In this second of a two-part series, Digital Health Futurist Maneesh Juneja examines the potential for digital health to meet the challenges facing China’s healthcare system.

China faces a ‘time bomb’ of health crises, with major problems that are largely preventable, according to a report in the Lancet this year. Those challenges are also opportunities, for those that wish to step in and help. It’s not simply about money, as the Chinese government has already increased spending on healthcare by more than 600% since 2000. It’s also about the intersection of people, policy & process, which don’t always move at the same pace. I’m particularly curious what role technology, and Digital Health play in helping China meet the challenges that lie ahead.

Does China have its own Digital Health sector or is it importing technology from foreign firms? Will China innovate in Digital Health or merely copy what’s been done in other nations? Let’s take a look.

During my research for this post, I attempted to understand the usage and growth of electronic medical records (EMR) across China, and it’s a huge challenge to find data that is also accurate. I did find a fascinating post, by James Ritchie, on 4 reasons why EMR firms won’t try China. He says,

“But health IT doesn’t export quite as easily as Pringles and KFC. I’ve seen China’s healthcare system up close several times, and if you ask me, making headway in the world’s most populous nation will be beyond difficult.” He also says, “No one understands China’s health IT.”

After my own efforts, I’m tempted to agree with him. However, Ritchie also wrote a subsequent article on a case study examining the efforts of a Chinese software company competing for hospital IT projects. One interesting point stated is,

“The interfaces of western medicine and TCM EMR systems are alike, because the patient flow paths at both kinds of hospitals are almost the same. But going back to the software writing stage, TCM EMRs required a different logic and very different terminology.”

Many of us outside of China are attracted by the growth in healthcare spending, forecasted to be $1 trillion by 2020, second only to the USA.

However, unravelling the mysteries of the Chinese landscape is likely to be a far bigger hurdle than actually developing a product that can add value to their system. Interestingly, an article by Leo Sun highlights that American companies such as IBM & Microsoft have actually made some progress in deploying their technology into Chinese hospitals.

Despite the excitement around Apple’s foray in healthcare, Sun doesn’t believe that Apple can be a healthcare platform in China. It’s a different market in China, where Xiaomi became the leading smartphone vendor in the 2nd quarter of 2014. One of Sun’s points really makes you think about the future of Digital Health in China. He wrote,

“Investors shouldn't think about the Chinese mHealth and health care IT markets in the same way as the American ones. Whereas the Chinese market is a young and fertile one that can be built from the ground up, American ones are still struggling with decades of old technology and necessary upgrades.”

There are many assumptions we operate under, which don’t hold in China.

For example, Facebook and Twitter are banned by the government—two of the tools that some of us have used to connect with each other on healthcare matters. How many of us could name the leading social networks in China, such as Qzone or Sina Weibo?

Now, you may feel reticent about rushing off to find healthcare clients in China. However, the British government is so hopeful for future prospects in China that it sent a delegation there in August 2014 to promote UK Digital Health businesses and products. In fact, Prime Minister David Cameron visited China himself in December 2013 as part of a trade visit, and three healthcare deals worth £120 million were signed between UK and Chinese firms.

According to a report this year from Boston Consulting Group, “Chinese consumers are the world’s most health conscious.”

It does make you wonder what the appetite will be for digital tools that may be used to support healthy and active lifestyles. Will products such as Baidu’s smart chopsticks be well received?

Given China’s size (it shares borders with 14 countries), and acute need to transform healthcare, adopting digital platforms that enable doctors to see patients remotely may well be a starting point for some of these new technologies. The question is, will it be Chinese firms like Tencent-financed Guahao that leads the way, or will it be foreign entrants?

Asia is leading the world when it comes to the use of mobile, with smartphone adoption now overtaking computer adoption—according to Google’s recent blog post.

Since smartphones are increasingly finding their way into healthcare, shouldn’t we be exploring the Digital Health market in China too? Getting your innovation into a heavily regulated market like healthcare is tough enough, but is it even tougher given China’s political history? A great post by Damjan P. DeNoble, reminds us that, “China's government distrusts almost any form of disruption,” citing an example where government use of Windows 8 was banned this year due to mistrust of the software.

Equally, there is mistrust of what people might be doing in China.

The breach of a hospital network in the USA this year, which led to data on 4.5 million patients being stolen, is believed to have originated in China. I believe trust is a critical element of any business relationship. How trust evolves between China and other nations is likely to be a significant factor impacting aspects of trade in Digital Health technologies.

In Digital Health, when we think of cutting edge research in pioneering new fields such as genomics and nanotechnology, many of us assume the USA is the undisputed leader, and always will be.

However, China is investing heavily to establish global leadership in both genomics and nanotechnology. In the 21st century, are we ready to adapt to a world where the biggest innovations in science might come from the East, rather than the West? Who will control these emerging technologies?

I believe that China is likely to play an increasingly larger role in the world this century.

Whether people outside of China get to play an increasing role within China is yet to be determined. Digital Health entrepreneurs still tell me they dream of making it big in Silicon Valley or San Diego, not Shanghai or Shenzen. I wonder if that sentiment will ever change. If so, what will drive that change? Will it be reduced opportunities in their home nations or greater opportunities in China—or a bit of both?

Some groups are not sitting on the sidelines waiting to see what might happen, they are taking the risk now. Take the recent announcement about Qualcomm and The George Institute for Global Health establishing the China Center for mHealth, which aims to support the Chinese government’s goal of improving community healthcare in China. One of the new center’s priorities is to “Support the development and expanded use of mHealth technologies globally.” What might your organisation lose by ignoring developments in China? Do you want to be a leader or a follower?

In this fascinating BBC documentary examining China, one of the closing questions asked is, “The government wants innovation, but it also wants control. The paradox is at the heart of China’s future, and no-one yet knows whether it can have both.”

For further information about Maneesh Juneja, take a look at his website or find him on Twitter @maneeshjuneja.

The nuviun blog is intended to contribute to discussion and stimulate debate on important issues in global digital health. The views are solely those of the authors.