the digital revolution in china: pacs and networks · 2018. 5. 27. · characteristics of chinese...
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The Digital Revolution in China: PACS and Networks
Gaojun Teng, Minglin Li, Vincent Li May 11, 2012
8th Annual MIIT Conference, Toronto
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Table of Content
• Background Information
• 2011 Chinese PACS Market Analysis
• Regional Health Network in Planning
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Background Information
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Increasing number of Health Institutions
• The number of Chinese health institutions are increasing over the years. The healthcare infrastructure is now well established.
• By the end of 2010, there are 937,000 health institutions, an increase of 20,000 from 2009. – Hospitals: 20918, increased 627 – Community level health centers: 902,000, increased 20,000 – Professional public health institions: 11835, increase 170
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Number of Chinese Healthcare Institutions
Total
Hospitals
Community Health Service Centers
Rural Health Service Centers
Clinics (Health stations, Care centers)
Table 1 2008-2010 Chinese Number of Healthcare Institutions
Village Health Stations
Women & Children Health Centers
Special Disease Prevention Centers
Centers for Disease Control
Hygiene Inspection Office
Source of data: MOH
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Hospitals
• Majority of the hospitals are public – Public: 13850 – Private: 7068
• Hospitals are classified in 3 levels – Level 3 (A):1284 (including AAA hospitals: 813) – Level 2 (B): 6472 – Level 1 (C): 5271 – Unclassified: 7891
• Hospital sizes based on # of beds – 800+ beds: 718 – 500-799 beds: 1069 – 200-499 beds: 3241 – 100-199 beds: 3496 – 0-100 beds: 12394
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Community and Public Health Institutions
• Community Healthcare Institutions – Community Health Stations: 33,000 – Rural Health Stations: 38,000 – Clinics: 173 ,000 – Village Health Clinics: 648,000
• Public Health Institutions – Center for Disease Control: 3513
• Provincial: 31 • Regional: 403 • County: 2822
– Hygiene Inspection Offices: 2992 • Provincial: 31 • Regional: 393 • County: 2490
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Healthcare Expenditure Surpassed 5% of GDP
• 2003-2009, the total gross healthcare expenditure grew from 658.41 billion RMB to 1.72048 trillion RMB, CAGR 17.36%
• Healthcare expenditure in % of GDP grew from 4.85% to 5.13%
• 2008-2009, Total gross healthcare expenditure grew 18.36%
• Public funds accounted for 27.4% of the expenditure – a 2.5% growth.
Source of data: Huatong Health, eHealth
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2011 Chinese PACS Market Analysis
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2011 Chinese PACS Market Size
• 2009-2011, Chinese PACS growth rate was at CAGR 25%+ • 2011 Chinese PACS market size was 1.04 billion RMB, a 28.4% growth • 2012-2015 projection for Chinese PACS market will continue 20%+
growth rate. 2015 market size will reach 2.6 billion RMB
Source of data: Huatong Health, eHealth
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2011 PACS Software Sales and Growth
• 2011 Chinese PACS software market size was 280 million RMB, at 40% annual growth rate
• 2015 projection will reach 710 million RMB
Source of data: Huatong Health, eHealth
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Digital Revolution is Happening…
• Chinese government is pushing for healthcare coverage for the population, especially in rural area. – More rural health stations – More equipment
• CR and DR markets are growing dramatically – CR market size was 2000 units in 2011 – There was a plan to deploy 7000 DRs in 2011-2012
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Analog is Not Going Away Soon…
• Most of the hospitals in China still print film!! – CR/DR/CT/MR images are printed on film. – It’s a tradition that the patient would want to take the film along
with the radiology report, even though the diagnosis could be done on PACS workstations.
• The film market is about 6 billion RMB/year and growing. • Annual sales of new imagers is about 10,000 units. • Reason – reimbursement for film
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Analog is Going to Be Replaced by Digital
• The city of Shanghai has published a new reimbursement structure for film and digital media (e.g. disc).
• Regardless of film or discs, the media price for each exam is 20 RMB/case.
• This pushes hospitals to consider disc as an alternative media to film.
• The adoption of disc media is very slow.
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Characteristics of Chinese PACS Trends
• The growth of PACS in China is not even • PACS adoption rate is 8-10 years behind the US market. • Top à down growth trend
– 80-90% AAA hospital – 10% county level hospital
• East à West growth trend - eastern region grow faster than western China.
