Health informatics in China () is about the health informatics or medical informatics or healthcare information system/technology in China.
The main review and assessment of health informatics in China for the WHO-Health Metrics Network was conducted in 2006 which details Provincial assessments, developing strategic plan outline, improving community health monitoring system, household surveys, routine health statistics system.
Due to the Health Informatization Development Plan, all hospitals are required to increase investment in building digitized hospitals. This requirement is 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 its healthcare information systems (HIS) had increased by nearly 16 percent to RMB 5.8 billion, year-on-year. This amount accounts for approximately 0.5% of the country's total healthcare expenditures of RMB 866 billion during the same period.
The market size is expected to expand to approximately RMB 15 billion in 2010. The development of China's HIT industry is generally considered to be at a preliminary stage, resembling that of western countries 20 years ago. However, as China learns more about available and emerging technologies, it now has the opportunity to leapfrog ahead.
Healthcare overview
China spent $97 billion, or 5.5% of its GDP, on healthcare in 2004. As previously stated, public spending on healthcare remains low; public spending in 2004 accounted for only 17% of total healthcare expenditure while out-of-pocket expenses reached 53.6%.
About 130 million people are covered under the National Social Insurance Program for Urban Employees, a program established in 2005. Another 50 million people are covered through government insurance. Yet less than 30% of China's population has medical insurance. Indeed, over 35% of the urban population and 50% of people in rural areas have no coverage at all.
China's current healthcare system is primarily composed of large public hospitals, supplemented by a small number of private, for-profit hospitals. As of 2005, there were 18,703 hospitals in China. Among them, 2,027 were private hospitals (10.83%). Chinese hospitals can be divided into three categories: general hospitals (70%), traditional Chinese medicine (TCM) hospitals (14%), and specialty hospitals (16%).
In addition, China has 5,895 outpatient facilities: 1,266 outpatient facilities and 541 traditional medicine facilities. As of 2005 China had 1,938,272 registered doctors who are primarily employed by hospitals.
History The reform and opening up in the early 1980s resulted in major changes in China's healthcare system, especially as a result of the dismantling of the rural cooperative medical system. After being given considerable financial independence, hospitals began to generate the majority of their income through user fees, a practice that continues today. Healthcare is now provided on a fee-for-service basis. The pricing structure attempts to facilitate equity by providing basic care below cost, with profits reaped through the (often excessive) sale of drugs and high-technology services; this structure leads to inefficiency and inappropriate patient care. Healthcare insurance coverage in China is low, with less than 30% of the population receiving any medical insurance.
China's health information technology HIT development has a brief history. Development commenced in the mid-1990s with financial management systems; only in the last five years or so have clinical systems been implemented. China has made progress in a relatively short time period, but weak application software and a scarcity of implementation skills delay further progress. Most Chinese hospitals are attempting to dramatically improve and extensively digitize their work processes in the near future.
Project on Construction of National Public Health Information System The work group of the Ministry of Health for information construction has drafted the Project on Construction of National Public Health Information System. The "Project" confirmed the guideline, objectives and principles of public health information system construction, proposed framework for further actions. On September 17, 2003, information construction workgroup of the Ministry of Health held a Meeting via television and telephone on construction of public health information system in China. The agenda included a work report in the field of information construction of the Ministry of Health, the introduction of Construction Project of the National Public Health Information System (Draft) and a report from the National Center of Disease Control on relevant requirements of SARS report system via network.
Mortality statistics As part of a major revamp of its health information system, China is merging two systems for collecting mortality data to gain a more accurate picture of how many people die and why. Cause-of-death data are playing an increasingly important role in the public health policy of China. Recently, Chinese Center for Disease Control and Prevention took part in a research project led by the Center for Statistics of the Ministry of Health on the disease burden and long-term health problems in China; the results were dramatic.
HIT Adoption Health information technology is now entering its second software generation in China, and IT usage in hospitals resembles that of the late 1970s in the United States. Most hospitals in China incorporate IT software into their payment and billing systems, and many have also begun integrating IT into clinical systems in the past five years.
The use of IT in clinical systems has emerged on a departmental basis. As a result of inexperience with IT infrastructure, however, hospitals have encountered several obstacles. Fragmentation, duplicative systems, and poor integration between diverse software systems have created "information islands" that impede data sharing.
