Vertical Integration of Electronic Health Records in Medical Consortiums: Dynamic Modeling Approach Based on the Evolutionary Game Theory

Abstract

Background China has continuously issued policies to speed up the interconnection, mutual recognition, sharing of medical information systems, and data integration management across regions and institutions. However, the vertical integration of electronic health records (EHRs) within the medical consortium is hampered by “poor mechanism and insufficient motivation” and the phenomenon of “free riding” among participating medical institutions, which makes the integration less effective. Objective We hope to clarify the game mechanism of stakeholders in the vertical integration of EHRs, and put forward targeted policy suggestions for improvement. Methods We constructed the “government-hospital-patient” tripartite evolutionary game model based on the detailed analysis of the research problems and their assumptions. We then simulated the game strategies and outcomes of each participant using the system dynamics approach to reveal the long-term strategy evolution mechanism of the core participants in the vertical integration of EHRs in the medical consortium, as well as the influencing factors and action mechanisms of each party’s strategy evolution to provide references for improving relevant policies. Results The evolutionary game system could eventually reach an optimal equilibrium, but in areas where the government was required to be in a dominant position, patient supervision was necessary to have a positive role, while a reasonable reward and punishment mechanism can promote active participation of hospitals. Conclusions The effective way to achieve the goal of vertical integration of EHRs in the medical consortium is to build a multiagent coordination mechanism under the guidance of the government. Meanwhile, it is necessary to establish a scientific integration performance evaluation mechanism, a reward and punishment mechanism, and a benefit distribution mechanism to promote the healthy development of vertical integration of EHRs in medical consortiums.

Incentive mechanism for sharing and using EHR in medical consortiums based on performance evaluation

“…The amount of shared costs invested is closely related to the hospital's effort, which can be characterized by the effort level. The effort level can be expressed as 1 2 βM 2 (26), where β represents the cost coefficient of hospital investment, and M represents the hospital's earnings level (benefit level). There are also certain risks for hospitals in the EHR integration.…”

“…These potential risks may include reduced revenues due to interoperability of test results, and patients loss due to convenient access to medical care. Such potential risk cost can be expressed as 1 2 γ a 2 δ 2 (27). Where γ denotes the risk avoidance intensity of the hospital, determined by the risk awareness of the hospital's decision-making level.…”

“…Patients who originally chose to seek medical treatment at this hospital may choose to seek medical treatment at another hospital. Which will further exacerbate the fierce competition among hospitals, thus hindering the realization of the goal of building medical consortiums (1). The integration of electronic health records (EHR) in medical consortiums is divided into two levels: the interconnection of infrastructures such as software and hardware, and the shared use of EHR resources.…”

Differences in influencing mechanism of clinicians’ adoption behavior for liver cancer screening technology between the leading and subordinate hospitals within medical consortiums

“…Different groups may exhibit different adoption behaviors towards particular technologies. Nevertheless, it is essential to note that there is some technology exchange and information communication between leading and subordinate hospitals within medical consortiums [ 28 – 30 ], which is not equivalent to two utterly independent medical institutions. Furthermore, since some appropriate health technologies that should be widely promoted have only been applied in leading hospitals but are far from widespread in subordinate hospitals [ 6 ], it is necessary to investigate the differences in influencing mechanisms of clinicians’ technology utilization behavior across different levels of hospitals.…”

Effects of medical consortium policy on health services: an interrupted time-series analysis in Sanming, China

“…Several studies have previously reported on the status of China’s MCs reform ( 8 ), regional practical experiences ( 12 ), theoretical frameworks ( 13 ), and development pathways ( 14 ). Although some studies have examined the effects of MCs policy using quantitative analyses, most of them have been conducted from a single perspective, such as assessing inpatient numbers ( 15 ), hospitalization rates ( 16 ), hospitalization expenses ( 17 ), physician flows ( 18 ), informatization construction ( 19 ), and health professionals’ views and satisfaction with regard to MCs reform ( 20 ). For example, Özkaytan et al ( 21 ) found that integrated care models could address complicated healthcare needs and enhance service continuity and coordination.…”