Digital Healthcare Transformation and Artificial ... Healthcare and Life Sciences Prof. Gert Bruche,

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  • Strategy and Transaction Advisors

    Healthcare and Life Sciences

    Prof. Gert Bruche, Founding Partner, BGM Associates GmbH

    April 2018

    Digital Healthcare Transformation and Artificial

    Intelligence: Where is China heading? Gert Bruche, Na Wang – Digital Health Asia Conference – Asia-Pacific Week 2018, April 24, Berlin

  • 2

    China‘s healthcare is a broken system - and one of the

    challenges for China‘s CP

    Proposition 1

    Source of images: Yang et al (2013), A Prescription for Danger

  • DRAFT 0.3 – WORK IN PROGRESS – NOT FOR DISTRIBUTION – Mar 18, 2015 3

    China Healthcare Flashlight

    http://www.xinhuanet.com/politics/2017-09/29/c_1121747583.htm0

    After great progress in the past, the explosion of non-communicable diseases

    challenges China‘s healthcare system

    Causes of death

    Sources: WHO (2014), World Bank (2014), ESC (2014), IDF (2014);

    76,5

    © BGM Associates 2018 - Gert Bruche & Na Wang – Any use of this material

    without written permission of BGM Associates is strictly forbidden

  • DRAFT 0.3 – WORK IN PROGRESS – NOT FOR DISTRIBUTION – Mar 18, 2015 4

    China Healthcare Flashlight

    * 2014; **CHC: Community Health Centers, THC: Township healthcare centers. Source Süssmuth-Dyckerhoff/Then (2017)

    The current healthcare system is top-heavy, based on ‚self-selection‘, and unable

    to cope with growing demand

    1,875

    6764

    ~70,000

    11,963

    63,4

    70,5

    20,0

    40,7

    Class III

    Class II

    Private

    CHCs**

    THCs

    No. of facilities* Patient inflow, mn*.

    High

    misdiagnosis

    rates

    Long

    waiting

    lines

    Repetitive exams

    High out-of

    Pocket cost

    Overburdened

    & badly paid

    doctors

    The Patient

    © BGM Associates 2018 - Gert Bruche & Na Wang – Any use of this material

    without written permission of BGM Associates is strictly forbidden

  • DRAFT 0.3 – WORK IN PROGRESS – NOT FOR DISTRIBUTION – Mar 18, 2015 5

    China Healthcare Flashlight

    China works on a massive transformation of its healthcare system and wants to

    solve its problems by 2030*

    Five year plans

    Increase # of

    doctors & improve

    training

    Public hospital

    reform

    Expand

    primary healthcare

    servicesBasic health insurance

     Gradually reduce

    out-of-pocket

    Equal access

    to urban & rural

    population

    „Healthy China

    2030“ Policy guidance

    Encourage private

    healthcare

    investment

    *excludes

    digitalization

    policies

    Reform

    of drug

    distribution

    Reform of

    medical device

    distribution Priorize domestic

    equipment

    manufacturers

    © BGM Associates 2018 - Gert Bruche & Na Wang – Any use of this material

    without written permission of BGM Associates is strictly forbidden

  • 6

    In healthcare digitalization and AI application China is in an early stage, but very dynamic

    Proposition 2

    Digital healthcare

    transformation

    Time

    2018

    © BGM Associates 2018 - Gert Bruche & Na Wang – Any use of this material

    without written permission of BGM Associates is strictly forbidden

  • DRAFT 0.3 – WORK IN PROGRESS – NOT FOR DISTRIBUTION – Mar 18, 2015 7

    Healthcare provision

    (Hospitals, CHCs)

    China HC digitalization

    Three overlapping arenas shape the digitalization of China‘s healthcare system and

    the use of AI

    Regionalized patient management

    Patient & consumer

    access

    China‘s enabling IT - Infrastructure

    Regional

    health cloud

    Remote data sharing

    ,vertical‘ referal &

    consultation among

    specialists Patient – doctor interaction;

    Self- diagnosis / monitoring;

    Wearables

    Clinical workflows

    and decision

    support

    & automation

    © BGM Associates 2018 - Gert Bruche & Na Wang – Any use of this material

    without written permission of BGM Associates is strictly forbidden

  • DRAFT 0.3 – WORK IN PROGRESS – NOT FOR DISTRIBUTION – Mar 18, 2015 8

    Healthcare provision

    (Hospitals, CHCs)

    China HC digitalization

    Government policies touch upon all three areas…

    Regionalized patient management

    Patient & consumer

    access

    Health cloud

    e.g.

