Health care reform in the public health system information technology seminar

[Abstract] China's public Health system is an important medical and Health system, part of "SARS" crisis exposed the country lags behind the Development of public Health, emergency response mechanism is not perfect, organize and direct the flow problems, the Information channels are not blocked and a series of drawbacks. Of particular importance is that it makes us clearly understand that conventional public Health system failures for a time the focus on solving the problems of public Health Information technology will solve the issue of this series is one important way.

[Keywords] health care reform, public health, Information technology

A public health implications
Traditional public health mainly refers to infectious diseases and environmental health improvements, while the modern sense refers to public health and infectious disease prevention and control of noncommunicable diseases, prevention of health social events (such as car accidents, poisoning, etc.), health management (including legislation, regulation and supervision), food hygiene and nutrition, the environment (air, water, etc.) health, occupational and labor sanitation, maternal and child and adolescent health, health education, health, and radiological protection and other categories.

Due to the constraints and recognize the limitations of economic Development, national public health service system is not exactly the same definition, while changes in the historical Development from the perspective of national public health service system is also changing. Traditional public health services including public health system, government administration, public health service providers, public health research organizations, etc. As our country is still in the primary stage of socialism, combined with the initial stage of China's special national conditions, China in transition public health service system should include government health administration, disease prevention and control, maternal and child health institutions, endemic diseases and disease control agencies and specialist urban and rural primary health services (rural hospitals, community health service centers).


Two of China's public health Information technology system of the main problems in
First, the fragmentation of the health management system, management structure and long situation and national public health Information system of the guiding ideology and principles, leading to the central and local public health information systems, vertical building, regional public health information system of horizontal contradictions between the National Public Health Information System is the guiding ideology: "overall planning, state-led, unified, joint construction, interconnection, sharing of resources." its guiding principle is: "unified planning, step by step, highlighting the focus, vertical and horizontal networking, standards, resource sharing, both peacetime and wartime, early warning and forecasting, multi-party investment, levels of responsibility, clear functions, hierarchical and equipment. "[ZW (] Ministry of Health Office of Health [2003] No. 212 document << Ministry of Health on national public health information system construction work related issues,>>. [ZW)] and the reform and opening up of public health management functions from the original unity of the exercise by the Ministry of Health, the gradual change for the later part of the functions separated to form a multi- sector management of the situation, a variety of public health administration, community, management of the long lead coordination and management of unified management very difficult, and public health information systems in the building requirements must co-ordinate planning and unified management, be able to achieve the best results. We have the ability to coordinate such a relationship, directly determines the success or failure of information system In addition, the health care system and public health systems are fragmented, public health organization system fragmentation between the serious, national public health information system construction general construction guidelines is vertical in the end, lateral to the edge construction methods to disease prevention and control information system is most typical of direct reporting of infectious diseases, and local disease prevention and control information system encountered a dilemma, or repeated duplication leading to grassroots reporting data, and generate data inconsistency errors, or national systems do not function integrated into the cover, but extremely difficult, this urban and regional information systems and between national systems is the same structural problems that the country longitudinal lateral system and regional systems integration, how to form a complete organic public health information network, how to combine is a difficulty in the construction of national public health information systems, when this very large information systems, structural problems should be fully research and demonstration, system construction hastily to avoid a couple of problems.

Second, the construction of public health information systems there is standardization and data sharing conflict. Health information standards of public health information system is the primary content, but also the health information system data to ensure the accuracy of a long time, our public health system in different business of running a number of separate information systems, although they are for the governments at all levels of decision-making provides an important basis for many, but there is a serious information island phenomenon, its role has been extremely limited. silos phenomenon mainly data between different systems is difficult to exchange, share, management is difficult to come from different regions, different departments for effective integration of resources, resulting in a huge waste of resources, from the perspective of data silos to express the reasons for the phenomenon mainly around the various departments of the lack of a standardized system of information system support, resulting in inconsistent data sources, statistical (time, range, standard) is different from statistical analysis algorithms are different, thereby affecting the data integrity and consistency, will definitely public health information system of data collection very difficult to bring the patient in a hospital test results, can not be used in other hospitals, some of the professional sharing of information between subsystems is difficult, "patient-centered" naturally more difficult for the point to the surface, so public health information system in the beginning of the construction, we must consider the standardization of information.

Third, capital, technology and the lack of talent. Sustained and effective funding of public health information system is an important success factor since the 1980s, China's health care reform since the trial, lack of government investment is leading public health problems an important reason in the public health information system, this problem is particularly prominent. After the reforms, China has adopted a fiscal responsibility system so that local public health information on the relative lack of investment in construction, and rely on market-based adjustment mechanism is very unwise, because the public health information technology functions rely on market allocation of resources is can not do, but also so that we do not want the dry and only rely on government financial support to succeed in the technology and talent, a new system for software Development companies do not have any experience, it is the needs analysis and professional system mechanical design, requires a lot of both rich in public health expertise, and knowledge of information technology, human resources Development, software development companies which are very scarce, such issues should be first university or research institution for a large number of independent research . Our national long-term is not in the medical informatics research and standardization of investment, financial savings on the surface, but the result of unreasonable construction of the system, the waste caused by repeated or failed several times in the investment in research. NHII in the United States in the study by Government invested heavily in the system's basic structure and function of research, we can learn from.

Fourth, there are public health information network coverage gaps. Disease reporting, disease surveillance system, network covers only county, municipal, provincial and national disease prevention and control, and disease and report public health emergencies and reporting units, mainly is above the county level medical institutions, urban community health service centers (stations), the rural township hospitals and village clinics, opened clinics and various forms of medical staff, but can not achieve direct reporting line.

Fifth, the health inspection information system lags behind and does not meet the health needs of law enforcement supervision of the National health information system a serious absence of supervision, and only some areas of information technology to carry out health inspection work, the country did not form a complete system.

