Tech Giants Enter the Fray as County-Level Medical Informatics Emerges as a New Battleground: A Quietly Launched Business Interoperability Platform Powers This Medical Consortium

Jiashan, a county-level city in the northeast of Jiaxing, Zhejiang Province, is located at the junction of Zhejiang and Jiangsu provinces and Shanghai Municipality. It is a fertile land of fish and rice crisscrossed by water networks. The famous Jiangnan water town of Xitang is located here.

The concept of county-level medical consortia first appeared in the "Guiding Opinions on Promoting the Construction and Development of Medical Consortia," issued by the General Office of the State Council in April 2017. The Guiding Opinions explicitly stated that medical consortia should be established at the county level to gradually achieve sharing of medical resources within the region, further enhance primary care service capacity, and promote a tiered diagnosis and treatment model characterized by initial consultations at the primary level, two-way referrals, separate management of acute and chronic conditions, and coordination between upper- and lower-level healthcare institutions.

Since then, more than 3,000 county-level medical consortia have been established nationwide. In May 2019, the National Health Commission and the National Administration of Traditional Chinese Medicine jointly issued the Notice on Promoting the Development of Close-Knit County-Level Medical and Health Consortia. The Notice stated that by the end of 2020, a new type of county-level medical and health service system—namely, close-knit county-level medical consortia—with clear objectives, well-defined rights and responsibilities, and coordinated division of labor would be initially established in 500 counties, striving to achieve a county-level patient visit rate of 90% and a primary care visit rate within counties of approximately 65%. Consequently, various types of healthcare informatics companies rapidly expanded their presence in county-level markets, with major players such as Huawei and Alibaba among them.

The Yangtze River Delta region has long been a highland for China’s economic model and cutting-edge technological innovation, and this holds true in healthcare reform as well. In August 2019, the Department of Primary Healthcare under the National Health Commission issued the “Notice on Printing and Distributing the List of Pilot Provinces and Counties for the Construction of Close-Knit County-Level Medical Communities,” increasing the number of pilot counties from the initially selected and announced 500 to 567. Additionally, two provincial-level pilots were added, with Zhejiang Province and Shanxi Province designated as pilot provinces for the construction of close-knit county-level medical communities.

Jiashan County administers three subdistricts and six towns, with a permanent resident population of nearly 400,000. However, there are only two hospitals in the entire county rated at Grade II Class A or above: the County First People’s Hospital and the County Traditional Chinese Medicine Hospital. As a result, residents typically seek medical care at these county-level facilities when they fall ill.

In 2018, Jiashan County initiated the construction of medical consortia. Led by the County First People’s Hospital and the County Traditional Chinese Medicine Hospital, two medical consortia were established to implement unified management over the County Second People’s Hospital, the County Maternal and Child Health Hospital, community health service centers, and township health centers. Following the launch of these consortia, tertiary hospitals have successively established joint general practice and specialty outpatient clinics in primary healthcare institutions, facilitating the downward flow of medical expertise and talent from public hospitals to the grassroots level, with the aim of achieving the goal that “minor illnesses are treated within townships, and major illnesses are managed within the county.”

It is understood that two-way referral is a key component of the construction of the medical consortium in Jiashan County. By establishing a two-way referral mechanism, primary healthcare institutions across the county have transformed from “individual entities” into a “group,” achieving centralized and unified management of personnel, finances, and materials. Hospitals of all sizes within the medical consortium have become “one family.” Relying on initial diagnosis at the primary care level, coordination between upper- and lower-level institutions, separate treatment for acute and chronic conditions, and two-way referrals, the “last mile” of the integrated healthcare service system has been bridged, making medical care more reassuring, convenient, comprehensive, and cost-effective for the public.

You Huimin, Director of the Department of Respiratory Medicine at the County First People’s Hospital, shared a story with VCBeat. A few days ago, while conducting consultations in Ganyao Town, Dr. You attended to a patient who experienced sudden chest tightness and shortness of breath. The patient’s condition did not improve after treatment at the local health center. Dr. You made a preliminary diagnosis of spontaneous right-sided pneumothorax and immediately decided to refer the patient to a higher-level hospital. As the Ganyao Town Health Center is a member unit of the County First People’s Hospital Medical Consortium, the patient was admitted to the superior hospital within just a few hours without any waiting period.

