| Summary: | 博士 === 國立中正大學 === 資訊管理系研究所 === 106 === In spite of spending a lot of money and manpower during last decades Minister of Health and Welfare (MOHW) of Taiwan couldn’t meet the expected level of acceptance of Electronic Medical Record (EMR) exchange by physicians. In order to improve the use of EMR exchange by physicians, the current thesis presents and validate an exploratory research framework to identify the factors that may affect physicians’ intention to use EMR exchange regarding elderly patients in EMR context. A comprehensive literature review was conducted and presented an initial research framework and related questionnaire was proposed based on the findings of the literature review. Then, the Delphi technique was utilized to validate this initial research framework. Four senior physicians at director level were invited to form an expert panel and consensus was reached after 3 rounds. Final research framework and relevant questionnaire were presented and used for the data collection. A survey was conducted to collect data from 4 different level hospitals of a major healthcare system in southern Taiwan. IRB of this research was approved before conducting the actual survey. A total of 432 questionnaires was distributed to MDs who served in this healthcare providers and 130 valid responses were received.
Exploratory Factor Analysis (EFA) was used to validate the results of the Delphi methods. The results of using both PCA and PAF indicate that seven factors (5 factors for Non-HIT and 2 factors for HIT) with 58 items is the most appropriate for research framework for conducting further analysis. Non-HIT factors are included: 1) Information Needed for Patients’ Condition; 2) Quick Access and Save the Data for Subsequent Use; 3) Utility of EMR exchange; 4) Shorten Interrogation Time; 5) Financial Incentives, and Healthcare Information Technology (HIT) factors are included: 1) Perceived Usefulness & EMR Exchange Characteristics; 2) Perceived Ease of Use. Based on the results of PCA and PAF, three models were proposed, these are: 1) HIT model, 2) Non-HIT model, and 3) All together model.
Multiple Regression was used to analyze above three proposed models. R2 of each model is as follows: 1) HIT model = 0.08, 2) Non-HIT model = 0.28 and 3) All together model = 0.29. Only one factor, Perceived Usefulness and EMR exchange characteristics, is significant in HIT model. Two out of five factors are significant in both Non-HIT and All together model. They are Information Needed for Patient’s Condition and Quick Access and Save Data for Subsequent Use. However, one factor Perceived Usefulness and EMR exchange characteristics is significant in HIT model but insignificant in All Together model.
Physicians are divided into four major medical specialties, they are 1) Internal Medicine, 2) Surgery, 3) Emergency and 4) Others. The distribution of sample size regarding above mentioned four categories is not significant with the distribution statistics of medical specialty in Taiwan published by MOHW. Another finding of this study indicates that medical specialty has a significant influence on physicians’ intention to use EMR exchange. Due to the limitation of sample size, different number of responses in each category and different needs of each category may result in 5 out of 7 factors are not significant in the current study. Although, only 2 factors are significant, the results of current thesis are still able to provide future guidance for MOHW and top management of healthcare providers to set up appropriate policies and incentives to encourage more MD to use EMR exchange. Furthermore, the content of the EMR exchange is one of the important issue for future research.
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