Exchange of electronic medical records the key factor
Guo Guangming Hung Ming-Jian Xiao Ruling
Information Management, National Chung Cheng University
kmkuo@mail.chimei.org.tw chemy@mis.ccu.edu.tw ring5012@mail.cyccatv.net.tw
Summary
This study proposes six factors of hospital electronic medical records exchange factor hypothesis to be verified through discriminant analysis.
Sample a total of 86 questionnaires sent, 36 valid questionnaires, response rate was 42%.
The
results showed that: uncertainty, expected benefits, mutual investment, and the influence of variables with different capabilities.
Keywords: social exchange theory, transaction cost theory, electronic medical records exchange
1. Introduction
Department of Health in the Republic of China by the year 91, "National health care institutions the status of the investigation of electronic medical records operations," the data show that hospitals in Taiwan Area has reached the level of information 88.6%, and in information technology has been the hospital, the medical records to a kinds of electronic level has reached 55.1% ratio; clinic, compared with 74.28% degree of information technology, information technology in the clinic has been in some degree of electronic medical records to the ratio of up to 59.9% (Linzi Ming, Peng Zhenxing, 2002) .
Therefore, medical institutions in Taiwan Area of electronic medical records has reached an adequate level.
Associated with the Department of Health has been launching a pilot program of electronic medical records, and public awareness of the advantages of electronic medical records and benefits, and thus to promote sharing of electronic medical record pilot program, hospitals with electronic medical records among hospitals can not exchange into the future to avoid the trend.
However, after another within the hospital although the medical records electronic, but the hospital electronic medical records to bolster the main purpose of the declaration of income as the main considerations leading to the willingness of hospital and other hospitals to carry out the exchange of medical information is not clear, thus affect the hospital electronic medical records exchange factors there is a need to
explore further.
In this study, from a social and economic side as the starting point to social exchange theory and transaction cost theory to study the
theoretical basis and reference to electronic data exchange of relevant literature study to explore the impact of "hospital electronic medical records exchange considerations."
2. Document Reference
2.1 The exchange of electronic medical records
According to the Department of Health conducted in 2002, the "national medical institutions the status of the investigation of electronic medical records
operations," the opinion, the so-called "some level of electronic medical records"
means the hospital's electronic medical record system at least one of the
following features: " general text-based information can handle, with instrument data connectivity, has been integrated medical imaging systems can provide multimedia medical records, and institution-wide data integration has been achieved (Linzi Ming, Peng Zhenxing, 2002). "Republic of China Department of Health issued in 2003 "Medical institutions to implement the draft Guidelines for electronic medical records", this draft law based on the medical provisions of Article 48 that the medical records in electronic medical records, including: "law enforcement operations by the doctor doctors the medical records produced, the inspection data and inspection reports other types of medical personnel, the records produced by the implementation of business (the Department of Health Information Centre, 2003). "
U.S. IOM (Institute of Medicine)in 1997,electronic medical records is defined as:
"There was an information system in electronic medical records, the system supports the user to use a complete and accurate information on the ability to remind and to warn physicians in clinical precautions, to provide clinical decision support, and can assist with medical knowledge with other systems
interconnected. "
U.S. CPRI (1995) Electronic medical records will be defined as "a man his life on the health status and medical care of the electronic information.
Electronic medical records not only the automation of paper medical record format, but contains all the health information category, such as: medical records, drug records, and test results of various tests and X-ray imaging. "
Waegemann (2000) to complete electronic records according to the different content of information, electronic medical records will be divided into: (1) automated
medical records (Automated Medical Record); (2)computerized medical record
(Computerized Medical Record); (3) to provider-based electronic medical records system (Provider-Based Patient Medical Record); (4) of electronic medical records (Electronic Patient Record); (5) electronic health records (Electronic Health Record) the five stages.
In
broad terms, these five stages were both considered to be electronic medical records, the only future we expect to achieve the goal and the electronic health records, electronic medical records it will not only personalized, continuously updated records of personal information in order to increase and provides analysis of clinical or academic research.
Difficult to consider the practical level, the hospital's electronic medical record of a degree of phase, thus, this study adopts a broad view of the above five stages are regarded as "electronic medical record" of the scope.
MRI (Medical Record Institude) in 2002,the survey showed that 75% of the respondents considered it necessary to the health care system in different (Healthcare Delivery System) sharing of patient information.
