Health Informatics in China (Chinese: ????? ) is about Health Informatics or Medical informatics or Health information systems/technology in China.
A major review and assessment of health informatics in China for the WHO Health Metrics Network was conducted in 2006 detailing Provincial assessments, developing strategic plans, improving public health monitoring systems, household surveys, routine health statistics systems.
Due to the Health Information Development Plan, all hospitals are required to increase investment in building digital hospitals. These requirements are expected to accelerate the growth of China's HIT market by about 25 to 30% a year during 2006-2010.
By the end of 2006, China's investment in health care information systems (HIS) had risen nearly 16 percent to RMB 5.8 billion, year-on-year. This amount accounts for about 0.5% of the country's total health care expenditures of RMB 866 billion over the same period.
The market size is expected to expand to about RMB 15 billion in 2010. The development of China's HIT industry is generally considered at an early stage, similar to that of western countries 20 years ago. However, as China learns more about available and emerging technologies, it now has a chance to leap forward.
Video Health informatics in China
Healthcare overview
Expenditure
China spent $ 97 billion, or 5.5% of its GDP, for health care in 2004. As stated earlier, public spending on health care is still low; public spending in 2004 accounted for only 17% of total health care spending while spending on pocket expenditure was 53.6%.
Coverage
Approximately 130 million people are included in the National Social Insurance Program for Urban Employees, a program established in 2005. Another 50 million people are covered through government insurance. But less than 30% of Chinese population have health insurance. Indeed, more than 35% of the urban population and 50% of people in rural areas have no coverage at all.
Infrastructure
The Chinese health care system currently consists mainly of large public hospitals, which are equipped by a small number of private, non-profit hospitals. In 2005, there were 18,703 hospitals in China. Among them, 2,027 are private hospitals (10.83%). Chinese hospitals can be divided into three categories: general hospital (70%), traditional Chinese medicine hospital (TCM) (14%), and special hospitals (16%).
In addition, China has 5,895 outpatient facilities: 1,266 outpatient facilities and 541 traditional treatment facilities. In 2005 China had 1,938,272 registered doctors primarily employed by hospitals.
Maps Health informatics in China
History
The economic reforms of the early 1980s resulted in major changes in China's health care system, primarily as a result of dismantling the rural cooperative medical system. Having been given sufficient financial independence, hospitals began to generate most of their income through user fees, a practice that continues today. Health care is now provided on a cost-for-service basis. The pricing structure seeks to facilitate equity by providing basic care under cost, with gains gained through the sale of over-the-counter medicines and high-tech services; this structure leads to inefficiency and improper patient care. Health insurance coverage in China is low, with less than 30% of the population receiving medical insurance.
China's health information technology HIT development has a short history. Development began in the mid-1990s with a financial management system; only in the last five years has clinical systems been implemented. China has made progress in a relatively short period of time, but weak software applications and scarcity of implementation skills delay further progress. Most Chinese hospitals are trying to dramatically increase and extensively digitize their work processes in the near future.
National Public Health Information Systems Development Project
The working group of the Ministry of Health for information construction has developed the National Public Health Information System Development Project. The "Project" confirms the guidelines, goals and principles of the public health information system construction, the proposed framework for further action. On September 17, 2003, an information construction working group from the Ministry of Health held a meeting via television and telephone on the construction of a public health information system in China. The agenda includes work reports in the field of information construction from the Ministry of Health, the introduction of the Construction Project of the National Health Information System (Draft) and reports from the National Centers for Disease Control on the relevant requirements of the SARS reporting system through the network.
Statistics of death
As part of a major change in its health information system, China combined two systems to collect death data to get a more accurate picture of how many people died and why. The cause of death data plays an increasingly important role in Chinese public health policy. Recently, the China Centers for Disease Control and Prevention took part in a research project led by the Department of Health's Statistics Center on the burden of disease and long-term health problems in China; the results are dramatic.
HIT Adoption
Health information technology is now entering the second generation of software in China, and the use of IT in hospitals resembles the late 1970s in the United States. Most hospitals in China incorporate IT software into their payment and billing systems, and many are beginning to integrate IT into clinical systems in the past five years.
The use of IT in clinical systems has emerged departmentally. As a result of the lack of experience with IT infrastructure, hospitals face several constraints. Fragmentation, duplication systems, and poor integration between various software systems have created an "information island" that impedes data sharing.
