Plans for online pharmacies hit a roadblock in China

by MICHAEL WOODHEAD

It was pitched as the great disrupter of the Chinese healthcare system: online sales of prescription drugs would reduce distribution costs, improve efficiency of the supply chain of medicines and be great for consumer choice, convenience and affordability. Unfortunately, despite a lot of official hot air, nothing has actually happened.

In May 2014 the Ministry of Commerce released a draft plan to 'open up' the pharmaceutical market to allow online sales. But since then there has been nothing heard from official sources about when and how online sales of prescription drugs will be permitted. While some of the big players such as Alibaba are positioning themselves to be online pharmaceutical vendors, it is still just talk: selling drug online is still illegal and insiders say the government is now dragging its feet on plan to open up the market. The pressure is coming from vested interests in the pharmaceutical industry and also from the powerful hospital lobby.

According to the Commerce Department, online sales of drugs are growing at a phenomenal rate. They say revenue has increased 50% in the last year and there are now 425 companies competing to sell pharmaceuticals online in a 4 billion yuan market. However, at present only non-prescription drugs can be sold online - that market is worth 200 billion yuan and only 2% of it is online. The much bigger market - the 800 million yuan prescription drug market - is still out of bounds. Analysts predict that up to 30% of drugs sales could move online - so there are huge stakes involved for those who win and lose on online pharmaceuticals.

According to Caixin magazine, plans for online sales of pharmaceutical are being opposed by those who say government-run hospitals will lose one of their main sources of revenue if this goes ahead. The China Pharmaceutical Association warns that prescription drugs must be dispensed under the supervision of a pharmacist to ensure quality of the product and also to ensure that it is going i the right for to the right patient.There is no guarantee that this will happen online, they say. They also point to the fact that online purchases of drugs will not qualify for heath insurance rebates - a crucial factor for most patients, who expect to get some or all of the cost of their medications reimbursed by their health insurance.

Hospital-based pharmacists have also attacked the proposals for having little real-world benefit. They say there is no clear evidence for the benefit of online sales of drugs from a clinical perspective. Are online sales of drugs being promoted to improve patient's health, or just as a trend or a money-making venture, they ask. They have called for a responsible "opening up" policy towards online pharmaceuticals from the government.

In the meantime, it seems China has stalled on the issue of online pharmacies.

If you think Dr Google is bad ... 'Dr Baidu' leaves woman 30,000 RMB out of pocket for botched operation

by MICHAEL WOODHEAD

[This is a long article explaining how Baidu paid search has contributed to the proliferation of a wide network of shonky clinics for 'sensitive' conditions such as STDs, Infertility and Gynaecology].

A Shanghai media outlet has exposed what it says is the all-too-common practice of dodgy hospitals paying large sums of money to get the top Baidu search rankings - and then overcharging patients for shonky treatments. The IT News cites the case of a woman called "Snow" who paid 30,000 yuan ($5000) for an operation to treat uterine fibroids at the Shanghai 85 Hospital after seeing it came top of the rankings when she Baidu'd her symptoms. However, after her condition worsened and the woman went to another public hospital, she found that she had been grossly overcharged for unnecessary and harmful treatments.

The article then reveals that  dubious private clinics and hospitals such as the 85 Hospital pay Baidu as much as 90,000 yuan ($15,000) a day to be listed as the top result for 'gynaecology hospital' on China's most popular search engine.

The article says its undercover reporter discovered that the 85 Hospital had set up 13 different Baidu accounts to pay for the top result ranking for various medical keywords. The information accompanying the search results claimed that the hospital was one of Shanghai's most prestigious institutions with a history of 66 years. In reality, however, the '85 Hospital' was just one floor of a PLA-run hospital that had been leased by the Putian Group of private clinics.

The trouble for the 43-year old Ms Snow started in 2014 when a routine work medical revealed she had uterine fibroids and an ovarian cyst.  When she searched on Baidu for these symptoms she saw the 85 Hospital had the top ranking and its gynaecology department was supported by many glowing testimonials.

When she consulted a doctor there, at a cost of several thousand yuan, she was told that the fibroids and cysts were worse than she had been told, and that she also had other pelvic problems. However, the doctor told her not to worry and reassured her that these could be cured with surgery. She went ahead with the surgery, being billed 17,000 yuan, of which she could only claim 3000 on her state medical insurance. (She was told beforehand that it would only incur 2000-3000 yuan out of pocket costs). Ms Snow was also called back for repeat follow up treatments to diminish inflammation, at a cost of 800 yuan per session. Her total outlay was 32,000 yuan.

Two months later, Ms Snow still had bad pelvic symptoms and went for a second opinion to the reputable Fudan University hospital gynaecology department. The doctor there told her she had premature menopause, and the condition was likely brought on by her recent operation. He was unable to judge on the appropriateness of her treatment because she had no medical records. However, when she mentioned the 85 Hospital he shook his head and said it sounded like a private  'contract clinic'.

When Ms Snow looked back on her experience at the 85 Hospital she began to suspect it was strange - as she had had to register in a separate office from the usual public patients - and all the offices and clinics were separated on the 4th floor. She had been accompanied by a nurse the whole time  to pay for treatment, and had been prevented from mixing with other patients. However, it was odd that she she had not been offered overnight recovery time at the hospital, which is usual practice for such a serious operation.

The doctor explained that gynaecology clinics were known as 'gold and silver' clinics to unscrupulous operators because women were embarrassed to talk about such complaints treatments and were easily persuaded to have unnecessary treatment.

When the IT Times followed up her case, it discovered that all the gynaecology keywords in Baidu automatically led to the "85 Hospital". It found that visitors to the 'public hospital' were asked about Baidu and then directed to the 4th floor where they were registered at a separate office from public patients. In the waiting room, the undercover reporter met other women who said they had been charged large amounts of money - typically 7000 yuan - for simple treatments that would usually only cost 2000 yuan in a public hospital. All of them had been directed to the clinic from Baidu and many had already spent several thousand dollars. They believed the clinic was reputable because of its high Baidu ranking and the testimonies there.