Kinkhorst et al (1996),as long as a clear definition of the gradual exchange of information, the use of electronic data exchange in order to provide a distributed medical information for medical professionals is feasible.
Department of Health, 2003, the "medical institutions to promote electronic medical records project" is expected to take eight kinds of medical information exchange, and taking into account the future of electronic medical records between different hospitals of interoperability and security, health certificate established in 2003 management center, between the hospitals will be able to exchange electronic medical records the way to achieve the medical records and reduce the waste of resources shared goals.
2.2 The electronic data interchange and electronic medical records exchange
As the patient information stored in different medical institutions, we can use electronic data message exchange to achieve the purpose of exchanging medical records, and to achieve a successful message exchange needs, including (Kinkhorst et al, 1996): (1) the use of available integrated message information system; (2) the use of widely accepted exchange standards: can be used to integrate information exchange between organizations; (3) network of regional organizations: medical experts and other medical institutions, regional organizations can network and secure exchange of medical and non-medical information.
Based on the views of other scholars Kinkhorst, electronic medical records exchange of electronic data
exchange should be considered as an application, the difference lies in the general electronic data exchange between organizations, only the text format of information exchange is involved in commercial activity between enterprises, and its impact mainly related to money.
The only electronic medical records between hospitals in addition to text format to exchange information, including still image data, such as X-ray and CT scan, etc., and the transmission of data content, in addition to the outside with the money and the lives of patients at stake.
Therefore, this research will "exchange of electronic medical records," defined as
"among hospitals a standardized format through the Internet to transmit the electronic medical record, its contents, including text, numbers, and the image data, physicians can provide immediate diagnosis and treatment reference used to achieve continuity of medical care, to improve the quality of medical care. "
2.3 The foundation of the research 2.3.1 Transaction cost theory
Transaction costs, the emergence of concept study began in 1937, Coase, it considers the environment of uncertainty and limited rationality will distort the operation of market mechanisms, leading to transaction costs arising.
Williamson (1975) that the transaction cost causes the contract is not complete, and can be divided into two kinds of pre-and post transaction costs.
Prior costs including the cost of information gathering, protocol negotiation costs, and the protection of contract costs; post costs include monitoring costs, implementation of the contract cost.
In addition, Williamson (1975, 1991)pointed out that transaction costs also include the management of inter-firm relationships to each other direct costs, as well as the opportunity cost of development of poor decision-making.
Williamson's analytical framework is based on people having sex in the two main assumptions: limited rationality and opportunism, and the transaction of the three major dimensions: asset specificity, uncertainty and the exchange interaction between the frequency determined.
2.3.2 Social Exchange Theory
Social exchange theory development since the 1950s, its roots in the unequal distribution of resources to explore the basis for the exchange of power.
Turner (1986) that the study of social exchange theory from many fields, including
economics, utilitarian, functional anthropology, conflict sociology, psychology and other behavior.
Promote vigorous development of this theory were related to
construct: (1) social exchange behaviorism; (2)social exchange structuralism; (3) the result of social exchange matrix; (four)network theory of social exchange.
2.3.3 Applicability of Theory (1) the applicability of medical
Currently there are many in the medical field to social exchange theory and transaction cost theory in the literature (Shortell, 1973; Dansky et al1996; Stiles and Mick, 1997; Ashton, 1998; Coles and Hesterly, 1998; Grembowskiet al 2002; Cote and Latham, 2003).
Premkumarand Ramamurthy (1995) that the social exchange theory provides the basis for the relationship between research organizations.
Hospital
management not only involves the patient's life and must shoulder greater social responsibility, the competitive pressures driven, hospital and other hospitals will also consider the relationship and cooperation, and thus inter-organizational exchange behavior occurred, and therefore social exchange theory sufficiently Research Hospital as the theoretical basis of the exchange act.
In addition, the transaction cost theory by the legal, economic, and
organizational integration of various fields is made, it can explain the very wide range, from sociology, political science, organization theory, contract law, corporate strategy, corporate finance, and marketing, etc. Jieke apply (Rindfleisch and Heide, 1997).
According to Rindfleisch and Heide (1997)on the collation of the major literature, transaction cost analysis can be applied to research issues associated with the exchange.
Type of organization in terms of hospital, medical centers, regional hospitals, district hospitals and clinics of four different levels of medical institutions, their staff possess the expertise and equipment are not the same, plus insurance coverage constraints and market competition, the medical institutions to found in strategic alliance (Barberet al, 1998), the manner of
cooperation, in order to achieve resource sharing and the goal of reducing costs, so can be used to study the transaction cost theory.
