Gao Xianfu: National Three Major Databases, Hebei Province Implements Four Major Databases

On December 11, 2016, at the Internet Doctors Forum on Medical and Health Big Data, Gao Xianfu, Director of the Planning and Information Division of the Hebei Provincial Health and Family Planning Commission, was invited to deliver a presentation titled “Hebei Health Cloud,” in which he introduced Hebei Province’s initiatives in medical and health big data development and the achievements attained to date.

Hebei is a major economic province surrounding Beijing and Tianjin. Its population ranks among the highest in China, reaching 74 million as of December 31 last year. The province administers one prefecture-level city, 155 counties and districts, and 22 directly administered counties.

Hebei’s informatization development has been relatively lagging behind on a national scale. In 1988, Hebei was commissioned by the Ministry of Health to develop a hospital accounting system. This system remained in use in many hospitals as late as 2008. Consequently, Hebei fell behind during the era of electronic medical records and smart healthcare. In recent years, in accordance with the National Health and Family Planning Commission’s “Guiding Opinions on Informatization for Population Health,” Hebei Province has made concerted efforts to catch up by implementing information systems for primary healthcare institutions and planning the Hebei Health Cloud.

This project is also a major healthcare reform initiative of the central government. In 2012, to improve the management level and service capacity of primary healthcare institutions, China implemented the Primary Healthcare Institution Management Project nationwide. The investment in Hebei Province amounted to RMB 164 million, with a requirement for local matching funds of RMB 110 million, to develop a province-wide unified information system featuring five major functions for integrated urban-rural healthcare management.

First, the system should be supported by a basic platform. Without such support, if the system were deployed to every county, information would fail to be aggregated upward. At that time, more than 95% of medical institutions at the county level and above in Hebei Province had implemented basic electronic medical records, establishing a certain scale foundation.

Centralized drug management was essentially established in Hebei Province by 2012. Building on this foundation, Hebei Province planned the Hebei Health Cloud in accordance with the national framework.

First, this project involves the construction of a provincial data center, which will support the establishment of a provincial-level cloud platform and cloud nodes across 11 prefecture-level cities. The cloud platform is basically built according to the SaaS (Software as a Service) model, relying on the data layer, interface layer, and service layer to provide management services. At the provincial level, the core component is the exchange system. This exchange system,

It is necessary to achieve platform integration with medical institutions at Level II and above. From the perspective of data sources, the health system comprises three major categories of data: the first category consists of data generated by primary healthcare institutions; the second category includes data produced by medical institutions at Level II and above; and the third category encompasses data arising from public health and family planning management.

After years of informatization construction in medical institutions, data remains fragmented across individual hospitals. How can real-time, interactive data exchange be achieved? In Hebei Province, there are 467 secondary-level and above hospitals, necessitating the establishment of a real-time interactive exchange system. A front-end system must be deployed at each hospital end. Data required during clinical diagnosis and treatment is pushed to the hospitals via the platform’s data exchange mechanism. Meanwhile, data generated by the hospitals themselves during medical processes is transmitted to the platform through the front-end system. This approach enables province-wide information sharing for patients seeking cross-institutional and cross-regional medical care.

Second, integrate systems such as public health and family planning into a unified cloud-based platform. This platform facilitates horizontal data exchange with relevant provincial departments and agencies. Such data exchange is implemented through a centralized exchange platform operated by a unified department under the provincial government.

While the national government emphasizes three major databases, Hebei Province has incorporated health resources into its framework, establishing four major databases.

Whether for doctors, nurses, or administrative staff, a unified identity recognition system must be implemented across the province; similarly, a unified identification system should be established for residents and patients throughout the province. In this way, the aggregated data will have clearly defined responsible entities and service recipients, ensuring accountability and traceability.

In the past, health insurance settlements were conducted through the health insurance platform, achieving point-to-point connectivity with each medical institution. After the completion of the Hebei Health Cloud, regional platforms directly interface with the health insurance platform, enabling settlements through data exchange between platforms. We refer to this as "One-Line Connect." While technically straightforward, the key challenge lies in inter-departmental coordination.

Fortunately, Hebei Province issued the Provisions on Information Sharing for E-Government in the form of a government decree last year. In August this year, the State Council released the Administrative Measures for Electronic Information, which stipulates that data exchange shall be conducted exclusively among departments and platforms, thereby prohibiting individual entities from directly collecting data from grassroots units.

Currently, China is advancing the construction of a social credit system nationwide. At its core, this initiative entails the aggregation and exchange of data. Only by comprehensively collecting information on every natural person, legal entity, and social organization can relevant authorities fully monitor and control our credit-related behaviors.

Supported by the data exchange system of medical institutions at Level II and above, the provincial and municipal platforms should be improved. Four major databases need to be established on these platforms: the population information database, the health resources information database, the electronic medical record (EMR) database, and the electronic health record (EHR) database. With the support of these platforms, the first step is to develop an integrated management information system for unified rural healthcare.

It is also necessary to establish a three-tier telemedicine operation and management platform at the provincial, municipal, and county levels. A four-tier telemedicine service system should be developed, with a provincial-level telemedicine operation and management platform serving as the hub. This platform will interface upward with national authorities and downward with municipal and county entities, enabling unified scheduling of all provincial healthcare institutions to achieve sharing of provincial resources while implementing vertical management of telemedicine services in municipalities and counties.

Concurrently, a drug and medical device management platform should be established, along with a three-tier (provincial, municipal, and county) resident health card management system. This also includes public health systems, health supervision and administration platforms, traditional Chinese medicine service management platforms, and family planning systems, among others. Supported by this infrastructure, these business systems and platforms will achieve unified data exchange with the regional platform, thereby enabling the development of integrated health and family planning services.

Currently, provincial-level projects—including the data center, cloud platform, and the province-wide unified open rural-integrated primary healthcare information management system—have been fully completed. Among the 467 medical institutions at secondary level and above, more than 270 have already connected to the platform, and it is estimated that approximately 80% will be connected by the end of the year.