2024-08-15
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Cloud film query option in a Beijing hospital service account Image source: mobile screenshot
China's filmless movement has been underway for more than nine years, starting with the launch of the country's first cloud film system by Tomorrow International. This year, this "bottom-up" change began to take root in Beijing's public hospitals.
According to the data, cloud film, also known as electronic film, is an electronic film stored in the cloud space. Patients can browse or download it through the electronic link in the text message or by scanning the QR code on the report. According to statistics from the Daily Economic News reporter, at least 20 companies in China have launched cloud film solutions. However, clinicians have a somewhat cold response to cloud film.
A staff member engaged in overseas medical services said that they don’t understand why traditional film is so widely used in China. Why is it difficult to promote the burning CDs commonly used in overseas hospitals in China? As the main force to replace traditional film in China, how will cloud film break through in the future?
Traditional film image source: Photo by reporter Zhang Jian of Meijing (data map, unrelated to the text)
In early August, Zhang Ming (pseudonym) was diagnosed with a bone fracture after taking an ankle X-ray at the hospital. Because it takes one to two hours to print an X-ray film, Zhang Ming, who has limited mobility, left the hospital after receiving the doctor's advice, thinking that it would not be too late to print the X-ray film at the next follow-up visit.
But when she got home, she found that she could already check the imaging report in the Internet hospital. In addition to seeing the examination description and diagnosis conclusion, she can also directly view the image, and in certain modes, she can even rotate, measure, and invert the image.
Later, Zhang Ming looked through his annual physical examination report from another hospital in Beijing and found that his chest CT images could also be viewed online from 2024, with the same functions as magnification and measurement. However, the online imaging software of the two hospitals was different, and the online imaging operation interfaces of the two hospitals were different.
Function menu of a "cloud film" Image source: provided by the interviewee
Zhang Ming didn't understand why the hospital asked him to print traditional films when he could already view cloud films online? Why did the "cloud films" that sounded a bit unfamiliar suddenly appear in many public hospitals in Beijing this year?
Cloud film is not new, and can be traced back to 2015. In March of that year, Tomorrow International (a corporate organization composed of medical equipment management and medical network software integration development companies) released the first cloud film system in China, and launched the China Filmless Movement in July, clarifying that the goal of cloud film is to replace traditional film.
In December 2020, the "Guiding Opinions on Further Standardizing Medical Behavior and Promoting Reasonable Medical Examinations" was issued. It requires that the sharing of examination data be promoted through the establishment of a data database or "cloud film". Since then, the "cloud film" of medical imaging has been encouraged and implemented in many provinces across the country.
In 2019, the inventor of "Cloud Film"Chairman of Ningbo Quanwangyun Medical Technology Co., Ltd.Pan Renjin once said: "In four years, the film usage in Yinzhou District (Ningbo City, Zhejiang Province) has dropped to less than 10% of the original." Data from the Gongyan Industry Research Institute also showed that the overall price of medical film industry products has been on a downward trend in recent years, with the average price dropping from 13.3 yuan per sheet in 2016 to 8.52 yuan per sheet in 2023.
But as of now, cloud film is far from replacing traditional film. Data shows that from 2016 to 2021, the output of the domestic medical film industry has increased year by year, and the domestic medical film market size will reach about 6.778 billion yuan in 2024. Gongyan Industry Research Institute believes that the emergence of new imaging technologies and alternatives may have an impact on the traditional medical film market, but the domestic medical film market size is still expected to reach 6.015 billion yuan in 2030.
According to statistics from the Daily Economic News, at least 20 companies in China have launched cloud film solutions, and Shanghai United Imaging Zhiyuan Medical Technology Co., Ltd. (hereinafter referred to as United Imaging Zhiyuan), a subsidiary of United Imaging Medical Technology Group Co., Ltd., is one of them. In August this year, the company told reporters that the participants in the cloud film market generally include four categories: professional cloud film manufacturers, imaging information manufacturers, information integration manufacturers and cloud resource manufacturers, but the mainstream manufacturers are of various types, and there are still few companies that can control most of the market share.
