Background
“Due to insufficient medical knowledge among patients, the content of medical records might cause misunderstanding and also possibly inappropriate disclosure of medical information.”“If the content of electronic patient records in a USB flash drive leaked out intentionally or unintentionally, what will happen? It seems that data security and privacy are quite important.”
Methods
Design of EPR
Evaluation of the attitudes among users
Data source and measurement instrument
Items (in a scale of 1 ~ 5; 1 = disagree, 5 = agree) | Extracted components | Physician | Medical record staff | Patient | ||||
---|---|---|---|---|---|---|---|---|
Mean | SE | Mean | SE | Mean | SE | |||
Privacy of patient may be violated
a
| Concern g | 3.85 | 1.05 | 3.68 | 1.16 | 3.82 | 0.94 | |
Should protect privacy through the conditional implementation by consent of patient
b ***
| Intention h | 3.91 | 1.03 | 4.11 | 0.86 | 4.49 | 0.76 | |
Supporting the promotion of inter-hospital electronic patient records exchange
c **
| Intention | 3.68 | 1.05 | 3.79 | 0.92 | 4.01 | 0.84 | |
User interface may affect the willingness to use the System d *** | Function i | 4.17 | 0.95 | 3.25 | 1.21 | |||
Comprehensive functions will increase the willingness to use the System e | Function | 4.12 | 0.93 | 4.18 | 0.82 | |||
The exchange system may have the data security problem | Concern | 3.94 | 1.05 | 4.04 | 1.04 | |||
Handling the exchange data increases work load | Concern | 3.32 | 1.18 | 3.18 | 1.12 | |||
Would like to share my orders with physicians in other hospitals | Intention | 3.64 | 0.97 | |||||
Expect the System to provide more comprehensive patient records | Intention | 3.79 | 0.95 | 3.93 | 0.82 | |||
Can increase quality of health care f ** | Intention | 3.63 | 0.99 | 3.89 | 0.78 | |||
Can change habit of handwriting in medical records to avoid misunderstanding | Concern | 3.19 | 1.11 | |||||
Can reduce repeated lab tests | Intention | 3.65 | 1.10 | |||||
Can increase efficiency of diagnosis and treatment | Intention | 3.41 | 1.14 | |||||
Concern about patient’s potential misunderstanding for the content of medical records | Concern | 3.86 | 1.03 | |||||
Will benefit patient through continuing health care | Intention | 3.79 | 0.91 | |||||
Will bring convenience to medical records operation | Intention | 3.82 | 0.77 | |||||
Will save storage space for medical records | Intention | 3.86 | 0.80 | |||||
May save manpower | Intention | 3.46 | 1.14 | |||||
May increase efficiency of medical records management | Intention | 3.61 | 0.88 | |||||
Understand the function of electronic patient records exchange | Function | 2.62 | 1.00 | |||||
May improve physician and patient relationship | Function | 3.80 | 0.88 | |||||
Do not care about the leak of personal medical information | Intention | 2.29 | 1.36 | |||||
Do not mind if physicians obtain my information through electronic exchange in case of a medical need | Intention | 3.59 | 1.05 | |||||
Exchanging hospitals will confidentially protect patient information | Concern | 3.69 | 1.13 | |||||
Electronic patient records provided by this system are reliable and safe | Concern | 4.44 | 0.80 |
Definition of variables
Participants
Statistical analysis
Results
Variables | Total | Physician | Medical record staff | Patient | ||||
---|---|---|---|---|---|---|---|---|
(n = 379) | (n = 155) | (n = 28) | (n = 196) | |||||
