Hainan Leads the Way in Digital Therapeutics: Innovating Application Scenarios to Overcome Implementation Challenges

Over the past one to two years, China’s digital therapeutics (DTx) industry has undergone a phase of rapid development, propelling DTx from relative obscurity to widespread public awareness in a short period. This transformation has been significantly driven by policy support. Recognizing the unique advantages of digital therapeutics, certain localities have introduced tailored initiatives aligned with their specific contexts to foster the growth of this sector.

In terms of research and supportive policies for digital therapeutics, Hainan has undoubtedly taken the lead in China. Whether it was pioneering the inclusion of digital therapeutics in provincial-level planning at the beginning of the year, or launching the world’s first “21 Measures” policy to support the full-cycle digital therapeutics industry mid-year, Hainan has successfully drawn significant attention from the digital therapeutics sector.

As we entered 2023, Hainan once again took the lead nationwide by initiating substantive and systematic efforts to implement digital therapeutics. In February, the General Office of the Hainan Provincial Committee of the Communist Party of China and the General Office of the Hainan Provincial People’s Government issued the “Notice on Printing and Distributing the ‘List of Practical Projects for the People in 2023 by the Provincial Party Committee and Provincial Government,’” which included the “Pilot Program for Digital Therapeutics in Cognitive Rehabilitation for the Elderly.” In early March, Hainan convened a promotion meeting for the construction of clinical trial centers for digital therapeutics, officially awarding plaques to the 20 provincial-level “Digital Therapeutics Trial Centers” designated the previous year and outlining specific task requirements.

From March 9 to 10, the Hainan Provincial Health Commission convened in Haikou the “Hainan Province Digital Therapeutics Industry Innovation and Empowerment Series – Seminar on Application Scenarios for Digital Therapeutics.” The event included sessions such as the “Seminar on Innovative Application Scenarios for Digital Therapeutics,” the “Seminar on Policy Interpretation and Corporate Implementation of Digital Therapeutics,” and the “Seminar on Hospital-Enterprise Collaboration in Digital Therapeutics.” Over the course of the two-day seminar, stakeholders from government, payers, hospitals, and the industry engaged in face-to-face discussions, generating significant insights into the practical implementation of digital therapeutics.

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In fact, this is not the first time Hainan has hosted such communication sessions. As early as last year, after deciding to include digital therapeutics in its provincial development plan, Hainan held a Digital Therapeutics Innovation Week and issued open invitations to key innovative digital therapeutics companies to come to Hainan. Six face-to-face seminars were conducted on topics including clinical trials, registration and approval, medical insurance reimbursement, and commercial insurance pilots for digital therapeutics. Participants spoke freely at the meetings, enabling government officials to gain a systematic understanding of the actual needs of digital therapeutics companies.

Building on the outcomes of these discussions, Hainan Province ultimately formulated the “Several Measures for Accelerating the Development of the Digital Therapeutics Industry in Hainan Province,” also known as the “21 Articles on Digital Therapeutics.” This is regarded as the first full-lifecycle industrial support policy for digital therapeutics to be introduced in China and even globally.

As digital therapeutics represent a major trend in digital health, this policy aligns well with the development direction of “Digital China.” In the latest round of State Council institutional reforms, the National Data Administration was established to coordinate and advance the planning and construction of Digital China, the digital economy, and digital society. From this perspective, Hainan’s “21 Measures for Digital Therapeutics” clearly demonstrate considerable foresight.

Meanwhile, Hainan’s execution capabilities have also left a deep impression. The first batch of policy tasks was fully implemented within just 21 days, fully demonstrating the determination, speed, and executive efficiency of the Hainan Free Trade Port. A senior media professional who has long tracked government policies expressed his admiration: “Having covered government policy reporting for over a decade, I find it extremely rare to see specific implementation measures involving multiple departments rolled out in such a short timeframe. This level of efficiency is truly breathtaking.”

However, it must be acknowledged that digital therapeutics (DTx) remains a frontier field. Physicians, patients, regulators, and payers all require time to deepen their understanding of DTx, which presents certain challenges to its practical implementation in China. Although there are existing practices and experiences globally, they cannot be directly replicated in the Chinese context due to differences in national conditions and institutional frameworks.

A frontline clinician told VCBeat that there are certain mismatches in the configuration of digital therapeutics (DTx) on the physician side. Physicians who are willing to use DTx lack eligible patients. “Clinicians fall into two categories. One group comprises leading experts, who have a relatively high acceptance of DTx. However, in addition to their clinical duties, they also bear administrative responsibilities and numerous research obligations, leaving them with barely enough time for meals, let alone time to utilize DTx.”

“Another category comprises junior doctors, particularly the vast number of clinicians working at the primary care level. These physicians are highly interested in digital therapeutics and eager to adopt them, yet they struggle to attract patients. Even when patients are inclined to use digital therapeutics, upon discovering that the provider is a resident or a physician from a lesser-known hospital, they often question the reliability and suitability of the treatment.”

