Background: Usually patients receive healthcare services from multiple hospitals, and consequently their healthcare data are dispersed over many facilities’ paper and electronic-based record systems. Therefore, many countries have encouraged the research on data interoperability, access, and patient authorization. This study is an important part of a national project to build an information exchange environment for cross-hospital digital medical records carried out by the Department of Health (DOH) of Taiwan in May 2008. The key objective of the core project is to set up a portable data exchange environment in order to enable people to maintain and own their essential health information. This study is aimed at exploring the factors influencing behavior and adoption of USB-based Personal Health Records (PHR) in Taiwan. Methods: Quota sampling was used, and structured questionnaires were distributed to the outpatient department at ten medical centers which participated in the DOH project to establish the information exchange environment across hospitals. A total of 3000 questionnaires were distributed and 1549 responses were collected, out of those 1465 were valid, accumulating the response rate to 48.83%. Results: 1025 out of 1465 respondents had expressed their willingness to apply for the USB-PHR. Detailed analysis of the data reflected that there was a remarkable difference in the “usage intention” between the PHR adopters and non-adopters (χ2 =182.4, p < 0.001). From the result of multivariate logistic regression analyses, we found the key factors affecting patients’ adoption pattern were Usage Intention (OR, 9.43, 95%C.I., 5.87-15.16), Perceived Usefulness (OR, 1.60; 95%C.I., 1.11-2.29) and Subjective Norm (OR, 1.47; 95%C.I., 1.21-1.78). Conclusions: Higher Usage Intentions, Perceived Usefulness and Subjective Norm of patients were found to be the key factors influencing PHR adoption. Thus, we suggest that government and hospitals should promote the potential usefulness of PHR, and physicians should encourage patients' to adopt the PHR.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: The rapid aging of the Taiwanese population has led to high medical needs for the elderly and increasing medical costs in recent years. The integration of patient information through electronic health records (EHRs) to reduce unnecessary medications and tests and enhance the quality of care has currently become an important issue. Objective: Although electronic data interchanges among hospitals and clinics have been implemented for many years in Taiwan, the interoperability of EHRs has still not been assessed. Hence, in this study, we analyzed the efficiency of data exchanges and provide suggestions for future improvements. Methods: We obtained 30 months of uploaded and downloaded data of EHRs among hospitals and clinics from the EMR Exchange Center (EEC) of the Ministry of Health and Welfare (MOHW) from January 2015 to June 2017. The objects of this study consisted of 21 medical centers, 84 district hospitals, 290 area hospitals and 5520 clinics. The four exchange EHR forms examined were blood tests, medical images, discharge summaries, and outpatient medical records. We used MYSQL software to save our data and used phpMyAdmin which is a PHP program to manage the database and then analyzed the data using SPSS 19.0 statistical software. Results: The quarterly mean uploaded volume of EHRs among hospitals was 52,790,721 (standard deviation (SD): 580,643) records. The quarterly mean downloaded volume of EHRs among hospitals and clinics was 650,323 (SD: 215,099) records. The ratio of uploaded to downloaded EHRs was about 81:1. The total volume of EHRs was mainly downloaded by medical centers and clinics which accounted for 53.8% (mean: 318,717.80) and 45.4% (mean: 269,082.10), respectively, and the statistical test was significant among different hospital accreditation levels (F=7.63, p<0.001). A comparison of EHR download volumes among the six National Health Insurance (NHI) branches showed that the central NHI branch downloaded 11,366,431 records (21.53%) which was the highest, and the eastern branch downloaded 1,615,391 records (3.06%) which was the lowest, and the statistical test among the six NHI branches was significant (F=8.82, p<0.001). The download volumes of laboratory tests and outpatient medical records were 26,980,425 (50.3%) and 21,747,588 records (40.9%), respectively, and were much higher than medical images and discharge summaries, and the statistical test was also significant (F=17.72, p<0.001). Finally, the download times showed that the average for x-rays was 32.05 seconds which was the longest, and 9.92 seconds for electrocardiograms which was the shortest, but there was no statistically significant difference among download times for various medical images. Conclusions: After years of operation, the EEC has achieved the initial goal of EHR interoperability, and data exchanges are running quite stably in Taiwan. However, the meaningful use of EHRs among hospitals and clinics still needs further encouragement and promotion. We suggest that the government’s leading role and collective collaboration with healthcare organizations are important keys to providing effective health information exchanges. Clinical Trial: MOHW105-IM-I-114-000017 (Department of Health and Welfare)

The Taiwan government has been promoting Electronic Health Records (EHRs) to primary care physicians. How to extend EHRs adoption rate by measuring physicians’ perspective of importance and performance of EHRs has become one of the critical issues for healthcare organizations. We conducted a comprehensive survey in 2010 in which a total of 1034 questionnaires which were distributed to primary care physicians. The project was sponsored by the Department of Health to accelerate the adoption of EHRs. 556 valid responses were analyzed resulting in a valid response rate of 53.77%. The data were analyzed based on a data-centered analytical framework (5-point Likert scale). The mean of importance and satisfaction of four dimensions were 4.16, 3.44 (installation and maintenance), 4.12, 3.51 (product effectiveness), 4.10, 3.31 (system function) and 4.34, 3.70 (customer service) respectively. This study provided a direction to government by focusing on attributes which physicians found important but were dissatisfied with, to close the gap between actual and expected performance of the EHRs. The authorities should emphasize the potential advantages in meaningful use and provide training programs, conferences, technical assistance and incentives to enhance the national level implementation of EHRs for primary physicians.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet