HEALTHY STRIDES

China aims to trans­form medicine through big data, with goal of pro­vid­ing smart care for ev­ery­body

China Daily European Weekly - - FRONT PAGE - By DAVID BLAIR david­blair@chi­nadaily.com.cn

Rapid ad­vances in an ar­ray of tech­nolo­gies are com­ing to­gether to en­able a tip­ping point that will fun­da­men­tally change med­i­cal ca­pa­bil­i­ties over the next decade. But ex­perts say changes in health­care sys­tems are needed to pro­vide the ben­e­fits of these ad­vances to the whole pop­u­la­tion.

Ge­nomics, the study of the im­pact of genes on health, is mov­ing quickly be­cause new big data an­a­lyt­i­cal tech­niques and data­bases are al­low­ing sci­en­tists to ex­plore com­pli­cated re­la­tions among hun­dreds or thou­sands of genes. Phar­ma­ceu­ti­cal com­pa­nies are work­ing on “pre­ci­sion medicines” that can tar­get

“The main is­sue about how China can be the world leader in smart health is the data shar­ing mech­a­nism.” DONG CHAOHUI vice-di­rec­tor of the Na­tional In­sti­tute for So­cial Se­cu­rity of the Min­istry of Hu­man Re­sources and So­cial Se­cu­rity

can­cers in an in­di­vid­ual. Ar­ti­fi­cial in­tel­li­gence rou­tines, de­vel­oped through ma­chine learn­ing, can pro­vide more ac­cu­rate di­ag­noses than most physi­cians.

A key con­cern about smart health is whether it will be cost-ef­fec­tive and af­ford­able for or­di­nary peo­ple. De­vel­op­ing pre­ci­sion can­cer drugs es­pe­cially de­signed for a pa­tient’s genome now re­quires highly skilled sci­en­tists and tech­ni­cians and is ex­pen­sive — maybe too ex­pen­sive to be widely used.

On the other hand, some smart health tech­nolo­gies may both save money and im­prove treat­ment. For ex­am­ple, wear­able body sen­sors com­bined with ar­ti­fi­cial in­tel­li­gence rou­tines may lead to cheaper and more ef­fec­tive treat­ment of di­a­betes. Ar­ti­fi­cial in­tel­li­gence pro­grams may al­low all doc­tors, in­clud­ing fam­ily doc­tors, to make bet­ter di­ag­noses. Telemedicine makes treat­ment eas­ier and more con­ve­nient. Robots may be able to help take care of hand­i­capped and el­derly peo­ple.

Dong Chaohui, vicedi­rec­tor of the Na­tional In­sti­tute for So­cial Se­cu­rity of the Min­istry of Hu­man Re­sources and So­cial Se­cu­rity, says the min­istry is “al­ready think­ing about in­clud­ing pre­ci­sion med­i­cal drugs and ge­netic tests in ba­sic cov­er­age. The con­cern is that ge­netic tests are still ex­pen­sive. If we use this tech­nol­ogy, it should be avail­able to ev­ery­body.”

Sim­i­larly, Jay Siegel, dean of the Health Sci­ence Plat­form at Tian­jin Univer­sity, em­pha­sizes the need to pri­or­i­tize ex­pen­di­tures on health­care. “The ques­tion that re­mains is how broadly the ben­e­fits of smart health will be dis­trib­uted. Right now, it is in the re­search labs, it has not had a ma­jor ef­fect on pub­lic health, it has not even been launched in any ma­jor pub­lic health sec­tor. Cer­tainly the use of ge­nomics to plan per­son­al­ized medicine has an enor­mous push in China and will have clin­i­cal ap­pli­ca­tions rel­a­tively shortly, but they are go­ing to be high-cost. We should cel­e­brate that there will be some peo­ple who have access to fron­tier treat­ments.

“But a uni­ver­sal health­care pol­icy still has to be cost-based if it wants to achieve the vi­sion of mak­ing de­vel­op­ment peo­ple-cen­tered and bal­anced,” Siegel says.

