民族地区基层医疗卫生机构信息化建设现状与效能研究

Development of Informatization in Primary Care in China's Regions Inhabited by Ethnic Minorities

背景“十三五”期间,民族地区基层卫生信息化发展迅速,为信息技术赋能基层医疗卫生机构能力提升奠定了基础,但卫生信息技术与基层医疗卫生机构效能的相关研究缺乏。目的了解民族地区基层医疗卫生机构信息化建设现状与效能,探索信息技术对于基层医疗卫生机构效能提升的影响。方法2020年7—10月,采用分层抽样的方法选取四川甘孜、凉山、阿坝3个自治州,共计23个民族县的84家基层医疗卫生机构进行问卷调查。问卷调查主要内容包括基层医疗卫生机构信息化建设现状、信息化效能。对23个民族县的卫生健康局负责人及基层医疗卫生机构院长进行座谈,主要围绕基层医疗卫生机构科室设置、服务开展现状、信息化建设现状、信息服务场景等内容开展座谈。结果软件建设方面,84家基层医疗卫生机构中,57家(67.9%)使用公共卫生系统,44家(52.4%)使用家庭医生管理系统,25家(29.8%)使用医院信息系统(HIS)。84家基层医疗卫生机构中,47家(56.0%)实现了纵向联通与区域信息化,联通机构多为区(县)级与医联体单位;69家(74.4%)横向联通单位是医保部门。仅18家(21.4%)基层医疗卫生机构设有独立的信息部门,34家(41.0%)机构没有从事信息化工作的人才。信息专业人才缺乏〔64家(76.2%)〕、资金不足〔52家(61.9%)〕及基础设施薄弱〔51家(60.7%)〕是目前民族地区基层医疗卫生机构信息化建设的主要问题。建设有区域信息化平台、纵向联通机制、以电子病历为核心的医院信息平台的基层医疗卫生机构在检验、检查科室设置及中医药服务提供情况方面优于未进行相应卫生信息化建设的机构,差异有统计学意义(P<0.05)。座谈信息显示,民族地区基层医疗卫生机构已基本完成信息化标准化建设,硬件设施配备到位,卫生信息化产生了效率提升、监管范围扩大、监管精细化、决策科学化、治理数字化等管理效能,以及服务效率提升、可及性增加、质量提升的服务效能。结论信息技术可突破民族地区基层医疗卫生机构服务开展“瓶颈”,促进民族地区基层医疗卫生机构科室设置、服务延伸,提高卫生服务可及性;信息技术可以创新民族地区基层医疗卫生机构服务模式;民族地区基层卫生信息化存在信息化运维投入持续性不足、应用不足、人才匮乏问题;应加强基层卫生信息化投入,建立规范、适用的卫生信息化培训机制,重视卫生信息人才队伍建设,深化信息技术在基层医疗卫生服务中的智能应用。

Background The rapid development of informatization in primary care in regions inhabited by ethnic minorities during the 13th Five-Year Plan period(2016-2020),has laid a foundation for the improvement of the serving capacity of primary care supported by information technologies,but there is a lack of research on information technology and the efficiency of primary care.Objective To assess the status including effectiveness of informatization in primary care in China asregions inhabited by ethnic minorities,to explore the impact of information technology on improving the efficiency of primary care.Methods From July to October 2020,84 primary care institutions in 23 ethnic counties in three autonomous prefectures of Sichuan(Ganzi,Liangshan and Aba)were selected by stratified sampling,and whose directors were invited to complete a self-administered questionnaire survey for understanding the status including effectiveness of informatization in their institutions.Furthermore,the heads of local health committees and directors of primary care institutions in these ethnic counties were invited to attend a group discussion regardingthe setting of departments,service development,status of informatization and settings for information services in primary care institutions.Results In terms of software construction,of the 84 primary care institutions,57(67.9%)used the public health system,44(52.4%)used the family doctor management system,and 25(29.8%)use the hospital information system.Forty-seven(56.0%)primary care institutions had achieved vertical connectivity with other institutions(mostly regional-and county-level institutions as well as other members in a regional medical consortium)using information technologies,and regional informatization.Institutions that had horizontal connectivity with 69(74.4%)of the primary care institutions were medical insurance departments.Only 18(21.4%)institutions had independent information departments,and 34(41.0%)did not employ information professionals.Lack of information professionals〔64(76.2%)〕,insufficient funds〔52(61.9%)〕and weak infrastructure〔51(60.7%)〕were main problems revealed in informatization construction.Institutions with regional informatization,vertical connectivity with other institutions,and the construction of a hospital information platform with electronic medical record system as the core were superior to those without in terms of setting of laboratory and examination departments and provision of traditional Chinese medicine services(P<0.05).According to the group discussion,the institutions had basically completed the construction of information standardization,with well-equipped hardware facilities,health informatization-derived management efficiencies,such as improved efficiency,increased scope of supervision,refined supervision,scientific decision-making and digital governance,and service potencies,such as increased efficiency,accessibility and quality of services.Conclusion Information technology could greatly contribute to the solving of bottleneck during services delivery in primary care in regions inhabited by ethnic minorities,which has promoted the setting of departments and service extension,and improved the accessibility of health services,as well as the innovation in service delivery modes in these institutions.Problems identified in the informatization construction include insufficient investment in informatization operation and maintenance,insufficient application and lack of information professionals.In view of this,it is suggested to strengthen the investment in informatization construction in primary care,establish a standardized and applicable health informatization training mechanism,pay attention to the construction of a health information talent team,and deepen the intelligent application of information technology in primary care services.