Adoption of Electronic Health Records (EHRs) in China During the Past 10 Years: Consecutive Survey Data Analysis and Comparison of Sino-American Challenges and Experiences

Abstract

Background The adoption rate of electronic health records (EHRs) in hospitals has become a main index to measure digitalization in medicine in each country. Objective This study summarizes and shares the experiences with EHR adoption in China and in the United States. Methods Using the 2007-2018 annual hospital survey data from the Chinese Health Information Management Association (CHIMA) and the 2008-2017 United States American Hospital Association Information Technology Supplement survey data, we compared the trends in EHR adoption rates in China and the United States. We then used the Bass model to fit these data and to analyze the modes of diffusion of EHRs in these 2 countries. Finally, using the 2007, 2010, and 2014 CHIMA and Healthcare Information and Management Systems Services survey data, we analyzed the major challenges faced by hospitals in China and the United States in developing health information technology. Results From 2007 to 2018, the average adoption rates of the sampled hospitals in China increased from 18.6% to 85.3%, compared to the increase from 9.4% to 96% in US hospitals from 2008 to 2017. The annual average adoption rates in Chinese and US hospitals were 6.1% and 9.6%, respectively. However, the annual average number of hospitals adopting EHRs was 1500 in China and 534 in the US, indicating that the former might require more effort. Both countries faced similar major challenges for hospital digitalization. Conclusions The adoption rates of hospital EHRs in China and the United States have both increased significantly in the past 10 years. The number of hospitals that adopted EHRs in China exceeded 16,000, which was 3.3 times that of the 4814 nonfederal US hospitals. This faster adoption outcome may have been a benefit of top-level design and government-led policies, particularly the inclusion of EHR adoption as an important indicator for performance evaluation and the appointment of public hospitals.

A Preliminary Study on the Abnormal Deaths and Work Burden of Chinese Physicians: A Mixed Method Analysis and Implications for Smart Hospital Management

“…Primary hospitals (primary medical institutions) are mainly engaged in prevention, rehabilitation, health care, nursing, and general outpatient services, thereby corresponding to community hospitals in the United States. Up to 2019, there were 11,266 primary hospitals, 9,805 secondary hospitals, and 2,779 tertiary hospitals ( 30 ) .…”

“…As an important technical means, HIT has the potential to improve service quality, improve service efficiency, ensure service safety, and reduce the cognitive and mental load of physicians at work ( 56 ). According to CHIMA Annual Surveys, the average electronic medical records adoption rate in sampled hospitals in China increased 3.6 times from 2007 to 2018, peaking at 85.3% ( 30 ). Based on the experience of foreign counterparts, with forward-looking top-level policy arrangements, good HIT software design and implementation, longer HIT clinical use time and adequate coverage, as well as necessary policy guidance, HIT can fulfill its potential promise to the medical industry and medical services by reducing the workload of physicians to a certain extent ( 57 – 59 ).…”

“…The literature screening process and detailed flow chart are shown in Figure 1. In the specific context of this study, the performance of search engines (30).…”

Digital Health Policy and Programs for Hospital Care in Vietnam: Scoping Review

“…Thus, future policies may seek to link EMR and HIT adoption with such benefits through clearly defined quality indicators to ensure meaningful HIT use. Lessons learned from some countries also recommend that financial incentives, when possible, should be made to increase EMR adoption [62][63][64].…”

Current Status of the Health Information Technology Industry in China from the China Hospital Information Network Conference: Cross-sectional Study of Participating Companies

“…From the perspective of discussion themes, EMRs are the research hotspot and focus shared by medical informatics academia and industry worldwide [ 7 ]. In contrast, China is more application oriented: the implementation rate of EMRs in Chinese hospitals has been approaching and surpassing that of the United States in recent years [ 8 ], but theoretical research and educational discussions are advanced in the United States [ 9 ].…”