Three valuable lessons are evident from China's HIT development over the past ten years:
Medical information should be integrated across all departments in the hospital. Poor integration of diverse software systems within hospitals impedes inter-hospital information exchanges and creates problems as IT use expands. In order for IT systems to benefit clinical services and hospital management, effective overall IT planning is necessary. Oversimplification of IT planning and a lack of clinician engagement have in the recent past led to poor return on investment (ROI) in HIT. Implementation requires not only strong project-management skills but also attention to end-user requirements and needs as well as to work processes re-engineering. Poor implementation has resulted in a large amount of work-process redundancy.
Government policy The Chinese government adopted an "informatization" approach in the 1990s, promoting IT development in all major industries, including the health sector, with one goal being to bridge the information divide. HIT policy began in 1995 with the "Golden Health Project," which sought to create the foundation for electronically linking health administration departments and hospitals as well as medical education and research institutes. Government efforts in the 21st century increasingly focus on health IT. For example, the 2003–2010 Ministry of Health Guidelines for HIT Development in China call for the introduction of EHRs and regional health information networks to be implemented throughout the country. Many hospitals are considering system-wide upgrades, and larger budgets are more readily available for these kinds of investments.
Organizations The Ministry of Health within the government and independent hospital administrators are the primary drivers of HIT adoption in China. Following the SARS epidemic, the Chinese government realized the importance of integrating an effective IT infrastructure into the country's health system. Additionally, after a decade of small investments in IT systems hospital leaders have become aware that IT can improve work processes and increase management efficiency.
Many other associations involved in HIT exist in China, including the National Medical Information Education (NMIE), Association of Chinese Health Informatics, Chinese Health Information Association, and Chinese Hospital Information Management Association (CHIMA). CHIMA is a branch of the Chinese Hospital Association, a nonprofit national industry and academic association focused on Health IT (similar to the AMIA in the United States).
Funding Provincial and local governments in China are the primary funders for regional health information networks and HIT in public hospitals. The national government facilitates investigation of standards and IT infrastructure development. Hospitals invest their own funds into clinical and institutional HIT systems. As of 2006, China spends a little over 0.7% ($700 million) of its national health budget on HIT. Of these funds: 70% goes toward hardware, 20% toward software, and 10% toward services.
Planning Spending on healthcare in China will grow dramatically over the next five years, potentially rising to 7% of GDP. HIT spending in China will likely grow even faster, with China's national goal to create EHR and regional health information networks throughout China. Major IT upgrades are now being considered in many hospitals. The focus of future HIT development in China includes the following: Electronic health records Regional health information networks to share electronic health data Better integration of diverse systems within individual hospitals, including agreement upon standards to support IT progress, and better management of change so that the new IT systems will make Chinese hospitals operate more efficiently. In order to accomplish these objectives over the next several years, hospitals will involve experts for IT planning and implementation of the new systems.
Challenges Issue Description Chinese software in its infancy Chinese hospital application software currently has limited capabilities, and Chinese software vendors are not as experienced in healthcare applications as foreign vendors. Proven products for clinical information systems do not yet exist. Lack of skilled HIT professionals Skilled workers with IT and healthcare and hospital management knowledge are lacking in China.Lack of strong change management expertise Strong change-management expertise is missing in China. The great challenge facing many Chinese hospitals is that they have limited experience to manage the changes after implementing major IT systems. Thus, many hospital leaders are hesitant to increase IT investment.Shenzhen Regional Health Information Network (RHIN) The Chinese government established as a national goal the implementation of a series of RHINs supported by digital hospitals throughout the country by 2010. The Ministry of Health selected the city of Shenzhen as a pilot site for the development of these RHINs.Chinese CDC surveillance system Responding to a request by the Ministry of Health in 2003, the Chinese CDC created a national web-based surveillance system for 37 communicable diseases to receive direct reporting from the majority of hospitals at the county level and above and from more than half of hospitals and clinics at the township level.Lack of strong change management expertise Shenzhen will support this RHIN by digitizing all of its hospitals, thus creating more efficient work processes and better management systems to improve healthcare delivery. The Ministry of Health hopes that the Shenzhen RHIN will become a model of what can be done in all across China.
Hospital information system