Smart Healthcare solutions in China and Europe, an international business perspective

The thesis is part of the Marie Curie Fellowship project addressing health related challenges with IoT solutions. The author tries to address the challenge for the implementation of telehealth solutions by finding out the demand of the telehealth solution in selected European economies and in China (chapter 1), analyzing the emerging business models for telehealth solution ecosystems in China (chapter 2), how to integrate telehealth solutions with institutional stakeholders (chapter 3) and why are elderly users willing to use telehealth solutions in China. Chapter 1 and chapter 2 form the theoretical background for empirical work in chapter 3 and chapter 4. The thesis addressed four research questions, namely “Which societal and social-economics unmet needs that Internet of Healthcare Things can help to resolve?”, “What are the business model innovation for tech companies in China for the smart health industry?”, “What are the facilitators and hurdles for implementing telehealth solutions”, “Are elderly users willing to use telehealth solutions in China?”. Both qualitative study and quantitative analysis has been made based on data collected by in depth interviews with stakeholders, focus group study work with urban and rural residents in China. The digital platform framework was used in chapter 2 as the theoretical framework where as the stakeholder power mapping framework was used in chapter 3. The discretion choice experiment was used in chapter 4 to design questionnaire study while ordered logit regression was used to analyze the data. Telehealth solutions have great potential to fill in the gap for lack of community healthcare and ensuring health continuity between home care setting, community healthcare and hospitals. There is strong demand for such solutions if they can prove the medical value in managing chronic disease by raising health awareness and lowering health risks by changing the patients’ lifestyle. Analyzing how to realize the value for preventive healthcare by proving the health-economic value of digital health solutions (telehealth solutions) is the focus of research. There remain hurdles to build trust for telehealth solutions and the use of AI in healthcare. Next step of research can also be extended to addressing such challenges by analyzing how to improve the transparency of algorithms by disclosing the data source, and how the algorithms were built. Further research can be done on data interoperability between the EHR systems and telehealth solutions. The medical value of telehealth solutions can improve if doctors could interpret data collected from telehealth solutions; furthermore, if doctors could make diagnosis and provide treatment, adjust healthcare management plans based on such data, telehealth solutions then can be included in insurance packages, making them more accessible

Towards a tricorder: clinical, health economic, and ethical investigation of point-of-care artificial intelligence electrocardiogram for heart failure

Heart failure (HF) is an international public health priority and a focus of the NHS Long Term Plan. There is a particular need in primary care for screening and early detection of heart failure with reduced ejection fraction (HFrEF) – the most common and serious HF subtype, and the only one with an abundant evidence base for effective therapies. Digital health technologies (DHTs) integrating artificial intelligence (AI) could improve diagnosis of HFrEF. Specifically, through a convergence of DHTs and AI, a single-lead electrocardiogram (ECG) can be recorded by a smart stethoscope and interrogated by AI (AI-ECG) to potentially serve as a point-of-care HFrEF test. However, there are concerning evidence gaps for such DHTs applying AI; across intersecting clinical, health economic, and ethical considerations. My thesis therefore investigates hypotheses that AI-ECG is 1.) Reliable, accurate, unbiased, and can be patient self-administered, 2.) Of justifiable health economic impact for primary care deployment, and 3.) Appropriate across ethical domains for deployment as a tool for patient self-administered screening. The theoretical basis for this work is presented in the Introduction (Chapter 1). Chapter 2 describes the first large-scale, multi-centre independent external validation study of AI-ECG, prospectively recruiting 1,050 patients and highlighting impressive performance: area under the curve, sensitivity, and specificity up to 0·91 (95% confidence interval: 0·88–0·95), 91·9% (78·1–98·3), and 80·2% (75·5–84·3) respectively; and absence of bias by age, sex, and ethnicity. Performance was independent of operator, and usability of the tool extended to patients being able to self-examine. Chapter 3 presents a clinical and health economic outcomes analysis using a contemporary digital repository of 2.5 million NHS patient records. A propensity-matched cohort was derived using all patients diagnosed with HF from 2015-2020 (n = 34,208). Novel findings included the unacceptable reality that 70% of index HF diagnoses are made through hospitalisation; where index diagnosis through primary care conferred a medium-term survival advantage and long-term cost saving (£2,500 per patient). This underpins a health economic model for the deployment of AI-ECG across primary care. Chapter 4 approaches a normative ethical analysis focusing on equity, agency, data rights, and responsibility for safe, effective, and trustworthy implementation of an unprecedented at-home patient self-administered AI-ECG screening programme. I propose approaches to mitigating any potential harms, towards preserving and promoting trust, patient engagement, and public health. Collectively, this thesis marks novel work highlighting AI-ECG as tool with the potential to address major cardiovascular public health priorities. Scrutiny through complimentary clinical, health economic, and ethical considerations can directly serve patients and health systems by blueprinting best-practice for the evaluation and implementation of DHTs integrating AI – building the conviction needed to realise the full potential of such technologies.Open Acces

Proposal and evaluation of online medical services expansion mode for specialties: a patient perceived value perspective

