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Healthcare

Managing hospital IT in China

By Jianggan Li | 10 July 2009

As the CIO of Sun Yat-sen Hospital, Niu’s choices are limited to what the market has to offer – a primary challenge for him.

“If there are applications or features that we want but are not available in the market, there is nothing much I can do,” he says it would be unwise to invest the hospital’s limited IT manpower in developing their own applications.

Established in Guangzhou in 1835, Sun Yat-sen Hospital was the first western medicine hospital in China. It is currently a teaching hospital of Sun Yat-sen University, both now named after Dr Sun Yat-sen, a physician who later lead the revolution to overthrow the last Chinese empire and established a republic.

Project managers With more than 2000 beds in four campuses and a daily outpatient count between 8000 and 9000, Sun Yat-sen Hospital has only a dozen people in the IT team, including medical informatics professionals, developers and support technicians.

And among them very few are adept in medical informatics or have a background in that field. “Most are computing graduates who have to study clinical practice along the way; same applies to our medical informatics graduates, who enter the field directly after school, without much practical experience,” Niu, whose degree was in mathematics, reveals.

As most hospital IT staff in China lack sufficient knowledge in this hybrid profession, Niu says there are not many training opportunities available in the country that focused on the subject matter.

“Vendors only give training on their specific projects, rarely on more profound issues,” he comments. As an alternative, people have to learn along the way, paying tuition fee during and after the implementation of particular systems.

Believing that his team is capable of developing its own ERP system, Niu says the it’s not worth the team’s time to apply constant changes required for the system.

“Therefore we don’t develop, we project manage,” Niu explains that his approach is to mould these software engineers into project managers, while buying package software or outsourcing the development to contractors.

He adds that a lot of hospitals in China which used to develop their own ERP systems have now switched to using vendor applications.

While domestic ERP vendors are now able to deliver systems catered to the needs of Chinese hospitals, Niu says he and his peers still have to look abroad for good clinical systems – but those are emerging in China as well. Currently, although hospitals prefer to procure brands like Siemens, GE and Infinitt, there are more than domestic PACS vendors in the country; and Niu is confident that one day they will reach international standards.

Consolidation Regarding the healthcare reform package recently announced by the central government, Niu hopes that the detailed execution plan, which is due to be released soon, will contain more government-led initiatives to interconnect the hospitals. “Grass-root efforts from hospitals will be very hard to achieve their goals, despite the large sum of money spent,” he comments. “If the government takes a lead and also invest money, it can be easily done.”

One important reason for that is the administrative fragmentation of the healthcare system, reveals Niu. Sun Yan-sen Hospital is directly under the Ministry of Health, so do a few other prestigious hospitals in the city of more than seven million inhabitants. However, the province, the prefecture, the different districts in the municipality all run their own groups of hospitals, not mentioning those belonging to the military and the Armed Police.

“Hong Kong managed to achieve a consolidated system across all public hospitals because it had strong government mandate,” Niu adds that he also sees that commitment in a few municipalities in China, though far from pervasive at the moment.

One of the cores of the healthcare reform is to strengthen community care, therefore lowering the total cost of healthcare incurred to both individuals and the society as a whole.

In China the centralised identification scheme managed by the Public Security authorities can be leveraged by medical authorities to create the unique identifier for patients. The easily-traceable identity will not only reduce errors in identification but also curb identify fraud which happens frequently in the country when it comes to medical insurance benefits.

A system like this has already be implemented in the prefecture-level municipality of Zhuhai; and convened by a respected professor at Sun Yan-sen Univeristy, to which Niu’s hospital is affiliated, experts from both the University and a few hospitals are working on developing a provincial level remote-diagnosis network covering the whole of Guangdong Province.

The project aims at integrating all the information of a particular patient step by step, so that experts based in Guangzhou, the provincial capital, can be well informed during consultation sessions for patients miles away.

“If we integrate region by region, it will be easy to aggregate all these at the provincial level,” Niu says the initiative is currently under assessment and consultation process.

Sun Yat-sen Hospital’s IT team will be in charge of deploying and managing the network, hardware as well as software applications for the system; and Niu hopes the successful implementation will create a de facto standard for similar projects in China, which lags behind other countries in standardisation. But more pressingly, Niu is looking at implementing a new ERP system to replace the incumbent which has become outdated over the years. The hospital has also issued a tender for a PACS system recently.

“We are updating our systems continuously,” he says. “Because hospital is a dynamic environment and IT has to keep up with it.”

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