Head of digital health China, Department for international trade, British Consulate General Shanghai. Former senior manager for KPMG Life science sector advisory business development. Member of the Association of the British Pharmaceutical Industry (ABPI) with MBA from Macquarie University. Supporting bilateral trade and investment of medical companies with ambitions to develop solutions in areas such as AI image analysis, clinical diagnostic decision support, online consultations, and remote patient monitoring.
One of the first things people usually dread about the thought of more technology in healthcare is the notion that there will be an unavoidable reduction in face to face contact with medical professionals. We have all become accustomed to trusting our doctors and can’t imagine replacing that valuable human interaction with something more robotic, especially when we are feeling most vulnerable. The psychological reassurance we get from physical interaction with medical professionals is often just as important as their medical opinion.
On the contrary, digital health tools should actually enhance our human interaction with healthcare professionals, while improving medical outcomes and make our health systems more resilient. Digital tools should not only be able to provide clinical decision support, but also remotely monitor our health conditions and provide personalized recommendations with the benefit of access to our personal electronic health record. When necessary patients can then be directed more accurately to a physician who will have more capacity, since non-essential face to face interactions can be phased out. In effect allowing better quality face to face interaction with a real, qualified person when needed, not less.
The speed of transmission of COVID-19 has left many to believe that traditional methods of identifying and tracing those infected or at risk of infection (contact tracing ) is ineffective, but could be improved using contact tracing technology. Despite pleas from epidemiologists for detailed information on the whereabouts of infected people – which they believe is crucial for tracking and controlling the epidemic, many are reluctant to surrender access to their data.
The traditional method of contact tracing relies on testing symptomatic individuals then conducting an interview to establish recent movements and those in close proximity (contacts), who are in turn tested and quarantined. However, this is tedious and inaccurate as relies on memory, leading to more transmission. Since it is estimated that up to 46% of transmissions occur from asymptomatic individuals, a more accurate and proactive form of tracing could improve the possibility of epidemic control, if used by enough people. In addition, by only sending notifications to only those at risk, epidemics could be contained with reduced need for mass quarantines that are detrimental to the economy and society.
“The contact tracing mobile app concept is very simple. If you are diagnosed with coronavirus, the people you’ve recently come into contact with will be messaged advising them to isolate. If this mobile app is developed and deployed rapidly, and enough people opt-in, we can slow the spread of coronavirus and mitigate against devastating human, economic and social impacts.” [Professor Christophe Fraser, Nuffield Department of Medicine, Oxford University’s Big Data Institute]
Several countries have already deployed their own versions of the contract tracing app or are in the process of development. Although the underlying principle is the same, the methods used to execute, speed of development and ultimately their effectiveness will vary due to many factor including cultural differences on privacy and how personal data should be handled particularly by the government.
Trace Together, contact tracing app launched in Singapore, avoids storing user data centrally and uses blue tooth to record proximity to other app users, helping to protect patient privacy.
For the many people quarantining at home, this meant they were unable to visit their normal medical provider and for those with medical needs, the means of obtaining professional medical advice became a challenge. This problem was recognised by many digital healthcare providers, and they sought to find a solution. In China Ping An Good Doctor saw a spike in recorded users of its online consultation service and this has no doubt added much needed capacity to the healthcare system. The volume of online consultations in China has grown from 30m in 2012 to 148m in 2016, representing a CAGR of 49%, but this still only accounts for ~2% of all consultations performed in China. During the epidemic most of the online consults were provided for free. In the UK, Babylon Health has ‘GP at hand’ and launched a customized covid-19-care-assistant (https://www.babylonhealth.com/coronavirus/covid-19-care-assistant).
Our limited knowledge of this new virus, is one of the reasons for the global spread of COVID-19. Amid the outbreak, credible, up-to-date and practical information was incredibly important for healthcare professionals, policy makers and the public. Along with an awareness and understanding of the symptoms, in order to quickly diagnose, and provide the appropriate treatment required.
