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Net Effect
The growing trend of Internet hospitals could mean more quality medical services
By Sudeshna Sarkar & Xu Bei | NO. 38 SEPTEMBER 22, 2016

The remote consultation room of the Wuzhen Internet Hospital in Zhejiang Province (XINHUA)

What is common to a housewife in Zhejiang, a lama in Gansu and a professional basketball team in Sichuan? To put it simply, all of them "go" to the same hospital. But to see it from a wider perspective, they are all beneficiaries of a technological revolution that is seeking to make quality healthcare available to all, no matter how far they live from prestigious hospitals or what their financial status is.

The new trend of "Internet hospitals" has become visible with the Wuzhen Internet Hospital coming up in Wuzhen, an ancient town in east China's Zhejiang Province, last year. It is the brainchild of the We Doctor group, a startup that shot to prominence when it was reported that its investors included heavyweights like the Hillhouse Capital Group, Goldman Sachs, Tencent, China Development Bank Capital and Fosun.

"Medical resources are distributed unevenly across China now," said Zhang Qunhua, President of the Wuzhen Internet Hospital. "But the Internet can be used to connect patients and doctors countrywide and provide high-quality medical resources to people anywhere. The government's Internet Plus strategy is a boost to Internet-based medical care."

The Internet Plus plan, announced by the State Council, China's cabinet, in July 2015, is meant to stimulate the economy by integrating technologies such as cloud computing and artificial intelligence to optimize sectors like manufacturing, agriculture, finance and medical care.

Zhang explained how the hospital works. Patients can register by walking in or through the Internet. The hospital has an extensive medical network—over 7,000 healthcare expert groups, 1,900 hospitals and 230,000 doctors. The patient can choose a specialist or consult the doctor recommended by the hospital. An appointment is made and on that day the doctor holds a consultation using a webcam and an instant messaging platform.

The patient's health data, including cardiac test results and x-rays, are stored in the hospital's database, to be accessed by the consulting doctor. During the consultation, the doctor can conduct examinations like measuring the body temperature or checking the blood pressure through machine-operated devices on site which will upload the results to the database. Then the doctor prescribes medicines or treatments in the hospital and a prescription is printed out.

A patient can come back for checkups after undergoing prescribed treatments like operations, which are conducted in brick-and-mortar hospitals.

The system has multiple benefits. It saves time and money. It also helps hospitals manage the flow of patients more efficiently. The Wuzhen Internet Hospital has a mobile app, which makes it accessible to practically everyone, everywhere. The result is 20,000 patients daily on average.

"The number is expected to go up to 80,000 by the end of the year," Zhang said. "We hope the hospital will become a nationwide family doctor platform and through it every family can have a doctor. No matter where you are, in a remote area or an impoverished county, through the Internet hospital you will be able to access the medical resources available in big cities."

An app poster in the lobby of the outpatient hall of the Guangzhou Women and Children's Medical Center in April 2015 (XINHUA)

Remote diagnosis

Renqing's story is a pointer to the world of convenience Internet hospitals can create.

The young lama from a remote village in northwest China's Gansu Province was diagnosed with a rare blood disorder when he was 6 years old and needed a stem cell transplant. Since the province was not equipped to do the operation, he had to be taken to Qingdao, a costal city in eastern Shandong Province, 1,800 km away. Subsequent checkups over the following years meant going all the way again to a hospital in Qingdao, which was strenuous and expensive. So when the monastery where he lives heard of the Wuzhen Internet Hospital, they brought the boy there in the very month it opened. The hospital arranged the connections with appropriate doctors and now, for checkups, Renqing can talk to doctors from the comfort of his monastery via the Internet, without having to step outside.

The first patient of the Internet hospital in Wuzhen was a housewife in Hangzhou Province, identified only by her surname Huang. A chronic cardiovascular patient, she was examined through video by a doctor from a hospital affiliated to the Zhejiang University School of Medicine on December 7, 2015, which also marked the hospital's official opening.

Two days later, Huang's prescribed medicine, bought online from the hospital's pharmacy, reached her home by courier, topping off a complete chain in medicare where almost everything is done online, including making payments and buying insurance.

Wang Qiang lives in a world poles apart from Huang's but their paths coincide at the Wuzhen Internet Hospital. He is the team doctor at the Sichuan Blue Whales, a Chengdu-based basketball team that has become a prominent member of the Chinese Basketball Association (CBA) and won the CBA finals last season. The team has signed up with the hospital. "Players may injure themselves during practice or matches," explained Zhang with the Wuzhen Internet Hospital. "Since the team doctor does not travel with the team everywhere, the Internet hospital can fill the vacuum."

There are actual patients too at the hospital, generally first-timers. Xu Wenjun, a teacher from the neighboring city Jiaxing, had come with her sister during their two-day tour, seeking treatment for a sudden itch they had developed, accompanied by rashes on their legs. Xu was especially worried about her sister, who was pregnant.

"The doctor registered our names, took pictures of our legs, and uploaded our information onto the platform," Xu said. "All we need to do now is download the app and get follow-up instructions. I'd never heard of an Internet hospital before. We wouldn't have come all the way here if we had known consulting a doctor was so easy!"

A villager in Huanxi Village is registered at the Huanxi County Elderly Center on September 3 (XU BEI)

A typical case

Water city Wuzhen, known as the Venice of China, is the perfect site for the Internet hospital. It started carving out an Internet niche from 2014 when it started hosting the World Internet Conference. One of the six foremost ancient towns south of the Yangtze River, it also holds an annual international theater festival.

