在高齡化加速、急重症需求攀升與醫護人力緊縮的情境下，醫療機構面臨更高的不確定性與服務壓力。相較於金融業已能透過跨平台資訊整合提供即時服務，醫療產業因涉及病人安全、高度專業分工與嚴格法規限制，數位轉型推進相對困難。需求遞增與人力遞減的雙重限制下，醫療體系已演變為高度動盪的複雜適應系統，傳統以穩定性、標準化為核心的運作模式已難以有效回應環境的突發變異，促使醫療機構必須具備醫療敏捷性，以在資源受限的情境下兼顧回應速度、決策效率與照護品質。
電子病歷作為醫療數位化的重要基礎，其價值並不僅止於資料保存，而在於能否支援即時資訊取得、臨床決策、跨部門協作與急重症救護流程銜接，進而提升醫療機構在動態環境中的應變能力。台灣醫療產業推動電子病歷已逾二、三十年，但早期客製化開發使系統間格式不一，形成資料孤島，限制電子病歷進一步發展的可能性。相較於單純建置資訊系統，當前更關鍵的問題在於電子病歷如何從單純的行政紀錄工具改造既有流程慣性、結合資訊技術深化應用，並打破機構藩籬以回應臨床問題與醫療敏捷需求。本篇研究以可供性實現理論與互操作性作為核心分析視角，探討在醫療機構面臨人力資源受限與急重症需求攀升的情境下，電子病歷的可供性如何透過互操作性的推進與範圍擴展加以實現，進而產出具體成果落實醫療敏捷價值。研究採質性研究中的個案研究方法，並選擇台南市立醫院作為個案，去了解其可供性實現的經驗與成果。
研究過程中發現，南市醫電子病歷發展歷程可區分為三個階段：導入、應用、協作。電子病歷導入為病歷電子化，透過互操作性將紙本資料轉為可儲存、可存取與可再利用的數位資源；電子病歷應用為系統數位化，透過資料結構化、條碼技術、閉環管理與國際標準對齊，提升資料一致性與臨床決策支援；電子病歷協作為跨機構協同化，透過QR Code與FHIR資料協定，將電子病歷延伸至院前救護場域。可供性實現理論展現組織角色在特定目標驅動下對資訊工件的感知，以及將潛在可能性轉化為實質行動達成具體成果的動態歷程(Strong et al., 2014)。在分析過程中進一步發現互操作性可補充說明電子病歷在跨系統運作中的關鍵條件，亦即資料不僅能被交換，還能被正確解讀、理解與運用(Rezaei et al., 2014)。當電子病歷所產生的資料、流程與系統能被有效串接並轉化為臨床決策、流程再造與跨單位協作時，醫療機構便能在變動環境中更快速回應病患需求，進而展現醫療敏捷價值(Berlin et al., 2017)。
研究結果顯示，電子病歷雖已在醫療機構中發展多年，但其互操作性仍有不足，台南市立醫院透過技術、結構、語義與組織層面的互操作性推進，成功驅動了電子病歷可供性的深化，使行政效率提升，並延伸至醫療安全管理與跨機構救護協作，最終形成醫療行政、醫療安全與醫療救護三個面向的醫療敏捷價值產出。
本研究對醫療產業深化電子病歷應用之理論與實務皆具有貢獻，不僅延伸可供性實現理論與互操作性觀點在醫療場域中的應用，也以醫療敏捷性作為可供性實現後之價值展現，說明資訊工件如何由技術潛能轉化為具體成果，同時為其他面臨高負荷挑戰的醫療機構提供實務啟發與推動示範，強調理論分析與醫療現場實踐相互結合的重要性。

In response to accelerated population aging, rising demand for acute and critical care, and healthcare workforce shortages, medical institutions are facing increasing uncertainty and service pressure. Under these conditions, traditional operating models centered on stability and standardization are no longer sufficient. Medical institutions therefore need to develop medical agility to improve response speed, decision-making efficiency, and quality of care under resource-constrained environments.
