Dr Tech, please

The In­ter­net is chang­ing the way peo­ple stay healthy and get well

China Daily (Latin America Weekly) - - Front Page - By LIU ZHIHUA

What we are do­ing is all about dis­tribut­ing med­i­cal sources more ef­fi­ciently. In the dig­i­tal age, in­for­ma­tion is the key to achiev­ing that.”

Zhang Tieshan, di­rec­tor with the in­for­ma­tion of­fice at China-Ja­pan Friend­ship hos­pi­tal in Bei­jing

They may not have the bed­side man­ner of the very best doc­tor, but the kind of apps that bring piz­zas and taxis to your front door may now be in the process of rev­o­lu­tion­iz­ing the way med­i­cal care is de­liv­ered.

For many Chi­nese that means not only be­ing much more aware of their state of health and be­ing able to take the ap­pro­pri­ate steps when nec­es­sary, but avoid­ing time-con­sum­ing waits in long hos­pi­tal queues that have long been one of the big­gest headaches for any­one seek­ing med­i­cal care.

Th­ese apps and other in­for­ma­tion tech­nol­ogy are also chang­ing the doc­tor-pa­tient re­la­tion­ship, with med­i­cal pro­fes­sion­als ben­e­fit­ing from the stream­lin­ing of pro­ce­dures and the greater knowl­edge now at the fin­ger­tips of the masses.

Driv­ing this rapid spread in the adop­tion of what has be­come known as mhealth are the ag­ing of Chi­nese so­ci­ety that has led to a sharp in­crease in chronic dis­eases, and the steady im­prove­ment of mo­bile in­fra­struc­ture and the wide­spread use of smart­phones and tablet com­put­ers, says a re­port by the China Cen­ter form Health In­no­va­tion, a non­profit or­ga­ni­za­tion, pub­lished in De­cem­ber.

Th­ese changes also hold the prom­ise of dra­mat­i­cally chang­ing the coun­try’s health care sys­tem from one based on episodic, in­sti­tu­tional health care to one that fa­vors long-term com­mu­ni­ty­based care, the re­port says.

In 2014, 66 mil­lion Chi­nese used mhealth ser­vices, and by the end of last year, the num­ber had more than tripled to 138 mil­lion, iiMe­dia Re­search, an In­ter­net re­searcher and mar­ket­ing com­pany, re­ported re­cently.

The com­mer­cial pos­si­bil­i­ties from that growth are ob­vi­ous, and iiMe­dia Re­search said that the mo­bile health mar­ket in China was worth 4.55 bil­lion yuan ($692 mil­lion) last year, and fore­cast that its value would al­most triple, to more than 12 bil­lion yuan, next year. 138mil­lion Num­ber of Chi­nese who used mo­bile health ser­vices in 2015, up from66 mil­lion the year be­fore

How­ever, as with any highly in­no­va­tive field in which in­di­vid­u­als and cor­po­ra­tions are pin­ning their hopes for ex­plo­sive growth, the way ahead re­mains de­cid­edly un­clear, mainly be­cause the busi­ness, ethics, le­gal and pol­icy ground rules are still ill de­fined.

For the mo­ment big com­pa­nies, small app de­vel­op­ers and hospi­tals are de­vel­op­ing a plethora of apps aimed at mak­ing health care ser­vices more ac­ces­si­ble and re­duc­ing the costs of med­i­cal treat­ment.

On Jan 16, Bei­jing Ci­jiNet­work Tech­nol­ogy, a sub­sidiary of Cim­ing Checkup, launched Ji­jiankang, an app that keeps track of a user’s health data and pro­vides pro­fes­sional ad­vice and health man­age­ment ser­vices.

The app was the com­pany’s first big move into mhealth af­ter two health checkup in­dus­try lead­ers, Cim­ing Checkup and Health 100 merged late last year, in it­self a hint of the kind of com­mer­cial jock­ey­ing for po­si­tion and power that the in­dus­try is likely to see as it grows.

More than 30 mil­lion health checkup re­ports have been in­put into the app’s data­base, and any­one who has had health check­ups with Cim­ing Checkup and Health 100 can read the dig­i­tal re­ports af­ter reg­is­ter­ing on­line.

Health re­ports from other checkup ser­vices can also be put into the app’s data­base, the aim be­ing to en­sure that all of a client’s health and med­i­cal records are syn­chro­nized, mak­ing it eas­ier to ob­tain health ad­vice and med­i­cal treat­ment from pro­fes­sion­als no mat­ter who they are or where they are.

Ser­vices pro­vided in­clude pro­fes­sional ex­pla­na­tions re­gard­ing cer­tain re­sults in a re­port, and health warn­ings based on com­par­ing a user’s med­i­cal checkup re­ports from pre­vi­ous years.