The undercover reporter was seen by a female Dr Huang, who had several professional certificates on the wall. After a cursory examination, Dr Huang referred the female journalist for an ultrasound, which shes aid showed major pelvic abnormalities. The treatment would involve surgery and the undercover 'patient' was advised to make a booking. However, when these scan results were taken to another hospital, the doctors said the scan was normal.

When the IT News reporter tried to make a complaint about the 85 Hospital at the city health department, she was told that the hospital was PLA controlled, and the department had no supervisory role over the hospital or the staff who worked there.

The reporter then investigated why the hospital came top of the Baidu listings, and found that the listings were all marked as 'promoted', meaning that they were effectively paid advertisements.  Strangely, there were many listings under different addresses but all led ultimately to the 85 Hospital website and 'information inquiry' hotline.

A 'WHOIS' search on the different web addresses showed that the registrant was a group know as the 411 doctor's group, which in turn was linked to the PLA 411 Hospital. An admin address was traced by a reporter to a backstreet cosmetic surgery clinic called the "Meilian Beauty Centre". These clinics were in turn linked to an investment group know as the Shanghai MingAi Group. Undercover enquiries about employment opportunities with this group were refered back to the parent company in Taizhou, Jiangsu.

According to the company records, the shareholders are Ling Fengyu and Sun Jinping. They were linked through another company, Shanghai Venus, with someone called Lin Chunguang. This in turn is listed as the same address as the Putian Medical Company boss. Further checking showed that all the former clinics and hospitals are listed as Putian subsidiaries.

This situation resembles the 2007 incident over a 'fake' Harmony Hospital. At that time a Shanghai Harmony Hospital was set up, which many assumed to be a branch of the renowned Beijing Harmony Public Hospital. However, it turned out to be a privately run venture recently set up by Putian's Lin Chunguang. The hospital was de-registered after it was found to have been providing overdiagnosis, overtreatment and overcharging of female patients at its Fertility Clinic. At that time Putian's Lin Chaungwang was spending hundreds of thousands of yuan on advertising for his clinics. All that has changed in the last eight years is that he is now channelling this advertising through online sources such as Baidu.

Investigations by IT News found that the 85 Hospital is paying about hundreds of thousands of yuan in fees to Baidu trough 13 different advertising accounts for the medical keywords related to gynaecology problems. For every click by a consumer on a keyword, the company must pay several hundred yuan (145-212RMB). In addition, the 85 Hospital has paid Baidu for a prestige 'verified' title  on listings, which costs an additional 5600 yuan per title.

When the reporter asked about this 'V' verification procedure with Baidu's Zhendao and Guojing Information agencies, she was told that PLA and Armed Police institution were not allowed to undergo such verification, but this could be worked around.

On the Baidu site the reporter scrolled through seven pages of search results for 85 Hospital without finding a single negative review. All were fulsome in praise for the 85 Hospital. However, from the 8th page onwards it was continual negative reviews of the hospital by users. This is an example of Baidu having its search results  customer weighted. Interestingly, the 'promoted' 85 Hospital has 3000 reviews saying that it is a '5 Star" institution, whereas the non-promoted Fudan University hospital has only 51 reviews.

Baidu says its star rating system is automated and resistant to human manipulation. However, one internet rating and review 'specialist' said fake reviews were offered for 1.1 yuan per review. Another internet services company contacted by the reporter said they had offered similar review 'paid review. services to other private clinics. They said they could offer website setup and hosting quite cheaply, but Baidu search result manipulation would cost a lot more. He said the price for setting up a  search manipulation service would be about 90,000 yuan a month for top health sites such as hospitals. His financial model was to start with a monthly spend of about 50,000 yuan, which would get a 1:1 return, increasing over a year to about80-90,000 yuan a month, with a return of 1:3.5 on investment for a hospital.

All this may be about to change after the now famous spat between Putian and Baidu over 'compensated search' advertising for Putian network clinics. Putian clinics said that they were halting all advertising in protest at being overcharged by Baidu, but the search engine said it was cleaning up its search results to eliminate unauthorised health clinic advertising. Nevertheless, when IT News tried entering search terms synonymous with Putian clinics such as  "men's illness" [STDs], "Fertility Clinic" and "Gynaecology Clinic" all the top results were still for private clinics of the Putian chain. It seems the advertising boycott proclaimed for 1 April has yet to start in reality.

In 2013 the party secretary for Putian city said the healthcare companies based in the city spent 1.3 billion  on internet advertising for their national chains of clinics and hospitals, which represented about half of Baidu's revenue. They also represented the biggest source of patients to the clinics. According to Baidu, its  revenue from online advertising and paid search was 3.2 billion yuan, of which healthcare was just one five main areas that contributed to 54% of revenue.  In 2014 Baidu CFO Li Xinzhe said he expected healthcare to be one of the top contributors to revenue. This year so far Baidu has increased its revenue by 34% on the previous year. Draw your own conclusions.

Mobile healthcare in China: all you need to know

by MICHAEL WOODHEAD
I've written a great deal about the bottlenecks in the Chinese healthcare system and the problems that stem from having a hospital-based initial consultation system as opposed to European-style general practitioner gatekeepers. While China is slowing moving towards community clinics (most notably in Shanghai) - it will be a while before there is any system that efficiently triages and treats the minor illnesses and also provides continuity for people with chronic disease. 
In the meantime, Chinese patients are struggling to access doctors hidden away in the fortresses that are State-Owned Enterprise hospitals. They face a lot of hassle to register for an appointment and then long waits to actually see a doctor in a rushed consultation. Nobody is happy with this situation.

