Wednesday, February 22, 2012

Lessons Learned from China

On Sunday I returned from a week in Shanghai and Hangzhou.   A remarkable trip that included daily meetings with government, academic, and clinical leaders.   What did I learn?

In China, about 5% of the GDP is spent on healthcare per year compared to 16% in the US.    Although there is wide variation in lifespan and other population health measures between rural and urban settings, there are few interesting observations about Chinese healthcare

*It's a single payer, publicly funded system that provides universal healthcare via a 14% payroll tax.
*There is a single national set of regulations and policies applied to all hospitals, clinics, and doctors
*There is a single set of national privacy laws
*Immunization is mandatory for the entire population
*There's a single national healthcare identifier

EHRs are widely used in China, however they are optimized for episodes of care, using templates for capture of selected data elements specific to a disease i.e. hypertension, hepatitis, diabetes.    The volume of patients is overwhelming - in one hospital I visited (Huashan), the  dermatology clinic sees 4000 patients per day.    The Chinese EHR enables clinics to document the basics of a problem specific encounter, facilitating extremely fast throughput.   The downside of this is that there is not a longitudinal problem list, medication reconciliation, or coordination of care to avoid repeat testing.

Health Information Exchanges are beginning and in Shanghai and there's a pilot in place which enables data sharing among the public hospitals.   The Chinese have designed an architecture to support HIE in cities, provinces, and across the country.   The idea is similar to the US NwHIN - a network of networks that shares detailed data on a local level and summary data on a national level.

The Standards for HIE are in the early stage and I have shared the US approach to the Consolidated CDA.   The Chinese believe that using building blocks of XML to specify aspects of the record for transition of care is exactly what they need.

I travel the world and over the past year I've worked on aspects of HIE in Japan, Scotland, New Zealand, Europe, and China.    The problems are the same all over - capturing the data, protecting privacy, creating standards-based summaries, embracing vocabularies, and providing decision support.   It's encouraging to see such progress.  In my lifetime, I believe we will achieve a level of healthcare data capture and sharing that enables us to improve healthcare quality, safety, and efficiency throughout the world.  We'll solve these problems, so that the next generation will reap the benefits.


Claudia said...

If it is paid for with a payroll tax, what do the people who are unemployed do?

Mark S said...

I wonder to what degree non-medical personell (i.e. the government) controls the actual care given in China's system. Or to state it another way, would a typical Chinese doctor have the freedom to decide appropriate courses of treatement that are individualized, inculde medication choices, or is emphasis on throughput hammering medical decisions into a single golden path where problem x always equals treatment y...