Construction and Optimization of a Smart Chronic Disease Management System for Community Hospitals in the Guangdong - Hong Kong - Macao ​Greater Bay Area Based on Cross-Border Medical Data Integration

Construction and Optimization of a Smart Chronic Disease Management

System for Community Hospitals in the Guangdong - Hong Kong - Macao

Greater Bay Area Based on Cross-Border Medical Data Integration

Jinfei Xu¹ Wei Lan²Baoying Liang¹ Yilin Ren³

(1. Center of Carbon Science and Technology Innovation, Zhuhai Fudan Innovation Rescarch Institute.519000, Zhuhai, Guangdong Province, China;

2. Embodied Media Laboratory, Graduate School of Media Design, Keio University, Hiyoshi Campus,Yokohama, Kanagawa, 223-8526, Japan;

3*.Zhuhai Research Center for Women and Children' s Sports Culture, College of Sports, Jinan University Zhuhai Campus, 519070, Zhuhai, Guangdong Province, China)

Abstract:In the process of healthcare integration in the Guangdong -Hong Kong -Macao GreaterBay Area, the demand for cross-border medical services among Hong Kong and Macao residentshas continued to grow. However, constrained by institutional disparities and jurisdictionalbarriers among the three regions, primary community hospitals face profound challenges inchronic disease management, including data silos, fragmented standards, and the absence ofcollaborative govemance. In response, this study integrates the Chronic Care Model (CCM) withcross-border data governance theory to explore the construction and optimization pathways of asmart chronic disease management system based on cross-border medical data integration. Usingthe technical architecture of a "medical data space" as the foundation, the study establishes atrusted mechanism for data circulation and innovatively designs a cross-border patient masterindex together with dynamic multidimensional dictionary mapping rules. This enables thehomogeneous cleansing and compliant circulation of multi-source heterogeneous HIS data,thereby achieving a logical reconstruction from fragmented diagnostic and treatment records tostandardized cross-border health records. To address challenges arising during systemimplementation, the study further proposes a "four-layer synergy" optimization strategyencompassing governance coordination, data circulation, technical architecture, and serviceinnovation. The findings indicate that the construction and optimization of this system effectivelyresolve the problems of fragmented health profiling and duplicate medical services, significantlyenhancing the continuity and precision of cross-regional chronic disease management. The studythus provides a replicable "Greater Bay Area model" for the digital transformation and integrateddevelopment of primary healthcare in the Greater Bay Area and other regions characterized bycross-institutional systems.

Keywords:cross-border medical data; smart chronic disease management; Guangdong-HongKong-Macao Greater Bay Area; community hospitals; data governance

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