There is a great imbalance and difference in the distribution of Chinese medical resources in urban and rural areas, as most medical resources are concentrated in urban areas. Against the backdrop of China’s promotion of "Internet + medical healthcare", medical institutions are encouraged to apply Internet and other information technologies to expand the space and content of medical services, but patients in remote places lack independent choice of consultation platform. Based on the theory of Maslow's hierarchy of needs, customer perception theory, Synergy theory, TAM and ACSIM, the model building of remote patients' perceived value satisfaction with online medical services for specialties is hypothesized. Take F hospital as the subject, The research provides an empirical research on the process rebuilding and redesigning specialized online health services based on the perceived value of remote patients. To obtain the perceived value needs of remote patients’ visits, this study carries out questionnaire survey to understand the main needs of remote patients visiting. The results show that: social contact and respect value need > safety and survival value need > self-value need > cost losses value. Meanwhile, the preliminary evaluation indicators of patients' perceived value are derived based on the results of the questionnaire. The research is mainly to verify the effect of the implementation of the Internet-based specialized medical partnership medical service access model for remote patients. The post-test questionnaire is designed to understand the overall level of remote patients’ perceived value of online medical services, including the level of perceived ease of use, the level of perceived usefulness, the level of perceived value, the level of satisfaction, and the level of synergy. Among them, the perceived usefulness scores the highest, It is found that the cost of the new model in terms of time, distance, expense, and energy has been significantly reduced. The research, through building the SEM model, tests the path relationships of relevant dimensions and mediating effect of the model of remote patients’ perceived value satisfaction with online medical services for specialties.Verifica-se um grande desequilíbrio na distribuição dos recursos médicos chineses nas áreas urbanas e rurais, visto que a maioria dos recursos médicos está concentrada nas áreas urbanas. No contexto da promoção chinesa de "Internet + saúde médica", as instituições médicas são incentivadas a recorrer à Internet e a outras tecnologias de informação para expandir o espaço e o conteúdo dos serviços médicos, mas os pacientes em lugares remotos não têm escolha independente da plataforma de consulta. Com base na teoria da hierarquia de necessidades de Maslow, teoria da perceção do cliente, teoria da sinergia, TAM e ACSIM, realizou-se a construção do modelo de satisfação do valor percebido de pacientes remotos, com serviços médicos online para especialidades. Considerou-se o hospital F como caso de estudo. A investigação fornece uma pesquisa empírica sobre o processo de reconstrução e redesenho de serviços de saúde online especializados, com base no valor percebido de pacientes remotos. Para obter as necessidades de valor percebido das visitas de pacientes remotos, neste estudo realizou-se uma pesquisa por questionário para entender as principais necessidades das visitas de pacientes remotos. Os resultados mostram que: contato social e respeito valor necessidade e > segurança e valor de sobrevivência necessidade > necessidade de valor próprio > valor de perdas de custo. Enquanto isso, os indicadores de avaliação preliminar do valor percebido dos pacientes são derivados com base nos resultados do questionário. O objetivo principal do presente trabalho é verificar o efeito da implementação do modelo de acesso a serviços médicos especializados, baseada na Internet para pacientes remotos. O questionário pós-teste foi projetado para compreender o nível geral de valor percebido de pacientes remotos de serviços médicos online, incluindo o nível de facilidade de uso percebida, o nível de utilidade percebida, o nível de valor percebido, o nível de satisfação e o nível de sinergia. Entre eles, a utilidade percebida pontua mais alto. Verifica-se que o custo do novo modelo em termos de tempo, distância, despesa e energia foi reduzido significativamente. Por meio da construção do modelo SEM, testaram-se as relações do caminho de dimensões relevantes, e o efeito mediador do modelo de satisfação de valor percebido de pacientes remotos, com serviços médicos online para especialidades

University of Malaya Research Bulletin, Volume 17, Number 1, 2017

Previously known as IPPP UM Research Bulleti

China's absorptive State: research, innovation and the prospects for China-UK collaboration

China's innovation system is advancing so rapidly in multiple directions that the UK needs to develop a more ambitious and tailored strategy, able to maximise opportunities and minimise risks across the diversity of its innovation links to China. For the UK, the choice is not whether to engage more deeply with the Chinese system, but how. This report analyses the policies, prospects and dilemmas for Chinese research and innovation over the next decade. It is designed to inform a more strategic approach to supporting China-UK collaboration

The Global Risks Report 2016, 11th Edition

Now in its 11th edition, The Global Risks Report 2016 draws attention to ways that global risks could evolve and interact in the next decade. The year 2016 marks a forceful departure from past findings, as the risks about which the Report has been warning over the past decade are starting to manifest themselves in new, sometimes unexpected ways and harm people, institutions and economies. Warming climate is likely to raise this year's temperature to 1° Celsius above the pre-industrial era, 60 million people, equivalent to the world's 24th largest country and largest number in recent history, are forcibly displaced, and crimes in cyberspace cost the global economy an estimated US$445 billion, higher than many economies' national incomes. In this context, the Reportcalls for action to build resilience – the "resilience imperative" – and identifies practical examples of how it could be done.The Report also steps back and explores how emerging global risks and major trends, such as climate change, the rise of cyber dependence and income and wealth disparity are impacting already-strained societies by highlighting three clusters of risks as Risks in Focus. As resilience building is helped by the ability to analyse global risks from the perspective of specific stakeholders, the Report also analyses the significance of global risks to the business community at a regional and country-level