Three proven lessons learned from China's HIT development over the past ten years:
- Medical information should be integrated in all departments in the hospital. Poor integration of diverse software systems in hospitals discourages the exchange of information between hospitals and creates problems when the use of IT is widespread.
- In order for IT systems to benefit clinical and hospital management services, effective overall IT planning is required. Simplifying IT planning and lack of past doctor involvement leads to poor return on investment (ROI) at HIT.
- Implementation requires not only strong project management skills but also attention to end user requirements and requirements as well as for reengineering process work. Poor implementation has resulted in a large number of work process redundancies.
Government policy
The Chinese government adopted an "informatization" approach in the 1990s, promoted the development of IT in all major industries, including the health sector, with one goal being to bridge the information gap. The HIT policy began in 1995 with the "Gold Health Project," which seeks to create a foundation for electronically connecting health and hospital administration departments as well as medical education and research institutions. The government's efforts in the 21st century are increasingly focused on IT health. For example, the Health Guidelines of the Ministry of Health 2003-2010 for HIT Development in China call for the introduction of EHR and regional health information networks to be implemented across the country. Many hospitals are considering improving the overall system, and larger budgets are more available for this type of investment.
Organization
The Ministry of Health in government and independent hospital administrators is a key driver of HIT adoption in China. After the SARS epidemic, the Chinese government realized the importance of integrating an effective IT infrastructure into the country's health system. In addition, after a decade of small investment in IT systems hospital leaders have become aware that IT can improve work processes and improve management efficiency.
Many other associations involved in HIT exist in China, including
- National Medical Information Education (NMIE),
- China Health Informatics Association,
- China Health Information Association, and
- China Hospital Information Management Association (CHIMA). CHIMA is a subsidiary of the Chinese Hospital Association, a national industry association and nonprofit academic focusing on Health IT (similar to AMIA in the United States).
Funding
Provincial and local governments in China are the principal funders for regional health information networks and HIT in public hospitals. The national government facilitates standardized inquiry and IT infrastructure development. Hospitals invest their own funds into clinical and institutional HIT systems. In 2006, China spent slightly more than 0.7% ($ 700 million) of its national health budget for HIT. Of these funds: 70% is used for hardware, 20% for software, and 10% for services.
Planning
Expenditures on health care in China will grow dramatically over the next five years, potentially rising to 7% of GDP. HIT spending in China is likely to grow faster, with China's national goal of creating EHR and regional health information networks across China. Major IT improvements are currently being considered in many hospitals. The focus of future HIT development in China includes the following:
- electronic health records
- regional health information network for sharing electronic health data
- better integration of the various systems in each hospital, including approval of standards to support IT progress, and improved change management so that new IT systems will make Chinese hospitals operate more efficiently. To achieve this goal over the next few years, the hospital will involve experts for IT planning and implementation of new systems.
Challenges
Hospital information system
The progress of hospital information systems (HIS) in China has made significant progress in recent years. HIS has played a very important role in the hospital, and the construction and work of HIS can improve the efficiency and quality of health care work. But the development of HIS in China is not balanced and there are many problems such as nonstandard hospital management, poor standardization, and lack of software development consolidation. As a result, HIS is currently unable to meet the reform needs of the Chinese health care system. In the future, for the sake of sharing medical information, telemedicine, improving hospital efficiency, integration needs to be realized.
In recent years, Hospital Information System (HIS) has been developed in several areas. Many hospitals have built HIS. According to the Ministry of Health in 2004, there were 6,063 hospitals of 15,924 who have built hospital information systems. It is estimated that about 70% of the district and above hospitals have built HIS by mid-2007.
In 2004, the total cost of information technology (IT) in the health sector was estimated at RMB 3.5 billion (US $ 423.5 million), which increased 25% compared to 2003. Most resources are committed to HIS. HIS's construction has taken a good effect, which alters the hospital management style, offers tremendous opportunities to reduce clinical errors (such as medication errors, diagnostic errors), to support health care professionals (eg timely and current availability of patient information), to improve maintenance efficiency (eg less waiting time for patients), or even to improve the quality of patient care. Today, HIS is not only a symbol of modern management, but also one of the core competencies of a hospital.
