Implementation of a city-wide Health Information Exchange solution in the largest metropolitan region in China

摘要

Objective: Health Information Exchange (HIE) enables providers to share healthcare information electronically across different organizations to promote safer, more efficient, and less costly patient-centered care. This paper describes the development and implementation of a city-wide HIE system in Shanghai, China. Methods: In 2006, as a product of the Chinese healthcare reform, the Health Information Exchange and Sharing Platform was proposed as a means to facilitate HIE within Shanghai. In collaboration with the Shanghai Hospital Development Center, a state-run nonprofit corporate, the HIE project was implemented across multiple levels within the city. The HIE system is based on the Service-oriented Architecture and complies with industry standards. Results: On September 2010, the first and largest Chinese HIE system was established. As of 2016 the system includes all of Shanghai's 38 tertiary hospitals (highest level hospitals in China), plus 6 district hospitals, and 40 community health centers, with coverage for 39 million patients. The system currently provides a rich source of patient information including encounter history, medication history, laboratory results, radiology images and reports, and clinical notes. Initial outcomes indicate a significant reduction in medication errors and duplication of tests, saving at least 48 million RMB a year, with overall improvement in the quality of care following implementation. Conclusion: The adoption of HIE in Shanghai resulted in improved access to accurate, complete, and relevant clinical information in real time, thus facilitating delivery of high-quality, cost-effective, and efficient care.