In early 2019, after winning the bid for the Jiashan County Medical Community Informatics Construction Project, ZHEJIANG MEDIINFO I.T.CO.,LTD, a HIT vendor, promptly dispatched a project team to Jiashan County. The team prioritized the development of the two-way referral function as the key focus of the first phase of the medical community platform. By sharing information on appointment slots, laboratory tests, diagnostic examinations, and hospital beds, the platform facilitated collaboration and resource sharing among medical community members, enabling appointments for healthcare resources outside the county (currently including medical resources in Jiaxing and Shanghai).

Zhang Chujun, Vice President of Zhejiang Mediinfo I.T. Co., Ltd., told VCBeat that the company is guided by the philosophy of “one platform, one center, and one suite of applications” and plans to complete the informatization construction of the Jiashan County Medical Community in three phases. In addition to the Phase I project currently under construction, Phase II will focus on the management of human resources, finances, and materials within the medical community, achieving unified personnel management (including recruitment, performance appraisal, and professional title promotion) and unified pharmaceutical management (covering tendering, distribution, and logistics). The main task of Phase III is to establish a data center within the medical community, integrate data from member institutions, provide research data for physicians within the medical community, and enable patients to access their medical records via mobile devices.

Specifically, after Zhejiang Mediinfo standardized the foundational dictionaries, it enabled appointment registration, shared laboratory testing, shared diagnostic imaging, and bed reservation within the Jiashan County Medical Community, facilitating the seamless flow of various diagnostic and treatment services across the consortium.

Appointment Registration.The medical consortium platform enables unified management of the appointment slot pool, facilitating sharing within the consortium, between consortia, and across regions.

Test Sharing.Based on the previously implemented information system for shared laboratory testing, the Medical Community Information Platform interfaces with the Hospital Information Systems (HIS) of various medical institutions to extract data, thereby aggregating laboratory test information such as referral and outsourced tests, costs, and test categories from different medical institutions.

Check Sharing.Patients schedule examination resources through the Medical Community Platform. After payment is completed at the initial diagnosis institution, the corresponding charge items can be distributed to various medical institutions via the Medical Community Information Platform to finalize the billing process.

Reserve a bed.Through an application, review, and feedback process, the medical consortium’s information platform manages bed-sharing operations. Additionally, leveraging a flexible appointment slot configuration feature, healthcare institutions can independently control the number of available appointment slots.

Furthermore, the Medical Community Information Platform developed by Zhejiang Mediinfo enables real-time data visualization through in-hospital large screens and mobile terminals. It aggregates management-related data—including healthcare personnel, operations, and two-way referrals—and presents it across three hierarchical levels: county-wide, medical community, and member institutions. This provides a comprehensive overview of the medical community’s operational status and offers data support for decision-making and analysis.

On September 30, 2019, the first phase of the information technology platforms for the two medical communities under Jiashan County’s jurisdiction was officially completed and launched, positioning Jiashan County at the forefront of nationwide informatization efforts in county-level medical communities.

“The most challenging aspect is coordination,” said Tu Shengwei, project manager for the Jiashan County Medical Community under Zhejiang Mediinfo. Although many regional health information platforms had been developed in the early stages—integrating county-level health record management and providing data access to physicians—data quality remained generally low, utilization rates among healthcare professionals were modest, and patient-facing applications were scarce. The tight-knit county-level medical community model has transformed previously loose collaborative relationships into more integrated ones. Typically, one to four such medical communities are established within a single county, aiming to retain patient resources within the system. During the implementation of IT projects for these medical communities, the coordination and interaction workload is substantial, given the large number of member institutions and the diverse array of IT vendors supporting them.

Fortunately, Zhejiang Mediinfo I.T. Co., Ltd. has accumulated years of experience in regional healthcare informatization. Meanwhile, with a large customer base among county-level people’s hospitals and county traditional Chinese medicine hospitals that serve as lead entities of medical consortia, the company possesses inherent advantages for capturing market share in the informatization construction of medical consortia. Zhang Chujun stated that Zhejiang Mediinfo has designated the informatization construction of medical consortia as a key strategic business direction for the year.

Furthermore, there is currently no clear answer as to what model should be adopted for the informatization construction of medical consortia. “Although there is a widespread desire to achieve innovation in management models within medical consortia, innovation is, in fact, very difficult,” pointed out Zhang Chujun. In response, Zhejiang Mediinfo I.T. Co., Ltd. undertook a research project on the functional development of an information system for managing human resources, finances, and materials in county-level medical consortia in Zhejiang Province, collaborating with universities to explore how to achieve unified management of these resources within such consortia.

