最高，護理人員的滿意度的滿意度最低。 3. 採複迴歸分析於科技構面與人性構面之品質對於使用者滿意度之影響，整體的校正後R平方為70.9%，標準迴歸係數估計指出，「系統使用」具有最佳的解釋力。 4. 採複迴歸分析於人性構面對於組織使用效益之影響，整體的校正後R平方為72.1%，標準迴歸係數估計指出，「使用者滿意度」具有最佳的解釋力。結論與建議:目前國內醫療資源的浪費比率高，可借由資訊化來避免浪費，例如IC卡的推動避免重複檢查等；而目前國內醫院資訊化的程度高，相對對資訊的依賴度也高，所以資訊安全的推動跟防護是很重要的，這也是病人安全的推動中很重要的一環；故建議醫院的管理階層應該注重醫院資訊安全的推動並投注相對的經費跟人力。

關鍵字

醫院資訊系統；使用者滿意度；系統評估；評估模式

並列摘要

Purpose:1. To discuss the differences and comparability or any improved factors from technology aspect of applying EMRS of medical information system between a organization's medical central hospital and a region hospital.2. To discuss the differences and EMRS users satisfaction and situation from human aspect of applying EMRS of medical information system between a organization's medical central hospital and a region hospital. 3. To discuss the satisfaction affects of doctors and nurses from information safety aspect of applying EMRS of medical information system between a organization's medical central hospital and a region hospital.4. To discuss the satisfaction affect of doctors and nurses of applying EMRS of medical information system between a organization's medical central hospital and a region hospital. Research Methodology:The assess tool of this paper include 7 aspects：(1)technology aspect: system quality、medical material quality、service quality、safety quality；(2)human aspect：use HIS condition、user satisfaction；(3)agency benefit: medical institution benefit and effect. The sample hospital: This paper use questionnaire interview in a hospital and a organization's medical central hospital as the research sample hospital to do the research. Sample subject：In this research apply the electronic medical record system which includes: PACS, LIS, HIS and CIS and other related medical systems to do the assessment. In view of above system terminal user (end users): doctors、doctor assistants、nurses、the medical record administrative staff、the medical affairs administration staffs and other related personnel as the subjects of this study. Data statistics analyze includes：chi-square test、analysis of variance(ANOVA) and multiple-regression-analysis. Research Findings:This research return questionnaire counts: 349 questionnaires of KMHK Hospital; 256 return questionnaires of Chung-Ho Memorial Hospital; this research result finding: 1. The two hospitals have significance differences in the Healthcare information system from the satisfaction in technical aspect; and both have similarly highest satisfaction of medical data quality; but the lowest satisfaction standard of service quality. 2. The two hospitals have significance differences in the HIS users satisfaction from human aspect of applying HIS of medical information system. The users satisfaction are the highest standard in both hospitals, but the system users satisfaction are the lowest standard. 3. About the satisfaction affects of doctors and nurses from information safety aspect of applying HIS between a organization's medical central hospital and a region hospital. Except in the two following “each page should present patient name to confirm your identity” and “may help patient to verify the medication treatment and related information” without significance difference, but in “easily to find out patient past medical record” has the highest satisfaction standard of both hospitals, but the lowest satisfaction standard in “provides patients information quantity from the PC”. 4. The two hospitals have significance differences in the satisfaction affect of doctors and nurses of applying HIS of medical information system. Both have the same highest standard in information safety system satisfaction, but the lowest standard in the system user satisfaction. Also its find out the high satisfaction standard of the system quality; medicare material quality; service quality and safety quality satisfaction would affect the high users satisfaction standard. Conclusions and Suggestions:Present the high waste ration of domestic medical resources, we could prevent wasting by the information system. For example use the IC card prevent the double check and etc.. Today we have high quality domestic hospital information, oppositely people more rely on technology system, therefore the information security impetus is very important, it is also further patient safety. Therefore I suggest that the hospital management department should pay more attention on the hospital information security impetus and invest more funds and manpower.