基層醫師使用健保醫療資訊雲端查詢系統滿意度及效益之探討

Percieved satisfaction and benefits of the NHI medical cloud system of primary care physicians

王乃玲(Nai-ling Wang)

指導教授 ： 邱亨嘉

高雄醫學大學/健康科學院/醫務管理暨醫療資訊學系碩士在職專班/碩士(2018年)

摘要

研究背景及目的
健保醫療資訊查詢雲端系統自102年推展雲端藥歷至106年之間擴展查詢項目以來，評量皆以數量指數為主，在醫師使用端於雲端查詢介面的運用、滿意度、以及醫療照護效益，尚缺乏相關的探討。本研究整合資訊系統成功使用模型ISSM (Information System Success Model)及其他學者的架構，來探討基層醫師在雲端系統使用上的狀況、滿意度及照護效益，以及影響使用的相關因素。
研究方法
本研究為前瞻性橫斷式研究，立意取樣各區基層醫師發放1220份問卷，有效問卷527份，回收率43.20%。計分為Likert scale 尺度量表五等距。以SPSS 20版為統計分析工具，每個構面Cronbach’s α為0.887至0.943之間。使用獨立樣本t檢定、ANOVA、複迴歸線性分析進行資料分析與驗證假說。統計顯著水準訂為P-value 0.05。
研究結果
常查詢的項目前三項分別為1.雲端藥歷、2.重複用藥、3.管制藥品。查詢的病人種類前三項依序為三高慢性病人、初診及多重疾病 、老年不穩定者。查詢項目達顯著差異的醫師相關特質為執業科別、有無參加醫療群及使用頻率。迴歸分析使用知覺性、系統運用品質都與滿意度達顯著關係。知覺有用性、資訊安全品質及使用滿意度是影響醫療照護效益的重要因子，尤以滿意度影響最強烈。
結論與建議
有用性、可信性、資訊品質及其安全性，滿意度對醫療照護效益也有正向影響。如果能再精進系統友善度及功能，醫師使用率高也有助於建立民眾健康巨量資料的準確性及時效性，對於國家衛生政策的規劃，如預防醫學、慢性病管理及防治，防疫、促進藥物研發，對全民健康將是一大助益。

關鍵字

健保醫療資訊雲端查詢系統 ； 資訊系統成功模式ISSM ； 醫師滿意度

並列摘要

Background and Purpose
This research explores the effects and benefits of user-driven cloud information in medical system to compromise the lack of medical networking, and to support new medical practitioners with multidimensional medical community-based care model through the use of technology. It integrates ISSM (Information System Success Model) and other framework to discuss the satisfaction of the use of electronic health records by primary care physicians in regards to facilitate doctor-patient communication, to enhance provider productivity and the process of medical care, and the factors that impact the implementation of online patient portal.
Method
Structural survey is designed to be the research method. Primary care physicians from six regions across Taiwan are the subjects of this research. 1220 questionnaires are randomly sampled with a 43.20% of survey response rate. Questionnaires are rated on a five-point Likert Scale with four pre-coded responses such as perceived use of information system, quality of information system operation, satisfaction of use by physicians, and effects of medical care. SPSS version 20 is used as statistical tool with Cronbach’s α for each pre-coded response ranging from 0.887 to 0.943. Independent sample t is used to conduct assessment. ANOVA and regression analysis are employed for data analysis and hypothesis tesing. P-value 0.05 is the statistical standard.
Results
The survey data reveal that primary physicians frequent patient portal on electronic medical history, repetitive use of prescriptions, and control on drugs. Patients of chronic diseases of hypertension、hyperglycemia、hyperlipidemia, new patients, and the unstable elders are the top three under patient category whose medical records have been visited the most. A significant difference is noted in primary physicians in terms of practice, medical networking and use of frequency for online patient portal. The research findings show a striking difference in user frequency in both aspects of perceived use of information system, and quality of information operation。Data analysis on use perception, quality of system operation affected by physicians’ satisfaction, perceived use of system on usability, easiness and credibility, as well as quality of system operation all combined to show a significant difference in satisfaction。whereas, no significant difference is noted in perceived easiness. In addition, no significant difference is identified in easiness of system usage when the effect on medical care and benefits are concerned. The findings also indicate that fine-tuning of the cloud system in medical information on these aspects to be user friendly can not only elevate user satisfaction rate but assist physicians in establishing high volume of online patient-centered records with accuracy and validity. The move with a successful implementation of electronic health medical records will further benefit national planning and policy on hygiene such as preventive medicines, chronic disease management and prevention, epidemic prevention, and research and development for medicines.

並列關鍵字

medical cloud ； primary physician ； satisfaction ； benefit

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