The disease is particularly acute in China’s rural areas: The countryside is home to around 42% of the total population, but six in 10 of the country’s heart disease sufferers. A rural-dwelling Chinese person is around 17% less likely to survive heart disease in any given year than an urbanite. This means that a diagnosis of high blood pressure, which can be the precursor to heart disease, could be inconvenient for someone living in the city of Shanghai, but a tragedy for their compatriot in the remote northwestern province of Qinghai.
The usual heart disease risk factors, such as poor diet, lack of physical activity and smoking, are rife in less developed areas. But that only partly explains the great divide in China’s heart disease statistics. There is also an unequal distribution of resources between the country’s cities and countryside, says Hu Lifei, a lead engineer at GE Healthcare. He explains that most of the country’s best doctors and latest medical equipment reside in urban areas.
This leads rural folk to seek treatment in the city, rather than their village clinic. “These central hospitals are overloaded,” Lifei says. A typical outpatient department in Beijing can treat up to 10,000 people per day.
It’s not an ideal situation, but there is hope for China’s rural patients and overworked urban doctors. Lifei is part of a team that’s using cloud computing technology and artificial intelligence (AI) to bring city-standard medical resources and diagnostic tools to the countryside. It means frail patients will no longer have to travel hundreds of kilometers to the city to receive top-level care, and also relieves the pressure on overcrowded central hospitals.
The technology is called Cloud ECG, with ECG standing for electrocardiogram, the test clinicians use to check for unusual signs in a heart's rhythm and electrical activity. ECGs are a staple of TV medical dramas: They’re the bedside monitors that, if the patient is lucky, emit regular electronic blips and jagged lines. But the monitors in rural China are enhanced with software that pumps a patient’s ECG images and underlying data into servers that expert physicians in central hospitals can access.
The remote physicians can then diagnose the patient without even being present — they have all the data they need from the web application. “It’s like having the city doctor in the same room at the rural clinic,” says Lifei.
A patient might arrive at the village clinic complaining of chest pain. If it’s their first visit, the on-duty clinician snaps a picture of their identification documents and medical history with a web-connected tablet. This registers them in the cloud so that all medical professionals using the same app can pull up their file. The clinician attaches sticky sensors to the patient’s chest and the ECG monitor begins to beep in time with the heartbeat. The images and underlying data begin to flow into the data server, or cloud.
The doctor in the city will be able to see the patient’s images and data on the app almost instantly. They might spot tiny anomalies in the peaks and troughs of a wave that indicate problems such as arrhythmia, coronary heart disease, cardiomyopathy or looming heart attack. They can double-check their diagnosis by drilling down into the raw data. Lifei says that whatever they find, they are carrying out the same detailed analysis that they would do “as if they were in the room.” The city doctor then uploads the report, which the rural clinician can see in just a few seconds.
The ECG machine’s built-in software crunches the numbers to ensure that city doctors see the most relevant data up front to make their diagnoses. “It might cut out 90% of the data, which allows the doctor to immediately concentrate on the right 10%,” says Lifei. This allows doctors to make faster and more accurate diagnoses.
It’s a win-win for both city and countryside. The rural patient has saved a journey to the city. And fewer out-of-town patients mean shorter waiting times in central hospitals.
The Cloud ECG platform, which uses GE Marquette 12SL software, isn’t just a chain of computers that allows for fast-twitch diagnosis. Lifei says it’s also an AI-enabled brain that continually analyzes the diagnoses in relation to the raw data: in this case, the billions of heartbeats from tens of thousands of patients. That means it gets better every time a city doctor submits a report. Lifei says Cloud ECG has boosted the accuracy of diagnoses to “greater than 90%.”
The shift to internet-powered healthcare might leave you wondering about the elephant in the room. “Fortunately, the internet infrastructure in China is very good,” says Lifei. China ranks in the world’s top 25 countries for average broadband speed, according to the Speedtest Global Index.
He adds that technology similar to Cloud ECG, which has now been deployed for two years in China, could soon be used in another Asian country with a huge population and underserved rural areas: India. “We are already discussing using the same system there — and possibly beyond.”
Lifei says that GE engineers in China will continue to upgrade and improve Cloud ECG. After all, action makes the heart grow stronger.