China's Health Card Program Offers Potential For Massive Data Mining

Fifty percent of the country's residents are slated to receive electronic medical cards by year's end, establishing a system that could vastly improve personalized care, comparative effectiveness research and adverse event monitoring.

China plans to issue electronic medical cards to 50% of its residents by the end of the year in a new commitment to overhaul the country's healthcare system and strengthen capacity to handle the sheer volume of Chinese patients.

The new system will not only enable patients to choose their physicians and hospitals more freely, but will also create a massive amount of patient and prescriber data that could be used for personalized care, comparative effectiveness research and enhanced adverse event monitoring.

Announced during the Second China Health Forum Aug. 19, the policy anticipates a new era using electronic medical records as a tool to share health data and improve outcomes, Ministry of Health Administration Chief Yan Hou said.

As a first step, an assortment of megacities, coastal regions and inland provinces were selected for the trial program, including Beijing, Shanghai, Jiangsu and Inner Mongolia. Two cards - the New Rural Cooperative Medical Insurance Card and the Medical Insurance Card - will be combined into one microchip-embedded Residents Health Card.

The ministry released a 70-page Residents Health Card technical manual in July, and the next step is to establish a policy for card management, the Ministry's Information Center Director Qun Meng said.

The card provides information in four major areas: identification; basic personal health data including blood type, disease history and allergy records; electronic medical records for treatments and associated reimbursement needs for urban and rural regions; and financing.

China's Case For Electronic Medical Records

As it implements its new system, China may look to Taiwan for benchmarking purposes. With the financial backing of China, Taiwan's electronic medical records and healthcare IT infrastructure has become one of Asia's rapid growth sectors.

Taiwan committed NT$300 million to connect more than 100 hospitals around Taiwan to a cloud-based system by the end of the year. The system stores diagnostic information, test results and prescription records, according to local media. The goal is to expand the system to more than 500 hospitals across the island.

With a population of 1.4 billion, China is in desperate need to update its health record system to cope with the volume of patients flowing through its hospitals and clinics. China's three-year $124 billion healthcare reform earmarks a large portion for technology upgrades.

The demand is such that market firm IDC estimates China's healthcare IT market will reach $2.4 billion in 2013, growing 19.9% per year on average. Tech giants such as IBM, Dell and Microsoft are rushing to get a piece of the market.

China's electronic medical records system will include general medical history, inpatient/outpatient and emergency records, physical examination records, clinic transfer records, medical reports and information on medical institutions visited, according to the Ministry of Health. Medical expenses and reimbursement coverage will also be included.

One early goal is to share and exchange clinical information among facilities across geographic regions. Regional medical facilities will be responsible for establishing and managing patient records.

Broad Pharmaceutical Application

China is not alone in bolstering healthcare through electronic records, and earlier adopters have found that electronic health records are more than just data for a doctor's reference; e-records could play a key role in comparative effectiveness research and improving health outcomes (Also see "Meaningful Electronic Health Records Needed For Comparative Effectiveness" - Pink Sheet, 11 May, 2009.).

Electronic records may be able to improve adverse event monitoring as well and could enable a more flexible regulatory regime. For instance, U.S. National Institutes of Health Director Francis Collins recently suggested that electronic records could make it easier to adopt a provisional drug approval system by providing a method to monitor and track real-world health outcomes.

NIH supports a 13 million patient HMO research network that could potentially allow agencies to track safety data, and U.S. FDA is trying to implement a much larger network via its Sentinel initiative (Also see "FDA Thinking "Seriously, Deeply" About Range Of Approval Strategies – Hamburg" - Pink Sheet, 4 Jul, 2011.).

In China, patients will have more flexibility to choose physicians and hospitals and more personalized care as a result of data provided to physicians. Patients will also be able to access their records online to monitor treatment.

And it is also possible that China could take an additional step by including genomic data in electronic medical cards, which would help collect biomarkers that could be used to develop customized treatments, according to the consulting firm Monitor Group.

In a report issued last year titled "China: The Life Sciences Leader of 2020," Monitor explored how electronic records could help transform China's life sciences industry.

"As China for the first time develops standardized diagnoses for its diseases, the accumulation of phenotypic data from hospitals and health centers around the country could prove of immense usefulness to Chinese researchers as they seek the best targets for drug treatments," Monitor said.

Privacy Concerns Remain

Amid frequent news reports of data leakage and privacy violations with electronic systems, from banking to social media, the practice of collecting personal health records has raised concerns about protecting privacy.

Taiwan's system has a closed network so that only certified medical personnel can access records and only from medical institutions. To further protect privacy, the network requires patient consent before medical personnel can access records.

In addition, the patient's health insurance card, the doctor's medical professional certificate, and a password and identification number are needed to log into the system, Taiwan Department of Health Medical Informatics Director Hsu Min-huei recently emphasized to local media. The system will automatically keep track of which doctors access which files, he added.

China's MOH has tried to address the privacy issue by designating four categories for card access: general, limited, system management and reimbursement, according to the card manual. Disease diagnosis, drug use, dosage, frequency of hospitalization, and facilities visited are accessible only by the more restrictive system management category.

In Shenzhen, an early adopter in implementing the card system, data are stored at the city-owned Medical Information Center. The card information is encrypted and physicians can access the data only after obtaining a patient's consent. The information also can be accessed by patients by logging into a website.

- Brian Yang ([email protected] )

[Editor's note: This article appears courtesy of PharmAsiaNews.com, Elsevier Business Intelligence's source for Asian biotech and pharmaceutical news. Register for a 30-day risk free trial - no credit card required.]