He believes that for digital therapeutics to gain acceptance among physicians, they must be linked to physician incentive structures. “There need to be application scenarios in which physicians receive appropriate compensation for the technical services provided during management, or demonstrate significant management outcomes that open up pathways for career advancement. Otherwise, given that physicians are already overwhelmed with work, relying solely on professional dedication will not sustain their engagement for long.”

“For example, one scenario in which physicians use digital therapeutics is to leverage the project’s strong research outcomes to create a pathway for career advancement. For instance, if the digital therapeutics company provides excellent support and patient management is highly effective, resulting in a very low loss-to-follow-up rate and a follow-up visit rate exceeding 80%, this can lead to high-quality publications,” he added.

Furthermore, he noted that digital therapeutics also place significant demands on physician resources. “Take diabetes management as an example: most participants enrolled in clinical trials are middle-aged adults. They are typically busy with work and genuinely need a channel to help them manage their condition. However, when they have questions and seek prompt assistance from physicians, they often fail to receive satisfactory feedback for two to three hours due to the physicians’ heavy workload. This delay may lead patients to doubt whether anyone is actually monitoring the platform. To address this, it may be necessary to assign a dedicated team to provide timely responses, or alternatively, leverage artificial intelligence to offer solutions.”

“In addition, the primary benefit patients currently derive from digital therapeutics is monitoring. This includes having effective channels for data collection and receiving prompts for follow-up examinations when patient indicators reach certain thresholds. Overall, patient engagement tends to be high initially but gradually declines over time. Human nature often leans toward comfort and convenience, making it difficult for individuals to adhere to recommendations such as eating less and exercising more. Therefore, a combined online and offline approach is often necessary to maximize patient benefits.” The physician noted that there is room for further improvement in digital therapeutics for both healthcare providers and patients.

To address the challenges and bottlenecks in the application of digital therapeutics, Hainan Province launched the “Hainan Digital Therapeutics Industry Innovation and Empowerment” series of events. The initiative aims to serve as a communication and collaboration platform for government agencies, enterprises, industrial parks, and medical institutions. By leveraging collective expertise and efforts, the program seeks to identify valuable application scenarios for digital therapeutics, thereby accelerating their effective implementation and widespread adoption.

Zhang Yuhui, Deputy Director of the Hainan Provincial Health Commission, Director of the Office of the Provincial Digital Therapeutics Industry Task Force, and Deputy Director of the Provincial Healthcare Reform Office, delivered an on-site address.

“Promoting the adoption of digital therapeutics is crucial to their development. Meanwhile, achieving high-quality development in healthcare during this new era urgently requires the support and impetus provided by digital therapeutics. An effective approach to meeting both needs is to strategically design innovative application scenarios. These innovative scenarios integrate digital therapeutics with current healthcare initiatives and align them with the responsibilities and requirements of medical institutions at all levels. This integration not only facilitates broader adoption of valuable digital therapeutics but also leverages them to accelerate, improve, and enhance the efficiency of various healthcare tasks. This is the outcome we aim to achieve,” stated Zhang Yuhui, Deputy Director of the Hainan Provincial Health Commission, Director of the Provincial Digital Therapeutics Industry Task Force Office, and Deputy Director of the Provincial Healthcare Reform Office.

As early as last year, Hainan Province decided to establish digital therapeutics clinical trial centers in nine areas: chronic disease management, rehabilitation, oncology, sleep disorders, orthopedics, psychiatric and behavioral/cognitive disorders, ophthalmology, nutrition, and a clinical research and translation base for digital therapeutics within the Boao Lecheng International Medical Tourism Pilot Zone. This marks the first large-scale, centralized development of digital therapeutics clinical trial centers in China, representing a significant boost to the digital therapeutics industry.

The selection of these areas is not arbitrary; rather, it is a decision derived from aligning the current state of China’s digital therapeutics industry with practical realities. Alternatively, this can be understood as follows: these areas largely represent the more mature segments of China’s digital therapeutics landscape and address the primary health issues and disease burden among residents.

According to VCBeat’s statistics on the business focus of active domestic digital therapeutics companies, cognitive impairment, ophthalmology, diabetes, mental health, and sports rehabilitation and sleep disorders (tied) are currently the top five areas. As the most concentrated field for digital therapeutics in China at present, the pilot application of digital therapeutics for cognitive impairment in the elderly has been included in Hainan’s 2023 plan.

Hainan was not the first to implement cognitive impairment screening among the elderly. In recent years, some regions have gradually promoted such screening. However, Hainan is the first province to roll it out on a provincial scale; in particular, its explicit proposal to use digital therapeutics for intervention and treatment is unprecedented.

In fact, digital therapeutics can indeed significantly transform the current landscape of this field. Taking pediatric mental and cognitive behavioral disorders as an example, patients have long faced substantial challenges in terms of treatment accessibility, quality, and cost. In 2022, the Hainan Women and Children’s Medical Center established a Clinical Trial Center for Mental and Cognitive Behavioral Disorders and introduced digital therapeutics for childhood autism, achieving notable results within a short period.

