臺灣西醫、中醫和牙醫診所資訊化及病歷電子化影響因素探討

To Explore the Factors affecting Computerization and Electronic Medical Record Acquisition in Western, Chinese and Dental Clinics in Taiwan

余偉綸(Yu Wei-Luen)

指導教授 ： 張明正 ； 邱政元

亞洲大學/健康學院/健康產業管理學系健康管理組/碩士(2004年)

摘要

在資訊時代尚未到來之前，各個健康照護的組織一直是以紙張作為儲存病歷的方式；但是，紙本病歷有很多的缺點。比起紙張病歷，電子化的病歷有不少的優點，如避免重複、減少花費、即時性、效率性、辨識容易…等。然而病歷電子化可能會遭遇到安全性、投資費用高、使用習慣和相關法規制度等的問題。根據鉅仁科技在2002年全國病歷電子化調查資料顯示，西醫診所資訊化的比例有77%，中醫診所有76%，牙醫診所有71%，總合台灣診所的資訊化比例有七成五之高。由於三個診所類別資訊系統的使用狀況不同，進行病歷電子化的階段和進展也不一致，值此電子病歷如火如荼發展之際，因此本研究欲了解不同的診所類別中，與其資訊化和病歷電子化有相關的因素，並且了解其對政府政策的態度與期望，再給予不同的建議。
研究結果顯示，比較三個診所類別的人員互動與經營環境，西醫和中醫診所內部較有標準的作業程序，中醫和牙醫診所的員工較有自主權。對政府政策之意見中，中醫和牙醫診所較支持政府推動電子病歷和相關政策的實施，法令不足和隱私權問題對西醫和牙醫診所病歷電子化影響較大。
預測診所資訊化和病歷電子化的邏輯斯迴歸模式發現，會影響診所資訊化的因素有：每週開診時數、專職負責資訊相關業務的人員（西醫和牙醫診所）、每年投入資訊應用的預算、人員互動和經營環境的作業程序和員工自主因素（只有牙醫診所）、對政府政策之意見的政府推動因素。會影響診所病歷電子化的因素有：每年投入資訊應用的預算（西醫和牙醫診所）、政府推動因素、政府協助和法令不足因素（只有西醫診所）、內部區域網路（西醫和中醫診所）、門診系統的採用情況、現有個人電腦數量（西醫和牙醫診所）等。
經本研究分析發現，西醫、中醫和牙醫診所對政府政策的態度不一致，推行電子病歷可能遭遇的困難點也不相同，因此相關單位應針對三個診所類別不同的需要給予協助或必要的介入。而各西醫、中醫和牙醫診所可參考本研究所得之顯著的結果，檢視目前所不足的部份加以改善，且因應2004年4月新醫療法通過病歷得以電子文件方式貯存，各診所也應配合衛生署和健保局的相關政策施行，作好全國病歷電子化的準備，使能早日達成電子健康病歷的目標。

關鍵字

西醫診所 ； 中醫診所 ； 牙醫診所 ； 資訊化 ； 電子病歷

並列摘要

Traditionally, health care providers use paper charts to store all medical documents. As the information technique developed, it becomes a trend to adopt EMR (Electronic Medical Record) to save the medical records. EMR has many advantages, such as: avoiding duplication, reducing cost, easily to recognize the content, and can be interchanged immediately, …etc. However, there are some problems of applying EMR, for example, security issue, high investment cost, the barrier to people using paper chart. According to “2002 National EMR status Investigation” in Taiwan, there is 77% computerization in Western clinics, 76% in Chinese clinics, 71% in Dental clinics, and 75% computerization in all clinics of Taiwan. The extent of computerization and adopting EMR in different clinics is quite different. But the reasons of the differences are not clear. This study explores predictors of computerization and EMR acquisition in three different clinics.
This study used dataset of “2002 National EMR status Investigation” in Taiwan to conduct logistic regression analysis using SPSS.
Research results show that comparing to staff interaction and operation condition of three kinds of clinics. More standard operation procedures exist in Western and Chinese clinics than in Dental clinics. The staff in Chinese and Dental clinics has more autonomy than Western clinics staff. For the attitude toward government policy, Chinese and Dental clinics support government’s implementing EMR policy more than Western clinics do. Insufficient legislation and privacy problem affect Western and Dental clinics more than Chinese clinics.
This study finds certain characteristics are more likely to be associated with higher computerization: working hours a week of the clinic, the full-time information professional (Western and Dental clinics), information budget a year, staff interaction and operation condition and staff’s autonomy (Dental clinics only), government implement factor.
As the factors relate to EMR acquisition: information budget a year (Western and Dental clinics), government implement factor, government assistance and insufficient legislation factor (Western clinics only), intranet (Western and Chinese clinics), ambulatory system, number of personal computers (Western and Dental clinics) were more likely to associate with EMR acquisition.
To sum up, Western, Chinese and Dental clinics have different attitude toward government policy and encounter different difficulties. Policy makers need to consider these different difficulties and provide necessary interventions for different clinics. Since new Medical Law was enacted at April 2004 in Taiwan, the medical record could be stored in electronic format. Each clinic should prepare itself to meet the implement of EMR.

並列關鍵字

Western clinics ； Chinese clinics ； Dental clinics ； Computerization ； EMR acquisition

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