THE CHINA MINISTRY OF HEALTH DELEGATION EDUCATIONAL VISIT TO HARVARD Where Does China Stand on the Global HIT Continuum? How Can China Leapfrog in HIT

THE CHINA MINISTRY OF HEALTH DELEGATION EDUCATIONAL VISIT TO HARVARD

Where Does China Stand onWhere Does China Stand onthe Global HIT Continuum?the Global HIT Continuum?

How Can China “Leapfrog” in HIT Use?How Can China “Leapfrog” in HIT Use?

Boston, MassachusettsBoston, Massachusetts December 13, 2012December 13, 2012

CHINA MINISTRY OF HEALTH DELEGATION AT HARVARDCHINA MINISTRY OF HEALTH DELEGATION AT HARVARD DORENFEST CHINA HEALTHCARE GROUPDORENFEST CHINA HEALTHCARE GROUP22

Presentation AgendaPresentation Agenda

•PagePage

Evolution of Global HITEvolution of Global HIT 33

Current Status and Future Direction of HIT in ChinaCurrent Status and Future Direction of HIT in China 1111

Where Does China Stand on the Global HIT Continuum?Where Does China Stand on the Global HIT Continuum? 2121

How Can China “Leapfrog” in HIT Use?How Can China “Leapfrog” in HIT Use? 2323

How Does Dorenfest Help?How Does Dorenfest Help? 2929


Opportunities to Improve the Healthcare Delivery Opportunities to Improve the Healthcare Delivery Process Have Been Pursued for Many YearsProcess Have Been Pursued for Many Years

Great redundancy of informationGreat redundancy of information

High error potentialHigh error potential

Lack of timelinessLack of timeliness

High costHigh cost

Organization complexityOrganization complexity


The U.S. Hospitals Have Sought an EMR/EHR Since the The U.S. Hospitals Have Sought an EMR/EHR Since the 1960s through Four Generations of IT Systems1960s through Four Generations of IT Systems

Finance Systems (1960s and 1970s) Finance Systems (1960s and 1970s)

Limited Clinical Systems (1970s and 1980s) Limited Clinical Systems (1970s and 1980s)

More Advanced Clinical Systems (Late 1980s and 1990s) More Advanced Clinical Systems (Late 1980s and 1990s)

Electronic Health Records (2000s)Electronic Health Records (2000s)


But Poorly Implemented Change Created Redundant But Poorly Implemented Change Created Redundant Work on Top of Original InefficiencyWork on Top of Original Inefficiency

Before IT=1x

2x

3x

4x

Growth in Growth in

RedundancyRedundancy

Total Hospital Work ProcessTotal Hospital Work Process


At the BeginningAt the Beginning

1.1. Large visionLarge vision

2.2. Hardware technology limited and expensiveHardware technology limited and expensive

Large computers Large computers

Inefficient software development methodologies Inefficient software development methodologies

3.3. Self development was the only software approach and remained the preferred Self development was the only software approach and remained the preferred approach for a period of time approach for a period of time

4.4. Packaged software emerged first as a customizable starter set and later Packaged software emerged first as a customizable starter set and later became products requiring less customization from user to user became products requiring less customization from user to user

5.5. As time passed, packaged software products became preferred As time passed, packaged software products became preferred

Less expensiveLess expensive

Faster to implement Faster to implement

But many problems in implementationBut many problems in implementation


The Late 1970s and 1980sThe Late 1970s and 1980s

1.1. Several generations of technology, software vendors, software approaches, Several generations of technology, software vendors, software approaches, and products came and went and products came and went

2.2. Software buying and implementation methods improved Software buying and implementation methods improved

Users and management became more involved Users and management became more involved

Functional requirements to define needs and compare vendors became Functional requirements to define needs and compare vendors became more complete and usefulmore complete and useful

User site visits, user customer references, and user discussions with User site visits, user customer references, and user discussions with counterparts at other hospitals became part of an improved buying counterparts at other hospitals became part of an improved buying approachapproach

3.3. Integration became a large problem as the number of software vendors used Integration became a large problem as the number of software vendors used by a hospital increased by a hospital increased

