現今醫療機構需要發展與組織新的方法以提供有效率的健康照護服務，而隨著通訊技術與網際網路的迅速發展，造成傳統面對面的醫療模式產生根本的變化。而醫療照護系統也因導入資訊通訊科技影響到醫療服務提供的方式，甚至與醫療照護提供者、顧客建立新的關係，進而顯著改變整體醫療照護的提供方式。本研究以變革理論為基礎，配合相關研究理論發展研究架構與假說，對於電子化醫療預備度及其對電子化醫療成功轉換之影響進行深入探討。關於電子化醫療預備度與轉換成功\\的影響因子，乃植基於理論基礎與醫療機構管理實務需求的架構上，藉由相關問卷的發展與實證，並透過國內大規模實證資料的調查與收集，以進行本研究理論架構之驗證。研究樣本的組成，乃由衛生署衛生統計年報資料庫及調查報告，所提出符合目前資訊化程度較高的醫療機構113家為代表樣本。關於本研究的概念模式與研究假說的驗證上，則應用最小偏平方法的分析軟體進行實證資料的統計分析。研究結果支持（R2=0.519）所建立的電子化醫療預備度的架構，其正向影響點子化醫療轉換的成功：朝向醫療照護體系的六大目標。同時也發現外在經營環境所產生的壓力是重要的調節因子，並影響預備度與成功\\轉換間之關係，上述目標皆獲得統計結果的充分證實。本研究成果除了在理論強化上提供了實證基礎，另對現代化醫療機構在推動或導入電子化醫療提出具體貢獻與應用，其可協助管理階層在導入前評估機構的準備程度，制訂確實可行的決策與方針，以提高電子化醫療成功轉換的機會。

This study presents a conceptual model to investigate the e-health readiness required by healthcare organization and the impact of such readiness in enhancing e-health transformation success, and how the entrepreneurial alertness associated with e-health readiness. A scale to measure e-health readiness was developed and validated; then it being tested to collect the large-scale survey data from hospitals’ top management team members. The partial least squares (PLS) method was empirically used to test the conceptual model and hypotheses through the large-scale survey collected. The empirical results support the proposed model. The analysis not only provides the evidence that the effect of entrepreneurial alertness on e-health readiness is direct also showing e-health readiness has a positive effect on e-health transformation success. The results advance the understanding what determining factors of the e-health transformation success and also can potentially be used in advance of e-health transformation for contemporary hospitals to check its e-health readiness level and prepare the needed changes for e-health implementations to ensure better e-health transformation.

Abstract I
Keywords I
1. Introduction 1
1.1 Background and Motivations 1
1.2 Research Objectives and Questions 4
1.3 Research Design 5
2. Theoretical foundation and conceptual model 12
2.1 Theory of Organizational Change 12
2.2 Developing a Framework for E-health Readiness 18
2.2.1 What’s E-health? 18
2.3.2 E-health Readiness 20
2.3 Development a framework for E-health Transformation Success 30
2.4 Entrepreneurial Alertness 39
2.5 Hospital Ownership and Type 42
3. Research Methodology 44
3.1 Measurement Development 44
3.2 Data Collection 50
3.3 Analysis Methods 52
3.3.1 Measurement Validation 53
3.3.2 Test of the Structural Model 55
4. Results 57
4.1 Measurement Properties 57
4.2 Test of the Structural Model 61
5. Discussions and conclusions 64
5.1 Discussion of Research Results 64
5.2 Research Contributions and Implications 65
5.3 Limitation and Future Research 67
5.4 Conclusion 68
Reference 70
Appendix A. Survey Instruments in Chinese 86

Afuah, A. and Tucci, C. L. (2003) Internet business models and strategies: Text and cases, (2nd Ed.) McGraw-Hill, Boston.
Anderson, J. C. and Gerbing, D. W. (1988) Structural equation modeling in practice: A review and recommended two-step approach, Psychological Bulletin, 103, 3, 411-423
Armenakis, A. A. and Harris, S. G. (2002) Crafting a change message to create transformational readiness, Journal of Organizational change Management, 15, 2, 169-183
Armenakis, A. A., Harris, S. G., and Mossholder, K. W. (1993) Creating readiness for organizational change. Human Relations, 46, 681-703.