Ap­ply­ing big data to health

In June 2016, China an­nounced a 60 bil­lion yuan ($9.05 bil­lion; 7.81 bil­lion euros; £6.89 bil­lion) pre­ci­sion medicine re­search and in­vest­ment pro­gram — by far the largest such pro­gram in the world. Guide­lines is­sued by govern­ment agen­cies, in­clud­ing the Na­tional Health and Fam­ily Plan­ning Com­mis­sion, say that a big data sys­tem in­clud­ing a uni­fied and in­ter­con­nected pub­lic health in­for­ma­tion plat­form should be cre­ated by 2020. The State Coun­cil, China’s Cabi­net, also is­sued guide­lines that en­cour­age a greater de­vel­op­ment role for “so­cially in­no­va­tive forces”, such as star­tups and other in­ter­net-based health­care com­pa­nies.

“The ini­tia­tive won’t just help im­prove re­lated pub­lic health ser­vices, but will also play a big role in eco­nomic and so­cial de­vel­op­ment,” says Jin Xiao­tao, vice-min­is­ter of the Na­tional Health and Fam­ily Plan­ning Com­mis­sion.

Chi­nese com­pa­nies and re­searchers are lead­ing the world in some types of smart health tech­nol­ogy. The Bei­jing Genome In­sti­tute, iCar­bonX and WuXi Nex­tCODE are among the lead­ers in ge­nomics and data anal­y­sis.

Siegel sees col­lect­ing, an­a­lyz­ing and ap­ply­ing data flows as the key to trans­form­ing medicine.

“Think of all the ways that you could col­lect data,” he says. “Body sen­sors, geno­typ­ing, clin­i­cal tri­als. It all goes into this huge well of in­for­ma­tion. The ques­tion is how do you dis­till an essence out of the pool and to what end? There are var­i­ous AI meth­ods, and sta­tis­ti­cal meth­ods, and they serve dif­fer­ent pur­poses. They can lead to per­son­al­ized di­ag­noses, ef­fec­tive clin­i­cal tri­als, broad val­i­da­tion of ef­fi­cacy, or analy­ses of post-launch ef­fi­cacy, just to name a few. If you are mon­i­tor­ing a pa­tient con­tin­u­ously, you can watch the ef­fects of the drug on a much tighter regime. There­fore, you can con­trol dosage and treat­ment regimes. So big data is at the cen­ter. “

China has a big com­par­a­tive ad­van­tage in big data be­cause it has the world’s largest data sets. Even some in­di­vid­ual big city hos­pi­tals might have thou­sands of beds, mak­ing very large clin­i­cal tri­als pos­si­ble. But access and us­abil­ity of that data can pose a prob­lem. Much of the data is not stan­dard­ized and there is no clear le­gal pro­ce­dure to al­low re­searchers or govern­ment of­fi­cials to gain access to it.

Li Lan­juan, an aca­demic with the Chi­nese Academy of Engi­neer­ing, says China by 2020 would have the world’s largest health data pool, cov­er­ing more than 1.4 bil­lion peo­ple. “As­sess­ment of data helps author­i­ties de­vise more targeted dis­ease pre­ven­tion and health man­age­ment plans,” she says.

Cur­rently, each large hospi­tal has its own data plat­form, mak­ing data shar­ing dif­fi­cult, she says.

Siegel says: “China has huge leads in ge­nomics re­search. In AI, they are both lead­ing and trail­ing. They are lead­ing be­cause there is a lot of re­ally so­phis­ti­cated re­search go­ing on, but lim­i­ta­tions in in­ter­net and com­puter access are hin­der­ing the way this in­for­ma­tion is dis­trib­uted.”

Dong, of the Min­istry of Hu­man Re­sources and So­cial Se­cu­rity, says: “The main is­sue about how China can be the world leader in smart health is the data shar­ing mech­a­nism. Ev­ery depart­ment has a lot of big data and per­fect records. But no pol­icy makes it easy to share the data in dif­fer­ent de­part­ments. Ev­ery depart­ment has per­fect data, but it is very hard to get data across to a dif­fer­ent depart­ment.”

