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系統識別號 U0026-0909201316220600
論文名稱(中文) 社會資本、交易成本及價值共創對跨院際電子病歷交換之研究
論文名稱(英文) Social Capital, Transaction Cost and Cocreating IT Value on Interorganizational EMR Exchange
校院名稱 成功大學
系所名稱(中) 企業管理學系碩博士班
系所名稱(英) Department of Business Administration
學年度 101
學期 2
出版年 102
研究生(中文) 蔡依如
研究生(英文) Yi-Ju Tsai
學號 R46004152
學位類別 碩士
語文別 英文
論文頁數 136頁
口試委員 指導教授-張心馨
召集委員-陳素雯
口試委員-黃瀞瑩
口試委員-洪崇傑
中文關鍵字 社會資本理論  交易成本理論  價值共創  跨院際電子病歷 
英文關鍵字 interorganizational EMR exchange system  social capital theory  transaction cost theory  value cocreation 
學科別分類
中文摘要 醫療產業因資訊科技迅速發展,已開始倡導跨院際電子病歷(Electronic Medical Records, EMR)交換,然而因多數醫療院所皆已建置院內EMR系統,若轉換成跨院際EMR交換系統,必需付出額外時間及成本。本研究針對不同醫療機構採用跨院際EMR交換系統的考量因素,以社會資本理論(Social Capital Theory)與交易成本理論(Transaction Cost Theory)探討跨院際EMR交換系統之可行性,並藉由科技價值共創(Cocreating IT Value)的概念引導出跨院際EMR交換系統,作為提供醫療科技價值,以及對參與交換的醫療院所之績效影響。本研究採紙本問卷方式共取得265份有效問卷,資料以結構方程模型(SEM)檢測。分析結果顯示,透過社會互動連結(Social Interaction Ties)及共同願景(Shared Vision)會影響醫療院所對投資跨院際電子病歷系統的意願,資產專屬性(Asset Specificity)與不確定性(Uncertainty)會造成醫療院所轉換系統的成本上升。當院所間產生較高投資意願(investments in relation-specific assets)及交易成本後,其所能共創的醫療科技價值也隨之提升,並對醫療機構之組織面、群體面及病患個人面產生良好的績效。本研究建議各級醫療院所應鼓勵其醫療人員參與研討會或學會聯誼,以增進彼此之社會連結關係。此外,導入跨院際EMR系統時,應明確訂定時程及預期成效,使相關醫療人員能瞭解組織排程,進而減低行為不確定的發生。
關鍵字: 社會資本理論、交易成本理論、價值共創、跨院際電子病歷
英文摘要 Due to the rapid development of information technology, the medical industry is now engaged in the cross-hospital exchange of electronic medical records (EMR). Nevertheless, most medical institutes have already developed specific EMR systems, suggesting that extra time and effort are needed to switch to a cross-hospital EMR exchange system. This study used social capital theory (SCT) and transaction cost theory (TCT) to explore the feasibility of an interorganizational cross-hospital EMR exchange system, and the factors that affect its adoption. The concept of value cocreation is also used to assess such a system, and its influence on the performance of participating medical institutes. This research collected 265 valid paper-based questionnaires from the medical staff of various institutes, and then analyzed them using structural equation modeling (SEM). The results showed that social interaction ties and shared vision positively affected medical institutes’ willingness to adopt the EMR exchange system, while asset specificity and uncertainty increased the related transaction costs. With a greater willingness to invest in relation-specific assets and meet the related transaction costs, this lead to an increase in medical IT value , as well as better results for the related medical institutes, medical staff, and patients. Therefore, this study suggests that such institutes encourage their medical staff to participate in seminars or reunions in order to develop their professional and social networks, and set up clear schedules and lusts of expected effects when introducing the cross-hospital EMR exchange system.

