VB Group Interview No.9: Dr. Xie Yongquan from Fuwai Hospital on Internet Healthcare from a Cardiac Surgeon’s Perspective

Guest of this issue: Xie Yongquan, Associate Chief Physician, Department of Cardiac Surgery, Fuwai Hospital
Time: September 9, 2015, 20:00–21:30
Host: Zhao Zhanshi
Guest Introduction: Professor Xie YongquanHe is an Associate Chief Physician in the Department of Cardiac Surgery at Fuwai Hospital, holding a Ph.D. in Surgery. He studied abroad at the University of Southern California in the United States. With 20 years of experience in cardiac surgery, he has served as the lead surgeon in over 1,000 cardiac surgical procedures to date. He has a strong interest in mobile health and has been a pioneer in its practical application, ranking second among the Top 10 Most Highly Rated Doctors in Chinese Valve Surgery on Haodf.com in 2014. In 2015, he participated in the development of an app for the Fuwai Coronary Heart Disease Medical Quality Improvement Study, which is currently being used for clinical research at Fuwai Hospital.
Topic Sharing:
After returning to China from studying in the United States in 2009, Professor Xie Yongquan first came into contact with Haodf Online, an internet-based healthcare platform, which marked the beginning of his exploration into digital healthcare. Professor Xie’s most significant observation was that internet tools enable physicians to rapidly establish their personal brands, whereas in traditional public hospitals, building a genuine personal brand requires a considerably longer period.




“Heart Health” App
As a cardiac surgeon, Xie Yongquan stated that his personal use of internet healthcare primarily focuses on postoperative patient management. Postoperative cardiac patients often experience numerous complications, making follow-up care after hospital discharge critically important. To this end, the medical team led by Xie Yongquan developed a mobile application called “Heart Health.” However, this app exists in the form of a research project and is used for rehabilitation management of coronary artery disease patients following coronary artery bypass grafting (CABG).
The app’s primary features include: providing educational content on heart health; reminding patients to take medications on schedule; adjusting medications based on changes in the patient’s condition; and transmitting data such as blood pressure readings to the medical team via the app. The backend is managed by a team of physicians and nurses, who can deliver general health guidance and address routine inquiries directly to patients through a question-and-answer format within the app. In the event of complications, patients transmit relevant data through the app to the backend system. Cardiologists and cardiac surgeons first conduct a preliminary consultation based on the data, and then notify the patient whether a return visit to the hospital is necessary for further examination and treatment.
Why Should Hospital-Based Projects Begin with Scientific Research? Professor Xie stated, “Most public hospitals lack sufficient motivation to conduct post-discharge patient follow-ups, resulting in inadequate funding and leaving physicians willing but unable to act. The majority of follow-up funding is allocated from research grants. Although some hospitals have established follow-up teams, they have consistently struggled due to insufficient funding and staffing, yielding only modest results.”

The operational funding for the “Heart Health” platform is derived from research grants. The platform has recruited nurses and college students, whose primary responsibility is to identify eligible patients and recommend the app to postoperative patients. Clinicians have also been mobilized to participate in this effort. Based on practical experience, Professor Xie found that patients who had undergone cardiac surgery at Fuwai Hospital and were capable of using smartphones generally expressed willingness to participate, particularly when recommended by their clinicians.

To date, the “Heart Health” platform has recruited more than 400 patients. Professor Xie stated that they will continue this initiative until the project is completed. Regarding future operations, such as what to do once research funding is exhausted, there are currently no further plans in place; it may be supplemented through other sources. Of course, it is also possible that “Heart Health” will become a routinely used app in cardiac surgery, with future agreements signed with patients being service contracts rather than informed consent forms for research.
For patients, the app also serves a supervisory role. Many patients tend to forget their past suffering once they have recovered, paying little attention to medication adherence or post-discharge precautions. With this app, patients can follow prompts to perform necessary actions, thereby providing supervision and improving patient compliance.

Abroad, pre- and post-consultation services for patients are generally not provided by surgeons. These countries have established tiered diagnosis and treatment systems and robust general practitioner networks, whereas China’s foundation in this area remains relatively weak. Regarding post-discharge care, patients previously received little to no follow-up after leaving the hospital. However, the situation has improved with the adoption of internet technologies, which represent a key advantage by enabling patients to communicate directly with their medical teams after surgery. As patient volumes increase and research responsibilities intensify, post-discharge services will increasingly be delivered via online platforms, thereby facilitating more convenient access to care for a larger number of patients.

Highlights: Questions and Answers
1. We have just discussed the application in post-discharge follow-up. How does mobile internet intervene in the pre-consultation phase? What role do hardware devices play?
Xie Yongquan:The Heart Health App is designed for postoperative care; we do not have a corresponding app for pre-consultation services. Fuwai Hospital currently offers a WeChat-based registration platform, which is limited to appointment scheduling. In terms of hardware, Fuwai Hospital has completed China’s first implantable ECG monitoring device implementation. However, I believe that performing cardiac surgery via telemedicine remains a distant goal. This is primarily due to legal considerations and safety concerns, the latter encompassing both the operational safety of the surgical procedure itself and the security of the remote signal transmission system. Initially, telemedicine was conceived for battlefield medical care, where remote experts would operate robots to perform emergency surgical interventions on the battlefield. The United States has conducted extensive research in this area.

