探討民眾對於醫院推行電子同意書之接受度

A Study on People's Acceptance of Making Electronic Statements of Consent to Medical Treatments Pushed by Hospitals

電子病歷發展在衛生福利部積極推動下已成效卓越，但紙本同意書文件，因民眾無適用的憑證工具進行簽章且無明確的同意書數位簽署法規可遵循，直到104年衛福部委託科技研究計畫，進行醫療院所同意書簽署數位化之可行性研究，才開始出現契機。本研究在電子同意書推動初期，以Rogers之創新擴散理論結合知覺風險與知覺安全建立研究架構，探討影響民眾對於醫院推行電子同意書接受度之促成與阻礙因素，期望作為政府部門及醫療院所擴大推動電子同意書策略及系統設計之參考依循。本研究以20-70歲之民眾為研究對象，回收有效問卷634份，回收率達96.4％，資料統計採用SPSS 22及Smart PLS 3.0進行假設驗證。結果顯示複雜性、相對優勢、相容性、可觀察性、可試驗性、知覺安全、績效風險、隱私風險均顯著影響接受態度，且接受態度是影響民眾對於醫院推行電子同意書接受意圖之最重要關鍵因素。簡言之，政府部門及醫療機構若能提升民眾對於電子同意書的使用觀感與評價，便可有效提升民眾之接受度，有助於電子同意書更快速發展。

The development of electronic medical record and the technology of electronic signature certificate in Taiwan have yielded excellent result under the advocacy of the Ministry of Health and Welfare in full effort. However, the issue of signing the statement of consent by the patient/next of kin is yet to be resolved, as there is no appropriate certification tool available to the public for electronic signature (e.g.: medical personnel ID). Furthermore, there is no law explicitly governs the signature of the digital statement of consent. It was not until 2015 that an opportunity for the advocacy of electronic statement of consent emerged. Under a research program commissioned by the Ministry of Health and Welfare in that year, a feasibility study on the digitization of signing the statement of consent has been conducted in several medical centers of Taiwan. This study is based on the Technology Acceptance Model (TAM) proposed by Davis and the Theory of Diffusion of Innovations proposed by Rogers to build up the research framework by combining perceived risk and perceived safety at the beginning of the advocacy of electronic statement of consent. This is an attempt to probe the receptiveness of the public to the use of electronic statement of consent from the perspective of the public with a view to providing reference for the governments and medical institutions and hospitals from the research findings for intensifying the advocacy of electronic statement of consent. The targeted group of this study is a population with age ranging from 20-70. Considering the use of electronic statement of consent is stranger to most people and that these people do not have the experience of using this instrument, we adopted the brief introduction of the use of electronic statement of consent at a particular hospital in Changhua to provide preliminary knowledge to the public, followed by the response of the public to an electronic questionnaire. There were 634 valid respondents. SPSS 22 and Smart PLS 3.0 were used in the statistical analysis of the data collected through descriptive statistics, analysis of variance, confidence analysis, and path analysis to test the hypothesis. The research findings indicated that ''Perceived Ease Use'', ''Relative Advantage'', ''Compatibility'', ''Perceived Safety'', ''Demonstrability'', and ''Testability'' did affect the attitude towards the use in the positive direction, and affected ''Performance Risk'' and ''Privacy Risk'' in the negative direction. Attitude towards use turned out to be a critical factor affecting the public to use electronic statement of consent. In other words, if the governments and medical institutions could improve the impression and evaluation of the public towards the use of electronic statement of consent, they could effectively affect the intent of use of the public, which in turn would help to speed up the development of the use of electronic statement of consent.