Cloud film market competition pattern Source: United Imaging Intelligence
According to data provided by United Imaging Intelligence, the monthly examination volumes of the radiology departments of a county hospital, a municipal hospital, and a district-level central hospital were 8,000, 15,000, and 18,000 cases, respectively. After receiving cloud film services, the annual savings in consumables purchases were RMB 1 million, RMB 1.2 million, and RMB 1.5 million, respectively. The economic benefits are very obvious.
However, the usage habits of doctors and patients are a major obstacle to product promotion. Specifically, the application of cloud film may require adjusting the existing workflow and redesigning the diagnosis and treatment procedures to adapt to the operation of the new system. However, many medical staff and managers are more accustomed to the traditional paper film operation method.
In the eyes of clinicians, this is not just a matter of usage habits. In early August, Hou Dailun, director of the Department of Medical Imaging at Beijing Chest Hospital affiliated to Capital Medical University, said in an interview with the Daily Economic News that after the hospital launched the cloud film function in April, it did facilitate the circulation of patient images, but the system has not yet been fully used for medical diagnosis. "The first reason is that patients need to verify the login platform on their mobile phones to access the cloud film; the second is that the screen of the mobile phone is small, the resolution varies, and it cannot reach the effect of medical computer monitors."
Hou Dailun believes that cloud film has enabled X-ray, CT, MRI and other images to be cloud-based, laying the foundation for the mutual recognition of inspection and test results across the country, but doctors should be provided with more professional medical terminals to facilitate them to retrieve patient images, and this terminal should meet a certain resolution to ensure clear display of images to ensure the accuracy of medical diagnosis. He also said that before filling the above gaps, cloud film is in a transitional stage and will coexist with traditional film for a period of time.
According to Hou Dailun's observation, if the imaging diagnosis results are normal, patients generally do not choose to print films. If the diagnosis results are abnormal or the subsequent health condition is poor and they need to go to other hospitals for treatment, the patients will return to the hospital and pay to print traditional films again. However, due to the limitation of cloud service resources, the storage of cloud films in the cloud is also limited to a certain period of time.
Although there is still a lot of room for improvement in cloud film, it seems to be a consensus in the industry that traditional film will be replaced.
In May this year, Cai Qiang, chairman of Beijing Shengnuoyijia Hospital Management Consulting (hereinafter referred to as Shengnuoyijia), a leading overseas medical enterprise, told reporters that he did not understand why traditional film was so widely used in China. According to his observation, overseas hospitals have generally abandoned the use of traditional film and turned to electronic images in digital format (usually burned CDs). Medical institutions can use professional software to enlarge, reduce, rotate and other operations on images, which greatly facilitates the diagnosis of patients' conditions.
Cheng Xiaoyu, the general manager of the medical department of Shengnuo, believes that CDs with medical images can not only unify the treatment requirements of medical institutions at home and abroad, but more importantly, improve the accuracy of diagnosis and reduce the misdiagnosis rate. For example, when a lung cancer patient was followed up in China, the doctor suspected that the patient had pleural metastasis by observing traditional films. However, American doctors used high-definition medical image originals for analysis and diagnosed that the changes in the pleura were more likely caused by trauma rather than the spread of cancer cells. Afterwards, the patient also remembered that he had indeed suffered trauma.
However, not every domestic hospital currently provides CD burning services, so Shengnuo can only purchase a professional imaging scanner to convert the patient's traditional film into digital format to meet the needs of remote consultation. However, the clarity and completeness of the scanned images cannot be compared with CDs.
Beijing Daily reported in January this year that only one of the 22 municipal hospitals in Beijing allowed patients to use USB flash drives to copy electronic medical images, while most hospitals could only burn CDs and charge tens of yuan for burning. Among the large general hospitals outside the municipal hospitals in Beijing, three can provide CD burning services, but not USB flash drive copying services; some hospitals do not provide any electronic image copying services, only films and paper reports.
Image source: Webpage screenshot
Why haven't CDs, which store images more stably, become popular? Hou Dailun told reporters that CD reading is a problem. On the one hand, it takes at least half an hour to read and analyze a complete medical image CD for consultation. If the results of each patient's film are stored on a different CD, it will be a big challenge to the efficiency of medical services and resource allocation.