Ayanian, J. Z., Weissman, J. S., Chasan-Taber, S., and Epstein, A. M. (1999) Quality of Care by Race and Gender for Congestive Heart Failure and Pneumonia. Medical Care, 37, 12, 1260–9
Bandura, A. and Jourden, F. J. (1991) Self-regulatory mechanisms governing the impact of social comparison on complex decision making, Journal of Personality and Social Psychology, 60, 6, 941-951.
Beckhard R. and Harris R. (1987) Organizational Transitions. Addison-Wesley, Reading, MA.
Benjamin, R. I. and Lewinson, E. (1993) A framework for managing It-enabled change, Sloan Management Review, 34, 4, 23-33
Bharadwaj, A. S. (2000) A resource-based perspective on information technology capability and firm performance: An empirical investigation, MIS Quarterly, 24, 1, 169-196.
Bostrom, R. P. and Heinen, J. S. (1977) MIS problems and failures: A socio-technical perspective part I: The causes, MIS Quarterly, 1, 3, 17-32.
Broadbent, M., Weill, P., and Clair, D. S. (1999) The implications of information technology infrastructure for business process redesign, MIS Quarterly, 23, 2, 159-182.
Brown, L. and Barnett, J. R. (2004) Is the corporate transformation of hospitals creating a new hybrid health care space? A case study of the impact of co-location of public and private hospitals in Australia, Social Science & Medicine 58, 2, 427-444.
Brown, M. (1998) The HealthMed Retrievers: Profiles of Consumers Using Online Health and Medical Information. New York, NY: Cyber dialogue.
Brynjolfsson, E. and Hitt, L. M. (2000) Beyond Computation: Information Technology, Organizational Transformation and Business Performance, Journal of Economic Perspectives, 14, 4, 23-48.
Burke, W. W. (1994) Organization development: A process of learning and changing, (2nd Ed.) Addison-Wesley Publishing, MA.
Byrd, T. A. and D. E. Turner (2001) An Exploratory Examination of the Relationship between Flexible IT Infrastructure and Competitive Advantage, Information & Management, 39, 1, 41-52.
Canto, J. G., Allison, J. J., Kiefe, C. I. et al. (2000) Relation of Race and Sex to the Use of Reperfusion Therapy in Medicare Beneficiaries with Acute Myocardial Infarction. N EngI J Med, 342, 15, 1094–100.
Chadwick, C., Hunter, L. W. and Walston, S. L. (2004) Effects of downsizing practices on the performance of hospitals, Strategic Management Journal, 25, 405-427.
Chassin, M. R. (1997) Assessing Strategies for Quality Improvement. Health Affairs, 16, 3, 151–61.
Chesbrough, H and Rosenbloom, R. S. (2002) The role of the business model in capturing value from innovation: evidence from Xerox Corporation's technology spin-off companies, Industrial and Corporate Change, 11, 3, 529-555
Chin, W. W. (1998) Issues and opinion on structural equation modeling, MIS Quarterly, 21, 1, 7-16.
Chin, W. W., and Gopal, A. (1995) Adoption Intention in GSS: Relative Importance of Beliefs, Data Base, 26, 2-3, 42-63.
Christensen, C. M. (1997) The Innovators Dilemma: When New Technologies Causes Great Firms to Fail, Harvard Business School Press, Cambridge, MA.
Churchill, G. A. (1979) A paradigm for developing better measures of marketing constructs, Journal of Marketing Research, 16, 1, 64-73
Craig, J. and Jutla, D. (2001) E-business readiness: A customer-focused framework, Addison-Wesley, Boston, MA.
Craig, J. and Jutla, D. (2001) E-business Readiness: A Customer-Focused Framework, Addison-Wesley, Boston, MA.
Cummings, T. and Worley, C. (1997) Organization Development and Change. West Publishing Co., Ohio.
