Key influencing factors of vertical integration of electronic health records in medical consortiums

https://doi.org/10.1016/j.ijmedinf.2022.104959Get rights and content

Highlights

  • An index system of influencing factors for vertical integration of electronic health records in the medical consortium was established.

  • A multi-layer hierarchical structure model of key influencing factors is obtained.

  • Three paths of interaction of key influencing factors for vertical integration of electronic health records in the medical consortium was found.

Abstract

Background

Similar to other countries around the world, China has incorporated the recording of electronic health data into its national strategy. After the completion of the decentralized construction phase, the construction of electronic health records in China has reached the stages of integration, sharing, and utilization. “Vertical integration” is the premise and foundation of “shared utilization” of electronic health records within the medical consortium, but it is also a bottleneck in realizing this goal.

Objective

The main purpose of this paper is to find out the key factors affecting the vertical integration of electronic health records in the medical consortiums, and to clarify the impact mechanism of these key factors, so as to provide reference for improving relevant policies.

Methods

In this study, an index system of influencing factors is established for cross-institutional vertical integration of electronic health records within a medical consortium, identifying key influencing factors using the combined fuzzy-DEMATEL-ASIM method and revealing the influence relationship and action mechanism among the key influencing factors using a multi-layer hierarchical influence structure model.

Results

There are 32 factors influencing the vertical integration of electronic health records in the medical consortium, 17 of which are key factors. According to the hierarchical structure of key influencing factors, they can be divided into three categories: surface-level factors, middle-level factors and deep-level factors.

Conclusions

In practice, these key factors should be prioritized for improvement and optimization to promote integration projects. In the future, we should focus on key influencing factors to precisely implement policies, such as introducing special promotion policies, unifying development planning, changing health insurance payment methods, establishing sharing standards, and raising public awareness.

Introduction

Electronic health records (EHRs) refer to systematic digital records of health information, such as medical treatment, chronic disease management, immunization, genetic history, and infectious disease prevention and control in the entire life cycle of residents through various collection channels [1]. Most countries in the world regard EHRs as the focus and breakthrough point in the reform and development of medical and health services, and incorporate it into the national strategies as an important infrastructure for health management informatization. The development of EHRs in China follows a realistic path of “independent construction, vertical integration, and shared utilization”. EHRs were built by each medical and health institution separately in the independent construction stage, which achieved a breakthrough from scratch, and the construction was effective and widely applied in hospitals. “Vertical integration” is the premise and foundation of cross-organizational “shared utilization”, key to the application value of EHRs, but it is also bottleneck to achieving the goal of “shared utilization”. However, the vertical integration of EHRs means that the interest structure of all parties will be reshaped. In reality, there is a common problem of “poor sharing mechanism and insufficient application motivation”, which leads to a slow process of sharing EHRs, resulting in a dilemma in the implementation of relevant policies.

The construction of EHRs is a major system project involving a wide range of aspects, and the complicated influencing factors have attracted extensive attention in various countries. However, researchers from different countries have reached different conclusions. For example, language issues, resistance to change and innovation, data ownership, and lack of access to national patient identification codes are important constraints to successful EHRs implementation in Morocco [2]. And price value, effort expectation, and convenience are key factors that influence the adoption of EHR technology by Egyptian consumers [3]. Akhlaq et al. identified political will and financial commitment as indispensable factors to improve hospital information interaction on a large scale [4]. E. Ndabarora believed that poor data quality, poorly managed hospital information systems, and low health information utilization are the main obstacles to EHR implementation [5]. Since 2003, the sharing of regional healthcare information with EHRs as the core has received intermittent attention from Chinese researchers, focusing on EHR management [6], collaborative platforms for shared services [7], privacy security protection [8], new technologies application such as blockchain [9], and willingness to share [10], etc.

Research on the factors influencing EHRs has become one of the most popular topics. however, previous studies have shortcomings. First, most of the relevant research is limited to the integration of medical information within an institution, and the entry perspective is more focused on the technical implementation of the existing management model. Second, most of the studies focus on the specific application, but pay insufficient attention to the key factors that guarantee the smooth implementation of EHR vertical integration. Therefore, we focus on the analysis of the key factors affecting the vertical integration of EHRs within medical consortiums. The results of the study can effectively reveal the hierarchical structure, mechanism of action, and key paths among the key influencing factors, which will be important grips and breakthroughs in the advancement of the integration project, and should be prioritized for improvement and optimization in practice. The article concludes with countermeasures and suggestions, which provide policy references for achieving the goal of “interoperability and shared utilization” of EHR.

Section snippets

Methods

The Fuzzy-DEMATEL-ASIM combined approach was used in this study. The decision-making trial and evaluation laboratory (DEMATEL) method was used to solve complex and difficult multi-criteria decision problems [11]. Triangular fuzzy numbers can transform uncertain language variables into definite values, which was used to resolve the paradox that object attributes cannot be measured accurately [12]. The AISM model was used to improve the persuasiveness of index level extraction results [13]. The

Index system of influencing factors

Current medical informatization focuses more on breaking through technical barriers, while many non-technical factors in the integration process are also important safeguards for effective sharing of EHRs. Through literature research, expert interviews and Delphi method, this paper finally constructs an index system of influencing factors containing 32 items, as shown in Table 1.

Impact index and ranking of influencing factors

The impact index includes the influence degree, affected degree (the degree of being influenced), center degree, and

Key factors influencing mechanism analysis

The surface-level factors of the vertical integration of EHRs in the medical consortium include optimizing and reorganizing business processes (F24), establishing benefit distribution and coordination mechanisms (F26), sharing technology standards (F31), privacy protection standards (F34), perceived usefulness (F61), and willingness to share medical and health data (F62). Surface factors are the most direct factors affecting the analysis object. These factors only accept directed arrows and do

CRediT authorship contribution statement

Sheng-Hu Tian: Writing – original draft. Yu Chen: Writing – review & editing. Tao-zhen Bai: Formal analysis.

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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