Keep Faith and Strive Forward - HISA · Keep Faith and Strive Forward Development on China’s Hospital Information Systems ... Internet of Things Cloud Computing RFID Tablet PC PDA

SHEN TAO

Deputy Director

Chinese Hospital Information Management Association

Keep Faith and Strive Forward

Development on China’s Hospital

Information Systems

Chinese Hospital Information Management Association

Established in 1997, and attached to Chinese Hospital Association

The most influential HIT professional association in mainland China

CHIMA

Health Informatics Society of Australia

Established in 1992

Agenda

Background

HIT Construction Features in China

Obstacles and Challenges

China Healthcare Industry Brief

31 provinces and municipality cities 1.368 billion people 974.4 thousand medical institutions

24.7 thousand hospitals

9790 thousand medical staff 2795 thousand licensed doctors

Mainland1754

1998

2435 2812

3166

0

1000

2000

3000

4000

2009 2010 2011 2012 2013

bill

ion

China Total Health Expenditure

With the development of economy, the public have higher demands

for their health and pay more attention to healthcare service quality

Source: China Statistical Yearbook, 2014

Change on way of life leads to the result that chronic

disease become the main economic burden

Continuous growth on urbanization:

54.77% by 2014

Aging problem becomes more

serious: 212 million aged 60 and

above, account for 15.5%

Main Drivers of HIT Development

HIT

Government Policy

Medical Institutions Demand

IT Develop-

ment

Mar. 2009, the government launched medical reform

• Promote HIT construction that focus on hospital management and EMR

• Promote cooperation of urban hospitals and communities via IT

• Positively develop telemedicine that oriented on rural and remote areas

Nov. 2013, the overall framework of HIT construction is issued by the government

Rapid growth on healthcare demands

• Payment model reform (DRGs, zero drug price difference); healthcare service supervision and performance evaluation

• Cost control and fine management; work process optimization, better patient experience

• 4 levels of HIT platform

• 6 applications on public health, family planning, healthcare, medical insurance, drug management and comprehensive management

• 3 data bases for demographic information, EHR, EMR

• 1 private network

• 2 security systems

Rapid development and years accumulation of IT

• 30 years accumulation on healthcare institutions IT construction

• Emerging of new technologies: virtualization, cloud computing, big data, IOT, mobile……

Agenda

Background



38.8%

23.8%22.6%

21.0%

22.5%20.0%

0%

10%

20%

30%

40%

0

10

20

30

2010 2011 2012 2013 2014 2015(E)

Public Health

Healthcare Institutions

Growth

Source：CCW Research (2015)

68.0%

32.0%

27.8%

72.2%

28.3%

71.7%

29.8%

70.2%

30.7%

69.3%

33.0

12.2

15.1

18.6

22.5

billion

27.5

31.4%

68.6%

Investment Scale Keeps Growing

Hospital IT Investment in Latest 3

Years

19.2%

13.2%

17.0%

14.0%

24.7%

7.7%

0.9%

3.4%

0.0%

22.1%

2.4%

2.7%

7.8%

18.5%

17.0%

14.0%

12.5%

3.0%

0% 10% 20% 30%

Non-response

below 0.5

0.5-1

1-2

2-5

5-10

10-20

20-50

above 50

Tertiary Hospitals(N=335) Non-Tertiary Hospitals(N=235)

Source: Survey on China Hospital IT Status 2014-2015(CHIMA)

million

EMR Adoption

1

2

3

4What see is what get + structured module + free text entry is basically settled.Mainstream products functions become convergence

Advocated by healthcare administration bodies, generally accepted by doctors and the public

Government healthcare service supervision and performance evaluation.Real-time monitor on healthcare quality(urgent lab value, HAI).Important data source for clinical research

Higher CIS adoption rateAttention to system integration technology

Obviously Rising Attention on

Clinical Related Applications

EMR is generally accepted

Writing software become matureData utilization is

regarded gradually

Push forward the whole development of CIS

National Push on EMR Adoption

Experience based,

gradually generalize

43

2

1Feb 2010, 《The Basic Specification of EMR》

Sep 2010, 《EMR Trails Work Plan》

Dec 2010, 《The functional Specification of EMR》

Oct 2011, 《Model of EMR Grading(MEG)》

EMR Adoption Status

38.3%

34.6%

27.1%

21.2%

7.7%

71.1%

0% 20% 40% 60% 80%

No Plans Yet

Plan to Implement

Implemented

2014-2015(N=570) 2009-2010(N=926)

Source: Survey on China Hospital IT Status 2009-2010/2014-2015(CHIMA)

