Interview With Dong Jiahong, Academician Of Chinese Academy Of Engineering

The continuous integration of Internet technology and medical services has effectively improved medical quality, efficiency and accessibility. Especially since the new epidemic, "Internet + medical health" has fully demonstrated the advantages of optimizing the allocation of medical resources. With the increasingly wide application of 5g, the integration of Internet, artificial intelligence and medical treatment has become a new focus in the field of health.

During the 2021 annual meeting of Boao Forum for Asia, Dong Jiahong, academician of Chinese Academy of engineering and President of Changgeng Hospital of Tsinghua University in Beijing, said in an exclusive interview with 21st century economic reporter that 5g meets the requirements of "high throughput, low delay and large connection", so that telemedicine can better play the role of multi-party real-time collaborative diagnosis and treatment.

Dong Jiahong believes that smart healthcare integrates multi-level linkage health care services and applications systematically. In the future, it is necessary to build a regional smart health care community, develop a regional integrated hierarchical diagnosis and treatment system, and build a new regional intelligent health and medical information platform.

As the leader of hepatobiliary surgery in contemporary China, Dong Jiahong proposed the paradigm of "precise hepatobiliary surgery" 15 years ago. "To achieve the precise balance between maximizing lesion clearance, maximizing organ protection and minimizing tissue damage is the core connotation of precision surgery," he told reporters

Dong Jiahong believes that with the development of science and technology, the effect of precision surgical treatment is also increasing“ Smart medical can improve the accuracy of intervention in disease assessment, clinical decision-making, surgical planning, data management and other aspects, so as to improve the treatment effect. "

He also suggested that young people should avoid staying up late often, which will damage the liver, cardiovascular, endocrine system and metabolism of the whole body.

Smart medicine may solve the problem of shortage of medical resources

"21st century": because of the epidemic situation, digital medicine has received great attention. What do you think of digital development in healthcare?

Dong Jiahong: the epidemic has indeed brought a great development opportunity to digital medicine and Internet medicine. Epidemic prevention and control requires social isolation. Doctors and patients, doctors and doctors, and drug and device providers are all isolated by society, resulting in space barrier and contact interruption. Therefore, the Internet should play a very important role in epidemic prevention and control. The Internet has overcome the space-time barriers and restrictions required by the epidemic situation, and enables the continuous and efficient implementation of medical services under the epidemic situation. For example, our Beijing Qinghua Changgeng hospital has developed Internet medicine in the case of the epidemic, so that patients in other cities who cannot come to Beijing can solve the problems of follow-up visit, follow-up and chronic disease management through internet medical treatment. Some patients in our city who can't come to our hospital for various reasons can also get the opportunity of seeing a doctor through internet medical treatment.

21st century: we are in the 5g era, so how should 5g + artificial intelligence + medical care integrate and develop?

Dong Jiahong: 5g provides medical data transmission with high throughput, low delay and large connection. Because medical data is very complex big data, it is difficult for 4G network to support fast, low delay, high-definition image and video transmission. 5g overcomes the problems of speed and clarity, so that telemedicine can play a better role in collaborative therapy. We have launched the world's first remote collaborative surgery supported by 5g network. In Beijing Information Center, I also gave remote operation guidance to the operating room of Changping Tsinghua Changgeng hospital and Shenzhen People's hospital. The three parties can share high-definition pictures remotely, and the transmission of images has almost no delay, which has reached the insensible delay of our vision. Doctors are like living together in a space, conducting collaborative surgical guidance and interaction. 5g can realize remote surgical communication and collaborative operation, and transfer high-quality expert resources to any remote area covered by 5g.

21st century: in fact, I think that the development of technology also has many challenges for doctors. What challenges and opportunities does the development of digital medicine have for doctors?

Dong Jiahong: doctors have two pursuits. First, to ensure the quality and safety of medical services for patients. When conducting remote guidance, it is necessary to accurately obtain the information of patients, including laboratory data, image data and other examination data. Therefore, the clarity of the image is critical, and the doctor should have the ability to accurately judge the patient's lesions on the network. Second, we should ensure that the operation is accurate and controllable. Although remote surgery has been tried, but the remote surgery has not been widely carried out, mainly subject to safety and precision controllability. In the future, with the progress of intelligent medical technology, the safety of remote surgery will be further improved, and remote surgery will be more widely carried out.

21st century: how do you look forward to the future of smart healthcare?

Dong Jiahong: in the future, by innovating the mode of medical service and optimizing the process of medical service, smart medical has four important effects: enhancing the ability of medical service, improving the efficiency of medical service, optimizing the medical experience of patients, and extending the time domain, airspace and field of medical service.

Our country is a big country with 1.4 billion people, but we only have 3.6 million doctors. Medical resources are extremely scarce, especially in remote areas and rural areas. The construction of smart medicine and digital medicine will be an important way to solve the shortage of doctors, especially to solve the imbalance of medical resources allocation.

