1、China National EHRHow Far We Are?,Huilong Duan, Ph.D.School of Biomedical Engineering & Instrument ScienceZhejiang UniversityEmail: ,Global Challenges in Health Care,Cost-containment and affordabilityExpanded accessHigh quality of health careChronic disease management (e.g. Cardiovascular diseases,
2、diabetes)Infectious disease prevention and management (e.g. H1N1 Flu, AIDS, SARS, TB),Current Health Care in China,Uneven distributed & limited health care resourcesLimited medical insurance coverageIncreasing costs,57% population in rural areas 80% hospitals in cities,Large amount ofmigrant people(
3、0.147 billion),Limited health Infrastructure(2.75 bed/1000),Aging population(0.144 billion),32 % 17% government48 % 29% society20 % 54% private,government,society,private,“Difficulty and high cost in seeking medical service” is the TOP ONE concern!- Society of China Analysis and Forecast Blue Book,
4、2007,Medical Expenses in China,Reform to Provide Better Health Care,Rural health,Public health,Community health,medical insurance systems that will cover all urban and rural residents.,Rural health,Public health,Community health,medical insurance systems that will cover all urban and rural residents
5、.,Establish national essentialdrugsystem,Health Care Reform in China,HIT Supports in the Reform,e-governmentWeb Port,e-hospital,Rural Cooperative Medical System,e-Health,5 Systems in Public Health,EHR is Critical in e-Health,Personalization,Regionalization,Passive treatment to proactive preventionSe
6、amless access to health services,Medical and health technologybased on modern electronics, engineering, information and bio-engineering,Isolation of the medical resources to subdivision, share, synergy regionalization,Electronic health record as the core Resources sharing as the basic,County or city
7、 level hospital,Data center,Government agencies,Urban and rural community health service agencies,City hospital,Related medical and health institutions,Citizen,HealthcareFace-To-Face,Health service,Informationization,Case 1: Communityhealth service in Dongchengdistrict ofBeijing,Case 2: Health Infor
8、mation System in Xiamen City,Regional Health Data Center,e-CDC,e-Community Healthcare,e-Hospital,e-Health Administration,e-Health Supervision,e-family healthcare,Up level health data center,Bank,Price Control,Supply,Drug administration,Civil Affairs,Insurance,Case 3: Regional health information netw
9、ork (医联工程) of Shanghai,GoalConnect hospitals and share medical informationImprove HIT adoption in hospitalsProvide economical and convenient healthcareFirstphaseShare information among hospitals: patients basic information, medical record, laboratory result, medical image and reportWeb port: query,
10、consult, appointmentPublic Health: statistics, monitoring,Avoid unnecessary repeated lab test and medical imaging examination,Case 4: National e-Health Key Technology and Regional Trial Implementation in Zhejiang Province,Supported by Ministry of Health, Ministry of Science and Technology, and Zheji
11、ang Province7 tasks to evaluate key technologies and the applications in e-health,Zhejiang Province22 regionsCovering 8 million population,Task 1：EHR modeling,Define health meta data and data sets from fetus to death Model EHR to cover all the key health points of entire life Define the services to
12、integrate all the health information together,Health care service cover the entire life,birth,death,Task 2：Standards and specifications development,Cooperation with organizations such as Ministry of Health, ChineseAssociation of Health Information, Standardization Administration of China, to develop
13、 and integrate standards that will meet the needs of e-health,Data classification and coding specification,Data collection and exchange norms,Standardize business processes,“Health Record basic infrastructure and data specification”(on trial)“EMR basic infrastructure and data specification” (Draft),
14、Task 3：Applications development on EMR,Advanced clinical information systemsData mining and analysis technologies on EMR,Task 4：Regional health information exchange platform,hospitals,community health service center,citizen,bank,supplier,pharmacy,business insurance,government,social insurance,blood
15、station,antiepidemic organization,maternity and child healthcare,health supervision,emergence center,Regional Data Center,Task 5：EMR based Tele-medicine platform,Task 6：Prompt clinical pathway and other CDSS adoption in hospitals,Task 7：Regional implementation and evaluation,Every 1,500 residents ha
16、s a family doctorHealth examinations for EHR (free of charge) every 2 yearsDepends on the adoption of HIT,Starting in 2009, a unified health record for all residents will be established throughout the country, promoting equality in right to basic health service - National Human Rights Action Plan of
17、 China (2009-2010)Focus on developing regional health information platform upon resident electronic health record, and hospital information platform upon EMR - major work plan of Ministry of Health in the year 2009,EHR related Actions in China,Establish a National EHR in China,Three major challenges
18、:,Interoperability Health policy levelHealth services levelSemantic levelTechnical and functional level Security and privacyLaws, regulations, and standardsSecurity and privacy educationTechnical practicesThe costGovernment role in investment,Semantic Interoperable EHR,Generic reference models for r
19、epresenting clinical (EHR) data e.g. EN 13606, HL7 CDA, openEHR Reference ModelAgreed clinical data structure definitions e.g. openEHR archetypes, HL7 templates, generic templates and data setsClinical terminology systems e.g. LOINC, SNOMED-CT,StandardizedArchitecture,StandardizedInterfaces,Standard
20、izedDataStructures,StandardizedDataVocabularies,StandardizedFunctional Behaviour,Major difficulties to achieve interoperability,Chinese version medical terminology standard, code systems and message exchange standardManagement and regulation lag behind the requirement of HITAgreed EHR/EMR conception
