醫院建置電子化住院醫囑系統的影響因素－ 以北台灣某醫療網為例

Abstract

當美國國家科學院的Institute of Medicine出版了”To Err is Human”後，資訊科技（IT）已逐漸廣泛的被用在醫療產業以提升病人安全及醫療品質，醫療用IT的建置在目前已經是可行而且實用。然而系統的推廣常因醫生過於忙碌及根深蒂固的醫療文化所阻礙。 本研究旨在探討一北臺灣醫療網所屬醫院內，包含了醫學中心，區域醫院及地區醫院，採用科技接受模式（Technology Acceptance Model, TAM）分析各院區推動電子化住院醫囑（Computerized Physician Order Entry, CPOE）的影響因素。 總共203位實際操作的醫護人員接受問卷訪問，人員有住院醫師、主治醫師以及專科護理師，內容包含電腦自我效能、CPOE使用經驗、認知有用性、認知易用性、滿意度和使用意願。 經分析統計發現，如同國外研究報告，TAM在國內亦可適用於醫療照護產業，同樣的認知有用性和認知易用性乃是主導使用意向和使用意願之原動力，影響因素依序是認知有用性，其次是認知易用性，第三是滿意度。再者若使用者每週使用電腦5小時以上者，對於電腦自我效能有提升作用。而電腦自我效能和以前有CPOE使用經驗則會顯著的影響認知易用性，接者影響認知有用性和滿意度。而認知有用性可影響滿意度和使用意願。但是醫院的主管當局的態度以及建置時間的長久，也是要考慮的因素之一。

Since the publication of “To Err is Human” by the Institute of Medicine in 1999, patients’ safety and care quality has become the top priority task force for every hospital. Application of information technologies (IT) in current era is feasible and practical. However, implementations of IT systems always encounter entry barriers, especially by doctors due to their heavy work load and practice culture. After implementation of computerized physician order entry (CPOE) system in the hospitals of a medical health network in Northern Taiwan, 203 medical personnel who had used the system were investigated by using constructed questionnaires. Those include medical residents, visiting staff and nurse practitioners. With applications of the technology acceptance model (TAM), factors such as computer subjective effectiveness, experience in using CPOE, perceived usefulness (PU), perceived ease of use (PEOU), behavior intention of use (BI) and actual system use were studied and analyzed. As with other reports, TAM is a practical model in healthcare IT. In the present survey, PU and PEOU are still the factors that precede the BI and resultant actual use. Previous CPOE experience and computer subjective effectiveness can influence PEOU which in turn affects PU and BI. Nevertheless, PU can lead to BI and actual use. One’s usage of computer over 5 hours per week has positive effect on computer subjective effectiveness. The proposed study explained 60.5% of accumulated explained variance.