In the informatization construction of the Jiashan County Medical Community, Zhejiang Mediinfo has gradually explored an implementation path for the “five-in-one” requirements of medical community reform. Zhang Chujun pointed out that the construction of county-level medical communities integrates county and township medical and health resources and implements unified operational management.

Specifically, efforts will be focused on reforming and improving the management systems and operational mechanisms of county-level lead hospitals and township health centers (community health service centers), to form a community of services, responsibilities, interests, management, and development between the lead hospitals and primary healthcare institutions. This will promote the rational allocation of medical and health resources within the county, facilitate the normal flow of personnel within the medical consortiums, significantly enhance the service capacity of primary healthcare, establish a reasonable and standardized order for medical treatment, improve the health status of the population, and increase residents’ satisfaction with healthcare reforms.

At the county level, improve the operational mechanisms of shared centers—including clinical laboratory centers, pathology diagnosis centers, medical imaging diagnosis centers, electrocardiogram (ECG) diagnosis centers, and sterile supply centers—to enhance operational efficiency, promote a model where primary care facilities conduct examinations and higher-level institutions provide diagnoses, and implement mutual recognition of laboratory and imaging test results across the region.

Leveraging mobile patient applications and anchored by a 360-degree view of patient diagnosis and treatment along with electronic health records, we provide an integrated, full-lifecycle health management service for residents. This service encompasses appointment scheduling, two-way referrals, telemedicine, online payments, health assessments, and self-management of health records. By adopting a dual online-offline approach, we aim to retain patients within county-level medical facilities for diagnosis and treatment, thereby enhancing residents’ sense of gain in healthcare and well-being.

Promote family doctor contract services, guide contracted residents to develop the habit of “seeking medical care in an orderly manner and adhering to referral agreements,” and establish a healthcare pattern characterized by “initial diagnosis at primary care facilities, coordinated interaction between upper- and lower-level institutions, separate management of acute and chronic conditions, and two-way referrals.” Achieve an increase in the county-level consultation rate to over 90% and the primary care consultation rate to over 65%.

The medical consortium establishes integrated management centers for medical services, human resources, finance, health insurance, public health, information technology, and logistics, operating based on the functional departments of the lead hospital.

Through the PC portal, mobile applications, and monitoring dashboards of the Medical Community Platform, comprehensive, multi-channel, dynamic, and real-time supervision is achieved. Driven efficiently by the “three pillars”—activating regulatory data, decentralizing data services, and managing health data—this approach ensures that supervision is data-supported and management is evidence-based. The construction of the Medical Community Platform enables administrators of county-level medical communities and member institutions to promptly grasp key operational metrics, including medical resources, patient flow, service outcomes, financial status, employee performance, clinical research, ongoing training, promotion and advancement, procurement and inventory, claims and debts, and infrastructure development. This facilitates scientific decision-making, assists managers and relevant personnel in timely handling of emergencies, and achieves efficient decision-making along with comprehensive and precise management.

The medical insurance payment system adopts a model of “global budgeting, appropriate retention of surpluses, and reasonable sharing of deficits,” gradually rationalizing the price ratios of medical services to reflect the labor value of healthcare professionals. We will fully implement the mechanisms of “one family,” “one account,” and “a unified strategy” for county-level medical consortia.

Gradually explore and implement capitation, point-based, per-bed-day, disease-specific, and DRG-based payment models for medical insurance funds within medical consortia. Establish a service capability assessment mechanism for medical consortia based on the standards for strengthening county-level hospitals, to promote precise improvements in medical quality and technical capabilities within these consortia.

At this stage, ZHEJIANG MEDIINFO I.T.CO.,LTD primarily addresses the informatization needs of medical consortia for county-level users by providing customized services. In addition to Jiashan County, the company has won bids and is progressively implementing medical consortium projects in other counties, such as Baoshan and Cangnan. According to Zhang Chujun, as a key vendor, the company assisted the Zhejiang Provincial Health Commission in drafting the Guidelines for the Informatization Construction of Medical Consortia in Zhejiang Province. It is also actively participating in the formulation of standards in other regions, including Sichuan Province. Building on its experience with earlier standalone projects, the company plans to roll out standardized products for the informatization construction of county-level medical consortia in the future.