新進住院醫師對電子病歷的看法－以科技持續理論探討

Perspectives on electronic medical records among new residents -applying Technology Continuance Theory

10.6288/TJPH.201806_37(3).107015

莊秋華(CHIOU-HWA CHUANG)；郭律成(LU-CHENG KUO)；楊銘欽(MING-CHIN YANG)

電子病歷 ； 醫療資訊系統 ； 科技持續理論 ； 知覺有用性 ； 知覺易用性 ； electronic medical records (EMR) ； health information systems ； Technology Continuance Theory (TCT) ； perceived usefulness ； perceived ease of use

台灣公共衛生雜誌

37卷3期（2018 / 06 / 19）

254 - 264

繁體中文

目標：本研究欲瞭解台灣某醫學中心新進住院醫師在擔任實習醫師時使用電子病歷後，對電子病歷的認知、態度、持續使用意向，以加強對實習醫師和新進醫師在電子病歷上的教育和臨床訓練。方法：本研究以科技持續理論（Technology Continuance Theory, TCT）為基礎設計結構式問卷，調查某醫學中心2017年新進住院醫師對電子病歷之認知、態度、滿意度及持續使用之意向，使用複迴歸分析驗證變項間的相關性。結果：本研究共發出292份問卷，回收276份（回收率94%）。填答者中，男性占65%，平均24.3歲，265位（96.0%）在擔任實習醫師時曾使用過電子病歷。複迴歸分析結果顯示，和受訪醫師是否會持續使用電子病歷有關的因素包括知覺有用性（p＜0.0001）、滿意度（p＜0.01）、病歷書寫表現（p＜0.0001）、書寫表現（p=0.01）。結論：新進住院醫師使用電子病歷和病歷書寫表現及學習表現具有正相關，且新進住院醫師對電子病歷之滿意度、態度及表現都和醫師持續使用電子病歷的意向呈現正相關。

Objectives: This research aimed to understand the cognition, attitude, and intention for continued use of electronic medical records (EMRs) among new residents following EMR use in their intern year at one medical center in Taiwan. As such, the goal of this study was to improve education and clinical training among interns and new residents who use EMRs. Methods: A structured questionnaire was constructed based on Technology Continuance Theory (TCT), which was used to investigate the cognition, attitude, satisfaction, and intention for continued use among physicians-in-training at a medical center in 2017. Regression analysis was used to analyze the relationships among variables. Results: A total of 292 sets of questionnaires were distributed, of which 276 were collected for a response rate of 94%. Males represented 65% of all respondents, with an average age of 24.3 years. Two hundred sixty-five residents (96%) stated that they used EMRs during their intern year. Regression analysis showed that the factors which affected intention to continue using EMRs among physicians are as follows: perceived usefulness (p＜0.0001); satisfaction (p＜0.01); medical records writing performance (p＜0.0001); and learning performance (p=0.01). Conclusions: Using EMR was positively associated with medical record writing and overall learning performance among new physicians. In addition, resident satisfaction, performance, and attitude towards EMR were positively associated with an intention to continue using EMRs.

