影響老年病人就診科別醫師使用電子病歷交換意願因素之初探研究

Factors affecting physicians’ intention to use electronic medical record exchange for older patients

目標：探討影響醫師取用其他醫療機構電子病歷意願的因素。方法：由文獻探討歸納影響醫師使用電子病歷交換意願之因素，經德菲法與文獻再搜集形成正式問卷，藉以對某醫療體系不同層級醫療機構之醫師進行問卷調查。以因素分析探討影響因素之資訊科技與非科技向度，再以階層迴歸探討所得向度對醫師取用其他醫療機構電子病歷意願與不同途徑取用可能性之影響。結果：因素分析後呈現九因素，階層複迴歸分析顯示影響醫師取用電子病歷交換意願的資訊科技因素為「資訊專業完整與知覺有用性」，非科技因素包括「病情需要病歷資訊」、「醫師需有時間取用」、「節省問診時間」、「取用快速可存為依據」四因素。不同診療途徑取用電子病歷之預測因素略有不同。結論：若欲提升醫師取用病人電子病歷交換之意願，宜重視臨床使用經驗，提供所需專業可信完整資訊，方有助於政策目標之達成。 Objectives: To determine factors that may influence physicians’ intentions of accessing electronic medical records (EMRs) at other institutions. Methods: A literature review was conducted to summarize factors that may affect physicians’ intentions of using EMR exchange. A questionnaire based on the Delphi method and a literature review was administered to physicians at different levels within medical institutions. Health information technique (HIT) and nonHIT factors were extracted through factor analysis and subjected to hierarchical regression analyses to investigate the dimensions potentially affecting physicians’ overall intention of using EMR exchange. The possibility to use EMRs when facing elderly patients at defferent medical services—including in-patient services, out-patient services, emergency health services, and health promotion—was also investigated. Results: Nine factors were extracted after the factor analysis. Then, the hierarchical regression analyses were conducted using these nine factors. The HIT factor “Integrated Professional Data and Perceived Usefulness” was concluded to affect the intention of physicians to use EMR exchange. The influential non-HIT factors included (1) information required regarding patients’ conditions, (2) physicians having time to access relevant information, (3) interrogation time shortening, and (4) quick access and data saving for subsequent use. The factors affecting the likelihood of EMR exchange varied marginally among different types of medical services. Conclusions: To improve physicians’ intentions of using EMR exchange, user experiences in EMR exchange at clinical practices should be emphasized. Providing professional and reliable integrated information is helpful for achieving health care policy objectives.