A Field Trial On Promoting The Application Of Electronic Health Records In Rural Grassroots

Objective：To research the appropriate and valuable mode that promotion and application ofelectronic health record (EHR) in economically less developed areas. Providerevelation and reference for other less developed regions to promote their EHR.Method：Select10populous ones in16townships as test point. According to rural doctors’education, age and service population, choose two adjacent community health servicestations (CHSS) from each township as object of study. Interventions includeleadership development, improving software systems, training health workers,developing relevant systems, development of special incentives, personalizedintervention for village doctors. Project team launched the baseline survey in October2011and the final survey in March2012. Through datas were analyzed by horizontaland vertical comprehensive comparison before and after the expirenment, evaluateeffects of project implementation.Results：1. Satisfaction of residents for CHSSs: After the intervention, the proportion of goodtreatment environment and simple procedure respectively increased from6.7%and18.2%to20.5%(Z=-10.129, P=0.000) and32.0%(Z=-4.002, P=0.000). Theproportion of village doctors always using electronic health records increased from7.4%to35.3%(Z=-8.824, P=0.000). After the intervention, the proportion ofsatisfactory and optimal treatment attitude and cost increased from68.5%and48.2%to88.8%(Z=-12.180, P=0.000) and61.5%(Z=-3.415, P=0.001).2. Satisfaction of village doctors using EHR: After the intervention, the proportion ofsatisfactory and optimal operation interface, basic medical Settings and public healthsettings increased from15.0%,40.0%,40.0%to75.0%(Z=-4.095, P=0.000),65.0%(Z=-2.055, P=0.049) and75.0%(Z=-2.115, P=0.034).The proportion ofsatisfactory and optimal EHR login speed increased from10.0%to60.0%(Z=-3.952,P=0.000). The proportion of satisfactory and optimal for improving and operating repair EHR increased from25.0%and40.0%to80.0%(Z=-3.239, P=0.001) and80.0%(Z=-2.656, P=0.012).3. Online survey of village doctors using EHR: After the intervention, EHR updaterate increased from32.7%to57.9%(χ2=-163.848, P=0.000). Compared withbaseline survey, the proportion of complete health management information ofhypertension in trail group and control group (Z=-9.113, P=0.000and Z=-6.150, P=0.000) were significantly improved, trial group were higher than control group infinal survey. The proportion of complete basic medical information in trail group andcontrol group (Z=-14.374, P=0.000and Z=-10.332, P=0.000) were significantlyimproved, trial group were higher than control group in final survey.Conclusion：1. The experiment proved the project established a model included leadershipdevelopment, improving and integrating software, training the medical staff,establishing service specifications, developing incentive policies and regularobservation and guidance.2. The study shows that this model could promote village doctors to use EHR,improve their efficiency and quality of work and improve villagers’ satisfaction withvillage doctors.3. This mode is suitable， viable and worthy for less developed rural areas.Government investment does not need invest a lot, no additional costs and specialhealth workforce， nor do need a lot of institutional issues. It gives inspiration andreference to other economically less developed areas.