Capital Medical University Affiliated Fuxing Hospital Establishes an Integrated Hospital-Community Referral System

On December 11, 2016, at the Internet Doctors Forum of the Medical and Health Big Data Summit, Song Yan, Director of the Information Center at Fuxing Hospital affiliated with Capital Medical University, was invited to deliver a presentation titled “Hospital Construction in Community Information Sharing,” introducingInformatics at Fuxing Hospital, Capital Medical Universityconstruction, as well as the achievements made at the current stage.

Fuxing Hospital, Capital Medical University, was established in 1950. As a national tertiary general hospital, it undertakes the teaching responsibilities for students of Capital Medical University, thereby also serving as a teaching hospital.

In 1995, a minor change occurred: we acquired and merged with Beijing Letan Hospital, which had previously been a community hospital providing community health services.2005In that year, we established a service model in which tertiary hospitals support community-level care, specifically with Fuxing Hospital, as a tertiary hospital, leveraging the Yuetan Community Health Service Center to form this service model.

Building on this foundation, we have established a referral system between hospitals and communities, focusing primarily on four conditions: hypertension, diabetes, coronary heart disease, and stroke. The State Council’s Guiding Opinions on the Reform of Public Hospitals also set forth relevant requirements, emphasizing the need to strengthen refined management in public hospitals, improve medical quality and service levels, and optimize related management processes, thereby enabling patients and residents to experience high-quality medical service workflows and care experiences. Furthermore, in terms of health insurance reform, we have undertaken related work in advancing disease classification groups.

To build a tiered diagnosis and treatment service model, we advocate the following principles: initial consultation at the primary care level, two-way referral, separate management of acute and chronic conditions, and coordination between upper- and lower-level medical institutions.Although it sounds easy, it is difficult to implement.

Establishing a tiered diagnosis and treatment model presents the challenge of ensuring that initial consultations take place at the primary care level. Our experience indicates that it is essential to enhance the service capacity and quality of care in primary healthcare settings. At Fuxing Hospital, general practitioners hold master’s or doctoral degrees, and there is active professional interaction between hospital specialists and community-based providers. In this regard, we have adopted a patient-centered approach, fostering collaboration between community health stations and the ten neighborhood committees in the Letan area. As a result, local residents receive medical care in a familial atmosphere, cultivating close and trusting relationships with their physicians.

Not only general practitioners, but also specialists maintain very close interactions with our hospital. In particular, through mechanisms such as two-way referrals and the triage of acute versus chronic conditions, we have established a green channel for emergency care between our hospital and community health centers. These mechanisms play a crucial role in advancing our health information technology infrastructure. Achieving coordinated care across different levels of the healthcare system requires not only policy support but also comprehensive coordination within the entire medical system.

The informatization construction of Fuxing Hospital, Capital Medical University, began in 1994. Prior to 2005, our outpatient and inpatient systems remained relatively independent, and integration was not achieved until 2006. The Letan Community Health Service Center also initiated its informatization plan in 2005. In 2006, we secured a research project from the Municipal Science and Technology Commission, which further advanced the hospital’s overall informatization development.

Prior to 2009, whether concerning research projects or existing mechanisms, all standards were coordinated internally. This included the sharing of electronic medical records and health archives with community healthcare providers, which was achieved through internal discussions and communications. It was not until 2009 that the hospital issued an official document to standardize the two-way referral process between the hospital and community healthcare providers. This document clarified both the workflows and the respective responsibilities, providing strong support for the advancement of the hospital’s informatization construction.

By 2011, the Health Bureau issued the "Notice on Carrying Out Referral Work Between Large Hospitals and Primary Medical Institutions," thereby standardizing the two-way referral system.

In terms of patient information, we have established an information management system centered on health records and medical case data. Previously, records were maintained using paper forms, until the community’s informatization infrastructure underwent gradual upgrades starting in 2007.

In terms of system process development, we have established several protocols. One is the hospitalization workflow between hospitals and community health centers, where physicians assess whether patients referred from the community require inpatient admission. The other is the protocol for bidirectional referral reception and applications, designed to leverage complementary strengths. Under this bidirectional referral mechanism between hospitals and community health centers, if a patient requires specialist consultation or further diagnosis and treatment, they will be routed through the process of referral from the community to hospital-based specialty clinics or expert outpatient services.

There is an imbalance in the level of diagnostic and testing equipment between community health centers and large hospitals. Although community physicians recognize the need for patients to undergo such examinations, they lack the necessary facilities. To address this, we have equipped community health centers with additional diagnostic and testing devices. Furthermore, in collaboration with partner developers, we have jointly designed technical specifications and workflows for bidirectional referral systems in community diagnosis and treatment. In our collaborations with other community health centers, we strictly adhere to these established workflows and technical standards.

For instance, in the Letian Community, inpatients requiring two-way referral must first submit a referral application. Upon acceptance by the hospital, the referral is linked to the hospital’s appointment slots. Within the hospital system, the only distinction for these patients is their identification as referred cases. For outpatient services, referral recommendations are provided based on whether the patient is scheduled for a specialist or subspecialty clinic. Additionally, patients can view their hospital test results at community health stations via the information platform.

One benefit is reducing the need for patients to make multiple trips, as they can access results from tertiary hospitals directly at community health stations. This also provides community physicians and general practitioners with diagnostic and treatment information from tertiary hospitals, including consultation recommendations.

We face multifaceted challenges in the future, necessitating more granular and relevant policies and procedures. This includes addressing how patients can seek medical consultation and treatment online, as well as enabling physicians to better engage in multi-site practice. These initiatives undoubtedly require support from corresponding policies, technological solutions, and information standards.

Furthermore, under the premise of sharing big data, we must also consider the platform’s data processing capabilities and business continuity; from all perspectives, it is essential to ensure that all operational systems run securely and stably.

Demand serves as the driving force, government policies provide support, and technological means act as safeguards. With the implementation of technology, policies, and demand, medical institutions must strengthen management to serve decision-makers while continuing to serve healthcare professionals; more importantly, they must serve the general public.