Enter the Mobile Healthcare providers (Cellphone for the Yanks). The Big Three at the moment are Baidu, Chunyu (Spring Rain) and Tencent-DXY. Let's deal with them one at a time.

Baidu are making big moves into mobile healthcare. They are China's biggest internet search engine and major internet player, so they have a lot of clout. Baidu are playing to their strength and basically offering an online appointments service, based on their search engine results.
The recently launched Baidu Doctor app allows users to find the nearest available doctors and book an appointment. It also includes some menus that allow the user to work out which kind of doctor they need to see. There is also a rating system that allows users to leave feedback on the quality of their experience. Baidu are rolling this service out nationally, province by province, and have made some strategic partnerships with key hospitals to ensure that they are offering appointments with certified, named doctors. So far they have signed up 1000 doctors nationally - not many in a country that has 3 million - but they are working to ensure that the doctors they enrol are kosher.
As a search engine, Baidu have had a bad reputation for advertising dodgy healthcare services, hence the recent falling out with the Putian chain of private clinics - who some have said owe more to marketing than medicine. Baidu are now trying to build up a reputation for quality and reliability - as well as convenience, and they certainly have the resources to invest in building up a network of doctors. However, by offering what is essentially an online referral system they seem to me to be duplicating the role of the general practitioner gatekeeper. How Baidu will sit with the government's policy of building up primary care and discouraging people from heading straight to hospital remains to be seen.

The next big name in mobile health is Chunyu - Spring Rain. They are essentially an online consultation provider - with an app turning the mobile phone into a telehealth device to allow the patient to speak directly to a doctor.  
www.chunyuyisheng.com claim to have 45,000 doctors online, and say they can hook up a patient with a doctor for a phone consult in just three minutes. The doctor provides advice and medical information in conjunction with Chunyu's online searchable medical library. The service also offers an electronic health record, personalised advice and links to nearby medical providers and pharmacies.

This seemed to be a promising avenue until the health ministry outlawed online consultations earlier this year except for patients registered with authorised hospitals. I'm not sure how Chunyu are managing their way round this, but they now say that users must be registered to receive medical consultations. They have also announced that Chunyu will be setting up bricks and mortar clinics in addition to their 'virtual' ones.
I personally am not a great believer in online consults. They may be useful as a convenient substitute for a limited number of consultations where the interaction between doctor and patient can be verbal - but most illnesses need a healthcare provider to be there to assess the patient in person. It is often the subtle signs that are only visible in the flesh so to speak that are the most crucial. Not to mention things like continuity of care, need for tests and scans and physical examination. When online doctors can remove earwax, change dressings and do Pap smears I'll get the app. Until then, it's just a glorified advice line.

Last but not least in the Mobile Health wave of the future is the partnership between Tencent and the doctors' forum site DXY.com (Ding Xiang Yuan - which translates as Lilac Garden).
I have a lot of respect for DXY.com because their forums are docgor-driven and the site for good quality doctor-to-doctor discussions. They also provide Continuing Medical Education (CME) and healthcare news. There's nothing really like DXY in the west. There are the so-called 'Facebook for Doctor' sites such as Sermo and Doc2Doc but they haven't really taken off and become universal in the way DXY has in China. I should point out that DXY is focused on younger doctors, though it does have content sourced from the older 'master clincians'. The success of DXY really reflects the positive attitude towards technology and social media among young Chinese - but sadly I think it also reflects the 'silo' mentality of Chinese healthcare and culture, cut off from the outside world. DXY features a lot of content and discussion around translated medical research from the west - the big journals such as JAMA for example. However, Chinese doctors seem to feel more comfortable discussing medical practice and developments in their native language and behind the Great Wall of DXY rather than venturing out into the wider online world and conversing directly in English. The lack of access to social media sites such as Twitter and Facebook means that most young Chinese clinicians can't take part in the many vibrant medical exchanges now going on in the social media sphere - groups such as Free Open Access medical Education (FOAMed), for example.

Anyway, Tencent has recently partnered with DXY, presumably hoping to harness all that young medical know-how and try to extend the online physician-to-physician communication links to physician-to-patient links. At a recent medical tech meeting, Tencent's investment manager Mu Yifei explained their philosophy in mobile health. Rather than being a 'disrupter' he said Tencent recognised that doctors would still be a the centre of any new online health system, and the company aimed to provide a new, smoother pathway between patients and doctors, based on data and information. Ma said that it was early days in mobile healthcare development, but they hoped to harness the skills of doctor online using the tools that have already brought them so much success in areas such as microblogging (Weibo), instant messaging (QQ) and their taxi app Didi (just banned). It's worth remembering that Tencent is a $200 billion company so they're not short of resources to invest in the mobile medical market.
Ma said the main areas for reform in medicine are unreliable costs, information silos, inefficiency in getting to see a doctor and the lack of good networks  for users of the healthcare system. He gave an example of how mobile networks for restaurants now allow users to find a restaurant, peruse the menu, order online, make a reservation then pay and leave feedback. Can this apply to healthcare too?

At present the DXY partnership offers only limited advice online for patients. The founder of DXY, cancer immunologist Dr Li Tiantian, is sceptical of the 'flashy' medical advice apps that are now in fashion. He has said  the future lies in two-way communication between patient and doctor, not one-way 'advice' from the physician. His vision is for patients to be given more encouragement to self manage their illness and give feedback to the healthcare provider. In this, he sees the longer term role of DXY in collecting and using information from patients - rather like a market research company - instead of just pushing out information and services to patients.