As of early March, just over two months after the first pediatric patient began treatment, more than 200 children had received digital therapeutic interventions at this clinical trial center, demonstrating significant improvements in therapeutic efficacy and a substantial reduction in treatment costs.

There are also corresponding scenarios in the field of maternal mental health. Maternal psychological well-being is relatively unstable; however, primary healthcare institutions lack sufficient capacity for psychological intervention, often stepping in only when mental health issues have become severe, by which time it is too late. Meanwhile, traditional psychological interventions relying on rating scales are time-consuming and exhibit low acceptance among pregnant and postpartum women.

Digital therapeutics can provide interactive, standardized, and rapid interventions, offering maternal and child healthcare providers a convenient pathway for comprehensive care, thereby improving maternal mental health.

Clearly, one of the goals of promoting digital therapeutics in Hainan is to significantly enhance the clinical standards and medical capabilities of hospitals in the region. Furthermore, as an innovative direction, digital therapeutics are driven by cutting-edge medical knowledge and supported by leading medical experts in China. Their introduction will also substantially elevate the research standards of local medical institutions, improving the current situation where the proportion of scientific research conducted by local hospitals within the province’s total research output lags significantly behind that of other provinces.

Digital therapeutics have also demonstrated significant success in the management of chronic diseases locally. Hainan has long been a high-prevalence region for hepatitis B, with maternal hepatitis B detection rates ranking among the highest nationwide. Under conventional treatment protocols, the rate of prevention of mother-to-child transmission (PMTCT) of hepatitis B could only reach approximately 90%, making further improvement difficult. In contrast, digital therapeutics can elevate the PMTCT rate to 99.7%.

Zhang Yuhui introduced that Hainan will gradually introduce application scenarios for digital therapeutics in the field of chronic diseases such as diabetes, hypertension, hepatitis, and tuberculosis: “Chronic diseases constitute the primary disease burden for Hainan residents. In the next step, we will focus on advancing efforts in the chronic disease sector, rolling out application scenarios as they mature. By integrating digital therapeutic products with Hainan’s healthcare service system to create a ‘synergistic effect,’ we aim to achieve results where 1+1 is far greater than 2.”

He stated that the “2+3” Health Service Package project is currently the focal point of Hainan’s health initiatives. It covers two common chronic diseases—hypertension and diabetes—as well as several other major diseases that severely impact the health of Hainan’s population, including hepatitis, tuberculosis, and severe cognitive impairment. These conditions represent key areas for the next phase of innovative application scenarios.

Taking diabetes as an example, compared with the basic health management for diabetes in national public health programs, the innovation of diabetes management in the “2+3” initiative lies in achieving full-cycle services encompassing “screening, diagnosis, treatment, and management,” establishing a whole-process management system centered on diabetes screening, treatment, and management, and exploring effective incentive mechanisms. This exploration is innovative, but it will inevitably encounter certain difficulties and challenges in practice.

“Last year, we piloted the ‘2+3’ Health Service Package project in three cities and counties, achieving significant results while also identifying certain challenges and issues. For service models like ‘2+3,’ which aim to establish full-cycle, cross-institutional, standardized, and integrated medical-preventive care centered on specific diseases, our current management approaches, service delivery methods, and assessment mechanisms are not yet fully aligned with the requirements. Comprehensive support and empowerment through digital technologies are needed, particularly the integration of digital therapeutics—a new technology that directly intervenes in health outcomes. In this direction, we will collaborate with innovative enterprises to integrate solutions featuring digital therapeutic innovations into the existing healthcare service system, significantly improving the effective disease control rates among patient populations such as those with diabetes, thereby ensuring tangible benefits for patients.”

“The clinical management of diabetes itself is not complex, and the accessibility and availability of medications are generally not problematic. The core challenges currently lie in two areas: first, effective glycemic control is closely linked to non-medical factors such as patients’ lifestyle behaviors and dietary habits; second, it relates to medication adherence. Many patients are reluctant to take their medications, either forgetting, underestimating the importance, or due to disease-related stigma. Digital therapeutics can play a pivotal role in integrating medical and non-medical health determinants and improving medication adherence. Applications for this category of diseases will be our key focus in the next phase,” added Zhang Yuhui.

After one to two years in the conceptual phase, digital therapeutics are entering a new stage of practical implementation. Identifying appropriate application scenarios that enable digital therapeutics to truly integrate into the existing healthcare system and address the pain points of all stakeholders will be key to their future development.

In this regard, Hainan has also taken the lead in China. By integrating local realities, it first identified suitable entry points in the field of mental health and plans to roll out application scenarios for other chronic diseases in the future. VCBeat will continue to closely monitor the current state of digital therapeutics applications in China, so stay tuned.