Drive All-round CIS Construction

5.6%

24.4%

0.0%

0.0%

7.9%

18.9%

0.0%

0.0%

3.1%

24.8%

22.6%

9.9%

0.0%

29.9%

31.4%

43.8%

27.1%

45.9%

48.0%

74.6%

8.8%

16.3%

16.8%

19.7%

23.2%

29.3%

32.6%

36.3%

36.8%

44.6%

45.8%

51.6%

52.6%

56.3%

58.1%

67.7%

71.1%

71.1%

74.2%

75.3%

0% 20% 40% 60% 80%

Regional Health Information…

Anesthesia Information System

Telemedicine system

Infection/HAI Surveillance System

Clinical Decision Support System

ECG Information System

Endoscopy Information System

Physical Examination…

Clinical Pathway Management…

PACS

Pathology Information System

ICU Information System

Clinical Knowledge Repository…

Ultrasonography Information…

Radiology Information System(RIS)

Laboratory Information System(LIS)

Electronic Medical Record(EMR)…

Outpatient and Emergency…

Inpatient Doctor Workbench

Inpatient Nurse Workbench

2014-2015(N=570) 2009-2010(N=926)


Model of EMR Grading(MEG)

Inpatient

Physicians

Inpatient

Nurses

Outpatient

Physicians

Ancillary Dept.

and Service

s

Laboratory

Procedures

Other Ancilla

ry Dept.

Records

Management

EMR Infrastructur

e

Order Entry

Lab Test Requests

View Lab Reports

Exam Requests

View Exam Reports

Inpatient Reports

Clinical Knowledge

Bases

Patient Assessment

and Management

Order Execution

Nurse Documents

Requests and

Appointments

Patient Records

Report Generation

Images

Order Entry

Lab Requests

View Lab Reports

Exam Requests

View Exam Reports

Clinic Visit Notes

Clinical Knowledge

Bases

Sample Processing

Result Records

Report Generation

Treatment Records

Surgery Scheduling,

Registration and Records

Anesthesia

ICU Monitory Data

Blood Preparation

Blood Matching

and Use

Outpatient

Pharmacy

Inpatient Pharmacy

Quality Control

Data Storage

E-authentication and

e-signature

Data Access Control

and Auditing

Backup and Disaster

Recovery

Item

sR

ole

sIt

em

s

2014 MEG Result

0

1

2

3

4

Inpatient

Physicians

Inpatient

Nurses

Outpatient

Physicians

Ancillary

Dept. and

Services

LaboratoryProcedures

Other

Ancillary

Dept.

Records

Manageme

nt

EMR

Infrastruct

ure

Eastern Middle Western

Source: National Institute of Hospital Administration

Grade 0

46.4%

Grade 1

10.4%

Grade 2

21.8%

Grade 3

15.3%

Grade 4

5.6%

Grade 5

0.3%

Grade 6

0.2%

Grades Description

Percentage, 2013

Amount

Percentage, 2014

Amount

7Fully-featured EMR and regional healthcare information sharing

0.04% 1 0% 0

6Close-loop medical data management and advanced CDS

0.16% 3 0.19% 4

5Centralized data management and consolidation of data from different depts.

0.21% 5 0.38% 9

4Hospital-wide information sharing and intermediate CDS

3.89% 94 5.61% 147

3Interdepartmental data exchange and primary clinical decision support(CDS)

13.05% 315 15.25% 400

2 Departmental data exchange 22.33% 539 21.78% 571

1 Departmental data collection 11.1% 268 10.41% 273

0 EMR not available 49.21% 1188 46.38% 1216

2014 MEG Result

2014 MEG Result2.9

22.4

6 2.8

42.2

0 2.6

72.7

91.4

83.1

73.2

91.9

82

.74

2.8

32.5

12.6

32.3

71.6

81.3

92.0

52.1

5 2.5

0

2.1

6 2.5

32.6

72.7

91.7

1 1.9

61.0

71.1

9 1.6

0

1.6

0

2.5

52.3

72.5

3

4.0

0

2.9

92.7

62.0

9

0.00

0.50

1.00

1.50

2.00

2.50

3.00

3.50

4.00

病房

医嘱

处理

病房

检验

申请

病房

检验

报告

病房

检查

申请

病房

检查

报告

病房

病例

记录

病房

医疗

知识

库

患者

管理

与评

估

医嘱

执行

护理

记录

处方

书写

门诊

检验

申请

门诊

检验

报告

门诊

检查

申请

门诊

检查

报告

门诊

病历

记录

医疗

知识

库

申请

与预

约

检查

记录

检查

报告

检查

图像

标本

处理

检验

结果

记录

报告

生成

一般

治疗

记录

手术

预约

与登

记

麻醉

信息

监护

数据

血液

准备

配血

与用

血

门诊

药品

准备

与调

剂

病房

药品

配置

病历

治疗

控制

病历

数据

存储

电子

认证

与签

名

病历

数据

访问

控制

系统

灾难

恢复

体系

病房医师病房护士门诊医师检查科室检验处理治疗信息处

理

医疗保障病

历

管

理

电子病历基

础

M-Health Application Continuous

Active

0.0%

0.0%

6.2%

10.9%

7.1%

20.7%

9.5%

14.6%

15.3%

20.2%

27.2%

45.8%

0% 20% 40% 60%

Internet of Things

Cloud Computing

RFID

Tablet PC

PDA

Wireless network

2014-2015(N=570) 2009-2010(N=1028)