This then, is my brief introduction to the mobile health players in China. It's a fast moving field, and like other areas of internet and social media in China, it is very much a local game, with western companies either excluded or late to the game. Having said that, China seems to be leading the way in mobile health - there is great enthusiasm for mobile solutions and the Chinese are avid early adopters. China also faces less of the red tape and regulatory barriers that exist in the west around matters such as patient privacy, confidentiality of data and the regulations around doctors' scope of practice when offering online consultations. The other big barrier to online health in the west is remuneration - doctors are highly paid and beholden to either medical insurers (the US) or national payers (NHS, Medicare) for their income. With huge pressure on their already mushrooming budgets healthcare payers are loathe to open up new channels in which doctors could claim income and further inflate costs.
In China, things are different. Doctors are poorly paid and at the mercy of their  State-Owned Enterprise hospital managers. The government is actively working to break these shackles and encouraging doctors to work independently in private practice. If China's doctors can see an income stream from mobile health, they may well jump in and meet the apparent huge demand for their services. The players in mobile health say that China's healthcare market will be worth trillions of yuan in 2020 - and much of that will be online.

Alibaba Health, iKang, Online consultations, Tobacco advertising ban, Antibiotics in food, HIV discrimination

by MICHAEL WOODHEAD

Hello and welcome to another week of China Healthcare. As China makes headlines around the world for its slowing economy, few have remarked that China's entrepreneurs are taking a different and more rosy view by re-focusing on healthcare. This week the Alibaba internet billionaire Jack Ma has issued a $2.5 billion vote of confidence in the prospect for online pharmacy in China by transferring his pharmacy e-commerce section to Alibaba Health ("Ali Jiankan" or alijk.com).  According to the WSJ, "Alibaba said the deal would position it to sell prescription pharmaceuticals should China’s reforms allow retailers to move in that direction".

At the same time, Forbes has profiled another internet millionaire who has made his fortune by turning to health. Zhang Ligang made his first fortune by founding the travel booking site e-Long, but he is more famous for building a chain of private clinics under the banner iKang. And if China really does shift to a more private healthcare system, companies like iKang should be at the forefront of the wave.

The NHFPC has banned online medical diagnosis. In a statement this week the health ministry said medical consultations cannot be conducted online as there have been too many cases of unqualified people offering medical advice, purporting to be experts. The ban does not seem to apply to accredited hospitals that have approved programs. What this means for online doctor apps such as Spring Rain (www.chunyuyisheng.com) remains to be seen.

Children in China are exposed to a wide variety of antibiotics in food, which may promote resistance. A study in Shanghai that tested the urine of more than a 1000 children aged between 8 and 11 years of age found that as most had traces of at least one antibiotic and many had several antibiotics in their system.  Altogether 18 different antibiotics were found in the urine of Shanghai children, reflecting the high levels of antibiotics used in food production in China. This was confirmed by another report out this week which noted that the Chinese food and livestock industries use 100,000 tons of antibiotics  a year to promote growth in animals reared for their meat.

A total ban on tobacco advertising n China has been urged by the WHO. The head of the China office of WHO said China had a treaty obligation to phase out tobacco advertising, and should start to do so at retail points of sale. However, the powerful state-owned tobacco industry might baulk at that. The relative power of the health and tobacco industry was shown this week when health minister Li Bin noted that new graduates could earn twice as much in the tobacco industry compared to medical graduates working in hospitals. She made the point that the basic salary for a university graduate working in the tobacco industry was 4571 yuan a month compared to only 2100 yuan a month for a junior doctor. Li Bin said there was a need to learn from Adam Smith and pay the market rate for medical graduates - and this would mean patients being prepared to pay higher medical fees.

And finally the question arises of whether anti-HIV discrimination still exists in the China's hospitals. A patient at the Sichuan University Huaxi Hospital says he was refused surgery when doctors discovered his HIV positive status. The man said he had been scheduled to have surgery for haemangioma but it was cancelled and he was told that he would instead be kept 'under observation' instead. The hospital rejected the discrimination claim, saying that it was standard practice to keep patients under observation before going ahead with surgery for this condition.

Bound feet, pirate hospitals and frequent flyer patients: just some of the medical news stories out of China this week

Bound feet not all bad for bones

Women who had their feet bound according to feudal Chinese tradition are more prone to osteoprosis but their enhanced balance skills mean they do not have excessive fractures, a study has found. A review of more than 250 elderly women who had bound feet by researchers at Kunming Medical University found that they had higher rates of osteoprosis than women of similar age.
However they did not seem to be in worse health or be more prone to fractures, the study found.
"This might be explained by compensation in physical activity to improve body balance, implying the importance of improving or maintaining body balance in overall prevention strategies against fragility fractures," the researchers said.

Trademarks use to fight pirate hospitals 

The renowned Beijing Tianlun fertility hospital has trademarked its name after finding that other hospitals around China were setting up 'Tianlun' fertility clinics and claiming to be affiliated to the famous clinic.

Frequent flyer patient

A Jiangxi endocrinologist has been called to provide emergency inflight medical help to the same woman twice in a month, according to CAAC News. The doctor treated the women on a flight to Thailand after she fainted. On the return flight he again answered a call for help and found he was helping the same woman with the same problem.

More family doctors for Henan

The Henan government claims to have re-trained almost 10,000 doctors to work as family doctors in community clinics and township-level hospitals. The government said the re-training program meant that Henan could not make family doctors available to 60% of people in rural areas and 100% of people in urban areas.

 Guangdong gets locals to sign up for GP cover

The Guangdong city of Huizhou says it has  got 30% of target patient populations to enrol with a family doctor. The city health authorities want to arrange GP cover for children under five, pregnant women, the elderly and people with chronic diseases. The authorities say they aim to have 50% of people enrolled by the end of the year.

Tianjin hospital gets Dr Weixin

A hospital in Tianjin has set up a smartphone service to allow patients to get advice, information  and book appointments via their phones. However, users said the electronic hospital system was clunky, did not allow access to many departments and they still had to queue to pay for appointments

Serious disease insurance cover to be nationwide.

