医疗信息系统使用行为管理 : 事前、事中还是事后控制?

Managing healthcare information system use : Input, process or output control?

Research output: Journal Publications and Reviews (RGC: 21, 22, 62)21_Publication in refereed journalpeer-review

View graph of relations

Author(s)

Related Research Unit(s)

Detail(s)

Original languageChinese (Simplified)
Pages (from-to)89-98
Journal / Publication管理工程学报
Volume35
Issue number3
Online published4 Mar 2021
Publication statusPublished - May 2021

Abstract

由于医院工作流程的复杂性及突发性,医生在完成病区的工作时可能会不完全按照系统默认的方式直接操作医疗信息系统(Health IS),而是采用间接使用的方式完成系统相关工作。间接使用行为指系统既定的用户(例如医生)不亲自使用系统,而是通过中间用户(例如实习生或者其他医生)代为操作系统来完成系统相关工作。尽管间接使用行为在医院场景中普遍存在,现有研究对于这种行为如何影响医生工作绩效的解释还十分有限。为了解决这个问题,本研究首先提出了直接和间接使用行为对于临床治疗服务质量和医患沟通服务质量的不同影响作用;接着,基于代理理论和组织控制相关文献,探索了三种控制机制(即事前控制,事中控制和事后控制)对于医生直接和间接使用行为影响的调节作用。本研究通过对某三级甲等医院242位医生的实地调研验证了所提出的研究假设。结果显示,医生直接系统使用行为能够提升医疗服务质量,而间接系统使用行为对于医疗服务质量有双向的影响,所提出的三种控制机制对于系统使用行为影响的调节作用各不相同。其中,事后控制不仅提高了直接和间接使用行为对临床治疗服务质量的正向影响,还抑制了间接使用行为对医患者沟通服务质量的负向影响。因此,本文提出事后控制是医生实施间接使用时最合适的控制机制。
With the promise of improving quality of care, hospitals worldwide have made substantial investments to embrace Health IS. Despite the wide adoption of Health IS, prior literature has reported a significant discrepancy between how the system is expected to be used and how it is actually used by the designated users. In hospitals, not all designated system users (i. e., principal physicians) employ the system by themselves. Many of them are found to delegate system-related tasks to other people (i. e., agent physicians)when employing the Health IS to accomplish hospital tasks. We term this behavior indirect system use. Despite the prevalence of indirect system use, extant literature typically focuses on direct system use (i. e., system users personally employ a system to accomplish work). The understanding of indirect system use impacts is limited. Without direct interaction, indirect system use can free users from their heavy workload, and that may improve both the efficiency and the quality of care. However, the literature on agency theory alerts that the agent physicians who actually perform system-related tasks may depart from the expectation of principal physicians because of the information asymmetry and goal conflict between these two parties. With the seemingly contradictory results, theoretically understanding and comparing the impacts of direct and indirect system use are crucial. This study hence aims to address the research questions: What are the performance impacts of the physicians′ direct use and indirect use? What mechanisms can be employed by hospital managers to induce the desirable performance outcomes for the two types of system use?

Based on control theory, IS-use literature, and healthcare practice, this study proposes a theoretical research model to address the identified research questions. With the trend of delivering patient-centered services, hospitals have greatly emphasized the clinical care quality that physicians provide to patients and the relationship between physicians and their patients. Thus, we examine two forms of quality of care in this research: clinical care quality (i. e., technical quality that physicians provide to deal with a specific aspect of care) and patient-physician interaction care quality (i. e., physicians′ interpersonal interaction and communication quality with their patients and their relational continuity). We first theoretically propose different effects of direct and indirect use on clinical care quality and physician-patient communication care quality. We then draw on the agency theory and organization control literature to identify the moderating effects of three control mechanisms: input control, process control, and outcome control.

A field study is conduct in a three-A hospital in China to test the proposed research model and hypotheses. The focal system is an electronic medical record system (EMRS) employed in the inpatient department of the hospital. The EMRS includes the basic functions of clinical documentation and viewing, order tracking and management, and result management, thus, indicating its generalizability in other healthcare organizations. We first conduct an on-site observation and interviews in the hospital, and they not only provided us a comprehensive understanding of the research context, but also confirmed the prevalence of indirect use. A survey is then conducted for the hypotheses testing. A total of 300 survey questionnaires are sent out, and 242 valid data are used for data analysis.

Partial least squares (PLS) method is used to conduct the measurement model analysis since some key variables of the research model are formative. The test results show that the data possess high reliability and high validity. Then the latent variable scores obtained by the PLS is used as the input to perform the multiple regression analysis of the structural model in Stata. As the results shown, physicians with high-level of direct use obtain better clinical care quality and physician-patient communication care quality; physicians who engage in high-level of indirect use tend to achieve improved clinical care quality, but reduced physician-patient communication care quality. Given the existence of information asymmetry and goal conflict between principal physicians and agents, the three different control mechanisms moderate the effects of system use in different manners. Specifically, outcome control would contribute the positive effect of indirect use on clinical care quality, but input control would undermine the effect. Furthermore, input control and outcome control would compensate the negative effect of indirect use on physician-patient communication care quality, but process control would increase the negative effect. Hence, it is believed that the outcome control works better than input and process control in inducing better system use performance. All these results not only expand the academic research but help hospitals and other healthcare organizations to leverage and manage indirect use behaviors by doctors

Research Area(s)

  • 医疗信息系统, 直接使用行为, 间接使用行为, 医生工作绩效, 控制机制, Healthcare IS, Direct use behavior, Indirect use behavior, Physician performance, Control mechanisms

Citation Format(s)

医疗信息系统使用行为管理 : 事前、事中还是事后控制? / 徐瑀婧; 童昱; 廖少毅 et al.

In: 管理工程学报, Vol. 35, No. 3, 05.2021, p. 89-98.

Research output: Journal Publications and Reviews (RGC: 21, 22, 62)21_Publication in refereed journalpeer-review