People.cn’s Shanghai Meeting Room Exclusive Interviews

LI Yongkui: How to build smart hospitals amid the pandemic?

April 07, 2020

Source: People.cn

Editor’s note: The internet and artificial intelligence have brought disruptive changes to many industries. The outbreak of the COVID-19 pandemic has also highlighted the shortcomings of traditional hospitals and forced a concentrated outbreak of online medical service demand. Smart hospitals are an indispensable component of smart city construction. With the development of big data, cloud computing, artificial intelligence, 5G and other technologies, it is urgent to meet the growing medical treatment and healthcare needs of the people.

How far is smart hospital from reality? The People.cn’s Shanghai Meeting Room invited Professor LI Yongkui, Deputy Directorof the Institute of Complex Engineering Management of Tongji University, Doctoral Supervisor of the School of Economics and Management of Tongji University, and Director of the Smart Hospital Construction and Operation Management Research Center to talk about the hot topic of “How to build smart hospitals amid the pandemic?”

People.cn: In the prevention and control of the COVID-19 pandemic, the hospitals are on the front line in the treatment of patients, and they have endured great pressure. Academician Wang Chen put forward the proposal of building mobile cabin hospitals, making them the main battlefields for the treatment of patients with COVID-19. Looking back now, while traditional hospitals played a key role in the prevention and control of the epidemic, what shortcomings were exposed and need to be fixed with the utmost urgency?

Li Yongkui: The pandemic made us realize deeply that the hospitals are an important part of the national public health emergency management system and national reserve system. The pandemic also highlighted the important role of the hospitals in responding to public health emergencies. It can be said that it is the main battlefield and frontline position of the fight against the pandemic, and the frontline medical personnel are also the “number one heroes” of this fight.

The difficulty of prevention and control of COVID-19 is rare in human history, and it can be categorized as an extreme challenge. Any single hospital, single city or even a single country can hardly deal with it on their own, which put forward the demand for resource matching and joint prevention and control measures at much greater scale.

The pandemic exposed the shortcomings of the current hospital operation and management model, that is, the various hospitals lacks cooperation to form a higher-efficiency hospital network system, so as to take advantage of the “group army” to deal with large-scale public health emergencies; it also exposed some shortcomings of the hospitals themselves, including the lack of rapid emergency response capabilities, resource allocation capabilities, peacetime and wartime integration and conversion capabilities, and the resilience of medical service continuity, etc. In other words, the hospitals do not know how to quickly presses the “switch” and the “acceleration” buttons while not triggering the “pause” of major medical services when a major crisis broke out.

In recent years, the hospitals have received massive funding for expansions, and their hardware and software have been greatly improved, however, it is still insufficient compared to the huge medical needs, and the aim of achieving high-quality services is still far away. During the pandemic, some hospitals were difficult to meet the anti-infection conversion requirements due to low design standards. Insufficient medical resources and backward management methods caused some medical staff to “fight the virus with no protection” or being frequently exposed to high-pollution areas; hospital logistics management were supposed to be able to use information technology, but they failed to provide sufficient support during the pandemic, these shortcomings need to be fixed after the pandemic is fully controlled.

People.cn: How will the hospitals build up capabilities to handle major public health crisis when COVID-19 is over?

Li Yongkui: Everyone is talking about retro-inspection. Obviously, due to the changes in the global pandemic situation, the prevention and control tasks still face a uphill battle, and new twists may still happen, but this does not prevent us from starting to summarize or reflect on the impact and long term influence of the pandemic, that is, we need to start to discuss how to improve the hospital’s ability to respond to major pandemics after COVID-19, and this may provide new ideas for the hospital’s 14th Five-Year Plan and even longer-term planning.

Due to the increasing complexity of the problems we face, resilience has become a hot word in recent years. The World Health Organization also proposed that in order to cope with future risks, hospitals need to have safer and more resilient capabilities.