Cunningham, C. E., Woodward, C. A., Shannon, H. S., MacIntosh, J., Lendrum, B., Rosenbloom, D., et al. (2002). Readiness for organizational change: A longitudinal study of workplace, psychological, and behavioral correlates. Journal of Occupational and Organizational Psychology, 75, 377-392.
Davidson, W. (1999) Beyond re-engineering: The three phases of business transformation, IBM Systems Journal, 38, 2/3, 485.
DeLuca, J. M. and Enmark, R. (2000) E-health: the changing model of healthcare, Frontiers of Health Services Management, 17, 1, 3-15.
Duncan, N. B. (1995) Capturing flexibility of information technology infrastructure: A study of resource characteristics and their measure, Journal of Management Information Systems 12, 2, 37-56.
Dyer, K. A. (2001). Ethical challenges of medicine and health on the Internet: a review. Journal of Medical Internet Research, 3, 2, e23.
Earl, M. J. (1993) Experiences in strategic information systems planning, MIS Quarterly, 17, 1, 1-24.
Earl, M. J. (2000) Evolving the e-business, Business Strategy Review, 11, 2, 33-38
EI Sawy, O. A. and Pavlou, P. A. (2008) IT-enabled business capabilities for turbulent environment, MIS Quarterly Executive, 7, 3, 139-150.
Ein-Dor P. and Segev, E. (1978) Organizational Context and the Success of Management Information Systems, Management Science, 24, 10, 1067-1077.
Englebardt, S. P., and Nelson, R. (2002) Health care informatics: an interdisciplinary approach. St. Louis, Mo.: Mosby.
Eysenbach, G. (2001) What is e-health? Journal of Medical Internet Research, 3, 2, E20.
Eysenbach, Gunther, Eun Ryoung Sa, and Thomas L. Diepgen. (1999) Shopping Around the Internet Today and Tomorrow: Towards the Millennium of Cybermedicine. BMJ, 319, 1294.
Ferguson, T. (1998) Digital Doctoring Opportunities and Challenges in Electronic Patient-Physician Communication. JAMA, 280, 1361–2.
Fink, L. and Neumann, S. (2007) Gaining Agility through IT Personnel Capabilities: The Mediating Role of IT Infrastructure Capabilities, Journal of the Association for Information Systems, 8, 8, 440-462.
Fiscella, Kevin, Franks, P., Gold, M. R. and Clancy, C. M. (2000) Inequality in Quality. Addressing Socioeconomic, Racial, and Ethnic Disparities in Health Care. JAMA, 283, 19, 2579–84.
Fishman, C. (1999) This is a Marketing Revolution. Fast Company, 24, 204.
Fung, V. and Magretta, J. (1998) Fast, Global, and Entrepreneurial: Supply Chain Management, Hong Kong style. An interview with Victor Fung. Harvard Business Review, 76, 102–14.
Gable, G. G., Sedera, D. and Chan, T. (2008) Re-conceptualizing information system success: The IS-impact measurement model, Journal of the Association for Information Systems, 9, 7, 377-408.
Gardside, P. (1998) Organisational context for quality: lessons from the fields of organizational development and change management, Quality in Health Care, 7, Suppl, S8-S15
Gerstner, Jr. L. V. (2002) Who Says Elephants Can't Dance? Harper Business, New York.
Gerteis, Margaret, Susan Edgman-Levitan, and Jennifer Daley. (1993) Through the Patient’s Eyes. Understanding and Promoting Patient-centered Care. San Francisco, CA: Jossey-Bass.
Greene, A. L. (2000) E-health: realizing the vision. Frontiers of Health Services Management, 17(1), 33-37; discussion 49-51.
Hackbach, G. and Kettinger, W. J. (2000) Building an e-business strategy, Information System Journal, 17, 3, 78-93
Hair, J.F., Anderson jr., R. E., Tatham, R. L., and Black, W. C. (1998) Multivariate data analysis with readings, 5th edition. Englewood Cliff, NJ: Prentice Hall.
