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Creating Nationwide e-Health Records for China by 2020

| By Olia Wen, Healthcare Industry Chief Architect, Huawei Enterprise Business Group

"Health China 2020" Strategic Plan

In September 2012, the "Health China 2012" Strategic Plan was released with the following mission: By 2020, establish comprehensive medical and healthcare systems providing access to basic medical and health services for every urban and rural resident. In addition it must ensure equal access for everyone to medical and health services, improve the overall health of all Chinese people, and establish health record utilization and management systems to cover all residents with IT-enabled healthcare services.

The 12th Five-Year Plan for IT-enabled Healthcare Services determined the roadmap for such developments, as defined in the "35212 Project." The "35212 Project" aims to establish health information platforms at national, provincial, and city levels by improving five systems: public health, medical service, new rural area cooperation, basic drug access, and comprehensive management. The project intends to establish two basic databases for resident health and electronic medical records, one private health network, one data standard system, and one network security system.

Health information platforms at the national, provincial, and city levels are the main vehicle for "establishing practical and shared medicine and health information systems" in the national healthcare reform package. The basic database of resident health records is placed on the health information platforms at both the city and county levels. The health records on these two platforms serve as a backup to one another as a safety measure.

Main Challenges of Creating Resident Health Records

China has a large population in multiple administrative divisions across a vast territory, with great differences among these areas. Health bureaus across the country differ greatly in terms of capabilities in planning, project implementation, and business operations. To create nationwide resident health records, the question of how small cities and counties establish district-wide health information platforms must be answered. The following challenges have been identified:

• Model selection and optimal integration of hardware infrastructure, especially platform and health record security management.

• Planning and implementation quality of the district health information platform.

• Survival and growth of the district health information platform.

To formulate an effective approach, including viable countermeasures in the development of district health information platforms at the city and county levels, three approaches are proposed:

• Ensure that an all-in-one platform for district health solutions can resolve the main risks inherent in infrastructure construction.

• Plan the platform independently of applications to ensure effective construction while reducing significant deviations from the overall project.

• Open the platform to the public and health information industry.

All-in-one District Health Information Platform

The all-in-one district health information platform aims to resolve issues concerning model selection, configuration, installation, commission optimization, and Operation and Maintenance (O&M) of hardware and basic software on the platform in one single project package deployment. Viewed from the perspective of cities and counties, the required key functions include:

• Selection and integration of servers, storage media, networks, security and communications products, and other hardware based on the business requirements of the platform, and business scale of typical cities and counties. Security measures must protect networks against attacks and ensure appropriate access control measures for health records.

• Automatic installation and deployment capabilities on the platform. For example, networks and IP Storage Area Networks (IP SANs) can be located and configured automatically. Computing nodes can be located and initialization software can be downloaded and installed automatically. Application-centric resources (including computing, storage, and network resources) are centrally managed. An O&M portal and a topology-based resource search function are available to enable visual resource management.

• Automatic O&M management. The platform supports flexible deployment and capacity expansion of applications, centrally manages resources for multiple services, and automatically monitors the operating status of services. Resources are redistributed among different services, based on monitoring results, to improve resource utilization and reduce costs.

Health Record Information Platform Independent from Applications

The data quality of health records on the district health information platform determines the capabilities of the entire platform. High-quality district health applications can only be developed based on a superior data platform. The data platform should be decoupled from specific applications and should not be affected by the development of applications. The data platform should first focus on preparing health record data.

• The platform must support both international and domestic health information standards, enlarge data standards for unique local services, and support the connection and collection of data from local hospital information systems, public health strip-line business systems, and social security and public security information platforms.

• The requirements for unified management and storage of medical images must be considered, in addition to the requirements for centralized or federated storage of image data for individual districts.

• Upon the connection and collection of comprehensive local health data, special designs must be made for health data usage. As an example, regional health information standards are released and the interfaces opened when invoking the platform data; that is, the application programming interfaces are opened. Support is provided for handling massive data in the health records to meet business requirements for medical administration and scientific research. Support is also provided for the development of critical services, such as data reports.

Development of Applications for Health Records

Following completion of the district health information platform, control over application development will be released. The following steps detail how to activate the health information industry chain:

• Release the application development interfaces to Independent Software Vendors (ISVs). The industry is better served if national standards for application development interfaces were established.

• The administrative departments for public health should qualify and manage local application developers to gradually create a resource pool.

• Develop industry applications gradually, based on three levels: First, the traditional district health domain; second, the mobile healthcare domain; third, the broader pan-healthcare domain, including drugs, insurance and guarantees, and health management.

A district health information system will be most productive with sound hardware implementation and good data quality. Opening the industry chain and the diversity of applications are required for the continuous optimization and development of the district health information platform. These measures will enable development of a comprehensive health record system by 2020, affording all residents of China with health records properly protected and readily accessible for improved wellness and better access to medical services.