East Meets West: The Shanghai Experience

Of all the places visited in China, Shanghai was by far the most western in its appearance and culture. With a population of over 18 million, Shanghai ranks first in population and population density. Beautifully shaped contemporary skyscrapers line the Shanghai skyline, contrasting the older, more traditional buildings.

The first evening in Shanghai, the delegation was treated to an acrobatic show performed by top Chinese acrobatic performers. These incredibly talented performers generally retire in their mid-twenties due to the strenuous acts. Just watching created sweaty palms and heart palpitations.

The next day we experienced the sites and culture in Shanghai. We walked the Bond on the Yangtze River where visitors can view Shanghai’s signature skyscrapers erected less than twenty years ago. From there we toured the Shanghai Museum, housing a high-quality collection of ancient Chinese bronze, coins, ceramics, calligraphy, paintings, furniture, and sculpture. We also toured a silk rug factory, a traditional Chinese garden, and shopped in Old Town. Delegates completed their day with a traditional Chinese foot massage.

The professional day included meetings at the Shanghai International Medical Exchange Center and the Shanghai Yueyang Hospital of Integrated Traditional Chinese Medicine and Western Medicine. The meetings focused on reviewing similarities and differences in electronic health records and documentation practices. The Medical Exchange Center affiliates with the Shanghai Health Bureau to facilitate the introduction of new technologies and medical exchange between China and other countries. The photo above shows the delegation presenting to the Shanghai International Medical Exchange Center. Where electronic health records exist in China, they’re used to capture diagnostic procedures, basic collection of demographics and health statistics, and financial administration. China uses ICD 10 rather than ICD 9 as we do in the U.S.

The hospital we visited in Shanghai was the most modern and clean facility in China. The physicians we met with attribute this to the increased competition in Shanghai for patients since more hospitals are located there and the influence of Western culture through television and movies. When the Chinese see modern, clean hospitals in the West, they want the same things in their hospitals. Much changed when President Nixon opened relations with China in the early ‘70s and Western medicine was introduced and widely used throughout China. Computers were introduced in the hospital in 1984 and information based medical recording started in 1998. However, many of the traditional Chinese medicine doctors don’t know how to use computers. This facility and others throughout China that use computers still rely on the printed medical record.

The Local and Rural Experience in China: Guilin

When flying into Guilin, one of the most popular Chinese cities for tourism, we were immediately struck by the beauty of the mountain formations. These formations are actually limestone karst hills formed more than 200 million years ago when the oceans receded from this area.

The delegation began the program in Guilin with a cultural day of traveling down the Li River on a flat bottom boat cruise. The river trip winded through small villages and the mountain formations. We saw water buffalo, caves, local fishermen, farmers, and children along the waterfront. We had the opportunity to visit a local village and tour a woman’s home. The home was a typical construction for the poor villagers who live in the countryside. The three-room home was made of brick and had dirt floors. As you step into the back of the home, there was an open-air kitchen. The utensils were crude and the woman cooked over a fire pit. The woman was selling hand made embroidery balls, her way of making an income.

The professional program offered a different perspective on healthcare delivery and medical record documentation from our experience in Beijing. We toured a Guilin hospital in the morning and a local clinic and health center in the afternoon. The hospital is beginning to implement computerized methods to capture health information for departmental services. Physicians have the ability to access diagnostic reports from decentralized locations on patient units. The hospital still prints out paper records and stores medical records in vertical file formats using a card catalogue system for retrieval. The local health center and clinic serviced the rural areas and was responsible for overseeing physicians who go out to practice in the villages. They deliver approximately 600 babies a year. There was a baby born while we were visiting. Although medical transcription roles don’t exist in China, the Chinese professionals were very interested in learning more about how this process can improve documentation.

Learning About the Chinese Medical Record System: Beijing

As we near the end of our four day stay in Beijing, the People-to-People Delegation learned a great deal about the people of China, its culture, and their medical records system. Upon arrival to Beijing, (the plane ride was 14 hours from LA to Hong Kong and two hours from Hong Kong to Beijing), delegates quickly changed and visited the Lama Temple. The Lama Temple is one of the sacred sites in Beijing and it houses one of the world's largest Buddhas, carved from a single piece of sandalwood.

On day two, we had an opportunity to present to approximately 200 physicians, nurses, and medical records personnel during an event hosted by the Chinese Medical Records Association (CMRA). There was great interest in the role of medical transcriptionist, since in China physicians are responsible for documenting care. Although medical records departments have personnel to provide quality checks, it is the primary responsibility of physicians to document encounters. However, as China moves toward fully adopting electronic health records, there is interest in learning more about the role of the documentation specialist and determining how it might be adapted into their medical records system. A subgroup of delegates is considering a task force to provide technical assistance and consultation to CMRA.

On day three, the delegation toured Capital University of Medical Sciences, founded in 1960, the key municipal university in Beijing and one the advanced medical institutes in China. The delegation held a roundtable discussion with university leaders and presented to a class of 50 medical information management students on healthcare information trends in the U.S. and the role of medical transcriptionists in patient care delivery.

The delegation also toured the Department of Medical Records at Peking Union Medical College Hospital, a 1,800-bed Class A hospital that averages 7,000 admissions per day. The photo above shows the scanning process used in their medical record department. We met with several medical records heads from the Northern China Provinces to discuss the challenges of health information in China. Chinese representatives were impressed with the level of support the U.S. receives from the Administration in moving our healthcare system to an electronic platform. The Chinese recognize the importance of this goal to improve patient care, decrease medical errors, and create more cost effective and efficient systems of care.

Day four was a cultural day where delegates and guests toured Tian’an Men Square, the Forbidden City, and climbed the Great Wall of China. The people we have met along the way have been very gracious, willing to share and exchange cultural stories, and make us feel at home. We also passed by the construction sites for the 2008 Olympics. We are now ready to fly to our next city, Guilin.

On the Road Again: Destination China

As part of the People-to-People Ambassador Program, I’m leading a delegation of industry professionals to China for a program on Healthcare Documentation and Data Capture. The delegation consists of three medical transcriptionists, two MT business owners, two transcription managers, an MT educator, and an administrator of an ambulatory specialty center. We also have four guests who have come along for the cultural opportunities. The delegation is from eight U.S. states and Canada. I’m writing this initial blog in the Los Angeles International Airport close to midnight. We arrive in Beijing through Hong Kong.

We have professional meetings scheduled with the Chinese Medical Records Association, several healthcare facilities in urban and rural areas, and a school for health information management. We’ll exchange ideas and discuss trends in healthcare documentation and data capture related to emerging technologies, information exchange, and educational efforts to address the growing complexity of clinical documentation. The delegation will also go to historical cultural sites and spend some time learning about the Chinese people and their culture. We hope you follow along as we provide the citizens of China information on the medical transcription profession in the U.S. and the essential role transcriptionists play in quality patient care delivery.