This study focuses on the electronic medical record (EMR) as a key foundation of healthcare digitalization. The value of the EMR is not limited to data storage but lies in its ability to support real-time information access, clinical decision-making, cross-departmental collaboration, and emergency care coordination. Although the EMR has been promoted in Taiwan for more than two to three decades, early customized system development created inconsistent data formats and data silos, limiting its further application. Therefore, the central issue is how the EMR can move beyond an administrative record-keeping tool to reshape existing routines, deepen digital applications, and support medical agility.
Drawing on affordance actualization and interoperability, this study examines how the affordance of the EMR is actualized through interoperability actions at different levels. Using Tainan Municipal Hospital as a qualitative case study, the research identifies three stages of EMR development: implementation, application, and collaboration. In the implementation stage, paper-based records are transformed into digital resources through technical and structural interoperability. In the application stage, data structuring, barcode technology, closed-loop management, and alignment with international standards enhance data consistency and clinical decision support. In the collaboration stage, the EMR is extended to prehospital emergency care through QR Codes and the FHIR data protocol, enabling cross-institutional coordination.
The findings show that affordance actualization explains how organizational actors transform the potential of information artifacts into concrete actions and outcomes (Strong et al., 2014), while interoperability explains how data can be exchanged, correctly interpreted, understood, and used across systems (Rezaei et al., 2014). When EMR-generated data, processes, and systems are effectively connected, they can support clinical decision-making, process adjustment, and cross-unit collaboration, thereby creating medical agility value (Berlin et al., 2017).
Overall, this study finds that Tainan Municipal Hospital deepened the actualization of EMR affordance through technical, structural, semantic, and organizational interoperability. This process improved administrative efficiency, strengthened medical safety management, and expanded cross-institutional emergency care collaboration. The study contributes to both theory and practice by extending affordance actualization theory and interoperability to the healthcare context, and by showing how the EMR can be transformed from technological potential into concrete outcomes that support medical agility.

李建璋. (2025). 統一台灣電子病歷的策略. 澄清醫護管理雜誌, 21(3), 4–12.
莊秀文, 劉越萍, & 林珮芸. (2023). 我國緊急醫療救護資訊智能平臺的回顧與前瞻. 台灣公共衛生雜誌, 42(2), 180.
Alpert, J. S. (2016). The electronic medical record in 2016: Advantages and disadvantages. Digital Medicine, 2(2), 48–51.
Anderson, C., & Robey, D. (2017). Affordance potency: Explaining the actualization of technology affordances. Information and Organization, 27(2), 100–115.
Ayaad, O., Alloubani, A., ALhajaa, E. A., Farhan, M., Abuseif, S., Al Hroub, A., & Akhu-Zaheya, L. (2019). The role of electronic medical records in improving the quality of health care services: Comparative study. International journal of medical informatics, 127, 63–67.
Babbie, E. R. (2020). The practice of social research (15th ed.). Cengage Learning.
Bender, D., & Sartipi, K. (2013, June). HL7 FHIR: An Agile and RESTful approach to healthcare information exchange. In Proceedings of the 26th IEEE international symposium on computer-based medical systems (pp. 326-331). IEEE.
Benson, T., & Grieve, G. (2016). Principles of health interoperability. Cham, Switzerland: Springer.
Berlin, G., De Smet, A., & Sodini, M. (2017). Why agility is imperative for healthcare organizations. McKinsey and Company.
Bernhard, E., Recker, J., & Burton-Jones, A. (2013). Understanding the actualization of affordances: A study in the process modeling context. In Proceedings of the 34th international conference on information systems (ICIS 2013) (pp. 1-11). Association for Information Systems (AIS).
Bloomfield, B. P., Latham, Y., & Vurdubakis, T. (2010). Bodies, technologies and action possibilities: when is an affordance? Sociology, 44(3), 415–433.
Boudreau, M. C., & Robey, D. (2005). Enacting integrated information technology: A human agency perspective. Organization science, 16(1), 3-18.
Chakraborty, S., Bhatt, V., & Chakravorty, T. (2020). Impact of digital technology adoption on care service orchestration, agility and responsiveness. International Journal of Scientific and Technology Research, 9(3), 4581–4586.
Chen, Y. P., Hsieh, S. H., Cheng, P. H., Chien, T. N., Chen, H. S., Luh, J. J., ... & Chen, S. J. (2010). An agile enterprise regulation architecture for health information security management. Telemedicine and e-Health, 16(7), 807-817.
