Digital health examination service for the elderly

The core value of the digital service for elderly health examinations is to transform the three major pain points of the past elderly physical examinations: "low participation rate, poor report readability, and lack of follow-up intervention" into an elderly health management portal of "high accessibility, easy-to-understand results, and closed-loop management". By the end of 2023 , this service has covered the primary health care system in 27 provinces across the country, and the participation rate of key elderly groups has increased by 29% compared with before. However, there are still two core unsolved problems of "insufficient adaptation of the digital divide and non-interoperability of cross-agency data", and a unified implementation standard has not yet been formed in the industry.

Let me tell you a true story I encountered last year when I was doing grassroots digital health community research in a certain city in the east. A 72-year-old Aunt Wang Guiying who lives in an old community in the west of the city has a 10-year history of high blood pressure. In the past few years, she almost never went to free physical examinations organized by the community, or It was because I couldn't spare two hours of queuing to send my grandson to school, or I had been there once before, and the report I got back had seven or eight red arrows drawn on it. No one told me about it, so I threw it in a drawer and forgot about it. It wasn't until I got dizzy and was hospitalized last year that I realized that my blood lipids had been above the standard for half a year. This year, their community changed to a digital physical examination system. They sent her text messages three days in advance. When the grid staff came to deliver physical examination reminders, they made an appointment with her after dropping off her grandson. She could sign in by swiping her ID card at the community hospital without filling out any form. The electronic screen at the door showed the progress of the queue in real time. After she had her blood drawn and done a B-ultrasound, the whole process took less than 40 minutes. Her son received the electronic physical examination report that night, and she herself received a voice call from the community hospital. She was given clear instructions on what to pay attention to when her indicators were high, and whether she could stop antihypertensive drugs. Two weeks later, the family doctor came to her home with an automatically generated follow-up sheet to adjust her diet plan. This is the most intuitive benefit of implementing digital services.

What’s interesting is that the industry’s current thinking on this matter is actually divided into two distinct groups. One group is the "technology-first group", advocating the use of intelligent equipment throughout the entire process, such as face check-in, AI-assisted film reading, and automatic synchronization of health files to maximize efficiency. A social welfare center in Guangdong I visited used AI to read chest CT scans three times faster than manual work. The detection rate of pulmonary nodules was 12% higher than manual work. The number of physical examinations for the elderly that can be undertaken in one day has doubled. But the voice of the other school of "prioritizing the elderly" is also very important. Director Li of a community hospital in Beijing complained to me that they had followed the trend and installed a fully self-service physical examination machine, but only three elderly people could use it in half a month. Most of the elderly people could not see the small words on the screen clearly, or they could not enter their mobile phone numbers. The original intention was to save manpower, but in the end it caused the elderly to travel unnecessarily. Later, two counselors were added to help the elderly operate it, and the usage rate was brought back. Now neither side can convince the other. Some places use all smart devices to save costs, while other places recruit a few more medical counselors. Essentially, they all choose the path based on the situation of the elderly in their own jurisdictions. There is no absolute right or wrong.

In addition to disputes over service logic, data security is also an unavoidable hurdle. Last year, the physical examination system of a district and county in Jiangsu leaked more than 2,000 physical examination reports of the elderly due to a security vulnerability of a third-party service provider. In the end, the health department fined the service provider 200,000 yuan before settling the matter. There is a lot of noise in the industry now about data storage solutions. Some people think that data must be stored in private servers of local health care systems to be safe. However, small and medium-sized cities simply cannot afford the annual operation and maintenance cost of hundreds of thousands. Some people think that the security protection level of cloud services of large companies is higher, but in the event of batch leaks, the scope of impact is too large. There is no unified standard yet, and all places are trying to cross the river by feeling the stones.

I have been working on the implementation plan of the grassroots digital health community for more than three years, and I have encountered many pitfalls. In fact, there is really no need to pursue a large and comprehensive perfect system. If a few small details are done well, the implementation effect can be doubled. For example, don’t just focus on WeChat for physical examination notifications. Many elderly people have their children help register WeChat and usually don’t read it at all. A two-pronged approach of SMS + verbal reminders from community grid staff can increase the examination participation rate by at least 15%. For another example, the physical examination report must be made in two versions. The professional version should be given to children and family doctors at the same time. The version for the elderly must have large characters + audio interpretation. Don't use terms such as "sinus arrhythmia" and "high low-density lipoprotein". It can be directly translated into "if you don't panic, you don't have to go to the hospital" and "eat less fat and walk more." It will only be useful if the elderly can understand it. Another point that is most easily overlooked is that the physical examination data must be directly connected to the family doctor's follow-up system. Don't let the doctor spend another half an hour manually entering a copy. The grassroots doctors are already busy. If this extra step is added, subsequent health intervention will most likely be in vain.

I was chatting with a friend from a provincial health commission a while ago. He said that he took his 78-year-old grandma for a physical examination last month. The medical counselor helped the old woman to swipe her ID card and printed the report in large print and stuffed it into her bag. The grandma told everyone when she got home that physical examinations are much more convenient now than before. You see, in fact, good digital health check-up services for the elderly never allow the elderly to adapt to technology, but the technology bends down to adapt to the elderly. In the final analysis, technology is just a tool that allows the elderly to truly enjoy convenience, which is the core meaning of this matter.