The experience and challenges of healthcare-reform-driven medical consortia and Regional Health Information Technologies in China: A longitudinal study
The experience and challenges of healthcare-reform-driven medical consortia and Regional Health Information Technologies in China: A longitudinal study
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中国医疗改革驱动的医疗联盟和区域卫生信息技术的经验和挑战：纵向研究
DOI：
10.1016/j.ijmedinf.2019.103954
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发表时间：
2019-11-01
影响因子：
4.9
通讯作者：
Lei, Jianbo
中科院分区：
文献类型：
--
作者：
Liang, Jun;Zheng, Xu;Lei, Jianbo
目的：为了实现医疗资源的普及--这是2010年以来第二次雄心勃勃的卫生改革的部分目标--中国政府旨在建立一个区域医疗联盟，并提高卫生信息交换（HIE）的效率。方法：对中国医院信息管理协会2006 - 2015年开展的年度调查结果进行纵向分析。调查结果主要涉及医院是否应加入区域医疗联盟、医院间医疗数据共享的方式以及院外信息交互系统。采用Bass扩散模型对2006 - 2025年中国医院加入联盟的比例进行拟合和预测。结果：截至2015年，共获得7272家医院的调查结果。合作医院的比例从2007年的3.0%上升到2015年的57.2%。医院间医疗数据的电子共享得到了迅速发展。仅依赖纸质文件进行数据交互的医院比例从2011年的43.3%下降至2015年的8.0%。加入联盟的医院与医院内部电子医疗数据交换的可及性之间存在很强的正线性相关（r = 0.925）。2015年，支持双重转诊和预约、医院与区域信息系统之间的数据浏览和远程咨询服务的医院比例分别从2011年的18.8%、16.8%和10.9%上升到65.0%、61.6%和81.9%。Bass预测模型表明，到2020年，我国将有90%的医院加入联盟的目标有望实现（调整后的R-2 = 0.93）。结论：我国政府采用了自上而下的高层次设计模式，推动了医疗联盟的快速发展，其中RHIT技术是关键的技术使能器。
Objective: To achieve universal access to medical resources-a partial goal of the second ambitious health reform since 2010-the Chinese government aimed to build a regional medical consortium and enhance the efficiency of health information exchange (HIE). We analyzed the experience of constructing a medical consortium in Chinese hospitals, which was based on regional health information technology (RHIT) promoted by HIE.Method: In this longitudinal study, we analyzed the results of the annual surveys that were conducted by the China Hospital Information Management Association from 2006 to 2015. The survey results mainly concerned whether hospitals should join the regional medical consortium, the methods used for sharing inter-hospital medical data, and the out-of-hospital information interaction system. The Bass diffusion model was adopted to fit and predict the proportion of Chinese hospitals joining the consortium from 2006 to 2025.Result: As of 2015, the survey results of 7272 hospitals were obtained. The proportion of hospitals in partnership systems increased from 3.0% in 2007 to 57.2% in 2015. There has been a rapid development in the electronic sharing of medical data between hospitals. The proportion of hospitals that relied solely on paper documents for data interaction decreased from 43.3% in 2011 to 8.0% in 2015. There was a strong positive linear correlation between hospitals joining the consortium and the accessibility of electronic medical data exchange within hospitals (r = 0.925). The proportions of hospitals that supported dual referral systems and appointments, data browsing between hospitals and regional information systems, and remote consultation services increased to 65.0%, 61.6%, and 81.9% in 2015, as compared to 18.8%, 16.8%, and 10.9% in 2011, respectively. The Bass prediction model showed that the goal of recruiting 90% of the hospitals to the consortium by 2020 will likely be achieved (adjusted R-2 = 0.93).Conclusion: The Chinese government has applied a top-down, high-level design model to promote the rapid development of a medical consortium, in which the RHIT technologies are crucial technical enabler.