The document discusses several topics related to digital health and healthcare technology. It begins by summarizing articles about China's need for more primary care doctors and how technology could transform hospitals. It then summarizes an article on China's new generation of entrepreneurs and innovative companies in various sectors including healthcare. The document concludes by discussing an English learning program for medical terminology and Aaron Rose's perspective on the future of digital health.

1. The Changing World
of Digital Health
Prepared for
Seattle Biz-Tech Summit
by
Aaron Rose
Sept. 30, 2017
Bellevue, Wash.

2. China Needs Many More
Primary-Care Doctors
The Economist, May 11, 2017
• The Chinese government has provided "greater
funding for community health centers."
• In 2015 there were around 189,000 general
practitioners (GPs). The government aims to have
300,000 by 2020.
• But there would still be only 0.2 family doctors for
every 1,000 people (compared with 0.14 today).
That is far fewer than in many Western countries.
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3. China Needs Many More
Primary-Care Doctors
The Economist, May 11, 2017
• Many people who seek medical help in China bypass
general practitioners and go straight to hospital-based
specialists. In a country once famed for its readily
accessible 'barefoot doctors', primary care is in tatters.
• It is not just long waiting-times at hospitals that
necessitate more clinics. People are living far longer
now than they did when the Communists took over in
1949: life expectancy at birth is 76 today, compared
with 36 then. People from Shanghai live as long as the
average person in Japan and Switzerland.
• Since 1991, maternal mortality has fallen by over 70%.
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4. China Needs Many More
Primary-Care Doctors
The Economist, May 11, 2017
• A growing share of medical cases involve chronic
conditions rather than acute illnessesor injuries.
GPs are often better able to provide basic and
regular treatment for chronic ailments.
• The country is also ageing rapidly. By 2030 nearly
a quarter of the population will be aged 60 or
over, compared with less than one-seventhtoday.
More family doctors will be needed to manage
their routine needs and visit the housebound.
• What role will technology play in the delivery of
primary care in China?
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5. How hospitals could be rebuilt, better than
before: Technology could revolutionize the way
they work
The Economist, Apr. 8, 2017
• Today, hospitals are where patients go for consultations
with specialists, and where specialists, with the help of
medical technicians and pricey machinery, diagnose
their ills. They are also the main setting for surgery and
medical interventions such as chemotherapy; and
where sick people go for monitoring and care.
• But high-speed internet, remote-monitoring
technology and the crunching of vast amounts of data
are about to change all that. In the coming years a big
chunk of those activities—and nearly all the
monitoring and care— could move elsewhere.
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6. How hospitals could be rebuilt, better than
before: Technology could revolutionize the way
they work
The Economist, Apr. 8, 2017
• Plenty of other institutions are trying to grab some
of the work—and profits—that will be displaced,
including primary-care groups, insurers and health-
management organizations.
• And technology firms are already playing a bigger
part in health care as phones become more
powerful and patients take control of their own
diagnosis and treatment.
• But the more far-sighted hospitals are hoping to
remain at the center of the health-care ecosystem,
even as their role changes.
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7. How hospitals could be rebuilt, better than
before: Technology could revolutionize the way
they work
The Economist, Apr. 8, 2017
• Picturing what hospitals could be, if the various
obstacles are overcome, means abandoning long-held
assumptions about the delivery of care, the role of the
patient and what makes a good doctor.
• Just as online banking made life more convenient for
consumers and freed up branch staff for complex
queries, online health care could mean fewer people
need to come to hospitals to be cared for by them.
Last year half of consultations ordered by Kaiser
Permanente, an integrated American health-care firm
that runs many hospitals, were virtual, with medical
professionals communicating with patients by phone,
email or videoconference.
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8. How hospitals could be rebuilt, better than
before: Technology could revolutionize the way
they work
The Economist, Apr. 8, 2017
• Shifting almost all dialysis and chemotherapy out of
hospitals is further off, but is on the way. And with
better remote monitoringsome chronically ill
patients who now need to be in hospitals will be
able to stay at home, only coming in when their
conditions deteriorate.
• Moving care outside institutions will both save
money and raise standards, by making patients
more comfortable and reducing infection rates.
