Expert Insights What can Digital Health do for China?
Smart devices and AI technologies can help prevent diseases, empower early treatment, and thus reduce the country’s dependence on triple-A hospitals in bigger cities. Yan Weiwu, associate professor of automation at Shanghai Jiao Tong University
Digital Health solutions are needed globally
The use of technology has proven to be a great enabler of efficiency within other areas like transportation and production. So, there is a good chance that using technology solutions within healthcare also can provide solutions here. Regulators have realized that technology backed solutions help fulfilling their obligation of enabling efficient and affordable access to healthcare. They are therefore among the biggest backers of Digital Health. At the end the results from deploying more technology and making use of the ever increasing amount of data available should improve quality of life and gear the systems more towards prevention and away from their heavy focus on treatment. We call it to shift from “sick-care” to true “health-care”.
China specific challenges
China, like the rest of the world, is suffering from increasing cost within its health care system. In addition to that, China’s healthcare system has some specific issues. One of the key issues certainly is its uneven distribution of health care capacity which is owed to the fact that China’s population is spread across a very large country with many people living in rural areas. Within China’s three-tier hospital system only 8% of hospitals are rated class III and therefore have access to the highest class capabilities and resources. The fact that these class III hospitals, which are mainly located in bigger cities, handle 50% of outpatient traffic nicely showcases the uneven distribution. Most of the resources is located in the big centers whereas the rural areas are very thinly covered. The uneven distribution comes along with sometimes very long travels, congested hospitals in city centers and generally long waiting hours. Especially the long travels are becoming an even bigger issue with ever more traffic in the streets of the major cities.
On top of that, access to and affordability of healthcare services in China is still relatively limited. With the percentage of people older than 60 years constantly increasing, enough health care capacity is key.
Despite the Digital Health journey already being kicked off in China and the world, adoption and progress has been relatively slow. But over time, the government has realized the need to act. Officials are convinced that allowing more technology into the system can offer solutions for improving the Chinese healthcare system over time. The health ministry has already held several meetings with digital health companies. And the National Health and Family Planning Commission of the People’s Republic of China (NHFPC) has started pushing for a national telemedicine network. Above all, in April the state council of the People’s Republic of China has communicated the Internet Plus Healthcare initiative which allows medical institutions to provide online diagnostics for specific diseases and other services.
Digital Health’s wide wings
Digital Health can on the one side increase operational efficiency in the system. For example next generation telemedicine and remote patient monitoring solutions can increase access to healthcare services for people living in areas where no coverage was available before and it can also act as triage filter for steering patients towards the right solution.
On the other hand the use of technology can improve existing products and services, offer new ways of doing things and generally make healthcare capacity accessible at reasonable cost.
This is what China’s system needs. Analyzing medical outputs like MRIs (magnetic resonance imaging) and CT scans (computer tomography) with the help of ever improving AI (artificial intelligence) can help solving the shortage of medical staff and can improve accuracy of the average outcomes. For example, a well-trained doctor may be able to recognize about 800 out of more than 2000 skin diseases. Well trained and data fed systems can, with the help of AI, diagnose all of them. Increased availability of data is fueling the progress in digital health. Some even call data the new oil.
A lot is going on already – still at the very beginning of a long journey
Improving the healthcare system is one of the focus areas of Chinese government’s 13th five year plan. Therefore, new initiatives which improve delivery of healthcare coverage across the country are deeply rooted and supported. The country’s capital city has therefore also implemented policies to enable action. This has led to the fact that, according to a recent Techwire Asia article, over 130 companies are working on projects how to apply AI in China’s healthcare sector. Facts like the very large market size, the strong regulatory/policy support, the need for action, demand from consumers and the long tenure of disrupting/renewing the healthcare system pulls in lots of companies of all sizes, from startups to mega caps. The outcome of such high level of engagement are projects like smart clinics in rural areas which allow remote consultation through telemedicine and therefore making medical capacity easily accessible, AI supported medical decision support which improves diagnosis outcomes or tech enabled next generation medical devices which make diagnosis tools more broadly available on a significantly lower price.
The projects currently under development and the products already on the market aim to improve the Chinese healthcare system through offering new ways of doing things. This in itself is triggering a fundamental shift away from the heavy focus on treatment more towards prevention. The availability of technology devices like fitness trackers which allow monitoring our health efforts and doing our own ECG (Electrocardiography is recording the electrical activity of the heart) at home or on the go enables each individual to better manage his/her health. This also allows spotting any potential health issues much earlier and therefore avoiding treatment at a stage where it’s probably already too late. The improved availability of devices for better managing peoples’ health most likely already takes a big portion of cost off the healthcare system and allows more affordable access to services in rural areas.
Some necessary pre-conditions
One of the major pre-conditions for Digital Health to happen in China, besides having the regulatory framework in place, is that new solutions need to be safe to be accepted by the market. Everybody agrees on the fact that security from a technology as well as from a medical outcome perspective is paramount. Events like the WannaCry virus which “switched off the light” in many UK hospitals in May 2017 was well noticed in the Chinese Digital Health community too. Security questions then make the regulator’s work look like a balancing act. On the one hand they want to help new technology driven products come into the market, on the other hand they need to make sure new products and services are safe. A policy issued by the National Health and Family Planning Commission for example states that telemedicine services have to be performed by medical institutions which automatically excludes ‘not qualified’ companies and therefore reduces the risk of unqualified advice.
The stars for Digital Health in China are clearly well aligned in the sense that A) there is a need for new solutions to bring down cost and improve quality as well as access to healthcare, B) politics and regulation, who usually hold back disruption, fully support it, C) industry stakeholders, including consumers, get a benefit out of it and are open to use new solutions and D) the market potential is huge which draws in enough capital to make it happen at the end. The fact that currently the healthcare system in China is still mainly dominated by public hospitals and state owned firms as well as some concerns around privacy, ethics and accountability may slow down adoption in the short term. Still, the Digital Health journey of revolutionizing healthcare through using technology has only just started, should last for quite some time and should have a sizeable impact across the whole industry.