The Chinese fable of Dong Feng tells of a skilled and generous medical practitioner from the Three Kingdoms period (AD 220–280) who treated the impoverished for free. In return, patients planted apricot pits. An orchard grew, and Dong Feng traded the fruit to the public in exchange for rice, wheat, corn, or millet, then distributed that grain to the poor. “Our goal,” says Dr. Yusheng Zhang, whose health care startup, Apricot Forest, takes its name from the story, “is to help as many doctors as possible to become like Dr. Dong.”
It’s an utterly unreasonable mission, given the circumstances. Most physicians in China work for state-run hospitals, where entry-level doctor wages are about $500 a month, on par with a taxi driver’s earnings. Workers like these aren’t exactly primed for pro bono labor. But it’s also a laudable and much-needed goal: China’s doctors are routinely juggling caseloads of 50 to 60 patients a day, which leads to trouble. Chinese hospitals experienced an average of 27 assaults in 2012, as fed-up patients beat, stabbed, and even killed the doctors who failed to meet their expectations. In this climate, any tool that improves care—or even speeds up a doctor’s day—is a humane benefit to all.
Apricot Forest offers a suite of three apps that aim to fix some of the core inefficiencies in China’s medical system. Twenty-five percent of China’s 2.5 million doctors now use at least one of the apps, as do about 2,000 new physicians every day. “I thought, What impact could I have if I could change the reality of Chinese people standing out in the cold all night in Beijing just to book an appointment?” says Zhang, 32. “If I could help make doctors’ work easier and more efficient?”
The primary app is MedClip, an all-in-one patient service system. Doctors can photograph, store, and organize patient records; dictate notes directly into a patient’s chart; send patients reminders and educational materials via China’s popular Weixin (aka WeChat) messaging system; and consult with other doctors on difficult cases. The second, e-Pocket, contains reference materials, such as drug formularies and specialized calculators. And the third, Medical Journals, helps doctors stay up-to-date on the latest research literature.
The apps are the product of Zhang’s long interest in medicine, which began when he fell seriously ill at age 12. Born in Sichuan province to parents who worked in a steel mill, he won a spot at the preeminent Peking University in Beijing, and went on to the top-notch Peking Union Medical College. A clerkship at Massachusetts General Hospital led him to Johns Hopkins University, where he received an MBA and a master’s in public health. “I came to realize that health care is in trouble in the U.S. and in China, but for different reasons,” Zhang says. “In the U.S., it’s too expensive. In China, quality and access are more pressing issues. There are not enough well-trained doctors or incentives to work for patients.”
While interning at Resolution Health, a data analytics subsidiary of WellPoint, Zhang realized that China’s doctors need more data—about patients, their records, and their illnesses. He returned to China in 2012; after a weekend at the Beijing Tech Hive startup accelerator, he had offers for $500,000 in seed money. Apricot Forest was born.
Zhang’s clients are the cash-strapped doctors of China, not the rich insurers who dominate the U.S. health system. So he makes money in other ways. Pharmaceutical companies place ads inside his apps to reach doctors. Apricot Forest takes a slice of the sales of books and other publications made accessible through e-Pocket and Medical Journals. And the company intends to charge patients for follow-up phone calls with their physician via MedClip. (Why do both sides agree to this arrangement? Because patients can’t currently connect with doctors easily, and the app lets doctors keep their phone numbers private and control the amount of contact.) Zhang ultimately envisions aggregating the data that physicians upload to MedClip, analyzing it, and selling the reports to companies that research, design, and market medical products. China doesn’t have the exacting patient-privacy laws of the U.S., but Apricot Forest says it follows U.S. privacy laws because Zhang would like to make his products available internationally.
To see how Apricot Forest works to solve doctors’ problems, I join two employees at a meeting with Dr. Chen Kui, an epilepsy specialist at Beijing Friendship Hospital. Friendship is ahead of many public hospitals in digitizing patient records, but that just means it has turned old paper documents into PDFs—which aren’t searchable by keyword, and can only be accessed via shared computers in the hospital. “Some of my fellow doctors have to stay until 11 p.m. just to finish up with the record-keeping,” Chen says. It’s this kind of inefficiency that made him an Apricot Forest user.
For two hours, the Apricot Forest employees get feedback from Chen as he walks from room to room of the sparsely furnished neurology ward. Chen is bespectacled and dressed in a white lab coat, and he speaks calmly and quickly, though his tousled hair gives some sign of the frenetic day he must have had. The MRI resolution, he tells them, should be higher; a photo he snapped of a brain scan didn’t display on his phone as clearly as he’d like. He’d also love patients to be able to upload videos and documents they want to share with him. As the Apricot employees take notes, Chen pulls a few two-inch-thick binders from his filing cabinet to show the paperwork that patients participating in clinical trials must fill out daily and bring back to the hospital every two weeks. “If they could just tap this into their phones every day, the data would be here faster,” he says.
The Chinese government is reforming its health care system, and Apricot Forest believes it is well positioned to capitalize. The changes would liberate more doctors from their state-hospital positions, allowing them to be self-employed or to work at multiple sites. That means Apricot Forest apps could become a traveling office, helping doctors manage patients on the go. And that would ideally unleash a bumper crop of better, more responsive doctors. Doctors more like Dong Feng.
[Photos: Matjaž Tančič]