|摘要: ||為達到提供持續性的醫療照護、加速病人診療決策、提昇醫療服務品質、與減少醫療資源浪費等目的，跨院電子病歷交換與推廣己成為政府重要醫療政策之一。醫師是病患醫療服務的主要提供者以及決策者，以及電子病歷交換系統的主要使用者，因此其對於跨院電子病歷交換的推廣扮演關鍵角色。本研究將以現有應用於探討系統持續使用意願的期望確認模式作為理論基礎，同時考量跨院電子病歷交換所具備知識(資訊)分享特性，以瞭解影響醫師跨院電子病歷系統持續使用意願之關鍵因素。並採用問卷調查法針對國內目前已通過電子病歷交換互通查驗醫院之醫師進行資料蒐集(滾雪球抽樣方法)，所蒐集資料再以最小平方法(PLS)之結構方程模型統計工具進行分析。本研究共回收106份問卷，扣除無效及填寫不完整5份問卷外，本研究有效問卷為101份。本研究發現醫師持續使用跨院電子病歷交換系統使用主要受到認知有用性(β=.514, p<.001)、滿意度(β=.177, p<.01)及認知風險(β=-.145, p<.01)的影響，模式整體變異解釋力為62.5%；滿意度會受到期望確認(β=.560, p<.001)及認知有用性(β=.326, p<.001)之影響，其整體解釋變異為67.1%；而認知有用性主要受到認知易用性(β=.341, p<.001)、期望確認(β=.325, p<.001)及資訊品質(β=.249, p<.01)之影響，認知有用性的整體解釋變異為62.8%。而認知風險主要受到信任(β=-.353, p<.001)及資訊品質(β=-.225, p<.001)的影響，其整體解釋變異為27.3%。信任主要受到資訊品質(β=.615, p<.001)的影響，信任整體解釋變異為37.9%。藉由本研究的進行將能發展出一個適用於評估醫師持續使用電子病歷交換的重要衡量工具，透過此工具將能深入瞭解醫療機構內醫師電子病歷持續使用意願的形成過程。醫療機構與衛生主管機關將可針對本研究所發現之影響醫師持續使用電子病歷交換意願的關鍵因素，採取適當的策略與措施，以加速國內電子病歷交換的發展。|
To achieve the continuum of care, facilitate clinical decision making, improve quality of care, and reduce the unnecessary waste of limited medical resources, the exchange and promotion of electronic medical records has become one of the most critical healthcare issues of the Taiwan government. Physicians are the key service providers and decision maker in providing medical services and the major users of electronic medical records exchange system, therefore; physicians play central roles in the promotion of electronic medical records exchange. This study aims for investigating key factors influencing physicians’ intentions toward electronic medical records exchange system continuance based on expectation confirmation model. The proposed model is extended by incorporating knowledge sharing perspective. The survey methodology was conducted for validating the proposed research model. The respondents of this study are physicians of the hospitals that had been certified to support cross-hospital exchange of electronic medical records. By using the snowball sampling strategy, the collected data were analyzed through partial least square statistical analysis technique. A total of 106 questionnaires were collected, excepting for 5 incomplete questionnaires, and 101 valid questionnaires were used for further analyzing. Our study found that physicians’ intention toward electronic medical records exchange system continuance (R2=0.625) was influenced by perceived usefulness (β=.514, p<.001), satisfaction (β=.177, p<.01), and perceived risk (β=-.145, p<.01). Satisfaction (R2=0.671) was influenced by expectation confirmation (β=.560, p<.001) and perceived usefulness (β=.326, p<.001). In addition, perceived usefulness (R2=0.628) was influenced by perceived ease of use (β=.341, p<.001), expectation confirmation (β=.325, p<.001), and information quality(β=.249, p<.01). Perceived risk (R2=0.273) was affected by trust (β=-.353, p<.001) and information quality (β=-.225, p<.001), while trust (R2=0.379) was affected by information quality (β=.615, p<.001). Therefore, the result of this study can provide an adequate measurement tool for understanding the factors affecting physicians’ intentions toward electronic medical records exchange system continuance and its influencing processes. Thus, Taiwan government and healthcare industry can make appropriate strategies and incentives for improving the widespread use of electronic medical records exchange system in Taiwan.