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9. How hospitals could be rebuilt, better than
before: Technology could revolutionize the way
they work
The Economist, Apr. 8, 2017
• For patients who must still be admitted to hospital,
the experience could be much more convenient
and pleasant. Hospitals could operate more like a
cross between a modern airport and a swish
hotel, with mobile check-in, self-service kiosks for
blood and urine tests and the like, and updates on
patients' and relatives' phones.
• For pre-planned visits an algorithm could decide
which tests are needed before a patient leaves
home. Some of these could be done in advance
and the resultsstreamed directly to patients'
electronicrecords.
9/30/2017 9ROI3, Inc.

10. How hospitals could be rebuilt, better than
before: Technology could revolutionize the way
they work
The Economist, Apr. 8, 2017
• In future, rather than checking patients' vital signs only
at intervals, or parking ICU-nurses next to beds, live
data-streams from medical machines and wearable
devices could flow straight to such command centers,
where supercomputers could screen them for
anything worth bringing to the attention of medical
staff.
• Doctors in the command center, or even in their own
homes, could be at patients' bedsides virtually with a
swipe of a touchscreen. All this would not only make
the hospital safer and more efficient; it would also
give medical staff a more complete record of patients'
progress.
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11. How hospitals could be rebuilt, better than
before: Technology could revolutionize the way
they work
The Economist, Apr. 8, 2017
• A command center could watch over patients not
only in hospitals, but also at home.
• Wearable devices that track vital signs, contact
lenses that monitor blood-sugar levels and smart-
stitches that measure the pH level of fluid in
wounds would all mean fewer patients in hospital
for monitoring.
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12. How hospitals could be rebuilt, better than
before: Technology could revolutionize the way
they work
The Economist, Apr. 8, 2017
• All this monitoring would bring two new risks: mass
hypochondria, as patients obsessed over their data and
flooded hospitals with requests for consultations; and
alarm fatigue, in both patients and medics.
• The antidote would be an intelligent monitoring
system combining all the different data-streams,
filtering out the least relevant and alerting staff only
when needed.
• A computer taught to recognize deviations from
standard recovery would be able to alert medical staff
to aberrations. For example, a pneumonia patient who
does not shake off a fever after two days of antibiotics
needs attention. Most others simply need to complete
the course of drugs, and get some rest.
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13. How hospitals could be rebuilt, better than
before: Technology could revolutionize the way
they work
The Economist, Apr. 8, 2017
• The surgeon's job, too, could be transformed. Today,
the use of robots in the operating room is limited
because they must be steered manually with a joystick.
• In future robots might be able to carry out some
standard procedures such as hip replacements
autonomously, with a surgeon getting things started
and the robot doing the rest.
• With more complex operations, a supercomputer
linked to a real-time virtual-reality (VR) machine could
help walk surgeons through their operations. It could,
for example, highlight where a tumor sits in the liver
and warn a surgeon about impinging on an artery, just
as a satnav warns of traffic jams ahead.
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14. How hospitals could be rebuilt, better than
before: Technology could revolutionize the way
they work
The Economist, Apr. 8, 2017
• The World Bank estimates that by 2030 the number of
health-care workers will need to double, compared
with 2013—an extra 40m workers globally.
• High rates of stress and burnout are already a
problem in health care; if workloads continue to
increase they will only rise further.
• But if medical staff are made more productive with
the help of computers, monitoring devices and robots,
they can be freed up to do the work that only humans
can do, and helped to do it better and more happily.
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15. China's Audacious and Inventive
New Generation of Entrepreneurs
The Economist, Sept. 23, 2017
• Baidu, Alibaba, Tencent, Didi Chuxing, and Ofo are part of a
new wave of inventive young firms emerging from China.
• A few years ago, Chinese innovation meant copycats and
counterfeits. The driving force is now an audacious,
talented and globally minded generation of entrepreneurs.
• Investors are placing big bets on them. Around $77bn of
venture-capital (VC) investment poured into Chinese firms
from 2014 to 2016, up from $12bn between 2011 and 2013.
• In 2016, China led the world in financial-technology
investments and is closing on America, the global
pacesetter, in other sectors.
