Feature | Coronavirus (COVID-19) | April 02, 2020 | Jilan Liu and HIMSS Greater China Team

Telemedicine, artificial intelligence, drones, robots and big data are being employed to fight COVID-19 in China

#COVID19 #Coronavirus #2019nCoV #Wuhanvirus

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Information technologies have played a pivotal role in China’s response to the novel coronavirus COVID-19 outbreak, such as proactive surveillance for rapid detection and diagnosis of infection, immediate isolation, rigorous contact tracing, quarantine of the close contacts, and exceptionally high awareness and acceptance of the measures among general public.

How China Handled the Pandemic

The outbreak of COVID-19 pneumonia began in Wuhan, capital city of central China’s Hubei province, in December 2019. It then spread to the rest of the country and globally. Development of healthcare information technologies (HIT) in recent years has significantly improved the entire Chinese society’s response capacity when facing the COVID-19 outbreak. It has played a pivotal role in China’s rigorous response measures, such as proactive surveillance for rapid detection and diagnosis of infection, immediate isolation, rigorous contact tracing, quarantine of the close contacts, and exceptionally high awareness and acceptance of the measures among general public. As stated in the “Report of the WHO-China Joint Mission on Coronavirus Virus (COVID-19),” China’s bold approach to contain the rapid spread of this new respiratory pathogen has changed the course of a rapidly escalating and deadly epidemic.1

Here are examples how China is harnessing the powers of information technologies to tackle the epidemic:

• Online epidemic information dissemination platforms;

• Artificial intelligence (AI)-assisted infection risk identification, temperature monitoring, online screening, and consultation platforms;

• AI-assisted radiological image interpretation and intervention recommendations;

• Community outreach and support;

• Big data analytics for epidemic prevention and control, including predictive modeling and turning point projection, and supercomputing for vaccine and drug development;

• Contact-free technologies, including unprecedented growth of Internet use in medicine; telemedicine services; care in the quarantine area; unprecedented growth in telecommuting and online education; drones deployed for crowd activity monitoring, environment disinfection and fever detection, and contact-free supply delivery; 5G-based robotics and infrastructure;

• IT security; and

• Internet-of-things (IoT) gaining popularity.

The emergence of innovative developments and uses of information technologies in China’s fight against the COVID-19 epidemic were unprecedented. China is fighting and, as is believed, on its way to winning the fight with the aid of technologies.

Online epidemic information dissemination platforms are critical in updating the public on coronavirus. What is worse than the virus itself is people panicking. Timely release of official statistics about the COVID-19 epidemic and keeping the public correctly informed of the current situation are vital to calm people and engage them to comply with the prevention and control efforts. Shortly after the outbreak, Chinese media in both the public and private sectors created platforms to release updates and knowledge about the epidemic.

At least five major official and commercial news websites and smartphone apps have been extensively accessed by people seeking up-to-date epidemic information, including the People’s Daily,2Dingxiangyuan (an Internet-based health news agency),3Alipay,4Tencent,5Chinese Financial Times,6 Toutiao, UC browser and Sogou. The figures include daily updated new and cumulative numbers of confirmed, suspected and critically ill cases, as well as the death toll nationwide, by province and city as well as global statistics. These numbers are sourced from China’s National Health Commission and the local health and disease control authorities.

The online media also provides a variety of useful information and tools, such as color-coded epidemic maps, trend curves, COVID-19 news stories, disease prevention and control knowledge, “Fact Check” guides to correct rumors and misinformation, and free COVID-19 consultation. Some online platforms even offer custom features like “My Epi Updates” for the users to tailor their own daily epidemic updates about the cities they take personal interest in, and Rides Look-up for travelers to find out if they have shared transit rides with any confirmed patient.

One of the most recent, popular features is called “Cases Nearby” and “Cases in My Neighborhood”,7 which display the reported locations of the confirmed cases close to the user’s current location and the areas the patient has gone to using cellphone base station data, without disclosing any personal information about the patient. Users can readily find all the commonly needed information and tools on one of these all-in-one epidemic information platforms. They have become so popular that as of Feb. 27, the Dingxiangyuan platform alone had received over 2.5 billion visits.3 The role that such platforms play in informing the public during the COVID-19 epidemic is tremendous.

