探討民眾對於醫院推行電子同意書之接受度

國內電子病歷發展與憑證電子簽章技術，在衛生福利部積極的推動下已成效卓越且純熟，但是需要病人/家屬簽名的同意書文件，因苦於民眾無適用的憑證工具可進行電子簽章(如:醫事人員卡)，且礙於無明確的同意書數位簽署相關法規可遵循，故不敢貿然推動電子同意書。直到民國104年衛生福利部委託科技研究計畫，進行醫療院所同意書簽署數位化之可行性研究，數家醫學中心率先試辦，才開始出現推廣的契機。電子同意書取代紙本同意書是不可避免過程，且無疑是完成醫院病歷無紙化的最後一哩路及最後一塊拼圖。本研究在電子同意書推動初期，以Rogers創新擴散理論為基礎，結合知覺風險與知覺安全建立研究架構，嘗試從民眾的觀點探討民眾對於醫院推行電子同意書之接受度，期望研究結果可作為政府部門及醫療院所擴大推動電子同意書策略及系統設計之參考依循。本研究以20-70歲之民眾為研究對象，考量電子同意書對多數人而言是陌生且未有使用經驗，故先以彰化某醫院使用電子同意書說明簡介為例提供民眾取得初步認知後，再進行電子問卷填答。回收有效問卷634份，資料統計採用SPSS 22 及Smart PLS 3.0進行描述性統計、差異分析、信效度分析、路徑分析假設驗證。研究結果顯示「複雜性」、「相對優勢」、「相容性」、「知覺安全」、「可觀察性」、「可試驗性」、「績效風險」、「隱私風險」均正向影響接受態度，且態度是影響民眾使用電子同意書最重要的關鍵因素。簡言之，政府部門及醫療機構若能提升民眾對於電子同意書的使用觀感與評價，便可有效提升民眾之接受度，有助於電子同意書更快速發展。關鍵詞：電子同意書、創新擴散、知覺風險、知覺安全

The development of electronic medical record and the technology of electronic signature certificate in Taiwan yielded result under the advocacy of the Ministry of Health and Welfare in full effort. However, the issue of signing the statement of consent by the patient/next of kin is yet to be resolved, as there is not appropriate certification tool available to the public for electronic signature (e.g.: medical personnel ID). Furthermore, there is no law explicitly governs the signature of the digital statement of consent. As such, no one dares to launch the use of electronic statement of consent further. It was not until 2015 that an opportunity for the advocacy of electronic statement of consent emerged. Under the research program commissioned by the Ministry of Health and Welfare in 2015, a feasibility study on the digitization of signing the statement of consent has been conducted in several medical centers of Taiwan. Indeed, the replacement of the hard copy of the statement of consent by its softcopy counterpart is inevitable, and is also the last mile of work and final piece of puzzle for creating paperless medical records in hospitals.This study is based on the Technology Acceptance Model (TAM) proposed by Davis and the Theory of Diffusion of Innovations proposed by Rogers to build up the research framework by combining perceived risk and perceived safety at the beginning of the advocacy of electronic statement of consent. This is an attempt to probe the receptiveness of the public to the use of electronic statement of consent from the perspective of the public with a view to providing reference for the governments and medical institutions and hospitals from the research findings for intensifying the advocacy of electronic statement of consent. The targeted group of this study is a population with age ranging from 20-70. Considering the use of electronic statement of consent is stranger to most people and that these people do not have the experience of using this instrument, we adopted the brief introduction of the use of electronic statement of consent at a particular hospital in Changhua to provide preliminary knowledge to the public, followed by the response of the public to an electronic questionnaire. There were 634 valid respondents. SPSS 22 and Smart PLS 3.0 were used in the statistical analysis of the data collected through descriptive statistics, analysis of variance, confidence analysis, and path analysis to test the hypothesis. The research findings indicated that “Perceived Ease Use”, “Relative Advantage”, “Compatibility”, “Perceived Safety”, “Demonstrability”, “Testability” affected the attitude towards use in positive direction, and affected “Performance Risk” and “Privacy Risk” in negative direction. Attitude towards use is a critical factor affecting the public to use electronic statement of consent. In other words, if the governments and medical institutions can improve the impression and evaluation of the public towards the use of electronic statement of consent, they could effectively affect the intent of use of the public, which in turn will help to speed up the development of the use of electronic statement of consent. Keywords: Electronic Statement of Consent, Diffusion of Innovations, Perceived Risk, Perceived Safety.