• 60% Hardware, 30% Software, 10% Service • Local vs. multinational companies
– Local PACS companies are much more active and stronger than multinationals
• Local language and workflow – RIS is 100% local
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PACS Technology
• Type of PACS – 90% PACS installed are still modality PACS – Some departmental PACS – Few enterprise PACS
• Most of the deployed PACS are using client-server technology
• Web based PACS is a new, but growing trend for clinical viewing.
• Mobile based viewing is very new. Only a few companies are promoting it.
• Will China leap frog to cloud storage? – XDS is very new concept. – Infrastructure will be a challenge (internet speed ranks 90th in the
world)
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Market Share of PACS Venders at AAA Hospitals
• The PACS market is still fragmented. • The top 3 players are Huahuai (15.8%),Tianjian (8.8%) and Neusoft (7.9%). • Other venders like GE, Carestream, Anke, Crealife, Star each has 3%-4% • Fuji, Infinitte, Zhonglian, Sanwei, Landwind each has 2%-3% • The rest is 36.8%
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Market Share of PACS Venders at County Hospitals
• Top 3 players are Zhonglian (28.6%), Anke (7.1%), ZKML (7.1%) • Tianjian, Neusoft, GE, Landwind each has 3-4% • The rest is 42.9%
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Hybrid Funding for AAA Hospitals
• The funding for PACS for AAA hospitals are shared between the government and the hospitals.
• The decision makers are mostly in the hospitals. • In some situation, e.g. Shanghai, a consortium is formed
to manage the tendering process. – Multiple venders are selected as “qualified venders”. – The hospitals then make their own decisions to choose between
“qualified venders”.
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Government Support for Country Hospitals
• MOH Policy #2010-1074 – Promote the development of IT infrastructure for county hospitals – Improve the hospital environment – Improve medical quality – Control medical expense – Improve service and hospital management capability – Promote information connectivity and data sharing
• In 2010, 3.9 billion RMB was allocated for healthcare IT infrastructure for Shanghai, Zhejiang, Anhui, Chongqing, Xinjiang provinces. The products included EHR, EMR, out-patient management.
• In 2011, 2.5 million RMB for each county hospitals was allocated in Beijing, Inner Mongolia, Jiangsu, Henan, Hunan, Yunnan, Ningxia, Xiangjiang provinces.
• In 2012, 20 billion RMB will be allocated for healthcare IT infrastrcture. • In 2012, there a campaign to fund the development of Chinese medicine
hospitals and ethnic group hospitals, including 1956 new hospitals. • The funding for these projects are often matched and managed by the
provinces.
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Example: Country Hospitals Configuration • Yunnan Province Project 2011-08 • The tender includes 11 modules for medial IT. The PACS module includes
following functionality. • Image storage and distribution for Xray, CT, ultrasound, endoscopy,
pathology. • Authorized user can share images and image related information between
hospitals over a remote conferencing platform. • Chinese PACS/RIS user interface.
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Regional Health Network in Planning
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Government Plans Healthcare Network • In the “12th Five Year Plan”, the government defined direction for
medical IT - “3521 Project”. – 3 levels of healthcare data platform
• Country • Province • region
– 5 applications • public health • medical services • new rural medical insurance plan • basic drug plan • general management
– 2 basic databases • EHR • EMR
– 1 special network
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Government Funding for Regional Medical Centers
• 1.254 billion RMB is allocated to fund 110 regional medical centers in 22 provinces. Each is given subsidy of 11.40 million RMB.
• The regional medical centers are selected based on the population, size of the region, transportation, etc. The AAA hospitals in the regions are preferred choice.
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Regional Medical Center Communication Front End
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Regional Medical Center Communication Front End
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Challenges
• Lack of integration • Lack of standards • Lack of continues investment • Lack of communication infrastructure • Lack of IT resources • Lack of high-end applications for decision support
– Stops at basic data gathering and management
• Low perception of value for software • Government sponsorship: success is measured by how
much money spent, not the outcome for productivity improvement.
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Conclusion • The PACS market is still in its infancy. • Chinese government is investing significantly in
healthcare infrastructure. • Medical IT is a key focus. • The investment coverage is broad, yet still not very deep. • Enterprise level PACS is rare to find • Basic radiology review is the focus of PACS, not clinical
applications. • Regional network approach is critical to the future success
of medical IT.
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Thank You