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16. China's Audacious and Inventive
New Generation of Entrepreneurs
The Economist, Sept. 23, 2017
• China's 89 unicorns (startups valued at $1bn or
more) are worth over $350bn, by one recent
estimate, approaching the combined valuation of
America's. And to victors go great spoils. There are
609 billionairesin China compared with 552 in
America.
• China's nimble new innovators are using world-
class technologies from supercomputingto gene
editing. Having establishedthemselves in the cut-
throat mainland market, many are heading
abroad.
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17. China's Audacious and Inventive
New Generation of Entrepreneurs
The Economist, Sept. 23, 2017
There are three main reasons why China’s determined
entrepreneurs can expand their businesses rapidly:
1. China's economy, the world’s second largest, is big enough to
let firms attain huge scale just by succeeding at home;
2. Chinese shoppers are voracious and venturesome, an
advantageto innovators with clever products but unfamiliar
brands. They are also unusuallyeager to embrace technology.
China's penetration rates for mobile phones and broadband
internet are high, making it easy for startups to reach a vast
market cheaply; and
3. State-dominated industries ranging from telecommunications
and banking to health care are woefully inefficient and even
hostile to consumers. This allowsagile newcomers,with
businessmodelsthat put the customerfirst and deploythe
latesttechnologies,to jump ahead of incumbents more easily
in China than their counterparts in developed markets.
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18. China's Audacious and Inventive
New Generation of Entrepreneurs
The Economist, Sept. 23, 2017
• The inefficiency of China's state-dominated
economy is another powerful force boosting
entrepreneurs.
• Young firms are using new technologies and novel
business models to push aside state-run laggards.
• China's health industry, for instance, is antiquated
and dysfunctional. Long queues are common at
state hospitals and access to drugs is complicated
by an opaque system of dispensation.
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19. China's Audacious and Inventive
New Generation of Entrepreneurs
The Economist, Sept. 23, 2017
AliHealth, an arm of Alibaba, is a leading online
prescription dispenser. The services are provided based
on the foundations of Alibaba including e-
commerce, big data and cloud computing. AliHealth
provides solutions for medicine buying and selling,
smart healthcare and product tracing.
http://www.alihealth.cn
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20. China's Audacious and Inventive
New Generation of Entrepreneurs
The Economist, Sept. 23, 2017
WeDoctor helps patients book medical appointments
using smartphones. The platform also provides
medical information and medical advice online.
www.guahao.com
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21. China's Audacious and Inventive
New Generation of Entrepreneurs
The Economist, Sept. 23, 2017
• Venus Medtech has invented a retrievable heart
valve intended for patients with high calcification in
their arteries.
www.venusmedtech.com
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22. China's Audacious and Inventive
New Generation of Entrepreneurs
The Economist, Sept. 23, 2017
• The best example of a local health-care disrupter
with global potential, however, is iCarbonX, a
health-data analytics firm from Shenzhen. Based on
the huge volume of data, they provide analysis and
prediction of people's health index.
www.icarbonx.com
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23. Health Tech Entrepreneurship in
the US: Disruption or Integration?
• According to Aaron Martin, chief digital officer at
Providence Health in Seattle, many of these
developers will first see a massive opportunity to
bring health care into the 21st-century.
• That excitement turns to bitterness after they begin
to understand the complexities of health care with
its entrenched interests, regulatory hurdles, long
sales cycles and more.
• "There's this pit of despair when people realize that
this stuff is really hard and complicated and the
penalty for screwing up is high."
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CNBC, Aug. 27, 2017, https://www.cnbc.com/2017/08/27/health-tech-founders-optimism-followed-by-pit-of-despair.html

24. ROI3's English Language Learning
for Medical Terminology
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25. ROI3's English Language Learning
for Medical Terminology
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26. ROI3's English Language Learning
for Medical Terminology
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27. ROI3's English Language Learning
for Medical Terminology
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28. Where Do We Go From Here?
Aaron Rose
President & CEO, ROI3, Inc.
US: +1 (206) 552-9601
HK: +852 8192 6501
Email: aaron.rose@roi3.com
@aarondrose
@ROI3inc
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