(2) the applicability of electronic medical records exchange
Emerson (1981) that social exchange must have a rational principle, the principle of marginal utility, and the three core principles of fair assumption.
Blau (1964) clearly pointed out that different economic transactions and social transactions, in economic transactions, the transactions of items have a clear market value, and the process for the existence of a written or unwritten contract, clearly defined
rights and obligations of both sides.
Social transaction is not, in social exchange, people on the transaction value of goods is determined subjectively, and both sides exchange process there are many uncertainties obligations.
Hall (2003)the use of social exchange theory to explore the large-scale, distributed and
information-intensive organizations to exchange information and knowledge and to analyze its applicability in the field of information technology.
Economic
transactions and social transactions based on the differences of consideration, Son et al (1999) integration of social exchange theory and transaction cost theory to explore the impact of retailers and suppliers to exchange electronic data link between the breadth of factors.
As the electronic medical record for medical information and knowledge is a kind of application, therefore the exchange of electronic medical records, in fact, the exchange of information and knowledge.
And in patient medical care for life-long trend, the exchange of electronic medical records for patients with functional integration, which not only generate economic benefits for the hospital
management, and can reduce treatment costs in the case of improving the clinical results of patients, Therefore, hospital medical records in electronic exchange of co-operation contract must be prepared to clearly regulate the exchange of rights and obligations of both sides, in order not to lose patients to hospital in the market.
Furthermore, the exchange of electronic medical records related to patient privacy, the exchange value of the identification in addition to other hospital staff must consider the patient's subjective perception, and hospital electronic medical records in a more obligation to the patient privacy be
protected.
Therefore, this study combines Blau (1964)and Emerson (1981) and other scholars of the view that the exchange of electronic medical records related to the question of the need to integrate the transaction cost theory and social exchange theory as the theoretical basis.
3. Research Methods 3.1 research structure
Framework of this study is shown in Figure 1.
Factors for each dimension were:
social constructs (trust, influence, and expected benefits of the three factors), and economic dimensions (including the asset specificity, uncertainty and mutual investment, the three factors).
3.2 Research procedure
In this study, a literature review on the development of research framework.
Second, based on literature reviews of research relevant variables and dimensions of a questionnaire designed by the two academic experts and practitioners of three expert meetings of experts, and from the practical point of view of the structure and amendments to the questionnaire.
Finally, to complete a
questionnaire before the test to determine the reliability, validity formally sent the questionnaire, after the formal questionnaire sent by the two stage classification and collection to be compiled after, and in accordance with the effective recovery of the questionnaire data analysis, and on the the hypothesis put forward and discussed.
3.3 Maternal and sampling design
In this study, the parent for the regional hospitals in Taiwan, the sample from the Department of Health of the Republic is based on 91years "the number of
hospitals in Taiwan ─ such as byownership and different levels of evaluation" of statistics, including 16 medical centers, Medical Centers 1 and 69 regional
hospitals, a total of 86 questionnaires were sent.
Questionnaire explicitly asked to respond to the hospital information department head or responsible for hospital-wide IT business unit heads.
A total of 41 questionnaires, 48% recovery rate, which then complete and can not remove invalid and invalid by the
telephone survey questionnaire 5copies of the actual number of 36 valid questionnaires, the effective rate of 42%.
For general research, the sample size should not be less than 50 factors, the need is greater than or equal to 100 or more, and be of at least 5 times the
number of variables (Gorsuch, 1983; Hairet al, 1998) .
Comrey (1973) also considered that the number of samples under 100, not suitable for factor analysis, preferably greater than 300in number.
Although the sample size in this study there is less recovery concerns, but according to Kaiser (1974) to KMO (Kaiser-Meyer-Olkin)
statistics to determine the suitability in terms of factor analysis, Kaiser KMOvalue of 0.50 that the following factors can not be analysis.
In this study, the KMO value dimensions are: social constructs (0.633), and economic dimensions (0.682), KMO values were greater than 0.60, it is sufficient for factor analysis (see Table 1).
Moreover, the correlation coefficient if the low and close to the factor of taking the more difficult, this one nature, the spherical test (Bartlett's Test of Sphericity)can also be used to test the measure of the correlation coefficient between projects, significant spherical test that the correlation coefficient as the factor analysis extracted factors sufficient to use (An index, 2000).
Purposes of this study, the research aspect of the spherical test results are all significant (see Table 1), which also support the research questionnaire recovery sufficient for factor analysis.
Table 1 KMOand Bartlett test
Structure Surface
KMO and Bartletttest
Social dimension
Kaiser-Meyer- Olkin measures of sampling adequacy of
Bartlett spherical test
Approximat e chi- square distribution
Freedom Significant
.633
120.202 36 .000
Economic dimension
Kaiser-Meyer- Olkin sampling adequacy of measures of
Bartlett spherical test
Approximat e chi- square
.682
156.587
distribution Freedom Significant
36 .000
Operational definitions and variables measured 3.4
In this study, the dimensions of the operational definition and measure of variables shown in Table 2, to measure the project are Likert (Likert) to design the five-point scale.
Table 2operational definitions and variables measured
Dimensio n
Variable
Operational definition Measure project Reference Scale
Commun ity
Trust Exchange of electronic medical records and the types of levels of hospital medical records to support the exchange of the extent of review of medical referral
Medical records exchange type, degree of support for medical referral review
Mohr and Spekman (1994);
Joshiand Stump (1999a)
Influence
The exchange of inspection services, hospital medical referral procedures, rates and timetable arrangements for the exchange of electronic medical records impact of rules
Service procedures, rates and timely process, exchange rules
Premkumar and Ramamurthy (1995);
Chwelos et al (2001)
Expected benefits
Hospital recurrent costs and reduce the cost of campus-level communication
Recurrent costs, communication costs for Cross
Chwelos et al (2001)
Economy
Asset specificity
Exchange of electronic medical records on demand into the extent of the special medical equipment
Special medical equipment
Buvik and Gronhaug (2000);
Heideand John (1990)
Uncertainty
Government policies and laws and the medical uncertainty of the
Government policies and regulations,
Joshi and Stump (1999a)
exchange of scientific and technological needs
demand for medical technology exchange
Mutual investment
Exchange to improve relations between the hospital, education and training, as well as the degree of investment adjustment
processes
Improve relations, education and training, operating procedures
Zaheer and Venkatraman (1995); Joshiand Stump (1999a)
3.5 Research hypothesis
A study based on graph structure and the literature summarized results of this research and development of the six hypotheses are:
H 1.1:Hospital trust each other to affect the electronic medical records she wishes to exchange wishes.
H 1.2:Hospital, the hospital's influence on the exchange will affect the campus-the willingness to exchange electronic medical records.
H 1.3:expected benefits will affect the hospital electronic medical records exchange shuffled across the will.
H 2.1: asset specificity will affect the hospital electronic medical records exchange shuffled across the will.
H 2.2:the uncertainty of law and technology will affect the hospital for a campus electronic medical records exchange wishes.
H 2.3:Hospital mutual investment will affect its exchange-shuffled across the will of electronic medical records.
4. Data analysis 4.1. Basic data analysis
(1) respondents had basic information
Respondents of the questionnaire the majority were male, 91.7% of the total sample; age distribution of the majority of 40 to 44years old, accounting for 27.8%
of all samples; of service to more than 10years in charge in the majority, of the total sample 25% of survey respondents had this show in the medical information of considerable experience.
(2) the background of some of the hospital
Hospital level the majority of regional hospitals, about 61%; hospital employees to 500 to 999 more, accounting for 38.9%; monthly turnover of 199million yuan to 1 more, about 30.6%; number of beds to 300 ~ 499 the majority, about 30.6%; number of IT departments to 9 (inclusive) the majority, accounting for about 36.1%.
4.2. The dimensions of reliability and validity analysis
This study will address the social dimensions and economic dimensions
separately reliability and validity analysis.
In the reliability testing area, Hairet al (1998) that theCronbach's α values greater than 0.7 means that the variable has a high reliability, if less than 0.35 should be rejected.
Table3shows, in addition to considerations based on the practical level, the trust factor in the
recommendations based on expert meetings be retained, the other variables Cronbach's α valueswere greater than 0.7.
The validity of measurement, the questionnaire used in this study was designed with reference to relevant literature, and then for the contents of the
questionnaire by the expert meeting to amend, and was measured again before the meeting of experts convened to modify the content of the questionnaire.
In
addition, this study used principal component analysis on all dimensions were independent variables for the construct validity of the test (see Table 3).
