醫師面對老年病人時之電子病歷交換資訊需求與意願的初探研究

A preliminary study of the information needed in Electronic Medical Records exchange and physicians' usage intention when treating elderly patients

目標：從需求面探討面對老年病人時醫師需要其他機構電子病歷的項目，及其對醫師使用電子病歷交換之意願與可能性的影響。方法：由文獻歸納電子病歷交換需求項目，以德菲法修改問卷，再對某醫療體系之醫師進行調查。復以因素分析探討電子病歷需求之因素，並以之對醫師使用電子病歷交換之意願與在不同診療途徑之使用可能性進行複迴歸分析。結果：電子病歷交換資訊需求之因素分析呈現四因素，醫師需求依次為：個人特殊病史，檢驗檢查報告，療程變化記錄，家系資料與照護記錄。個人特殊病史有助於增進醫師取用意願與在住院和急診時取用電子病歷交換之可能性，家系資料與照護記錄則可增進醫師於預防保健時取用電子病歷之可能性。結論：醫師面對老年病人最需要的病歷內容非現行電子病歷交換平台之主要項目。建議電子病歷交換宜以使用者需求為出發點，將來可考慮自健保資訊系統自動擷取醫師所需之重要項目，或由醫師協助彙整提報，以增進電子病歷交換之臨床應用價值。

Objectives: This study explored the information in Electronic Medical Records (EMR) exchange that physicians need when dealing with elderly patients, and the relationship between information needed and physicians' intention to use EMR exchange in clinical settings. Methods: A questionnaire containing items of EMR exchanges crucial in the treatment of elderly patients was constructed based on a literature review, revised by the Delphi method, and distributed to physicians in a medical care system. Factors underlying the items were revealed by factor analysis and subject to multiple regression analysis to determine their relationships with physicians' intention to use EMR exchange. Results: Four factors listed in a descending order of necessity for treating elderly patients were identified: Patient's Special History, Laboratory and Radiology Reports, Progress Notes, and Family Data and Healthcare Records. Patient's Special History could facilitate physicians' intention to use EMR exchange and the likelihood of adopting EMR exchange for in-patient and emergency care, while Family Data and Healthcare Records may enhance the possibility of using EMR exchange for preventive care. Conclusions: The information most needed in EMR exchange when treating elderly patients is not among the main retrieval items provided by the current EMR exchange platform. It is recommended that the information physicians need should be the major concern when designing an EMR exchange system. The items that physicians need the most can be retrieved automatically from National Health Insurance information systems or provided by physicians in order to enhance the clinical value of EMR exchange in the future.