Keywords: interorganizational EMR exchange system, social capital theory, transaction cost theory, value cocreation
論文目次 Contents
摘要---------------------------------------------------iii
Abstract-----------------------------------------------iv
誌謝-----------------------------------------------------v
Contents-----------------------------------------------vi
List of Tables-----------------------------------------ix
List of Figures-----------------------------------------x
CHAPTER 1 INTRODUCTION----------------------------------1
1.1 Research Background---------------------------------1
1.2 Research Objectives---------------------------------4
1.3 Research Procedures---------------------------------5
CHAPTER 2 LITERATURE REVIEW AND RESEARCH HYPOTHESES-----6
2.1 Electronic Medical Records (EMRs)-------------------6
2.2 Social Capital Theory (SCT)------------------------11
2.3 Transaction Cost Theory (TCT)----------------------17
2.4 Investments in Relation-specific Assets------------22
2.5 Cocreating IT Value--------------------------------25
2.6 Joint Performance----------------------------------29
2.7 Conceptual Framework-------------------------------30
2.8 Hypotheses Development-----------------------------32
CHAPTER 3 RESEARCH DESIGN AND METHODOLOGY--------------47
3.1. Definition of Constructs--------------------------47
3.2. Measurement Development---------------------------50
3.3. Research hypotheses to be tested------------------52
3.4. Pilot Test----------------------------------------53
3.5. Data analysis procedure---------------------------57
3.5.1. Demographics and descriptive statistic analysis-57
3.5.2. Factor analysis---------------------------------57
3.5.3. Reliability and validity analysis---------------58
3.5.4. Structural equation model-----------------------58
CHAPTER 4 RESEARCH ANALYSES & RESULTS------------------60
4.1. Data collection and demographics analysis---------60
4.2. Descriptive Analysis------------------------------63
4.3. Measurement Model Analysis------------------------66
4.3.1. Confirmatory Factor Analysis (CFA)--------------66
4.3.2. Reliability Analysis and Convergent Validity----70
4.3.3. Discriminant Validity Analysis------------------72
4.4. Hypotheses Testing--------------------------------73
4.5. Additional Analysis-------------------------------79
4.5.1. EMR Stage---------------------------------------79
4.5.2. Rank--------------------------------------------81
4.5.3. Type--------------------------------------------83
4.5.4. Years of EMR Implementation---------------------84
4.5.5. Professional Title------------------------------86
4.5.6. Seniority---------------------------------------88
CHAPTER 5 CONCLUSIONS AND RECOMMENDATIONS--------------92
5.1. Hypotheses Discussion-----------------------------92
5.2. Demographic and Research Variables---------------102
5.3. Theoretical Implications-------------------------103
5.4. Managerial Implication---------------------------106
5.5. Limitations and Directions for Future Research---107
References--------------------------------------------110
Appendix A: Measurements for all Constructs-----------118
Appendix B: Path Diagram of Measurement Model (First order) ------------------------------------------------------123
Appendix C: Path Diagram of Measurement Model (Second Order) ------------------------------------------------------124
Appendix D: Formal Questionnaire----------------------127
Appendix E: Pre-questionnaire-------------------------132

List of Tables
Table 3-1 Summary of Overall Constructs----------------48
Table 3-2 Research Hypotheses to be tested-------------52
Table 3-3 Result of Pilot Test (N=37)------------------54
Table 4-1 Basic Information of Medical Institutes (N=265) -------------------------------------------------------61
Table 4-2 Respondent Characteristics (N=265)-----------62
Table 4-3 Descriptive Analysis of Scale Items on Each Variable-----------------------------------------------63
Table 4-4 Confirmatory Factor Analysis (N=265)---------67
Table 4-5 Results of Measurement Model Fit for Confirmatory Factor Analysis----------------------------------------70
Table 4-6 Results of Convergent Validity and Reliability Analysis-----------------------------------------------71
Table 4-7 Results of Discriminant Validity Analysis----73
Table 4-8 Results of SEM Model Fit---------------------76
Table 4-9 Results of SEM Paths Analysis----------------78
Table 4-10 Summary of Hypotheses Testing---------------78
Table 4-11 ANOVA Result of EMR stage-------------------80
Table 4-12 ANOVA Result of Rank------------------------81
Table 4-13 ANOVA Result of Type------------------------83
Table 4-14 ANOVA Result of EMR Implementing Year-------85
Table 4-15 ANOVA Result of Professional Title----------86
Table 4-16 ANOVA Result of Seniority-------------------88


List of Figures
Figure 1-1 Research Procedures--------------------------5
Figure 2-2 Conceptual Research Framework---------------31
Figure 4-1 Result of the SEM---------------------------75

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