The
structure factors of the choice criteria are followed Hair et al (1998) point to a choice, these views are: (1) the characteristic value of each factor (Eigenvalue) to be greater than 1; (2) to the maximum variance axis method After rotation, factor loading obtained (Factor Loading) of the absolute value of greater than 0.5; (3) 22 items to measure differences between the factor loading greater than 0.3.
Therefore, this study questionnaires of experts already have considerable validity and construct validity.
Table3 The dimensions of the principal components analysis
Dimensio
Factor Name
Measure project Because Su
Principal component
Variance
(Cumulative Cronbach'sα
n Load eigenvalue variance)
Commun ity
Trust Types of medical records exchange
0.870 3.108 34.533%
(34.533)%
0.5391
Support test check
0.779
Referral to support the referral of ancillary
0.782
Influence
Rules and
procedures for service
0.814 1.633 18.140%
(52.673)%
0.8156
Medical referral rates check the schedule in time
0.863
Record Exchange Rules
0.741
Adoption of medical records exchange
0.729
Expected benefits
Recurrent costs 0.862 1.594 17.706%
(70.379)%
0.7124
Communication costs for Cross
0.895
Economy
Asset specificity
Special medical equipment - the exchange of hospital
0.855 3.417 37.966%
(37.966)%
0.7758
Special medical equipment - hospital itself
0.898
Uncertainty Government policies and laws
0.887 1.788 19.756%
(57.722)%
0.7998
Medical needs of science and
technology exchange 0.877
Mutual investment
Improvement of relations -the exchange of hospital
0.723 1.690 18.774%
(76.496)%
0.8867
Initial education and training
0.773
Improvement of relations -the hospital itself
0.825
The hospital processes to adjust
0.850
Adjustment of the exchange processes Hospital
0.925
4.3. Discriminant analysis results
Hair et al (1998)estimated for the different functions that must have statistically significant, otherwise the interpretation of the results will be meaningless.
In this
study, Wilks' Lambda value test has been used with and without the exchange of electronic medical records is the average of the two groups were significantly different, Table 4shows the 5% significant level, this study is the average of the two groups significant difference.
Explain the difference of the two important indicators were standardized for the different load and different coefficients.
The former said that the function of individual differences between predicted variables and the simple correlation, which consider the difference between predicting variables on the overall contribution of the function (Hairet al, 1998; Klecka, 1980).
Difference between load and avoid the collinearity problem is not only more, and in the analysis of small samples are more stable, and therefore the first priority should be to explain differences between different function loading (Hairet al, 1998).
Although the standardized coefficient the greater the difference between this forecast is the contribution of variables on the higher difference between groups, but also can not tell the difference function can discriminate the groups, through various groups to be further to understand the difference between the average properties of functions (Chen Shunyu, 1998 ).
Load and standardized by different factors will help to understand the distinction between different functions to the more discriminating variables, and then as the control of a hospital electronic medical records exchange policy.
In this study, the explanation for the hypothesis test
results, except according to Hair et al (1998)point of view, to distinguish between absolute load of greater than or equal to 0.3 as the base variables, the
standardized difference and the average coefficient and groups to assist explained.
Table 4shows, this study analyzed four different load greater than 0.3and 4 variables significantly higher absolute value of standardized coefficients of variables, which were: uncertainty, expected benefits, mutual investment, and impact ability.
Table4different results
Wilks' Lambda = .647 df = 6 Chi-Square = 13.498 Sig of F = .036
Factor name
Say
Different load
Standardized coefficient
Have adopted
Not used
Mean
Standard
deviation Averag e
Standard deviation
Trust -0.019 0.135
2.9286
0.7644 2.8182
0.3670
Influence
0.352 0.330
3.4821
0.6966 3.1591
0.6434
Expected benefits
0.575 0.514
4.1429
0.6022 3.6591
0.6616
Asset specificity
-0.012 0.245
3.2500
0.8026 2.9545
0.8296
Uncertainty
0.749 0.470
3.6786
0.8223 3.1364
0.7588
Mutual investment
0.562 0.430
3.0571
0.5680 2.6273
0.7388
Listed in Table 4for the difference between the results of the study and interpretation of hypothesis verification can be described as follows:
4.3.1 Social dimension
In the social dimension of the three hypotheses of the test results as follows:
H 1.1:Hospital trust each other to affect the electronic medical records she wishes to exchange wishes.
