Background:
County-level cervical cancer screening programmes in health-resource-limited settings often rely on fragmented paper records and weak longitudinal tracking. This can lead to avoidable repeat screening (over-screening), incomplete colposcopy follow-up, and gaps in precancer management—reducing efficiency and undermining progress toward elimination targets. 

Objectives:
To assess whether deployment of an optical character recognition (OCR)–enabled One-Identity (One-ID) digital platform is associated with improvements in screening efficiency and continuity of care, focusing on over-screening, colposcopy completion, CIN2+ detection, and CIN2+ management completion. 

Methods:
We conducted a real-world, descriptive pre–post observational evaluation across six rural counties in Shanxi, Yunnan, and Sichuan Provinces (2021–2024). The platform integrates OCR-based ID capture, deterministic One-ID linkage, real-time duplicate alerts, task lists, and dashboards, with service delivery supported via a web console and a WeChat mini program. Screening encounters (N=153,978) were analysed by comparing pre-digital (primarily paper-based, 2021–2023) versus post-digital periods (2024). Differences in proportions were tested using chi-square or Fisher’s exact tests, and absolute changes with 95% confidence intervals were calculated. 


Results:
Across 153,978 encounters, over-screening (repeat screening within a short look-back window after a documented negative test) declined from 12.64% in 2023 to 0.17% in 2024, corresponding to an absolute reduction of 12.17 percentage points (95% CI 11.94–12.40; P<0.001). The proportion receiving a first screening within the preceding 3 years increased from 78.3% to 88.2% (P<0.001). Colposcopy completion improved from 64.1% to 84.9%. CIN2+ detection increased from 0.35% (pooled 2021–2023) to 0.67% in 2024 (absolute increase 0.32 percentage points; 95% CI 0.25–0.40; P<0.001). Among sites with fully ascertained outcomes, completion of CIN2+ management rose from 56.0% to 76.2% (absolute increase 20.2 percentage points; 95% CI 13.3–27.2; P<0.001). Improvements were observed across age groups, counties, and service delivery strategies. 

Conclusions/Implications for practice or policy:
An OCR-enabled One-ID digital population-management platform was associated with near-elimination of over-screening and meaningful gains in follow-up and precancer management in rural, health-resource-limited programmes. Scalable digital reinforcement of identity linkage, de-duplication, and closed-loop follow-up may strengthen programme efficiency and quality, complementing shifts toward HPV-based screening. (This pre–post assessment is descriptive and not designed to infer causal effects.)

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