In order to help healthcare staff provide care for patients, understand the latest research, have the professional knowledge to accurately diagnose, and provide the most suitable treatment, the BMJ Publishing Group (a professional medical knowledge provider, owned by the British Medical Association) issued over 10 COVID-19 related, special resources (https://www.bmj.com/coronavirus) for clinicians. These resources are in multiple formats and cover areas such as a ‘best practice clinical decision support tool (https://bestpractice.bmj.com/info/coronavirus_covid-19/)’, interactive learning modules on infection control and protective equipment, clinical research and education – with topics including, ‘a guide for doctors’. These BMJ resources are available to healthcare staff worldwide and free of charge, so that all healthcare providers can have access to evidence-based, expert medical knowledge, at any time.
These specialist resources are based on collective, global evidence-based research, and the guidelines relating to COVID-19. Before they are published online, they are carefully reviewed, screened and evaluated by professional teams, in order to extract the required detail needed for accurate diagnosis and treatment, which in turn directly guides clinical decision-making. These resources are analysed by experts, and undergo a rigorous peer review, before they are made available to healthcare professionals.
This tool enables healthcare professionals to access up-to-date information, enhance their medical knowledge around COVID-19 and supports them in providing a timely, accurate diagnosis and the best treatment solutions for their patients. To date, these specialist resources on COVID-19 have been viewed over 300,000 times worldwide.
There are many opportunity areas in China. A recent study by Morgan & Stanley has forecasted the Internet health industry to be worth RMB50 Billion by 2022 and RMB200 Billion by 2026. Many of the segments are well covered already by familial Chinese tech companies. Lack of insurance coverage has been a challenge in the adoption of online medical services especially for fee-paying services. However, broadening of insurance coverage in terms of geographic region, disease categories, and medical service type has occurred recently. In February 2020 National Health Commission issued an approval notice to promote internet-based healthcare services for online consultations, e-prescriptions, online patient education, and internet hospitals.
The main segments and key players locally and globally
One of the best ways to see the impact of digital health is when viewed from the perspective of the patient journey, particularly in NCD’s (Non Communicable diseases) such as cancer. Using AI image analysis and CDS (Clinical decision support) tools with telemedicine for second opinions and video consultations for patient follow ups that are all integrated to the electronic patient record can increase accuracy, save time, reduce costs and improve medical outcomes. This can be done in parallel to incentivizing the training and recruitment of GP’s across China.
Oncology Enhanced Patient pathway
China has a huge opportunity to lead the world in digital health. Since it has many of the elements for its effective wide-scale application. Lots of data, strong IT infrastructure available to most and a culture that quickly adopts new technology. Philips future health study, already rates China#1 in digital health use. However, there are still areas that need to be carefully developed.
Source: Philips future health study（2019）
Currently too many Chinese patients rely on too few AAA (Class iii) hospitals. China central government has recognized that it needs to develop its primary healthcare capabilities to help monitor and triage patients rather than everyone heading to the big city hospitals. Traditionally this would require GP medical training and building physical clinics, which is underway, but is time and investment heavy.
Imbalance of Hospital Resources in China
Alternatively, China can use technology to implement digital primary care solutions such as online consultations as a first line for patients. A key component of implementing digital solutions is Health Informatics. This is a discipline that refers to the capability not only to gather and store healthcare big data but also to have access to the latest clinical expertise and standards that allow you to make the appropriate medical decision. The UK has deep expertise in Health Informatics and this is a popular theme at several conferences in China lately.
The World Artificial Intelligence conference WAIC in Shanghai on July 11th is China’s largest annual AI technology conference and the COVID-19 epidemic was a major theme. “Intelligent Connectivity – Shared Health” A dedicated health industry forum, organized by CAICT gathered global experts from industry and academia to discuss a range of themes. Professor Richard Hobbs, head of applied digital health at Oxford University gave detailed account of the broad benefits of an integrated EHR that incorporates comorbidities and screening initiatives. This presentation was well received and also shown on Shanghai local television.
Further, the UK-China Health and Medical Big Data Forum will be held On August 16th in Chongqing. It is organized by the BCSHI (British Chinese Society of Health Informatics), Chongqing Institute for Intelligent Healthcare and Population Health Research, The Medical Informatics Department of Chongqing Medical University, Chongqing big data application and development administration, and Chongqing Economy and information commission.