影響基層診所醫師使用電子病歷滿意度之研究

A Study of Primary Care Physicians' Satisfaction on Using Electronic Health Record

背景：基層診所為提昇醫療服務品質及簡化作業流程，已普遍採用資訊科技，而電子病歷之發展與應用，在政府主導及極力推動下，已成為台灣各醫療院所現階段推行的重點。目的：瞭解影響基層診所醫師使用電子病歷滿意度之相關變項。方法：本研究對象為參與行政院衛生署2010年「加速診所實施電子病歷推廣案」，並向衛生局完成報備之西醫診所，以經效度及信度檢定之自填式結構性問卷進行普查，共計發出1034份問卷，回收556份，回收率53.77％。結果：本研究以複迴歸分析發現：每月門診量為1000-1999、2000-2999及3000人以上(β=0.193，p<0.001；β=0.149，p<0.001；β=0.118，p=0.002)；成本效益(β=0.164, p<0.001)、知覺易用性(β=0.273，p<0.001)、主觀規範(β=0.228，p<0.001)、安全(β=0.166，p=0.019)與使用意願(β=0.161，p=0.01)對基層診所醫師使用電子病歷滿意度有顯著的正向影響；而隱私有顯著的負向影響(β=-0.242，p=0.001)，此模式可解釋49.9％之變異量(Adjusted R2 =0.499)。結論：基層診所醫師之「認知易用性、主觀規範、安全及隱私、使用態度及意願、成本效益」，為使用電子病歷滿意度之顯著變項。而電子病歷系統若能協助醫師診療與行政作業，提供友善介面及清楚易懂的系統操作，兼顧資料安全及病人隱私，且在主管機關政策推動及宣導下，將可提升基層診所醫師使用之滿意度。

Background: Emerging health information technology has been generally adopted by primary care physicians to enhance quality of care and improve service of process in Taiwan. Particularly, Electronic Health Records (EHRs) has become one of the major issues for healthcare provider due to change by government policy and financial subsidy. Objective: To investigate variables which influence primary care physicians' satisfaction on using EHRs. Methods: Our subjects are primary care physicians who have applied the subsidy to implement EHRs sponsored by the Department of Health. We conducted the survey by a valid and reliable questionnaire. A total 1103 questionnaires were distributed to physicians, 556 useable responses were received resulting in a response rate of 53.77%. Results: From the multiple regression, we found that monthly service volume of primary care physicians: 1000-1999, 2000-2999 and above 3000 (β=0.193, p<0.001; β =0.149, p<0.001; β=0.118, p=0.002), cost effectiveness (β=0.164, p<0.001), perceived ease of use (β=0.273, p<0.001), subjective norms (β=0.228, p<0.001), security (β=0.166, p=0.019) and willingness to use (β=0.161, p=0.01) had significantly positive effects on EHRs satisfaction. However, privacy had negative effect on EHRs satisfaction (β=-0.242, p=0.001), This model can explain 49.9% variance (Adjusted R2 =0.499). Conclusion: Perceived ease to use, subjective norms, security and privacy, intention and cost-effectiveness of using EHRs had significant effects on primary care physicians' satisfaction. Therefore, we believe that primary care physicians' satisfaction will be raised if EHRs can enhance clinical and daily works effectively, provide easy and user-friendly interface, assured security and privacy, and accompanied by government's promoted policy.