e-Health Service based on

Multi-Stakeholder
Perspectives
基於多方視角的電子健康服務

Instructor: Prof. 尤松文

Student: 阮日桑
Student ID: BAH110013
 TABLE OF

01 04
CONTENTS

INTRODUCTION RESEARCH
FRAMEWORK

02
THEORETICAL
05
MODEL ANALYSIS AND
BACKGROUND RESULTS

03
RESEARCH
06
DISCUSSIO
FRAMEWORK N
2
 1.
INTRODUCTION

The value of global e-Health market is on track to reach $315 billion

by 2025. Empirical studies show that e-Health services considerably
reduce the frequency of clinic visits, as well as costs. However, the
current level of use of e-Health services is still lower than expected.
Why???
到 2025 年，全球電子醫療市場的價值有望達到 3150 億美
元。實證研究表明，電子醫療服務大大降低了就診頻率和成
本。 然而，目前電子醫療服務的使用水平仍低於預期。
3
 1.
INTRODUCTION

Some previous studies gave the following reasons:

 Patients feel dissatisfied with e-Health information system.
 E-Health information systems do not deliver the desired
performance or quality.

之前的一些研究給出了以下原因：
 患者對電子健康信息系統不滿意。
 電子衛生信息系統無法提供所需的性能或質量。

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 1.
INTRODUCTION

Recent IS studies increasingly highlight the importance of considering

multiple stakeholders and evaluating e-Health issues from a service-
oriented viewpoint. Still, previous studies of patients’ use of e-Health
services largely fail to consider the distinct stakeholders on both sides
of the services - customers and providers.

最近的信息系統研究越來越強調考慮多個利益相關者和從面向服
務的角度評估電子衛生問題的重要性。 儘管如此，以前對患者
使用電子醫療服務的研究在很大程度上沒有考慮服務雙方的不同
利益相關者 - 客戶和提供者。 5
 1.
INTRODUCTION

So, this study has the following major objectives:

• First, apply the theory of stakeholders to identify key e-Health service
stakeholders.
• Second, review prior literature and the associated theoretical notions to
develop our hypotheses.
• Next, analyze the survey and interview data.
• Finally, discuss the results.

首先，應用利益相關者理論來識別關鍵的電子衛生服務利益相關者。其次，
回顧先前的文獻和相關的理論概念以發展我們的假設。接下來，分析調查和
訪談數據。最後，討論結果。
6
 2. THEORETICAL
BACKGROUND

2.1 e-Health Service

2.2 The Theory of Stakeholders and

e-Health Service

2.3 The VP Concept in e-Health

Service

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 2.1 E-HEALTH
SERVICE

In essence, e-Health services are based on ICT (information and

communication technologies) designed to support medical or care-
giving activities. For example, e-Health services may involve
telemedicine through which medical professionals electronically
or remotely address patient’s various needs.

本質上，電子衛生服務基於旨在支持醫療或護理活動的
ICT （信息和通信技術）。 例如，電子醫療服務可能涉及遠程
醫療，醫療專業人員通過該遠程醫療以電子方式或遠程方式滿
足患者的各種需求。
8
9
 2.1 E-HEALTH
SERVICE

Prior literature collectively highlights the potentially critical nature of

an integrated examination of e-Health patients, e-Health physicians,
and e-Health care managers (ex: staff and nurses) in understanding e-
Health service issues, because each of these stakeholders could play
major roles in determining e-Health service outcomes.

先前的文獻共同強調了對電子醫療患者、電子醫療醫生和電子醫
療保健管理人員（工作人員和護士）進行綜合檢查在理解電子醫
療服務問題方面的潛在關鍵性質，因為這些利益相關者中的每一
個都可以 在確定電子衛生服務結果方面發揮重要作用。
10
2.2 THE THEORY OF
STAKEHOLDERS AND E-HEALTH
SERVICE
The theory of stakeholders aims to identify key groups of stakeholders and clarify
their interest relationships. In other words, rather than considering all stakeholders,
the focus should be on those who are relatively more noticeable or influential.
When applied in an e-Health service context, the theory of stakeholders indicates
that e-Health patients, e-Health physicians, and e-Health care managers are the key
e-Health service stakeholder groups.

