数字化时代的区域卫生信息平台顶层设计研究

Research on Top-level Design of Regional Health Information Platform in Digital Era

近年来政府下大力气开展区域卫生信息平台建设,致力于在医疗服务机构间进行安全和标准化的信息共享,旨在对业务流程和医疗服务效果产生积极影响。但区域卫生信息平台的规划设计相对传统,而医疗领域的环境和技术发展已发生巨大变化,即平台涉及到多方利益的协调和对复杂技术组件的编排,对平台的开发和应用提出了挑战。对此,数字化平台和医疗信息系统的研究强调一个全面系统的顶层设计对促进平台深度应用具有重要意义。从社会技术系统的视角出发,以服务主导逻辑和网络实体系统为理论基础,提出框架模型。以佛山区域卫生信息平台为例,对参与平台设计、实施和应用的相关组织和人员进行深度访谈,通过明晰区域卫生信息平台中社会和技术元素的交互过程,实现对理论框架的深化和拓展。研究结果表明,区域卫生信息平台中医疗服务提供者和接受者的角色正在模糊化,平台通过整合和分享多元化的信息、知识和制度等资源,促进不同成员间的价值共创。相应地,各项技术组件被编排成五层级架构,促进平台实现资源整合和再利用。基于此,提出融合社会和技术元素的全面的区域卫生信息平台顶层设计架构。将服务主导逻辑纳入到区域卫生信息平台的研究,探讨在数字化带动的医疗服务变革环境下平台的角色价值,弥补了已有研究从产品输出的角度分析平台问题而导致的对社会属性探讨的不足。另外,强调平台技术在价值共创研究中的关键作用,认为价值共创要建立在整合并重新组织异质性资源的基础上,拓展了价值共创的研究范畴。提出的顶层设计架构既强调了平台在实践中的服务意识,也阐述了实现医疗服务价值共创的具体过程,为全国各地区的区域卫生信息平台建设提供参考。

Unprecedented effort from governments are focused on secure,standardized,electronic transfer of health information among healthcare organizations,termed as the regional healthcare information platform（ RHIP）,which is expected to have effective impacts on health care procedures and treatment outcomes. However,the design of RHIP has remained relatively consistent as the traditional platform even though its practices have evolved in response to both environmental and technological changes in healthcare industry,which means the multi-stakeholders and complicated technology components lead to challenges for the platform development and application. Previous findings from digital platform and healthcare information systems suggest that a comprehensive and systematic top-level design may have significant impacts on the assimilation of regional health information platform.By combining the service-dominant logic and cyber-physical systems,the present work aims to design and improve the platform＇s top-level infrastructure from a socio-technical system perspective. On this basis we conduct a case study on Foshan＇s RHIP by way of interviewing related organizations and staff who are involved in the platform design,implementation and application,inorder to enrich and extend the theoretical model by understanding the interaction process between social and technical elements within RHIP.The results indicate that the roles of healthcare service providers and receivers are blurring in the regional healthcare information platform,which enables the value co-creation for participators by sharing the diversified resources including information,knowledge and institutions. Accordingly,various technology components are configured and orchestrated to form a 5-layered platform infrastructure based on cyber-physical systems theory,in order to realize the resources integration and reutilization. Thus,the social and technical elements are merged to develop a comprehensive top-level design for RHIP.By incorporating the service-dominant logic into the platform design,this study explores the role of RHIP played in the changing healthcare circumstance enabled by digitalization,which compensates for the weakness of previous studies that are almost conducted from a perspective of technology development instead of social attributes. In addition,we underline the significance on the platform technology in the field of value co-creation research whose attention is mainly put on the interaction among individuals,by proposing a multi-layered technology structure that is able to integrate and recombine the diversified resources for various users to share mutual benefits. The developed top-level design of RHIP is of great significance for other cities to design and construct RHIP,by emphasizing the service logic of the platform in practice,as well as elaborating the technical processes to accelerate the value co-creation.