This is the second in a two-part post about technology and managerial capabilities as applied to health institutions in China.
Technology
I remember that in visiting county-level hospitals last summer, the biggest complaint I heard from local doctors was the time that it took to fill out patient charts. Seeing outpatients and even doing surgery wasn’t the problem. It was filling out endless pages of paperwork that kept them in the office until late into the night, which in turn was depressing their enthusiasm for seeing more patients.
Returning this summer, I was presently surprised to see that the situation had improved slightly. Of the three hospitals I visited, two of them (I didn’t visit the third) had since implemented a rudimentary electronic patient record system. By that, I mean that they had used Microsoft Word to create a template for a patient chart, which they would go through and modify for each patient, print it out, and attach it to the back of the handwritten paper forms. Shaved off a good chunk of time, doctors from both hospitals told me. But there was nevertheless still a stack of handwritten forms at the beginning of each patient’s chart. And no records at all for outpatient or follow-up visits.
For SEER, we’re trying to do things a little differently. Back in the spring, as I was mentally envisioning the long-term patient referral model, I realized there was a big problem. A village health worker finds a patient that needs to be referred and calls up the county hospital doctor. Fine. But we’re beginning with 25 VHWs at each hospital. Eventually to be expanded to the 200 or so within each county.
At that rate, the county hospital doctor might as well quit his job and take phone calls all day.
What we needed first was a system that would allow VHWs to send simple screening information to the county hospital without requiring someone to pick up at the other end. What we needed was JavaRosa.
It’s a simple prompt-driven form for data entry that can be modified to suit each specific project. It doesn’t require a smartphone, and will run on any Java-enabled phone. And it sends all screening data via SMS to a computer at the county hospital, where it can sit patiently until the doctor logs on.
The second part of the system we needed was the software that would run on this computer. It would need to serve the following functions:
- Collect SMS-based data from multiple VHWs’ phones and display them in an organized fashion
- Allow the county doctor to organize and dispatch a van to pick up patients when a sufficient number accumulate
- Communicate with the VHWs to coordinate patients’ post-operative follow-up
So we developed a web-based system to do all that, which could further serve as a data collection and report-generation system, for program evaluation purposes:
The key to this whole system—and I think it’s a message that applies to implementing new technology in general—is to find the appropriate level of sophistication. Back in the spring, I had people telling me that I should invest in smartphone-based technology, because it could provide much more power and potential to expand in the future. Had those people actually been in the parts of rural China that I went to this summer, they likely would’ve realized that that kind of technology would’ve been a terrible match for the local conditions. It’s a challenge for some of our VHWs to just figure out texting. Add to that the fact that there’s a certain amount of mobility among VHWs in China, and suddenly providing smart phones to 50 VHWs as part of a pilot project seems a little ludicrous.
This specific case is symbolic of the issues that surround many medical technologies in “developing countries” (some prefer to call China an emerging economy). Take cataract surgery: today’s top-of-the-line surgical method for cataract is a technique known as phacoemulsification, in which a machine is used to dissolve the clouded lens before siphoning it out. To date, there’s not much evidence to suggest that phaco gives better postoperative results than small incision ECCE (in which the lens is removed through a small cut in the side of the eye), and given the fact that many cataracts found in rural areas are mature cataracts which are difficult to dissolve by phaco, small incision surgery might actually be a better fit for rural China. Did I mention that phaco usually costs ten times as much?
Still, there are people who still advocate for newer, sexier technology. “I really believe that phacoemulsification is the most cost-effective solution, even in rural hospitals.” Says the representative from Alcon, one of the largest providers of phaco machines in China.
This is the second part of a post about innovation in management and technology as applied to healthcare in China. But at the same time it’s also a soliloquy to chance encounters and the possibilities they can open up.
Back in the spring, when this idea—what seemed like wishful thinking at the time—popped into my head, I had no clue how a technology-dumb biology major such as myself could make such a system happen. A few days later I received a nondescript email from Swarthmore College inviting me to participate in their annual Lax Entrepreneurship Conference.
And that made me remember that when I had attended the year before, I had met an alum by the name of Ted Chan who at the time had been fervently preaching to me about the coming importance of technology in healthcare.
So I google’d his name, found his contact information, and sent him an email. He referred me to his colleague Chris Moses. Who suggested I post something on the google group ict4chw.
So I did. And was amazed when I signed on the next day and found no less than 14 replies waiting for me in my inbox.
One of them was from a man named Mathias Lin… 
…who was looking for “use cases in healthcare IT / ICT4D, esp. in rural China”, and suggested I contact him once I arrived in Guangzhou.
Intrigued, I did.
And he’s the one who’s worked with me to develop this whole electronic referral system.
In Sight 