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Bridging space and time with telemedicine

2020.06.10 By Xu Shenglan and Li Qiwei

Online consultations and telemedicine are creating new diagnosis and treatment models that use medical resources more efficiently, replacing long queues in crowded hospitals with a patient-oriented, personalized, and collaborative networked service.

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In 2019, China’s telemedicine market was worth 11.45 billion Chinese yuan (US$ 1.62 billion). According to Zhao Jie, director of the National Telemedicine Center of China (NTCC) at the First Affiliated Hospital of Zhengzhou University (FAHZU), telemedicine is crucial to fighting the COVID-19 epidemic and a must-have for public health. He stresses that the telemedicine technology of tomorrow will offer greater potential and allow anyone, anywhere access to high-quality healthcare services.

Making telemedicine accessible anywhere

WinWin: What was the original aim and mission of the National Telemedicine Center?

Zhao Jie: We set up the Henan Provincial Remote Consultation Center in 1996. In 2012, telemedicine was widely applied, and in 2014, the center was upgraded to the Henan Provincial Telemedicine Center.

This marked the establishment of a complete telemedicine service platform in Henan, covering 108 county-level healthcare facilities in the province. We set up data centers in 18 cities that year, and in 2016, equipped each of the 108 facilities with equipment for scanning medical records.

The telemedicine platform now offers a full range of functions, including full consultations, remote pathological diagnosis, remote imaging diagnosis, remote ECG diagnosis, remote education, surgical guidance, and remote monitoring. This has established a five-level interconnected comprehensive telemedicine service system.

In 2018, Henan Provincial Telemedicine Center, founded by FAHZU, was formally upgraded into a national-level facility called the National Telemedicine Center of China, becoming the first national telemedicine center in Henan.

To date, we’ve offered our telemedicine services free of charge, including terminals, network usage fees, remote consultations, and remote training for tier-1 hospitals.

The remote consultation system is proven to boost diagnosis and treatment standards and optimize patient structuring. We’ve achieved the national aim of treating minor illnesses at the county level and keeping 90 percent of consultations at county-level health facilities.

In a populous province like Henan, service standards offered by primary-tier healthcare professionals can be very uneven. The remote consultation and training system has dramatically enhanced their standards and the service capacity of hospitals at the primary level.

WinWin: How developed is telemedicine in China overall?

Zhao: Telemedicine is a new healthcare model that has emerged along with advancements in computer and communication technology and combines modern medicine with ICT.

It meets demands for inter-hospital, inter-regional, and even international medical assistance and collaboration, and maximizes the sharing of healthcare resources. The telemedicine healthcare model has tremendous value in solving healthcare problems in China such as the difficulty and expense of seeing a doctor who’s located far away and inefficient appointment systems.

Telemedicine in China has gone through various stages of development, including simple communication over the telephone, video over IP on software like QQ, specialist video systems, and advanced video conferencing systems. But none of these systems are able to collect and transmit key medical diagnosis data in the required timeframe.

So, Henan Provincial Telemedicine Center decided to build a leading nationwide telemedicine service system in collaboration with Huawei and other partners. The system acts as a regional collaborative healthcare service platform. It has multiple remote functions, including training, consultation, pathological diagnosis, and imaging diagnosis. It also offers an ECG diagnosis and monitoring center and clinic and a precision medicine center. The system supports seamless data integration and exchange between hospitals, transforming traditional video conference-based telemedicine into a data exchange service platform.

Sharing information and resources on telemedicine platforms promotes access to high-quality medical resources in smaller healthcare institutions in Henan, supporting county-level hospitals and providing them with guidance and teaching. Not only does this reduce the difficulty and expense of visiting bigger hospitals in towns and cities for patients in remote and rural areas, it also drives tiered diagnosis and treatment in the province.

WinWin: What are the National Telemedicine Center’s long-term plans?

Zhao: Since founding the National Telemedicine Center, we’ve established a seven-level medical service system spanning the international, national, provincial, city, county, township, and village levels.

The center has set up system interoperability with other provinces and cities, including Shandong, Xinjiang, Shanxi, Sichuan, Fujian, and Guizhou, as well as countries like the US, Russia, and Zambia. It also conducts research for the National Health Foreign Aid Telemedicine Platform and the Belt and Road Health Silk Road Telemedicine Platform.

The platform currently connects to more than 1,300 healthcare facilities within the province and beyond. Every year, it facilitates over 40,000 online consultations; diagnosis for over 500,000 cases in specialist wards, including ECG, pathology, and imaging; and more than 300 distance training sessions, with a combined audience of 500,000. In the future, we will build a system based on one private network, one platform, and one data center to provide services globally.

Defeating distance

WinWin: What role has the National Telemedicine Center played so far in combating the COVID-19 epidemic?

Zhao: As the chair of the Telemedicine Special Committee of the Chinese Health Information Association and a supporting institution of both the National Telemedicine Center and the National Engineering Laboratory for Internet Medical Systems and Applications, FAHZU was keenly aware of the critical role of telemedicine in fighting the epidemic.