The app also makes avail­able to users in­for­ma­tion on paid ser­vices pro­vided by health fa­cil­i­ties, such as risk eval­u­a­tion on can­cer, Alzheimer’s and car­dio­vas­cu­lar dis­ease, and per­son­al­ized health man­age­ment ad­vice.

Users de­cid­ing to avail of such ser­vices can make ap­point­ments with pro­fes­sion­als through the app and pay for them through the same chan­nel.

“With elec­tronic pay­ment plat­forms such as WeChat and Ali­pay, a smart­phone be­comes an elec­tronic purse, and with Ji­jiankang, a smart­phone be­comes a health guardian,” says Kang Guixia, co-founder and chief tech­nol­ogy of­fi­cer of Bei­jing Ciji Net­work Tech­nol­ogy.

“Our goal is to halve the in­ci­dence of chronic dis­eases among users,” Kang says.

But mak­ing health data widely avail­able for per­sonal health man­age­ment is

The re­al­ity is that it is time con­sum­ing and a has­sle for pa­tients to see a doc­tor in China... We make all the ap­point­ments avail­able on­line so that pa­tients can make the ap­point­ment any time and any­where...”

Zhang Tieshan of China-Ja­pan Friend­ship Hos­pi­tal in Bei­jing

just one of the many func­tions mhealth per­forms.

In China, where the dis­tri­bu­tion and qual­ity of med­i­cal ser­vices can vary greatly from re­gion to re­gion, city to city and town to town it is com­mon to wait for days and months to get an ap­point­ment with a se­nior doc­tor, es­pe­cially in the best hospi­tals.

Some peo­ple be­come so des­per­ate that they are will­ing to pay thou­sands of yuan to buy from scalpers an ap­point­ment with a med­i­cal ex­pert that in a hos­pi­tal’s of­fi­cial sys­tem of­ten costs just 14 yuan. Mhealth holds the prom­ise of re­duc­ing the preva­lence of such un­scrupu­lous prac­tices.

Many hospi­tals have de­vel­oped a mo­bile sys­tem for pa­tients to make ap­point­ment with doc­tors. Th­ese hospi­tals in­clude Bei­jing Chil­dren’sHospi­tal, Pek­ingUnionMed­i­cal Col­lege Hos­pi­tal, Nan­jing Chil­dren’s Hos­pi­tal in Nan­jing, Jiangsu prov­ince, and Xin Hua Hos­pi­tal and Rui Jin Hos­pi­tal in Shang­hai, the lat­ter two linked to Shang­hai Jiao Tong Univer­sity School ofMedicine.

Zhang Tieshan, di­rec­tor of the in­for­ma­tion of­fice of the China-Ja­pan Friend­ship Hos­pi­tal in Bei­jing, en­thuses over the po­ten­tial that mhealth has in help­ing pa­tients find doc­tors they need.

The hos­pi­tal started work­ing with the IT gi­ant Baidu in 2013, and now all its 40,000 ap­point­ment op­por­tu­ni­ties with doc­tors in a day are avail­able five to 10 days in ad­vance on Baidu Doc­tor, an app for mak­ing ap­point­ments with physicians.

“The re­al­ity is that it is time-con­sum­ing and a has­sle for pa­tients to see a doc­tor in China be­cause of the lim­ited pool of re­sources and the lack of equilibrium in how they are dis­trib­uted,” Zhang says.

“We make all the ap­point­ments avail­able on­line so that pa­tients can make the ap­point­ment any time and any­where in a way that suits them.”

Apart from us­ing the app, clients can also make ap­point­ments through the hos­pi­tal’s of­fi­cial WeChat ac­count, as well as through en­tries about its doc­tors or clin­i­cal de­part­ments on its web­site and Baidu En­cy­clo­pe­dia. There are also links to Baidu Doc­tor.

Users can also share ap­point­ment en­tries with friends through so­cial me­dia.

Hospi­tals can of­ten be mono­lithic labyrinths in which it is easy to get lost, and the apps pro­vide dig­i­tal maps of hospi­tals that are so de­tailed that pa­tients can search for routes even within a sin­gle floor.

“What we are do­ing is all about dis­tribut­ing med­i­cal sources more ef­fi­ciently,” Zhang says. “In the dig­i­tal age, in­for­ma­tion is the key to achiev­ing that”

Haodf, lit­er­ally good doc­tor, was among the first in­China to of­fer ap­point­ments with doc­tors and other health ser­vice for smart­phone users.

Es­tab­lished in 2006, haodf.com is the most widely rec­og­nized doc­tor re­view and dis­ease con­sult­ing web­site plat­form in the coun­try, cov­er­ing more than 374,000 doc­tors from more than 4,600 hospi­tals na­tion­wide.