Comprehensive hospital resilience capabilities should include: first, the hospital’s ability to withstand, absorb, respond, and recover; and second, the hospital must not only have the ability to withstand emergencies, but also maintain and expand medical care to respond to the sudden increase in patient demand; the third is to include the ability to adapt to unexpected challenges, the ability to return to normal conditions and the ability to learn from experience and prepare for future challenges.

To improve the resilience of hospitals in response to a major pandemic, we need to start from three aspects: the first aspect are the engineering systems, we need to improve the rapid adjustment and flexible expansion capacity of the hospital’s functional systems, which is very critical in the early stage of a pandemic; the second aspect are the hospitals, we need to upgrade the rapid response and adaptability of the individual hospital’s service system, which is important for the needs to cope with medium-scale outbreaks; the third aspect is the overall medical system, we need to improve the complexity of the medical system governance ability and leadership, this resilience aspect determines whether a city, a region or even a country can effectively respond to the overall requirement of handling major outbreaks. All these aspects call for a more intelligent supporting “core”.

People.cn: During the COVID-19 outbreak, major internet medical institutions, such as Ali Health, Tencent Healthcare, Ping An Health, WeDoctor, Medlinker, and Dxy.com, opened free online clinics to relieve offline pressure and reduce cross-infection. Will online medical services become a major trend in the medical field in the future?

Li Yongkui: Some people said that during COVID-19, the hospitals pressed the “pause button”. This revealed that usually many patients do not need to go to the hospital, and most of the medical resources are effectively “run”. Although this view is one-sided, it also reflects the fact that some medical services can indeed be provided online. The internet hospitals that have been vigorously developed in recent years have helped a lot at critical times. However, it is too early to conclude that the “spring of online medical care is here”.

But it also gives us an inspiration, that is, the pressure of medical services can not be alleviated by the expansion of traditional hospitals, we should “seek new paths” from the internet, to relieve concentrated medical care pressures generated by patient’s tendency to “run the medical resources of key hospitals” through innovative ways, and this is a win-win situation for both hospitals and patients.

Of course, not all medical services can be provided online, such as clinical examinations, regular tests, laboratory tests, emergency services, surgery, etc., still need to be performed at a physical hospital, and we need to combine the use of online and offline resources.

However, the online medical experience during COVID-19 may affect the patients’ choice in the future, and the re-division of labor between physical hospitals and internet hospitals will accelerate. The rapid development of online medical services will also bring challenges to standardized management. We should not allow chaos to ruin the future of online medical services. It is also necessary to standardize the industry and tackle some bottlenecks, such as the normalization of medical insurance payments.

People.cn: Compared with traditional hospitals, what kind of hospitals can be called a smart hospital? And what are the necessary components?

Li Yongkui: When we talk about smart hospitals, what everyone may think of is the scenes in the blockbuster science-fiction movies. That is the vision. The smart hospital cannot be built in a day, nor is it to say that a bunch of technology thrown together can be called a smart hospital. It may be called a smart hospital in the narrowest sense. I want to emphasize that we need higher-level smart hospitals, which requires breakthroughs in many ways.

The first is a conceptual breakthrough, which is to redefine the function of the hospital. There is no doubt that hospitals provide medical care service, but the nature of that service is constantly undergoing profound changes. From changes in population structure and disease spectrum, to people’s increasing needs for a better life, to changes in diagnostic techniques and equipment such as genetic diagnosis and artificial intelligence, and to changes in service models such as professional service outsourcing, hospital functions are constantly evolving. This puts forward a broader proposition for smart hospitals, that is, where are the boundaries of the hospitals in the future, what are the functions of the hospitals, and what are the ways for medical services to be delivered?

Speaking from what we know, smart hospitals will break through the existing boundaries of “hospital”, it will be a new ecosystem that merges basic research, clinical research, research conversion, prevention, medical technology, treatment, rehabilitation, and public health management all together. As Guo Chongqing, the Academician of the Chinese Academy of Engineering and Professor of Tongji University said, the best hospitals at present are not smart hospitals. Instead of seeking technological breakthroughs, smart hospitals are better established by using information technology as a means to build achieve a breakthrough in patient-centered medical services.

