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Abstract: Drawing on the 1998 China national health services survey data, this study estimated the poverty impact of two smoking-related expenses: excessive medical spending attributable to smoking and direct spending on cigarettes. The excessive medical spending attributable to smoking is estimated using a regression model of medical expenditure with smoking status (current smoker, former smoker, never smoker) as part of the explanatory variables, controlling for people''s demographic and socioeconomic characteristics. The poverty impact is measured by the changes in the poverty head count, after smoking-related expenses are subtracted from income. We found that the excessive medical spending attributable to smoking may have caused the poverty rate to increase by 1.5% for the urban population and by 0.7% for the rural population. To a greater magnitude, the poverty headcount in urban and rural areas increased by 6.4% and 1.9%, respectively, due to the direct household spending on cigarettes. Combined, the excessive medical spending attributable to smoking and consumption spending on cigarettes are estimated to be responsible for impoverishing 30.5 million urban residents and 23.7 million rural residents in China. Smoking related expenses pushed a significant proportion of low-income families into poverty in China. Therefore, reducing the smoking rate appears to be not only a public health strategy, but also a poverty reduction strategy. [Copyright &y& Elsevier]

Abstract: Objective: For the purpose of establishing electronic health record (EHR), business-oriented health data distributed in different systems should be integrated to focus on individuals. This study is aimed at collecting health data items that are now nationally available in various health information systems, and harmonizing them by modeling and defining the data elements. Methods: This study followed a bottom-up strategy in data standard development. Health data items were identified and collected by referring to national health service regulations, consulting domain experts and performing field investigations. Data items were classified and modeled based on recognized domain knowledge, information standards and specifications developed by standard development organizations (SDOs) of other countries. Data elements were extracted from data items and defined according to ISO/IEC 11179 –Metadata registries (MDR) and confirmed needs. Results: 1588 data items were collected from 33 recording forms that have been used nationally in health services, and were classified with a conceptual data model that was composed of 7 super classes (healthcare clients, healthcare providers, birth registry, health event/act, healthcare process, death, and others) and 15 classes (person''s identification, person''s socio-demographic characteristics, address, communication, provider-organization, provider-individual, birth, health event/act, observation, procedure, drug and material administration, recommendation, evaluation, expenditure, death, others). By normalizing the concepts and representations of data items, data elements were derived and defined as the attributes of classes in the data model. Data items were specified as instances of corresponding data elements. Conclusions: A large number of health data have been collected nationwide but person''s life-long health record is incomplete and inconsistent now. To integrate such massive quantity of health data from various sources, a conceptual data model was established to organize data items, avoiding conflicts and duplications in between. For data consistency, data elements should be extracted from the data items and defined as attributes of classes in the data model by choosing essential metadata attributes. Treating data items as instances of well defined data elements might make data in different contexts manageable and agreeable. To be semantically unambiguous, further study should be performed to deal with the standardization of detailed medical information, and perfect the approach of data harmonization. [Copyright &y& Elsevier]

Abstract: Objective: Exploring solutions for infectious disease information sharing among hospital and public health information systems is imperative to the improvement of disease surveillance and emergent response. This paper aimed at developing a method to directly transmit real-time data of notifiable infectious diseases from hospital information systems to public health information systems on the Internet by using a standard eXtensible Markup Language (XML) format. Methods: The mechanism and work flow by which notifiable infectious disease data are created, reported and used at health agencies in China was evaluated. The capacity of all participating providers to use electronic data interchange to submit transactions of data required for the notifiable infectious disease reporting was assessed. The minimum data set at national level that is required for reporting for national notifiable infectious disease surveillance was determined. The standards and techniques available worldwide for electronic health data interchange, such as XML, HL7 messaging, CDA and ATSM CCR, etc. were reviewed and compared, and an XML implementation format needed for this purpose was defined for hospitals that are able to access the Internet to provide a complete infectious disease reporting. Results: There are 18,703 county or city hospitals in China. All of them have access to basic information infrastructures including computers, e-mail and the Internet. Nearly 10,000 hospitals possess hospital information systems used for electronically recording, retrieving and manipulating patients’ information. These systems collect 23 data items required in the minimum data set for national notifiable infectious disease reporting. In order to transmit these data items to the disease surveillance system and local health information systems instantly and without duplication of data input, an XML schema and a set of standard data elements were developed to define the content, structure and semantics of the data set. These standards make it possible to view and analyse the data accurately outside the hospital information systems in many different document formats. The paper also identified other issues involved in notifiable disease reporting in the future, such as the adoption of approved vocabulary standards and implementation problems such as the route, secure transfer, parsing, and objective identifying of the XML message. Conclusions: XML is an increasingly important standard for exchange and transmission of data between disparate applications and systems. As in its early stages of developing an interoperable health information system in China, the XML document structures could be a way to exchange the notifiable case information among interest parties on the web at present. [Copyright &y& Elsevier]

Abstract: Objective: To describe the current status of and future plans for health informatics and related standards in China and analyze the problems raised in the process of standardization for health informatics. Methods: Data were collected through investigation and interviews, complemented by a comprehensive review of relevant literatures and regulations/law documents about health informatics and related standards in China. Results: Health informatics has been greatly developed in China. Significant resources were committed to construct and improve the health information system. Approximately 35–40% of hospitals have constructed hospital information system. Over 80% of medical organizations above the county/district level, 27% of town level hospitals and all CDC above the county/district level can transmit real-time epidemic situation reporting through public health information system. However, lack of standards became a bottleneck to utilize and improve health informatics. China has adopted some vocabulary, classification, coding standards and message standards. Moreover, several national standardization actions for health informatics have been taken. In the process of standardization, the main barriers consist of financial, technical, cultural and language problems, legal and ethical concerns and others. Conclusions: Informatics has the potential to play an important role in China''s healthcare reform process and standards are the basis for the information sharing and interoperability. Governments and partners of health informatics have realized the importance of standards and taken the initiatives in trying to solve the problem of lacking standards, but much work still needs to be done. [Copyright &y& Elsevier]