China's minister for social security has said that his department will fully introduce nationwide social medical insurance for serious diseases within the year. However, critics have saod that hospitals will use the cover to claim rebates for unneccessary treatments while local governments will not have the finances to support the scheme. Meanwhile a group from Renmin University in Beijing have suggested that micro-credit schemes be used to give poor rural people access to funds to pay for their medical bills. The scheme would operate in the same way as micro-credit programs running in developing countries to provides funds for business startups.

Family planning staff become child development aides

The staff of local family planning departments may move into child development work and away from enforcing the single child policy, if a pilot program in Shaanxi is successful. The program sees family planing agency staff assisgned to follow up children up to the age of three to ensure they are meeting basic development goals in care and education, according to Caixin.


And this week's violence against healthcare workers:

Zhejiang: An armed man opened fire in a Zhejiang hospital and had to be disarmed by police after he injured one man and threatened patients and staff in the Haiyang country hospital.

Shanghai: A drunk man took a hostage at knifepoint at the emergency department of Shanghai No. 9 People’s hospital yesterday morning and injured a policeman who intervened.

Hebei: a  gang armed with machetes smashed up the emergency department of Baoding Hospital and severed the hand of a man who was being treated for minor injuries from an earlier attack. The man had been involved in an earlier altercation with the gang and they had come for payback, police said.

Liuzhou: a man got 10 days administrative detention and was fined 200 yuan for attacking a female doctor at a Liuzhou hospital. The man hit the female doctor because he was unhappy with the treatment his father was receiving for a bladder problem.

Beijing: A patient with a grudge over hand surgery assaulted a surgeon at the Jishuitan Hospital. The patient had previously had eight stitches in his  finger and was unhappy because it did not bend the way it did before the injury.

Patients ignore primary care clinics | Decline in Hepatitis A | Online ratings platform launched for hospitals

The government's newly created network of primary care clinics are struggling for recognition in China, according to a new survey carried out in Chengdu. More than 60% of people surveyed had not heard of the primary care clinics and didn't know where they were located, according to local media. Most people surveyed also said they would still prefer to go direct to hospital for treatment rather than go to a local community clinic, the survey showed.

China has seen huge reductions in hepatitis A over the last two decades, with rates of infection falling from 94% to 42%, a study carried out in Hebei has shown. Rising living standards, better hygiene and widespread childhood immunisation have contributed to the drop in hepatitis rates, and also resulted in most infections being delayed until adolescence rather than infancy, according to researchers from Shijiazhuang. However, the lower infection rates mean that many people now have little immunity to the disease and will benefit from immunisation, the researchers say.

A Tripadvisor-like mobile online platform has been developed that allows patients to rate their experience with hospitals and health providers in China. The Care Voice (Kangyu in Chinese) is a Shanghai-based  social platform that enables consumers to share reviews on hospital services, physicians and treatments and connect with other patients and professionals.

"Fake" GPs in Shanghai | 5-in-1 vaccine shortage | Appointments by WeChat: China medical news for Friday 14 February

Shanghai appears to lead China in the introduction of family doctors, but many of the so-called general practitioners (GPs) are fake, says Zhu Shanzhu, the chairman of the Society of General Practice, Chinese Medical Association. In an article in Global Times, Dr Zhu says that Shanghai is on target to have a GP for every resident by 2020, when people will be able to register with a family doctor working out of their local community health centre. However, Dr Zhu says many of the family doctors assigned to the health centres are not true GPs because they are specialists such as surgeons. Shanghai must therefore commit to training doctors in family medicine, she said.

A second death has been reported from the novel influenza strain H10N8 in Jiangxi. According to Shanghai Daily, a 75-year-old man died in Nanchang. Health authorities have urged the public to stay away from live poultry.

Shortages of the popular paediatric 5-in-1 combination vaccine have been reported due to transport congestion and delays ove the Chinese New Year. The imported vaccine, made by Sanofi, immunises against diphtheria, tetanus, pertussis, polio and Haemophilus influenza Type B and costs around 600 yuan for each of the four doses. Parents prefer it over free domestic vaccines because it reduces the number of needles their child has from 12 to four.

Hospitals in Beijing are offering appointments and medical results via WeChat, ECNS reports. The social media service is being offered by 21 municipal hospitals to patients who sign up and obtain a password.

A Shaanxi woman claims one of her kidneys was secretly removed during an operation she had more than 20 years ago. The woman made the shock discovery that she was missing a kidney when she had a hospital scan for back pain. The only possible explanation was that it must have been removed when she had an operation on her ovaries 26 years previously, she told TV reporters. The woman returned to the hospital where she had the operation but they rejected her claims and denied all responsibility for the incident.

A hospital in Hainan is pioneering a new model of "treat first, pay later" care. The hospital in Haikou has dropped the usual registration system in which patients pay a deposit ahead of treatment. the hospital managers say the new system is more convenient, but relies of the trust of patients to pay for their treatment afterwards. Non-payers will be put on a black list and refused further treatment, they said.

A Beijing academic has called on the government to stop the tobacco industry's deceptive marketing of "low tar, less harmful" cigarettes. Professor Yang Gonghuan of the Department of Epidemiology and Statistics, Institute of Basic Medical Science, Chinese Academy of Medical Science, says the claim that low tar cigarettes are less harmful is incorrect. However the slogan is used by industry to encourage smokers to stay with the habit. Writing in Tobacco Control, he urges the government to "stop the execution of this deceptive strategy for tobacco marketing".

And a kidney specialist in Guangzhou has been praised in the Chinese media for continuing to work despite being confined to a wheelchair. Reports say Dr Ke continued seeing 20 patients a day at the PLA 458 Hospital over the Chinese New Year despite having broken her patella and being unable to walk. Patients praised the doctor but she said any of her colleagues would have done the same thing.

