JMIR Publications

ABSTRACT

Background:

The medical consortiums take the integration of electronic health records (EHR) as a breakthrough and the construction of an integrated medical service system as the ultimate goal. However, the construction of the medical consortiums has broken the balance between the original medical order and interest pattern. While promoting active cooperation among hospitals, it has also intensified active competition among hospitals.

Objective:

The purpose of this paper is to reveal the internal evolution mechanism of the co-opetition strategies adopted by the superior and subordinate hospitals in the medical consortiums, and to lay a theoretical foundation and policy reference for achieving the goal of EHR integration.

Methods:

On the basis of analyzing the structure of the main players in the co-opetition game and their game motivations, we established an evolutionary game model, analyzed the impact mechanism of key parameters, simulated the dynamic evolution process of the co-opetition strategies using MATLAB, and finally proposed actionable policy recommendations.

Results:

The results indicate that the complementarity of EHR, the willingness and ability of hospitals to use EHR, and the average revenue of unit EHR have a positive promoting effect. The investment cost of unit resources has a negative hindering effect on achieving the EHR integration. The original income of hospitals and the stock of EHR have no substantial impact on the evolution direction of the game system.

Conclusions:

The medical consortiums should actively involve all levels and different types of medical institutions, and continuously improve hospitals’ willingness and ability to use EHR through training, assistance, support, sinking of medical resources, etc. The government should establish a reward and punishment system, optimize the operation mechanism and supervision mechanism of the medical consortium, monitor and punish opportunism behaviors such as “free riding”. We should continue to strengthen the construction of hospital informatization infrastructure, and actively improve the technical standards, content standards and sharing standards for the construction of EHR. In addition, designing reward and punishment mechanisms and cost accounting based on “unit EHR resources” is also of great significance for promoting the EHR integration.