National Health Commission Mandates All Tier-3 Hospitals Achieve EMR Level 4+ by 2020

To the Health and Family Planning Commissions of all provinces, autonomous regions, municipalities directly under the Central Government, and the Xinjiang Production and Construction Corps:
To fully implement the Healthy China Strategy, carry out the "Opinions of the General Office of the State Council on Promoting the Development of 'Internet + Medical Health'," and continuously advance the construction of information systems in medical institutions with electronic medical records (EMR) as the core (hereinafter referred to as EMR informatization), the relevant work requirements are hereby notified as follows:
I. Enhance Awareness of the Importance of Electronic Medical Record Informatization Construction
In his report to the 19th National Congress of the Communist Party of China, General Secretary Xi Jinping emphasized the implementation of the Healthy China Strategy, the comprehensive establishment of a high-quality and efficient healthcare service system, and the improvement of modern hospital management systems. Premier Li Keqiang pointed out that leveraging “Internet Plus” holds immense potential for improving key areas of public welfare, and attention should be paid to enhancing regulatory efficiency through the use of the internet, big data, and other technologies. Advancing the informatization of electronic medical records (EMR) is of great significance for establishing and improving modern hospital management systems, ensuring medical quality and safety, improving the efficiency of medical services, enhancing patients’ healthcare experience, strengthening supervision of medical services, and promoting the development of “smart hospitals.” Health administrative departments at all local levels and medical institutions of all types and tiers should further raise their awareness, vigorously promote the informatization of EMR systems, and strive to provide the people with comprehensive, full-cycle health services.
II. Establish and improve the working mechanism for the informatization of electronic medical records
Local health administrative departments at all levels and medical institutions of all types and tiers shall prioritize the development of electronic medical record (EMR) information systems, leveraging this initiative as a key driver for advancing the modern hospital management system. They must reinforce the central role of EMRs in the informatization of medical institutions, establish and improve long-term working mechanisms, and continuously deepen related efforts. The principal leaders of medical institutions are the primary persons responsible for EMR informatization. The medical affairs department, serving as the lead unit, shall oversee the overall planning of EMR informatization, coordinate with other departments—including information technology, clinical departments, pharmacy, medical technology, and relevant functional departments—strengthen management and quality control, ensure that EMR informatization serves clinical practice, and safeguard medical quality and safety. Clinical departments, pharmacy, medical technology, and other relevant functional departments shall be guided by clinical service needs and patient-centered care, propose requirements for EMR informatization based on actual work conditions, and continuously refine and improve these requirements during the application of information systems. The information technology department shall establish communication and coordination mechanisms with all relevant departments, and strengthen system development, maintenance, operation, and technical support in accordance with identified needs.
III. Continuously Strengthening the Informatization Construction of Electronic Medical Records
(1) Achieve full coverage of all diagnosis and treatment service stages. On the basis of inpatient medical records, physician orders, and other systems, healthcare institutions shall prioritize extending electronic medical record (EMR) informatization to various diagnosis and treatment stages, including outpatient care, pharmacy, nursing, anesthesia and surgery, medical imaging, laboratory testing, and pathology, so as to comprehensively enhance the level of informatization in clinical diagnosis and treatment. By 2020, tertiary hospitals shall achieve full EMR informatization coverage across all diagnosis and treatment service stages.
(2) Leverage the function of clinical diagnosis and treatment decision support. Healthcare institutions are encouraged to embed clinical pathways, clinical practice guidelines, technical specifications, and medication guidelines into their information systems during the development of electronic medical record (EMR) infrastructure, thereby enhancing the standardization of clinical diagnosis and treatment. The incorporated clinical pathways, clinical practice guidelines, technical specifications, and medication guidelines shall be reviewed and approved by the Medical Quality Management Committee of the respective healthcare institution.
(3) Promoting System Integration and Interconnectivity. In the process of advancing the informatization of electronic medical records (EMR), medical institutions shall prioritize top-level design and coordinated implementation, strengthen the construction of hospital information platforms, and facilitate the transition of disparate information systems across different departments from fragmentation to integration and ultimately to seamless fusion. This approach aims to progressively resolve issues of information silos and vertical stovepipes, culminating in a unified, platform-based EMR information system. By 2020, tertiary hospitals shall achieve interconnectivity of information across all clinical care processes within the institution, attaining Level 4 maturity in the Standardized Maturity Assessment for Hospital Information Interconnectivity. Authorized personnel accessing any terminal from any department within the hospital shall be able to retrieve relevant clinical information according to their access privileges. For closely integrated medical consortia, interconnectivity among the EMR information systems of all constituent medical institutions shall be established.
IV. Fully Leverage the Role of Electronic Medical Record Informatics
(1) Promote the improvement of medical management standards.
1. Strengthen the supervision of diagnosis and treatment practices. Local health administrative departments at all levels and medical institutions of all types and tiers shall actively develop and apply information-based assessment tools. By conducting backend monitoring of electronic medical record (EMR) information systems, they shall analyze and determine whether diagnosis and treatment practices comply with relevant laws and regulations, core institutional policies, technical specifications, medication guidelines, and other requirements.
