社区卫生服务中心信息化建设实践及政策建议

Information Construction in Community Health Service Centers and Implications for Policy

背景从国家层面自上而下推进的大数据战略和"互联网+健康服务"政策面临着数据孤岛困境,在"强基层"背景下基层信息化在此困境中的发展现况缺乏深入研究。目的旨在深入调查社区卫生服务中心的信息系统建设现况、数据的采集方式和利用,为政策完善提出建议。方法2018年12月-2019年1月,在广州市一家全国百强社区卫生服务中心开展案例研究,采用现场观察法和焦点访谈法收集数据,并收集社区卫生服务中心文档材料,用NVivo软件辅助分析。结果该社区卫生服务中心现有信息系统35个,互不连通,信息采集效率低且重复采集突出,信息系统功能不完善,相应的考评负面影响着社区卫生服务中心工作人员的工作积极性,数据在规划和发展社区健康服务上的作用未发挥,上级管理部门在系统设计规划和对社区信息利用指导方面存在不足。结论社区卫生服务中心信息系统信息采集的便利性不足,信息在促进社区卫生服务能力提升方面没有发挥明显作用,信息化对辅助上级考评起到一定的作用,但对工作人员尤其是公共卫生人员的工作积极性有负面影响。建议加快完善上层政策,将政策转化为行业规范引导市场开发,改变数据采集方法和考评的思路,加强社区信息利用指导。

Background The big data strategy and"internet+health service"policy which are promoted from the national level to the grassroots level are faced with the dilemma of isolated data islands.Under the background of"strengthening grassroots",research on development of informatization at grassroots is scarce.Objective To investigate the current status of information systemin community health service centers(CHSCs)from aspects of construction,data collection approach,and data utilization of these data,and give recommendations for policy making.Methods A case study was conducted in one of the National Top 100 CHSCs in Guangzhou from December 2018 to January 2019.Field observations and focus interviews were used to collect data.Relevant documents were also collected.NVivo was used in content analysis.Results In the CHSC under observation,there were a total of 35 information systems and these systems were not connected to each other.Data were collected in a low efficiency manner and repeated collection was a problem.Related work performance assessment negatively impacted the working motivation of the staff because the function of the information systems was imperfect.The center seldom used data in these systems to plan and enhance community health services.This phenomenon reflected the insufficiency of the upper-level administrative department in system design and planning and data use guidance.Conclusion Information collection in information systems is inconvenient in the CHSC and information does not play a significant role in promoting community health service ability.Informatization supports work performance assessment in some extent,but it has a negative impact on work enthusiasmof the staff,especially the public health personnel.We suggest that speeding up improvement of upper level policies about the construction of information platform and data sharing,and transforming polices into regulations to guide the market development.We also suggest change the approaches of data collection and work performance assessment,and strengthen guidance of community information utilization.