Wang Shan: The Notion That Public Hospital Leaders Resist the Internet Is a False Proposition

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Good evening, dear friends. It is a great pleasure to have this opportunity to exchange ideas with you all today.

Today’s topic is “Internet Healthcare,” though I personally prefer the term “Healthcare + Internet,” as it better aligns with my perspective. For now, however, let us proceed with “Internet Healthcare” as our subject of discussion.

When it comes to internet-based healthcare, strictly speaking, I have the following observations:

First, it is inevitable and irresistible for any medical institution’s healthcare service system, as well as physicians, to adopt internet technology.

Second, discussions on internet healthcare are becoming increasingly rational, with fewer topics focused on the stock market or hype-driven concepts.

Third, in reality, there is significant variation in how individuals interpret the concept of internet healthcare. This discrepancy has led to some misguided criticisms in past discussions, as participants were not engaging with the issue from a shared framework or perspective.

We will discuss why any healthcare service system—including hospitals, medical institutions, and physicians—inevitably needs to adopt internet technologies and cannot remain apart from this trend. This requires us to start with a broad discussion of internet-based healthcare.

In a broad sense, internet healthcare, or the concept of “healthcare + internet,” leverages the internet as a platform to deliver a range of services—including medical care, health management, and wellness—by integrating information technologies such as mobile communications, big data, cloud computing, and cognitive computing. In a narrow sense, internet healthcare refers specifically to the application of the internet and the aforementioned internet and information technologies to facilitate clinical consultations and diagnostic and therapeutic activities between physicians and patients.

Internet healthcare, in its broad sense, encompasses a wide range of activities. It also involves a series of services that do not take place directly between doctors and patients, such as health education, appointment registration, customer service, internet-based financial settlement, and online review and settlement of medical insurance claims. These refer to the application of internet technologies to non-clinical services involved throughout the entire diagnosis and treatment process.

For truly non-core, non-medical services, the challenges are relatively minor and the opportunities more abundant when viewed from the perspective of serving patients and physicians. In contrast, applying internet-based platforms and technologies to interactions between doctors and patients poses substantial challenges, whether in terms of mechanisms, policies, patient safety in clinical care, or their use in medical research.

The first challenge we encountered pertains to the legal and regulatory requirements governing medical administration. Under our current medical administrative regulations, specifically the Physicians Law, physicians are required to practice within medical institutions. The issue we are currently addressing involves remote services delivered via internet technologies, where consultations are not conducted between physicians but rather involve a physician engaging in discussions with a patient through internet-based platforms. We have already encountered such issues.

The second point concerns the true essence of medicine. I firmly believe that with the advancement of modern technologies, such as internet and information technology, patients will be able to independently analyze, diagnose, and treat their conditions, as well as propose treatment recommendations. However, at present, regardless of color fidelity or disease assessment, the absence of physician-led diagnosis and treatment would compromise healthcare quality and even jeopardize patient safety.

Therefore, in the context of medical research, it is not strictly a matter of internet technology being incapable of providing support; rather, achieving precision medicine and personalized treatment, and conducting a series of analyses such as genomics, metabolomics, and proteomics, requires not only substantial financial investment but also the long-term accumulation of data from large-scale cohorts, as only such extensive datasets are suitable for application in medical research.

Second, why do we say that discussions on internet healthcare are becoming increasingly rational? Claims such as “internet healthcare will disrupt traditional healthcare” or “public hospital presidents are resistant to internet healthcare” are false propositions. These topics are no longer heavily debated, as the application of internet technology is neither inherently public nor private; rather, it presents an opportunity to restructure the landscape of medicine and the healthcare service system.

Recently, another topic has emerged concerning scalpers. In fact, if scalpers did not engage in utterly unconscionable practices but instead provided services to those in need through their own labor and paid taxes in accordance with regulations, we could not argue that they pose a significant problem. Moreover, claims that internet healthcare applications can help eliminate scalpers or promote tiered medical care stem from an initial understanding of the issue that focused merely on treating symptoms rather than addressing root causes.

When implementing certain measures, we must not rely on simplistic thinking to solve problems. For instance, the current policy of “unlimited appointment registration” does not mean that patients can register without limits on the same day; rather, it allows those who fail to secure a same-day appointment to book slots for subsequent days. One might ask: Can this approach effectively eliminate ticket scalpers?

First, it is not called “unlimited appointment slots.” Our high-quality medical services have limited daily capacity, which means that after securing an appointment, patients may need to wait several days before their consultation. Second, are we turning a blind eye to scalpers? If someone puts on a suit, sits in an office at a computer, and claims they can help you access scarce medical resources, isn’t that essentially acting as a scalper?

In fact, we do not assign inherently positive or negative definitions to the concept of “scalpers.” Let us analyze this: If individuals unscrupulously charge exorbitant fees for profit and fail to comply with relevant national regulations while providing appointment-registration assistance services, such practices must be curbed; these constitute negative scalping. However, if services are provided—leveraging intellectual effort, energy, time, and financial costs—to assist others in securing medical appointments, with reasonable fees charged and full compliance with national regulations, then such scalpers should not be viewed negatively.