II. Does this app have a caregiver portal? If not, how should elderly patients use it?
Xie Yongquan:First, the patients who focus on this App are basically users of smartphones or smart mobile devices. I have found that many elderly people now have a lot of free time and use their mobile phones no less than young people do. It is often not difficult for them to apply such products. Therefore, I believe that in terms of efficiency, this method is much better than telephone follow-up. Of course, this App also has some limitations. If patients do not use smart mobile devices or do not use them well, it can be considered to let the accompanying family members install this APP. If this still does not work, some patients can only be excluded, and their postoperative follow-up can only be carried out through traditional methods.

3. What is the current user base of this app? Is the collected data of high value, or is the primary value directed toward patients?
Xie Yongquan:Since the beginning of this year, the app has recruited approximately 400 users. While the data value is not particularly high, the cost is low, and it facilitates basic communication with the medical team, offering significant value to patients. As the platform continues to be developed, we can accomplish much more, and its value to physicians will undoubtedly increase over time. As part of our research project, we are also considering integrating this platform with wearable devices in the future to enhance the efficiency of postoperative follow-up.

IV. Are there currently any medical apps primarily focused on postoperative follow-up?
Xie Yongquan:I have used several post-operative follow-up apps. For instance, the mobile version of Haodf Online, which I currently use, offers post-discharge follow-up features. However, due to various reasons, hospitals are generally reluctant to share data, and physicians have limited time and energy, significantly diminishing the value of these tools.

V. Are you currently attempting to integrate any wearable devices? In your opinion, what are the primary barriers to selecting wearable devices?
Xie Yongquan:We are not currently considering connectivity with wearable devices, as this app is ultimately a research project. Our immediate focus is on completing the project on schedule, which includes finishing participant recruitment, meeting the target number of patient participants, and conducting efficacy analysis. Regarding the choice of wearable devices to connect, I believe price is certainly not the primary factor; rather, safety and timeliness are more critical. For patients who have undergone cardiac surgery, having already spent RMB 80,000–100,000 on the procedure and endured significant suffering, cost is unlikely to be their main concern if a smart device can genuinely provide postoperative care benefits. What truly matters is the product’s effectiveness. This also reflects trust in physicians. Of course, different population segments exhibit varying degrees of price sensitivity. If the device serves only a secondary prevention role, experience in China suggests that most people are generally unwilling to incur additional expenses, meaning they are more price-sensitive. This “price” refers not only to the hardware cost of the device but also to the cost of subsequent services provided. Such individuals strongly prefer visiting hospitals to consult doctors directly, which indirectly highlights that the compensation for medical professionals’ labor services in China is too low.

VI. Postoperative Management Issues?
Xie Yongquan:Postoperative management involves two key aspects: data collection and data analysis. The latter is a challenge that is not easily addressed within China’s current healthcare system. In my view, whether in cardiology or cardiac surgery, physicians often lack the time and energy to handle such tasks, necessitating a dedicated team for this purpose. While such teams are readily available abroad, similar services are currently lacking in China. In the future, it is highly likely that specialized teams will emerge to address this issue through outsourcing. However, seamless sharing of information across different hospitals must be ensured.

7. What changes do you think the emergence of companies like Haodf Online has brought to our daily work as physicians? In what areas do you believe further improvements are still needed?
Xie Yongquan:First, regardless of whether I work within or outside the public healthcare system, personal branding is highly important to me, although the pace of development may differ. Through lightweight online consultations, some physicians can generate substantial income; however, for me, such consultations are not the primary objective. My main goal is to leverage internet-based channels to connect with patients who need medical care, ensuring that those seeking my services can easily find me online. Regarding companies like Haodf Online (Good Doctor Online), I believe that professional service teams should not attempt to handle every aspect of care or solve all problems. Instead, they should focus on addressing common, standardized issues, as individualized patient needs certainly cannot be resolved by a single, uniform team.

8. Would you proactively recommend postoperative management apps developed by internet healthcare companies to your patients?
Xie Yongquan:If such an app existed, I would likely recommend it, but I have some doubts about whether patients would actually use it. In China, there is a prevailing phenomenon where patients who undergo surgery with me tend to trust only the guidance provided by me and our hospital, often disregarding advice from other platforms. For instance, some patients insist on purchasing prescribed medications out-of-pocket at our hospital, even though these drugs are available locally and eligible for insurance reimbursement. They harbor concerns that medications purchased locally might be counterfeit or less effective than those from Fuwai Hospital. This issue stems from broader challenges within China’s healthcare trust system. Therefore, if I were to recommend an app to my patients, they would be more likely to use it only if it were affiliated with our hospital, or if we were directly involved in the platform, or if it enabled them to contact me directly through the app.

9. If neither apps nor lightweight consultations can establish patient trust, how do you think renowned physicians can quickly break away from their reliance on prestigious hospitals and rapidly build their own personal brands?
Xie Yongquan:Given that over 90% of hospitals in China are public, and the vast majority of truly skilled physicians work within the public healthcare system, it is possible to build a personal brand; however, doing so without the backing of a prestigious hospital remains highly challenging. With the aid of internet tools, personal branding may be achieved more rapidly than in the past, but such brands can also be dismantled more easily. Therefore, physicians must ensure that their service quality is exceptional, even when treatment outcomes are less than satisfactory, thereby minimizing potential damage to their professional reputation.