利益相關者理論旨在識別利益相關者的關鍵群體並闡明他們的利益關係。 換
句話說，與其考慮所有利益相關者，不如關注那些相對更引人注目或更有影
響力的人。當應用於電子醫療服務環境時，利益相關者理論表明電子醫療患
者、電子醫療醫生和電子醫療保健管理者是關鍵的電子醫療服務利益相關者
群體。
11
2.3 THE VP CONCEPT IN E-HEALTH
SERVICE
VP (value proposition) determines the success of service, largely because service value
creation essentially hinges on the fulfilment of VP. In other words, different participants
in the same service may have different VPs, because they inherently have different benefit
expectations when engaging in service activities or events.
For example, patient VP may pertain to facilities, reliability, responsiveness, convenience,
control, choice, and so forth, whereas physician VP may pertain to diagnosis time, work
productivity, patient-wellness, communication with patients, and so forth.

VP （價值主張）決定了服務的成敗，很大程度上是因為服務價值的創造本質上取決於
VP 的實現。 換句話說，同一服務的不同參與者可能有不同的 VP ，因為他們在從事服
務活動或事件時，天生就有不同的利益期望。例如，患者 VP 可能與設施、可靠性、
響應能力、便利性、控制、選擇等有關，而醫師 VP 可能與診斷時間、工作效率、患
者健康、與患者的溝通等有關。
12
2.3 THE VP CONCEPT IN E-HEALTH
SERVICE

In sum, this study focus on patients, physicians, and care

managers and identify them as key e-Health service stakeholder
groups.

總之，本研究側重於患者、醫生和護理管理人員，並將他們
確定為關鍵的電子醫療服務利益相關者群體。

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 3. RESEARCH
FRAMEWORK
First, we propose that physicians, patients, and care managers may influence each other
when engaging in e-Health service activities to fulfill their e-Health service VPs.
首先，我們建議醫生、患者和護理管理者在從事電子健康服務活動時可以相互影
響，以實現他們的電子健康服務副總裁。

H1a H1b H1c

Fulfillment of physician e-
Health service VP is
positively associated with
fulfillment
of patient e-Health service
VP.
Fulfillment of physician e-
Fulfillment of care manager
Health service VP is
e-Health service VP is
positively associated with
positively associated with
fulfillment
fulfillment of patient e-
of care manager e-Health
Health service VP.
service VP.

醫生電子健康服務 醫生電子健康服務副 護理經理 e-Health

VP 的實現與患者電 總裁的履行與護理經 服務 VP 的實現與患
子健康服務 VP 的實 理電子健康服務副總 者 e-Health 服務 14
現呈正相關。 裁的履行呈正相關。 VP 的實現呈正相
 3. RESEARCH
FRAMEWORK
Next, we propose that the fulfillment of the e-Health service VPs of physicians, care
managers, and patients may respectively and positively affect patients’ continuous use of
e-Health services. 接下來，我們提出，醫生、護理經理和患者的電子健康服務副總
裁的履行可能分別對患者持續使用電子健康服務產生積極影響。

H2a H2b H2c

Fulfillment of physician e-
Fulfillment of patient e- Fulfillment of care manager
Health service VP is
Health service VP is e-Health service VP is
positively associated with
positively associated patients’ positively associated with
patients’
continuous use of e-Health patients’ continuous use of e-
continuous use of e-Health
services. Health services
services.