However, in reality, you no longer see scalpers in the outpatient lobby. Instead, they are found in offices, dressed in suits and ties, helping to resolve these issues. If they do not strictly adhere to relevant regulations and reap exorbitant profits, they are essentially modern-day scalpers. Technology alone cannot fundamentally alter the operational mechanisms of the entire system architecture. It is merely a tool or technique that may enhance the effectiveness of existing good practices, but it is not the fundamental solution to the problem.

Regarding the third issue, which is the focus of our discussion today, there is no uniform understanding of the concept of internet healthcare among individuals. When we discuss support for internet healthcare and raise questions about the challenges it faces, it becomes evident that participants are not analyzing these issues from the same level or perspective.

This suggests that, after such extensive deliberation and discussion, we need to systematically examine the challenges and opportunities associated with internet healthcare, addressing each aspect individually.

Wang Shan:Compensation for healthcare professionals is one of the key factors in delivering high-quality care. However, individuals’ needs extend beyond salary to include respect, a sense of security, and other elements that collectively shape their well-being within healthcare institutions and influence their attitudes and behaviors when caring for patients. At the same time, it is important to recognize that physicians adhere to their own professional ethics, which cannot be equated simply with monetary considerations.

Wang Shan:Large hospitals have been exploring the establishment of medical and healthcare service consortia. To date, 482 medical institutions across China, including numerous community-level facilities, have formed such consortia. Internationally, this is referred to as regional healthcare services, a system that encompasses at least three models.

The first type is the tightly integrated model, in which primary, secondary, and tertiary medical institutions all extend into the community, with unified ownership and high efficiency.

The second type is the joint-venture model, in which medical institutions at all levels form a consortium through equity joint ventures, thereby establishing shared financial interests.

The third model is known as the contractual system, which in fact involves no structural changes.

Among these three models, outcomes are highly favorable when the needs within communities and hospitals align with the services hospitals can provide. However, for cases where needs are ill-defined or patients are less engaged, the effectiveness is relatively lower, particularly given that these entities operate as affiliated institutions.

Wang Shan:Strictly speaking, the multi-site practice of physicians is a top-level design by the government. If such a top-level decision is made, it cannot be merely a simple policy; rather, it requires a comprehensive set of supporting policies. These include core human resource management, various security and insurance systems, detailed management of medical institutions and healthcare personnel, and the introduction of actionable policies addressing a series of issues related to medical administration and pharmaceutical regulation. Only with the implementation of this complete policy framework can a healthy system of multi-site practice be established. Internationally, there are varying approaches to multi-site practice, but they all rely on integrated policy systems rather than isolated measures. The ability of individual physicians to practice at multiple sites is merely a superficial manifestation of this broader systemic arrangement.

Wang Shan:My view is that once the organizational structure and processes of the tiered diagnosis and treatment system are established, the application of the internet will enhance its efficiency. Furthermore, I fully agree with the concept of internet-based healthcare; if broadly defined internet healthcare is applied to physician training, although I lack direct evidence proving cost savings in training, logical reasoning suggests that costs would be reduced. Strictly speaking, internet technology will undoubtedly play a significant role in promoting the development of future medical talent.

Wang Shan:There is also the so-called problem of “information silos.” I understand that what this friend is referring to is not the internal information silos within individual healthcare institutions, but rather the issue of interconnectivity and data sharing among different entities. These are two distinct levels:

At the first level, to date, our country lacks mandatory informatization standards. While national standards do exist, they are not compulsory. This has resulted in actual technical interoperability issues—systems cannot be connected, integrated, or shared—which is the primary cause.

Second, I have always been cautious about interoperability. China’s development of internet-based healthcare has progressed almost in sync with international trends. However, our emphasis on privacy protection and data security has not kept pace with global standards. Therefore, in my personal view, the issue of information sharing is unrelated to whether the data is publicly or privately owned.

Many hospitals are still facing the need for further reform, as the issue of internal information silos remains unresolved. While achieving the integration of data flows and financial flows within a hospital may sound simple in theory, it is far from easy in practice. If breaking down information silos within a single hospital is such a formidable challenge, the task of enabling information interoperability and sharing between hospitals is even more arduous.

Wang Shan:The concept of big data has not yet seen widespread practical implementation, particularly within our industry. Moreover, there are currently two common misconceptions regarding the understanding of big data:

The first misconception is that whenever big data is mentioned, everyone focuses on the “big,” assuming that data becomes “big data” simply when it reaches a certain volume. This is merely a literal interpretation. In terms of scale, big data is generally considered to reach the petabyte (PB) level. Peking University People’s Hospital is one of the earliest hospitals to implement health information systems. From the inception of its informatization efforts until last year, the total data volume of Peking University People’s Hospital amounted to only slightly over 100 terabytes (TB). Therefore, strictly speaking, the data held by a single hospital does not yet qualify as big data. Of course, I am referring to our current situation; if we were to include the data generated from proteomics, genomics, metabolomics, and other omics analyses of our patient resources, the volume would indeed reach the threshold of big data.