Started out all manual with duplicate entry into multiple systems Started out all manual with duplicate entry into multiple systems

Moved to “hard coding” of interfaces between systems Moved to “hard coding” of interfaces between systems

Caused a focus on the development of standards for software products of Caused a focus on the development of standards for software products of different vendors to communicate with each other different vendors to communicate with each other


The 1990s and 2000sThe 1990s and 2000s

1.1. Management of the buying and implementation of IT software continued to Management of the buying and implementation of IT software continued to improveimprove

2.2. A new generation of software systems emerged, with better features and A new generation of software systems emerged, with better features and functions built on superior technological platformsfunctions built on superior technological platforms

3.3. Integration problems kept growing, causing the movement from hard coded Integration problems kept growing, causing the movement from hard coded interfaces to standards such as HL7, and interface engines which facilitated the interfaces to standards such as HL7, and interface engines which facilitated the transfer of data in a more efficient way between software systems transfer of data in a more efficient way between software systems

4.4. Clinical data repositories, data analytics tools, and clinical decision support Clinical data repositories, data analytics tools, and clinical decision support systems emerged systems emerged

5.5. The pressure for physicians to enter orders through CPOE grew in the late The pressure for physicians to enter orders through CPOE grew in the late 1990s and early 2000s1990s and early 2000s. .

6.6. The U.S. 2009 Healthcare Stimulus Program emphasizes the further expansion The U.S. 2009 Healthcare Stimulus Program emphasizes the further expansion of EHR use, and today much activity is going on in this areaof EHR use, and today much activity is going on in this area


HIT Evolution in the Rest of the WorldHIT Evolution in the Rest of the World

Canada started in the late 1970sCanada started in the late 1970s

Europe and Australia began in the early 1980sEurope and Australia began in the early 1980s

Asia began in the 1990sAsia began in the 1990s

Canada, France, Germany, England, and Australia all started later than the Canada, France, Germany, England, and Australia all started later than the U.S., Invested less, and have made more progressU.S., Invested less, and have made more progress

Hong Kong started even later, invested less, and now is the state of the art Hong Kong started even later, invested less, and now is the state of the art in HIT use in the world in HIT use in the world

China HIT is now at an earlier stage of development. China has the goals China HIT is now at an earlier stage of development. China has the goals and desire to “leapfrog” the rest of the world in HIT use in the next few and desire to “leapfrog” the rest of the world in HIT use in the next few years years


China Ministry of Health Delegation at HarvardChina Ministry of Health Delegation at Harvard

Current Status and Future Direction Current Status and Future Direction of HIT in Chinaof HIT in China


The Development of HIT in China The Development of HIT in China

1.1. Chinese hospitals began to computerize in the early 1990s Chinese hospitals began to computerize in the early 1990s

2.2. The initial focus of computer efforts was on financial systems The initial focus of computer efforts was on financial systems

3.3. In the early 2000s, Chinese hospitals began to implement IT for clinical In the early 2000s, Chinese hospitals began to implement IT for clinical systemssystems

4.4. Many software solutions are now available, with well over 1,000 smaller Many software solutions are now available, with well over 1,000 smaller software companies now operating in the HIT market in Chinasoftware companies now operating in the HIT market in China

5.5. Between 2005 and 2010, China hospital spending on IT grew from 5 billion Between 2005 and 2010, China hospital spending on IT grew from 5 billion RMB in 2005 to 16 billion RMB in 2010, and to 21.5 billion RMB in 2011 RMB in 2005 to 16 billion RMB in 2010, and to 21.5 billion RMB in 2011

6.6. This rapid growth in spending will continue at an even more rapid pace over This rapid growth in spending will continue at an even more rapid pace over the next several years the next several years


Factors Contributing to Future Spending Growth Factors Contributing to Future Spending Growth in China HITin China HIT

1.1. Redundant, expensive, and error-prone hospital work processes led to the initiation Redundant, expensive, and error-prone hospital work processes led to the initiation and development of HIT in China and development of HIT in China