At present, our national medical system is being reshaped, and under the promotion of the "healthy China" strategy, medical and health services have changed from the past focus on treatment of disease to the current health-care, gradually forming a mature medical service system, providing health care covering the whole population, the whole career and all dimensions, and constructing the prevention and treatment, rehabilitation, chronic disease management, prevention and treatment Comprehensive health and medical services such as elderly care. This service is a huge project, and also requires the joint efforts of the whole society to promote the optimal allocation of resources. Smart health plays two main roles in the process of rebuilding the medical system. First of all, smart healthcare integrates the multi-level health care services and applications systematically. In the past, different levels of medical institutions have different functional positioning, resulting in fragmented and fragmented medical services. Now, through the information system, digital medicine and intelligent medical treatment, the diagnosis and treatment institutions at all levels are organically integrated to form a systematic medical service system. Secondly, we should graft smart medical means on top of the systematic medical service system to enable the health care service system and realize the "4E effect". This is of great significance to the construction of modern health care service system in our country.

"Precision surgery" is helpful to improve the therapeutic effect of liver cancer

21st century: you are also an expert in hepatobiliary surgery. The mortality rate of liver cancer has been high in China. Why is the mortality rate of liver cancer so high in China?

Dong Jiahong: it is mainly because of the late diagnosis of liver cancer. In addition, the effective treatment for advanced liver cancer is not enough.

If we want to improve the overall efficacy of our country, the first thing is to strengthen prevention. Now more than 80% of liver cancer patients in our country are caused by hepatitis B and hepatitis C. Therefore, preventing and blocking the transmission of hepatitis B and hepatitis C and reducing the incidence of liver disease is the most important strategy.

Secondly, we need to manage the high-risk groups, such as patients with alcoholic liver disease, fatty liver disease, and patients with chronic liver damage. Effective chronic disease management, regular screening, early detection of liver cancer, early treatment, so as to improve our overall treatment efficiency. At present, the 5-year survival rate of liver cancer patients in China is slightly higher than 9%, while that in Japan is more than 50%. Behind the huge gap is that Japan has implemented a nationwide screening mechanism for high-risk groups. Therefore, it is very important to realize early diagnosis and treatment through screening of high-risk groups.

Third, accurate medical treatment should be carried out for patients with liver cancer, so as to improve the cure rate of patients. Nowadays, there are many methods to treat liver cancer, such as hepatectomy, liver transplantation, interventional therapy, radiotherapy, biotherapy, immunity and targeted therapy. We need to study and judge how to make accurate decisions and accurately use the most appropriate treatment methods according to the particularity of each patient's condition, so that patients can get the optimal treatment benefits.

If every liver cancer patient can get accurate medical treatment, it can not only improve the treatment effect, but also avoid the waste of medical resources, and realize the value medicine with maximum cost-effectiveness. This is also a problem that we need to study and explore in the construction of health care.

21st century: you just mentioned precision therapy. 15 years ago, you proposed "precise hepatobiliary surgery". Can you explain this concept in detail?

Dong Jiahong: "precise hepatobiliary surgery" is aimed at the specific condition of each patient, through accurate decision-making and accurate application of the most appropriate treatment method, so as to achieve the balance between the three surgical elements of lesion clearance, liver protection and damage control, and ultimately achieve the safe, efficient and minimally invasive surgical intervention, so as to maximize the health benefits of patients. In short, precision surgery is equivalent to military precision strike, with the minimum damage and the minimum loss of surrounding tissues to achieve maximum lesion clearance. This is what precision surgery is all about.

21st century: what is the difference between precision surgery and targeted therapy?

Dong Jiahong: the concepts of both are precise. Precision should be an effective intervention for target lesions. Surgery is through surgery to achieve the precise attack and removal of lesions. The targeted drug is an effective and accurate attack on tumor cells by means of drugs.

21st century: will smart medicine boost the concept of precision surgery?

Dong Jiahong: smart medicine can improve the accuracy of intervention in the aspects of disease assessment, clinical decision-making, surgical planning, rehabilitation management and so on, so as to improve the treatment effect. Intelligent medical treatment surpasses the limit of human physiology and intelligence in perception, cognition, decision-making and intervention to improve the accuracy of treatment.

21st century: according to your experience, what are the positive effects of "precision surgery" on the treatment of liver cancer in the past 15 years?

Dong Jiahong: in the past 15 years, with the progress of medicine, surgical technology, digital technology and intelligent technology, under the guidance of precision concept and technical system, the global surgical technology has developed rapidly. This is mainly reflected in our understanding of the biological behavior of liver cancer and other related tumors through the development of genomics, which has laid an important foundation for medical decision-making and program formulation. Secondly, a variety of intelligent imaging methods enable us to more accurately determine the scope of lesions and invasion. Through the method of virtual reality and mixed reality, we can guide the surgical operation accurately in the operation, so as to accurately remove the lesion part and realize the maximum tissue protection. The third is to improve the accuracy of decision-making through big data driven diagnostic decision-making, and avoid decision-making relying on experience. Empirical decision-making has been gradually replaced by data-driven decision-making, which greatly improves the accuracy of decision-making. This series of positive effects promote the rapid development of surgery in the concept of precision.

(Editor: Xu Xu)