Healthcare Information Systems in China

By: Kanliang Wang & Wansong Zheng (China)

Learn about the Project

Healthcare is a basic requirement of human beings and an important component of the social life. Healthcare information systems (HIS) is emerging as a critical part of healthcare institutes. It improves health services and enhances healthcare information for the hospitals. This proposed project analyzes HIS in China, a research topic　neglected by the researchers. Drawn upon actor-network theory and the HIS evaluation model of Heeks (2006), we propose a research framework that attributes the success or failure of the HIS usage to whether it can align the interests of hospitals, patients and government. We will employ this framework to conduct case study on three sorts of reprehensive HIS in China：hospital HIS, community HIS, and telemedicine system. By finishing the project, we will be able to delineate the history and current situation of HIS applications in China. We will identify the future challenges of HIS adoption in China’s healthcare sector. Our research results will be published as a report for the national informationalization authority and public healthcare authority of China, which offers policy guidance for China to use HIS to achieve its national priority of social development. Some academic articles will be published, which will recommend some lessons from the Chinese experience for other developing countries in implementing HIS. Our analytical framework can be used in further HIS research.

Research Problem and Justification
In recent decades we have witnessed the dramatic innovation in information technology and wide application of information systems (IS). Especially, the role of information technology in promoting social development has been recognized, and ICT4D has become an important research theme for IS scholars. This proposed research project aims to contribute to ICT4D research by focusing on the applications of IS in the healthcare sector in China.

The usage of IS or information technology in healthcare is commonly called as HIS or e-Healthcare, respectively. People define HIS in different ways. A systematic review by Pagliari et al. (2005) suggests that this term encompasses a set of concepts related to health, technology and business. In this proposal, we refer HIS to the use of networked information and communication technology, including IS, internet, intranet, satellite network, telecommunications network etc, to support healthcare business.

HIS is an emerging research field in the intersection of medical informatics, public health and business (Ilvonen, Ekroos and Kujala, 2006). HIS research has been mainly based in the medical institutes, and professional journals on health policy and management (e.g. International Journal of Medical Informatics) have been the main outlets of disseminating the HIS research results. The majority of scholars from this background are interested in exploring how healthcare institutes like hospitals and clinical practices use HIS to improve the operational efficiency (Dawes and Sampson, 2003; Sharma et al, 2006). There is a need to investigate into the HIS issue from the sociotechnical perspective (Berg, 1999). In response to this call, in recent years mainstream IS scholars add to HIS research by focusing on the social and organizational aspect of HIS, and HIS research begins to appear in leading IS journals (Braa, Monteiro and Sahay, 2004). However, so far, most of the available publications are descriptive and lack theoretical explanations. We need more research efforts in theoretically exploring the social and technological issue concerning HIS applications.

Healthcare is a basic requirement of human beings. Due to its role in improving health services and enhancing health information, HIS is emerging as a critical part of social development. However, the present literature is mainly about HIS in the developed world. Comparatively we need to know more about HIS in developing countries (Braa, Monteiro and Sahay, 2004). Especially, HIS in China remains a research gap.

As early as one decade ago, Wu (1997) reminded researchers that HIS might become an important component of hospital management in China’s hospitals. However, only in recent years HIS adoption in China’s healthcare sector started to get momentum. The Chinese government set the development strategy as constructing a harmony society. One of its targets is to offer better healthcare service to all of its citizens living in different parts of China. Recognizing the role of HIS in achieving this target, the State Council requires the hospitals must invest at least 5% of revenue in HIS per year. As a result, now in China HIS has been widely used in big hospitals, and is diffusing fast to all levels of hospitals and from big cities to rural areas (Fu and Ren, 2002; Li and Fang, 2006; Zhang, 2008). An examination on HIS in China is of practical significance.

Consequently, we set the objective of this proposal as to understand the history and current situation, and identify the future challenges of HIS adoption in China’s healthcare sector. We will propose an analytical framework, which can be used in further HIS studies. We expect our research results will provide policy guidance for China to use HIS to achieve its national priority of social development, and offer useful lessons to other developing countries from the Chinese experience.

Specifically, this proposed research will answer the following questions:

What is the history and current situation of HIS in China? What kinds of information technologies have been used? In China, what are the characteristics of the internal administration and macro regulation of healthcare sector in general and HIS in particular?
How to measure the failure or success of HIS in China?
How to understand HIS adoption in the Chinese healthcare institutes as a result of interest alignment of hospitals, patients and the government?

Findings

Based on social capital theory and planned behavior theory, we designed a research model. After surveying 270 physicians, the results were showed below figure. Firstly, we studied the physicians’ intention from the perspective of knowledge, the combined model has a satisfactory explanation of physicians’ intention (R2=0.52). This suggests that apart from individuals’ intention, social capital plays an important role in the sharing of medical knowledge. Secondly, we find that there are no direct effects of reciprocity and social trust on intention to share knowledge, being mediated by attitudes towards sharing knowledge. Finally, these results reveal that loss of knowledge power has strong and negative impacts on physicians’ attitudes toward share electronic medical records. In China, physicians believe that medical knowledge confers power, thus protecting it is a form of job insurance. The government should intensify efforts to protect both the intellectual property, as well as stabilize the health infrastructure so that employees can work collaboratively, rather than protecting intellectual silos. Loss of knowledge power has both direct and indirect impacts on intention to share knowledge, although the effects are in opposite direction. We do suggest that this phenomenon is a basis for future research within the domain of knowledge sharing, since this is a special circumstance involving medical information and culture factor. The HIS in China is quite complex, yet is in the nascent stage of development. Many physicians find it inconvenient to use this system; we recommend that HIS designers need to make this system easy to use, thus improving physicians’ perceived behavior control. Besides, the manager should improve education in a group setting to increase the degree of subjective norms about the HIS. We expect these research results will provide policy guidance for the Chinese government within the healthcare sector, and offer useful lessons to other developing countries.

PI’s Current Progress (To be made available soon)

Video clip of Mr. Wansong Zheng, sharing his experience along the journey with SIRCA.