2.2. Fueled by the Ministry of Health (MOH) guidelines for health IT development issued in Fueled by the Ministry of Health (MOH) guidelines for health IT development issued in 2003, calling for all cities in China to implement RHNs and digital hospitals by 2010, 2003, calling for all cities in China to implement RHNs and digital hospitals by 2010, hospitals began to purchase clinical systems in a variety of areas hospitals began to purchase clinical systems in a variety of areas

3.3. In 2009, China Healthcare Reform was passed, and a stimulus spending program of In 2009, China Healthcare Reform was passed, and a stimulus spending program of almost one trillion RMB in new spending was initiated to support Healthcare Reformalmost one trillion RMB in new spending was initiated to support Healthcare Reform

4.4. Improved use of IT is one of eight pillars of the new China Healthcare Reform. The Improved use of IT is one of eight pillars of the new China Healthcare Reform. The 3521 project national vision for HIT was summarized in the twelfth five-year plan for 3521 project national vision for HIT was summarized in the twelfth five-year plan for HIT to provide the framework for HIT and RHN development in China from 2011 to HIT to provide the framework for HIT and RHN development in China from 2011 to 2015. Focuses of HIT development include:2015. Focuses of HIT development include:

Improve hospital IT systems leading to digital hospitalsImprove hospital IT systems leading to digital hospitals

Implement electronic health records (EMR and EHR)Implement electronic health records (EMR and EHR)

Create the second wave of RHN development to provide data sharing throughout Create the second wave of RHN development to provide data sharing throughout cities, provinces, and at a national levelcities, provinces, and at a national level

IT systems to support expanded healthcare insurance IT systems to support expanded healthcare insurance


Factors Contributing to Future Spending Growth Factors Contributing to Future Spending Growth in China HIT (Continued)in China HIT (Continued)

5.5. The vision document for 3521 is comprehensive and extensive, and may be The vision document for 3521 is comprehensive and extensive, and may be summarized as follows: summarized as follows:

3 levels of health information platform – nation, province and region (city 3 levels of health information platform – nation, province and region (city or county)or county)

5 groups of applications – public health, healthcare service, health 5 groups of applications – public health, healthcare service, health insurance, drug administration, general managementinsurance, drug administration, general management

2 basic databases – resident electronic health record and electronic 2 basic databases – resident electronic health record and electronic medical recordmedical record

1 dedicated health infrastructure network1 dedicated health infrastructure network

2 sets of systems – data standards system and network security system2 sets of systems – data standards system and network security system

6.6. Much spending is going on right now to implement first steps in the Much spending is going on right now to implement first steps in the execution of this vision. execution of this vision.


What Are the Key Factors Impeding Success in Chinese What Are the Key Factors Impeding Success in Chinese Hospital IT Use?Hospital IT Use?

1.1. Low investment in the 20-year period 1990 to 2010 caused slow progress Low investment in the 20-year period 1990 to 2010 caused slow progress in HITin HIT

2.2. Weaknesses in the approach to buying and implementing new IT systems Weaknesses in the approach to buying and implementing new IT systems has created unnecessarily redundant work processes, poorly integrated has created unnecessarily redundant work processes, poorly integrated systems, and unhappy users systems, and unhappy users

3.3. The weaknesses in approach to buying of HIT software products in China The weaknesses in approach to buying of HIT software products in China followed a similar path to how earlier adopter countries started their HIT followed a similar path to how earlier adopter countries started their HIT efforts. Most of the world has learned from their own bad experiences to efforts. Most of the world has learned from their own bad experiences to find better ways to buy and implement HIT systemsfind better ways to buy and implement HIT systems


What Are the Key Factors Impeding Success in Chinese What Are the Key Factors Impeding Success in Chinese Hospital IT Use?Hospital IT Use? (Continued) (Continued)

4.4. The current foundation of HIT efforts in China, including software and The current foundation of HIT efforts in China, including software and hardware platforms, and integration tools, is in need of improvement to hardware platforms, and integration tools, is in need of improvement to support the accomplishments of China’s vision for HIT improvementsupport the accomplishments of China’s vision for HIT improvement