Chiu, R. K., Tsai, K. C., Chang, C. M., Koh, S. L., & Lin, K. C. (2007). The implementation of an agile information delivery system in building service-oriented e-healthcare network. International Journal of Enterprise Network Management, 1(3), 283-298.
Chong, I., & Proctor, R. W. (2020). On the evolution of a radical concept: Affordances according to Gibson and their subsequent use and development. Perspectives on Psychological Science, 15(1), 117–132.
Creswell, J. W., & Poth, C. N. (2016). Qualitative inquiry and research design: Choosing among five approaches. Sage publications.
De Mello, B. H., Rigo, S. J., Da Costa, C. A., da Rosa Righi, R., Donida, B., Bez, M. R., & Schunke, L. C. (2022). Semantic interoperability in health records standards: a systematic literature review. Health and technology, 12(2), 255–272.
Denzin, N. K. (2012). Triangulation 2.0. Journal of mixed methods research, 6(2), 80–88.
Ritzer, G. (Ed.). (2007). The Blackwell encyclopedia of sociology (Vol. 1479). Malden, MA: Blackwell.
Dove, R. (1991). The 21s Century manufacturing enterprise strategy. Iacocca Institute, Lehigh University, AD-A257176.
Flick, U. (2024). The SAGE handbook of qualitative research quality. Sage Publications.
Gerring, J. (2006). Case study research: Principles and practices. Cambridge university press.
Gibson, J. J. (1977). The theory of affordances. Hilldale, USA, 1(2), 67–82.
Gioia, D. A., Corley, K. G., & Hamilton, A. L. (2013). Seeking qualitative rigor in inductive research: Notes on the Gioia methodology. Organizational research methods, 16(1), 15–31.
Glaser, B., & Strauss, A. (2017). Discovery of grounded theory: Strategies for qualitative research. Routledge.
Goldman, S. L., Nagel, R. N., & Preiss, K. (1995). Agile competitors and virtual organizations: strategies for enriching the customer (Vol. 8). Van Nostrand Reinhold New York.
Gopal, G., Suter-Crazzolara, C., Toldo, L., & Eberhardt, W. (2019). Digital transformation in healthcare–architectures of present and future information technologies. Clinical Chemistry and Laboratory Medicine (CCLM), 57(3), 328–335.
Greeno, J. G. (1994). Gibson's affordances.
Heiler, S. (1995). Semantic interoperability. ACM Computing Surveys (CSUR), 27(2), 271–273.
Herzlinger, R. E. (2006). Why innovation in health care is so hard. Harvard business review, 84(5), 58–66, 156.
Hillestad, R., Bigelow, J., Bower, A., Girosi, F., Meili, R., Scoville, R., & Taylor, R. (2005). Can electronic medical record systems transform health care? Potential health benefits, savings, and costs. Health affairs, 24(5), 1103–1117.
Iroju, O., Soriyan, A., Gambo, I., & Olaleke, J. (2013). Interoperability in healthcare: benefits, challenges and resolutions. International Journal of Innovation and Applied Studies, 3(1), 262–270.
Kai, E., Rebeiro-Hargrave, A., Inoue, S., Nohara, Y., Maruf, R. I., Nakashima, N., & Ahmed, A. (2014, May). Empowering the healthcare worker using the Portable Health Clinic. In 2014 IEEE 28th International Conference on Advanced Information Networking and Applications (pp. 759-764). IEEE.
Kasunic, M., & Anderson, W. (2004). Measuring systems interoperability: Challenges and opportunities.
Kitzmiller, R., Hunt, E., & Sproat, S. B. (2006). Adopting best practices:" Agility" moves from software development to healthcare project management. CIN: Computers, Informatics, Nursing, 24(2), 75–82.
Lenz, R., & Kuhn, K. A. (2004). Towards a continuous evolution and adaptation of information systems in healthcare. International journal of medical informatics, 73(1), 75–89.
Martínez-García, M., & Hernández-Lemus, E. (2013). Health systems as complex systems. American Journal of Operations Research, 3(1A), 113–126.
Miles, M. B., & Huberman, A. M. (1994). Qualitative data analysis: An expanded sourcebook. Sage publications.