21、 and recognitionStandard-based HIT systems and productsClinical informatics research and knowledge base support,Difficult to share data between information islandsClinical information system adoption is low, clinician get insufficient benefits from HITRepeated low-level HIT applications exhausted mo
22、st of the investment,Security and Privacy,MOH “Measures for the Administration of Electronic Certification Services in Healthcare (on trial)” begin trial implementation at Jan. 1, 2010Privacy & Security standard and implementation specifications like HIPAA in the US are not available Should coordina
23、te with interoperable architecture design work and general privacy legislation procedureElectronic certification service provider is needed to support the future national EHRBoth clinicians and patients lack security and privacy consciousness,Governments role,Standard maker,Systemdeveloper,Strategic
24、 investor,StrategyPlanner,Policy maker,Industrysupporter,Best practice promoter,Infrastructureconstructor,Constructionsupervisor,Systemoperator,Many roles for the government to choose in e-health. Different role has different cost and riskPlanner and investor,HIT standards break out in China,Health
25、Record basic infrastructure and data specification (on trial) at May 19, 2009.EMR basic infrastructure and data specification (Draft) at August 4, 2009. Technical Solution for Regional Health Information Platform based-on EHR (on trial) at December, 2009National Health Data Dictionary and Meta Data
26、Management System at December, 2009 Measures for the Administration of Electronic Certification Services in Healthcare (on trial) at December, 2009Electronic Medical Record basic specification (on trial) at March, 2010,Ministry of Health of China published several HIT standards since 2009:,A Study o
27、n Information Infrastructure of A nationwide EHR,Jointly funded by China NSF and Chinese Academy of EngineeringPart of the study on national long term development strategy of engineering science and technology of China,Project Director: Huilong Duan,National EHR Roadmap,2010,2020,2030,Preparation &T
28、rial(2010-2016),Construction &Development(2017-2025),Operation &Refinement(2025-2030),201550% 3-level hospital30% urban community health center20% rural hospital or clinicAdoption interoperable EMR/EHRDemonstration regional EHR,202080% 3-level hospital50% urban community health center50% rural hospi
29、tal or clinicAdoption interoperable EMR/EHREstablish above 10 province level EHR systems.,2025100% 3-level hospital90% urban community health center80% rural hospital or clinicAdoption interoperability EMR/EHRA nationwide interoperable health information network formed,Preparation and Trial (2010-20
30、16),TasksMedical informatics basic constructionEnterprise information constructionRegional EHR demonstrationPlans in detailEstablish a national organization to lead and coordinate the national wide Health IT efforts and responsible for drawing the detail blue print of National EHREstablish professio
31、nal standard organizationsModify and new law and regulation adjusting to e-health Healthcare information security and privacy actEMR regulationLaunch finance and policy to accelerate standard-based interoperability EMR adoption in hospitals,Construction and development (2017-2025),TasksWidespread st
32、andard-based interoperability EMR in hospitals National EHR infrastructure constructionPlans in detailNationwide high speed networks for health information exchangeConstruct national standard EHR information infrastructure, such as Identity, Service, Auditing Service, Encryption Service, User Authen
33、tication Service, et al.Promote knowledge systems and applications such as clinical decision support system, digital clinical guideline, clinical pathway Promote self-care and household medical systems and devices integrated in the EHROnline billing in the new medical security systems, develop fundi
34、ng monitoring tools,Operation and refinement (2025-2030),TasksRefine the operation mode and regulation systemA complete e-health system based on national EHRPlans in detailEstablish professional national EHR operator, gradually operates in market modeStudy the deep utilization of national EHR data r
35、esource and add value for enterprise connect in national EHR networksPopularize the self-care and family-care health service supported by professional systems and applicationsAccelerate the new healthcare service modeCommunity health deal with most of the health problems3rd level hospital only accep
36、t transfer patient from GP,EHR in translational medicine,Integration of genomic information in EHR may lead to genotype-to-phenotype correlation analysisChina national EHR, on 1.3 billion persons health and medical data and information, will have a significant impact on translational research,Standa
37、rd semantic interoperable EHR provide the possibility to reuse the data for research purposes,Colorectal Cancer Translational Research Center at ZJU,Participating institutions- School of Medicine- Sir Shaw Run Run Hospital - School of Biomedical Engineering & Instrument ScienceProvide efficient comm
38、unications and resource sharing between biomedical and clinical researches in colorectal cancerBenefit patients with medical discoveries,Information infrastructure to enable translational research,Translational EHR in future,China National EHR long way ahead,Most of the hospitals still use paper-bas
39、ed medical recordsCurrently available standards are far from enough for e-healtha common problem in most countries, especially in ChinaLack of professional talents in both research and industrymedical informatics education just beganShort of products and systems in the marketSome social obstacle will exist for a long timehospitals unwilling to share their dataclinician unwilling to change their workflowpeople unwilling their privacy under risk,Thank you!,
