A proposal by Robin Li (李彦宏) -founder of Baidu (百度) and an influential figure amongst China’s policymakers- yet again attracted the attention to the Medical Cloud. He thinks that Medical Cloud contains rich clinical data which catalyzes the research and application of electronic medical records, improving the medical system, so as to alleviate the problem of insufficient medical resources and uneven distribution between urban and rural parts of China. Indeed, launched by the Government in 2016; rights and responsibility of data collection, sharing and utilization and cloud management have been regulated, stimulated and outsourced by giving them to the third party companies and SOEs.
“9) We will implement the Healthy China Cloud Service Plan, build an integrated platform for healthcare services, provide remote consultation, remote imaging, remote pathology and remote ECG diagnosis services; and improve the mutual recognition and sharing the mechanism of inspection results. We will promote data resource sharing and collaboration between large hospitals and medical institutions, general practitioners and specialists …”
A literal translation of Article 9 says that the government will collect all the medical data coming from the smallest clinic in Guizhou to the biggest hospital in Shanghai; process it and make it useful within the cloud; and give access for this data to whoever and whenever necessary; to provide a smarter healthcare services ecosystem to the public.
Once again, what is seen as “personal” in the west, had not seen that private and allowed to be exchanged for the sake of other purposes in China.
What is so earth-shattering about Medical Data Privacy in the West?
There are a variety of reasons for placing a value on protecting the privacy, confidentiality, and security of medical data. Underlying causes are summarized as personal autonomy, individuality, respect and dignity. However, it should be noted that we all have different dignity and self-respect evolution criteria; the solemnity of these sort of “social value-based” laws are questionable.
From a pragmatic point of view; the most significant reason is that if the patient does not trust the doctor, he/she will not share the reality on what has been happening in his body, which eventually results in less effective diagnosis&treatment. In fact; even the belief that the medical data is well protected and will not be disclosed without consent influences the entire process positively.
Several mass medical data theft cases filed so far. Institute for Critical Infrastructure Technology stated that between 27.8 million and 67.7 million people have had their medical records stolen since they started keeping data in 2009. Medical records may include a person’s full name, address, emergency contact information, social security number, insurance details, the name of treating physicians, diagnoses, prescriptions, treatments and several other very sensitive pieces of information. This is why they are traded as a valuable asset amongst hackers and may be used in undreamed of frauds and crimes.
In the U.S. medical data is protected by the Health Insurance Portability and Accountability Act (HIPAA) which was passed in 1996 and still the law is still in effect. HIPAA protects any information that doctors, nurses, and other health care providers put in the medical record, any conversation that doctor has about patient's care, any information about the patient in the health insurer's computer system, and any billing information about the patient. The law states that none of this information can be shared with the third parties without the patient’s consent.
Although the efficiency and beneficialness of the law criticized by many; it still protects the patient’s information from any third-parties and this American approach was copied or adapted by and inspired to several other developing and developed economies in upgrading their medical data laws and regulations accordingly.
We can not tell the same for the Chinese. Since the very first days of the establishment of Modern China, they have never approached to the legislation and regulation from a “copy-paste” approach; but they tailored for China, with a purely pragmatic activity-based approach.
Who Process Medical Data in China?
There are two types of major medical data processors in China; State-Owned Enterprises (SOEs) that possess the legal right to collect and process the mass data directly from hospitals and private companies who collect various types of data from individuals in exchange to several types healthcare services.
In 2016, three SOEs were licensed and granted the right to collect the big data from China’s hospitals: China Health and Medical Big Data (中国健康医疗大数据), China Medical Big Data Industry Development Group (中国健康医疗大数据产业发展集团公司) and China Medical Big Data Technology Development Group (中国健康医疗大数据科技发展集团). (English titles were unofficially translated by the author) The detailed analysis of these SOEs activities’ are not in the scope of this article, and this article only covers the private companies whose activity scopes are med-tech, big-data, AI or/and IoT.
Founded in 2015, 12Sigma (图玛深维) is one of the first companies in China to introduce AI and deep learning into the medical image diagnosis and medical data analysis. The Company’s “Cloud Cad” product aims to provide doctors with accessing the medical image data at any time from anywhere in the world while giving an AI diagnosis help to the medical personnel who has limited technical capacity in reading the medical data of CT, MR, CR, DR, ECT, DSA, ultrasound, endoscopy, pathology and various other medical equipments. As of April 2019, the company has accumulated around CNY 200 million fundings in Series B. The company is operated from Beijing, Suzhou and San Diego offices with around 70 known employee.
Founded in 2012, Yitu Tech (依图科技) is one of the most comprehensive AI companies in China with its CNY 671 Million (Series C ) cumulative fundings. They have activities in Security, Healthcare, Finance, Retail and Smart City industries. Its product “care.ai” powered by AI+Big Data; providing a supportive diagnosis and treatment platform for doctors and medical personnel. The more medical data care.ai processes and collects, the more it gets accurate. Zhejiang Provincial People’s Hospital uses Yitu’s smart medical imaging platform for the early detection of lung cancer, and another hospital in Guizhou cooperates with Yitu developing a preliminary diagnosis platform. In March 2019, Huawei and Yitu (依图科技) published the intelligent healthcare cloud co-developed by them during an AI Conference held in Fuzhou. Founded by Zhu Long (朱珑) and Lin Chenxi (林晨曦); Sequoia China and Zhen Fund back the company. The company operates in China, Singapore and the USA with around 500 employees.
United Imaging (联影医疗) is yet another company that aims at launching a Medical Cloud solution for several applications. In fact, the company is one the biggest and most assertive MI, MRI, CT and Xray Machine producers globally; and it wants to convey its excess technical and financial capacity to the medical cloud application; linking regions, hospitals, and departments to achieve a high-quality medical resource-sharing in the Cloud. Not surprisingly, their cloud product “uCloud” has not yet submitted to the FDA of the US. For this product, they see China as the potential market to start with. The company raised CNY 3.3 Billion (Series A) funds and operates in the US and China with more 3000 employees.
China’s internet giant Tencent’s WeDoctor and PingAn’s Good Doctor are the other massive apps that provide AI driven projects.
It is not an enigma that China needs to upgrade its data privacy regulations. The Government acknowledges the fact. Perhaps, the government currently prioritize its more significant structural healthcare problems before dealing with medical privacy.
“The country will need a more comprehensive regulation and legislation in personal information and data protection. Premier Li urged all related departments to work with the National Health and Family Planning Commission (NHFPC) to further improve data protection.” stated the State Council of China.
Current lax of regulation is an excellent opportunity to feed the algorithms with massive real individual data for Chinese companies.
When WeChat Pay and AliPay first started to operate in China, there was no regulation to protect any personal data of the payee or the payer; moreover, these applications have started as non-licensed, non-bank financial operators. Today, their payment transactions surpassed the entire transaction volume processed within the baking system of China; creating the most advanced mobile payment ecosystem globally. In public security, Chinese gave up their privacy to the State Owned and private institutions who collect their offline online activity data to get more secure and traceable environment. In contemporary China, employing big-data and smart systems, the most crowded and complex country turns out to be one of the safest countries, globally.
In Healthcare, it would be too naive to state that Chinese life expectancy will reach to that of Europeans and Japanese; but would be valid to predict that they will possess the best AI and Big Data powered med-tech solution providers.