Chi Chunhuei, Lee Jwo-Leun, Schoon Rebecca
College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA.
Adv Health Care Manag. 2012;12:75-109. doi: 10.1108/s1474-8231(2012)0000012008.
The purpose of this article is to investigate one core research question: How can health information technology (HIT) be assessed in a national health care system context?
DESIGN/METHODOLOGY: We examine this question by taking a systematic approach within a national care system, in which the purpose of HIT is to contribute to a common national health care system's goal. to promote population health in an efficient way. Based on this approach we first develop a framework and our criteria of assessment, and then using Taiwan as a case study, demonstrate how one can apply this framework to assess a national system's HIT. The five criteria we developed are how well does the HIT (1) provide accessible and accurate public health and health care information to the population; (2) collect and provide population health and health care data for government and researchers to analyze population health and processes and outcomes of health care services, (3) provide accessible and timely information that helps to improve provision of cost-effective health care at an institutional level and promotes system-wide efficiency; (4) minimize transaction and administrative costs of the health care system; and (5) establish channels for population participation in governance while also protecting individual privacy.
The results indicate that Taiwan has high levels of achievement in two criteria while falling short in the other three. Major lessons we learned from this study are that HIT exists to serve a health care system, and the national health care system context dictates how one assesses its HIT.
ORIGINALITY/VALUE: There is a large body of literature published on the implementation of HIT and its impact on the quality and cost of health care delivery. The vast majority of the literature, however, is focused on a micro institutional level such as a hospital or a bit higher up, on an HMO or health insurance firm. Few have gone further to evaluate the implementation of HIT and its impact on a national health care system. The lack of such research motivated this study. The major contributions of this study are (i) to develop a framework that follows systems thinking principles and (ii) propose a process through which a nation can identify its objectives for HIT and systematically assess its national HIT system. Using Taiwan's national health care system as a case study, this paper demonstrated how it can be done.
本文旨在探讨一个核心研究问题：在国家医疗保健系统背景下，如何评估健康信息技术（HIT）？
设计/方法：我们通过在国家医疗保健系统内采用系统方法来研究这个问题，在该系统中，HIT的目的是为实现国家医疗保健系统的共同目标做出贡献，即以高效方式促进人群健康。基于此方法，我们首先制定一个框架和评估标准，然后以台湾为例，展示如何应用该框架评估国家系统的HIT。我们制定的五个标准是：HIT在多大程度上（1）为民众提供可获取且准确的公共卫生和医疗保健信息；（2）收集并为政府和研究人员提供人群健康和医疗保健数据，以便分析人群健康以及医疗保健服务的过程和结果；（3）提供可获取且及时的信息，有助于在机构层面改善成本效益高的医疗保健服务提供，并提高全系统效率；（4）尽量减少医疗保健系统的交易和行政成本；（5）建立民众参与治理的渠道，同时保护个人隐私。
结果表明，台湾在两个标准方面取得了较高成就，而在其他三个标准方面存在不足。我们从这项研究中学到的主要经验是，HIT的存在是为医疗保健系统服务的，国家医疗保健系统背景决定了如何评估其HIT。
原创性/价值：关于HIT的实施及其对医疗保健服务质量和成本的影响，已有大量文献发表。然而，绝大多数文献关注的是微观机构层面，如医院，或者稍高一点的层面，如健康维护组织（HMO）或健康保险公司。很少有人进一步评估HIT的实施及其对国家医疗保健系统的影响。这种研究的缺乏促使了本研究。本研究的主要贡献在于：（i）开发一个遵循系统思维原则的框架；（ii）提出一个国家可以确定其HIT目标并系统评估其国家HIT系统的过程。本文以台湾的国家医疗保健系统为例，展示了如何做到这一点。