患者電子健康服務 醫生電子健康服務 護理經理 e-Health

VP 的實現與患者持 VP 的實現與患者持 服務 VP 的履行與患
續使用電子健康服務 續使用電子健康服 者持續使用 e-Health 15
呈正相關。 務呈正相關。 服務呈正相關
3. RESEARCH FRAMEWORK

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 4. RESEARCH
METHODOLOGY

4.1 Operationalization of Constructs

4.2 Data Collection

1
7
 4.1 OPERATIONALIZATION OF
CONSTRUCTS
VP for e-Health service patient (PVP)
e-Health service physical
PVP1: Tangibles 有形資產 equipment is attractive, and the
supporting staff is nice.

e-Health service information

PVP2: Reliability 可靠性 and knowledge is usable and
correct whenever needed.
Butt and de Run (2010);
PVP3: Responsiveness 響應能 e-Health service delivery is Kastania and Zimeras (2008);
力 timely and fast. Teshnizi et al. (2018)

e-Health service offerings are

PVP4: Assurance 保證
trustworthy and dependable.

e-Health service offerings are

PVP5: Empathy 同情
considerate and personalized 18
 4.1 OPERATIONALIZATION OF
CONSTRUCTS

We quantify physician e-Health service VP with the following constructs:

productivity, communication, and wellness.
VP for e-Health service physician (DVP)
e-Health services can improve the
process of generating healthcare
DVP1: Productivity 生產率 outcomes for patients (e.g.,
streamlined or optimized
processes). Catan et al. (2015);
Macdonald et al. (2018);
e-Health services can improve Schooley et al. (2016)
DVP2: Communication 溝通
patient-physician communication.

e-Health services can improve

DVP3: Wellness 健康
patient wellness. 19
 4.1 OPERATIONALIZATION OF
CONSTRUCTS
VP for e-Health service care manager (CVP)
CVP1: Financial incentives 財政獎
e-Health services can lead to satisfactory salaries.
勵

CVP2: Work environments 工作環境
CVP3: Job risks 工作風險
CVP4: Interpersonal relationships
人際關係
e-Health services can improve working conditions. Afzali et al. (2014);
Barnoy et al. (2020);
Fagerström et al. (2017);
e-Health services can eliminate exposure to Li et al. (2013);
medical malpractice risks. Pelotti and Pari (2014)
e-Health services can lead to better opportunities
for improving relationships with patients and
colleagues.

Patient’ continuous use

Willingness to continue using the services

DV: Continuous use 連續使用
(true/false) 20
2 DATA COLLECTION

In this study, we collect research data from National Taiwan University Hospital
(NTUH) and collect data in 2 phases.

01
First, we conduct focus group interviews. The interview targets are
physicians and care managers in the four NTUH e-Health service
departments. Our aim is to identify VPs and important stakeholders. 我
們進行焦點小組訪談

02
Next, we conduct comprehensive surveys after
the interviews, send the questionnaires to
physicians, care managers, and patients involved
in NTUH’s four e-Health service departments. 我
們在面試後進行全面調查
5. MODEL ANALYSIS AND
RESULTS 5.1 Measurement
Model Analysis

5.2 Structure
Model Analysis

5.3 Summary of
Findings

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MEASUREMENT MODEL ANALYSIS

We use a partial least squares (PLS) approach for data analysis.

24
 5.2 STRUCTURE MODEL
ANALYSIS

We use a bootstrapping approach in SmartPLS with 5,000 samples created to

estimate path coefficients.

25
 5.2 STRUCTURE MODEL
ANALYSIS
The results show 5 strong paths—the exception being the path from the fulfillment of physician
VP to patient VP, leading to the rejection of H1a. In addition, the fulfillment of physician VP
can significantly affect the fulfillment of care manager VP, but the impact is negative, meaning
that the more physician VP is realized, the less care manager VP is realized; thus, our findings
do not support H1b. We also find that care manager VP is negatively associated with patient
VP, leading to the rejection of H1c. Finally, the VPs of all the stakeholders (patients,
physicians, and care managers) are positively and significantly associated with patients’
continuous use, supporting H2a, H2b, and H2c.

