What is the current healthcare market like in China?


 I won the IDG venture pitch competition in 2018. Subsequently, I was invited to participate in a road show organized by the ChinaSF and GlobalSF, a non-profit organization based in the city of San Francisco, CA. The event lasted for a week (March 17-22) during which we met with over two hundred leaders of Chinese hospitals and government officials. We visited three different cities; I learned about the latest policy and opportunities in the care management market using Artificial Intelligence in China.

1.     A Comparison of the China and US healthcare market


a)     Insurance payment and reimbursement systems are different.

医保(yi bao) is the primary health insurance in China; every citizen enjoys its basic medical coverage. The US. Medicare system is accessible to only patients who are sixty-five years and above while 医保accommodates everybody in China.  Basically, the hospitals are allocated a major quota annually; the patients undergo comprehensive and lengthy annual wellness checks to meet the requirements for insurance coverage. There is no plausible way to reduce the duration of medical checks or accrued costs. Many hospitals currently contend with an excess number of patients who have daily appointments, which is an indication that the main focus should be access to Medicare.


b)    The Interoperability of EMR system is different

In China, the EMR systems are disconnected; each hospital/clinic has an independent EMR system were patient’s records are discretely stored with no external access. The interoperability of the system is at a zero level. However, it can be affirmed that the Chinese organizations act by instructions from the government. The EMR data will be promptly presented to the government if such a request is made.


Hospitals have different capacities to perform Medical Data Analytics

In the hospital, the EMR system serves as a means to collect data, there is no formal reporting, and the data analytics department in hospitals keeps a record of the patient population for the government. This information is also available to medical researchers.


c)     Care Management targets are different

In China,CCM (Chronic Care Management) is at its budding stage, due to the payment model, the first group of patients targeted by the CCM in China is the rich and famous 人群, while in the US, Medicaid, and Medicare cover the costs of CCM for the poor and elderly patient population.


            In Summary, there are differences between the healthcare systems in China and the US. Many of the issues encountered in the US do not exist in China. Most importantly, there is no provision for reimbursement regarding the CCM or Annual Wellness checks; instead, the costs are covered by the insurance system.


2.     Healthcare Opportunities in China


a)     Care Management for the top tier population (高端人群)

In China, the number of rich and high-level government officials who demand more convenient access to better care is rising.  These groups of people are willing to pay expensive membership fees in view of accessing a care management program that provides;


1) A comprehensive medical record,

2) Access to medical experts and foreign physicians,

3) Access to local specialty doctors (专家挂号服务)

4) Access to gene therapy (基因注射)

5) Prescription of supplements (高级康复产品)

 6) Prediction and disease prevention (智能健康)

7) Travel assistance to seek medical treatment overseas etc.




b)    Care Management for seniors (智能养老)

In the next five years, China is expected to invest billions of dollars in modernizing its Senior Care System. It is common knowledge that this is an area many organizations are desperate to invest. Currently, major investments in senior Care Systems is focused on acquiring real estate and provide better staff services. From this perspective, system implantation is almost regarded as secondary, while integrating systems to promote health care in the area of Senior Care is important.


c)     Integrated hospitals system and healthcare (大健康 + 网络医疗)


The major hospitals in Beijing, Shanghai, and Guangzhou are exploring significant initiatives such as Massive healthcare projects.  There are two areas of focus:


1)    Building an online hospital system to promote the coordination of healthcare services generally. A major part of these efforts is experimental and targeted at only evaluating the situation. The people involved do not have a definite plan to accomplish these goals. Seminars and conferences are organized frequently; during these programs, active conversations are held. However, there are seeming lapses in implementation.


2)    Developing accurate care coordination procedures by connecting community hospitals and resources社区医院


3)    Using existing medical data to develop disease diagnosis and prevention: 大数据疾病诊断和预防。 This area is more clinical and big data-centric. Current focuses are developing solutions using big data to diagnosis specific diseases such as Diabetes, Cancer, etc. Big companies such as Alibaba are already partnering with different hospitals to commence on projects for lung cancer diagnosis.


In part II of this memorandum, I am going to explain how Lucidact plan to partner with local governments to take advantage of some of the above opportunities. 

Beyond EMR: Care Management with Intelligent Pathways

In a recent article published by JAMIA (Journal of the American Medical Informatics Association), an AMIA task force outlined five broad goals that will improve the value that EMRs provide to patients, who are the ultimate customers of the Healthcare system. The goals summarized in a Healthcare IT News article generally aim to facilitate care delivery, foster innovation, and prioritize efforts on patients. 


One way to redesign in order to produce patient-centered care delivery is to focus on satisfying patient interactions in terms of experience and outcomes.  Taking a page from each of the playbooks focusing on patient journeys, applications of Design Thinking to better serve the patients, and use of care pathways to deliver better outcomes, it seems that the natural progression is an EMR design that considers all actions, actors, and artifacts (data included) in the patient’s care journey. 



Imagine such design attributes:


No specific interfaces, all participants - doctors, clinicians, DME vendors, SNLs, patients, loved-ones, other care providers, etc. - have some way to access what they need, and to add to the EMR the actions they have taken.


