Challenges for Telehealth in China

Although there are undoubted opportunities, telehealth also faces many challenges in China. Despite the successes of early telehealth systems in China, not many of them were self-sustaining, and few are still in operation today. A number of implementation barriers remain to be overcome. These include the following.

A lack of understanding of telehealth by society

Often, telehealth is perceived by health authorities as a low spending priority. Because telehealth is not clearly defined, there are different definitions of telehealth, which makes it difficult for patients to understand its potential. Telehealth might adversely affect the relationship between health professionals and patients compared with normal face-to-face consultations. The reasons include physical and mental factors, depersonalization, different process of consultation, reduced confidence of patients and health professionals, different knowledge and skills required of health professionals, and ergonomic issues. There are also various factors that prevent health professionals from accepting telehealth, including too much change, lack of a user-friendly interface, failure to collect the most important information, inadequate training of physicians to use the system, and lack of control by the organization over physician practices. Factors such as doubt about the quality of the telehealth and conflicts between the telehealth procedure and traditional clinical schedules will prevent patients and health professionals from accepting the new system.

Incomplete telehealth organizational structure and lack of human resources

In many health institutes that conduct telehealth programmes, there are no special telehealth departments or staff. Lack of organizational and personnel resources is a major constraint on telehealth development.

Lack of standards

In China, the telehealth systems and services are developing very rapidly, but the standardization of telehealth lags behind. Standardization of telehealth system components and services is an important element for integration of heterogeneous systems. There are no standards for telehealth in China, and this has restricted developments. For example, in the rural hospitals, there is no digital X-ray equipment, so, when they need to transmit X-ray images to specialists in the cities, the X-ray films are often digitized using a scanner. In practice, poor-quality images result, which would be much improved if there were standards to control the digitization process.

Absence of legislation and regulation

Lack of legislation and regulation is also a major barrier to telehealth development and deployment. There are some national regulations for telehealth, such as regulations governing remote consultation administration. But the work on regulation lags far behind the development of telehealth. There are also some legislative barriers. There is no related law focusing on telemedicine, electronic signatures and patient privacy protection. There are problems with medical malpractice liability, because of legal uncertainties.

High cost and insufficiency of funds for telehealth development

Telehealth depends on new technologies. The devices are often relatively expensive. Also, telecommunication costs can be high. However, funds for telehealth are insufficient, because the benefits of telehealth are mainly realized by the patients. Thus, investors do not have a great interest in this field. Another problem is that hospitals in remote and rural areas have a higher demand for access to telehealth services, but also have smaller budgets.

Unbalanced development in different areas in China

Because of unbalanced development, many hospitals in remote and rural areas cannot apply telehealth, owing to limitations of equipment, human resources and telecommunications.

Lack of reimbursement for telehealth services

In China, health insurance does not cover expenditure on telehealth services. Thus, patients need to pay for telecommunications and specialists’ fees themselves. This represents a major economic burden for patients.

Lack of evaluation of telehealth programmes

Policy makers lack evidence from evaluation research to help them to decide how to support the development of telehealth.