He says the cen­tral govern­ment now re­quires doc­tors to pro­vide data to the health in­sur­ance agency in or­der to get re­im­bursed. But the health in­sur­ance fund is col­lected by the lo­cal govern­ment, not the cen­tral govern­ment. “Each city has its own data stan­dard. The cen­tral govern­ment just pro­vides a guide­line.”

Luo Guoen, professor of eco­nomics and di­rec­tor of the China Cen­ter for Health Eco­nomics Re­search of the Na­tional School of De­vel­op­ment at Pek­ing Univer­sity, says: “One big con­di­tion for the de­vel­op­ment of big data in China is le­gal reg­u­la­tion and le­gal pro­ce­dures for the ef­fi­cient use of big data. Right now, for ex­am­ple, we do have so many big data sets all over China from hospi­tal claims data, hospi­tal clin­i­cal data, in­sur­ance claims data, na­tional in­sur­ance data and so forth. But we do not have good access to them. If we don’t use it, it is a big waste. The most im­por­tant thing is to cre­ate le­gal and trans­par­ent rules

that give access to big data, while still pro­tect­ing le­git­i­mate needs for pri­vacy, con­fi­den­tial­ity and se­crecy.”

Jin Xiao­tao, the Na­tional Health and Fam­ily Plan­ning Com­mis­sion vice-min­is­ter, said in 2016: “By 2020, a big data in­dus­trial sys­tem of med­i­cal ser­vices should be cre­ated, with a na­tional pub­lic health in­for­ma­tion plat­form and a de­vel­op­ment model that fits na­tional con­di­tions. (We will) es­tab­lish a uni­fied and in­ter­con­nected pub­lic health in­for­ma­tion plat­form. By in­te­grat­ing med­i­cal big data re­sources, in­tel­lec­tual med­i­cal ser­vices will be pro­vided to ben­e­fit peo­ple, and re­lated laws and reg­u­la­tions will be re­leased.”

In April, the NHFPC an­nounced the cre­ation of China Health­care Big Data Co, which is charged with pro­mot­ing data shar­ing and sup­ply-side struc­tural re­form in health­care. It will build na­tional and lo­cal in­dus­trial parks to use health­care big data.

Luo of Pek­ing Univer­sity says: “A re­cent ar­ti­cle sug­gested that around 40 per­cent of peo­ple with di­a­betes are not aware of the con­di­tion. For the peo­ple who are get­ting treat­ment, half of them did not reach the right level of con­trol. That sug­gests that if we can use this IT-based tech­nol­ogy to al­low in­di­vid­u­als to bet­ter man­age their con­di­tion, work­ing with their fam­ily doc­tors, we can bet­ter deal with this con­di­tion. These dis­eases don’t have to be treated in big hos­pi­tals. The access to big hos­pi­tals is much more costly than IT-based man­age­ment in com­mu­nity-based pri­mary care set­tings. There is no way physi­cians work­ing in big hos­pi­tals can take care of dis­ease man­age­ment.”

Treat­ing chronic-dis­ease pa­tients is very ex­pen­sive for the health­care sys­tem be­cause the pa­tients need life­long care. It’s hard be­cause it re­quires big changes in pa­tient be­hav­ior. Wear­ables such as watches with heart rate sen­sors and con­tin­u­ous glu­cose sen­sors that can be em­bed­ded un­der the skin, com­bined with AI rou­tines that can give con­tin­u­ous real-time in­for­ma­tion to doc­tors and guid­ance to pa­tients, have the po­ten­tial to help solve this prob­lem.

“I an­tic­i­pate that within the next three to five years, you will see these things be­gin to roll out, par­tic­u­larly things us­ing body sen­sors and re­al­time de­tec­tion as a way to mon­i­tor di­ag­no­sis and treat­ment,” says Siegel, of Tian­jin Univer­sity. “We are very close to see­ing lots of ad­vances in this.“

Shen Hongquan, CEO of Long­men Cap­i­tal Man­age­ment, a ven­ture cap­i­tal firm that spe­cial­izes in health­care in­vest­ment, says China is lead­ing the world in telemedicine and ap­ply­ing the in­ter­net-of-things to hos­pi­tals. His com­pany is in­vest­ing in those fields as well as in smart health fo­cused on chronic dis­ease man­age­ment.

