| 摘要: | 背景：臺灣的醫療院所一般皆已經開始實施電子病歷，但大都並未
進行院際間的電子病歷交換。實施全國醫療院所電子病歷交換將有
助於資訊分享、提升照護效率、避免醫療資源浪費，提供民眾完整
且連續的醫療照護。目的：在本研究進行期間，我們與中部某醫學
中心合作，利用台灣醫學資訊學會所制定之電子病歷交換格式，建
構電子病歷跨院交換環境。目的為探討醫師、病歷管理員與病患所
預期電子病歷跨院交換系統實施之影響及其態度之相關因素。方法
：利用結構式問卷進行橫斷式量化調查，於2008年3月至5月期間，
針對台中市某醫學中心及區域醫院3 種使用者，利用方便抽樣方法
進行調查，總共回收379 個樣本（回收率為70%），進行後續的統計
分析。結果：區域醫院醫師(p=0.01)、男醫師(p=0.02)、工作11-15
年醫師(p=0.49)、使用電腦7-10 年(p=0.043)及使用電腦10 年以上
(p=0.04)之醫師較擔心電子病歷交換時之資料安全問題；民眾近三
個月內就醫2-5 次者對電子病歷資料較有安全上之顧慮(p=0.003)。
病歷室主管(p=0.022)認為電子病歷交換能節省病歷儲存空間及病歷
室人力。使用電腦4-6 年(p=0.021)及10 年以上(p=0.001)之醫師認
為電子病歷交換能提升醫療品質；使用電腦經驗越豐富之民眾認為
電子病歷交換能提升醫療品質(4-6 年：p=0.020、7-9年：p=0.010
、10 年以上：p=0.021)。醫學中心之醫師(p=0.013)、男性病歷管理員(p=0.021)、26歲-35歲病歷管理員(p=0.027)及使用電腦4-6年之民眾(p=0.049)較支持電子病歷交換之推動；整體而言，有257 位
(67.9%)受訪者表示贊同電子病歷交換推動，惟有257 位(67.9%)擔心隱私被侵犯，其中以民眾最擔心隱私(p=0.046)。因此，使用者雖表示支持電子病歷交換，但仍非常在意個人醫療隱私之保密性。結論：本研究證實隱私問題為電子病歷交換推動的最大爭議，但大都同意實施電子病歷交換能提升醫療品質。醫療院所必須提供安全無慮之交換環境且應徵得病患同意後再進行電子病歷交換。主管機關應增修電子病歷交換辦法以確保資訊安全與病人隱私，並輔導醫療層級較低之醫院進行病歷交換系統之建置，以達成各醫療院所皆能進行跨院電子病歷交換之目標，進而提升醫療品質與醫療競爭力。
Rapid developments of information technology greatly impact
on the design of health care systems. By adapting
information technology, efficiency and competition of health care organizations can be enhanced to meet the patient needs.Although most of the hospitals in Taiwan have developed their own EMR systems independently, however, the exchange and integration of EMRs among hospitals are yet to occur.Therefore, Executive Yuan authorized Taiwan Association for Medical Informatics to establish Taiwan electronic Medical record Template (TMT), a medical record exchange standard in Taiwan, in order to promote quality and continuum of care. Patients can thus possess their own EMRs, understand their health information, and experience EMR exchange across hospitals in receiving comprehensive services. The present investigation implemented an inter-hospital EMR exchange system, conforming to the TMT format, in a medical center located in Taichung City for POC (proof of concept) study. It targeted three kinds of users, including physicians, employees from department of medical record management, and patients, to explore their attitudes toward the system with an emphasis on whether they support the new exchange system as well as on related factors which affect their attitudes. Convenience sampling and a structured questionnaire were used in this cross-sectional study from March to May, 2008. A total of 379 valid samples
(response rate 70%) were obtained from a medical center
and a regional hospital in Taichung City. The results
show that physicians who were male (p=0.02), worked in
regional hospitals (p=0.01), had worked for 11-15 years
(p=0.49), and had used computers for 7-10 years (p=0.043)
and more than 10 years (p=0.04) were more concerned about
data security regarding medical record exchange. People
who sought medical advices 2-5 times in recent three months
were more concerned about data security in medical record
exchange (p=0.003). The supervisors of the medical record
department agreed that the EMR exchange can save storage
space and manpower (p=0.022). Physicians who have used
computers for 4-6 years (p=0.021) and more than 10 years
(p=0.001) supported that the system can improve quality
of medical care. Experienced computer users agreed that
the EMR exchange can improve quality of medical care
(p<0.05). Physicians from medical center (p=0.013),
male (p=0.021) and senior employees (p=0.027) from
medical record management, and patients using computer
for 4-6 years (p=0.049) showed higher degrees in supporting
EMR exchange. In conclusion, 257 (67.9%) users supported
EMR exchange; however, 257(67.9%) users worried about
privacy issue in EMR exchange. Among these users, patients
worriedprivacy most (p=0.046).In summary, this study has
confirmed that privacy is the greatest concern regarding
EMR exchange. In addition, the quality of care is expected
to be enhanced through the exchange system. The outcomes
of this survey provide useful information to the academic
researchers and healthcare practitioners, which can also
be used as a basis for evaluating related healthcare
policies and strategies. |
