Dr Tech, please
The Internet is changing the way people stay healthy and get well
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.