AI-assisted coronavirus infection risk identification, temperature monitoring, online screening and consultation platforms. All the Internet hospitals and cloud-based medical consultation platforms owned by businesses or hospitals launched free online consultation services soon after the outbreak to help the general public screen possible infections. Demand for cloud consulting and telemedicine providers has surged.

Hangzhou Join Health Technology Co., Ltd. quickly developed an AI tracking platform for people at risk for COVID-19. It provides self-registration and crowd management modules for high-risk populations, such as people who flew out of Wuhan and were in close contact with an infected person, isolated at home, or those with a fever.8 Integrated with the smart follow-up platform, which has been operated by Join Health for many years, the AI tracking platform is interfaced with more than 400 hospitals for sharing information and following up the daily health status of high-risk groups. 

The “Manniu Health” team under Wonders Group has developed a free online screening toolkit called “COVID-19 Quick Test.” The team compiled clinical guidance and epidemic investigation strategies and employed big data and artificial intelligence technologies to build the toolkit, which helps residents quickly understand their health status, infection risks and offers recommendations according to the screening results.9

On Feb. 26 health authorities in Wuhan started recommending that residents use online screening apps. Changsha, a city in Hunan Province, launched a COVID-19 infection early self-screening feature on “My Changsha” app, the city’s official comprehensive services platform. Shanghai and other major Chinese cities also initiated similar efforts.10 Users can receive an instant conclusion about their infection risks with personalized recommendations from the system’s AI. The system generates messages based on the answers a person enters for a set of simple questions. Automated responses include “Keep up with strict precautions to minimize risks,” “Immediate self-isolation is required,” “Please report to the local community authority,” or “Please go to hospital.”

Some apps even give specific instructions, such as how to take precautions, how to conduct self-isolation for 14 days and where to find a fever clinic or designated hospital. Self-screening features like this have also been created on smartphone apps, and are a helpful tool for early infection detection and care. 

Tsinghua University Institute of Precision Medicine, Institute of Artificial Intelligence and Tsinghua University Affiliated Beijing Tsinghua Changgung Hospital jointly developed and launched the COVID-19 Self-Screening System Feb. 1, which is open for free public access.11

A “Traditional Chinese Medicine + AI” by TCM Brain, a tech company in Hangzhou specializing in AI applications in traditional Chinese medicine, also recently launched nationwide.12

Big data generated by cellphone numbers, transportation records and online payment records is also helping to disrupt virus transmission. Initially it was only used to trace people who flowed out of Wuhan. Now we find that whoever has shared the same train, flight, bus or taxi with a confirmed patient may be tracked down and contacted anywhere in China.

An example of this technology involved a taxi driver in Zhejiang province who was diagnosed with COVID-19. Most of his passengers within 14 days were tracked down with their online payment records. Nine passengers who paid by cash reported to local authorities after they saw the trip details published on public media.13 

Trains, the No. 1 means of travel in China, carried some 3 billion passengers during the 2019 Spring Festival period. Now all train riders are required by the Chinese railroad authority to register a personal cellphone number when they purchase a ticket, according to a recent policy.14 This facilitates tracking down and contacting passengers suspected of infection or having shared a ride with a patient. Used together with the national digital railway ticketing system, transit-based big data is a powerful tool to track and tackle possible transmission.