Shanghai hospitals' database hacked and records sold to drug companies

translated by Michael Woodhead
A 'mole' hacked into the databases of three major Shanghai hospitals using wireless laptops and extracted drug usage data that was sold to pharmaceutical company representatives, Eastday reports.
The Huangpu court has found two people guilty of fraud after they downloaded drug data from the three hospitals and sold it for 12,000 RMB to drug company contacts. One of the hackers worked in the technical department of one hospital, the other was a pharmacist. The hacker used a laptop computer while sat in a car in the carpark of the hospitals to hack into the wireless network. They were caught in July 2013 when IT staff noticed unauthorised users extracting data, and traced them to the nearby car park, where they were arrested by police. They were fined 5000 RMB and sentenced to one year in jail.
In the past, pharma companies would sometimes pay hospitals for the drug usage data, but this practice has been outlawed. The hackers made contact with drug company representatives and told them they could sell the information each month for 46 different drugs for 250 RMB per item. They emailed the data to the drug company employee, who will be tried separately for corruption.

Shandong's "Doctor QQ" dispenses online remedies for the housebound

In Shandong's Jinan city, Dr Li Lihua is encouraging his housebound patients to consult him first on QQ before trying to go to hospital. In October 2013, Dr Li set up his own doctor-patient commnity on the social media site QQ and now has 60 patients on his 'list'.
He encourages them to consult with him online for minor ailments and he says the QQ service offers them attention and confidentiality. The doctor in charge of the Shanxi Lu health station says this way he can help people avoid going to hospital and if they need to go to the hospital he can refer them to the most appropriate department and doctor.
One example was a web friend who asked about toothache - Dr Li tells him which antibiotic and anti-inflammatory medications to take, to avoid hot and spicy foods and to drink plenty of fluid.
According to the Qilu Evening News, Dr Li says this helps him to keep in contact with patients who otherwise would not get to see a doctor.

Suzhou hospitals get real time online data monitoring for insurance and medication claims

The Suzhou social insurance fund has implemented an online real time data handling system for 43 hospitals that allows medical insurance claims and medication dispensing to be verified to enhance quality assurance and prevent fraud. The new system replaced the old manual input of claims data last year, and allows the health fund to collate medical insurance claims data alongside medication use and patient and hospital details. The system allows the social insurance centre managers to identify abnormal prescribing patterns and to give feedback directly to the hospital and the clinicians. For instance, in the first three months of operation data analysis has revealed that some male patients have been given medications for female medical problems and others have been given drugs for a different indication to the one for which they were being treated. The new system marks such anomalies with a red flag and gives feedback to the prescriber and to the hospital.
Source: Suzhou Daily

Telehealth trialled in Xinjiang regional hospitals

Liu Xiaohong, deputy director of the cardiovascular medicine department of Karamay Central Hospital, successfully worked with Wang Yan, an expert from Wuhan Tongji Hospital, through a teleconsultation platform to develop ideal treatment plans for two cardiovascular patients.
The two elderly patients have been diagnosed with coronary heart disease and chronic obstructive pulmonary disease, respectively, and have been given proper treatment after a series of check-ups, including electrocardiograms and CT scans, and teleconsultation video conferences.
This is not the first time that Karamay Central Hospital has integrated telecommunication technology with diagnosis and treatment. It is cooperating with more than 20 famous hospitals from around China to deliver high-quality medical service and care.
Source: China Daily

China medical news roundup for Friday 15 November

 

Village doctors empowered with cloud computing

Doctors serving China’s 900 million people living in rural areas are being helped with cloud computing. In a pilot study, researchers from Taiwan equipped village doctors with Health Information Technology and developing an electronic health record (EHR) system.

The EHR system based on a Cloud-computing architecture was developed and deployed in Xilingol county of Inner Mongolia using various computing resources (hardware and software) to deliver services over the health network using internet when available. From 2008 to 2011 health records were created for 26% (291,087) of 1,108,951 Xilingol residents. There were 10,240 cases of hypertension and 1,152 cases of diabetes diagnosed and registered. Furthermore, 2,945 hypertensive and 305 diabetic patients enrolled in follow-up. Implementing the EHR system revealed a high rate of cholecystectomies leading to investigations and findings of drinking water contaminated with metals. Measures were taken to inform the population and clean drinking water was supplied.

The researchers concluded: “The Cloud-based EHR approach improved the care provision for village doctor in rural China and increased the efficiency of the healthcare system to monitor the health status of the population and to manage preventive care efforts. It also helped discover contaminated water in one of the project areas revealing further benefits if the system is expanded and improved.”

 Full study: Computer Methods and Programs in Biomedicine

Unifying medical insurance is a gradual process: expert

China is attempting to put its three medical insurance systems under one administration, but a healthcare researcher has warned that obstacles still remain, and an effective solution is to merge two of them initially.

The move can only be done step by step, and the first step is to unify the management of the urban resident basic medical insurance and the new rural cooperative medical scheme, Ying Yazhen, of the National Health Development Research Center under the National Health and Family Planning Commission (NHFPC), was quoted as saying in a report carried on Thursday by the China Business News.

Merging the two insurance schemes is feasible as they are similar in terms of fund raising, reimbursement standards and the income of people under their coverage, Ying explained.

She said many places in China, such as parts of the eastern coastal province of Zhejiang and the central province of Anhui, have already merged the two insurances and realized a free capital flow between the two.

Considering its huge population and imbalanced economic development, China implements three separate medical insurances -- the urban workers basic medical insurance for urban employees, the new rural cooperative medical scheme for the rural population, and the urban resident basic medical insurance for people who are not included in the first two insurances, mainly the underage and unemployed residents in cities.

