影響台灣電子病歷採用之關鍵因素：醫院觀點

Critical Factors Affecting EMR Adoption in Taiwan: A View of Hospitals

電子病歷系統對病患、醫師和醫療機構具有潛在的實質效益，2007年起在衛生署推動下十一家醫學中心開始進行可互通電子病歷的試辦計畫。由於較少文獻針對醫院採用可互通電子病歷的障礙及挑戰進行研究，以致醫院考慮採用電子病歷時缺乏可參考的背景資訊。因此，本研究透過問卷調查及專家討論方式蒐集醫院相關意見，針對影響醫院採用電子病歷的障礙及關鍵因素進行探討，研究結果發現「對醫師的誘因」、「系統的互通性」、「病患資訊的安全與隱私」，以及「電子病歷所造成的社會及組織變革」等因素將會影響醫院對電子病歷的採用。針對這些關鍵影響因素，本研究參考美國推動經驗，提出相關政策建議，以提供政府及相關機構參考；期能有助政府制定有效政策，移除推動障礙，加速電子病歷的互通及使用。

Electronic medical record (EMR) systems have the potential to provide substantial benefits to patients, physicians, and health care organizations. In 2007, the Department of Health (DOH) has set up an interoperable EMR system project among eleven medical centers. Since few studies address the barriers and challenges of interoperable EMR adoption in Taiwan, very little background information can be provided to assist pilot hospitals when considering EMR adoption. Therefore, we performed a survey to assess barriers to and critical factors in adopting an EMR system in these participating hospitals. Using a questionnaire survey and expert panel to solicit opinions from hospitals, our study identified several major issues affecting the adoption of an EMR system including 'incentives for the clinicians', 'interoperability of systems', 'security and confidentiality of patient information', and 'social and organizational change caused by EMR'. Several suggestions were proposed to the government and stakeholders based on these critical factors identified and experiences of U.S.. With a better understanding of these critical factors, the government can develop enabling policies to break down the barriers and facilitate the widespread of interoperable EMR in Taiwan.