n
| % |
N
| % |
n
| % |
n
| % | |
Personal Characteristics | ||||||||
Gender
a
| ||||||||
Male | 214 | 56.46 | 116 | 74.84 | 4 | 14.29 | 94 | 47.96 |
Female | 165 | 43.54 | 39 | 25.16 | 24 | 85.71 | 102 | 52.04 |
Age
a
| ||||||||
≦25 | 55 | 14.51 | -- | -- | 7 | 25.00 | 48 | 24.49 |
26-35 | 184 | 48.55 | 93 | 60.00 | 13 | 46.43 | 77 | 38.29 |
36-45 | 82 | 21.64 | 40 | 25.81 | 5 | 17.86 | 38 | 19.39 |
46-55 | 38 | 10.03 | 18 | 11.61 | 2 | 7.14 | 18 | 9.18 |
56-64 | 14 | 3.69 | 4 c | 2.58 | 1 | 3.57 | 9 | 4.59 |
≧65 | 6 | 1.58 | -- | -- | -- | -- | 6 | 3.06 |
Education
a
| ||||||||
Junior high school or lower | 9 | 2.37 | -- | -- | -- | -- | 9 | 4.59 |
Senior high school | 25 | 6.60 | -- | -- | 9 | 32.14 | 16 | 8.16 |
College | 282 | 74.41 | 125 | 80.65 | 19 | 67.86 | 138 | 70.41 |
Master degree | 53 | 13.98 | 20 | 12.90 | -- | -- | 33 | 16.84 |
Doctoral degree | 10 | 2.64 | 10 | 6.45 | -- | -- | -- | -- |
Experience of computer use
b
| ||||||||
Never or <1 year | 13 | 3.43 | 3 | 1.94 | 1 | 3.57 | 9 | 4.59 |
1-3 years | 18 | 4.75 | 7 | 4.52 | 1 | 3.57 | 10 | 5.10 |
4-6 years | 56 | 14.78 | 16 | 10.32 | 7 | 25.00 | 33 | 16.84 |
7-10 years | 90 | 23.75 | 33 | 21.29 | 8 | 28.57 | 49 | 25.00 |
≧10 years | 202 | 53.30 | 96 | 61.94 | 11 | 39.29 | 95 | 48.47 |
Occupation
| ||||||||
Industry or commerce | 26 | 13.27 | ||||||
Government or education | 30 | 15.31 | ||||||
Healthcare | 36 | 18.37 | ||||||
Service | 38 | 19.39 | ||||||
Student | 32 | 16.33 | ||||||
Other | 34 | 17.35 | ||||||
Number of outpatient visit in the past three months
| ||||||||
0 | 48 | 24.49 | ||||||
1 | 53 | 27.04 | ||||||
2-5 | 83 | 42.35 | ||||||
≧6 | 12 | 6.12 | ||||||
Work Characteristics | ||||||||
Job seniority
| ||||||||
<1 year | 19 | 12.26 | 5 | 17.86 | ||||
1-5 years | 61 | 39.35 | 7 | 25.00 | ||||
6-10 years | 23 | 14.84 | 6 | 21.43 | ||||
11-15 years | 24 | 15.48 | 6 | 21.43 | ||||
≧16 years | 28 | 18.06 | 4 c | 14.29 | ||||
Level of hospital
| ||||||||
Medical center | 105 | 67.74 | ||||||
Regional hospital | 50 | 32.26 | ||||||
Human Aspects | ||||||||
Reason to use EMR
| ||||||||
Convenient to access medical information | 91 | 58.71 | ||||||
Useful for work | 11 | 7.10 | ||||||
Not prefer handwriting | 13 | 8.39 | ||||||
EMR is mandatory | 30 | 19.35 | ||||||
No use and no benefit | 5 | 3.23 | ||||||
Other | 5 | 3.23 | ||||||
Technology Aspects | ||||||||
Major information source of this EPR
| ||||||||
Friend or colleague | 36 | 18.37 | ||||||
Internet | 12 | 6.12 | ||||||
Government institution | 8 | 4.08 | ||||||
Relative | 5 | 2.55 | ||||||
Hospital | 29 | 14.80 | ||||||
Other | 14 | 7.14 | ||||||
Never heard of | 92 | 46.94 |
Variables d | Physician a | Medical record staff b | Patient c | |||
---|---|---|---|---|---|---|
(n = 155) | (n = 28) | (n = 196) | ||||
Mean |
P
| Mean |
P
| Mean |
P
| |
Personal Characteristics | ||||||
Gender
| 0.113 | 0.027* | 0.232 | |||
Male | 3.834 | 4.401 | 4.430 | |||
Female | 4.133 | 3.686 | 4.555 | |||
Age
| 0.837 | 0.002** | 0.041* | |||
≦25 | 3.322 | 4.565 | ||||
26-35 | 3.807 | 4.603 | 4.516 | |||
36-45 (≧36 for medical record staff) | 4.141 | 4.205 | 4.512 | |||
46-55 | 4.031 | 4.382 | ||||
56-64 | 3.514 | 4.309 | ||||
≧65 | 4.173 | |||||
Experience of computer use
| 0.252 | 0.011* | 0.186 | |||
Never or <1 year | 4.209 | |||||
1-3 years (≦3 years for physician) | 3.724 | 4.442 | ||||
