Portal de Periódicos da CAPES

Letter from China

2018; Wiley; Volume: 23; Issue: 7 Linguagem: Inglês

10.1111/resp.13319

1440-1843

Chunxue Bai,

Travel-related health issues

Respirology and the Asian Pacific Society of Respirology represent a remarkable array of countries, cultures and lung disease profiles in the Asia–Pacific Region. There are often interesting changes, developments, controversies and problems that occur in the region that go unappreciated—and often unnoticed—by others in this region. The Editors-in-Chief felt that this presented an opportunity to get to know more about our region whilst providing some entertaining reading. It is our hope that our readers will enjoy the 'Letter', look forward to reading it and ultimately offer to contribute and help to inform us of what is happening in their 'backyard'. Correspondence and opinions about the 'Letter' are welcomed. Giant Pandas, which live in the remote mountains of southwest China, are usually 1.2–1.8 m in height and 80–120 kg in weight. Their fur is black and white and bamboo is their main food. They have a round face, huge black rims around their eyes and a round body shape. They turn their toes in and retain this position as a habit while walking. All of these features make them among the most admired animals in the world (see Fig. 1). The Giant Panda has lived on Earth for at least 8 000 000 years. They are widely regarded as a 'Living Fossil' and a 'National Treasure of China'. Moreover, they are the promotional ambassador of the World Wildlife Fund (WWF) and the most recognized protected species worldwide. According to the third national survey of the Giant Panda population, there are only 1600 wild Giant Pandas left in the whole world. So they are first-class national protected animals. As of October 2011, a total of 333 Giant Pandas have been bred in captivity. The lifespan of a wild Giant Panda is around 18–20 years, while it can be over 30 years in captivity.1 Pandas are lucky, as they are highly protected and regarded as a national treasure. In contrast, the people living in the same remote mountains or country sides, are unlucky because it is very difficult for them to gain access to quality health care. Compared with the large comprehensive hospitals in Chinese cities, small rural hospitals have scant access to high-level medical devices, the local doctors have limited clinical experience and the local patients often have a poor understanding of health issues. As a result of these three deficiencies ('Three Low Areas'), many patients prefer to go to big hospitals seeking diagnosis and treatment, causing difficulties in registration and administration, which we refer to as the 'Two Difficult Areas'. The influx of rural patients into city hospitals limits the time city doctors and specialists can spend with each patient to work on prevention, healthcare, disease management and rehabilitation, which we refer to as the 'Four Limitation Areas'. These issues are a severe burden on the Chinese healthcare system. In an attempt to solve these problems, the National Health and Family Planning Commission of the People's Republic of China has sought to establish a hierarchical medical system, aiming to promote more appropriate service levels of community doctors.2 Severely unwell patients will have authority to choose either the secondary-level hospital or the tertiary-level hospital, or the family doctor may authorize transfer of the patient with a high priority to the most suitable hospital for specialist care. This system is called the '1 + 1 + 1' medical model and the hierarchical medical system which means one community hospital + one secondary-care hospital + one tertiary-care hospital. The system will address the 'Two Difficult Areas' and 'Four Limitation Areas', but the 'Three Low Areas' problem remains, especially with regard to the skill differential between doctors working in community versus major hospitals. This is a priority for improving district-level healthcare in China and other developing countries. The emergence of the Medical Internet of Things (MIOT) is timely, as it could provide an efficient platform to address these problems. The MIOT is the application of the Internet of Things (IOT) to medicine.3 It is an advanced aspect of telemedicine, including three basic procedures (sensing, transferring and intelligent processing of patient information) and 10 functions (online monitoring, location and traceability, alarm and linkage, command and dispatch, plan and management, security and privacy, remoting maintenance, online upgrade, leader's table and statistics and decision).4 In 2014, the National Health and Family Planning Commission proposed accelerating both the promotion of the national health informatics project and telemedicine systems for rural and remote areas. From the national perspective, the MIOT is an essential part of the development of telemedicine in China. The MIOT could be widely applied in medical education, preventive medicine, diagnosis, treatment, recovery and aged care. Through the theory and technology platform of MIOT, a connection among three terminals, including patients, large and small hospitals, could be established. Thus, the integration of doctors, patients and medical devices (such as BaiDX system and PM2.5 spirometry) across the healthcare continuum could be realized. The variation between the doctors' experience and resources could be diminished if the quality of treatment could become more comparable across small and high-level facilities, and the current 'Three Low Areas' condition in small hospitals will be solved. Through the tri-modal connected terminal platforms based on the MIOT, patients would be diagnosed, assessed and administered treatment remotely from major hospitals; then the community doctors would cooperate with doctors in the major hospitals to manage ongoing treatment, which will improve the 'Three Low Areas, Two Difficult Areas and Four Limitation Areas'. In the future, we would be closer to reaching the dream of the full space–time connection of three latitudes (sensing, transferring and intelligent processing), the combination of three populations (the doctors in big and small hospitals and the patients), the achievement of education, prevention and healthcare, the brand-new mode to benefit all our lives. It is estimated by the Global System for Mobile Communications (GSMC) that, in 2017, the market value of global MIOT would reach 23 billion U.S. dollars and will reach 49 billion U.S. dollars in 2020. According to the prediction of the third-party institution, iiMedia Research, there will be a similarly large MIOT market in China, because of the great importance China has attached to research on the MIOT. I have a great interest in the MIOT3 and have published books on these topics (Medical Internet of Things,3 Practical Medical Internet of Things,4 Manual of Medical Internet of Things on Hierarchical Diagnosis and Treatment5) and one White Book (e-Health 4.0: How Virtualization and Big Data are Revolutionizing Healthcare6). In these books, I hope to illustrate how to apply the MIOT in the diagnosis and treatment of respiratory disease. This includes the advanced BaiDX system and PM2.5 spirometry devices, which have already been applied for early diagnosis of lung cancer based on artificial intelligence diagnosis and management of chronic airway disease using the MIOT.7 Currently, there are over 500 branch centre hospitals of the Chinese Alliance Against Lung Cancer all around China utilizing MIOT technologies in early diagnosis and whole course management of lung cancer, COPD, asthma and obstructive sleep apnoea hypopnea syndrome (OSAHS). Future plans include the establishment of an MIOT college, research institution and MIOT doctor groups. MIOT-based hierarchical diagnosis and treatment, as well as real-world studies will improve healthcare in China, especially for patients with respiratory disease.