Fever is the most common symptom of novel coronavirus infection and high-performance infrared thermal imaging allows for rapid body temperature measurement of groups of pedestrians and people in crowds. High-performance infrared thermal cameras have been installed at the entrances of some major train stations and airports in China. The devices capture thermal images of mass people flow in real time and rapidly detect people with an abnormal temperature. Unlike human measurement, the technology works 24/7 and greatly reduces risk of transmission via human contact. Tech companies are also proposing to use AI to establish the identity of passengers in the measurement area, allowing those suspected of infection to be immediately separated from the crowd.15 

To allow the front-line disease control staff to measure body temperature without physical contact, world leading drone developer DJI launched an emergency temperature measurement solution for drones. By applying a simple modification of a cotton swab, DJI adapted their drones designed to monitor temperature fluctuation in industrial environments to function with the accuracy needed to identify fever in humans at physical distance. Using a cotton swab as a known temperature reference, DJI improved the reading accuracy of their instrument improved to ±0.5 degrees Celsius.16 Drones equipped with a thermometer are used for measuring body temperatures in some neighborhoods where the people don’t have to come out of their homes. The person to be measured is instructed by a loudspeaker on the drone to step closer to the window for temperature taking without any physical contact.17

Numerous online telemedicine companies, including Chunyu Yisheng and some hospitals, launched free Internet-based consultation services within days after the epidemic began. WeDoctor started to provide psychological counseling online. Xikang Cloud Hospital offers free online COVID-19 consultation. Zhuojian China provides free imaging consult service for Internet hospitals.18 PKU-HIT helped hospitals to deploy new online fever consultation in less than six hours free of charge.19 China Mobile devised free remote consultation platforms for the medical teams in Guangxi, Shanghai and Jiangsu and helps Chongqing, Sichuan and Zhejiang to provide 5G-based remote diagnosis and treatment, screening and thermal imaging. 

There is a vast number of people under quarantine or self-isolation. Many of them need professional psychological counseling, which is now readily available online.18 Online counseling apps are offered to all the individuals isolated because of the epidemic, including the popular “Healthy Living Club,” an online counseling app specially developed for the COVID-19 epidemic.

AI-assisted radiological image interpretation of coronavirus and intervention recommendations. Artificial intelligence is finding its place in the fight against the coronavirus. AI-assisted medical image reading programs have been tested and launched to help diagnose COVID-19 patients more quickly. A cloud-based coronavirus pneumonia diagnosis service using AI-assisted computed tomography (CT) image interpretation was launched by Huawei Cloud, a healthcare business of Huawei.20

According to a recent report, the Public Health Center of Shanghai validated a similar technology,21 which could read lung computed tomography (CT) imaging with an equivalent accuracy to an experienced human radiologist. The software was developed by YITU Tech, a Shanghai hi-tech company specializing in health AI.21 Both technologies are capable of processing CT images in seconds and speed up diagnosis significantly. 

Winning Health, a health IT company in Shanghai, released a cloud-based AI-assisted diagnosis assistant for COVID-19, providing free online screening and diagnosis services for physicians and radiologists to ID the suspected cases more efficiently. The product has been adopted by the major anti-epidemic operations such as the Henan province’s version of “Xiaotangshan Hospital”.22 Similar products and services are launched by tech giants like Tencent.

Community outreach and support concerning COVID-19. Huangpu district, Guangzhou city, Guangdong province launched a Huangpu District Epidemic Prevention and Control Platform23 to keep track of the community risks and situation. With the app the residents can submit daily health status reports, which are reviewed by their grid health manager, a health or community worker designated for a section of the district who would respond with a message, a phone call, or even a home visit accordingly. The latest update of the app is an “I Need” feature for those residents isolated in their homes for suspected infection.23 The user may type in what daily necessities he or she needs, like rice, meat, vegetables and medications. The community officials will help buy and deliver them to the isolated residents after receiving the message on the app. The “City Cloud Brain” is a city-wide integrated urban administration system of Yan’an City, Shaanxi Province. It incorporates over 1,300 video feeds from public stationary CCTV, AI-powered surveillance cameras, drone-borne cameras and portable digital recorders to monitor the gathering of crowds in public areas and help dispatch police officers to discourage gathering.11