Hikmet, N. and Chen, S. K. (2003) An Investigation into Low Mail Survey Response Rates of Information Technology Users in Health Care Organizations, International Journal of Medical Informatics, 72, 3, 29-34
HIMSS (2008) Enabling Healthcare Reform Using Information Technology, http://www.himss.org/2009CalltoAction/
Holt, D. T., Armenakis, A. A., Field, H. S. and Harris, S. G. (2007) Readiness for organizational change: The systematic development of a scale, The journal of Applied Behavioral Science, 43, 2, 232-255
Hoque, F., Sambamurthy, V. Zmud, R. Trainer, T., and Wilson, C. (2006) Winning the 3-legged race: When business and technology run together, Prentice Hall, NJ.
Hulland, J. (1999) Use of Partial Least Squares (PLS) in Strategic Management Research: A Review of Four Recent Studies, Strategic Management Journal, 20, 2, 195-204
Iacovou, C. L., Benbasat, I. and Dexter, A. S. (1995) Electronic data interchange and small organizations: Adoption and impact of technology., MIS Quarterly, 19, 4, 465-485.
Information Systems That People Want To Use. Sloan Management Review, 35, 4.
Institute of Medicine (2000) Medicare: To Err Is Human: Building a Safer Health System. Linda T. Kohn, Janet M. Corrigan, and Molla S. Donaldson, eds. Washington, D.C.: National Academy Press, 2000b.
Institute of Medicine (2001) Crossing the quality chasm: a new health system for the 21st century, National Academy Press, Washington, D.C.
Ives, B. and Jarvenpaa, S. L. (1991) Applications of global information technology: Key issues for management, MIS Quarterly, 15, 1, 33-49
Jones, R. A., Jimmieson, N. L., and Griffiths, A. (2005) The impact of organizational culture and reshaping capabilities on change implementation success: The mediating role of readiness for change. Journal of Management Studies, 42, 361-386.
Kalakota, R. and Robinson, M. (2001) E-business 2.0: Roadmap for success, Addison Wesley Inc., Longman
Katz, d. and Kahn, R. (1978) The social psychology of organizations, John Wiley, New York, NY.
Kayworth, T. R., Chatterjee, D. and Sambamurthy, V. (2001) Theoretical Justification for IT Infrastructure Investments, Information Resources Management Journal, 14, 3, 5-14.
Kearns G. S. and Lederer A. L. (2003) A resource-based view of strategic it alignment: How knowledge sharing creates competitive advantage, Decision Sciences, 34, 1, 1-29
Kenagy, J. W., Donald M. B., and Miles F. S. (1999) Service Quality in Health Care. JAMA, 281, 7, 661–5.
Kerlinger, F. N. and Lee, H. B. (2000) Foundations of behavior research, 4th ed., Fort Worth, TX
Koppel, R., Metlay, J., Cohen, A., Abaluck, B., Localio, A., Kimmel, S. and Strom, B. (2005) Role of computerized physician order entry systems in facilitating medication errors, JAMA, 293, 1197-1203.
Kotter J. P. (1996) Leading Change, Harvard Business Press, Boston, Mass.
Kotter J. P. (2008) A sense of urgency, Harvard Business Press, Boston, Mass.
Lai, J. Y., Ong, C. S., Yang, C. C., and Wang, C. T. (2008) Assessing and managing employee readiness for embracing e-business, Proceedings of the 2008 ACM Special Interest Group on Computer Personnel Research Annual Conference, 79-87
Laudon, K. C. (2009) Essentials of management information systems, (8th Ed.) Pearson/Prentice Hall, Upper Saddle River, NJ.
Leavitt, H. J., & Whisler, T. L. (1958) Management in the 1980's, Harvard Business Review, 36, 6, 41-48.
Lederer, A. L., Mirchandani, D. A. and Sims, K. (2001) The search for strategic advantage from the world wide web, International Journal of Electronic Commerce, 5, 4, 117-133
Lewin K. (1951) Field Theory in Social Science, Harper and Row, New York
Lewin, K. (1961) Quasi-stationary social equilibria and the problem of permanent change, in: The planning of change; readings in the applied behavioral sciences, W. G. Bennis, K. D. Benne and R. Chin (eds.), Holt, New York, p. 781.
