Upgrading and replacing existing medical information systems is one of the important means of digital transformation in primary healthcare, the Consolidated Framework for Implementation Research Constructs (CFIR) is widely used to guide implementation research across various stages and states, however, there are few research reports on the application of CFIR in medical service scenarios in China.

To analyze the implementation elements of digital transformation in primary healthcare based on CFIR.

In January 2023, 12 community health service institution managers and family doctor team members in Wuhou District, Chengdu, were selected as the subjects of the survey. A self-designed questionnaire was used for the survey, and statistical analysis was conducted using the SPSSAU software.

The effective recovery rate of the questionnaire was 100% (279/279), group and the family doctor team group is different (57.15% vs. 23.64%), and their perceptions of the sources of pressure for urgency also vary. The top three overall pressures are the demand for the supporting of the grassroots medical service model (59.14%), the strategic development needs of the institution (11.83%), and the efficiency support for personal business operations (9.68%). Respondents believe that the upgrade of the information system still needs adjustments in the transformation of service models and information technology function support (80.29%), the establishment of a unified organizational structure for promoting information technology construction (65.59%), and an independent data aggregation and management mechanism (65.23%). The top three tasks for completing digital transformation are the improvement of medical staff's health management and digital capabilities (6.21 points), the optimization and capability reshaping of the family doctor team (5.84 points), and the upgrade and transformation of the information system (5.22 points). 59.86% of the respondents support or strongly support the digital transformation goals and logic, but only 32.26% believe they can complete or lead other members to quickly implement digital transformation in their positions, and only 0.72% believe they can become members of the district-level "combat" team. The results of Logistic regression analysis showed that the clarity of the district-level strategic communication (OR=1.933), the degree of recognition of the transformation goals and logic of the above service model (OR=1.640), choosing to gain patient trust and support as the main external pressure (OR=1.159), and the expectations for the future district-level information system (OR=1.540) were positive influencing factors for individual efficiency; the impact of the current information system on daily business (OR=0.700) and the acceptance of the time for upgrading the system (OR=0.728) were negative influencing factors for individual efficiency. The above six influencing factors were distributed across five CFIR dimensions, and the implementation process accounts for two.

The timing for implementing the upgrade and transformation of the information system in Wuhou District, Chengdu, is relatively mature. Digital transformation is a systematic project involving multiple roles and links, and it requires a systematic organizational structure to drive the implementation process. CFIR can help enhance the insight into internal and external environments during the implementation process of digital transformation and successfully identify implementation elements.

对现有医疗卫生信息系统进行升级、换代是基层医疗数字化转型的重要手段之一，而实施性研究综合框架（CFIR）适用于多种实施阶段和不同状态，但国内关于医疗服务场景应用CFIR的研究报道较为少见。

基于CFIR分析基层医疗数字化转型的实施要素。

2023年1月，选择成都市武侯区12家社区卫生服务机构管理者及家庭医生团队成员作为调查对象，采用自拟调查问卷进行问卷调查，采用SPSSAU软件进行统计学分析。

本研究有效问卷回收率为100.00%（279/279）。仅有9.32%的受访者认为对现有信息系统进行结构化升级不紧迫，管理者组和家医团队组对紧迫性的感受不同（57.15%与23.64%），对紧迫性的压力来源感受不同，总体压力前三为基层医疗服务模式配套需求（59.14%）、机构战略发展需求（11.83%）和个人业务开展的效率支持（9.68%）。受访者认为信息系统升级还需要在服务模式与信息化功能支持的转化（80.29%）、推进信息化建设的统一组织架构（65.59%）、独立的数据汇聚和管理机制（65.23%）方面做出调整。完成数字化转型前三的任务为医务人员健康管理及数字化能力提升（6.21分），家庭医生团队配置优化、能力重塑（5.84分），信息化系统升级改造（5.22分）。59.86%的受访者支持和非常支持数字化转型目标和逻辑，但只有32.26%的受访者认为可以完成或带领其他成员完成数字化转型在本岗位的快速落地，仅有0.72%的受访者认为可承担区级"战斗"团队任务。Logistic回归分析结果显示，区级战略传达的清晰程度（OR=1.933）、认可以上服务模式转型目标和逻辑的程度（OR=1.640）、选择获得患者信任和支持为主要外部动力（OR=1.159）、对未来区级信息系统的期待（OR=1.540）是个人能效的正向影响因素；现在信息系统对日常业务的影响（OR=0.700）、对升级系统时间的接受度（OR=0.728）是个人能效的负向影响因素。以上6个影响因素分布在5个CFIR维度，且实施过程占2个。

成都市武侯区实施信息系统升级改造的时机已较为成熟，数字化转型是多角色、多环节的系统化工程，需要系统化的组织架构来推动实施过程。基于CFIR可以帮助提升数字化转型实施过程中对内、外部环境的洞察力，成功找出实施要素。