Miller, R. H., & Sim, I. (2004). Physicians’ use of electronic medical records: barriers and solutions. Health affairs, 23(2), 116–126.
Oliver, M. (2005). The problem with affordance. E-learning and Digital Media, 2(4), 402–413.
Patri, R., & Suresh, M. (2017). Modelling the enablers of agile performance in healthcare organization: a TISM approach. Global Journal of Flexible Systems Management, 18(3), 251–272.
Patri, R., & Suresh, M. (2019). Agility in healthcare services: a systematic literature exploration. International Journal of Services and Operations Management, 32(3), 387–404.
Patton, M. Q. (2014). Qualitative research & evaluation methods: Integrating theory and practice. Sage publications.
Poksinska, B. (2010). The current state of Lean implementation in health care: literature review. Quality management in healthcare, 19(4), 319–329.
Pozzi, G., Pigni, F., & Vitari, C. (2014). Affordance theory in the IS discipline: A review and synthesis of the literature. In AMCIS 2014 Proceedings.
Radnor, Z., & Osborne, S. P. (2013). Lean: a failed theory for public services? Public management review, 15(2), 265–287.
Rezaei, R., Chiew, T. K., Lee, S. P., & Aliee, Z. S. (2014). Interoperability evaluation models: A systematic review. Computers in Industry, 65(1), 1–23.
Saldaña, J. (2021). The coding manual for qualitative researchers. Sage publications.
Sambamurthy, V., Bharadwaj, A., & Grover, V. (2003). Shaping agility through digital options: Reconceptualizing the role of information technology in contemporary Firms. MIS quarterly, 27(2), 237–263.
Sarmiento Falla, J. F., & Karwowski, W. (2024). Survey-based studies of the agility construct in the healthcare sector: A systematic literature review. Applied Sciences, 14(3), 1097.
Sherehiy, B., Karwowski, W., & Layer, J. K. (2007). A review of enterprise agility: Concepts, frameworks, and attributes. International Journal of industrial ergonomics, 37(5), 445–460.
Sindhwani, R., Singh, P. L., Prajapati, D. K., Iqbal, A., Phanden, R. K., & Malhotra, V. (2019). Agile system in health care: literature review. Advances in industrial and production engineering: select proceedings of FLAME 2018, 643–652.
Strong, D. M., Volkoff, O., Johnson, S. A., & Pelletier, L. R. (2009). A theory of clinic-EHR affordance actualization.
Strong, D. M., Volkoff, O., Johnson, S. A., Pelletier, L. R., Tulu, B., Bar-On, I., Trudel, J., & Garber, L. (2014). A theory of organization-EHR affordance actualization. Journal of the association for information systems, 15(2), 2.
Thomas, A., & Suresh, M. (2023). Readiness for agility adaptability and alignment in healthcare organizations. IISE Transactions on Healthcare Systems Engineering, 13(2), 161–174.
Tolf, S., Nyström, M. E., Tishelman, C., Brommels, M., & Hansson, J. (2015). Agile, a guiding principle for health care improvement? International journal of health care quality assurance, 28(5), 468–493.
Tracy, S. J. (2024). Qualitative Research Methods: Collecting Evidence, Crafting Analysis, Communicating Impact. John Wiley & Sons.
Volkoff, O., & Strong, D. M. (2017). Affordance theory and how to use it in IS research. In The Routledge companion to management information systems (pp. 232–245). Routledge.
Wang, S. J., Middleton, B., Prosser, L. A., Bardon, C. G., Spurr, C. D., Carchidi, P. J., Kittler, A. F., Goldszer, R. C., Fairchild, D. G., & Sussman, A. J. (2003). A cost-benefit analysis of electronic medical records in primary care. The American journal of medicine, 114(5), 397–403.
Wegner, P. (1996). Interoperability. ACM Computing Surveys (CSUR), 28(1), 285–287.
Yin, R. K. (2018). Case study research and applications (6th ed.). Sage publications.
Zammuto, R. F., Griffith, T. L., Majchrzak, A., Dougherty, D. J., & Faraj, S. (2007).Information technology and the changing fabric of organization. Organization science, 18(5), 749–762.
Zeng, M. L. (2019). Interoperability. KO Knowledge Organization, 46(2), 122–146.