China's First Level-8 EMR Hospital Marks a Milestone in Healthcare Digitalization
In 2018, when the updated “Grading Evaluation Methods and Standards for Functional Application Levels of Electronic Medical Record Systems” raised the highest level of EMR grading to Level 8, the average application level among tertiary hospitals in China was 2.11, while that among secondary hospitals was merely 0.83.
For a long time, achieving the highest level in the Electronic Medical Record (EMR) grading system remained an elusive goal for numerous hospital administrators, IT departments, and clinicians in China. In the four years following the establishment of the new standards, only two hospitals attained Level 7 in the first year, and no hospital managed to reach Level 8.
A milestone was established in 2023.
The "Notice on the Results of Newly Added High-Level Medical Institutions in the 2022 Electronic Medical Record System Functional Application Level Evaluation," recently published by the Hospital Management Institute of the National Health Commission, shows that a total of 89 medical institutions have been included in this year's list of high-level medical institutions for electronic medical records.
Among them, Fuwai Hospital of the Chinese Academy of Medical Sciences topped the list, becoming the first and only hospital in China to receive a Level 8 rating.
"In the view of industry insiders, Fuwai Hospital's achievement of the first Level 8 EMR rating is both a surprise and an expected outcome."
Fuwai Hospital has consistently maintained a leading position in the national electronic medical record (EMR) system grading. During the period when the highest possible rating was Level 7, it was one of only two hospitals in China to achieve this top tier, alongside Shengjing Hospital of China Medical University, naturally positioning it well to strive for Level 8. The more significant and encouraging aspect, however, lies in the positive impact brought about by Fuwai Hospital’s breakthrough in EMR grading. Having accumulated substantial experience and established exemplary models through its pursuit of high-level EMR certification, Fuwai Hospital is now well-equipped to assist other hospitals in achieving higher ratings.
Hospital information construction centered on electronic medical records (EMRs) has always been a key component of China’s new healthcare reform. EMR grading can significantly enhance the quality of medical big data, prevent data from remaining underutilized, reduce medical errors, and improve the quality and safety of healthcare.
Upgrading electronic medical records (EMRs) means that clinicians can access complete and traceable patient diagnosis and treatment data more quickly, making their work more convenient; for hospital administrators, it signifies a significant improvement in management efficiency and greater precision of medical data.
To standardize the evaluation criteria for electronic medical records (EMR) and encourage active participation from hospitals, the current levels of EMR system application are divided into nine tiers. The criteria for each tier include requirements for individual EMR subsystems as well as for the healthcare institution’s overall EMR system.
Basic Requirements for the Graded Evaluation of Overall Application Level of Electronic Medical Record Systems
From the current domestic rating landscape, a large number of tertiary hospitals’ electronic medical record (EMR) ratings fall within the Level 4–6 range, which is closely tied to hospital data governance. If a hospital achieves Level 6 within this range, it indicates that the institution has resolved long-standing issues in its informatization construction, such as data silos and data barriers.
In contrast, only four hospitals have achieved a Level 7–8 rating to date. This stage of evaluation not only requires hospitals to meet various internal development standards but also expands the assessment scope to include regional health informatization construction, mandating compliance with regional medical information sharing and ensuring continuous improvement in hospital safety and quality.
Content and Requirements for Electronic Medical Record (EMR) Application Rating Levels 4–8
According to Luo Yi (pseudonym), head of the Rating Review and Consulting Department at Huazhuo Technology: Level 7 of the Electronic Medical Record (EMR) system requires medical safety and quality control, as well as regional medical information sharing. It mandates the comprehensive use of medical information for departmental medical safety and quality management. Hospitals must be capable of sharing patients' medical information from outside their own institutions to facilitate coordinated diagnosis and treatment. Level 8 of the EMR system integrates cross-institutional medical and health records, vital signs monitoring data, and follow-up information for departmental medical activities. It requires mastery of medical quality information within the region relevant to the department and its application for the continuous improvement of departmental medical safety and quality.
Compared with Level 7 accreditation, the Level 8 accreditation recently achieved by Fuwai Hospital of the Chinese Academy of Medical Sciences places greater emphasis on the inter-institutional application and utilization of regional healthcare quality indicators. To attain Level 8 accreditation, hospitals must meet numerous requirements, such as:
1. Hospitals must fully integrate information on medical care, public health, and health monitoring to deliver integrated healthcare services;
2. Benchmark against regional healthcare quality indicators to continuously monitor and manage the medical safety and quality levels of this healthcare institution, driving ongoing improvement;
3. Share patient medical and health information with centralized display capabilities, including medical information from within and outside the institution, health records, vital signs monitoring, follow-up information, and patient-generated health data (such as health records and wearable device data). When creating an advance directive, patient-generated health data can be reviewed as a reference for understanding the patient’s condition.
4. Leverage patients' medical and health data to develop continuous treatment and care plans for them;
5. Treatment recommendations can be proposed by leveraging medical and health information from both within and outside the patient’s healthcare institution;
6. Patient-collected data are clearly labeled, enabling comparison with institutional data and the generation of trend charts.
However, despite the numerous requirements and restrictions, Luo Yi does not believe that achieving a Level 8 hospital rating presents any technical difficulties.