Currently, with reforms in the health care system and the entry of the WTO, HISs faces many challenges in China. Medical domains will evolve into standardization and internationalization, which stimulate different class hospitals and many related organizations (eg insurance agents, financial organizations, community stations), into large integers. However, the HIS front did not consider the standard medical information, and could not share medical information.
Current status
Computers began to be used in hospitals in China in the 1970s, but were used as hospital information management since 1984. According to content, style and coverage, HIS in China underwent four phases. They are as follows:
- Stand alone. Mostly used in outpatient expenses, inpatient costs and warehouse management during the late 1970s and early 1980s.
- Local area network of departments. A representative application is inpatient management; outpatient costs and drug delivery systems, and drug management systems.
- Integrity of hospital information system. Many major hospitals build hospital information integrity systems on ethernet over 100m since the early 1990s.
- Telemedicine. With the development of IT and networking, many major hospitals are starting to learn
apply telemedicine, in which digital diagnostic images such as CT scan, MRI and CT ultrasound can be transmitted.
The first three phases focus on hospital information management and a patient-centered fourth phase.
In general, the development of HIS in China has made significant progress since the 1990s. According to several sample inquiries about HIS, there are many characters as follows: HIS development is unbalanced, differences across different regions are very significant. In more advanced areas, the proportion of hospitals with HIS is high, and HIS rates are also high, most are in the third phase, and some hospitals are in the fourth phase.
In fact, his HIS in many hospitals was no worse than in a foreign advanced hospital. On the other hand, the rate of HIS in the developing regions is low, the proportion of hospitals with HIS is also low, and most are in the second stage. But the potential market of HIS is very good. In 2004, the proportion of hospitals with HIS in Eastern China was above 80%, whereas, less than 20% in Northwest China.
"No. 1 Military Project"
"No. 1 Military Project" is important in China's HIS development. This project is a hospital information system consisting of more than 30 basic subsystems. It was developed by the PLA General Logistics Department in collaboration with Hewlett-Packard in 1997. The project has achieved success and enhanced the development of health informatics in China. So far, more than 200 hospitals have adopted this system. This HIS type has become a successful and advanced representative in China. The HIS of "No. 1 Military Project" was implemented at Xiaotangshan Hospital during the SARS outbreak in 2003. The patients suffering from SARS were treated and the system played an important and highly praised role by specialists.
Although the development of HIS has reached many, but most HIS concentrate more on hospital fiscal operations and administrative aspects. Only 10% of hospitals with HIS have developed a patient-centered Clinical Information System, while 5% build Image and Communication Archiving Systems.
Primary issues
While there has been good progress over the past two decades, especially over the past 10 years, there are many issues that limit further progress. The main problem is as follows.
Disadvantages of Standardization/Interoperability
Hospital information relating to medical care, education, medical research, personnel, money, and substance, et al. The unification of titles, concepts, classifications and codes is a basic prerequisite for information exchange. But the most difficult is the standard is not united. For example, the title and code of case reports, drugs, personnel, equipment, inspections and checks are different across hospitals. The definition, description and practice of practice for the same thing are different. Because without a dictionary of standardized unified and authoritative household data standards, as well as various HIS developed by various companies with different codes and standards, two bad results emerged. The first is that every hospital should develop a consumer dictionary, which results in wasted energy, money, substance and time. The second is the standard and the user dictionary is made differently, which affects the unit to the internet and can not share information. As discussed in the previous section, the HIS "Np.1 Military Project" is very good. Nevertheless, there are many problems in standardization. Results from some investigative investigators revealed that 99 tables of code should be consistent, but only 31 were consistent. Worse, 27 codes in 27 military hospitals have 27 formats. Using message standards, including Health Level 7 ( HL7 ), is a prerequisite for ensuring interoperability between different hospital systems. However most hospitals do not consider this issue and some HIS apply HL7. Only in some developed areas, such as Guangdong province, the government requires that HIS developers should adopt or refer to the HL7 standard to transmit patient clinical information. Reforms in Chinese health care systems require different class hospitals and many related organizations, such as insurance agents, financial organizations, community stations, can share and interoperate patient information. But the standardization of bad information in HIS can not meet the needs.
