CHAPTER 6 – CONCLUSION
6.2 L IMITATIONS AND I MPLICATIONS OF F UTURE R ESEARCH
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CHAPTER 6 – CONCLUSION
6.1 Conclusion
This study aimed to provide quality evaluation criteria that consider the value perspectives of multiple stakeholders involved in a service triangle relationship of an e-health service—namely, the hospital, case managers, physicians, and patients. After analyzing our results, we found that hospitals and physicians positively affect the value of patient perspective and that case managers do not. Case managers, in terms of e-Health services, have not been to establish a unique work position, so they have not been able to discover their job value. We suggest that case managers should be given the complete professional training for e-Health care and established certification in the future to boost morale and thus improve service quality. In addition, the most important thing is to ensure smooth and real-time communication between case managers and physicians.
In the past, few published articles have addressed the issue of multiple value perspective interactions in an e-Health service setting. In the study, we reviewed several value components of performance and redefined them for suiting the context of e-Health care service. Therefore, this study contributed to literature by providing an e-Health service performance assessment framework, which systematically developed a scale for evaluating e-Health service quality in terms of the value perspectives of multiple stakeholders and their interactions.
6.2 Limitations and Implications of Future Research
Although we proposed that performance assessment should include the values of multiple stakeholders, our study was limited in that we couldn’t collect patients’
actual data and that there were too few samples. In the future, with the development of e-Health care, there will be more organizations that will supply e-Health care services with more service content. Future research could include the studies of promotion specialists in e-Health service and expanding the case studies that out of hospital to include nursing home and communities.
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Appendix A – Complete Questionnaire for Physicians of “Tele Care Center” in e-Health Service
台大醫院遠距照護醫生意見調查表
醫師編號： 本問卷採不記名方式，請放心填答
項目 題 目 5 4 3 2 1
第一部分：遠距照護服務
BE1 對加入遠距照護的醫生，醫院有提供合理的獎勵制度
BE2 加入遠距照護服務使醫師增加了額外的工作風險責任
BE3 遠距照護服務會促進醫師與病人之間的良好關係
BE4 加入遠距照護服務讓我很有成就感
BE5 加入遠距照護服務對於自我的學習成長有幫助
BE6 加入遠距照護服務對我未來職涯規劃是有幫助的
第二部分：醫院整體價值
BV1 我認為醫院提供遠距照護可以增加收益
BV2 我認為醫院提供遠距照護可以提升病人的滿意度 BV3 我認為醫院提供遠距照護可以提升病人的治癒率 BV4 我認為醫院提供遠距照護可以有效改善醫療照護流程 BV5 2.5 我認為醫院提供遠距照護可以提升醫院的社會觀感
註：計分原則：「5 分」表示非常同意；「4 分」表示同意；「3 分」表示普通；
「2 分」表示不同意；「1 分」表示非常不同意。
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Appendix B – Complete Questionnaire for Case
Managers of “Tele Care Center” in e-Health Service
台大醫院遠距照護個管師意見調查表
