Research On The Dynamic Mechanism Of Vertical Integration Of Electronic Health Records Within Medical Alliance

Many countries around the world,including China,regard the construction of electronic health records as the focus and breakthrough for the reform and development of medical and health services.These countries have gradually incorporated electronic health records into their national strategies as an important infrastructure for health management informationization.They hope to rely on electronic health records to reduce medical costs,avoid medical errors,improve medical standards,achieve grassroots first diagnosis,hierarchical diagnosis and treatment,and two-way referral,thereby solving livelihood issues such as “difficult and expensive medical treatment”.However,in reality,there are old criticisms such as the “low qualification rate and low utilization rate” of electronic health records.When sharing and using electronic health records within the medical,there are also problems such as “poor promotion mechanism and insufficient application motivation”.This situation has seriously hindered the promotion and application of electronic health records and the sustainable and healthy development of e-Health.In recent years,China has intensively issued a number of policies to promote the integration of electronic health records strongly within the medical consortiums.This paper uses collective action theory,stakeholder theory,competition theory,principal-agent theory and relevant policy theories to construct a logical analysis framework of “influencing factors-game mechanism-dynamic system-incentive mechanism”.And adopts Fuzzy-DANP-AISM,evolutionary game and system model construction methods to study the construction of a dynamic mechanism in the vertical integration of electronic health records within a medical consortium based on current national policies.In the study,MATLAB and system dynamics methods were used to conduct numerical simulation experiments on relevant models to further verify the reliability,effectiveness,and applicability of the model construction.The research content of this paper mainly includes four aspects.First,an index system of influencing factors for vertical integration of electronic health records in the medical consortiums was constructed.Key influencing factors were identified,and the degree of impact of each key factor was analyzed.Second,by constructing the competing game model between superior and subordinate hospitals and the three-party evolutionary game model between “government,hospitals and patients”,the game process of core stakeholders in the vertical integration of electronic health records within the medical association was profoundly analyzed,thus revealing the inner mechanism of unified action of each entity.Third,on the basis of explaining the composition of dynamic elements and their generation paths,a dynamic system framework for the vertical integration of electronic health records within the medical consortiums was established.Fourth,an incentive mechanism has been designed for the sustainable sharing and interoperability of electronic health records within the medical consortiums.The main findings of this paper focus on the following areas.First,there are currently 32 factors affecting the vertical integration of electronic health records within a medical consortium,of which 17 are key influencing factors,and there are 2influencing transmission paths.Second,in the vertical integration of electronic health records,superior and subordinate hospitals have a competitive and cooperative relationship,and the size of the hospital has no impact on the competitive and cooperative relationship.Improving the complementarity of electronic health records,hospital utilization capacity,and average revenue per unit resource is important for optimizing the competitive and cooperative relationship.Third,hospitals have the potential willingness to act uniformly for the realization of vertical integration of electronic health records under the leadership of the government.The strategy choices of core subjects are jointly determined by a variety of external factors,and the construction of a multi-body synergistic mechanism is the way to realize the goal of vertical integration of electronic health records within the medical consortiums.Fourth,the vertical integration power system of electronic health records within the medical association includes external driving force,internal traction force,and environmental synergy.Fifth,the ability to increase the value added of electronic health records and the ability of hospitals to use electronic health records has a positive incentive effect,while the cost of hospital input and the intensity of risk aversion will hinder the achievement of the goal of vertical integration of electronic health records.Promoting the vertical integration of electronic health records within the medical consortiums is a systematic project.It requires not only the establishment of a dynamic system of multi-stakeholder collaboration,but also sound institutional safeguards and strong policy support.Based on the findings of this paper,the following countermeasures are proposed.First,establish and improve laws and regulations,strengthen the top-level design,and introduce specialized promotion policies.Secondly,participating organizations within the health care union should unify development planning,establish sharing standards,and weaken the public’s perception of risk.Thirdly,we will innovate the way of medical insurance management,further strengthen publicity and education,and enhance public awareness.Fourth,carry out performance evaluation,coordinate multi-party participation,and continuously improve the construction model of the medical consortiums.Fifth,optimize the allocation of resources,promote the upgrading of the capacity of hospitals to use electronic health records,and continuously internalize the willingness of hospitals to integrate electronic health records.This paper enriches the theory of cross-institutional information systems and information resource integration within the medical association.The findings of the study expand the theoretical perspectives of electronic health records influencing factors research,further reveal the intrinsic mechanism of collective action and the basic path to break the “free-rider” opportunism,and also enrich the forms and methods of power system division.The results of the study provide a practical reference framework for promoting the vertical integration of electronic health records within the medical consortiums,further enrich the theoretical basis for the integration of cross-institutional information systems and information sharing,and expanding the depth of application of related theories in the field of e-health to a certain extent.The countermeasure suggestions have certain practical reference value for the realization of vertical integration of electronic health records in the healthcare consortium.