title: Empowering village doctors and enhancing rural healthcare using cloud computing in a rural area of mainland China.
abstract: BACKGROUND
  China's healthcare system often struggles to meet the needs of its 900 million people living in rural areas due to major challenges in preventive medicine and management of chronic diseases. Here we address some of these challenges by equipping village doctors (ViDs) with Health Information Technology and developing an electronic health record (EHR) system which collects individual patient information electronically to aid with implementation of chronic disease management programs.
  
  
  METHODS
  An EHR system based on a cloud-computing architecture was developed and deployed in Xilingol county of Inner Mongolia using various computing resources (hardware and software) to deliver services over the health network using Internet when available. The system supports the work at all levels of the healthcare system, including the work of ViDs in rural areas. An analysis done on 291,087 EHRs created from November 2008 to June 2011 evaluated the impact the EHR system has on preventive medicine and chronic disease management programs in rural China.
  
  
  RESULTS
  From 2008 to 2011 health records were created for 291,087 (26.25%) from 1,108,951 total Xilingol residents with 10,240 cases of hypertension and 1152 cases of diabetes diagnosed and registered. Furthermore, 2945 hypertensive and 305 diabetic patients enrolled in follow-up. Implementing the EHR system revealed a high rate of cholecystectomies leading to investigations and findings of drinking water contaminated with metals. Measures were taken to inform the population and clean drinking water was supplied.
  
  
  CONCLUSIONS
  The cloud-based EHR approach improved the care provision for ViDs in rural China and increased the efficiency of the healthcare system to monitor the health status of the population and to manage preventive care efforts. It also helped discover contaminated water in one of the project areas revealing further benefits if the system is expanded and improved.
authors.affiliation: Graduate Institute of Medical Informatics, Taipei Medical University and Taipei Medical University Hospital, Taipei, Taiwan.
authors.forename: Che-Wei
authors.initials: CW
authors.lastname: Lin
authors.affiliation: College of Medical Science and Technology, Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei, Taiwan; Institute of Biomedical Informatics, National Yang Ming University, Taipei, Taiwan.
authors.forename: Shabbir Syed
authors.initials: SS
authors.lastname: Abdul
authors.affiliation: College of Medical Science and Technology, Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei, Taiwan; Institute of Translational Medicine, Taipei Medical University, Taipei, Taiwan.
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Clinciu
authors.affiliation: Health Informatics Centre, Karolinska Institutet, Sweden.
authors.forename: Jeremiah
authors.initials: J
authors.lastname: Scholl
authors.affiliation: Healthgrid Technology Inc., Beijing, China.
authors.forename: Xiangdong
authors.initials: X
authors.lastname: Jin
authors.affiliation: Healthgrid Technology Inc., Beijing, China.
authors.forename: Haifei
authors.initials: H
authors.lastname: Lu
authors.affiliation: Healthgrid Technology Inc., Beijing, China.
authors.forename: Steve S
authors.initials: SS
authors.lastname: Chen
authors.affiliation: College of Medical Science and Technology, Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei, Taiwan.
authors.forename: Usman
authors.initials: U
authors.lastname: Iqbal
authors.affiliation: Institute of Industrial Management, King Fahd University, Dhahran, Saudi Arabia.
authors.forename: Maxwell J
authors.initials: MJ
authors.lastname: Heineck
authors.affiliation: College of Medical Science and Technology, Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei, Taiwan; Department of Dermatology, Wanfang Hospital, Taipei, Taiwan. Electronic address: jack@tmu.edu.tw.
authors.forename: Yu-Chuan
authors.initials: YC
authors.lastname: Li
mesh_terms: D002681:China; D016494:Computer Security; D057286:Electronic Health Records; D006801:Humans; D008490:Medical Informatics; D010820:Physicians / Q000523:psychology*; D011209:Power, Psychological; D011787:Quality of Health Care; D019035:Rural Health Services / Q000592:standards; D014584:User-Computer Interface; D000078329:Workforce
keywords: Cloud computing; Electronic health record; Health information technology; Rural healthcare; Village doctor