    Adoption of EMR systems

    (along w hospital reform)

    e.g.

    ‚Healthy China Cloud

    Service Plan‘ till 2020

    Long-distance medical

    system; cloud-based data

    handling within regions

    Promote Internet plus

    action plan in healthcare

    (online healthcare

    platforms)

    2017.7 Development Plan

    on the New Generation of

    Artificial Intelligence (The

    State Council)

    2017.8 CDFA regulates AI-

    aided Dx, impl. by 8.2018

    e.g.

    2014.Clarification of

    telemedicine service models

    (B2B, B2C)

    2015-2010 Plan:

    Promotes Internet-based

    services; supports wearable

    device service technology

    © BGM Associates 2018 - Gert Bruche & Na Wang – Any use of this material

    without written permission of BGM Associates is strictly forbiddenSource of phone screenshot: own enquiry

  • DRAFT 0.3 – WORK IN PROGRESS – NOT FOR DISTRIBUTION – Mar 18, 2015 9

    Cumulative Capabilities* Stage

    Complete EMR (data sharing, ware-

    housing, continuity across all patients 7

    Physician doc. struct. templates; full

    CDSS closed loop medication 6

    Full RAD PACS (different aspects in

    other regions) 5

    Clinical practitioner order entry, clin.

    decision support (St. protocolls) 4

    Nursing/clinical doc, clinical decision

    support (error checking), PACS

    outside radiology

    3

    Clinical data and basic decision

    support; sharing possible 2

    Three basics installed: Radiology,

    Laboratory, Pharmacy 1

    No full installation of three basic

    clinical info systems 0

    Healthcare Provision (Hospitals, CHCs)

    *Simplified, adapted terminology; **HIMMS Asia: Analytics (2018)

    All***

    4.2%

    27.1%

    10.1%

    35,9%

    16.4%

    2.6%

    1.7%

    2.1%

    In the ‚digitalization‘ of its hospitals China is still in an early stage….

    EMR Adoption Model (HIMSS)*

    ~77%

    ~97%

    848 Tertiary

    Hospitals**

    0

    0,1%

    0,6%

    2,7%

    22,2%

    31,7%

    12,0%

    30,7%

    1,0%**

    0,3%**

    ~ 2013 ~ 2015

    2018

    © BGM Associates 2018 - Gert Bruche & Na Wang – Any use of this material

    without written permission of BGM Associates is strictly forbidden

  • DRAFT 0.3 – WORK IN PROGRESS – NOT FOR DISTRIBUTION – Mar 18, 2015 10

    Healthcare Provision (Hospitals)

    Source of images: Litjens et al (2017), A survey of deep learning in medical imaging.

    The most promising clinical AI applications in the medium term are in diagnostic

    imaging, with a number of American and Israeli Startups in the lead…

    Computer Aided Detection

    (CADe)

    Quantitative Tools

    Decision Support

    Computer Aided Diagnosis

    (CADx)

    Screening Diagnosis Treatment Monitoring

    Detection regions of Interest

    (e.g. pot. cancerous lesions)

    Measurement (properties e.g.

    density, volume)

    Classification per modality

    (e.g.benign/malignant)

    Integration multidisciplinary,

    multiparametric

    EMR, health databanks)

    © BGM Associates 2018 - Gert Bruche & Na Wang – Any use of this material

    without written permission of BGM Associates is strictly forbidden

  • DRAFT 0.3 – WORK IN PROGRESS – NOT FOR DISTRIBUTION – Mar 18, 2015 11

    Healthcare Provison (Hospitals)

    Chinese players are entering AI based diagnostic imaging as well, often jumping

    right away to CADx, i.e. automated classification/diagnosis

    Tencent Miying

    • 11.2017: Government plan to build

    national AI innovation platform w

    four partnering companies

    • Tencent‘s AIMIS chosen as

    national diagnostic imaging

    platform

    • CADx platform: lung, breast,

    colorectal, esophaegel cancer, …

    • Tested in 10 Level III hospitals, ~

    100 more hospitals lined up

    • Will probably become first choice

    for many hospitals

    Other diagnostics players

    Probability of

    malignancy

    © BGM Associates 2018 - Gert Bruche & Na Wang – Any use of this material

    without written permission of BGM Associates is strictly forbiddenSource of images: Tencent (2018), https://miying.qq.com/official/product/breast

  • DRAFT 0.3 – WORK IN PROGRESS – NOT FOR DISTRIBUTION – Mar 18, 2015 12

    Case example: the ‚hierarchical medical solution‘ for Anhui

    Province by Shanghai United Imaging Heal