Lewis, B. R. and Bryd, T. A. (2003) Development of a measure for the information technology infrastructure construct, European Journal of Information Systems, 12, 2, 93-109
Liang, H., Saraf, N., Hu, Q. and Xue, Y. (2007) Assimilation of enterprise systems: The effect of institutional pressures and the mediating role of top management, MIS Quarterly, 31, 1, 59-87
Markus, M.L. and Benjamin, R.I. (1997) The Magic Bullet Theory in IT-Enabled Transformation, Sloan Management Review, 38, 2, 55-68.
McKersie, R. B. and Walton, R. E. (1991) Organizational Change. In The Corporation of the 1990s: Information Technology and Organizational Transformation (Scott Morton MS, Ed.), Oxford University Press, New York.
Milstein, A. (2006) Health information technology is a vehicle, not a destination: A conversation with David J. Brailer, Health Affairs, 26, 2, w236-w241.
Mirani, R. and Leaderer, A. L. (1998) An instrument for assessing the organizational benefits of IS projects, Decision Sciences, 29, 4, 803-838
More, G. C. and I. Benbasat (1991) Development of An Instrument to Measure The Perceptions of Adopting An Information Technology Innovation. Information Systems Research, 2, 3, 192-222
NOIE (2003) Final report of the NOIE review of the spam problem and how it can be countered: Report. National Office for the Information Economy
Nutt, P. (1986) Tactics of implementation, Academy of Management Journal, 29, 2, 230-261
O'Hara, M. T., Watson, R. T. and Kavan, C. B. (1999) Managing the three levels of change, Information Systems Management, 16, 3, 63-70.
Ontario Hospital eHealth Council. (2001) An eHealth blueprint: Setting the course for action. An Ontario hospital perspective. http://www.oha.com
Orlikowski, W. J. (1996) Improvising organizational transformation over time: A situated change perspective, Information Systems Research, 7, 1, 63-92.
Osterwalder, A. and Pigneur, Y. (2005) Clarifying business models: Origins, present, and future of the concept, Communications of AIS, 2005, 16, 1-25.
Palmer, S. and Torgerson, D. J. (1999) Definition of Efficiency. BMJ, 318, 1136.
Parasuraman, A. (2000) Technology readiness index (TRI): A multiple-item scale to measure readiness to embrace new technologies, Journal of Service Research, 2, 4, 307-320.
Parente, S. T. (2000) Beyond the hype: a taxonomy of e-health business models, Health Affairs, 19, 6, 89-102.
Paul, D. (1994) Incentive Plans Can Work, Harvard Business Review, 52, 178.
Podsakoff, P.M., & Organ, D.W., (1986) Self-Reports in Organizational Research: Problems and Prospects, Journal of Management, 12, 4, 531-544.
Porter, M. E. and Teisberg, E. O. (2006) Redefining health care: creating value-based competition on results, Harvard Business School Press, Boston, Mass.
Quinn, J. B. (1982) Managing strategies incrementally, Omega, 10, 6, 613-627
Ravichandran, T. and Rai, A. (2000) Quality Management in Systems Development: An Organizational System Perspective, MIS Quarterly, 24, 3, 381-415.
Reason, J. (1990) Human Error. New York, NY: Cambridge University Press
Robbins, S. P. and Judge, T. A. (2008) Organizational behavior, (13th Ed.) Pearson/Prentice Hall, Upper Saddle River, NJ.
Roberts, B., Jarvenpaa S. and Baxley, C. (2006) Evolving at the speed of change: Mastering change readiness at Motorola’s semiconductor products sector, MIS Quarterly Executive, 2, 2, 58-73.
Rockart, J. F., Earl, M. J. and Ross, J. W. (1996) Eight Imperatives for the New IT Organization, Sloan Management Review, 38, 1, 43-55.
Ross, N. A., Wolfson, M. C., Dunn, J. R. et al. (2000) Relation between Income Inequality and Mortality in Canada and in the United States: Cross Sectional Assessment Using Census Data and Vital Statistics. BMJ, 320, 898–902.
Ryan, R. M. and Deci, E. L. (2000) Intrinsic and extrinsic motivations: Classic definitions and new directions, Contemporary Educational Psychology 25, 1, 54-67.