The second is the organizational breakthrough, which is to redefine the shape of the hospital. If smart hospitals have undergone great changes in the boundaries and functions of hospitals, it will inevitably lead to changes in the nature, boundaries, composition and relationships of hospital organizations, and the division of labor between different hospitals will also be reshaped. Large hospitals, specialized hospitals, community hospitals, rehabilitation hospitals, pharmacies, family doctors, etc. will cooperate and form symbiosis relationships with each other, and will be decentralized. Ultra-large-scale single hospitals will no longer be the development trend, and hospitals with complementary functions will form a nationwide distributed hospital network. Relying on modern information technology, this boundless hospital network will provide medical services in a more flexible, agile, lean, professional, and convenient manner, a true transformation centered on end customers (patients).

The next transformation is a breakthrough in the operational model, which needs to be redefined. Hospitals are one of the oldest types of organizations. Most hospitals operate in a more traditional way, but the trend of the internet redefining everything will change this situation.

In the context of smart hospitals, hospitals will no longer be just an institution or a physical place but will become a platform and an industrial network. This platform or industrial network will reshape the industrial chain, supply chain and value chain of medical services. Every stakeholder needs to reposition itself in this chain, which is also the ecological basis for the future growth of smart hospitals.

Smart hospitals are inseparable from modern information technology, but I did not spend a lot of time talking about technical issues. It is not unimportant, but I remind you not to fall into the “technical trap” of smart hospitals. The COVID-19 pandemic put the construction of smart cities into the “spotlight”. The effectiveness of hundreds of billions of investments that were put into the construction of smart cities in the past few years has become the focus of controversy and discussion, the building of smart hospitals may face the same critique.

But from the current perspective, there is a trend of “labeling” in smart hospitals construction. Smart hospitals are not the accumulation of new technologies, technology is the foundation, but more important is the intelligent core. At the same time, smart hospital is also a concept of continuous iteration. With the development of technology, the degree of “smart” is also growing. Of course, this growth also comes at a price. That is, it requires continuous and high investment. Smart hospitals are “luxury goods”, and it is not appropriate for individual hospitals to build their own version of a “smart hospital” separately. It needs to be built with a vision to become the unified platform of the whole medical care industry, and it requires meaningful investment and involvement of powerful technology companies, medical industry groups and investment entities.

People.cn: China’s has obvious advantages in acquiring medical big data, how far is China from building the true smart hospital?

Li Yongkui: Due to the complexity of the future smart hospital ecosystem, we cannot judge who will build the first true smart hospital, or when and where. We need to pay more attention to how to build this ecology, rather than building a self-enclosed “smart hospital”.

Taking into account the particularity of the medical care and public health management issues, China’s system and institutional advantages will provide some advantageous support, but we need to seek breakthroughs, we need to make use of both government and market forces, we need to uphold the spirit of interdisciplinary cooperation, joint construction, and sharing.

Academician Guo Chongqing has made a judgment call that whoever has the data, computing power, and algorithms will gain the leading position in future development. China’s role in the new technological revolution and industrial transformation is changing from a follower to a leader; The application of artificial intelligence in smart hospitals is scenario-driven, China has a huge network, rich medical application scenarios, obvious advantages of data “samples”, and strong market demand, all these factors may make China the biggest winner. Considering Shanghai’s overall medical standard, R&D resources, medical resources and the advantages of the Yangtze River Delta’s medical needs, I believe that the future has come and it is a good time for Shanghai to build a truly smart hospital.

原文链接：

人民上海会客厅专访系列之：李永奎：疫情之下，智慧医院如何建设？

https://sh.people.com.cn/n2/2020/0407/c134768-33931375.html