5.5. On many occasions hospital and health bureau leadership, not knowing On many occasions hospital and health bureau leadership, not knowing what they do not know, are continuing to make similar mistakes to the past. what they do not know, are continuing to make similar mistakes to the past. By paying much greater attention to what worked and did not work in early By paying much greater attention to what worked and did not work in early adopter countries of the world and using more of what worked and less of adopter countries of the world and using more of what worked and less of what did not work, Chinese hospitals and health bureau leaders will make what did not work, Chinese hospitals and health bureau leaders will make much greater progress toward their vision and “leapfrog” goalsmuch greater progress toward their vision and “leapfrog” goals


The Current Computing Environment in a Typical Large The Current Computing Environment in a Typical Large Complex Chinese Hospital Today Complex Chinese Hospital Today

Major Ancillary Systems

Note: Chart taken from a couple of real hospital situations with each vendor or product family shown in a different color

Sample Current Systems (High Level View)

Major FinancialSystemsMajor Clinic

OR/Anesthesia(Vendor 5)

R.I.S./PACS(Vendor 4)

L.I.S.(Vendor 3)

Blood Bank(Vendor 3)

Bar Code(Vendor 3)

Ultrasound(Vendor 6)

Stomatology (Vendor 7)

Financial(Vendor 2)

MD Workstation(Vendor 2)

Pharmacy(Vendor 2)

L.I.S.(Vendor 3)

Core Vendor(Vendor 1)

Inpatient EMR(Vendor 8)

Cashiering(Vendor 2)

General Accounting (Vendor 2)

Medical Records(Vendor 11)

Medical Ins(Vendor 9)

Medical Ins(Vendor 10)

Human Resources(Vendor 12)

Performance Assessment System

(Vendor 13)Policy Exchange

Platform (Vendor 13)

Webport System(Vendor 13)

Hospital Website (Vendor 13)

Office Automation

Systems

MajorAdmin Systems

Order Management

Inpatient Physician Workstation

Outpatient PhysicianWorkstation

Inpatient Pharmacy

Outpatient Pharmacy

Inpatient ADT and Billing

Outpatient and ER Registration

Outpatient Pricing and Charging

Material Supply

Smart Card

Patient ConsultationSurvey

Lab Price System

Instrument and Equipment

Management

InpatientInsurance Interface

RF Card Producing Sub-System

Many Other Niche andSpecialty Systems


The Competitive EnvironmentThe Competitive Environment

1.1. There are over 1,000 small software vendors active in China HIT There are over 1,000 small software vendors active in China HIT

2.2. The market segments with the most vendors are HIS, PACS, RIS, LIS, and The market segments with the most vendors are HIS, PACS, RIS, LIS, and EMREMR

3.3. All HIT vendors in the market started in a city and most are still operating in All HIT vendors in the market started in a city and most are still operating in that city or a small region around the city. that city or a small region around the city. Many of these smaller local vendors Many of these smaller local vendors have a dominant market share in the area they service. have a dominant market share in the area they service. Some HIT vendors are Some HIT vendors are becoming more national in scopebecoming more national in scope

4.4. Many vendors in the hospital computer systems market offer heavily Many vendors in the hospital computer systems market offer heavily customized solutions rather than products. These heavily customizable customized solutions rather than products. These heavily customizable solutions create greater dependency on the software vendor and are more solutions create greater dependency on the software vendor and are more difficult/expensive to keep current when vendors release new software updates difficult/expensive to keep current when vendors release new software updates periodically periodically

5.5. Chinese hospital leaders would like to see a new generation of HIT software Chinese hospital leaders would like to see a new generation of HIT software developed for the country to assist in helping them accomplish their “leapfrog” developed for the country to assist in helping them accomplish their “leapfrog” objectives objectives


Major Areas of Future Development and Opportunity in Major Areas of Future Development and Opportunity in the China HIT Marketthe China HIT Market

1.1. Application software will become more productized with greater tools to support Application software will become more productized with greater tools to support the growing use of IT in hospitals the growing use of IT in hospitals