Links to free download http://www.hi138.com 3 policy recommendations
3.1 HL7 standards recommended by the United States public health standards for the construction of information
Health information exchange seventh layer protocol (Health Level Seven, HL7) organization is a non-profit international organizations, primarily in the health care environment and management of electronic clinical data exchange standards development. HL7 is the standard name. "Level Seven" means ISO-OSI Layer 7 (application layer), HL7 organization with reference to the International Standards Organization ISO (International Standards Orgnazitions), using the Open Systems Interconnection OSI (Open System Interconnection) communication mode, HL7 is satisfied that the highest layer, application layer is shown in Figure 1.

HL7 standard contains 256 events, 116 message types, 139 segments, 55 types of data, data dictionary 408, involving 79 kinds of coding systems, but in the application of the HL7 standard, the standard does not necessarily need to involve the entire contents, you can choose they need the application-related events, message type, and segments on it, while in the data dictionary and coding system for HL7 standard is not mandatory, you can allow users to choose the standard content only for recommendation.

HL7 standard can be carried out in different systems addressing the interface, these systems can send or receive certain information, including hospitalization or treatment were registered, discharged or transferred (ADT) data, queries, resources, and scheduling doctor's table, the doctor's advice , diagnosis, clinical observations, statements, master file update information, medical records, doctor's referral arrangements for those who care and treatment.

Within the hospital HL7 for exchange between different medical information systems medical records, clinical test results, financial information, but also for hospitals, between hospitals and insurance companies, hospitals and a large number of higher authorities the exchange of information between the demand.

A sound public health information network, in addition to routine health statistics data collection, aggregation and analysis, but also contain the epidemic or pandemic communications, vaccine management, public reporting laboratory results, medical insurance groups management, and even electronic health record (EHR) management and other public health aspects. involves a number of sector institutions, including the patient, hospital, government health departments, disease prevention and control center (CDC), public laboratories, or even legal, social security department, so public health information network system has such a request: a common interface through the use of technology and standards to ensure information sharing across multiple departments to ensure that information remains in many processed the original semantics and context. This need the entire public health system, and related medical information systems, laboratory information systems and other systems with the same or interlinked data exchange format. using the HL7 standard data interface engine technology is to introduce the latest HL7 v3.0 example of a public health class through the introduction of this class, HL7 can better describe the case of public health and expression. So, with the latter being popular relational database, and data mining technology, based on HL7 v3.0 public health information system to better describe the public health information, the formation of the HL7 standard public health information shown in Figure 2.

3.2 Government departments and the importance of sustained and effective financial support
Construction of public health information system needs of multi-sectoral and multi-field collaboration in the construction process requires a lot of organization and coordination, the strength of the various organizations to mobilize together to continuously address the information process and difficulties encountered in the various contradictions reduce blindness, increase awareness, information technology is an important guarantee for the smooth development, while all this depends on the government departments in charge of planning, there are plans to gradually expand. In addition, public health information system is the construction of social welfare project is a great investment, a long period of project investment, which requires government-led, public health information systems, the thematic investment information system construction, including one-time capital investment and annual operation and maintenance after the completion of the cost of Initially, when building the hardware, software, space, manpower and other expenses for the one-time investment in the project construction is completed, the annual cost of network communications, information systems management, maintenance costs, consumables and other recurrent expenditure costs etc need to build before taking into account, therefore, should take into consideration during construction, fully taking into account national policies, see the state special funds and local funds can meet the special construction projects, identify good sources to ensure the funding, so that information systems built to run long down.

3.3 to enhance the training and the quality of personnel training and education
Public health information system to be useful, ultimately the public health professionals. Talent is the health information technology system lags behind other sectors of the important reasons. In order to give full play to the biggest public health information systems effectiveness, on the one hand the introduction of health professionals, the other to strengthen the training of existing personnel information In the construction of public health information system should be fully consider the quality of personnel, pay attention to the introduction of high-quality health information professionals to strengthen the existing health staff training.

3.4 of specialized research
Practice has proved that, in order to make public health information system to meet the actual needs of the construction process require a dedicated research team to work with computer companies. Let alone a computer company to conduct the project, it is difficult to build an information system good, especially in the field of public health due to the software company personnel on the field of public health knowledge about very little in the process of building understanding on many issues will inevitably bias, which need to maintain close contact with professionals, enhance communication, the software business development staff as clearly as possible the same time, it allows business people to understand the system construction, in order to develop a practical need for information systems.


Notes:
① Infectious Disease Outbreaks: Bj ~ crrofism PreparednessEfo ~ sHave Improved Public Health Response Capacity, but GapsRemmn [J]. GAO-o3-654T.Washington.DC: April 9.2003.

② Federal Emergency Management Agency SemiannualRegulatoryAgenda [J]. Federal Register, Vo1.67, No.236/Monday, December 9,2002 Unified Agenda.

③ Centers for Disease Control and Prevention CDC: Improvement in Local Public Health Preparedness and Response Capacity-Kansas ,2002-2003 [J]. MMWR-M orb-Mortal-W kly-Rep.2005, 13,54 (18): 461 - 462.

④ Qiguo Long, the hole is, ZOU Zong. HL7 in public health information system application [J]. Journal of Preventive Medicine, 2006,33 (6).

References:
[1] Ge Yanfeng, Gongsen, etc. China's medical reform issues • root • a way out [M]. Beijing: China Development Press, 2007.

[2] Zhang Dongyuan Readers medical literature for information on behavior and its influencing factors [J]. Chinese Library of Medicine, 2000,9 (1) :26-27.

[3] Jiang Hanping U.S. standards for health information work [M]. Beijing: Science Press, 2005. Links to free download http://www.hi138.com