The second misconception is the belief that with large volumes of data, we can conduct big data analytics using existing hardware and software environments. In reality, big data requires its own dedicated hardware infrastructure, system software, and specialized applications.

Moreover, big data technology is most suitable for unstructured data, whereas our traditional medical data are predominantly structured. Therefore, I am concerned that once the concept of big data lures decision-makers on board, every institution will rush to adopt it, leading to a new round of waste in terms of hardware and software investments.

Big data technology is inherently about sharing and interconnectedness. It requires a multi-center approach to truly achieve sufficiently large data volumes, enabling the use of high-speed, specialized big data analytics hardware and software for analysis. If these foundational tasks are executed well, they will not only contribute to the development of medicine in China but also influence the advancement of global medicine.

Wang Shan:Hospital-enterprise collaboration involves three key components. First, hospitals, medical institutions, and health management organizations must establish a comprehensive data collection chain that covers the entire life cycle, all dimensions, and the entire population. This constitutes the foundational element of the healthcare service system—namely, the high-quality acquisition of raw data. Second, testing of biological specimens, genomics, proteomics, and metabolomics requires joint investment from technology companies and pharmaceutical enterprises leveraging big data for drug R&D, thereby enabling access to existing specimens and various cross-omics data. Third, collaboration with enterprises specializing in data analysis is essential. Only by integrating these three components can the future of medical big data be realized.

This is the O2O model enabled by the internet, which is inevitable.

In practice, stakeholders are approaching this from various perspectives. Returning to the core essence of healthcare means perfecting the tiered diagnosis and treatment system, with internet technology serving as a catalyst; those who leverage it effectively will achieve faster development.

Regarding internet-based cloud information platforms, we were among the earliest adopters. In my view, this represents a developmental trend; however, the primary concern for most stakeholders is security. In fact, current global technologies have already reached the safety levels required for practical application. Moreover, adopting cloud platforms can significantly reduce costs for hospitals. I believe that the informational infrastructure of various institutions will inevitably undergo transformation in the future, with an added layer of protection, as migrating to the cloud resolves challenges such as off-site data backup. Our hospital’s data is already hosted on a cloud platform, which has indeed achieved an appropriate level of security.

Wang Shan:As I was originally a surgeon, after stepping down from my position as hospital president, I resumed my role as a surgeon. Therefore, I engage in clinical practice and also supervise some graduate students. Additionally, I frequently conduct training sessions for state-owned enterprises or handle affairs within professional associations.

Wang Shan:It appears that these three points are not entirely accurate. The establishment of Peking University International Hospital primarily draws on two types of resources: first, the medical resources affiliated with Peking University Health Science Center (formerly Beijing Medical University), and second, Peking University’s institutional assets or, alternatively, social capital.

As for “+Internet,” it would be inaccurate to claim its presence. In terms of informatization, the new platform developed by Peking University People’s Hospital over nearly a decade was directly transferred to Peking University International Hospital, enabling its immediate application. Therefore, describing Peking University International Hospital as “public hospital + social capital + Internet” is not precise. In reality, it adopts a Public-Private Partnership (PPP) model, wherein a public institution leverages socially raised capital and implements the transferred information technology. After 12 years of effort, Peking University International Hospital was established. Its construction represents a successful implementation of the PPP model, with an investment of nearly RMB 5 billion without any fiscal funding.

Wang Shan:For home-use devices intended for screening, I believe the abandonment rate of such wireless mobile devices is very high. Non-medical devices can follow a fashion-oriented product strategy. Medical-grade home devices face challenges regarding product quality and future applications; however, given that home healthcare is an emerging trend, I remain highly optimistic about the prospects of home medical devices overall.

Wang Shan:As a practitioner of Western medicine, when it comes to Traditional Chinese Medicine (TCM), I have reached an age where, after turning 50, I dare only admit my lack of understanding rather than express disbelief. Moreover, numerous successful cases have strengthened my conviction that there are matters which, although beyond my comprehension, cannot be dismissed. I believe that TCM holds significant potential and promising prospects in the management of chronic diseases. However, caution is indeed warranted when dealing with critically severe or acute conditions.

Wang Shan:Regarding the supporting policies for multi-site practice, I merely provided a few examples earlier. In fact, there is a series of issues to address, such as the definition of responsibilities and rights between physicians and their primary practice site, how performance evaluations are conducted by the primary employer, and how workload assessments, compensation, and benefits are managed at secondary practice sites. Therefore, while there is much international experience to draw upon, it is essential to establish a comprehensive and actionable set of supporting policies.