2.2. New application software to serve the not yet automated areas of clinical work New application software to serve the not yet automated areas of clinical work processes are emerging very quickly processes are emerging very quickly

3.3. Integration tools to facilitate the development of an improved IT environment Integration tools to facilitate the development of an improved IT environment will emerge will emerge

4.4. Data analytics products and support tools to facilitate better data analysis, Data analytics products and support tools to facilitate better data analysis, reporting, and decision making will emerge as Chinese Hospital Managers reporting, and decision making will emerge as Chinese Hospital Managers grow in sophistication grow in sophistication

5.5. New service and implementation approaches are beginning to emerge New service and implementation approaches are beginning to emerge

General contracting for entire efforts with some company software and General contracting for entire efforts with some company software and some partner softwaresome partner software

Front end planning, buying, and implementation services purchased from Front end planning, buying, and implementation services purchased from independent third parties to help hospitals make better buying decisions independent third parties to help hospitals make better buying decisions and create more successful implementation of software and create more successful implementation of software


Today Chinese Hospital HIT Investment Is Spent Today Chinese Hospital HIT Investment Is Spent Differently Than the Rest of the World Differently Than the Rest of the World

SOURCE: CCW ResearchSOURCE: CCW Research


Where Does China Stand on the Where Does China Stand on the Global HIT Continuum?Global HIT Continuum?



Broad Comparison of U.S. and China HIT SituationsBroad Comparison of U.S. and China HIT Situations

. .

Key Element U.S. China

Per Capita Healthcare Spending $8,500+ $100+

Employees per bed 6 to 12 1 to 2

HIT Spending Very high Very low

Number of Software Vendors in a Hospital 80+ 20+

Integration Status Okay Very bad

Size of IT Staff Very Big Small

Dependence on Software Vendors Medium Very High

Implementation Approaches Fair Bad

Historic Data Available in Any Form Lots Very Limited

Historic Data Available in Accessible Automated Form Considerable Very limited

Clinician Use of Data Growing Limited to none


How Can China “Leapfrog” How Can China “Leapfrog” in HIT Use?in HIT Use?



China Healthcare Leaders Want to “Leapfrog” the World China Healthcare Leaders Want to “Leapfrog” the World in IT Use in IT Use

Chinese hospitals and health bureaus are carefully considering how to be Chinese hospitals and health bureaus are carefully considering how to be more successful in taking next steps forward in IT usemore successful in taking next steps forward in IT use

There is a recognition that for China to accomplish its objectives in HIT There is a recognition that for China to accomplish its objectives in HIT requires the following: requires the following:

– Learning quickly from the global experienceLearning quickly from the global experience

– Overcoming resistance to changeOvercoming resistance to change

– Knowing how to manage changeKnowing how to manage change

– Doing more of what the rest of the world did right and less of what Doing more of what the rest of the world did right and less of what they did wrong to avoid mistakes other countries have made and they did wrong to avoid mistakes other countries have made and China is still makingChina is still making

– Developing more expertise in these areas of need quickly Developing more expertise in these areas of need quickly


How Did the Rest of the World Get to Their How Did the Rest of the World Get to Their Present Level?Present Level?

1.1. The U.S. started first, made a huge amount of error from inexperience, and The U.S. started first, made a huge amount of error from inexperience, and has created an advanced, but very inefficient HIT program has created an advanced, but very inefficient HIT program

2.2. The next group of adopters, including Canada, Europe, and Australia, did The next group of adopters, including Canada, Europe, and Australia, did better than the U.S. by learning from the U.S. experience better than the U.S. by learning from the U.S. experience

3.3. Later adopters in Asia, such as Hong Kong, have accomplished the best Later adopters in Asia, such as Hong Kong, have accomplished the best results in the shortest period of time by paying very close attention to the results in the shortest period of time by paying very close attention to the experience of others and doing more of what they did right, and less of what experience of others and doing more of what they did right, and less of what they did wrongthey did wrong


What Are the Key Success Factors in HIT Use What Are the Key Success Factors in HIT Use in the Rest of the World?in the Rest of the World?

