Luo Jinrong lives in Gekeng, a poverty-stricken village in the remote mountains of Yangshan County, Guangdong Province in southern China. She couldn’t have imagined utilizing artificial intelligence (AI) would improve her health.
What Is AI, Anyway?
One day in late October of last year, Luo started feeling short of breath, and her pulse raced. She went to the village clinic to see Doctor Huang. Despite Luo’s obvious ailments, the doctor could not diagnose theproblem. He took a brand-new portable electrocardiograph analyzer out of a box and began a test.
After a few minutes, the device displayed the message: “Due to insufficient performance of the aortic valve, you are advised to be admitted to hospital for further examination.”
“How could a machine determine what a doctor does not?” Luo was not sure whether to take the device seriously or not.
Doctor Huang was not sure either. But as a doctor, he took the suggestion seriously. “We better trust the analyzer,” he admonished his patient. “Insufficient performance of aortic valve will gradually lead to myocardial failure, which could be fatal.” Luo was admitted to the county hospital for further diagnosis and treatment. The analyzer was right. Luo stayed in the hospital for 10 days. After she was discharged, she told all her friends about Doctor Huang’s miraculous machine.
Installed on the device was the AI Doctor, a smart teleconsultation app developed by Guangdong Second Provincial General Hospital, located 200 kilometers from the village. The app was introduced to 55 povertystricken villages of Yangshan County, which have benefited tremendously from the improvements in healthcare and diagnosis in the remote mountains.
Internet Plus Medical Care
Some remote mountain villages are far from everywhere.
Just how far? Taipingdong Village, a Yao ethnic village, is nestled in a mountain 1,200 meters above sea level. It takes villagers two hours to drive down the mountain and another two hours to reach the nearest county town. An ambulance from the hospital would take four hours to reach the village and another four to return. “In extremely bad weather, there’s no way to get a patient out of the village,” commented Cai Xigang, director of the Yangshan County Health Bureau.
In April 2015, his county was designated as the recipient of assistance and support from the provincial hospital.
How will the provincial hospital provide this support? The institution’s 2,000-plus doctors and nurses provide outpatient services to 1.5 million people annually. It could dispatch a dozen staffers to the county hospital, but it would be impossible to staff all 13 township hospitals and 159 village clinics in the county. A decision was made by Tian Junzhang, president of the provincial hospital, to extend the reach of the internet hospital that had been built the year before to all the village clinics. The internet hospital was the predecessor of the AI Doctor, which was intended to provide residents of remote villages with teleconsultation and diagnosis services.
The internet hospital was a resounding success in cities and towns of the Pearl River Delta. In remote rural areas, however, things did not operate as smoothly as hoped after initial infrastructure and training was completed.
“A prescription could be written after teleconsultation, but the village doctor still didn’t have the prescribed medicine at his clinic,” explained Zhang Gangqing, a provincial hospital doctor who was appointed president of the county hospital. “Another problem was instinctive resistance to the internet from some senior village doctors who remained steadfastly more confident in their own experience than modern equipment,” he added with a wry smile.
The internet hospital had to solve the problems arising with its outreach.
To better communicate, the provincial hospital provided the county hospital with assistance in setting up an internet hospital platform. When a village doctor encounters a complicated case, he should seek the clinical decision support (CDS) from county hospital doctors, who can also seek further assistance from provincial hospital doctors on the platform.
Due to the restrictions of the procurement system, village clinics are only supplied with essential medicines. To meet needs for emergencies, the county hospital helped village clinics build their own medicine storage stocked with the same type of medicines used by provincial hospital doctors.
During its first three years of operation, the internet hospital became more and more popular in the townships and villages of Yangshan County. One villager had suffered from chronic gastritis for many years. Doctor Huang referred him through the platform to an expert of the TCM (traditional Chinese medicine) department of the provincial hospital, who prescribed some TCM herbs. The prescription effectively solved the patient’s problem. He has maintained good health for more than two years since.
“The villager came back with seven or eight other villagers to consult the expert from the provincial hospital through my computer,” revealed Doctor Huang.
AI Doctor App
As more and more villagers warm up to seeing doctors at the provincial hospital online, the Guangdong internet hospital platform has already made 17 million teleconsultations over the last four years, with daily receptions rising from dozens to 40,000.
With the online crowds came another problem.
While doctors at the provincial hospital became overwhelmed with long queues of online patients, village clinics were packed with people waiting a long time for a turn due to slow connection speed.
The long queues online were akin to long queues in a real hospital. AI became a natural fix for the problem. The AI Doctor app developed by the provincial hospital is free for the public to use. In July 2018, the Guangdong Provincial Health Commission introduced the app to the 55 poverty-stricken villages of Yangshan County as part of a health promotion project of povertyalleviation efforts: Internet Plus Medical Care.
The changes were major: from internet hospital to AI Doctor, from a desktop monitor to a mobile phone screen, from dialogue with a human doctor to dialogue with a mobile phone. Village doctors were reluctant to believe that a mobile phone could solve online queues. The villagers wondered whether a mobile phone could treat its patients as a doctor.
The backend engineers employed by the provincial hospital are confident in the AI Doctor—an app harnessing big data and artificial intelligence. It has collected and analyzed an enormous medical database and knowledge map including 118,000 medical entries, 3,674 kinds of disease, 5,375 kinds of clinical manifestation, 4,495 test indexes, 1,773 test markers, 1.8 million items of relevant experience of medical knowledge points, 456 single disease clinical guidelines and 300 million medical records of top-level hospitals. Furthermore, the app can learn from collected data to develop its own diagnosis capabilities.
Better Care with AI
One hot summer day, Zhang Mulin, a farmer from Datang Village, fainted while working in the field. Village doctor Wang Yulian rushed to his aid with the AI Doctor and a new portable electrocardiograph analyzer.
“I had thought he was suffering from heat stroke,” admitted Doctor Wang, “But the AI Doctor diagnosed myocardial infarction and suggested I treat him with nifedipine.” Doctor Wang sees an increasing number of villagers suffering from cardiovascular and cerebrovascular diseases. “As a village doctor, I wasn’t always sure how to treat my patients,” she conceded. “With the AI Doctor and portable equipment, things are getting easier and I feel more confident.”
Deng Jinke is a 35-year-old doctor serving Datangping Village. He has been working in the village since his graduation from the local health school 10 years ago. His village is a typical poverty-stricken village with a resident population of 500, 160 of whom are living under the poverty line.
The AI Doctor has changed Doctor Deng’s method of operation. He also feels his care improving and a sense of fulfillment from interaction with the AI Doctor.
Over time, village doctors have found their medical skills and knowledge unwittingly improving due to usage of the AI Doctor. “For example, it was hard to argue with villagers who believe an injection is more effective than oral medication,” revealed Doctor Deng. “Now I just insist that oral medication be taken because that’s what the app says.”
Village doctors are learning how to utilize the AI Doctor while the AI Doctor is constantly optimizing and improving itself. Today, the app supports picture and voice input. By scanning the patient’s ID card, the AI Doctor can identify the patient and build a health record automatically.
According to the plan of the Guangdong Provincial Health Commission, all doctors serving 2,277 poverty-stricken villages in the province will be provided with the AI Doctor and relevant equipment to assist them with their duties.