Leung Gabriel M, Yu Philip L H, Wong Irene O L, Johnston Janice M, Tin Keith Y K
Department of Community Medicine, Medical and Health Research Network, University of Hong Kong, Faculty of Medicine Building, 21 Sassoon Road, Pokfulam, Kong Kong ROC.
J Am Med Inform Assoc. 2003 Mar-Apr;10(2):201-12. doi: 10.1197/jamia.m1202.
Given the slow adoption of medical informatics in Hong Kong and Asia, we sought to understand the contributory barriers and potential incentives associated with information technology implementation.
A representative sample of 949 doctors (response rate = 77.0%) was asked through a postal survey to rank a list of nine barriers associated with clinical computerization according to self-perceived importance. They ranked seven incentives or catalysts that may influence computerization. We generated mean rank scores and used multidimensional preference analysis to explore key explanatory dimensions of these variables. A hierarchical cluster analysis was performed to identify homogenous subgroups of respondents. We further determined the relationships between the sets of barriers and incentives/catalysts collectively using canonical correlation.
Time costs, lack of technical support and large capital investments were the biggest barriers to computerization, whereas improved office efficiency and better-quality care were ranked highest as potential incentives to computerize. Cost vs. noncost, physician-related vs. patient-related, and monetary vs. nonmonetary factors were the key dimensions explaining the barrier variables. Similarly, within-practice vs external and "push" vs "pull" factors accounted for the incentive variables. Four clusters were identified for barriers and three for incentives/catalysts. Canonical correlation revealed that respondents who were concerned with the costs of computerization also perceived financial incentives and government regulation to be important incentives/catalysts toward computerization. Those who found the potential interference with communication important also believed that the promise of improved care from computerization to be a significant incentive.
This study provided evidence regarding common barriers associated with clinical computerization. Our findings also identified possible incentive strategies that may be employed to accelerate uptake of computer systems.
鉴于香港和亚洲地区医学信息学的应用进展缓慢，我们试图了解与信息技术实施相关的促成障碍和潜在激励因素。
通过邮政调查，对949名医生的代表性样本（回复率 = 77.0%）进行询问，要求他们根据自我认知的重要性对与临床计算机化相关的九个障碍列表进行排序。他们还对可能影响计算机化的七个激励因素或催化剂进行了排序。我们生成了平均排名分数，并使用多维偏好分析来探索这些变量的关键解释维度。进行了层次聚类分析，以确定受访者的同质亚组。我们进一步使用典型相关分析来确定障碍集与激励因素/催化剂集之间的总体关系。
时间成本、缺乏技术支持和大量资本投资是计算机化的最大障碍，而提高办公效率和提供更高质量的护理被列为计算机化的最高潜在激励因素。成本与非成本、医生相关与患者相关以及货币与非货币因素是解释障碍变量的关键维度。同样，实践内部与外部因素以及“推动”与“拉动”因素解释了激励变量。确定了四个障碍集群和三个激励因素/催化剂集群。典型相关分析表明，关注计算机化成本的受访者也认为财务激励和政府监管是计算机化的重要激励因素/催化剂。那些认为对沟通有潜在干扰很重要的人也认为计算机化有望改善护理是一个重要的激励因素。
本研究提供了与临床计算机化相关的常见障碍的证据。我们的研究结果还确定了可能用于加速计算机系统采用的激励策略。
