Empowering Universal Health Services through a Full Life-Cycle Electronic Health Record System

1.Challenges

The resident health record serves as a standardized and scientific documentation of all health service activities across an individual’s life course, providing a fundamental platform for delivering full life-cycle health services. However, fragmented health data across regions and institutions, coupled with residents' limited access to their complete health information, has hindered the continuity, precision, and effectiveness of health services, as well as public participation in self-health management. In response, Chongqing Municipality has successfully integrated and interconnected information systems across the entire healthcare sector, establishing a unified, city-wide electronic health record (EHR) system. Each resident is assigned a unique, comprehensive health record that captures their full health data history, thereby promoting standardized openness, pragmatic application, and empowering universal health services.

2.Proposed Solution
(1) Policy Framework.

The reform was designed according to the principle of "one record per person," ensuring that every resident in the city possesses a unique electronic health record. These records aggregate comprehensive health and medical data from all healthcare institutions citywide, and are accessible externally through resident authorization to support comprehensive health management initiatives.

The system employs national identification numbers as the sole identifier, creating 28.35 million unified EHRs across the municipality. Data from hospital information systems (HIS), laboratory information systems (LIS), and picture archiving and communication systems (PACS) across medical institutions are collected through a standardized channel, and residents’ life-cycle health data are integrated into their personal health records. To date, the system has aggregated over 35 billion data entries from all public hospitals (and some private hospitals), township health centers, community health service centers, and disease control institutions. The data encompass person-centered services such as basic public health services, outpatient visits, inpatient treatments, immunizations, and birth certificates, achieving real-time, cross-institutional and cross-district data exchange and dynamic updating.

(2) Strategies.

Key implementation measures have focused on three areas. First, empowering residents in self-health management: the EHR presents a time-axis view of health and medical information, allowing residents to conveniently access and manage their health status via a mobile app. Pilot applications of artificial intelligence have been launched to create individual “health portraits” and to implement color-coded family doctor service management. Second, closing the loop on basic public health service management: all basic public health data are recorded in the EHR system. AI engines are deployed to intelligently flag missing items, logical inconsistencies, and abnormal fluctuations within the data, generating tiered alerts that are pushed to primary healthcare institutions for verification and correction. Third, enabling data-driven clinical care: 77,000 physician workstations have been connected to the EHR query function, allowing authorized healthcare providers to retrieve patients' historical health records to facilitate faster and more accurate diagnoses while reducing redundant testing.

3.Outcomes and Impact

The initiative has yielded notable achievements. First, residents’ awareness and engagement in self-health management have significantly improved, with over 7 million resident inquiries into personal health records in 2024, and an increase of 2.53 percentage points in the city’s health literacy rate. Second, public satisfaction with basic health services has further increased: by 2024, resident awareness and satisfaction rates regarding basic public health services rose by 4.19 and 5.85 percentage points, respectively. Third, the financial burden of healthcare on residents has been substantially alleviated: since January 2024, mutual recognition of examination results has avoided redundant tests, saving residents approximately 214 million RMB in medical expenses. Moreover, digital imaging has replaced more than 80% of traditional CT and MRI film usage, reducing consumables costs by over 400 million RMB, thereby significantly easing both out-of-pocket expenditures for residents and pressure on the health insurance system.