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- BMJ Health Informatics
- Continuity of Patient Care
- Electronic Health Records
- Health Smart Cards
- Patient-Centered Care
People-centred integrated care, with an emphasis on ensuring healthcare services are well coordinated around people’s needs,1 is regarded as a global strategy towards universal health coverage.2 Underutilisation of information technology and lack of interoperability are identified as the main organisational barriers to advancing integrated care.3 Thus, the incorporation of digital health technologies in healthcare is essential for driving an integrated model of care.4 5 With the COVID-19 pandemic catalysing the rapid adoption of digital technology, the digitisation of healthcare delivery systems has become a pressing global need.6 7 However, there are a few studies about practices in how digital health technology is used to support integrated care.
In recent years, China has embarked on an ambitious journey to digitise and integrate its healthcare system. A critical cornerstone of this development is implementing the ‘electronic health (eHealth) card’,8 a technological solution aimed at promoting seamless and efficient healthcare services across the nation. The purpose of this paper is to share the Chinese practice about how the use of eHealth cards offers the potential to promote the integrated healthcare system. We hope the insights can aid the global effort to transition towards more integrated and efficient digital healthcare systems.
The dilemma of information fragmentation
In the past, residents in China faced a persistent bottleneck issue of ‘multiple cards coexisting but non-interoperable’ when seeking medical care. It means that from birth, patients would have to obtain numerous cards, such as identity cards, immunisation cards, health insurance cards, medical cards, etc, with medical cards differing when visiting different hospitals. These cards are issued by different departments with a lack of uniform data standards, resulting in poor linkage and access between various card information. The issue of information fragmentation led to fragmented healthcare services, such as duplicate tests and procedures due to lack of access to records when transferring, and lack of coordinated care for patients with complex conditions across different healthcare providers.
The solution of eHealth card
The eHealth card is a smart card based on quick response (QR) code technology, rolled out top-down nationwide by China’s health authorities as a universal healthcare service card. It significantly resolves the ‘multiple cards coexisting, non-interoperable’ problem. This card integrates a citizen’s ID card, social security card, immunisation card, maternal and child health card and medical cards of various hospitals, and contains personal information, health information, medical history records across providers and care settings and other information (figure 1). It is also linked to payment accounts such as bank cards, Alipay, WeChat, etc, and has financial payment capabilities. People can register and receive an eHealth card through a mobile service terminal, and can also link family member accounts.
The design of electronic health card and an implementation example of medical services. QR, quick response.
The eHealth card generates a unique code for each resident and becomes a unified identity identifier across regions and institutions throughout the country. This card has widespread applications, providing residents with ‘online and offline’ medical services (eg, appointment, consulting), public health services (eg, contracted general practitioner services, immunisation records), healthcare financial payment, medical insurance settlement, etc. It acts as a key, providing access to and linking a range of person-centred healthcare and financial services, available anytime and anywhere as needed. When a patient comes to see a doctor, the doctor can read the QR code of the eHealth card through external equipment such as the scanning pier, quickly identify the patient’s information and check the patient’s complete health records. The medical service process is shown in figure 1. It is helpful to reduce patient wait times and improve the efficiency and quality of diagnosis and treatment.
Advancing integrated healthcare through eHealth card
The evolution of eHealth cards is a technological leap and a strategic step towards creating a more integrated, people-centred healthcare system. The card offers several key benefits, which include:
Data integration and interoperability
At the heart of the eHealth card is its prowess in integrating diverse sets of health data, providing a linkage key for sharing information across different healthcare providers. This means that whether it is a local clinic or a large hospital, the patient’s data can be accessed and updated in real time, bridging gaps and enhancing the quality of care. Meanwhile, data interoperability can ensure consistency in how data are recorded, stored and shared, preventing data fragmentation and fostering a cohesive health information ecosystem. Importantly, the integrated data repository can be a goldmine for researchers and policymakers facilitating their research and policy making. It enables the analysis of large datasets to understand health trends, identify potential areas of improvement and formulate policies that are grounded on solid empirical evidence.
Facilitating continuity and coordination of care
The eHealth card plays a pivotal role in fostering continuity of care, which is often disrupted due to geographical or institutional barriers. This card enables a seamless transition between different care levels and providers, particularly for patients with complex care needs. Patients no longer need to worry about the cumbersome process of transferring records and information as they move from primary to secondary or tertiary care facilities, thus minimising the risks associated with fragmented care.9 10 In addition, the eHealth card can foster a collaborative approach to healthcare where different specialists and healthcare providers can work in unison based on the unified information entry. This initiative can prevent duplication of tests and procedures, streamline the care process and facilitate timely medical interventions.
Empowering patients
The eHealth card enables the integration of data and information to shift from an institution-centric model to a patient-centric model. First, the integrated records on the eHealth card, owned by the patients, empower them with enhanced access to and control over their healthcare information. This will help foster greater patient autonomy in managing their health, thereby enhancing their health management capabilities. Second, with consent policies for their data authorisation, patients have greater transparency into how their data are used, which is instrumental in building essential trust. Third, the eHealth card can establish a continuous family health record by linking family member accounts, promoting comprehensive health management throughout the entire life cycle for all citizens. As China advances its Healthy China 2030 agenda, putting citizens at the centre of the health system will require digital tools like eHealth cards that activate patient engagement.
The future implementation challenges
Since its first national launch in December 2017, it took more than 5 years for China’s eHealth cards to go from initial establishment to almost ‘universal coverage’ across the population. Despite the apparent benefits, the widespread implementation of eHealth cards also brings about several challenges, notably data privacy and security concerns. It is imperative to develop robust security protocols to protect sensitive health information from unauthorised access and breaches. Collaborative efforts involving governmental agencies, healthcare institutions and technology companies are needed to formulate strategies that safeguard data integrity while promoting responsible use. Further, facing the surge in users of internet and mobile health in the digital health era, the integration of data-driven healthcare is an inevitable trend. The eHealth card should adapt to support emerging technologies like wearables, artificial intelligence chatbots and remote patient monitoring that bring new data streams. Meanwhile, Chinese public awareness and adoption of the eHealth card should be strengthened in the future.
Conclusion
The eHealth card lays the crucial groundwork for realising China’s long-sought goal of integrated healthcare. Ensuring the successful implementation and utilisation of the eHealth card requires concerted efforts from all stakeholders, including government bodies, healthcare providers and the community at large. Through the use of eHealth cards, China is well on its way to transforming its healthcare landscape, towards a more integrated, efficient and high-quality healthcare system in the digital age.
Ethics statements
Patient consent for publication
Footnotes
Contributors WT: conceptualisation, writing—original draft. TG and YL: writing—review and editing. WL: supervision, writing—review and editing.
Funding This study was funded by China Postdoctoral Science Foundation (2023M732419).
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.