About 100,000 doc­tors an­swer queries on dis­ease di­ag­no­sisandtreat­ment­frompa­tients on the web­site, and they write dis­ease education ar­ti­cles from a clin­i­cal per­spec­tive.

In 2011 Haodf de­vel­oped two apps — one for pa­tients and the other for doc­tors — to ex­ploit­the­newhealth careprac­ticeon­mo­bile devices, and to en­cour­age one-to-one com- mu­ni­ca­tion be­tween doc­tors and pa­tients.

In the case of ill­ness, app clients can put ques­tions to the doc­tor of their choice, ei­ther through free on­line con­sult­ing, or through paid phone calls that cost 100 yuan to 200 yuan per 10 to 15 min­utes.

They can also make ap­point­ments with doc­tors, in­clud­ing 4,000 of the top spe­cial­ists.

In a med­i­cal con­sul­ta­tion in a hos­pi­tal, pa­tients can scan a code on a doc­tors’ desk that al­lows them to com­mu­ni­cate with the doc­tor through the app later.

About 40,000 doc­tors have reg­is­tered to use the app as a tool for fol­low-ups with pa­tients, says Liu Siyue, a mar­ket­ing ex­ec­u­tive with Haodf.

Ad­di­tion­ally, the com­pany of­fers a kind of triag­ing ser­vice in which pa­tients with cer­tain ques­tions can be di­rected to the ap­pro­pri­ate doc­tors. Pa­tients can also make records about ail­ments, in­clud­ing symp­toms, and about med­i­ca­tion, mak­ing it eas­ier to com­mu­ni­cate ac­cu­rately and ef­fec­tively with doc­tors ei­ther on­line or off­line.

Doc­tors are able to sub­mit ar­ti­cles about dis­ease preven­tion and treat­ment to the app avail­able to all users and, more im­por­tantly, en­sure that ar­ti­cles rel­e­vant to cer­tain users are di­rected to them, says Liu.

“With mo­bile devices such as smart­phones it is much eas­ier for pa­tients and doc­tors to com­mu­ni­cate di­rectly.”

Zhang Tieshan, di­rec­tor of China-Ja­pan Friend­ship Hos­pi­tal, be­lieves there is much more that mhealth has to con­trib­ute in China. More apps need to be de­vel­oped to op­ti­mize health care and make hospi­tals func­tion more ef­fi­ciently, he says.

For ex­am­ple, apps should make it easy to pay med­i­cal bills on­line, thus sav­ing time for both pa­tients and hospi­tals.

For those who need to go to a hos­pi­tal of­ten, such as preg­nant women hav­ing check­ups, apps linked to med­i­cal in­sur­ance pack­ages should be de­vel­oped to ob­vi­ate the need for hav­ing re­peat­edly to go through the same pro­cesses, whether they re­late to treat­ment or pay­ment, says Zhang.

He also ad­vo­cates long-dis­tance med­i­cal care, shar­ing of health data — such as on ad­verse drug re­ac­tions and his­to­ries of al­ler­gies — and elec­tronic med­i­cal records, and broader col­lab­o­ra­tiona­mongdif­fer­ent clin­i­cal de­part­ments and hospi­tals.

Hos­pi­tal ser­vices could also be greatly stream­lined by in­te­grat­ing med­i­cal con­sum­able ma­te­rial sup­pli­ers into their mo­bile sys­tems, he says.

Ul­ti­mately, Zhang says, ev­ery­one will ben­e­fit from this in­forma­ti­za­tion in terms of ef­fi­ciency, re­duc­ing costs and de­liv­er­ing bet­ter med­i­cal ser­vices.

How­ever, one mo­bile in­dus­try prac­ti­tioner who asked not to be iden­ti­fied, but who wanted to add a dose of re­al­ism to such op­ti­mism, says that mhealth in China needs to achieve many more things be­fore it can be said that the promised rev­o­lu­tion has been de­liv­ered and the sta­tus quo has been up­ended.

For one thing, this ob­server says, many app de­vel­op­ers are sim­ply copy­cats out to make a quick buck who are apt to waste valu­able so­cial re­sources and leave the health care sec­tor short of the in­no­va­tion it so des­per­ately needs.

In this pi­o­neer­ing field, too, a con­sis­tent set of le­gal frame­works is yet to be de­vel­oped, leav­ing many open to risks of all sorts, he says.



Get­ting a reg­is­tra­tion ticket in Bei­jing’s pres­ti­gious hospi­tals is still a tire­some busi­ness.

An In­ter­net hos­pi­tal in Wuzhen of Zhe­jiang prov­ince. Doc­tors com­mu­ni­cate with their pa­tients on the In­ter­net who could be hun­dreds of miles away.

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