When access ≠ acceptance: How clinical specialty demands shape mutual recognition on medical examination/test result reuse in Chinese hospitals: A study on a pilot province of China’s medical digital reform

Background Despite widespread electronic health records adoption, interoperability for sharing examination/test results across healthcare institutions remains limited, leading to redundant testing, increased costs, and compromised care. China’s mutual recognition policy for medical examination/test results, implemented via the interoperable results sharing platform(IRSP), aims to address this. However, variations in adoption across clinical specialties and the impact of hospital-level pathway interventions are poorly understood. Methods Utilizing hospital-level administrative data from Zhejiang Province’s IRSP (Oct 2023 – Sep 2024), this quasi-experimental study compared three intervention hospitals (blocking the “Overlook Access” pathway) with three control hospitals. We analyzed core recognition metrics (Access Rate-AR, Total Recognition Rate-TRR, Cross-Hospital Access Rate-CHAR, Cross-Hospital Recognition Rate-CHRR) across 12 clinical specialties. Analyses employed magnitude-based inference for intervention effects, Spearman correlations for specialty variations, and descriptive statistics for hospital-type comparisons. Results Blocking the “Overlook Access” pathway significantly increased access metrics (AR: Intervention median 98.9% vs. Control 44.6%, Cohen’s d = 2.02; CHAR: 99.5% vs. 57.6%, d = 2.85) but paradoxically decreased TRR (18.2% vs. 44.3%, d = −2.72), with minimal impact on CHRR. Substantial variations existed across specialties: Orthopedics and traditional Chinese medicine showed consistently higher access and recognition, while hepatobiliary and endocrinology faced significant challenges. Pediatrics exhibited high access but critically low recognition (e.g., Hospital H: TRR 2.05%, CHRR 2.82%), attributed to rapid physiological changes and data applicability concerns. Strong correlations existed within access metrics (AR-CHAR, ρ = 0.92, p < 0.001) and within recognition metrics (TRR-CHRR, ρ = 0.88, p < 0.001), but weak correlations between access and recognition. Conclusion This study reveals a critical distinction between access to external medical records and their actual clinical recognition, demonstrating that information interventions alone are insufficient to improve the recognition rates. Clinical specialty-specific factors significantly influence recognition behaviors, reflecting variations in data utility, stability, and diagnostic practices. Institutional success in promoting mutual recognition depends on comprehensive, multi-level strategies. The IRSP exemplifies China’s progress in health data interoperability, yet sustainable mutual recognition ultimately hinges on clinical relevance rather than mere accessibility.