電子病歷紀錄（Electronic Medical Record – EMR）是記錄病患所有就醫以及診療資訊。將病患紀錄以電子化處理不但能使醫院獲得較完整的病患資訊，更有利於醫護人員進行有效率的疾病醫療。依Chang et al. (2012) 與Lehmann et al. (2015) 研究數據顯示大部分醫院的電子病歷仍然處於初期至中期階段，然而醫護人員抗拒使用行為乃其中影響成敗關鍵因素之一。因此，本研究主要以公平理論（equity theory）與心理抗拒理論（psychological reactance theory）之觀點，探討醫護人員評量醫院在執行EMR系統時的預期互惠義務表現是否讓醫護人員知覺未履行承諾與組織正義，進而導致醫護人員產生心理契約違背及抗拒使用EMR行為。另，探究醫護人員個人特質（如：個人科技創新性和醫療科技管理能力）及醫院管理方式（如：回應抗拒行為），是否能減緩醫護人員的抗拒行為。本研究同時採質性與量化分析，首先與12位資深醫護與資訊人員進行深度訪談，以確認研究架構的邏輯與適用性，再配合理論與文獻設計問卷。問卷調查對象為醫護與資訊人員，總共回收489份有效問卷做為量化分析與假設檢驗。資料分析結果顯示知覺未履行承諾與知覺組織正義皆會影響醫護人員之心理契約違背並產生抗拒使用EMR行為。干擾檢測顯示，承認系統問題並修正之回應策略是最有效回應醫護人員抗拒行為的方法。醫護人員個人於IT創新性與醫療科技管理能力的程度高低，在知覺組織正義對於心理契約違背或知覺未履行承諾與知覺組織正義對於抗拒使用EMR行為之間具有顯著的差異。因此，本文建議醫院在執行導入新病歷紀錄系統時應更重視醫護人員之負面使用經驗並改善之。此外，在系統導入的工作分配與程序上應更透明和尊重執行，避免讓較有能力的醫護人員承擔過多的責任與工作負擔，以降低其情緒耗竭。最後，建議醫院應建立一套完整的雙向溝通機制，以提升醫院和醫護人員彼此的了解，達成雙贏的效果。

Electronic medical record (EMR) system which records patients’ entire consulting and diagnostic information on electronic basis can not only provide hospital sufficient information but also enable physicians to make accurate disease diagnoses effectively. Chang et al. (2012) and Lehmann et al. (2015) indicated that most of the hospital’s medical record system is in the early to medium phase and healthcare professional resistance behavior to adopt the system is a crucial element to hinder success. Therefore, this study attempts to discuss whether the healthcare professional evaluation on the hospital performance of the expected reciprocal obligation will lead to healthcare professionals’ perceived unmet promises and perceived organizational justice, and results in psychological contract breach (PCB) and generated resistance behavior to EMR implementation from the perspective of equity and psychological reactance theory; furthermore, to study whether the effects of healthcare professionals’ personal trait (e.g., personal innovativeness in IT & healthcare technology management (HTM) competency) and the hospital management practice (e.g., responses to resistance behavior) can potentially mitigate the healthcare professional resistance behavior. By applying both qualitative and quantitative research approach, 12 cases of in-depth interview was conducted with senior healthcare professionals and IT staffs to ensure the reliability of research framework and hypotheses; and develop survey questionnaire based on these outcomes. Four hundred and eighty-nine valid questionnaires have been collected from healthcare professionals and IT staffs for quantitative analysis and hypotheses testing. The results demonstrated that perceived unmet promises and perceived organizational justice had effect on healthcare professional PCB and generated resistance behavior to EMR implementation. In term of the moderating effects, acknowledgement and rectification responses approach was the most suitable method in response to the healthcare professional resistance behavior; healthcare professionals with high- or low-PIIT and high- or low-HTM competency had significantly different between groups in the effect of perceived organizational justice on PCB or the effect of perceived unmet promises and perceived organizational justice on resistance behavior to EMR implementation. The study suggested that the hospital should be more concentrated on the healthcare professional negative using experience and improves it; besides, the hospital should perform more transparent and respected in job and responsibility distribution, and avoid giving heavy workload and responsibility to the healthcare professionals who are more capable and talented to mitigate their emotional exhaustion. Finally, the study suggested that the hospitals should develop a complete two-way communication mechanism to increase the understanding between the hospitals and healthcare professionals to obtain a win-win situation.

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