On the other hand, currently few computers in hospitals are equipped with optical drives. Although some "antique" computers have optical drives, they sometimes cannot open all the CDs. This is because the burning software and electronic image reading software of each hospital are different, so the reading of CDs in different hospitals is also subject to certain restrictions.
Du Ping (pseudonym) has personally experienced this. He told reporters that in 2016, he took a CT imaging disc provided by a private hospital to a tertiary hospital in Hubei Province for treatment. The doctor who initially treated him was unwilling to read the disc because he was worried that the disc could carry a virus. After some twists and turns, the doctor found a computer that was not connected to the Internet but equipped with an optical drive, and was able to complete the disc reading and diagnosis.
Later, Du Ping copied the images on the CD to his home computer and found that the CD had its own imaging software. He thought that if the patient took the burned CD and computer to see a doctor, it would be fine, but the cost of the consultation was indeed too high.
The reporter noticed that neither cloud film nor CD is currently an officially recognized diagnostic basis, and the problems that need to be solved are not only hardware such as terminal displays, but also the establishment of industry mechanisms and the distribution of interests among multiple parties.
According to reports, first of all, cloud film services in many provinces have not yet been included in the scope of medical insurance reimbursement, and the charging standards are not unified. Based on various public information, among the provinces that have issued "digital imaging" charging policies across the country, some provinces will set the price at 20 yuan/time in 2023, and some provinces will set the price at 25 yuan/time. In Beijing, hospitals basically provide cloud film for free. In 2021, the Guangxi Zhuang Autonomous Region Medical Insurance Bureau responded to the "Guilin Municipal Medical Insurance Bureau's request for instructions on charging issues related to the local development of 'medical imaging cloud services'" and stated that according to the relevant guidance of the National Medical Insurance Bureau, medical imaging cloud services do not fall within the scope of medical service price items. Public medical institutions that do not provide physical films shall not charge fees by providing so-called "cloud films" and other methods.
Cooperation model between cloud film manufacturers and hospitals Source: United Imaging Intelligence
Secondly, according to the "Medical Device Classification Catalog" implemented on August 1, 2018, as the imaging recording media of the secondary catalog category, only medical laser film, medical dry laser film, and thermal film can be used as the basis for diagnosis. As early as 2019, industry insiders questioned: "Is it illegal to use cloud film as the basis for diagnosis at this stage?"
In addition, medical institutions do not recognize each other's "cloud films", and imaging information can only be "circulated" within each hospital, which is a real challenge for cloud films to replace traditional films. During this year's National "Two Sessions", Zhang Junjie, a member of the National People's Congress and deputy director of Nanjing First Hospital, proposed "Suggestions on Accelerating the Application of Medical Imaging "Cloud Films", calling for accelerating the mutual recognition of inspection and test results between medical institutions to further facilitate patients' medical treatment.
Zhang Junjie believes that the promotion and application of "cloud film" also requires local health administrative departments, medical insurance departments and quality control organizations to accelerate the mutual recognition of inspection and testing results among medical institutions.
In addition, it is necessary to strengthen security technology protection to prevent the leakage of patient privacy. Zhang Junjie believes that medical institutions that implement "cloud film" need to do a good job of security protection in accordance with relevant laws and regulations. At the same time, he suggested that the national and provincial health administrative departments take the lead in unifying the spatial storage of "cloud film" and the supporting security protection measures.
At present, relevant work is in progress. United Imaging Zhiyuan staff told reporters that in order to achieve the interconnection and interoperability of medical imaging data, more than a dozen provinces in China are currently building imaging cloud platforms. Usually, the project is led by the provincial health and health commission, and a cooperative relationship is established with one or a few manufacturers, and public hospitals in the region jointly participate in the construction. However, its implementation scope and progress are affected by local policies and actual implementation conditions, and there are certain differences. At present, cloud film services in most regions have not yet been included in the scope of medical insurance reimbursement.
Daily Economic News
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