When its neighboring city Hangzhou hosted the G20 Summit on September 4-5, Wuzhen too basked in the reflected limelight as the summit organizers showcased it before visitors. The Wuzhen Internet Hospital is the epitome of China's efforts in implementing inclusiveness in healthcare. Inclusivity was also one of the themes of the G20 Summit.

How inclusive it really is can't be fully gauged until you visit Huanxi, a tiny village of about 2,000 people in Tonglu County of Hangzhou. Of them, 400 are senior citizens, many of them living on their own in "empty nests," after their adult sons and daughters have moved to cities in search of better jobs or a more exciting life. To look after these senior people, the local government has built the Huanxi Elderly Center. Elderly people with no one to cook for them at home can drop in for lunch and dinner at the canteen in the center. The meals are heavily subsidized with diners paying between 2-3 yuan (29-44 cents). For recreation, there is a library and most importantly, there is a medical center that provides smart medical services.

Dr. Zhou Xiaojun presides over the medical center. The 45-year-old is the only doctor in the village where all the residents are from the same clan and share the same family name Zhou.

"I was at the end of my tether in the past," Dr. Zhou confessed. "As the houses are scattered in the village, when I was doing house calls, I would have to run from one end of the village to another day and night."

Things changed when the center began cooperation with Helowin, a Hangzhou-based company specializing in Internet-connective medical equipment. The center has two large screens. While one connects local patients to hospitals in big cities through video conferencing, the other displays the relevant health information of the patient, such as the heart rate or blood pressure. Senior citizens, especially those living on their own, wear a bracelet that is connected to Dr. Zhou's computer system. The bracelet begins to emit little beeps when its wearer's blood pressure changes, alerting Dr. Zhou wherever he is.

Sixty-nine-year-old Zhou Yiqun owes his life to the smart device. "I have high blood pressure," he said. "One night, I was overtaken by dizziness and such pain that I thought I was going to die. I was told later that I was having a stroke." His bracelet raised the alarm and Dr. Zhou rushed in, just like the rescuing hero in the movies, with an ambulance in tow. The patient was swiftly taken to the Tonglu County Hospital and given emergency treatment. He survived, thanks to the quick action. It was two days later that his son and two daughters managed to reach his bedside. "I could see the god of death waiting outside the door," the feisty survivor said with a grin. "But the smart healthcare treatment firmly shut the door between him and me."

A large screen at the Huanxi Elderly Center which connects local patients to hospitals in big cities through video conferencing (XU BEI)

A tertiary business

Though a commercial company, Helowin professes the same philanthropic goal that the Wuzhen Internet Hospital does. Sun Bin, its CEO, once worked in the medical equipment industry, and became concerned at the uneven distribution of healthcare resources she saw.

"Good doctors are always in big cities. So I used to wonder if it's possible for more Chinese to get better medical services," she said. "In the villages and counties, if someone is ill, it is hard to get timely treatment, especially specialized treatment. For chronic patients, it is hard to get admission in a city hospital immediately in case of an emergency."

Medical care is also a huge financial burden for villagers, she said. "Villagers' earnings are not high and if they have to go and stay in a big city for treatment it adds to the expenses. On the other hand, the small village medical centers can't afford the high-quality, expensive equipment big city hospitals have. But if the two were connected, the resources could be shared. So I wanted to introduce a new model for long-distance treatment." There are other companies like Helowin. The Internet hospital has created a tertiary industry of smart medical equipment manufacturing.

It is a win-win situation for big hospitals too, Sun pointed out. "With smart medical care, big city hospitals can manage their patients more effectively and avoid the rush they usually face as everyone wants to be treated there. After an online diagnosis, they can refer patients to smaller county hospitals which have the required treatment facilities and in this way, the patient needs to be admitted in hospital for only a couple of days in case of an actual operation or complex treatment."

A decade ago, villagers didn't pay much attention to their health. They ate salty food and neglected to do physical checkups. But now, smart medical care devices, some of which can be used by patients on their own, are creating health consciousness among villagers and making them realize the importance of timely checkups.

A large screen at the Huanxi Elderly Center which is a cloud-based health information platform (XU BEI)

An established trend

Internet hospitals and smart medical services are growing in China. In Zhejiang, there is another Internet hospital, the Ningbo Cloud Hospital. Guangdong Province in south China has an Internet hospital and in Wuhan, Central China's Hubei Province, Ali Health, the Alibaba Group's online medical and health service provider, has teamed up with the Central Hospital of Wuhan to start an Internet hospital.

The phenomenon has been noted among medical circles far and wide. In an article in its August 2015 issue, The Lancet magazine said the growth of China's Internet medical services suggests a direction for future healthcare, especially for developing countries.

"With the wide availability of the Internet and decreasing cost of distant medical services over time, the Internet hospital model has implications for many developing

countries, where medical services and resources are concentrated in big cities," said the article The Internet Hospital: an Emerging Innovation in China. "It also has implications for the health of migrants and cross-country health care. Besides, the system could improve health education and raise health awareness among the wider public, since patients can easily gain access to professional health consultancy."

(Reporting contributed by Chen Ran)

Copyedited by Dominic James Madar

Comments to zanjifang@bjreview.com

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