1.1. Good front end methods for buying and implementing new HIT systems, with a Good front end methods for buying and implementing new HIT systems, with a focus on functional specifications and user buy-infocus on functional specifications and user buy-in

2.2. Physician and user leadership with the involvement of many physicians and Physician and user leadership with the involvement of many physicians and usersusers

3.3. Good integration tools to support the purchase of software products from Good integration tools to support the purchase of software products from different vendors in a more seamless waydifferent vendors in a more seamless way

4.4. Software products with user modification tools that match the needs of the Software products with user modification tools that match the needs of the hospitals and can easily be upgraded to reflect changes and new ruleshospitals and can easily be upgraded to reflect changes and new rules

5.5. Careful learning from their own experience and the experience of other Careful learning from their own experience and the experience of other countries to minimize mistakes in the process of buying and implementing HIT countries to minimize mistakes in the process of buying and implementing HIT systemssystems


China Has Moved Too Fast in the Following Areas China Has Moved Too Fast in the Following Areas of HIT Developmentof HIT Development

1.1. Oversimplifying vision and ideas so that execution brought disappointment Oversimplifying vision and ideas so that execution brought disappointment

2.2. Buying HIT systems too quickly with too little front end planning and too little Buying HIT systems too quickly with too little front end planning and too little user involvement user involvement

3.3. Adopting best of breed software acquisition approaches without adequate Adopting best of breed software acquisition approaches without adequate attention to how these different software vendor products would fit together as attention to how these different software vendor products would fit together as a unit and work seamlessly in the hospital a unit and work seamlessly in the hospital


China Has Moved Too Slow in the Following Areas China Has Moved Too Slow in the Following Areas of HIT Developmentof HIT Development

1.1. To recognize the value and to invest in the methods to integrate a variety of To recognize the value and to invest in the methods to integrate a variety of different software vendors, and to not use too many software vendors if they different software vendors, and to not use too many software vendors if they cannot be integratedcannot be integrated

2.2. To address cultural impediments to good change management by involving To address cultural impediments to good change management by involving the users more and adopting processes that lead to good buying decisions the users more and adopting processes that lead to good buying decisions


Creating More Success in the Current China Healthcare Creating More Success in the Current China Healthcare EnvironmentEnvironment

1.1. There is much momentum for change. More money will be spent and better There is much momentum for change. More money will be spent and better results are mandatoryresults are mandatory

2.2. Because of limited investment for many years in China HIT, Chinese hospitals Because of limited investment for many years in China HIT, Chinese hospitals have created a poor foundation for implementing its HIT vision of the future, have created a poor foundation for implementing its HIT vision of the future, and have made many of the same mistakes that the U.S. made in its early and have made many of the same mistakes that the U.S. made in its early adoption of HIT adoption of HIT

3.3. Now China is at a crossroads. It is spending much money to accomplish a very Now China is at a crossroads. It is spending much money to accomplish a very grand HIT visiongrand HIT vision

4.4. But more careful front end planning at every level of the country – from the But more careful front end planning at every level of the country – from the hospital to the health bureau to the national level – must be done to support the hospital to the health bureau to the national level – must be done to support the execution of what could be a wonderful vision if successfully implementedexecution of what could be a wonderful vision if successfully implemented

5.5. By recognizing what the rest of the world learned from their successes and By recognizing what the rest of the world learned from their successes and failures, and doing more of what the rest of the world did right, and less of what failures, and doing more of what the rest of the world did right, and less of what the rest of the world did wrong, China will be able to make much faster and the rest of the world did wrong, China will be able to make much faster and better progress in the future of HIT implementation better progress in the future of HIT implementation


How Does Dorenfest Help?How Does Dorenfest Help?