However, the two insurances set for urban residents are managed by the country's Ministry of Human Resources and Social Security, while the scheme for rural people is administrated by the NHFPC. The State Council, or China's cabinet, decided this March to put the three insurances under one administration in order to reduce government redundancy and raise efficiency in medical services. Ying suggested putting all the three insurances under the control of the NHFPC because it is best placed to coordinate the management of the insurances and the medical service fees and quality.

But the researcher insisted that a gradual process is needed for such unified administration.

Compared with the other two systems, the insurance for urban employees is quite different in its participation polices and financing levels, which can be five to seven times higher, Ying told the China Business News.

What's more, its reimbursement percentage for participants, which may reach up to more than 90 percent, is also much higher than the scheme for the rural population and the insurance for unemployed urban residents, according to Ying. The reimbursement percentages of the latter two are often about 55 percent of what patients should pay for medical services.

Ying said there have been rare examples across the country in which the three insurances have been merged for unified management; however, even where this has been attained, administrators have not been able to manage free capital flow among the three insurances.

Source: Global Times

Shanghai to set up China’s first translational medicine centre

The country's first national-level translational medicine center will be established in Shanghai to promote health benefits for individuals and communities.

Translational medicine, also known as translational science, is a discipline within biomedical and public health research. It focuses on translating laboratory findings into diagnostic tools, medicines, procedures, policies and education to improve the health of individuals.

"Translational medicine in China is rapidly growing, though started recently. The establishment of the new center will boost the development of translational medicine in the country," said Zhao Qiang, vice-president of Shanghai Ruijin Hospital.

Covering an area of 60,000 square meters, the research center will have 300 beds for clinical research. And its research will focus on tumors, cardiovascular disease and metabolic diseases among others.

This weekend, the 8th Sino-US Symposium on Medicine in the 21st Century will be held in Shanghai on Nov 16-17, and this year's theme is translational medicine. Medical experts and scholars from both home and abroad will come together to discuss the latest research and the practice's development in the world.

Source: China Daily

Shanghai cracks down on illegal medical practices

At a conference in the Jiading district of the city of Shanghai, on Nov 11, the organizers announced plans to monitor the medical services field in the fight against illegal medical practices.

The related crackdown mainly targets unlicensed practitioners, unnecessary fetal gender tests, and sex-selective abortions.

The district government began its medical monitoring efforts back in 2005 and in the intervening years has developed a governmental management system involving health supervisors and community health service centers. And, things have worked out well, with the discovery of 2,373 illegal activities, with punishment handed out in 742 of the cases, and 54 handed over to the judiciary resulting in 41 people being sentenced.

Source: Jiading District News

Rainbow masks a hit for Hunan surgical staff

Have you ever walked into an operating room fearing the surgeons? Fear not, because rainbow-colored surgical masks and caps designed to ease patients' tension is apparently the latest thing to hit Chinese hospitals.

Allegedly inspired by the hit TV show, Grey's Anatomy, doctors and nurses of Hunan Provincial Maternal and Child care hospital have joined in on the fashion.

With a variety of patterns such as flowers, clouds, animals, Hello Kitty and more, doctors believe the color helps calm the patients and distract them - presumably from the likelihood that they'll lose an ovary during a pelvic operation or get blinded during a nose job. Zing!

Source: Shanghai-ist

Why China can't copy US when it comes to e-health

While some great Chinese companies have been built on the back of 'inspiration' from established Western firms, this formula doesn't appear effective in the healthcare and pharmaceutical fields.
China is good at copying is not news. Many Chinese firms prosper because they successfully emulate foreign firms’ products and business models. In fact, one could argue there are more of these “micro-innovations” around than “original innovations”, and that “micro-innovating” firms are more likely to succeed because they have giants’ shoulders to step on. Hence the challenge: what would Chinese firms do when they cannot simply “copy and paste”?
This is essentially the challenge companies must face if they want to make a dent in the healthcare and pharmaceutical industry. Observers have noted that these industries are hotbeds for entrepreneurs nowadays, and things are only going to get more serious with the proliferation of mobile devices and government mandated changes such as electronic records. Of course, to break into industries notorious for their conservatism is not going to be an easy task; essentially, today’s entrepreneurs have to succeed at where the legendary Jim Clark failed. And for an IT company to break into these industries, there are many, many pitfalls.
For Chinese companies trying to make things happen locally, there are even worse. The Chinese healthcare and pharmaceutical industries are so different from their American counterparts that it is extremely difficult, even impossible, for Chinese entrepreneurs to find role models to emulate.
Take HaoDaiFu (meaning “Good Doctor”), for example. The company’s goal is to become a Yelp for Chinese hospitals and doctors. Launched in 2006, Good Doctor arrived on the scene even before American companies such as Castlight that aim to make the healthcare industry more transparent in the U.S.
Yet while Castlight has received more than $100 million in financing, the Good Doctor is still searching for the ever elusive revenue. Seven years into the game, the founder of Good Doctor confessed that it’s still too early to talk bucks.What happened to Good Doctor is not unique. While there are many companies entering the healthcare industry, none of them have a clear business model.
The difference between the fate of Castlight and Good Doctor is the difference between American and Chinese healthcare landscape. The American healthcare industry is fractured, and it needs to be more top-down model a la the Cheesecake Factory. The Chinese industry, on the other hand, is almost the exact opposite. The Chinese government dominates almost every aspects of the industry. In fact, the government’s tentacle runs so deep that even Chinese doctors count as governmental officers according to the SEC.
Such an industry doesn’t need a yelp. Let’s say everyone is dissatisfied with the service quality of Peking Union Medical College Hospital. But what are going to do when you get really sick? You still have to go there, because it’s the best hospital in China, and you don’t have a second option.
The Chinese healthcare industry is much like the story about the gambling parlor in 19th Century America. As the story goes, a guy was gambling in a small town. A friend told him that the game was rigged, but the gambler decides to stay, remarking, “I know it’s crooked, but it’s the only game in town.”
Because of the government’s dominance, most of the American business model is obsolete in China. In fact, Chinese healthcare industry is so unique that you cannot even borrow wisdoms from other Chinese industries. The Good Doctor model is fine for dinning and wining (see Dianping.com), but it’s useless in healthcare. For Chinese entrepreneurs to make an impact, they must navigate uncharted territories. Now we can finally see if Chinese entrepreneurs have what it takes to truly innovate.
Source: TechNode

