Tian Shenghu, Chen Yu
Business School, Yunnan University of Finance and Economics, Kunming, China.
School of Management and Economics, Kunming University of Science and Technology, Kunming, China.
JMIR Serious Games. 2023 Mar 6;11:e41528. doi: 10.2196/41528.
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.
We hope to clarify the game mechanism of stakeholders in the vertical integration of EHRs, and put forward targeted policy suggestions for improvement.
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.
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.
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.
中国不断出台政策，以加速医疗信息系统的互联互通、互认共享以及跨地区、跨机构的数据集成管理。然而，医疗联合体内部电子健康记录（EHR）的纵向整合受到“机制不完善、动力不足”以及参与医疗机构之间“搭便车”现象的阻碍，致使整合效果不佳。
明确电子健康记录纵向整合中利益相关者的博弈机制，并提出针对性的改进政策建议。
在详细剖析研究问题及其假设的基础上，构建“政府-医院-患者”三方演化博弈模型。随后运用系统动力学方法模拟各参与者的博弈策略与结果，以揭示医疗联合体中电子健康记录纵向整合核心参与者的长期策略演化机制，以及各方策略演化的影响因素和作用机制，为完善相关政策提供参考。
演化博弈系统最终能够达到最优均衡，但在需要政府占据主导地位的领域，患者监督需发挥积极作用，同时合理的奖惩机制可促进医院积极参与。
实现医疗联合体电子健康记录纵向整合目标的有效途径是在政府引导下构建多主体协调机制。同时，有必要建立科学的整合绩效评估机制、奖惩机制和利益分配机制，以推动医疗联合体电子健康记录纵向整合的健康发展。