Based on the national integrated government service platform, Alipay has developed an epidemic prevention and control health QR code system. The “Health QR Code” is generated from the data entered into a standard questionnaire about a person’s recent exposure possibilities and risks. The QR code is meant as a COVID-19 health status certificate for residents and people traveling back to work24 when they enter and exit the city. The code uses three colors — green, yellow and red — to represent low, medium and high exposure risk, which risk levels accordingly designate the user’s freedom of travel. Users with green codes are approved to board public transit, for example, while users with red codes are directed to self-segregate at home for 14 days. The Alipay Health QR code can be interfaced with Dingtalk, Alibaba’s telecommuting platform for companies. Tencent WeChat also launched a similar feature on their mini-app to help communities and individuals using the three-colored online health certificate. Wonders Group has developed a personal code for Shanghai residents on a local app, which updates the user’s health status with regularly updated data.25

Big Data Analytics for Epidemic Prevention and Control

Big data has been a powerful weapon in fighting the epidemic. Most of the technologies mentioned above are built on top of big data, which has become a valuable asset for tackling the COVID-19 epidemic. By aggregating and analyzing the epidemic data with advanced analytics techniques for big data and cloud computing, public health authorities have been able to optimize their decision-making. Local authorities use big data tools like Baidu Migration Map to determine how many people came to the economically developed cities or left for the broad rural areas, and understand their distribution, predict the number of potentially infected, so as to decide supply allocation and control measures.26

Moreover, for instance, based on big data, the authorities may determine how many people had been to the seafood market that was believed to be ground zero of the outbreak, before it was shut down, and inform those people of their disease control decisions. Additionally, the authorities also use prediction models to estimate the distribution of asymptomatic patients and predict the likely turning point of the epidemic after factoring in other data such as trends in confirmed and emerging cases. From users’ smart bracelets and watches, Huami Technology has collected over 26.76 million sleep and resting heart rate data of 115,000 people in Hubei province and the nearby Anhui province, which are used for building a prediction model for flu.27 Professor Huang Senzhong and his team from the School of Statistics and Data Science of Nankai University are offering data support for epidemic prevention and control with regular epidemic predictive analyses.28

Supercomputing for vaccine and drug development. Several supercomputer centers in China are working to assist China CDC in developing new vaccines. Researchers are using supercomputers for target exploration, drug selection, primer and experiment optimization, pharmacological and toxicological studies. Designated lLabs that have received the viral strains have begun vaccine R&D and drug selection.10 Alibaba has opened up all its computing power to the global research community free of charge.29

Contact-free Technologies Help Prevent Spread of Coronavirus

Many of the online healthcare and telemedicine platforms are seeing unprecedented growth. Most routine hospital visits for chronic disease follow-up and drug refill, as well as elective hospital admissions, have been deprioritized to free up resources and give priority to the care for the COVID-19 patients and minimize risks for cross infection in the otherwise over-crowded hospitals.30 Independent Internet-based healthcare providers and Internet hospitals that are affiliated to a hospital offline have introduced a variety of measures to booster use of online registration and consultation. Winning Health,31 a health IT developer in Shanghai with an online consultation product line, is seeing soaring demand since the beginning of the epidemic.

Ewell, a HIT company in Hangzhou, has deployed an online consulting system for a number of hospital clients since the outbreak began, including MDT platforms for remote multi-disciplinary consultation for the critically ill cases.32 An online health consultation application from PingAn Group, one of China’s largest health systems, reports a 5-10 fold increase in the use of online registration and consultation.33 On Feb. 23, Shanghai Medical Insurance Authority announced the “12 Measures for Medical Insurance” after the Zhejiang Provinvial Medical Insurance Authority took the lead to include Internet and healthcare services for medical insurance reimbursement on Feb. 10.34 With the opening up of the medical insurance policies, sharply increased demand for the Internet and the healthcare industry is widely expected.

