Lessons from China’s Radiology Technologists

My colleague, Norm, wasn’t the only one who spent time this summer seeing China’s healthcare reform firsthand. I also traveled to the region with Chuck Schneider, Software Lead of our User Experience team, for a usability project that looked at the micro behaviors of radiology workflow at large hospitals in Shanghai and Hong Kong.

Four large hospitals graciously allowed us to shadow their rad techs’ use of Carestream technology during patient imaging studies. This gave us a detailed look – down to user touches and timing – at their radiology departments’ high-volume workflows.  These observations provide opportunities to look for greater efficiency that could be driven by design changes.

Our time at these hospitals left an indelible mark on us, and the contrast between this healthcare system and the situation in the U.S. was striking.

Mike Venturino, Carestream

Mike Venturino and Chuck Schneider with Carestream Health's software team in Shanghai, China

A few things became immediately clear during our observations:

  • Department Physical Layout Enables High Throughput – These high-volume radiology departments see more than 200 patients per day.  Often a typical department in the U.S. has a layout more like a labyrinth that requires the tech to greet the patient at a waiting room and escort them to the exam room. The outpatient imaging facilities in Shanghai and Hong Kong were designed to enable patient self-queuing and self-escort into the exam room. Technologists remain in the exam room and patients bring themselves to room as soon as the previous patient is finished. At one facility patients needing to change into an exam gown did so before entering the exam room. This difference in layout and patient responsibility allows the radiology department to see more patients each day, often in less time.
  • More Resources and Division of Labor – In the U.S. it’s not uncommon to have 1 technologist perform all steps of a patient exam. In the outpatient facilities we observed, there was a minimum of two rad techs and sometimes as many as four—each with their own responsibility for a specific procedure of the exam. For instance, one technologist positioned the patient while another previewed the previous image and set up the system to capture the next image.  In one hospital, two additional technologists formatted the previous patient’s images and closed out that previous patient’s exam, in essence working two patients in parallel. Performing all these duties simultaneously significantly sped exams. China’s investment in recruiting and training radiology professionals gave these hospitals the staff they need to operate more efficiently.
  • Fractions of a Second Count – The head technologist at one of the hospitals said it best when she shared her team mantra: trimming even fractions of a second off an exam can boost the department’s productivity. We saw this come to life in many ways from a tiled color circle in front of a wall stand that helped patients understand where they needed to be without additional tech instruction to the decision not to wait for a preview before repositioning a patient for the next image (because most of the time a retake won’t be necessary). In some cases these fractions of a second saved allowed exams with 3 views to be completed in as little as 2.5 minutes.

Like Norm, our visit made it clear that there are so many lessons other countries take from China’s healthcare reform successes and struggles.

Mike Venturino, PhD, is Lead Human Factors Engineer, Design and Usability, at Carestream Health.

Rural Healthcare Reform Lags in China Beyond Third and Fourth Tier Cities

Carestream CMO

Norman Yung, Chief Marketing Officer, Carestream Health

In my previous posts, I took a look at the impact China’s investment in rural healthcare is having on third and fourth-tiered cities like Nan Chang and Ying Tan. My latest visit to Ta Qiao, an agricultural village with 6,500 residents, however, indicates there’s still a tremendous amount of work that needs to be done to improve the 620,000 village clinics in rural China.

In Ta Qiao, there are a total of five medical clinics, one government sponsored and four privately owned and operated, that treat simple illness and medical problems. I visited the government-sponsored clinic located within one kilometer of village square.  The largest medical facility in Ta Qiao, comprised of a two-story building owned by the government, it stood in stark contrast to the small store-front private clinics.

Trained as physicians, the couple who runs the Ta Qiao medical clinic sees approximately 20 to 30 patients per day.  When I arrived at the clinic around 9 am there were already 10 patients in the reception area with another three to four in the semi-private patient rooms.

The Ta Qiao village clinic is a basic medical facility equipped to treat common illness, deliver children and take vital signs.  It has a reception area, admission office, rooms for dedicated departments (e.g., internal medicine, maternity, pharmacy, etc.) and about 10 patient beds.  The clinic has some rudimentary medical equipment, but does not have any X-ray imaging equipment.

Ta Qiao Government Medical Clinic

Ta Qiao Government Medical Clinic

To get an X-ray, a villager would travel by car to a neighboring hospital in a city like Ying Tan. A taxi costs about 75 RMB each way.  Compound that cost with the fact that the villager will be responsible for paying the medical services rendered.  A common treatment for the administration of shots (e.g., antibiotics) ranges in cost from 30 to 50 RMB.  For someone who is making only 1,200 to 1500 RMB per month, healthcare costs add up quickly.