4-6 years (≦6 years for medical record staff) | 3.815 | 3.740 | 4.459 | |||
7-9 years | 3.734 | 4.609 | 4.395 | |||
≧10 years | 4.005 | 3.782 | 4.592 | |||
Work Characteristics | ||||||
Job seniority
| 0.017* | 0.021* | ||||
<1 year | 3.414 | 4.401 | ||||
1-5 years | 3.581 | 4.613 | ||||
6-10 years | 4.085 | 3.424 | ||||
11-15 years (≧11 years for medical record staff) | 4.490 | 3.736 | ||||
≧16 years | 4.321 | |||||
Human Aspects
| ||||||
Reason to use EMR
| <0.001*** | |||||
Convenient to access medical information | 4.089 | |||||
Useful for work | 4.053 | |||||
Not prefer handwriting | 3.943 | |||||
EMR is mandatory | 3.539 | |||||
No use and no benefit | 2.742 | |||||
Other | 3.393 | |||||
Level of concerns
| <0.001*** | 0.002** | <.001*** | |||
Low | 3.644 | 3.522 | 4.177 | |||
High | 4.172 | 4.565 | 4.696 | |||
Technology Aspects
| ||||||
Usefulness of functions
| 0.012* | 0.547 | 0.270 | |||
Low | 3.725 | 3.956 | 4.410 | |||
High | 4.128 | 4.131 | 4.541 | |||
Major information source of this EPR
| 0.017* | |||||
Friend or colleague | 4.485 | |||||
Internet | 4.701 | |||||
Government institution | 3.801 | |||||
Relative | 4.977 | |||||
Hospital | 4.188 | |||||
Other | 4.627 | |||||
Never heard of | 4.582 |
Variables d | Physician a | Medical record staff b | Patient c | |||
---|---|---|---|---|---|---|
(n = 155) | (n = 28) | (n = 196) | ||||
Mean |
P
| Mean |
P
| Mean |
P
| |
Personal Characteristics | ||||||
Gender
| 0.171 | 0.021* | 0.237 | |||
Male | 3.618 | 4.822 | 4.426 | |||
Female | 3.904 | 3.692 | 4.559 | |||
Age
| 0.034* | 0.018* | 0.109 | |||
≦25 | 3.533 | 3.951 | ||||
26-35 | 3.437 | 4.887 | 3.973 | |||
36-45 (≧36 for medical record staff) | 3.296 | 4.350 | 4.027 | |||
46-55 | 4.542 | 4.097 | ||||
56-64 | 3.844 | 4.049 | ||||
≧65 | 4.372 | |||||
Experience of computer use
| 0.521 | 0.498 | 0.029* | |||
Never or <1 year | 4.093 | 3.367 | ||||
1-3 years (≦3 years for physician) | 3.451 | 4.158 | 3.777 | |||
4-6 years (≦6 years for medical record staff) | 3.779 | 4.520 | 4.139 | |||
7-9 years | 3.857 | 4.097 | ||||
≧10 years | 3.956 | 3.987 | ||||
Occupation
| 0.015* | |||||
Industry or commerce | 4.129 | |||||
Government or education | 4.279 | |||||
Healthcare | 3.866 | |||||
Service | 4.186 | |||||
Student | 3.990 | |||||
Other | 3.627 | |||||
Number of outpatient visit in the past three months
| 0.046* | |||||
0 | 3.832 | |||||
1 | 3.986 | |||||
2-5 | 4.067 | |||||
≧6 | 4.350 | |||||
Work Characteristics | ||||||
Level of hospital
| 0.006** | |||||
Medical center | 4.022 | |||||
Regional hospital | 3.500 | |||||
Human Aspects
| ||||||
Reason to use EMR
| 0.024* | |||||
Convenient to access medical information | 4.161 | |||||
Useful for work | 4.122 | |||||
Not prefer handwriting | 3.980 | |||||
EMR is mandatory | 3.550 | |||||
No use and no benefit | 2.870 | |||||
Other | 3.995 | |||||
Level of concerns
| 0.010* | 0.574 | <0.001*** | |||
Low | 3.889 | 4.042 | 3.655 | |||
High | 3.468 | 4.298 | 4.227 | |||
Technology Aspects
| ||||||
Usefulness of functions
| 0.004** | 0.589 | 0.407 | |||
Low | 3.458 | 4.048 | 4.077 | |||
High | 3.937 | 4.292 | 3.966 | |||
Major information source of this EPR
| 0.049* | |||||
Friend or colleague | 4.255 | |||||
Internet | 3.964 | |||||
Government institution | 3.757 | |||||
Relative | 4.426 | |||||
Hospital | 3.920 | |||||
Other | 4.192 | |||||
Never heard of | 3.910 |