Typical M-Health Applications

Outpatient Infusion Management

Mo

bile

Ward

Ro

un

d

Mobile Nursing

Typical M-Health ApplicationsM

ed

ical W

ast

eM

an

ag

em

en

t

APPs:AppointmentQueryGuidancePayment

Eq

uip

men

t Po

siti

on

ing

Data Value Gradually Showed

Co

mp

lian

ce C

heck

of

Med

ical In

sura

nce

Clin

ical P

ath

way

Man

ag

em

en

t

Use

Co

ntro

lo

f An

tibio

tics

Rem

ind

er o

f RD

U

Data Value Gradually Showed

HA

I Mo

nito

r

Lab

Urg

en

tV

alu

eA

lert

DR

Gs E

xpen

seA

nalysis

Clin

ical R

ese

arch

Focus on Improving Medical

Experience

Self-ServiceOne-Card Service ModelWeChat, Smart Phone

Example of Regional HIT

Construction

HIT private network in Fujian province:5 levels province, city, county, township and

village

86 healthcare administration bodies

1356 public healthcare institutions

10 military hospitals

37 private healthcare institutions

16000 village clinics in the future

Shanghai

•Blood Collecting and Supplying organizations

•Communities

•Comprehensive Hospitals

•New Village Cooperation Healthcare Institutions

•First-Aid Centers

•MCH Organizations

•CDC

Push Forward Residents Health

Card Regional trials in 29 provinces

Agenda

Background



Obstacles of HIT Development in

China

3.7%

3.3%

17.2%

20.4%

25.3%

25.6%

26.7%

38.4%

41.1%

41.8%

51.1%

67.9%

0% 20% 40% 60% 80%

Others

Unsuccessful Implementation of IT Plan

Lack of Legal or Policy Support

Lack of Clinical Leadership

Difficulty Achieving End-User Acceptance

Lack of Top Management Support

Lack of Strategic IT Plan

Lack of Medical Data Standards

Difficulty Proving ROI

Vendors Inability to Deliver Product

Lack of Staffing Resources

Lack of Adequate Financial Support

Source: Survey on China Hospital IT Status 2014-2015(CHIMA)

Rapid-growth but Insufficient

Investment

5.6%

9.4%

17.1%

0%

5%

10%

15%

20%

Total Health Expenditure as % of GDP

Imbalance of Regional Development

Different regions and hospitals present different HIT development levelEconomy

Leadership

Talents

0

1

2

3

4

Inpatient

Physicians

Inpatient

Nurses

Outpatient

Physicians

Ancillary

Dept. and

Services

LaboratoryProcedures

Other

Ancillary

Dept.

Records

Manageme

nt

EMR

Infrastruct

ure

Non-Tertiary

Hospitals

Tertiary

Hospitals

0

1

2

3

4

Inpatient

Physicians

Inpatient

Nurses

Outpatien

t

Physicians

Ancillary

Dept. and

Services

Laborator

y

Procedure

s

Other

Ancillary

Dept.

Records

Managem

ent

EMR

Infrastruct

ure

Eastern Middle Western

Lack of IT Talents

Critical shortage of multi-disciplinary talents in healthcare institutionsAverage IT FTEs in Chinese hospital is 9 (tertiary

12, below tertiary 5)──Survey on China Hospital IT Status 2014-2015(CHIMA)

Average IT FTEs in American hospital is 39──25th Annual HIMSS Leadership Survey

Difficulty in breaking through system dilemma in short termUnsatisfactory in education system

Long training cycle, Insufficient pay in return, Lots of temptation from outside……

Vendors Incapability to Meet Users

Needs

Lack of clear understanding on the complexity and difficulty of HIT industry needs for products development

Lack of professional talents

Low market concentration2622 hospitals attended MEG, 2014320 EMR vendors

Total users number of top 10 vendors is 796, account for 30.4%

Top 1 vendor’s user number 149, account for 5.7%

Source: National Institute of Hospital Administration

Top 10 Vendors, Number of Users,

2014

149

132

97

7670 66 64

5648

38

2.09

2.54

2.27 2.39 2.50 2.39 2.28

2.66 2.81

2.42

0.00

1.00

2.00

3.00

4.00

0

40

80

120

160

C62 C1 C17 C11 C15 C6 C19 C10 C13 C16

Ave

rag

e G

rad

e

Nu

mb

er

of

Use

rs

EMR Vendor Code

Low Degree of Standardization

5.6%

18.6%

3.8%

5.4%

21.8%

28.5%

38.3%

72.7%

3.3%

11.4%

5.4%

6.1%

37.7%

37.7%

52.5%

78.3%

0% 20% 40% 60% 80%

Non-response

Others

LOINC

SNOMED

HL7

ICD9

DICOM3

ICD10

2014-2015(N=570) 2009-2010(N=1028)


Conclusion

Developing Is an Unyielding Principle

Whoever seeks shall findQui cherche trouve

May this conference be a complete success!