Telemedicine services. Major hospitals have long established a telemedicine mechanism with medical groups or internet hospitals, and during the epidemic telemedicine is finding even broader use. Ngari Health participated in the reinforcement of Wuhan Huoshenshan Hospital to complete the commissioning of debugging and enabling of the remote consultation platform.35 In Guangdong province, the COVID-19 Medical Team holds online multi-disciplinary consultation conference calls with experts in other cities.36 Expertise from West China Hospital, Sichuan University can view and discuss lung images of COVID-19 cases with physicians in Wuhan through a 5G telemedicine platform.37 The First Affiliated Hospital of Zhongshan University also offered multi-disciplinary consultations with hospitals in Wuhan,38 where more than 30 experts in over 10 specialties engaged in discussions of the critically ill COVID-19 cases. Even more potential is being released as almost every major Chinese hospital across the country has some extent of telemedicine capability.

Care in the isolation wards. According to the head of the Nursing Department at the First Affiliated Hospital of Xiamen University, the designated hospital for the treatment of COVID-19 in Xiamen city, China Unicom has provided mobile devices, 5G network and cloud video services for the hospital isolation wards, enabling the collection and transmission of patient information in the isolated area much quicker. The 5G network shortens the distance between nurses
and patients.

The care team formed a WeChat group with each patient for routine communication. Psychological and symptomatic reporting cards are created for patients to fill out and sent to the care team online for nursing interventions. Some nurses are assigned to the other two hospital campuses in Xiamen. In order to achieve the simultaneous implementation of specialized care plans in the three places, cloud video conferences are carried out through a 5G network on a  routine basis.

Unprecedented growth in telecommuting and online education. The novel coronavirus outbreak began right before the beginning of China’s Spring Festival holiday season, the country’s most celebrated, and the longest, holiday with the world’s largest population migration over a very brief period of time. The holiday season has been officially extended twice, initially for one week and then for another two weeks, for most businesses and all schools across the country for fear of virus infection. All citizens, except those engaging in the epidemic response, are required to stay home and away from crowds. With the back-to-work and back-to-school dates postponed, telecommuting and online education providers have found demand and opportunities like never before. 

To minimize delay of classes for students, a number of Chinese online education providers have opened up their recorded lessons free of charge and provide live-streaming classes where the teachers give lectures in front of a camera either alone in a classroom or from their own homes. Telecommuting has become a new norm during the epidemic. Online ordering, gaming and many other Internet-based industries are also seeing unprecedented growth. Ding Talk, a telecommuting platform of Alibaba,39 Com WeChat of Tencent,40 and Troila Technology41 have even promised free-of-charge services until the epidemic ends.

Drones deployed for crowd activity monitoring, environment disinfection and fever detection. The novel coronavirus is transmitted by droplet and possibly by contact. Proper self-protection and social distancing are known effective measures for reducing transmission. Close and immediate physical contact is discouraged. Drones are now used in China on many occasions for fighting the epidemic. Police officers remotely control drones with a camera and a loudspeaker to monitor people outdoors.42 Gathering of crowds and not wearing a mask in outdoor public places may result in an airborne instruction asking the people to scatter and go home or to put on a mask. Use of the drones has considerably improved the monitoring efficiency with notable results. Farm dusting drones are modified for urban environment disinfection in some cities.41 In Zhongwei city, Ningxia autonomous region, local community workers use a drone to spray disinfectant.43

Contact-free take-out food delivery. Some of China’s leading take-out food apps including Meituan44 and Ele.me45 are trying out this new way of delivery. When placing an order, the users can call the courier and agree on a location to drop the food. The courier gives the user a call or a message on the app after the drop is made, and then the user goes out to pick it up. The process prevents any direct physical contact. To take it to the next level, automated smart delivery robots are sent to deliver food on some special locations such as to a designated hospital caring for COVID-19 patient.

5G-based Robotics and Infrastructure to Help Fight Coronavirus

Robots are being dispatched to work in hospitals during the epidemic to perform functions such as screening and orienting patients, delivering supplies, medications and food, disinfecting spaces, and even providing company. A handful of Chinese hospitals including Wuhan Union Hospital have received robots specially tailored to the COVID-19 epidemic.46 Use of robots in contagious environments helps reduce chance of cross-infection and saves resources.

