CEO SUMMARY: It was record attendance at the major pathology congress which took place in Hangzhou, China, last month. Because of the ongoing growth of China’s economy, the demand for healthcare—and for high-quality clinical lab and pathology testing—is rising at an accelerated pace. During his visit to the pathology congress and Chinese hospital labs, your editor gained useful insights about the state of lab medicine in China—and why there will be more collaboration with labs in the U.S.
FEW WOULD CHALLENGE the statement that China is on its way to developing into the world’s single largest market for clinical laboratory testing and anatomic pathology services.
The basic facts are indisputable. It is the most populous nation on earth, with 1.3 billion people. The number of public hospitals in China is about 14,000 and the number of private hospitals is 5,736, according to a statement from China’s Ministry of Health. Many of these are huge facilities by U.S. standards, boasting between 1,000 and 3,400 beds.
Last month in Hangzhou, China, a record crowd of approximately 1,200 pathologists gathered for the 17th Congress of the Chinese Society of Pathology and the 1st Annual Meeting of Chinese Pathologists. Your editor was there to deliver a presentation about the role of quality management systems (QMS) in histopathology labs.
This was my first trip to China and it was an opportunity to get a first-hand understanding of laboratory medicine in this rapidly-developing nation. The pathology congress conducted sessions over three days and I also had the opportunity to visit a number of clinical laboratories and anatomic pathology labs in hospitals in both Hangzhou and Shanghai.
There was much to see and learn about laboratory medicine in China. This briefing is a first attempt to communicate useful impressions that will help pathologists and clinical laboratory administrators in other countries understand some of the more important drivers of medical laboratory testing in China.
Throughout my visit to China, everyone was friendly and most hospitable. Not only was this true of the pathologists at the congress and during our site visits, but it was equally true of the people we met in the community.
This Asian Tiger is roaring and Chinese pathologists and lab scientists are positive about their opportunity to advance patient care. They recognize that their health system, their laboratories, and their medical skills start from a different level, when compared with world-class clinical laboratories and anatomic pathology labs in advanced economies.
Chinese pathologists are eager to acquire and use new laboratory technology and instrument systems. My impression is that the majority of pathologists and lab scientists I observed at the pathology congress are actively building their personal skills and expertise. There were over 100 presentations at the Congress and all were well-attended.
Eager to Acquire More Skills
Take this, then, as a starting point for understanding the state of laboratory medicine in China. There is a recognition that the current state can be improved and much work must be done to raise the level of training for pathologists and to add capabilities to their laboratory facilities.
The next useful insight about laboratory medicine in China is that the global in vitro diagnostics (IVD) manufacturers play an essential role in helping Chinese pathologists and lab professionals upgrade the capabilities of their laboratories and advance their personal skills. These vendors are introducing their Chinese lab customers to “best practices” in lab medicine, for example.
More specifically, lab suppliers are proactively making “knowledge transfer” a key element of their business strategy in China. Local pathologists welcome this access to the latest information and innovations in laboratory medicine.
Vendors Arrange Site Visits
I saw this repeatedly at the pathology congress and during my site visits. For example, it was Thermo Fisher Scientific, Inc., which helped arrange my presentation at the conference, along with site visits to prominent hospital laboratories in Hangzhou and Shanghai. This included translation services which were essential, since I don’t speak Chinese and not every pathologist is comfortable speaking English.
Thanks are also extended to Aperio Technologies, Inc., for arranging my visit to the Chinese pathology laboratory at Second Affiliated Hospital in Hangzhou. This pathology lab has a relationship with the pathology department at UCLA that includes use of digital pathology in ways that enable specialist pathology consults and advanced subspecialist training for Chinese pathologists.
I will write about the details of this arrangement in an upcoming issue of THE DARK REPORT. Their collaboration across the Pacific Ocean has been active for more than a year. It provides an early example of how and why some anatomic pathology cases are likely to cross international borders.
Clinical Lab Site Visits
For site visits to clinical laboratories, it was Siemens Diagnostics that provided essential help. Because of their relationships, I was able to visit several clinical labs in hospitals in both Hangzhou and Shanghai.
One laboratory site visit was particularly notable, since it was an example of a private medical clinic/hospital organized somewhat along the lines of the concierge medicine practice as it exists in the United States. More will be written on that site visit in upcoming issues of THE DARK REPORT.
As I participated in these activities and site visits, it became clear that IVD companies and lab suppliers are an essential channel for clinical knowledge and state-of-the-art technology. The importance of this to the Chinese laboratory medicine profession should not be underestimated.
For that reason, in the upcoming brief- ings about these laboratory site visits, it will be important to recognize the role of the vendors who facilitated what turned out to be rich exchanges of information for all parties involved in each site visit.
China’s Heathcare System
These insights provide you with some context for what I saw and learned while in China. There are specific elements of healthcare and laboratory medicine in China that are similar to healthcare and lab medicine in the United States.
First, government budgets for hospitals fall short of covering the full cost of operating the hospitals and their associated out-patient clinics. That is one reason why there is a flourishing private market for healthcare. Chinese providers want to attract cash-paying patients as a source of additional revenue.
At the same time, many Chinese patients are skeptical of the quality of care that may be provided by hospitals, physicians, and laboratories in their communities. Thus, providers want “quality hallmarks” that patients will recognize.
For this reason, CAP’s lab accreditation program is seen as a differentiator that will be recognized by patients and physicians. Similarly, The Joint Commission (TJC) has a program for hospitals in China that is administered by Joint Commission International (JCI). There are 12 Chinese hospitals that have achieved JCI accreditation.
It also appears that the clinical laboratory market in China now includes a category of national reference and esoteric lab testing companies. Similar to ARUP Laboratories, Inc., and Mayo Medical Laboratories, here in the United States, these are independent laboratory companies that solicit lab specimen referrals from hospitals throughout China.
Reference Testing Lab Firm
One such company is Kingmed Diagnostics. Not only has it entered into the digital pathology arrangement with UPMC (see sidebar on page 17), but it is also a CAP-accredited laboratory. It recently earned its accreditation to ISO 15189 through the China National Accreditation Service for Conformity Assessment (CNAS).
As these observations indicate, there was much to see and learn during my first trip to China. With significant numbers of Chinese pathologists, Ph.D.s, and laboratory scientists training in the United States, it is logical to assume that these professional relationships will carry forward and form the basis for many more trans-Pacific collaborations involving medical laboratories in China and the United States.
Chinese Pathologists Look To United States for Expertise
WHILE IN HANGZHOU, CHINA, LAST MONTH to participate in the 17th Congress of the Chinese Society of Pathology, the largest international presence were pathologists practicing in the United States. This can be taken as a sign that Chinese pathologists are very interested in the U.S. models of anatomic pathology and laboratory medicine.
The China-U.S. pathology links seemed to center around two elements. First, there was a large contingent of Chinese or Chinese-American pathologists who are practicing in the United States and who were at the pathology congress to deliver presentations on their pathology subspecialty interest. This is evidence of a rich educational exchange in laboratory medicine between the two nations.
The second element involved American pathologists who are actively courting clinical and business relationships with pathologists in China. For example, a number of pathologists from UPMC Health System (University of Pittsburgh Medical Center) led sessions at the pathology congress. UPMC’s Department of Pathology has a digital pathology consulting arrangement with Kingmed Diagnostics. This is an independent laboratory company based in Guangzhou, China.
Also present at the pathology congress was a pathologist representing the College of American Pathology (CAP). CAP offers its laboratory accreditation program in China. It currently has 14 Chinese laboratories which have met its accreditation requirements.