Sackett, D. L., William M. C. Rosenberg, J. A. Muir Gray, et al. (1996) Evidence Based Medicine: What It Is and What It Isn’t. BMJ, 312, 71–2.
Sambamurthy, V. and Zmud, R. W. (1992) Managing IT for success : the empowering business partnership, Financial Executives Research Foundation, Morristown, NJ.
Sambamurthy, V., Bharadwaj, A. and Grover, V. (2003) Shaping agility through digital options: reconceptualizing the role of information technology in contemporary firms, MIS Quarterly, 27, 2, 237-263.
Segars, A. H. (1997) Assessing the unidimensionality of measurement: A paradigm and illustration within the context of information systems research, Omega, 25, 1, 107-121
Shortliffe, T. (2005) Strategic action in health information technology: Why the obvious has taken so long, Health Affairs, 24, 5, 1222-1233.
Sivo, S. A., Saunders, C., Chang, Q. and Jiang, J. J. (2006) How low should you go? Low response rates and the validity of inference in is questionnaire research, Journal of the Association for Information Systems, 7, 6, 351-414.
Strub, D. W. (1989) Validating instruments in MIS research, MIS Quarterly, 13, 2, 147-169
Teece, D. J., Pisano, G. and Shuen, A. (1997) Dynamic capabilities and strategic management, Strategic Management Journal, 18, 7, 509-533.
Thompson, T. G. and Brailer, D. J. (2004) Strategic framework: the decade of health information technology: Delivering consumer-centric and information-rich health care, Department of Health & Human Services.
Timmers, P., (1999). Electronic Commerce: Strategies and Models for Business-to-Business Trading. Wiley.
Venkatraman, N. (1990) Performance Implications of Strategic Coalignment: A Methodological Perspective, Journal of Management Studies, 27, 1, 19–41
Venkatraman, N. (1994) IT-enabled business transformation: From automation to business scope redefinition, Sloan Management Review, 35, 2, 73-87.
Vroom, V. H. (1964) Work and motivation, John Wiley & Sons, New York, NY.
Walker, C. A. (2004) Change readiness: A construct to explain health and life transitions, Journal of Theory Construction and Testing, 8, 1, 26-33.
Weil, P. and Ross, J. W. (2005) A matrixed approach to designing IT governance, Sloan Management Review, 46, 1, 26-34
Weil, P. and Vitale, M. (2002) What IT infrastructure capabilities are needed to implement e-business models? MIS Quarterly Executive, 1, 1, 17-34
WHO (2005) What is e-health? http://www.emro.who.int/his/ehealth/AboutEhealth.htm.
Willcocks, L. P. and Feeny, D. (2006) IT outsourcing and core IS capabilities: Challenges and lessons at Dupont, Information Systems Management, 23, 1, 49-56.
Wu, J. H. and Wang, Y. M. (2006) Measuring KMS success: An attempt to extend and respecify DeLone and McLean's Model, Information & Management, 43, 6, 728-739.
Wu, J. H., & Shiah, T. L. (2008) Developing e-business dynamic capabilities: An analysis of e-Commerce innovation from I-, M-, to U-commerce. Journal of Organizational Computing and Electronic Commerce, 18, 1-17.
Wu, J. H., Chen, Y. C., and Greenes, R. A. (2009) Healthcare technology management competency and its impacts on IT-healthcare partnerships development, International Journal of Medical Informatics, 78, 71-82.
Wu, J. H., Huang, A. S., Hsia, T. L., & Tsai, H. T. (2006). Revolution or evolution? An analysis of e-health innovation and impact using a hypercube model. International Journal of Electronic Healthcare, 2, 1, 12-34.
Zhu, K., Kraemer, K. L., Xu, S. and Dederick, J. (2004) Information technology payoff in e-business environments: an international perspective on value creation of e-business in the financial services industry, Journal of Management Information Systems, 22, 1, 17-54.
Zmud, R. W. and Cox, J. F. (1979) The Implementation Process: A Change Approach, MIS Quarterly, 3, 2, 35-43