Constructing a nationwide interoperable health information system in China: The case study of Sichuan Province

Cardiovascular Informatics: building a bridge to data harmony

The search for new strategies for better understanding cardiovascular disease is a constant one, spanning multitudinous types of observations and studies. A comprehensive characterization of each disease state and its biomolecular underpinnings relies upon insights gleaned from extensive information collection of various types of data. Researchers and clinicians in cardiovascular biomedicine repeatedly face questions regarding which types of data may best answer their questions, how to integrate information from multiple datasets of various types, and how to adapt emerging advances in machine learning and/or artificial intelligence to their needs in data processing. Frequently lauded as a field with great practical and translational potential, the interface between biomedical informatics and cardiovascular medicine is challenged with staggeringly massive datasets. Successful application of computational approaches to decode these complex and gigantic amounts of information becomes an essential step toward realizing the desired benefits. In this review, we examine recent efforts to adapt informatics strategies to cardiovascular biomedical research: automated information extraction and unification of multifaceted -omics data. We discuss how and why this interdisciplinary space of Cardiovascular Informatics is particularly relevant to and supportive of current experimental and clinical research. We describe in detail how open data sources and methods can drive discovery while demanding few initial resources, an advantage afforded by widespread availability of cloud computing-driven platforms. Subsequently, we provide examples of how interoperable computational systems facilitate exploration of data from multiple sources, including both consistently-formatted structured data and unstructured data. Taken together, these approaches for achieving data harmony enable molecular phenotyping of cardiovascular (CV) diseases and unification of cardiovascular knowledge.

The efficiency analysis and spatial implications of health information technology: A regional exploratory study in China

The new adoption of healthcare information technology is costly, and effects on healthcare performance can be questionable. This nationwide study in China investigated the efficient performance of healthcare information technology and examined its spatial correlation. Panel data were extracted from the Annual Investigation Report on Hospital Information in China and the China Health Statistics Yearbook for 2007 through 2015 (279 observations). Stochastic frontier analysis was employed to estimate the technical efficiency of healthcare information technology performance and related factors at the regional level. Healthcare information technology performance was positively associated with electronic medical records, total input, and cost of inpatient stay, while picture archiving and communication systems and net assets were negatively related. Local Indicators of Spatial Association showed that there existed significant spatial autocorrelation. Governmental policies would best make distinctions among different forms of healthcare information technology, especially between electronic medical records and picture archiving and communication systems. Policies should be formulated to improve healthcare information technology adoption and reduce regional differences.

Improving the performance of social health insurance system through increasing outpatient expenditure reimbursement ratio: a quasi-experimental evaluation study from rural China

Background

China has set up a universal coverage social health insurance system since the 2009 healthcare reform. Due to the inadequate funds, the social health insurance system reimbursed the inpatient expenditures with much higher ratio than outpatient expenditure. The gap in reimbursement ratios resulted in a rapid rising hospitalization rate but poor health outcomes among the Chinese population. A redistribution of social health insurance funds has become one of the main challenges for the performance of Social Health Insurance.

Methods

Two comparable counties, Dangyang County and Zhijiang County, in Hubei Province of China, were sampled as the intervention group and the control group, respectively. The Social Health Insurance Management Department of the intervention group budgeted 600 yuan per capita per year to the patients with 3rd stage hypertension to cover their outpatient expenditures. The outpatient spending in the control group were paid out-of-pocket. The inpatient expenditures reimbursement policies in both groups were not changed. Besides, the Social Health Insurance Management Department of the intervention group budgeted 100 yuan per patient per year to township physicians and hospitals to provide health management services for the patients. While, the health management services in the control group were still provided by health workers. A Propensity Score Matching model and Difference-in-differences model were used to estimate the net effects of the intervention in dimensions of medical services utilization, medical expenditures, SHI reimbursement, and health outcomes.

Results

One thousand, six hundred and seventy three pairs of patients were taken as valid subjects to conduct Difference-in-differences estimation after the Propensity Score Matching. The net intervention effect is to increase outpatient frequency by 3.3 (81.0%) times (P < 0.05), to decrease hospitalization frequency by 0.075 (− 60.0%) times (P < 0.05), and to increase the per capita total medical service utilization frequency by 3.225 (76.8%) times (P < 0.05). The per capita total medical expenditure decreased 394.2 (− 27.7%) yuan. The SHI reimbursed 90.3 yuan more per capita for the outpatient spending, but the per capita inpatient expenditure reimbursement and per capita total medical expenditure reimbursement decreased significantly by 282.6 (− 44.0%) yuan and 192.3 (− 28.5%) yuan, respectively (P < 0.05). The intervention reduced the per capita inpatient out-of-pocket expenditure and the per capita total out-of-pocket expenditure by 192.8 (− 36.7%) yuan and 201.9 (− 29.9%) yuan, respectively (P < 0.05). The intervention significantly decreased the diastolic blood pressure of the intervention group by 2.9 mmHg (P < 0.05) but had no significant impact on the systolic blood pressure (− 7.9 mmHg, P > 0.05).

Conclusion

For China and countries attempting to establish a universal coverage SHI with inadequate funds, inpatient services were expensive but might not produce good health outcomes. Outpatient care for patients with chronic diseases should be fundamental, and outpatient expenditures should be reimbursed with a higher ratio.