隨著電子病歷的發展與環保意識抬頭，各醫院陸續邁向病歷無紙化，希望透過病歷無紙化，降低營運成本、提高醫療品質與病人安全，並簡化作業流程以縮短病患等候時間，加速看診流程，因此推動病歷無紙化對於醫院資訊應用具有高度價值。本研究主要目的以適應性結構化理論為基礎，並以社會技術觀點加以擴充，探討資訊科技醫院進行病歷無紙化過程中受到人與新技術互動結構影響，以及對運用資訊科技適應過程的分析。本研究採用個案研究法進行，以立意抽樣針對個案醫院電子病歷推動委員會成員進行深度訪談。本研究發現結合社會技術觀點之結構調適理論(包含社會技術系統、運用結構及運用支持結構等構面)可以被有效應用於了解醫院發展病歷無紙化的過程以及影響因素。在社會技術系統方面，高層重視並積極參與以及團隊成員特性為影響無紙化病歷的重要因素；在運用結構方面，病歷無紙化的執行(推動)方式與貫徹性為推動之關鍵；而在運用支持結構方面，必須能妥善運用現有資訊與科技特性，解決病歷無紙化推動問題。因此，醫院於推動病歷無紙化時，高層的支持與參與、團隊成員特性、執行(推動)方式與貫徹性、以及妥善運用現有資訊與科技特性等因素都有助於病歷無紙化之推動。在病歷表單的轉換上，建議以共同表單先執行，以達最大的效益。最後，應持續針對發展病歷無紙化過程所產生問題進行排解並建立處理機制，以降低推動時遭遇的困難。 With the rapid development of electronic medical records and the growing trend of environment protection, many hospitals are conducting paperless medical reocrds through information technologies in order to reduce operational costs, improve medical quality, and patient safe. Through the promotion of paperless medical records, it is helpful and valuable for reducing unnecessary clinical processes and patients’ waiting time. This study aims to to explore the impacts of the interactions between people and technolgoies on the promoting and adaption processes of paperless medical records of the case hospital based on an extended adaptive structuration theory which is an integration of adaptive structuration theory and soci-technical perspective. The case study research methodology was used to collect in-depth insights from members of electronic medical records committee of the case hospital by using purpousive sampling strategy.This study found that the extened adaptive structuration theory (including, social technical systems, IT structure, and appropriation support) is appropriate for investigating the development of paperless medical records in the case hospital. We found that top management support and active participation and characteristics of team members in social technical perspective, execution methods and details related to implmention in IT structure, and the utilization of necessary information and technologies in appropriation support are critical for promoting paperless medical records. In addition, we suggest to choice the highly frequently used paper medical record forms as the higher priority to become paperless medical record forms in order to gain the maximum benefits. Furthermore, to continuiously collect problems related to paperless medical records and to establish well accepted problem-solving mechanisms are the key points to mitigation the difficults and resistances for prmoting paperless medical records.