Previously involved in inter-organizational exchange of electronic data confirmed trusted trading partners can significantly enhance the extent of use of electronic data exchange (Hart and Saunders, 1997),the only exchange in the hospital electronic medical records, this study did not have enough evidence support, which may cause the inference is: in the current payment under the medical Xia, hospital sources of income Zhuyao National Health Insurance, so Yi Shi Even if medical records provided by other hospitals, but for the addition of hospital income, Bulun whether the original diagnosis and treatment of hospital necessary tests have been carried out checks, inspections will be arranged for repeat testing to determine the lesion has not been completely refer to other hospital records, resulting in no significant difference between ability.
For example: At present, many patients were diagnosed with a disease, the patients and their families often want to seek professional opinions of other doctors to know more about their condition, and peace of mind to accept the treatment, this is the so-called
"second opinion consultation "(Second Opinion Consultation), it did get all the medical records previously reported, for a second opinion consultation is an important step, but the current domestic situation, if the patient sought a second opinion O'clock, Yishirenghui Zhongxinanpai Yicixiangguan The test checks, do not entirely trust the doctor patient medical records in other hospitals, like this
situation could lead to this hypothesis is not significant.
H 1.2:Hospital, the hospital's influence on the exchange will affect the campus-the willingness to exchange electronic medical records.
According to Iacovou et al (1995) empirical results, partners, small business pressure is the main reason for electronic data exchange.
Hart and Saunders (1998) also pointed out that the influence of customers for the types of electronic data exchange (Diversity)have a significant effect.
Results of this study have sufficient evidence to support the hospital's impact on the exchange of the hospital will conduct a campus that affect their willingness to exchange electronic medical records, and on the practical level, whether in clinics or district hospitals, due to limited medical equipment must rely on the regional hospital or medical center to provide necessary assistance, and regional hospitals or medical centers are able
to use this influence by requiring clinics to regional hospitals, or the exchange of electronic medical records can be related to medical record review inspection reports, or test, this a phenomenon also support the results of this study.
H 1.3:expected benefits will affect the hospital electronic medical records exchange shuffled across the will.
Iacovou et al (1995) found that organizations related to the cognitive benefit is its use of electronic data exchange, one of the factor.
Chwelos et al (2001)pointed out that the expected benefits of electronic data exchange on the organization does have significant impact.
Discriminant analysis showed that there is sufficient evidence to support the expected benefits of electronic medical records on hospital use, exchange a significant impact.
On the domestic current medical environment, the constraints of the global budget, the hospitals all working best to win a higher income, such as participation in self-management, through review of hospital processes and strengthen control measures to meet the required health insurance of the indicators.
Therefore, the hospital, the use of electronic medical records exchange, if truly operational benefits for the hospital, and reduce the recurrent costs of the expenditure, thus increasing hospital revenue or enhance the reputation of great help to the hospital, the hospital certainly willing to participation in electronic medical records exchange.
4.3.2 Economic perspectives
In the economic dimension of the three hypotheses of the test results as follows:
H 2.1: asset specificity will affect the hospital electronic medical records exchange shuffled across the will.
According to Heide and John (1990)study states: the special manufacturers and suppliers of investment assets, the level of cooperation for both sides showed a positive correlation with each other.
Statistical analysis of this study, the results have not been the same view, the possible inference is: "in accordance with the provisions of Medical Law Fifth 10: hospitals, clinics due to limited equipment and expertise, can not determine the cause of the patient or to provide a complete treatment, referral of patients should be recommended. "such as computer tomography and magnetic resonance and other special equipment, not all hospitals had the capacity to buy, so no such equipment through a medical referral hospital must be a way for patients to review examination or treatment,
but CT scan or MRI of the special examination of the ratio of the total medical record is not high.
So regardless of whether specific assets hospital, a factor in this recognition of their difference is very small, resulting in no significant difference between ability.
H 2.2:the uncertainty of law and technology will affect the hospital for a campus electronic medical records exchange wishes.
The literature that the uncertainty will lead to the partners can not establish long-term relationship, and the use of electronic data exchange has a negative effect (Heideand John, 1990; Zaheer and Venkatraman, 1995).
If the Government is to promote electronic medical records of law or policy has been unable to determine, medical institutions will be at a loss; If the exchange of medical technology and techniques required can not be identified, the medical institutions will be more hesitant, coupled with conditions of National Health Insurance poor conditions, not to invest in electronic medical records exchange shuffled across.
Therefore, the difference between this study results appear in the government policies, laws and exchange of electronic medical records technology required for uncertain cases, it will affect she wishes to conduct the exchange of electronic medical records will.