Wuhan, at the epicenter of the COVID-19 outbreak, has been on a strict quarantine. With the number of patients rising continuously, the capacity of medical facilities has been extremely stressed. There were not enough beds to admit and isolate the infected and suspicious patients. The state authorities mobilized massive resources to assist the city to fight the epidemic shortly after it began. Two new makeshift designated hospitals, the 1,000-bed Huoshenshan Hospital and the 1,200 bed Leishenshan Hospital (named after the Gods of Fire and Thunder believed to fight away diseases in Chinese ancient mythology), were built and operationalized in 10 and 12 days.47 To help the public awareness of additional resources that are being developed, live broadcasts and streaming of those new hospitals were well received.48 Technology companies are also moving very quickly. For example, Huawei completed planning, inspection, laying of optic fiber, base station installation and commissioning of the 5G communication infrastructure for the Huoshenshan Hospital (Fire God Mountain Hospital) in three days to support remote command, teleconferencing, remote surgery and data transmission of the newly built hospital.49 Large new hospitals in Wuhan have also launched EMR systems and network systems at an extraordinary speed. DHC, a major Chinese health IT vendor, deployed the EMR system of the Huoshenshan Hospital in just 10 days.31

Increasing IT Security

When organizations become increasingly digital, IT security cannot be over stressed. 360 Security, a cyber security firm in Beijing, captured an attack that exploits a COVID-19 themed file. The attacker used the file to launch an APT attack (a computer intrusion process by a hacker) on healthcare organizations. Staff from 360 Security confirmed that the hacker used a spear-phishing strategy, where the intrusion bait was sent by email. Some of the bait files were named Wuhan Travel Information Collection Form.xlsm.50 Once the receiver clicks on the file, the intrusion is triggered.

IoT Gaining Popularity to Help Track Clinical Specimens

The “Biosafety Credibility Management Platform,” a series of products from Honor Trends, a Beijing tech company specializing in smart management of frozen bio-products, integrates IoT micro-chip, AI and blockchain technologies for unique identification of clinical specimens, blood, supplies and reagents used for fighting the epidemic.51 Medical waste intelligent cloud management system from Ewell, one of China’s leading HIT companies in Hangzhou, helps better hospitals’ management of medical and other wastes.52 The intelligent temperature detection solution for epidemic prevention and control provided by Tencent Cloud improves efficiency and safety of temperature measurement with online resident registration, automatic temperature collection and personal information management,53 which also provides a one-stop feature to support a community’s offline temperature taking processes.

Conclusion on the Use of Health IT  to Fight Coronavirus

The COVID-19 epidemic poses threat and danger for all. The entire Chinese nation is fighting the virus in solidarity. As eloquently said in the “Report of the WHO-China Joint Mission on Coronavirus Virus (COVID-19),” in the face of a previously unknown virus, China has rolled out perhaps the most ambitious, agile and aggressive disease containment effort in history. Achieving China’s exceptional coverage with and adherence to these containment measures has only been possible due to the deep commitment of the Chinese people to collective action in the face of this common threat.1 

In the fight against the COVID-19, numerous information technologies have sprung up and been adopted in various aspects of disease control, healthcare as well as people’s daily living and work. “The time gained by rigorously applying COVID-19 containment measures must be used more effectively to urgently enhance global readiness and rapidly develop the specific tools that are needed to ultimately stop this virus,” the report stated.1 This is where information technologies come in to play a crucial role.

This article does not exhaust the scenarios and applications where China has and continues to adopt technologies to modernize and empower its fight against the epidemic. We are confident and look forward to witnessing and embracing the unprecedented impact of information technologies upon China’s epic anti-epidemic campaign and a better future for all. 

Jilan Liu, M.D., MHA, is the CEO for HIMSS Greater China. She was previously principal and consulting director of the Greater China Joint Commission International (JCI). As chief executive for HIMSS Greater China, Liu and her team made a significant breakthroughs with hospitals and the HIT industry in the greater China region to embrace international HIT standards, certification requirements and to rethink prudent approaches to IT investments and operations. 


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