Social network site aims to link doctors with drug companies

Baitianshi will link Chinese doctors to drug companies and suppliers

 Japanese venture capital CyberAgent Ventures has announced that it is putting funds into Baitianshi, a social network that connects doctors and pharmaceutical companies in China.
As with many deals from CyberAgent, the level of investment and stake being purchased has been left unannounced.
Baitianshi was founded in December 2010 and it is a real-name social network (online aliases are very often anonymous or characterized in China/Asia) which allows doctors to improve their communication with pharmaceutical suppliers and firms.
The company says it has struck partnerships with “major general hospitals in China” and that, to date, more than 200,000 doctors have used the site. The addition of capital from CyberAgent will see Baitianshi take advantage of the VC firm’s “wide range of resources throughout Asia”.
Read more: TheNextWeb

China's haphazard hospital domain names cause confusion

by Michael Woodhead
Before seeing a doctor, many Chinese people will look at a hospital 's official website, but China's hospital official domain names are very confusing and the messy system invites deception and fraud, critics say
Investigations by reporters show that the official websites of some China's top hospitals have different suffixes and 56 different kinds of domain names have fifty-six kinds. Some have .cn suffixes such as the Beijing Union Medical College Hospital (www.pumch.cn), some are dot-coms, such as the Huaxi Hospital (www.cd120.com); others are .com.cn,  .org and even .net, such as the Henan Provincial People's Hospital (www.hnsrmyy.net).
These extensions have different meanings, and  the Director of the Centre of Telecommunications Research Institute at the Ministry of Industry and the Internet, Dr He Baohong, says that according to international norms, .com is the business enterprise domain, .net is the domain for network service providers, .org is the domain name for a non-profit organization, and .cn is China's national top-level domain. So it seems the use of the .com domain suffix by top hospitals does not reflect their public service or non-profit organisation role.
China's hospital domain naming system is also not user friendly. Domain names for major hospitals come in a wide variety, some are based on the hospital initials  such as the Sino-Japanese Friendship Hospital website (www.zryhyy.com.cn); some are named based on pinyin, such as Huashan Hospital website (www. huashan.org.cn), some use the hospital name and "hospital" for the the domain name, such as the Fuwai Hospital website (www.fuwaihospital.org). The domain names of some hospitals are just indecipherable, such as the Guangdong Provincial People's Hospital (www.e5413.com), which looks like a "shanzai" (fake).
The  PR department of the Guangdong Provincial People's Hospital, said "e5413" really is the official website of the hospital, because "5413" is a homonym that sounds like "I am a doctor," aand the hospital wanted to take the name as a meaningful and easy to remember.
It is actually too simple for  hospitals to register the domain name, all  they  need to do is find a domain registrar and there are no strict requirements. Currently there are more than 80 domain name registrars, and registration can be made for .com, .org, .net, and .cn sites. All that is needed is a valid ID and often less than a hundred dollars you can register a domain name.
The hospital website name should standardised. Compared with hospitals, other public organisations that have contact with the daily life of ordinary people are named more systematically and according to regulations. The official websites of government departments are unified as .gov.cn,  the name mainly in English or with an abbreviation. For example, the Ministry of Health (www.moh.gov.cn) and the General Administration of Sport (www.sport.gov.cn). In the field of education, whether public or private the universities have edu.cn endings, such as Peking University (www.pku.edu.cn), and Henan Vocational and Technical College, (www.hnzj.edu.cn). Internationally, the official websites of major hospitals are  almost all based on .org endings, such as Massachusetts General Hospital (www.massgeneral.org) and Mayo Clinic (www.mayoclinic.org). Hospitals outside the Chinese mainland, use a local suffix and generally .org subdomains, such as Taiwan's Chang Gung Medical Group (www.cgmh.org.tw), while Hong Kong hospitals are with the Hospital Authority (www.ha.org.hk) .
Dr He Baohong says there are no obstacles to unified domain name specifications for hospitals in China. Public hospitals may be assigned to the non-profit organisation from the point of view of the meaning of the domain name, and the standardised suffix of choice would be .org, or org.cn. For-profit hospitals have available domain suffixes such as .com or com. cn end, to give patients an idea at a glance. In addition, there is also the opportunity within the website domain name registrar to have unified domain names under hospital.cn. This could be achieved as long as the health sector and public and private hospitals co-operate with each other.
Read more: China Healthcare

Ministry of Health sets up national telemedicine training centre

The Ministry of Health has approved the establishment of a national telemedicine management training centre in the Sino-Japanese Friendship Hospital in Beijing.
Commissioned by the Ministry of Health, the centre will mainly carry out the following tasks:
1. Collecting and  analysing information about telemedicine at home and abroad to study the opinions and suggestions for the development of a telemedicine system;
2. Assist the Ministry of Health set up a national telemedicine QC network, to organise and carry out quality control work;
3. Organise the drafting of telemedicine management standards, to carry out the training of professionals in telemedicine. 　 　 I
The Ministry of Health has established a national telemedicine training centre to promote the integration of China's medical resources through modern information technology and to improve the capacity of primary health care services. The centre will also seek to resolve telemedicine technology standards that are currently not uniform, and to promote information sharing and interoperability between systems. It will also promote telemedicine demonstration sites and the establishment of standards and norms of the development of telemedicine and promotion through training, to promote sustainable development of telemedicine.

Read more: MD Tech