早期療育電子病歷資訊整合平台之發展與評估

Abstract

「早期療育」 的特色，是必須透過各治療組分項評估、資料彙整並集結整體評估結果，以確立個案診斷及提供後續療育計畫，面對這種跨醫療團隊的工作模式，本研究期待利用醫療資訊系統，針對團隊溝通與效率來作有效的改善。依醫療團隊之期望與需求，發展建置一「早期療育電子病歷資訊整合平台」。 本研究以DeLone 與McLean 資訊系統成功模式（2003 ）[1]為主軸，同時加入「主管支持」的構面，建構一個資訊系統的評估模式，以個案醫院早療團隊的角度來衡量醫療資訊系統的成功，藉由醫療人員使用後的問卷收集與資料分析，探討使用者對醫療資訊系統的關鍵接受因素，並瞭解早療人員的使用情形與使用滿意，進而提出在系統上的改善方向與修正的建議。 本研究為橫斷式問卷調查研究，經文獻探討建立研究架構與設計結構式問卷，經由專家問卷效度測試後，對使用系統的醫療人員進行問卷調查。共收集34份有效問卷。此系統的使用者對七個構面在衡量問項之評價上都給予正面的肯定，然而評價離「非常滿意」仍有一段差距，可見使用者對此系統實際使用與期待仍有一段落差。 結果顯示預測使用者對系統的「使用滿意」最具影響力的為 「系統品質」，而不同職務的「使用滿意」也不相同；對「使用」最具影響力的為「使用滿意」。 將資訊科技應用於早期療育的團隊醫療，可作為醫院建置團隊醫療整合系統的參考，可以輔助團隊整合與溝通更有效率，與更準確的執行醫療行為，結果是符合個案醫院需求且被認同的，此系統開發的經驗建議導入醫療資訊系統時應該深入瞭解醫師與所有專業治療人員的意見與需求，建立一個合用的資訊系統， 俾使系統的使用更臻完善 。

'Early intervention' is characterized by evaluations completed by each treatment team respectively, information collection and outcome integration, in order to ensure diagnosis for each individual and to provide follow-up early intervention treatment program. Under this inter-disciplinary team model, the purpose of this study is to develop the 'Early intervention electronic medical record Information integration platform' based on the expectation and requirement of the inter-disciplinary team by utilizing Health Information System(HIS) with focusing on improvement of team communication and effectiveness. This study used the Information System Success Model (Delone and McLean, 2003) as the main component, adding the conception of 'Top Management Support', to establish an assessment model for the information system. By collecting questionnaires applied by the medical team members and analyzing the data, this study then investigated the key factors of how users accepting the information system, and found out the “usage “ as well as the “usage satisfaction”, furthermore, proposed recommendation in improving and correcting the information system for the view of the early intervention inter-disciplinary team. This study is a cross-section questionnaire survey research. The research framework was established after literature review. After professional questionnaire validity test, this questionnaire investigations were applied to all medical team members who used the information system. There were 34 valid questionnaires obtained. The users gave positive feedback on the assessment of seven concepts of the study, however, still far from 'very satisfy'. It seemed that there is still a gap between the user's expectation and the practical application. The outcome showed the 'quality of system' was the most influential item in 'usage satisfaction'. Users with different positions had different 'usage satisfaction'. 'Usage satisfaction' is the most influential to 'use'. In conclusion, utilizing information technology on the early intervention inter-disciplinary team can improve integration among each team, effectiveness of team communication and accuracy of medical behavior. These outcomes are qualified and recognized by the hospitals with individuals. These outcomes can be used to establish 'inter-disciplinary integration system'. The experience of developing this system also suggests to profoundly understand the opinions and requirements of all medical doctors and professionals involving treatment program when using HIS, in order to ensure a proper and comprehensive operation of HIS.