個管師編號： 本問卷採不記名方式，請放心填答
項目 題 目 5 4 3 2 1
FE1 以工作量來看，我滿意目前的薪資水準
FE2 我滿意目前的獎懲及留任制度
FE3 這份工作需要擔負的風險和責任是在合理範圍之內
FE4 與護理人員相較，這份工作更易與病患建立良好關係
FE5 這份工作讓我很有成就感
FE6 個管師的工作經驗對自我的學習成長有幫助
FE7 這份工作對我未來職涯規劃是有幫助的
計分原則：「5 分」表示非常同意；「4 分」表示同意；「3 分」表示普通；「2 分」
表示不同意；「1 分」表示非常不同意。
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Appendix C – Complete Questionnaire for Patients of
“Tele Care Center” in e-Health Service
台大醫院遠距照護個案滿意度調查表
個案編號： 受訪時間： 醫生編號：
個案連繫不到 拒訪電話無人接聽其他
項目 題 目 5 4 3 2 1
第一部分：個案對於儀器設備之滿意度 CV1 使用「相關儀器、設備」之滿意程度
CV2 「相關儀器、設備」量測數據準確度之滿意程度 CV3 參與服務後，對於病情的控制或改善程度是否滿意 CV4 對於各項問題及時回應及處理的狀況是否滿意 CV5 對於遠距照護服務人員服務態度是否滿意 CV6 對於所提供之健康照護知識是否滿意 CV7 對於病患的關注程度是否滿意
第二部分：個案對於照護服務之參與態度
CV8 目前，由於經濟部補助計畫，此項服務有免費試用。但在未來沒有計畫補 助下，可能要改採收費的方式，您的態度是：
若要付費，即不會使用即使要付費，也會使用 CR1 3.1 未來我對使用此項服務之態度：
不會持續使用會持續使用本人會持續使用外，並會讓家人或友人一起 來使用
註：第一部分計分原則：「5 分」表示非常滿意；「4 分」表示滿意；
「3 分」表示普通；「2 分」表示不滿意；「1 分」表示非常不滿意。
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Appendix D – Question List of the Group Interview (Chinese)
Physicians:
1. 現在參與遠距醫療系統計畫的醫師人數？通常是哪些層級和科別？
2. 遠距醫療照護系統對於門診的回診情況有實際影響(回診率降低或提高診斷
準確程度)嗎?而遠距醫療系統的報告會做為門診診斷的參考嗎?有和台大醫 院其他系統做整合(資料同步)嗎？
3. 對於病人的遠距醫療系統報告會醫師會主動固定追蹤參考嗎？還是經由個
管師主動告知病人的特殊狀況？每位個管師會固定和同一個醫生報告嗎？
如何分配？
4. 遠距醫療系統會增加醫師的工作負擔嗎？例如:需要多花時間看病人的報
告。
5. 初步的問題狀況是交由個案師來判斷嗎(例如上傳資料不正常)？到了什麼
樣的層級才需要報告給醫師知情？
6. 醫生對系統介面功能會有操作不易的情況嗎？
7. 醫生在遠距醫療系統扮演了病情諮詢和推廣系統的角色，會不會加重原本就
吃緊的業務，如果會的話，您會希望系統或流程方面應該做什麼樣的改進？
8. 病患需要量測什麼儀器和取得什麼資料嗎？
Case Managers:
1. 您的病患是否有特別需要哪些遠距醫療儀器或功能？而哪些儀器特別要求
數據必須有高準確性？
2. 您的病患透過遠距醫療服務與您聯繫中有哪些地方特別注意的？
3. 遠距醫療服務的系統介面或報表以哪種方式呈現對病患比較易於理解？
4. 目前的遠距醫療服務的系統介面功能是否有助於病患資料管理？而您還希
望需要有哪些功能？
5. 目前的遠距醫療服務對於工作流程是否有幫助？而您希望如何改進？
6. 目前的遠距醫療服務的報告(報表)或系統介面呈現方式是否容易瞭解和操
作？而您希望如何改進？
7. 在有限的人力之下進行遠距醫療服務是否會產生人力配置上的困難？要怎
麼去應付？
8. 在服務產品推廣上，面對顧客的推廣，要如何的說服病人及家屬相信及願意
購買這項服務？
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Appendix E – Interview Contents and Framework Application for Patients’ Value (Chinese)
Tangibles
Cardiovascular Disease Care Service:
個管師：老人家(病人)都會懷疑說我手按了以後，哪裡還有手可以開機，還會打電話回來求救，
讓我覺得儀器商的教導方式讓人匪夷所思。
個管師：病人打電話進來有一半都是因為機器的問題。
個管師：為有一些病人他本身是心臟疾病，但是他對於一些高科技產品的使用上面還有一些不熟 悉地方，所以在過程當中因為不熟悉，因為都是新的，所謂為遠距創新就是遠距病人 沒聽過，遠距給的服務內容病人不是很熟悉，設備也不會很熟，所以要去參與一個新 東西的過程當中會覺得麻煩，這我不會，還要去學這個東西，就是會覺得麻煩。
第 28 次會議紀錄內容
【Q&A】：不及時；心電圖無法正確傳輸 Q: 個案血糖數據無法上傳，回報是操作人員問題 A: 儀器商派人教學機器之使用方法
Q: 個案要退約，反應是因為機器重複發生問題 A: 因病人要回南京
Q: 耳溫和血壓問題，血壓低，使用者量不到血壓 A: 可能找其他廠商的血壓計
Q: 個案血壓低，使用者量不到血壓 A: 醫師請個管師整理此病患資料
第 44 次會議紀錄內容 耳溫槍的問題：
測量次數≠show 值次數；show 值≠實際量測值
Definiation Post-discharge Care Service
Cardiovascular Disease Care Service
Chronic Disease Care Service
Hospice Care Service
The function complexity
of medical devices Low High Medium Medium
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Cardiovascular Disease Care Service:
個管師：有些個案是單獨的老人家，會擔心機器有沒有傳好，三班打電話進來問有沒有傳到給我
Cardiovascular Disease Care Service:
個管師：其實病人會覺得比較安心，在藥物、飲食、生活作息上可以得到控制。
個管師：病人也會信任我們，但是在病房病人比較對我們不容易信任。
個管師：我的部分覺得對病人最大的差別就是情緒上的支持，他們有一些情況的話，因為醫療情
個管師：我的部分覺得對病人最大的差別就是情緒上的支持，他們有一些情況的話，因為醫療情