應用修正科技持續理論探討電子病歷使用行為之研究

A Study On The Behavior In Electronic Medical Record With Modified Technology Continuance Theory

許恒韶(Hsu, Hengshao)

指導教授 ： 黃維民

國立中正大學/管理學院/資訊管理系醫療資訊管理研究所/碩士(2012年)

摘要

台灣從1995年開始實施全民健保後，醫院便開始使用紙本病歷來做為保險給付的重要憑證，但紙本病歷經年累月地大量增加，造成病歷室空間需求的增加也造成醫院內員工龐大的工作量。近年來，醫療機構不斷將金錢投資在資訊科技上，透過資訊科技有效提升生產力且逐漸關注影響使用者在科技採用與使用之重要關鍵因素，如電子病歷。而在醫院內，醫師的接受及持續使用是影響成功推動電子病歷持續使用之重要環節。因此，本研究期望能透過修正後科技持續理論(Technology Continuance Theory, TCT)之架構，加入「工作相關性」與「電腦自我效能」去解釋及預測醫師對於電子病歷系統的接受以及持續使用行為，以達到正確評估影響關鍵因素。本研究以行政院衛生署公告「99年度實施電子病歷及互通績優醫院」之某醫學中心為研究對象，共發出250份問卷，有效問卷為181份，有效回收率為72.4%；並應用SPSS 17.0與SmartPLS 2.0統計軟體進行資料分析。研究結果顯示，態度為最主要會影響醫師持續使用電子病歷行為意圖之變數，其次為知覺有用性；滿意度或知覺易用性也會間接透過態度對持續使用意圖產生影響。另外，知覺有用性也會間接透過滿意度，再經過態度而影響持續使用意圖。故研究建議，醫療機構應顧及電子病歷使用者的整體感受，降低使用者反對與排斥之推行障礙，間接地也會影響醫療照護行為或照護品質。

關鍵字

電子病歷 ； 科技持續理論 ； 科技接受模式 ； 期望確認理論 ； 持續使用意圖

並列摘要

Taiwan has implemented National Health Insurance (NHI) since 1995. The hospitals began to use the paper medical record to apply the insurance payments. But the paper medical records increase constantly that result in the increase space requirements of the medical centers and the huge workload of the staffs. In recent years, the medical institutions continue to invest their money into information technology to enhance productivity effectively, and even concern about the impact factors of user usage in technology such as electronic medical records (EMRs). In the hospitals, physician’s acceptance and continuance use might be an important part to successfully carry out continuing use electronic medical records. Therefore, this study expects to explain and predict the physicians’ acceptance and continuance use on EMR by the framework of modified technology continuance theory to join job relevance and computer self-efficacy, and that we can assess correctly the impact of key factors. In this study, we chose one outstanding performance hospital in 2010 academic year to implement and exchange electronic medical records for the sample which was published by Department of Health, Executive Yuan. A total of 250 questionnaires were administered to physicians and 181 (72.4%) completed the questionnaire; and we used SPSS 17.0 and SmartPLS 2.0 statistical software for data analysis. The results showed that attitude is the most important variable to affect the continuance use intention of physicians in electronic medical records, and followed by perceived usefulness; satisfaction or perceived ease of use also indirectly affected continuance intention through attitude. In addition, perceived usefulness would indirectly affect continuance intention through satisfaction, and then attitude. Therefore, our research suggestions are that medical institutions should concern about the overall feeling of the electronic medical records users, reduce barriers and opposition, and it will also indirectly affect health care behavior or health care quality.

並列關鍵字

Electronic Medical Record (EMR) ； Technology Continuance Theory (TCT) ； Technology Acceptance Model (TAM) ； Expectation Confirmation Theory (ECT) ； Continuance Intention

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