Integrated System Layout
The development began to accelerate since the early 1990s. All levels of health administration, hospitals and some information development companies invested enormous effort and money into HIS's development. Especially in the developed regions such as Beijing, Shanghai, Guangdong, Shandong, Jiangsu, HIS achieve success and have a larger scale. Yet the reasons for those without a plan as a whole and control for HIS by the health-related administration, without standards to comply with and without supervision by some related administrations led to the non-normative HIS development process. These are two bad results. The first is that HIS is developed for free, the software has no standards, therefore the developed platforms vary. The second problem is that HIS develops companies in different levels, and many of them do not specialize in HIS development, they are not familiar with the hospital management style and workflow, or they only know some specialized hospitals. In addition, some companies have the idea of ​​wanting immediate success and instant benefits, and are only considered current benefits without long-term investments. Some companies even think that the HIS market has potential, so they make some simple shared system packages, and take some steps to deceive the users. All of the above had a severe negative effect on his development.
Hospital Management Model
The hospital management model had a major influence on HIS construction. HIS implementation requires both structural technical and behavioral, and HIS development must be done within the context of development itself. Applications with HIS but without studying and absorbing have become a bottle of neck for HIS's development. Compared with hospital directors with MBA diplomas in the developed world, who manage hospitals, most hospital directors in China are good medical experts, but they are not familiar with modernization management. They have experience in management methods, but do not know normative management and science. When building HIS in their hospital, they usually request that HIS accommodate with their existing management mode even though their management mode is unscientific and unreasonable. In addition to the complexities of hospital management, work flow and circumstances in different hospitals are very different. To meet the needs of hospital management, developers must act in accordance with the actual circumstances, which causes HIS can not meet the needs of information communication and sharing due to low currency and commercialization. Good HIS should optimize the hospital process, but in many Chinese hospitals, this is not the case, poor hospital process flow compromises good HIS.
National standardization priorities
There are many problems in HIS construction in China, among which interoperability is one of the most important. The absence of a universal and consistent standard for managing and exchanging clinical and administrative information has been identified as an obstacle to exploiting and improving HIS. Therefore, one of the priorities in national standardization action is to accelerate the development of important standards for HIS. In fact, after several years of running information systems, healthcare providers recognize that standards are the basis for information sharing and interoperability. The Chinese government is also aware of the issue and has sought to build health information platforms and networks. One of the hypotheses is that standardization for health informatics is an authoritative field, in which market mechanisms do not work. Also, due to incentive imbalances, often providers who invest in standardization can not benefit directly, therefore they may prefer to invest in networks rather than in standardization. Governments may play a role to stimulate adoption by setting standards. In fact, the government is indeed taking steps to enforce the development of standardization. In 2003, the Ministry of Health released the National Health Informatics Development Layout (2003-2010).
The layout shows one of the principles of standardization for health informatics: combines the adoption of international standards and the development of national standards. At the end of 2003, the Leading Group for Health Informatics at the Ministry of Health initiated three projects to solve the problem of the lack of health informatics standards, including the China National Health Information Framework and Standardization, the Basic Data Set of Public Health and Data Sets Basic Hospital System Standardization (CBDSS). CBDSS is one of the important projects of the medical information standardization program, which will improve the progress of hospital information and the entire health system. China Hospital Information Management Association (CHIMA) undertakes the project task of CBDSS. The purpose of the project is to produce a set of standard data sets, which are necessary for HIS. Currently, most of these projects are completed, 11 subgroups and 1 group with CBDSS are formed. Since 2003, the government has launched more than ten projects related to health standardization in sequence, and substantial progress is made in standardization of medical information.
Theory of Dependency
Currently, the majority of HIS run in China is the Hospital Management Information System (HIMIS), and they can not share medical diagnostic information because of the various standards and formats adopted by various manufacturers. There are now HIS, Radiological Information Systems (RIS), Laboratory Information Systems (LIS) and Picture Files and Communication Systems (PACs) in many larger hospitals, each system running independently in most hospitals. With the development of health research and health standardization, this problem can be solved by HIS. In the future, for the sake of sharing medical information, telemedicine, improving hospital efficiency, extending medical services, optimizing work procedures, Himis will evolve into HIS-centered patients, all independent systems including electronic patient records will realize integration. Further, HIS will shift from supporting healthcare professionals to patients and consumers, from centralized to regional and global health information systems with expanded functionality and new tasks.
International cooperation
SGER: Transnational Public Health Informatics Research: US-China CollaborationSource of the article : Wikipedia
0 Comments