乡村“医卫结合”何以走向形式化?——电子健康档案的应用及其社会后果  

How Did the Medicine-Public Health Integrated Model in Rural Areas Become Formalized?The Implementation and Social Consequences of the Electronic Health Records Project

作　　者：吴志鹏 姚泽麟[2] Wu Zhipeng;Yao Zelin

机构地区：[1]华东师范大学中国现代城市研究中心暨社会发展学院 [2]华东师范大学社会发展学院、上海市“中国特色的转型社会学研究”社会科学创新研究基地

出　　处：《社会发展研究》2023年第2期57-75,M0004,共20页Journal of Social Development

基　　金：2020年度国家社会科学基金重大项目“中国公共卫生防疫史研究”(项目编号:20&ZD221;主持人:杜丽红)的阶段性成果。

摘　　要：本文从技术和组织的互构论出发,通过对电子健康档案在赣中C镇落地过程的案例考察,揭示电子健康档案(Electronic Health Records, EHRs)从生产到使用的整个链条。研究发现,基于信息技术的外部制度刚性,在感知有用性和感知易用性的双重作用下,乡镇卫生院成立了由护士组建的公卫科,而以往卫生健康网络中的乡村医生由于路径依赖等原因自动成为该项目的签约村医。由于身处技术应用的末端,乡村两级卫生机构对技术进行反馈和施加影响的空间几近于无;随着外部制度环境的强化,医卫结合模式也陷入形式化运转的困境。因此,在政策制定和执行过程中,应当注重信息技术应用的乡村社会基础,以助力实现公共卫生服务的均等化递送目标。Based on the technologyorganization inter-construction theory,this paper reveals the whole chain of Electronic Health Records(EHRs)from production to use through a case study of the implementation process of EHRs in Town C of Guangzhou,thereby opening the black box of digital production.Under the external institutional rigidity of information technology,more specifically,under the effects of perceived usefulness and perceived ease of use,the township hospital established a public health department formed by nurses.Moreover,rural doctors in the previous epidemic prevention network automatically became the contracted village doctors for the project due to path dependency and other reasons.There is almost no room for technology revision by township hospitals and village clinics,which are at the lowest end of the spectrum of technology application.With the strengthening of the external institutional environment,the medicinepublic health integrated model has been in the dilemma of formalized operation.It is essential to focus on the rural social foundation of the ICT application to help achieve the goal of equal delivery of public health services.

关 键 词：公共卫生服务递送 电子健康档案 乡村医疗卫生机构 医卫结合模式 

分 类 号：R197.1[医药卫生—卫生事业管理]