H 2.3:Hospital mutual investment will affect its exchange-shuffled across the wishes of electronic medical records.
Mutual investment relationship can be seen as a commitment to each other (Zaheer andVenkatraman, 1995), and in the case of small investments, the promise of higher value (Bakos and Brynfjolsson, 1993).
Joshiand Stump (1999b) is that
through mutual investment can generate a "co-dependent relationship", to avoid Partners speculative behavior.
The study also shows that there is sufficient evidence to support the hospital's investment in each other will affect their electronic medical records exchange shuffled across the will.
The hospital, the hospital if the exchange of the two sides can cooperate with each other under the premise of co-ordination and investment, both in the medical record exchange processes required on the hardware or with the adjustment, will she wishes to carry out an impact of electronic medical records exchange.
5. Conclusions and recommendations
For the hospital electronic medical records exchange shuffled across the former must be fully aware of the relevant factors, can only advance obstacles and
ensure success.
The empirical results of this study were obtained four factors with different capabilities, which are: uncertainty, expected benefits, mutual investment, and the influence of other factors.
For the use of information technology considerations, the empirical results of this literature review and the results are not exactly the same, based on this phenomenon, this study suggests that lead is a result of the hospital part of the medical industry, its vital patient safety Therefore, by the National Health Insurance policy and the impact of laws and regulations even in the general industry, so hospitals often use electronic medical records exchange of health care policy and health care reporting standard is the primary concern.
Secondly, Taiwan has long been rich in medical resources, but the uneven distribution of large hospitals in serious illness, minor ailments to hospital for treatment of small acts of the case not been fully implemented, resulting in small hospitals difficult to survive, while the total budget for the implementation of the system led to hospital The competition is more intense, and the hospital
electronic medical records exchange must be carefully considered its investment cost and potential benefits.
In addition, in response to increasingly intense business environment, hospitals compete to form alliances to improve
competitiveness, so the hospital is not only external influence alliance chips, and is effective to promote the exchange of electronic medical records must be considered factors.
Although the hospital association to improve the transfer switch to check each other's implementation, but in consideration of the National Health Insurance and medical records are not fully integrated case, the people she wishes to enjoy the easy duplication of health care resources (for example:
she wishes to repeat the medical treatment), thereby reducing reliance factor in the alliance and the Hospital to promote the exchange of electronic medical records in the role.
Based on the results of empirical research, this study as follows:
(1) strengthen the partnership between the hospital
The face of the impact of national health insurance and medical care change, the hospitals all working wholeheartedly into the thinking about how to increase hospital income, and health insurance benefits in the existing poor conditions, how to maintain the normal operation of the hospital.
Therefore, hospitals should seek to integrate electronic medical records related to the exchange of medical
resources, reduce duplication of investment and a waste of repeated testing and inspection to establish two-way transfer of information systems and establish a good turn seized channel in order to effectively conserve resources and enhance primary care service.
(2) to enhance the exchange of electronic medical records in order to increase the effectiveness of incentives for the propaganda
Because of the limited national health insurance, unless the application of a technology useful to the hospital's income, or hospitals tend to maintain the existing practices.
Therefore, the Government should be broad public awareness of the benefits of the exchange of electronic medical records and related health insurance benefits to increase incentives to encourage hospitals to exchange the operation of electronic medical records.
(3) early identification of electronic medical records policies and regulations
According to the Department of Health (2002) survey, the medical institutions operating in the implementation of electronic medical records the occasion, most hoped that the Government can help solve, and to note include: the clarity of the policy, relevant laws and regulations of the supporting measures, the government units exchange of electronic medical records should be required to follow the policy of early identification law, allow medical institutions to follow.
(4) operation of electronic medical records training
As the required standard electronic medical records technology, there is no one standard that is acceptable, if the government agencies came forward to meet the standards set by government agencies, provide jobs to train, hospital medical records will help and hospital electronic medical records exchange between each other's development.
(5) continue to promote research projects related to electronic medical records
As electronic medical records into electronic medical records exchange basis, and the electronic health record goals for the future development of electronic medical records, due to the present there is no single and successful electronic medical records exchange mode, and the exchange of electronic medical records cover a wide range of social and economic issues non-minority research that is
able to spy picture.
Thus, government, academic community, continue to invest is needed in research.
References:
Because of space limitations, the literature contains less than prepared, if necessary, please contact the second author.