2. Strengthen the management of clinical practice privileges. Medical institutions shall incorporate information such as physician qualifications, nurse qualifications, physician prescribing privileges, surgical privilege levels, and antimicrobial prescribing privileges into the electronic medical record (EMR) system for backend control. Meanwhile, tiered and categorized access controls shall be implemented for medical personnel to log in to the EMR system, record, review, and modify medical record information, and sign medical documents, thereby preventing unauthorized clinical practices.
3. Strengthen quality control and evaluation. Medical institutions shall leverage electronic medical record (EMR) information systems to conduct statistical analysis and evaluation of indicators related to the quality, effectiveness, and efficiency of medical services. Establish an informatized indicator system for quality control, define quality control checkpoints and methodologies, and implement comprehensive, real-time, whole-process medical quality control. Inspections related to medical management and the accreditation and evaluation of medical institutions should fully utilize EMR information systems. Data should be collected via online or offline channels through standard interfaces or plugins, enabling remote analysis and evaluation to achieve “four reductions and one improvement,” namely, reducing the number of on-site inspection experts, the scope of on-site inspection content, the duration of on-site inspections, and human interference during on-site visits, while improving the authenticity and reliability of inspection results.
(II) Improving the Medical Service Experience.
1. Promote the integration of online and offline medical and health services. Encourage medical institutions to leverage information technologies such as the Internet to expand the scope and content of medical services, and to provide safe and appropriate medical and health services via internet-based platforms on the foundation of physical medical institutions. Advance online data collection, remote monitoring, remote guidance, and health education; conduct online follow-up consultations for certain common and chronic diseases; permit physicians to issue online prescriptions for certain common and chronic diseases after reviewing patients’ medical records; and enable pharmacists to perform online prescription reviews and medication delivery.
2. Promote convenient medical services. Actively leverage internet technologies to continuously optimize medical service processes, providing patients with convenient services such as online appointment scheduling, mobile payments, bedside settlement, visit reminders, result inquiries, and information push notifications, thereby improving the efficiency of medical services. Strengthen the statistical analysis of patient visit data by conducting big-data analyses on the distribution of outpatient visits across departments and over time. Optimize the layout of outpatient departments and diagnostic/testing units, promote staggered scheduling for consultations, examinations, and treatments, effectively triage patients, and reduce overcrowding and waiting times.
(3) Promoting the Development of Smart Hospitals. Through the informatization construction of electronic medical records (EMR), we will explore and establish sound standards, management norms, and quality control methodologies for smart hospitals. We will leverage the advantages of technologies such as the Internet, big data, cloud storage, cloud computing, blockchain, and robotics in medical administration, gradually enabling patients to receive smarter, more efficient, convenient, safe, and human-centered personalized diagnosis and treatment during their healthcare visits. We encourage the integration of mature artificial intelligence (AI) into EMR information systems to harness its capabilities in intelligent triage and guidance, assisted data collection, auxiliary laboratory, pathology, and imaging diagnostics, clinical decision support, and intelligent follow-up tracking, thereby improving the work efficiency of healthcare professionals and safeguarding medical quality and safety.
V. Strengthen the Evaluation of the Informatization Level of Electronic Medical Records
Local health administrative departments at all levels shall, in accordance with the *Administrative Specifications for the Application of Electronic Medical Records (Trial)*, *Functional Specifications for Electronic Medical Record Systems (Trial)*, and other relevant regulations, guide medical institutions within their jurisdictions to strengthen the construction and management of electronic medical record (EMR) information systems. They shall also conduct evaluations of EMR informatization development in accordance with the *Graded Evaluation Methods and Standards for Functional Application Levels of Electronic Medical Record Systems (Trial)*, so as to continuously improve the overall level of EMR informatization in their respective regions. By 2019, all tertiary hospitals within their jurisdictions shall reach Level 3 or above in the graded evaluation of EMR application, achieving data exchange among different departments within the hospital; by 2020, they shall reach Level 4 or above, realizing hospital-wide information sharing and possessing clinical decision support capabilities.
VI. Ensure the Security of Information System Construction and Operation for Electronic Medical Records
Information security management systems are an integral component of the core systems for medical quality and safety. Medical institutions shall strengthen the security protection of information systems, ensure secure storage and disaster recovery backup of medical data, and prevent risks of patient medical information leakage. They shall strictly comply with regulations on information security and the confidentiality of health and medical data, rigorously manage patient information and clinical data, protect patient privacy, and safeguard information security. Sensitive data, such as patient information, shall be stored within China. Local health administrative departments at all levels shall strengthen supervision, guidance, and security oversight of the transmission, sharing, and application of electronic medical record data by medical institutions; establish and improve security assessment mechanisms for the external sharing of sensitive data, including patient information; and ensure information security.
For any issues encountered in the informatization of electronic medical records, localities may contact the Bureau of Medical Administration and Hospital Management of this Commission.

Contact Persons: Zhang Meng and Zhang Wenbao, Medical and Nursing Division, Bureau of Medical Administration
Contact Number: 010-68792200, 2730
Email: YZYGJYHC@NHFPC.GOV.CN

August 22, 2018

(Information Disclosure Method: Proactive Disclosure)