[论文解读] Towards an Electronic Health Record System in Vietnam: A Core Readiness Assessment

Stefan Hochwarter, Do Duy Cuong+2 more|arXiv (Cornell University)|May 28, 2020

Electronic Health Records Systems参考文献 19被引用 9

一句话总结

本研究采用定性方法（如参与式观察、文件分析和深度访谈）评估了越南在全国范围内实施电子健康记录（EHR）系统的根本准备情况。研究识别出若干关键挑战，包括碎片化的遗留系统、缺乏标准化接口以及对国家标准的需求；同时强调了由于越南医疗体系的集中化结构，其在制度支持和集中实施方面具备较强准备度。

ABSTRACT

Previous studies have shown that health information technologies have a positive impact on health systems. Electronic health record (EHR) systems are one of the most promising applications, demonstrating a positive effect in high income countries. On the other hand, robust evidence for low and middle income countries is still spare. The aim of this study is to initiate a carefully planned nationwide EHR system in Vietnam by assessing the core readiness. The assessment structure is mainly based on previous research, which recommends a readiness assessment prior to to an EHR system implementation. To collect data, participant observation, document analysis and an in-depth interview were used. This study has revealed new insights into the current situation on EHR in Vietnam. The Ministry of Health is currently working on improving the conditions for future implementation of a Vietnamese EHR system. There are issues with the current way of handling health records. These issues are encouraging the Ministry of Health to work on identifying the next steps for an EHR system implementation. The integration of an EHR system with current systems seems to be challenging as most systems are commercial, closed source and very likely have no standardised interface. In conclusion, this study identifies points which need to be further investigated prior to an implementation. Generally, health care workers show good awareness of new technologies. As the Vietnam's health care system is centrally organised, there is the possibility for a nation-wide implementation. This could have a positive impact on the health care system, however, besides rigours planning also standards need to be followed and common interfaces implemented. Finally, this assessment has focused on only one level of readiness assessment. Further research is needed to complete the assessment.

研究动机与目标

• 评估越南在全国范围内实施电子健康记录（EHR）系统的根本准备情况。
• 识别越南医疗领域EHR采纳过程中存在的系统性、技术性和组织性障碍。
• 评估当前医疗记录管理的现状，为未来实施规划提供依据。
• 研究卫生部在推动EHR系统开发与标准化中的作用。
• 为结构化、全国协调的EHR推广提供基于证据的建议。

提出的方法

• 在选定的越南医疗机构开展参与式观察，以了解当前的记录管理实践。
• 对现有卫生信息政策、指南和系统规格文件进行分析。
• 对关键利益相关者（包括医疗提供者和卫生部官员）进行深度半结构化访谈。
• 采用基于低收入和中等收入国家EHR实施研究的准备度评估框架。
• 综合定性数据，识别基础设施、互操作性和标准化方面的缺口。
• 聚焦于一个准备度层级——核心制度与技术准备度，同时承认尚需进一步评估其他层级。

实验结果

研究问题

• RQ1 越南公共医疗体系中的医疗记录管理现状如何？
• RQ2 哪些制度、技术和组织因素影响越南全国性EHR系统实施的准备度？
• RQ3 越南现有的卫生信息系统在多大程度上支持或阻碍互操作性与EHR整合？
• RQ4 卫生部在塑造EHR实施未来发展中扮演何种角色？
• RQ5 越南集中式EHR推广面临哪些关键挑战与促进因素？

主要发现

• 卫生部正在积极改善未来EHR实施的条件，显示出制度层面的承诺。
• 当前越南的医疗记录实践分散且非标准化，凸显了数字化转型的迫切需求。
• 大多数现有卫生信息系统为商业软件、闭源系统，且缺乏标准化的应用程序编程接口（API），增加了系统整合的难度。
• 尽管存在技术挑战，医疗工作者对采用新型卫生信息科技表现出高度意识和开放态度。
• 越南的集中式医疗体系为全国范围的EHR实施提供了独特机遇，可通过协调规划实现。
• 本研究识别出制定国家标准和通用接口的必要性，以确保EHR系统具备互操作性并实现长期可持续性。