1. How to Fly with the Dragon Chinese Healthcare Reform and Informatics Innovation May 3, 2012

2. Chinese Informatics Innovation “Chinese healthcare reform includes sweeping changes to health insurance coverage and care delivery models. It provides opportunities for foreign suppliers to introduce innovative technology and services to the government, hospitals, providers, and patients to support the transformation.” Dr. Qi Li Consultant, Partners Harvard Medical International Global Clinical Strategy, Harris Healthcare

3. Chinese Healthcare Reform • Started in 2009 with the goal of provision of affordable and equitable basic health care for all by 2020 • Total spending is 850 billion CNY or 77 billion pounds so far • Five key areas • Expand insurance coverage to 90% of the population • National essential medicine system • Improve primary care delivery system • Make public health services available to all • Pilot public health reforms

4. Complex Governance and Financing Structure Source: Early appraisal of China’s huge and complex health-care reforms, Winnie Chi-Man Yip, William C Hsiao, Wen Chen, Shanlian Hu, Jin Ma, Alan Maynard, Lancet 2012: 379:833-42

5. Population Trends Source: 2011 Chinese government estimates

6. Public Hospital Reform • Clearly state the roles and functions of public hospitals • Shift strategy to market competition and private ownership of public hospitals • Address dispersion of responsibility and power between various city departments • Reorganise the responsibilities and power of government departments • Change in the decision-making power of individual public hospitals

7. Informatics Innovation • Regional Health Information Exchange • Clinical Pathway • Antibiotics Utilization Management

8. Shanghai Health Information Exchange – E Link Project • Deployed in Shanghai with 30m residents since 2006 • Funded by Shanghai Hospital Development Corp • Connect 23 academic medical centres, 6 municipal districts and 40 community health centres • In 2010, contains records for 16m residents, 40m visits, 160m prescriptions, 15m lab results, 800k case notes • Use decision support alerts to reduce 48m CNY unnecessary tests in the first year • Became the model for other large cities

9. Clinical Pathway • Government sponsored initiative to standardize care, improve reimbursement accuracy, measure quality, and control costs • Shanghai #6 Hospital went live in early 2010 • Clinical pathway systems are now used in over 10 hospitals nation wide • Over 150 clinical pathways have been developed by the hospitals covering all major conditions • Shanghai plans to deploy city wide clinical pathway for centralized knowledge management and analytics

11. Antibiotics Utilization Management • A major government initiative to control cost and reduce drug resistance • Shanghai #10 Hospital deployed an electronic decision support and surveillance solution in 2010 • Incorporate rule authoring, point of care alerts, and BI reporting modules • Integrated with local EMR and CPOE modules

12. 勾选经验性治疗 获取患者诊断、感染部位、过敏史、检查检验结果信息

13. Additional Trends in Technology Needs • EMR mandates • Reimbursement model shift • Drug expenditure control • Clinical training and workforce development • Hospital performance management

14. Turn Opportunities into Businesses • Influence key decision makers everywhere (in China and outside China) • Work through local distributors • Invest in localization development efforts • Pick the right city/province to start