He says China’s health­care sys­tem is plagued by low ef­fi­ciency in hos­pi­tals and low ser­vice qual­ity. But “smart health can help make the process of vis­it­ing a doc­tor be­come sim­ple and can en­hance the ef­fi­ciency of the clin­i­cal process and sat­isfy the cit­i­zens and also help the hospi­tal im­prove its in­for­ma­tion and man­age­ment level”.

Zhang Jian­min, health busi­ness di­rec­tor of Sun­shine In­sur­ance Group, says that “more and more health in­sur­ance com­pa­nies are fo­cus­ing on chronic dis­eases like di­a­betes, car­dio­vas­cu­lar dis­ease, kid­ney dis­ease and so on.”

Sun­shine of­fers in­sur­ance that re­im­burses di­a­betes pa­tients who de­velop crit­i­cal con­di­tions such as loss of a foot or eye­sight or the de­vel­op­ment of kid­ney dis­ease. “Telemedicine is used in the prod­uct de­sign,” says Zhang. “The pa­tient can talk to a doc­tor or get ad­vice from an AI im­ple­men­ta­tion over their mo­bile phone.”

He adds: “We hope this prod­uct will de­lay the crit­i­cal ill­ness and lower the costs. How­ever, this is a new prod­uct and we don’t yet have a time­line to prove it is ef­fec­tive.”

Zhang em­pha­sizes that he is stat­ing his per­sonal opin­ion, which is not nec­es­sar­ily the po­si­tion of Sun­shine In­sur­ance.

A po­ten­tial prob­lem for in­sur­ance com­pa­nies is that ge­netic tests may cre­ate a sit­u­a­tion where only pa­tients fac­ing higher risks of se­ri­ous dis­eases would sign up for cov­er­age. Ac­cord­ing to Zhang, this “ad­verse se­lec­tion” prob­lem could un­der­mine the fi­nances of all in­sur­ance providers.

In Oc­to­ber last year, Pres­i­dent Xi Jin­ping an­nounced the Healthy China 2030 blue­print to re­form the coun­try’s health­care sys­tem.

The plan em­pha­sizes that the cur­rent sys­tem, which is based on large hos­pi­tals in big cities, can­not deal ef­fec­tively with the needs of the pop­u­la­tion. In­creas­ing the ca­pa­bil­ity of lo­cal clin­ics and fam­ily doc­tors is key, es­pe­cially for pa­tients with chronic dis­eases or con­di­tions such as di­a­betes, high blood pres­sure or car­dio­vas­cu­lar dis­ease. It also calls for more em­pha­sis on help­ing peo­ple stay healthy, not just treat­ing dis­ease af­ter the fact.

The blue­print em­pha­sizes four core prin­ci­ples: health as a de­vel­op­ment pri­or­ity, in­no­va­tion, sci­en­tific de­vel­op­ment, and fair­ness and jus­tice. So tech­nol­ogy is an en­abler, but or­ga­ni­za­tional change is needed to take full ad­van­tage of the op­por­tu­ni­ties, ex­perts say.

Zhang of Sun­shine In­sur­ance says: “For the next 10 years, re­form of the Chi­nese med­i­cal plat­form will have the big­gest im­pact. What could be revo­lu­tion­ary is not smart health, but re­form of the health­care sys­tem.”

LI MIN /CHINA DAILY

PHO­TOS PRO­VIDED TO CHINA DAILY

A ro­bot with ar­ti­fi­cial in­tel­li­gence pro­grams can pro­vide ser­vices to the el­derly.

Doc­tors at a hospi­tal in Haikou, Hainan prov­ince, use a re­mote di­ag­no­sis sys­tem to pro­vide med­i­cal ser­vices to a pa­tient in San­sha.

Dong Chaohui, vice-di­rec­tor of the Na­tional In­sti­tute for So­cial Se­cu­rity of the Min­istry of Hu­man Re­sources and So­cial Se­cu­rity

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