臺灣博碩士論文加值系統

由於現今社會對於醫療照護品質的要求逐漸提升，醫療產業必須思考更有效率的管理模式以面對環境的改變。因此，導入電子化醫療系統並結合資訊通訊科技(ICT)已成為醫療產業管理之趨勢。以病歷管理而言，電子健康紀錄(EHR)雲端化能提供醫療產業一個提升效率的管理模式，然而，雲端運算之軟體即服務(Software-as-a-Service)是否能有效支援EHR之管理，成為本研究重要的討論議題。準此，本研究採資源配適理論(Resource-matching theory)探討EHR與軟體即服務間的配適度，並以利害關係人理論(Stakeholder theory)探討雲端化之電子健康紀錄對使用者的影響。此外，並以資訊隱私關注檢測EHR與軟體即服務之間配適的干擾效果。研究對象為醫護人員，研究方法採紙本與網路問卷方式共取得232份有效問卷，以結構方程模型(SEM)檢視假設。資料分析結果顯示：(1)EHR與軟體即服務間有良好的配適度；(2)電子健康紀錄雲端化可為使用者帶來利益；(3)資訊隱私關注存在部分的干擾效果。最後，本研究建議醫療院所應全面導入電子健康紀錄系統協助病歷之管理，以提升院際間病歷交換之效率；而政府單位應建立負責監督電子健康紀錄之推行的專案團隊，並負責深入推廣雲端化電子健康紀錄給所有民眾使用，以實現電子健康紀錄所帶來之利益，並達成提升醫療照護品質之目的。

The medical industry must consider a more effective management model to respond to the changes resulting from an increased requirement for quality of care. Therefore, the implementation of electronic health systems combined with information communication technology (ICT) has become a trend in the medical industry. In the case of patient record, Cloud Computing-based electronic health records (EHRs) provide a model to improve management efficiency in the medical industry. As a result, the issue of whether or not Software-as-a-Service (SaaS) Cloud Computing technology supports EHR management is the most important issue addressed in this study. Resource-matching theory was adopted in this study to discuss the match between EHR and SaaS, and stakeholder theory was adopted to discuss the benefits of using cloud-based EHRs. In addition, this study considered the information privacy concern to be a moderator between the matching of EHR and SaaS. The respondents were medical personnel, and the methodology was an online and paper-based survey including 232 valid questionnaires. The hypotheses were tested using structural equation modeling. The following are the results: (1) EHR and SaaS are well-matched; (2) cloud-based EHRs can benefit users; (3) the moderating effect of information privacy concern is partial. Finally, this study suggested that all medical institutions should implement EHRs to manage medical records and improve record exchange between institutions; governments should organize a team in charge of supervising EHR promotion to people. As a result, people can benefit from cloud-based EHRs and improve quality of care.

摘要 I
Abstract II
CONTENTS IV
List of Tables VI
List of Figures VII
CHAPTER 1 Introduction 1
1.1 Research Background and Motivations 1
1.2 Research Objectives 5
1.3 Research Process 6
CHAPTER 2 Literature Review and Hypotheses Development 8
2.1 Cloud Computing 8
2.2 Electronic Health Records (EHRs) 18
2.3 SaaS-EHR Characteristics Matching 26
2.4 Stakeholder Benefits 28
2.5 Concern for Information Privacy 31
2.6 Conceptual Framework 33
2.7 Hypotheses Development 35
2.7.1 SaaS Features and EHR Characteristics and SaaS-EHR Characteristics Matching 35
2.7.2 SaaS-EHR Characteristics Matching and Stakeholder Benefits 39
2.7.3 The Moderate Effect between SaaS Features and SaaS-EHR Characteristics Matching: Concern for Information Privacy 44
2.7.4 The Moderate Effect between EHR Characteristics and SaaS-EHR Characteristics Matching: Concern for Information Privacy 46
CHAPTER 3 Methodology 48
3.1 Measurement Development 48
3.2 Research Hypotheses 51
3.3 Questionnaire Design 52
3.4 Pilot Test 54
3.5 Data Analysis Procedure 61
3.5.1 Demographics Statistic Analysis 61
3.5.2 Factor Analysis 61
3.5.3 Reliability and Validity Analysis 62
3.5.4 Structural Equation Model 62
3.5.5 Hierarchical Regression Analysis for Moderating Effects 63
CHAPTER 4 Results of Data Analyses 64
4.1 Data Collection and Demographics Analysis 64
4.2 ANOVA Analysis 66
4.3 Measurement Model Analysis 67
4.3.1 Exploratory Factor Analysis (EFA) 67
4.3.2 Criterion-related Validity Analysis 69
4.3.3 Confirmatory Factor Analysis (CFA) 69
4.3.4 Reliability Analysis and Convergent and Discriminant Validity Analysis 71
4.4 Hypotheses Testing 74
4.4.1 Structural Model Analysis 75
4.4.2 Hierarchical Regression Analysis – Moderating Effect Testing 77
4.4.3 Summary of Hypotheses Testing 78
4.4 Additional Analysis 79
CHAPTER 5 Conclusions and Recommendations 81
5.1 Research Findings 81
5.2 Theoretical Implications 87
5.3 Managerial Implication 89
5.4 Limitations and Directions for Future Research 93
REFERENCES 95
Appendix A: Questionnaire and item codes (English) 119
Appendix B: Questionnaire (Chinese) 122
Appendix C: Path Diagram of Measurement Model for CFA 130

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