We quickly conducted drills on epidemic prevention and control, telemedicine system deployment, and technical solutions. We also communicated with and reported to Henan’s epidemic prevention and control (EPC) command and the leaders of Henan Health Commission to make advance arrangements and take proactive action.

Henan’s EPC command and the Health Commission decided to build a remote consultation system covering all designated healthcare facilities in the province. National Telemedicine Center’s entire staff worked to optimize the plan, coordinate materials and stakeholders, and put together 18 emergency teams overnight.

Partnering with Huawei and others, they set up the remote consultation system to act as a comprehensive service system for EPC and remote telemedicine, overcoming numerous difficulties to complete the first batch of system deployments to 130 health facilities in less than 82 hours. The system was based on 5G SA and fixed-line converged networks.

As the outbreak progressed, they completed deployment of the consultation system in 17 additional designated healthcare institutions as well as all isolation wards at FAHZU, all in just two days. They also deployed a 5G SA mobile rounds system for isolation wards at FAHZU. This would provide a robust information support platform for EPC in the province.

With the systems in place, Henan’s EPC command could monitor isolation wards in all 147 designated hospitals and clinics, using mobile rounds to understand the changing condition of all critically ill patients in the province. This meant all those who were seriously ill could receive consultations from province-level specialists via the system.

An expert group organized by Henan Province Department of Health could also conduct daily real-time consultations for critical patients in all 147 designated health facilities using the system, and it allowed us to explain treatment plans and provide technical guidance for medical staff in all health facilities in Henan.

As a result, the success rate of critically ill patients’ consultations and treatment was dramatically improved and the ability of first-tier hospitals and clinics to deal with the epidemic was enhanced, increasing survival rates. The system was a first line of defense for seriously ill patients and increased the quality of EPC in Henan considerably.

WinWin: What impact will the epidemic have on the development of telemedicine in future?

Zhao: Without a remote consultation system acting as basic support, first-tier healthcare facilities would have faced huge challenges treating COVID-19 in Henan. Thanks to the system, Henan was able to unify and standardize diagnosis and treatment plans, which significantly improved the treatment of patients with COVID-19.

For the digital transformation of healthcare in the future, telemedicine applications based on video conferencing will gradually be more personalized, as mobile devices such as smartphones become increasingly ubiquitous. Every patient will be able to receive precision services on mobile devices.

As cutting-edge technologies like cloud computing, IoT, big data, and 5G gradually mature, more potential will emerge for optimizing processes and enhancing the efficacy of telemedicine. With the help of cloud, case information can be shared between different health institutions, and diagnosis and treatment information can be quickly added or changed, providing a reference for doctors to fully understand patients’ conditions and formulate suitable treatment plans.

Next-gen telemedicine systems will integrate different information systems, network technologies, medical imaging equipment, and traditional medical systems, as they evolve into a new generation of integrated telemedicine systems.

Future cooperation

WinWin: Moving forward, how will new technologies such as 5G help to upgrade telemedicine technology and benefit more people?

Zhao: The application of 5G in the healthcare field will promote systematic reform and accelerate the transformation of public hospitals. The hospitals of tomorrow will be able to conduct cross-border medical treatment and become “hospitals without borders.” 4K high-definition video bandwidth supported by 5G technology will allow different healthcare institutions to share high-quality medical resources, rapidly improving the standard of health professionals at the primary level. 5G will also help large public hospitals integrate clinical research and fully integrate hospital management systems.

5G offers high bandwidth, low latency, and high reliability, meeting the needs of human-machine interconnections and real-time data sharing. In the event of an mergency anywhere in Henan, for example, FAHZU emergency command vehicles and ambulances can arrive at a specified location very quickly to carry out on-site command and treatment.

Since 2019, FAHZU has carried out China’s first 5G healthcare demo project, working with Huawei and others to carry out analysis, joint debugging, and network testing of service scenarios like 5G emergency rescue, remote B-scans, remote consultation, intensive care, and VR. We’ve built China’s first 5G non-standalone healthcare experimental network and 5G standalone smart healthcare private network, which involved setting up 30 5G base stations in FAHZU’s three branch hospitals. And we’ve implemented Henan’s first 5G rural telemedicine pilot in Guangshan County, Xinyang.

WinWin: How would you describe the partnership between Huawei and National Telemedicine Center and what do you anticipate for the future?

Zhao: With FAHZU’s telemedicine service platform and telemedicine system driven by both audio/video tech and data, we’ve enabled data sharing. This is unique in China. We signed a strategic cooperation agreement with Huawei in 2011 and, together, we selected regional collaborative healthcare hospitals for each of Henan’s counties and cities. Then in 2015, we established a joint innovation center for telemedicine and big data. Huawei was also heavily involved in constructing the National Telemedicine Center, providing products and solutions, including active-active data centers, video terminals, and medical big data. Going forward, we will step up cooperation. Deploying a core platform comprising Huawei HD video terminals and with FAHZU acting as a hub, we will connect all secondary healthcare facilities and above in Henan Province to the National Telemedicine Center, achieving the true sharing of high-quality medical resources and transforming the future medical ecosystem.