# Co-Opetition Strategies of Superior and Subordinate Hospitals for Integration of Electronic Health Records Within the Medical Consortiums in China Based on Two-Party Evolutionary Game Theory: Mixed Methods Study

## TL;DR

This study uses game theory to analyze how hospitals in China's medical consortiums cooperate and compete to integrate electronic health records, offering policy recommendations for better collaboration.

## Contribution

A novel evolutionary game model to understand co-opetition dynamics in EHR integration among hospitals in medical consortiums.

## Key findings

- EHR complementarity, willingness to use EHR, and average revenue per unit of EHR positively promote integration.
- Investment cost per unit of resources hinders EHR integration.
- Original hospital income and EHR stock do not significantly affect the evolution of co-opetition strategies.

## Abstract

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

This study aimed to explore the internal evolution mechanism of the co-opetition strategies adopted by the superior and subordinate hospitals in the medical consortiums, providing a theoretical foundation and policy reference for achieving EHR integration.

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 (MathWorks), and finally proposed actionable policy recommendations.

The results indicate that three factors positively promote EHR integration: (1) EHR complementarity, (2) hospitals’ willingness and ability to use EHR, and (3) the average revenue per unit of EHR. Conversely, the investment cost per unit of resources hinders EHR integration. Neither the original income of hospitals nor the stock of EHR significantly affects the evolution direction of the game system.

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, and sinking of medical resources, etc. The government should establish a reward and punishment system, optimize the operation and supervision mechanism of medical consortiums, and monitor and punish opportunism behaviors such as “free-riding.” It is also crucial to strengthen the construction of hospital informatization infrastructure and improve the technical, content, and sharing standards for EHR construction. In addition, designing reward and punishment mechanisms as well as cost accounting based on “unit EHR resources” is also of great significance for promoting the EHR integration.