电子病历系统使用行为对绩效影响的实证研究
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摘要
医院信息系统是国内医院现代化建设的新兴热点，是目前我国卫生信息化的重点内容。“十二五”卫生信息化建设工程规划中明确指出，电子病历系统是医院信息化建设的核心，是建设区域医疗平台的基础，对国家卫生信息化建设具有重要意义。数字化医院依靠现代化的医院信息系统，将医院业务软件、数字化医疗设备及计算机网络平台集合一体，以提高医疗服务效率和管理质量。2011年，卫生部制定了电子病历基本规范，并在全国110家医院推行电子病历试点工作。同时，也出现了“IT生产率悖论”现象，即一些医院的IT投资并没有提高绩效，反而使医院深陷投资“泥潭”。西方学者提出了时滞假说、替代效应假说等以尝试打开IT投资与绩效之间的“黑箱”，引入丰富的学科理论诠释信息系统绩效评价，然而，评价维度指标及作用机理依旧存在较大争议，IT技术如何提升企业绩效仍缺乏统一的理论框架支撑。因此，本文基于财务管理和行为科学理论，从电子病历使用行为影响因素出发，探究系统使用行为对绩效影响的因素和路径，主要内容包括：
解释信息系统使用行为对绩效影响的因素和路径。以信息技术接受理论为基础，在归纳理性行为理论、计划行为理论和创新扩散理论基础上，融合任务技术匹配理论，以信息系统成功理论为核心，解释电子病历系统使用行为对绩效影响的因素模型，并提出相关研究假设。同时，基于电子病历系统的技术任务特征来研究系统使用行为的主要影响因素，及其如何改进工作流程来提高医疗效率和质量，以此作为论文研究的理论基础。
构建医院信息系统使用行为对绩效影响的结构方程模型。融合任务技术匹配和信息系统成功理论，设计技术服务因素、用户个人因素及使用行为因素的指标。通过测量模型的信度、收敛有效性及判别有效性的数据分析，对结构模型的假设进行验证。通过对不同年龄、性别及科室医生使用行为对绩效影响的比较，对绩效影响的显著性和差异性进行实证分析，研究电子病历使用行为对绩效的影响因素与影响路径。
构建电子病历使用满意度对绩效影响的回归模型。基于期望理论构建以门诊病人人次、诊费收入及病案质量为绩效衡量指标的3个回归模型，运用医院经验数据，实证检验电子病历系统使用满意度对绩效的影响。采用回归分析方法，利用SPSS.15软件运算，探究不同年龄、性别、学历及科室医生的电子病历使用满意度对绩效影响是否存在显著性差异，进一步验证满意度与医生门诊病人人次、诊费收入及病案质量指标之间的相关关系。
提出了研究信息系统使用绩效的新视角和新方法。目前国内外学者对医院信息系统的研究均未能触及医生层面，对不同年龄、性别及科室医生的系统使用绩效分析能够丰富此项研究，为信息系统使用绩效的评价提供新视角。同时采用结构方程和回归方程模型，运用医院经验数据和医生调查问卷，实现了对系统使用绩效的显著性和差异性检验，有效解决了传统度量方法的不足，为信息系统绩效评价的度量提供了新视角和新方法。
从理论上看，基于行为科学理论对不同医生使用行为进行影响因素模型的实证比较分析，有助于拓展信息系统绩效理论的研究空间。同时，基于医生调查问卷和医院实际经验数据对模型进行显著性和差异性检验，有效解决了传统度量方法的不足，为信息系统绩效度量提供了新视角。从实践角度看，本研究一方面有助于发现医院信息系统绩效管理的不足，帮助医院改进绩效管理方案和管理制度，提高医院核心竞争力；另一方面，丰富的信息系统绩效评价理论有利于加强企业战略管理，有利于实现IT投资价值最大化，为我国卫生信息化的成功实施夯实理论基础。
Hospital information system is the emerging hotspot in domesticmodernization of hospitals, which is also the main content of the nation’s healthinformatization. It is clearly pointed out in the12th Five-Year Plan of HealthInformatization Construction that electronic medical records system is the coreof the construction of hospital information, the base of construction of theregional medical platform, which is significant to the he nation’s healthinformatization construction. The digitization of hospital relys on modernmedical and information technology to improve the quality of medical services,management level and the efficiency of operations. In2011, the Ministry ofHealth has developed the basic specifications for electronic medical records, andcarried out the experimental work in110hospitals across the country. Meanwhile,the phenomenon IT Productivity Paradox appeared, which some hospitals’investment in IT did not enhance the performance, however, made them in therough mud. Western researchers posed the “Time delay hypothesis”,
Substitution Effect hypothesis to try to open the black box between the ITinvestment and performance. They brought the affluent theory to explain theevaluation of information system performance. However, the evaluation indexand function mechanism had lots of disputes, and how IT technology enhancesthe enterprises’ performance lacks the theoretical framework. So, it is analyzedthat the factors affecting the use of electronic medical records from thisperspective, designing to improve the effect of the use of electronic medicalrecords system and the level of performance management, ultimately improve thecore competitiveness of the hospital. The main content of the paper is asfollows：
Explain the mechanism of the information system using behavior to theperformance effect. From the theory of information technology acceptance,information system success theory as the core， summarizing the theory ofreasoned action abroad, planned behavior, and innovation diffusion, integratingthe technical task of matching theory, it analyzes the model of the impact of the electronic medical record system using behavior on performance, proposesrelated research hypothesis, and explores the main affecting factors from thetechnical features of the system, to seek an effective way to improve workingefficiency, which are the important support of the thesis.
