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International informatics: the Chinese experience.

China. The awakening giant, home of the world's largest population and the emerging economic superpower. With 1.3 billion people, burgeoning health problems, and an aging population, China is gearing up their informatics engines and putting the power of their collective minds to work. In anticipation of the explosion of informatics in China, 23 US informaticians headed to China last fall to survey and consult with like-minded Chinese about healthcare information technology (IT).

Our delegation was comprised of nurses, physicians, informatics and computer scientists, academics, practitioners, and consultants from the informatics realm. The trip was part of the International People to People program, and was the first ever organized by People to People around the theme of Informatics. To be frank, it was a challenging trip to plan. Although not considered a "new" specialty by many reading this article, there are still many in the US who struggle to understand what informatics is--and what it is not. Compound this exponentially by trying to arrange an informatics delegation to another country, throwing in language and cultural differences! The end result however was a visit that was challenging, phenomenally interesting, and personally rewarding.

In participating in a People-to-People program, participants are allowed to either book their own airline ticket or meet in a departing city (ours was LA) and travel en masse. Many of us ended up on the same flight from LA to Beijing where we were met by our Chinese national representative, Tony Zhao. As the purpose of People to People International is to "enhance international understanding and friendship through educational, cultural and humanitarian activities involving the exchange of ideas and experiences directly among peoples of different countries and diverse cultures", we spent the first evening learning very rudimentary Chinese expressions, getting briefed on culture and customs, and learning how to gracefully eat with chopsticks. We coalesced that evening into a jolly group of informaticians, forming new friendships, sharing interests, and setting goals for our visits.

While in Beijing, we met with the China Medical Informatics Association (CMIA) leadership team. The CMIA is the counterpart to the American Medical Informatics Association (AMIA). Our team also visited the Capital University of Medical Sciences, and the Peking Union Medical College. Both of these Universities are the intellectual powerhouses for health sciences in China, and both stand poised to provide fuel for the growth of intellectual informatics in China. We also met with members of the Telemedicine Center of Number 310 Military Hospital, where we learned about telehealth applications being used by the Chinese military. China stands at the brink of harnessing informatics, yet we quickly determined that the US understanding of informatics and the Chinese understanding of informatics were quite different. Examples of some of these differences are described later in this article.

As part of the cultural exchange aspect of the trip, while in Beijing, our delegation also experienced the Peking Opera, the Forbidden City, Tiananmen Square, and the Great Wall of China. Beijing, the site of the upcoming Olympics, is in full swing modernizing for the Games. Massive public works projects are underway, including the movement of large coal-burning power plants to more remote areas in an attempt to improve the air quality. While having our formal picture taken in Tiananmen Square, a misguided and distraught woman attempted suicide by slashing her wrists in a political protest. We believe that had she known we were nurses and doctors that she would have made this attempt elsewhere! It was interesting to note that even though we were all informaticians, we are still healthcare providers in our soul--tourniquets were applied and care given until an ambulance arrived. Not once did I hear anyone say "reboot"!

Our trip continued as we all flew to Chongqing, the world's most populated city. Chongqing is the site of the Three Gorges Dam, and it sits on the steep hills above the confluence of the Yangtze and Jialing Rivers. While in Chongqing, we visited the First Affiliated Hospital of the Third Military Medical University, where we met with the Director of the Nursing Departments, and the Director of the Hospital. This very modern and beautiful hospital rivaled those seen in the West. Of particular interest was the Neonatal Intensive Care Unit (NICU). Parents are not allowed into the NICU, so the Chinese have created tele-visiting facilities where the parents can sit at a monitor and visually observe their babies. While this does not substitute for hands-on, it is an interesting technological compromise that offers some solace to concerned parents. In Chongqing, we also visited a rural elementary school, a rural village, and the Dazu Stone Carvings (a United Nations Educational, Scientific and Cultural Organization World Cultural Heritage site). The elementary school was very poor by US standards, the rooms do not have heat and the children work on small chalkboards, but the children were bright and eager to learn. They entertained us by singing the Chinese national anthem, we made them laugh with our terribly off-key rendition of "My Country 'Tis of Thee".

Our final stop was in Shanghai, which looks remarkably like any large western city. It is the fourth largest city in the world. In Shanghai was visited the Shanghai Jioa Tong University, the Fudan University Medical College, and the Shanghai Bioinformatics Center. These highly advanced settings are home to much of China's work in computational biology, genomics, and proteomics. Shanghai is also shopper's paradise, so our delegation actually spent the last afternoon of our time in China shopping at "China Town" in Shanghai.

So, what is the summation of the trip? In my opinion, informatics in China is about where the US was 20 years ago--in some respects. The word "informatics" in China is still viewed primarily as signal and image processing, number crunching, and computational analysis. We did not see informatics as we know it deployed routinely in the patient care setting. We did see examples of digital x-ray (PACS), but only in a few of the more advanced "showcase" settings. There are advanced sites that are at the experimental stages with informatics actually woven into the care process, but again, these are primarily at the "showcase" sites such as the Peking Union Medical College (PUMC) in Beijing.

Where is nursing informatics in China? It would be best to first talk about where nursing is in China. Nursing in China is growing. Johns Hopkins School of Nursing just initiated the first PhD program for nurses located in China in the Spring of 2005 at (PUMC). The number of nurses with advanced degrees in China is very low, which impacts the growth of nursing informatics within the country and has prevented nursing in China from making the same types of advances as nursing in other countries. Questions about the nursing use of IT in China were occasionally met with a bit of a confused look--primarily because the use of IT in healthcare in China is quite rare, dominated by physicians and computer scientists, and focused primarily on computationally complex tasks such as image processing. However, this is changing in China. Growth of nursing programs and the awareness of the Chinese people of the importance of informatics is rapidly transforming the healthcare scene. The increase of the middle class in China, the movement towards less reliance on the government for healthcare, movement toward capitalism with "Chinese characteristics", the growing influence of Western medicine, and the Severe Acute Respiratory Syndrome (SARS) scare of 2003 has resulted in increasing interest in informatics and biosurveillance in China. China, with its massive population, economic power, authoritarian government, and intellectual capital stands poised to make its mark on global healthcare informatics.

Many of our delegation have parleyed the visit into ongoing relationships. The CMIA is ending a delegation of 15 top Informaticians to the fall meeting of AMIA in late October of 2005 to collaborate and enhance relationship with US counterparts. We hope that the connections between US Universities and members of our delegation may influence the growth of Nursing Informatics in China. Regardless, our delegation was given the chance to look into the Chinese informatics engine. We were given a glimpse that we are not soon to forget.
COPYRIGHT 2005 Capital Area Roundtable on Informatics in Nursing
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Author:Abbott, Patricia A.
Publication:CARING Newsletter
Geographic Code:9CHIN
Date:Jun 22, 2005
Words:1359
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