The Dorenfest Group Is Bringing Needed New The Dorenfest Group Is Bringing Needed New Skills to China Skills to China

1.1. Hospital Operations Improvement and Change ManagementHospital Operations Improvement and Change Management

2.2. IT Program Improvement, Problem-solving, Strategy, and Planning IT Program Improvement, Problem-solving, Strategy, and Planning

3.3. New Approaches to Buying IT Systems in a Stronger Partnership with New Approaches to Buying IT Systems in a Stronger Partnership with Users Users

4.4. New Ways to implement IT Systems New Ways to implement IT Systems


Examples of Dorenfest Projects in ChinaExamples of Dorenfest Projects in China

The Dorenfest China Healthcare Group was formed in 2006 to offer consulting The Dorenfest China Healthcare Group was formed in 2006 to offer consulting services to China Hospitals and Health Bureaus. We have worked with over services to China Hospitals and Health Bureaus. We have worked with over 25 Hospitals and Health Bureaus 25 Hospitals and Health Bureaus to help them use information technology to help them use information technology more effectively and have consulted with a variety of Western companiesmore effectively and have consulted with a variety of Western companies

Examples of Examples of Health Bureau Clients Health Bureau Clients for RHN and digital hospital planningfor RHN and digital hospital planning

– ChongqingChongqing

– ShenzhenShenzhen

Examples of Examples of Hospital Clients Hospital Clients

– Beijing Electricity HospitalBeijing Electricity Hospital

– Foshan City First People’s Hospital Foshan City First People’s Hospital

– Peking University Third HospitalPeking University Third Hospital

– Rizhao City People’s HospitalRizhao City People’s Hospital

– Shanghai Changning Maternity & Infant Health InstituteShanghai Changning Maternity & Infant Health Institute


Examples of Dorenfest Projects in China(Continued)Examples of Dorenfest Projects in China(Continued)

Examples of helping Examples of helping Clients from Other Locations Clients from Other Locations bring their skills to Chinabring their skills to China

– AetnaAetna −− IntelIntel

– Hong Kong Hospital AuthorityHong Kong Hospital Authority −− Microsoft ChinaMicrosoft China

– IMS ChinaIMS China −− Phillips Healthcare ChinaPhillips Healthcare China

Examples of helping Examples of helping Chinese Companies Chinese Companies with HIT market questionswith HIT market questions

– Donglian–Hangzhou East AssociatesDonglian–Hangzhou East Associates − Simcere Pharmaceuticals− Simcere Pharmaceuticals

– Heren HealthHeren Health −− SinopharmSinopharm


THANK YOU.THANK YOU.FOR MORE INFORMATION CONTACT:FOR MORE INFORMATION CONTACT:

SHELDON I. DORENFEST OR XIAO LIUSHELDON I. DORENFEST OR XIAO LIU

THE DORENFEST GROUPTHE DORENFEST GROUP THE DORENFEST CHINATHE DORENFEST CHINANBC TOWER, SUITE 2725NBC TOWER, SUITE 2725 HEALTHCARE GROUPHEALTHCARE GROUP455 N. CITYFRONT PLAZA DRIVE455 N. CITYFRONT PLAZA DRIVE HUAIHAI EAST ROAD NO. 45HUAIHAI EAST ROAD NO. 45CHICAGO, IL 60611-5555CHICAGO, IL 60611-5555 HUAIHAI PLAZAHUAIHAI PLAZAU.S. OF AMERICAU.S. OF AMERICA SUITE 908SUITE 908PHONE: 312-464-3000PHONE: 312-464-3000 SHANGHAI, CHINASHANGHAI, CHINAFAX: 312-467-0541FAX: 312-467-0541 PHONE: 021-51001821PHONE: 021-51001821

WEB SITE ADDRESS: WEB SITE ADDRESS: www.Dorenfest.comwww.Dorenfest.com

E-MAIL ADDRESS: E-MAIL ADDRESS: [email protected]@Dorenfest.com

SHELDON’S E-MAIL ADDRESS: SHELDON’S E-MAIL ADDRESS: [email protected]@Dorenfest.com

XIAO’S E-MAIL ADDRESS XIAO’S E-MAIL ADDRESS : : [email protected]@Dorenfest.com

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THE CHINA MINISTRY OF HEALTH DELEGATION EDUCATIONAL VISIT TO HARVARD Where Does China Stand on the Global HIT Continuum? How Can China Leapfrog in HIT