Construct structural modular mode of hospital information system usingbehavior to the performance effect. It constructs structural equation model of theimpact of the system using behavior on performance by index designing forfactors of technology service, users and the using behavioral. It verifies thehypothesis model by data analysis of measurement reliability, convergent anddiscriminant validity. By comparing the impacts on the performance, it doesempirical analysis on the significant differences of the performance, and studiesthe influencing factors and path.
Construct regress mode of electronic medical records using satisfaction tothe performance effect. Through using the empirical research methods ofmultiple regression analysis and SPSS.15, it constructs three regression modelswith outpatients’ amount, consultation income and medical record quality asperformance indicator, to analyze how the satisfaction factors affect theperformance when doctors use electronic medical records. Gender, age, academicqualifications and departments of doctors as control variables, it explores thesignificant difference of the effect on doctors’ performance, and test therelationship between satisfaction and performance of electronic medical records.
Pose the new perspective and methods of researching information systemusing performance. Through the research of electronic medical recordsinfluencing factors, the paper analyzes the impact on performance with newperspective and method, improves the system of management information, andmaximizes effectiveness of information system in hospital. This study strives tomake a breakthrough, both in theory and in practice, to provide guidance andreference for the successful implementation of health information technology inChina.
Theoretically, the current research on the hospital information system homeand abroad fails to address the doctor's level. Based on behavioral theory, theempirical comparative analysis on influencing factors model of different age,gender and department doctors, helps to expand the scope of the research on performance theory of information systems. At the same time, based on thesignificance and difference test to the medical questionnaire and hospitalexperience data, an effective solution is found to improve the traditional metrics,thus providing a new method and a new perspective for the information systemperformance metrics. From a practical perspective, on the one hand, this studyhelps to identify the problems in the performance management of the hospitalinformation system, so that hospitals can improve performance managementprograms and management systems to improve hospital core competitiveness; onthe other hand, a wealth of information system performance evaluation theoriesis liable to strengthen the enterprise strategic management, and therefore,conducive to maximize the value of IT investments, and lay a solid theoreticalfoundation for the successful implementation of health information technology inChina.
解释信息系统使用行为对绩效影响的因素和路径。以信息技术接受理论为基础，在归纳理性行为理论、计划行为理论和创新扩散理论基础上，融合任务技术匹配理论，以信息系统成功理论为核心，解释电子病历系统使用行为对绩效影响的因素模型，并提出相关研究假设。同时，基于电子病历系统的技术任务特征来研究系统使用行为的主要影响因素，及其如何改进工作流程来提高医疗效率和质量，以此作为论文研究的理论基础。
构建医院信息系统使用行为对绩效影响的结构方程模型。融合任务技术匹配和信息系统成功理论，设计技术服务因素、用户个人因素及使用行为因素的指标。通过测量模型的信度、收敛有效性及判别有效性的数据分析，对结构模型的假设进行验证。通过对不同年龄、性别及科室医生使用行为对绩效影响的比较，对绩效影响的显著性和差异性进行实证分析，研究电子病历使用行为对绩效的影响因素与影响路径。
构建电子病历使用满意度对绩效影响的回归模型。基于期望理论构建以门诊病人人次、诊费收入及病案质量为绩效衡量指标的3个回归模型，运用医院经验数据，实证检验电子病历系统使用满意度对绩效的影响。采用回归分析方法，利用SPSS.15软件运算，探究不同年龄、性别、学历及科室医生的电子病历使用满意度对绩效影响是否存在显著性差异，进一步验证满意度与医生门诊病人人次、诊费收入及病案质量指标之间的相关关系。
提出了研究信息系统使用绩效的新视角和新方法。目前国内外学者对医院信息系统的研究均未能触及医生层面，对不同年龄、性别及科室医生的系统使用绩效分析能够丰富此项研究，为信息系统使用绩效的评价提供新视角。同时采用结构方程和回归方程模型，运用医院经验数据和医生调查问卷，实现了对系统使用绩效的显著性和差异性检验，有效解决了传统度量方法的不足，为信息系统绩效评价的度量提供了新视角和新方法。
从理论上看，基于行为科学理论对不同医生使用行为进行影响因素模型的实证比较分析，有助于拓展信息系统绩效理论的研究空间。同时，基于医生调查问卷和医院实际经验数据对模型进行显著性和差异性检验，有效解决了传统度量方法的不足，为信息系统绩效度量提供了新视角。从实践角度看，本研究一方面有助于发现医院信息系统绩效管理的不足，帮助医院改进绩效管理方案和管理制度，提高医院核心竞争力；另一方面，丰富的信息系统绩效评价理论有利于加强企业战略管理，有利于实现IT投资价值最大化，为我国卫生信息化的成功实施夯实理论基础。
Hospital information system is the emerging hotspot in domesticmodernization of hospitals, which is also the main content of the nation’s healthinformatization. It is clearly pointed out in the12th Five-Year Plan of HealthInformatization Construction that electronic medical records system is the coreof the construction of hospital information, the base of construction of theregional medical platform, which is significant to the he nation’s healthinformatization construction. The digitization of hospital relys on modernmedical and information technology to improve the quality of medical services,management level and the efficiency of operations. In2011, the Ministry ofHealth has developed the basic specifications for electronic medical records, andcarried out the experimental work in110hospitals across the country. Meanwhile,the phenomenon IT Productivity Paradox appeared, which some hospitals’investment in IT did not enhance the performance, however, made them in therough mud. Western researchers posed the “Time delay hypothesis”,