The “backbone” that holds all participants and their actions together is an intelligent pathway that drives even seemingly disparate actions toward the care goals, and possibly even toward each organization’s goals


Only information needed to move the patient along toward a better stage in the pathway is required. That way, no one needs to solve the difficult problem of collecting data from all organizations involved with the patient. But this means that the pathway, again, is intelligent enough to know, prompt for, or even automatically ingest the required data.



Now all participants are privy to the patient's requirements, and are guided accordingly toward the goals. The intelligent pathway even takes care of scheduling, as most participants cannot afford the time and efforts to track the patient's current pathway position, let alone identify the next required action. EMRs will still do what they do best – store data safely and maintain necessary privacy – but information access, decision making, and actions to take are now happening concertedly in the full social context of patient care. The intelligent pathway acts like an “Invisible Hand”, guiding the entire “care project”, which in many cases is lengthy and involves many agents, as they move toward the expected outcomes.

Where Are Your Patients in Their Journeys?

Every doctor has a desired care pathway in mind for each patient, however there is no smart way to support the execution of those care pathways.  Based on research results, patients that followed their pathways are more likely to achieve the desired outcomes than those that resorted to usual cares. Currently, clinics from San Francisco General Hospital to Singapore have devised creative methods such as 3 x 5 cards, and post-it stickers and notes. Care teams constantly perform chart reviews in order to put data from the EMRs and other sources (e.g. referrals, claims, DME vendors) into the context of each patient's care. We need an intelligent way to automatically ingest and digest such data and then proactively guide care delivery in care pathways.



Benefits of active intelligent pathways

We can leverage IT to keep track of the patients, activating pathways from their passive stages: the guidelines in medical literatures, and workflows in clinicians' minds. Computers are better than all of us in multitasking, and it’s much cheaper to deploy computers than to hire another clinician – throwing people at the problem doesn’t make it go away, it barely and inefficiently handles the current situation.

Imagine that the activated pathways can be created easily by a clinician via simple drag-and-drops. The pathways can also be customized for each patient on the fly.  Once a patient's pathway is activated, it will constantly collect data at the back end, coordinating care-team efforts and helping to inform the care-team's decisions about possible courses of action.

Now each day the clinicians can focus on completing bite-size tasks generated by the pathways, which are responsible for guiding their efforts toward - for example - patient safety, achieving expected outcomes, and patient and staff satisfaction.


We need active intelligent pathways to remain competitive

Within a competitive environment (healthcare reform), the fine touches show that you’re on top of your patients' goal, which helps to deliver satisfaction and ultimately better care. 

Healthcare organizations are not immune to competition; are you ready for the more educated patients who are demanding more today?


Care Flows: Patient-centric, Long-running Workflows

While I was working at my last world-renowned cancer center, we were faced with a unique challenge, the Center's leadership invested substantially to initiate a new survivorship program. By definition, cancer survivors are those who have completed the treatments in their treatment plan but who need continuous monitoring and support from their care teams.  As the first step towards building the program, we needed to identify a cohort of patients who have completed their treatment - sound simple?

We discovered that there is no simple way to find those patients in the EMR system without physicians spending weeks reading through clinical notes and charts.  It is a harsh reality that despite the huge amount of data in each patient’s record, there is no quick way of identifying any patient's current stage of their care journey. 

According to the 2010 IBM Healthcare and Life Sciences Thought Leadership study, Redefining Value and Success in Healthcare: Charting the Path to the Future, healthcare ranked as the least efficient industry in the world, with more than $2.5 trillion wasted annually.  Today the healthcare industry is facing similar challenges that other traditional manufacturing and commercial industries faced in the 1990s:Medical directors are trying to make their organizations fitter and smarter, in order to survive competition and further flourish.

Healthcare organizations are beginning to look at optimizing the healthcare IT environment to make it more flexible, with the ability to adapt to evolving business requirements.

The healthcare industry’s unique needs make it difficult to find a good solution.

The healthcare industry is unique, its overall processes are complex, and most importantly, it is not only operations-centric, but also people-centric. Traditional business process management techniques such as Six Sigma cannot meet comprehensive requirements such as these.

By being people-centric, business managers of healthcare organizations need to be able to visualize their current processes in the quickest and smartest way, and to hypothesize different scenarios without interrupting the current patient care processes.  They also need to focus on patient experience and dynamic case management.

With the absence of computerized tools, most healthcare organizations are adopting LEAN methodology which means manually conducting process improvement activities. After extensive discussions and a roomful of post-it notes and wall charts, all workflow is statically drawn on separate pieces of paper. There is no real-time connection between the paper workflow and the physical processes in the clinics.  Moreover, the data that can be mapped to the new workflow will not be available for the reporting team to query until months later.  

If we start thinking even more patient-centric, we quickly get out of the single office visit workflow, e.g. from arrival to departure, into "long-running workflows" in which many others may participate in ensuring the patient completes his/her care plan action items.  Such long-running workflows, which we call "care flows", are typical in specialty-care and chronic-care management.

In my next blog post, I will be writing about the kind of care flow management platform that will actually work in the healthcare environment.