影響醫院醫師及資訊主管電子病歷交換意圖之因素

The factors affecting hospital physicians and information officers’ electronic health records exchange intention

研究背景與目的：為提升醫療照護品質、減少醫療錯誤及降低醫療成本，近年來，歐美先進國家逐步推行電子病歷的建置及資訊交換。目前國內雖亦藉由國家政策推行電子病歷跨院互通，但各醫院推動互通之時間及執行程度等情形均不相同。再者，醫院醫師與資訊主管在電子病歷交換中是重要成員，但兩者分別扮演使用者及服務提供者不同的角色。因此，瞭解國內醫院電子病歷互通使用情況及交換意圖，並進一步探討醫院醫師與資訊主管觀點的影響因素，成為重要的研究議題。方法：本研究為一橫斷性研究，以科技－－組織－－環境理論為研究架構，發展結構式問卷。以國內已實施電子病歷交換之343 家醫院的電子病歷委員會醫師成員及資訊主管為研究對象。共回收醫師樣本155 份、資訊主管168 份問卷，問卷回收率為45.2%及49%，後續以SPSS 21.0 進行統計分析。結果：雙變項分析結果顯示，醫師及資訊主管僅在「法令規章」題項有顯著差異(t=-2.656，p 值＜0.01)。從迴歸分析發現，認知利益(β=0.208, p＜0.05)、相容性(β=0.231, p＜0.05)及法令規章(β=0.180, p＜0.05)子構面對醫師之電子病歷交換意圖影響顯著。而資訊主管部份，有顯著影響之子構面包含認知利益(β=0.270, p＜0.01)、上級支持(β=0.265, p＜0.001)及法令規章(β=0.215, p＜0.01)。結論：雖然認知利益及法令規章之變項對醫師及資訊主管電子病歷交換意圖有顯著影響，但醫師較關切電子病歷互通時之相容性，而資訊主管特別需要上級支持。因此建議醫院需具備足夠的資訊能力及高階主管的支持來建置電子病歷交換系統，同時政府機關應訂定相關規範及提供誘因，以提高醫院使用電子病歷交換的意願。

Background & Object: In recent years, US and some European countries has implemented the Electronic Medical Record (EMR) Exchange system to enhance the quality of care, reduce medical errors and costs of healthcare. Although Taiwan followed advanced countries’ steps to promote EMR exchange by government policies, hospital had different approaches and completions individually due to their strategies and resources. Hence, the factors affecting hospitals’ EMR exchange intention was an important issue for us to explore. Methods: A cross-sectional study conducted which was used structured questionnaire based on the technology-organization-environment theory. The subjects included the in charge physicians and information officers of electronic medical records exchange from 343 hospitals implemented EMR exchange system. 155 hospital physicians and 168 information officers were responded and the response rate was 45.2% and 49% respectively. SPSS 21.0 statistical software was used for subsequent analysis. Results: According to the bivariate analysis, hospital physicians and information officers had significant difference in the variable of 'laws and regulations' (t=-2.656, p value＜0.01). We also found from multiple regression analysis, the factors which influenced the physicians' intention of EMR exchange were 'perceived benefits'(β=0.208, p＜0.05), 'compatibility'(β=0.231, p＜0.05), and 'laws and regulations'(β=0.180, p＜0.05). in contrast to the information officers, the factors influenced the intention of EMR exchange were 'perceived benefits'(β=0.270, p＜0.01), 'management support'(β=0.265, p＜0.001), and 'laws and regulations'(β=0.215, p＜0.01). Conclusion: For the intention of EMR exchange, both the 'perceived benefits' and 'laws and regulations' were significant factors for hospital physicians and information officers. However, hospital physicians were more concerned about EMR’s 'compatibility' and information officers demanded for 'management support' from hospital executives. We suggest that hospital should get IT capability and executives support to build up EMR exchange system. Also government should establish policies and provide incentives for hospitals to increase the EMR adoption intention and behaviors.