A Comparative Study On EHR Evaluation Between U.S And China

ObjectiveIn recent years,the central government and the local government at all levels have stepped up policy and fiscal support for medical informatization,thus creating an unprecedented good policy context for the development of medical and health informatization.China’s major hospitals have established various information systems,such as HIS,PACS,LIS,EHR,hospital integrated platform,regional health information platform,and remote medical platform.In this campaign,the establishment of electronic medical record system constitutes the focus,and how to evaluate the requirements on the electronic medical record has become an important issue.China and the United states respectively established the application and evaluation standards of electronic medical record in 2010 and 2009.This study aims to compare the contents and promotion of the standards in both countries.First,this paper will focus on the differences in the the contents of the evaluation standards of China and the US,and second,it will examine the promotional effect of the two standards in the past years,the influencing factors,the policies that can be mutually drawn on,and the suggestions for improving the application and evaluation of China’s electronic medical record.MethodsThe major methodologies of this paper include literature study,comparative study and expert interview.In terms of literature study,the author focuses on the period between January 1,2005 and December 30,2015,and conducts document search by key word searching in seven databases,including ELsevier,Springer-link,Pubmed,EBSCO,CNKI,Wanfang,and VIP.On the basis of reading the documents,other documents are manually supplemented.On the basis of literature study,the paper compares the US’ Electronic Health Record Incentive Program("meaningful use" standards)and China’s Grading Evaluation Method and Standards for the Level of Functions and Application of Electronic Medical Record in terms of evaluation standards,evaluation methods,and evaluation procedures,explores the differences in the evaluation of electronic medical record in the US and China,sums up related problems and suggests solutions based on expert interviews.Assessing the equivalence of American standards and Chinese standards,using the Kendall harmonious coefficient to prove the consistency.Finally,drawing on the Structure-Process-Outcome model and in three parts-organizational system,process management,and policy outcome,the author systematically compares the promotion of the application standards of electronic medical record in China and the US,and evaluates the promotional effect of the evaluation standards in practice by looking at the adoption rate of the evaluation standards by the hospitals in the two countries.Then the author analyzes the influencing factors in the different promotional effect from organizational system and process management,and proposes policy recommendations on for promoting electronic medical record in China according to the current development status of China’s electronic medical record.Results1.With regard to the "Meaningful Use(MU)"of electronic medical records,the Objectives of Eligible Hospital is 24 in Stage 1,22 in Stage 2,which are in horizontal comparison with 37 evaluation items for the application level classification of Chinese electronic medical records,namely 15 and 12 cases respectively to different levels of Chinese standards;according to the Chinese standard,17 items pay attention to the hospital internal process evaluation project,which has no corresponding standard in the United States.2.Via expert interviews and survey feedback,the results demonstrate that the evaluation standard of the United States is closest to the fourth level of Chinese,of which the Kandall Coefficient of Concordace is 0.870 and 0.888 respectively(P<0.05).3.From the policy output effect of comparative analysis,the participation rate of America hospitals for the "Meaningful Use" of electronic medical records reached at 85%in five years,which is much higher than that of 39%to the evaluation criteria for the application of Chinese electronic medical records(P<0.01).4.As for the analysis of comparison organization system,from aspects such as strategy,access mechanism,standard collaboration and evaluation approval,etc,three institutions,namely ONC,CMS and HITSP,jointly promote the application of electronic medical records and evaluation work on personnel training,demonstration community,regional support and so forth,which can be concluded that the organization system of the U.S.electronic medical records application evaluation is more mature;China currently only has a pilot electronic medical records office which is responsible for the evaluation of the assessment work,in lack of top-level design organization,as well as standard coordination mechanism,leading the relatively weak overall system and less supporting measures.5.Apropos of the comparison analysis of process management,the American standard has been updated for three times,provided with the incentive plan of electronic medical records,through the economic stimulus to encourage the use,driving for the standard promotion;since the promulgation of Chinese standard in 2010,there has not yet been updated,also without any relevant incentive feedback mechanism.Conclusion:1.The reasons that Chinese standard coverage is far lower than MU in U.S.may include:1)the imperfect organization;2)lack of systematic supporting measures;3)lack of economic incentives.2.The policy formulation for EHR in Chinese should fully realize the complexity and long-term nature,as in the strong policy support,perfect organization,supporting actions,American promotion plans were still repeatedly frustrated and postponed,so under the circumstance of unfavorable conditions,Chinese medical institutions when develop electronic medical records,as well as the promotion plan for health big data,need to be equipped with clear understandings about it.3.We should pay full attention to the top-level strategic design of electronic medical record promotion,that shall not only focus on the standard content,but need to be more clear about the application of electronic medical records to formulate a long-term guiding plan,pay attention to the output performance,promote large medical institutions to adopt electronic medical records at the same time,and also are required to catch concerns of small hospitals and clinics on the application of electronic medical records.4.The evaluation action should focus on the entire system,so as to form evidence-based decision-makings,continuously adjust,promote standards that can be updated depending on the needs of different stakeholders and the development of the times,and maintain the effectiveness of standards and prospective.5.We shall also learn from the American experience to take advantage of the Medicare/Medicaid funds compensation as economic incentives,in order to promote coordination between diverse stakeholders,improve the efficiency of the whole society that can obtain better benefits,and provide sustainable impetus to the development of evaluation standards.