“Within the overall project construction, the graded evaluation of electronic medical records (EMR) has been standardized over many years, so there are no significant challenges in meeting the grading criteria. The key lies primarily in the hospital’s own understanding of and enthusiasm for EMR evaluation, as well as its collaboration with the contractor to jointly advance the implementation and execution of the project.”
Particularly for hospitals striving to achieve higher accreditation levels, the evaluation of electronic medical record (EMR) systems has long transcended the mere construction of systems and functionalities. The “hard nuts to crack” now include shifting management paradigms, supplementing top-level design, reengineering legacy workflows, and breaking down barriers to data utilization. This reflects both the original intent and the core challenges of informatization and EMR system application evaluations.
From this perspective, whether a hospital can achieve the highest levels (Level 7 and Level 8) in the Electronic Medical Record (EMR) grading system hinges primarily on its strategic choices and dedicated efforts.
According to VCBeat statistics, as of August 2023, a total of 312 hospitals across China have received high-level Electronic Medical Record (EMR) ratings. Among them, one hospital was rated at Level 8, three at Level 7, 40 at Level 6, and 268 at Level 5.
2022-2023 Status of High-Level Electronic Medical Record (EMR) Grading in China
Statistical data clearly reveal that domestic hospitals remain highly enthusiastic about achieving Levels 5 and 6 in the Electronic Medical Record (EMR) grading system, willingly dedicating significant time and resources to EMR upgrades. However, few hospitals choose to surpass this threshold and invest in pursuing Level 7 or 8 ratings.
Some industry insiders believe that after data was designated as the fifth major factor of production—alongside labor, land, and capital—the state successively introduced policies such as the “14th Five-Year Plan for the Development of the Big Data Industry” and the “Twenty Measures on Data,” prompting hospitals to engage in passive data governance. Meanwhile, with the advancement of intelligent technologies like artificial intelligence and big data, a growing number of hospital administrators have shifted their perspectives, viewing data as an asset and initiating proactive data governance efforts. Driven by the combination of these passive and proactive forces, hospitals are now more willing to devote time and effort to electronic medical record (EMR) systems related to data governance.
However, given that the return on investment for regional informatization-driven electronic medical record (EMR) construction is difficult to estimate, blind investment may impose substantial costs on hospitals. After all, achieving Level 4 EMR accreditation has already required tens of millions of yuan in funding; meeting the standards for Level 5 necessitates an additional investment of several tens of millions of yuan; and further advancements in accreditation levels will entail costs measured in hundreds of millions of yuan, which are beyond the financial capacity of ordinary tertiary hospitals.
Furthermore, even for achieving targets such as Level 4 and Level 5, most hospitals treat the certification process as a long-term objective, spreading the substantial costs over several years to alleviate financial pressure and mitigate investment risks. Data from HIT Expert Network shows that the average time required to advance from Level 5 to Level 6 is 2.3 years. Fuwai Hospital, which recently advanced from Level 7 to Level 8, dedicated at least five years to this undertaking.
From this perspective, it is impractical for hospitals in China to participate in EMR Level 7 and Level 8 assessments on a large scale. For hospitals whose size and role have not reached a certain scale, participating in higher-level EMR application assessments is not a rational choice; investments in clinical capabilities and hospital management may bring greater value to the hospital.
However, we cannot deny the positive significance of Fuwai Hospital’s achievement of Level 8 in electronic medical record (EMR) application for the entire industry.
On one hand, there are currently no enterprises in the market capable of providing comprehensive solutions related to Level 8 Electronic Medical Record (EMR) rating.Top-tier hospitals like Fuwai Hospital need to have the capacity to proactively plan, develop, and build systems, thereby pushing the upper limits of medical informatization capabilities in China.
On the other hand, the average level of electronic medical records (EMR) in China’s public hospitals still falls short of the national target, which aims for Level 3 EMR adoption in secondary public hospitals and Level 4 in tertiary public hospitals. Consequently, achieving higher EMR ratings remains a key priority in the digital transformation initiatives of most hospitals.
It is anticipated that more hospitals will "sprint" toward achieving higher-level ratings for Electronic Medical Records (EMR). In particular, Level 5, as the entry point for advanced-tier certification, remains highly challenging to attain. Over the next few years, it will be mainstream for tertiary hospitals to strive for Level 5 and aim for Level 6.
For the numerous top-tier tertiary hospitals that have already reached Level 6,This event served as a “benchmark,” boosting the enthusiasm and confidence of major hospitals in striving for Level 7 and Level 8 ratings in the Electronic Medical Record (EMR) Grading Evaluation.。
Meanwhile, we cannot overlook medical IT companies, which are key stakeholders in hospital EMR grading. Hospital informatization initiatives centered on EMR and interoperability certifications have long been a major revenue source for medical IT firms; however, the relevant market has contracted repeatedly due to the impact of the pandemic.
Nowadays, breakthroughs have been achieved in the grading of electronic medical records (EMR) systems in hospitals. We may see more hospitals collaborating with healthcare IT companies to participate in higher-level healthcare informatization construction, accelerating the arrival of the era of digital and intelligent healthcare.