Villages like Ta Qiao, which is up to an hour by car from nearby hospitals, have to rely on government-sponsored and private clinics to receive the most basic healthcare services. These rural clinics need more medical equipment and trained professionals to provide more critical healthcare services affordably to villagers.  This will only become more important as China’s population ages.

Taking an X-Ray at One of 29,000 Township Hospitals in Rural China

Carestream CMO

Norman Yung, Chief Marketing Officer, Carestream Health

As my trip to China continues, this week I had the opportunity to join my brother-in-law at Ying Tan Hospital  for a follow-up X-Ray for his right wrist, which was injured three months ago.

Considered a fourth-tiered city, Ying Tan Hospital serves over 500,000 people from the town population of 250,000 residents and those from surrounding areas coming for care.  The leading medical facility in the area, the hospital recently expanded its operations and moved into its current buildings only a few years ago. I jumped at the chance to see China’s healthcare reform in action.

Admission was fairly efficient. After a few minutes in line, my brother-in-law was registered as a patient, which included having to pay all associated costs – 112 RMB for the imaging procedure plus 5 RMB for doctor’s visit.  While the government covers a portion of inpatient services like complex exams and surgeries, people in rural China with average monthly income from 1,200 to 2,500 RMB, are responsible for paying for the costs of simple exams like x-ray.

A recently renovated facility, Ying Tan Hospital operates CT, ultrasound and x-ray imaging equipment.  In this case it was located in a standalone, nearby facility within walking distance. Once we arrived, we waited about 12 minutes for a radiology technician to see us and take the x-ray (with Carestream technology).

Ying Tan Hospital China

Ying Tan Hospital Entrance

After about 15 minutes, my brother-in-law received the x-ray medical film images and a written report on the diagnosis.  He then returned to the first building to meet with the radiologist, who spent a few minutes reading the X-ray film on a light box, as well as the initial report and gave us his interpretation.  Unfortunately, because my brother-in-law did not bring his original x-ray images, taken at another hospital, we were unable to compare and contrast with the prior images.

This visit echoed my original impression of China’s rural healthcare reform. Clearly investments are being made in improving rural healthcare, as indicated by the expansion of Ying Tan Hospital and its medical equipment.  However, there are many opportunities to deliver more efficient care.

Consider my brother-in-law’s experience. While I saw a few uses of digital radiography in the hospital, a networked health IT system would have eliminated the need to print film, allowed the x-ray to be viewed from different buildings to save the radiologist and patient time, and improved diagnostic confidence with quick access to prior images.

I’m headed next to a village clinic in Ta Qiao this week to get a fuller picture of how someone in rural China receives healthcare.

Let me know in the comments if you have questions about village clinics – I’m happy to ask!

INFOGRAPHIC: China’s Rural Healthcare Reform

Carestream CMO

Norman Yung, Chief Marketing Officer, Carestream Health

This summer, I am spending a month in China sightseeing and visiting family and friends.  My in-laws live in a very rural part of China in a village called Ta Qiao with population of roughly 6,500 people.  To give this some perspective, Beijing has about 13 million permanent residents and another 10 million plus folks floating in and out of the capital.  This trip gives me an opportunity to see first-hand the country’s efforts to reform healthcare in rural China.

Before I arrived in China a couple weeks ago, reports indicated that while major progress has been made there is still tremendous work to do.

More than 835 million people, which accounts for 95 percent of rural residents, have joined the New Rural Cooperative Medical System for access to affordable health coverage. But with two-thirds of rural clinics in disrepair, government construction to improve thousands of rural medical centers is just picking up steam.

From what I’ve seen, it is too early to tell how fast and significantly the gap is being narrowed between urban and rural residents’ access to care.  However, one thing is clear: urban medical centers continue to outpace rural facilities in spend on and use of new medical technologies.

During my time in Ta Qiao, I plan to visit a village clinic to see how medical care is being delivered and what advanced technologies, if any, are being used.  I’m also on the hunt for examples of how advanced health IT systems are connecting urban and rural medical facilities and professionals for better diagnosis and patient care.  For that, I will venture to a nearby town, Ying Tan, with population of roughly 250,000 people located closely to Nanchang, a 3rd tier city with roughly 2.5 million people.

Are you following China’s reform? What areas should have greater focus? What lessons can other countries take from China’s successes and struggles?

Need a quick primer on the rural initiatives in China’s healthcare reform? See our infographic below.

China Healthcare Infographic

Special thanks to the Frontier Strategy Group for letting us use their data.