Substitution Effect hypothesis to try to open the black box between the ITinvestment and performance. They brought the affluent theory to explain theevaluation of information system performance. However, the evaluation indexand function mechanism had lots of disputes, and how IT technology enhancesthe enterprises’ performance lacks the theoretical framework. So, it is analyzedthat the factors affecting the use of electronic medical records from thisperspective, designing to improve the effect of the use of electronic medicalrecords system and the level of performance management, ultimately improve thecore competitiveness of the hospital. The main content of the paper is asfollows：
Explain the mechanism of the information system using behavior to theperformance effect. From the theory of information technology acceptance,information system success theory as the core， summarizing the theory ofreasoned action abroad, planned behavior, and innovation diffusion, integratingthe technical task of matching theory, it analyzes the model of the impact of the electronic medical record system using behavior on performance, proposesrelated research hypothesis, and explores the main affecting factors from thetechnical features of the system, to seek an effective way to improve workingefficiency, which are the important support of the thesis.
Construct structural modular mode of hospital information system usingbehavior to the performance effect. It constructs structural equation model of theimpact of the system using behavior on performance by index designing forfactors of technology service, users and the using behavioral. It verifies thehypothesis model by data analysis of measurement reliability, convergent anddiscriminant validity. By comparing the impacts on the performance, it doesempirical analysis on the significant differences of the performance, and studiesthe influencing factors and path.
Construct regress mode of electronic medical records using satisfaction tothe performance effect. Through using the empirical research methods ofmultiple regression analysis and SPSS.15, it constructs three regression modelswith outpatients’ amount, consultation income and medical record quality asperformance indicator, to analyze how the satisfaction factors affect theperformance when doctors use electronic medical records. Gender, age, academicqualifications and departments of doctors as control variables, it explores thesignificant difference of the effect on doctors’ performance, and test therelationship between satisfaction and performance of electronic medical records.
Pose the new perspective and methods of researching information systemusing performance. Through the research of electronic medical recordsinfluencing factors, the paper analyzes the impact on performance with newperspective and method, improves the system of management information, andmaximizes effectiveness of information system in hospital. This study strives tomake a breakthrough, both in theory and in practice, to provide guidance andreference for the successful implementation of health information technology inChina.
Theoretically, the current research on the hospital information system homeand abroad fails to address the doctor's level. Based on behavioral theory, theempirical comparative analysis on influencing factors model of different age,gender and department doctors, helps to expand the scope of the research on performance theory of information systems. At the same time, based on thesignificance and difference test to the medical questionnaire and hospitalexperience data, an effective solution is found to improve the traditional metrics,thus providing a new method and a new perspective for the information systemperformance metrics. From a practical perspective, on the one hand, this studyhelps to identify the problems in the performance management of the hospitalinformation system, so that hospitals can improve performance managementprograms and management systems to improve hospital core competitiveness; onthe other hand, a wealth of information system performance evaluation theoriesis liable to strengthen the enterprise strategic management, and therefore,conducive to maximize the value of IT investments, and lay a solid theoreticalfoundation for the successful implementation of health information technology inChina.
引文
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