1. 黃興進、呂卓勳、蕭如玲、陳瑞甫(2009)。影響電子病歷交換效益關鍵因素之研究：醫師觀點。電子商務學報，11，95-118。
   連結：
2. Abdekhoda, M,Ahmadi, M,Gohari, M,Noruzi, A(2015).The effects of organizational contextual factors on physicians' attitude toward adoption of Electronic Medical Records.J Biomed Inform,53,174-9.
3. Aggelidis, VP,Chatzoglou, P(2009).Using a modified technology acceptance model in hospitals.Int J Med Inform,78,115-26.
4. Bhattacherjee, A(2001).Understanding information systems continuance: an expectation-confirmation model.MIS Q,25,351-70.
5. Boonstra, A,Broekhuis, M(2010).Barriers to the acceptance of electronic medical records by physicians from systematic review to taxonomy and interventions.BMC Health Serv Res,10,231.
6. Churchill, GA, Jr,Surprenant, C(1982).An investigation into the determinants of customer satisfaction.J Mark Res,19,491-504.
7. Dalcher, I,Shine, J(2003).Extending the new technology acceptance model to measure the end user information systems satisfaction in a mandatory environment: a bank's treasury.Tech Anal Strat Manag,15,441-55.
8. Davis, FD,Bagozzi, RP,Warshaw, PR(1989).User acceptance of computer technology: a comparison of two theoretical models.Manag Sci,35,982-1003.
9. Davis, FD,Venkatesh, V(1996).A critical assessment of potential measurement biases in the technology acceptance model: three experiments.Int J Hum Comput Stud,45,19-45.
10. Ellaway, RH,Graves, L,Greene, PS(2013).Medical education in an electronic health record-mediated world.Med Teach,35,282-6.
11. Hammoud, MM,Dalrymple, JL,Christner, JG(2012).Medical student documentation in electronic health records: a collaborative statement from the alliance for clinical education.Teach Learn Med,24,257-66.
12. Ismail, NIB,Abdullah, NHB(2011).Developing electronic medical records (EMR) framework for Malaysia's public hospitals.Proceedings of 2011 IEEE Colloquium on Humanities, Science and Engineering Research,Penang, Malaysia:
13. Keenan, CR,Nguyen, HH,Srinivasan, M(2006).Electronic medical records and their impact on resident and medical student education.Acad Psychiatry,30,522-7.
14. Liao, C,Palvia, P,Chen, JL(2009).Information technology adoption behavior life cycle: toward a Technology Continuance Theory (TCT).Int J Inf Manage,29,309-20.
15. Melas, CD,Zampetakis, LA,Dimopoulou, A,Moustakis, V(2011).Modeling the acceptance of clinical information systems among hospital medical staff: an extended TAM model.J Biomed Inform,44,553-64.
16. Morton, ME,Wiedenbeck, S(2010).EHR acceptance factors in ambulatory care: a survey of physician perceptions.Perspect Health Inf Manag,7,1c.
17. Pai, FY,Huang, KI(2011).Applying the technology acceptance model to the introduction of healthcare information systems.Technol Forecast Soc Change,78,650-60.
18. Peled, JU,Sagher, O,Morrow, JB,Dobbie, AE(2009).Do electronic health records help or hinder medical education?.PLoS Med,6,e1000069.
19. Rogoski, RR(2003).Having it your way. Three physicians who were early adopters and who remain vocal EMR advocates share their insights about the utilization, challenges and benefits of EMRs.Health Manag Technol,24,12-6.
20. Rouf, E,Chumley, HS,Dobbie, AE(2008).Electronic health records in outpatient clinics: perspectives of third year medical students.BMC Med Educ,8,13.
21. Sayyah Gilani, M,Iranmanesh, M,Nikbin, D,Zailani, S(2017).EMR continuance usage intention of healthcare professionals.Inform Health Soc Care,42,153-65.
22. Schenarts, PJ,Schenarts, KD(2012).Educational impact of the electronic medical record.J Surg Educ,69,105-12.
23. Spreng, RA,MacKenzie, SB,Olshavsky, RW(1996).A reexamination of the determinants of consumer satisfaction.J Market,60,15-32.
24. Stephens, MB,Corcoran, TS,Motsinger, C(2011).Clinical documentation in electronic medical records: the student perspective.Med Sci Educ,21,3-6.
25. Venkatesh, V,Davis, FD(2000).A theoretical extension of the technology acceptance model: four longitudinal field studies.Manag Sci,46,186-204.
26. 溫信財、何政勳、王臻稜(2013)。影響基層診所醫師使用電子病歷滿意度之研究。醫療資訊雜誌，22，1-14。
27. 衛生福利部：電子病歷推動專區。http://emr.mohw.gov.tw/emrlist.aspx。引用2017/05/12。Ministry of Health and Welfare, R.O.C. (Taiwan). Promoting electronic medical records site. Available at: http://emr.mohw.gov.tw/emrlist.aspx. Accessed May 12, 2017. [In Chinese]

1. 黃興進,翁儷禎,佘明玲(2019)。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。台灣公共衛生雜誌，38(4)，416-430。
2. 蕭如玲,陳奕翰,陳定紘(2021)。影響醫師使用分級醫療電子轉診系統因素與成效評估之初探。台灣公共衛生雜誌，40(4)，406-418。