At present, China's medical informatization construction is still in its infancy. What elements should be included in medical informatization, what are the difficulties in the construction process, and what are the future prospects? Ning Yi, director of the Information Center of the General Logistics Department of the People's Liberation Army, Chen Xuecai, deputy general manager of Tianjian Technology Group, and Li Baoluo, a medical information expert, shared their views.
What are the elements of medical information construction?
Chen Xuecai: I believe that regional medical informatization construction should be divided into three aspects: first, there must be an integrated engine, including the engine of data integration and the engine of process integration, integrating medical information; secondly, there must be resources that can be integrated. Including process integration and data integration to form a complete data center that can help medical services; the third is the application, which needs an environment suitable for future development, in which various applications, including process reengineering, are launched. Applications, applications for clinical decision support, etc.
Ningyi: The Ministry of Science and Technology, the Health Planning Commission and the military health department are doing some exploratory research to study the modes and specific practices of regional medical informatization. There are many factors to be considered in the creation of a regional medical informatization model, such as research on policies and regulations, such as whether personal health big data can be opened for commercial opening. At present, there is no such regulation in China.
Also, a lot of creative work is required in the sharing of networked medical resources or patient information. For example, the formulation of information standards, China is still relatively weak. Our information interfaces - including medical devices , data structures of various types of HIS systems, and data standards are different, and it is difficult to share information on a regional scale. For example, during the SARS epidemic in 2003, we encountered this problem at Xiaotangshan Hospital. Because of the lack of a unified information standard, patient information cannot be shared. Doctors in other hospitals can only rely on handwritten patient information and then fax the information, which is very inconvenient. Although Xiaotangshan Hospital and local hospitals have their own information systems, the data standards and formats are different, and there is no effective interface for information sharing.
Moreover, in the operation process, how to communicate and share information between the upper and lower hospitals is also a problem. For example, the diagnosis of a higher level hospital, how to recognize the lower level hospital? In addition, in some underdeveloped regions, the financing of networking, equipment purchase, technology and personnel training must be considered. At present, the cost of community medical institutions is basically that the state pays the bills. The hospitals above the second and third grades generate income from themselves and have the resources to carry out informatization construction. However, it is difficult for community hospitals and medical institutions in underdeveloped areas to have funds for information construction.
Li Baolu: First of all, there must be a network covering the wide area network of the region. There must be an organization that can control this network and be able to coordinate stakeholders in the region. These stakeholders include residents, patients, medical institutions, health departments, medical insurance departments, and information builders. Without the management of this organization, it is impossible to achieve regional medical information sharing.
Where is the difficulty in building regional medical informationization?
Chen Xuecai: From a technical point of view, I feel that there is no difficulty, no matter whether it is software or hardware. The software is divided into two levels, one is applied, and the other is an integrated platform. There is no standard for integrated platforms in China, but there are standardized platforms abroad, and we can learn from foreign experience. With the platform, you can apply development on it. From the hardware point of view, building a regional medical information system is nothing more than a server, storage equipment, this is just an investment problem. If the surrounding small hospitals are collaborated with the top three hospitals, the hardware investment will cost about 30 million yuan. But most hospitals do not have this economic ability. There is a question of who pays the bill.
Li Baoluo: Chinese people complain that it is difficult to see a doctor, but there are very few complaints about the quality of medical care. Even in big cities, this kind of appeal has not been shown. In foreign countries, prevention of medical errors and improvement of medical quality are considered first. The involvement of any new technology is demanded rather than technology driven. Moreover, foreign countries generally believe that IT technology is ready, but in China, is IT technology really ready?
The weakness of the informationization foundation of medical service institutions is also a major obstacle to the realization of regional medical informationization in China. How many patient allergies are there in the computers in China? How many hospitals have stored the results of the laboratory tests in the computer? These are all information that is closely integrated with the clinic. We have conducted a statistic that 60% of hospitals have realized computer storage of laboratory results, which is the highest in computerization in China. However, laboratory information systems have different concepts, some of which are only for pricing and billing, and some include laboratory results. Moreover, our survey is more concentrated in developed tertiary hospitals and high-end hospitals in developed regions, with more than 400. In fact, among the 18,000 hospitals in the country, more community medical institutions are not included, and perhaps only 10% or 20% of hospitals have achieved computerized results of laboratory tests.
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