2
6
5.3 SUMMARY OF
FINDINGS
The results of our empirical
analysis show that along with
the fulfillment of patients’ e-
Health service VP, the
fulfillment of physicians’ and
care manages’ e-Health
service VPs bolster patients’
continuous use of e-Health
services.
The results of our analysis
do not support our
hypotheses that the
fulfillment of physicians’ e-
Health service VP would
positively affect the
fulfillment the e-Health
service VPs of care
managers and patients.
27
6. DISCUSSION

The findings of this study provide one vital clue for improving the currently lower-than-
expected use of e-Health services; they suggest that this lower-than-expected use
probably hinges on service care managers.
• the fulfillment of their VPs all can positively affect patients’ use of the services
• the fulfillment of physicians’ VP is negatively correlated with the fulfillment of care
managers’ VP.
• the fulfillment of care managers’ VP is negatively correlated with the fulfillment
of patients’ VP.

這項研究的結果為改善目前低於預期的電子醫療服務使用情況提供了一條重要線
索； 他們認為，這種低於預期的使用可能取決於服務護理經理。
• 他們的 VP 的履行都會對患者對服務的使用產生積極影響
• 醫生 VP 的實現與護理管理者 VP 的實現呈負相關。
• 護理管理人員 VP 的實現與患者 VP 的實現呈負相關。 28
6. DISCUSSION

We suggest that creating a successful e-Health service business will require

sufficient organizational support to mitigate the negative relationships between
e-Health service care managers and both physicians and patients. Such support
may include trainings and education that are tailored to enhancing the
effectiveness of e-Health service care managers’ engagement in related e-Health
systems, activities, tasks, and so forth.

我們建議，創建一個成功的電子醫療服務業務需要足夠的組織支持，以減
輕電子醫療服務護理經理與醫生和患者之間的負面關係。 這種支持可能包
括培訓和教育，旨在提高電子衛生服務管理人員參與相關電子衛生系統、
活動、任務等的有效性。
29
7. CONCLUSIONS

In sum, the contributions of this study are 2-fold.

First, most existing e-Heath studies adopt one-
sided perspectives-either those of physicians or
those of patients-as opposed to the multi-
stakeholder perspective adopted in this study.

總之，這項研究的貢獻是雙重的。 首先，大
多數現有的 e-Heath 研究採用片面的觀點 -
無論是醫生的觀點還是患者的觀點 - 與本研究
中採用的多利益相關者觀點相反。

3
0
7. CONCLUSION

This study’s findings should prove useful for the management of e-Health
services in hospitals. Many hospital managers and executives understand the
importance of adopting service-oriented perspectives to improve their e-Health
performance, but they lack clear information about their key service
stakeholders, as well as the impact of these stakeholders’ relationships on
patients’ continuous use of e-Health services.

這項研究的結果應該證明對醫院的電子醫療服務管理有用。 許多醫院管理
人員和高管了解採用面向服務的觀點來提高其電子醫療績效的重要性，但
他們缺乏關於其主要服務利益相關者的明確信息，以及這些利益相關者的
關係對患者持續使用電子醫療的影響。 - 健康服務。
31
7. CONCLUSION

This study’s limitations include the size and scope of our data sample. Multiple and
ample data sources from a wide range of hospitals in different countries would aid
tremendously in enhancing the generalizability of our findings. In addition, we did not
investigate the influence of e-Health service patients’ families. These limitations
highlight
potentially fruitful directions for future studies.

這項研究的局限性包括我們數據樣本的大小和範圍。 來自不同國家廣泛醫院的多
個和充足的數據源將極大地有助於提高我們研究結果的普遍性。 此外，我們沒有
調查 e-Health 服務患者家屬的影響。 這些限制突出了未來研究的潛在富有成果的
方向。
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THANK YOU
FOR YOUR
ATTENTION!

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