M is making a name for itself in the Asian market. After opening successfully in Korea in 1997, M was introduced into Thailand in February, 1998. The greatest Asian market, however, is China, where its influence has not been widely felt, despite earlier efforts (See "Features of M Required in China: Insights from Translating FileMan" by Feng Huang, M Computing Vol. 2, No. 5 Nov. 1994). The purpose of this article is to introduce the situation with respect to marketing M in China based on personal observation and past experience.
There have been several occasions when the time appeared ripe for M to be introduced to China. Hospitals were beginning to recognize the need for computerized information systems. With guidance from Professor Richard F. Walters, the first Chinese MUMPS was introduced. Soon thereafter, with assistance from Dr. D.B. Shires, then Chair of IMIA (the International Medical Informatics Association), DSM was made available to a single Chinese hospital in Beijing at The Oncology Hospital of the Academy of Medical Sciences of China, using a PDP-11/23.
There were, however, two barriers to continued expansion of the use of M in China. First, all available M systems at the time ran only on mini or mainframe computers, which were not generally available in China. The second problem related to processing Chinese characters in M: many people believed (erroneously) that M could not deal with the Chinese characters, and this impression remains in the minds of many technicians in China today.
A second opportunity for introducing M to China came in the early 1990s. Earlier, in the latter half of the 1980s, the database package dBASE III had become widely used in China, with a great many applications based on that package. However, users were beginning to recognize limitations in this package. Furthermore, Ashton-Tate (the developer of dBASE) merged with Borland; to the Chinese mind, this meant that dBASE would cease to exist, and another package must be found to replace it. This led to a search for other options. At the same time, a project was included in China's National Five Year plan, the eighth such plan of the Chinese government. Oracle, Foxpro, and M were selected as targets for investigation for a national hospital information system. Work started at the People's Hospital of Beijing Medical University, and Data- Tree M (DTM) was used to implement a Chinese version of the VA FileManager (Huang, 1994). This work was done independent of DataTree's direct involvement. In 1993, four Chinese experts attended the 22nd Annual MUMPS Users' Group meetings in Washington, D.C. One of their assignments was to discuss closer cooperation between DataTree management and the Chinese representatives. It appeared as though, with help from DataTree, M would come to China at last. However, no sooner had this agreement been reached when DataTree merged with InterSystems, as the Chinese delegation learned while still in the United States. Again, because of mistrust of mergers, the M project was terminated, and a second opportunity to bring M to China was lost.
After the termination of efforts to introduce M as a part of the eighth Chinese National Five Year Plan, the two remaining contenders, Oracle and FoxPro, also failed to meet expectations and were abandoned. Instead, SQL Server with PowerBuilder was selected as the platform on which to base the Chinese hospital information system. This project was completed in March, 1997. The system was developed in the People's Hospital of Beijing Medical University. Despite many problems, this system is running today and is considered the best hospital information system in China. The total development investment for the hospital was 6 million yuan ($700,000), with a research investment of 10M yuan. (Editor's note: The author informs us that the average personal income in Beijing is 11016 yuan, approximately $1,327 per year.)
The success of this Chinese Hospital Information System (CHIS) seems to imply that there is no room for other systems to be introduced. However, that is not the case. CHIS has increased interest in HISs in general, demonstrating that, with sufficient investment, a good hospital information system can be developed. However, CHIS would probably not be adopted in many other hospitals because of its deficiencies, which include a relatively low productivity for the investment, lack of flexibility and poor messaging capability. As a result, Chinese technicians are actively searching for other alternatives at this time.
In addition to the demonstrated success of CHIS, other factors in the general situation in China are encouraging hospitals to build computer-based HISs. In 1997, there were about 10 million personal computers.
Their cost is low enough that even individuals can afford them. This also means that they are cheap enough for hospitals to establish HISs based on PCs.
Another factor that encourages development of HISs is support from the government. In 1995, the Chinese national government established a "Golden Health Engineering" or a "National Health Information Building Engineering Project." Its goal is to organize and encourage building information systems and networks. This information system would apply not only to hospitals, but also to such programs as public immunology, oncology, etc.,—in other words, to impact all sorts of health delivery systems.
When CHIS became a reality, many hospitals and companies started to develop their own systems. One such system, the General Army System, was developed in cooperation with Hewlett-Packard Corporation. This system was declared to have been successful, and the Chinese Hewlett-Packard Corporation has already begun to market their HIS packages, POPHIS V2.0.0 and INFORMED V1.0.0. Their total investment is greater than 10M yuan.
Another well-known system in China is that of the Beijing Hospital, which developed a system in collaboration with IBM's Chinese subsidiary. This system, with a total investment of 6M yuan, succeeded in building an HIS in the first affiliate hospital of the China Medical University, with an installation investment of 10M yuan.
Recently, this same system has been installed at the first hospital of Jiang Su province. Many experts and administrators consider it one of the best systems.
Up to the present, more than ten large-scale hospitals and approximately 100 medium-scale hospitals in China have developed or have started to develop their own hospital information systems. Other hospitals are beginning to do so. There are over 700 hospitals in China with bed capacities over 500 beds, so the market is large. With this great a demand, the opportunity arises again for M to participate.
Unlike the situation in earlier years, software is now copyright protected in China. Several lawsuits have demonstrated this fact, so it appears that software developed would be protected. This means that the development efforts of individuals and companies interested in building complex software systems would be protected. People are aware of copyright provisions, and they also recognize that software development costs may exceed the cost of hardware necessary to run these systems. They are much more selective in software purchases as a result.
The greatest barrier for M in the Chinese market is that there is no current M-based hospital information system in the country at this time. There have been many lectures and seminars on M in China attended by technicians. These people are aware of the potential of the language, but they need a sample system to study in greater detail so that they can persuade their management that M is international, not just English, in its focus. Many people believe that a sample demonstration M-based HIS is the only way to gain acceptance for M in China. Other problems exist, such as the lack of M programmers and lack of Chinese documentation etc., but these problems could be solved more easily if a demonstration system were available. The best way to get started would be for some group to collaborate with a large hospital or other unit to build a test HIS of MIS with M. A careful implementation plan is needed.
There is a real market for M in China. The interest is there, and anything seems possible. M vendors should make a strenuous effort to capitalize now on this favorable situation. It is not without risks and challenges, but the potential reward is great.
Feng Huang is an Associate researcher and the Director of Medical Statistics of the People's Hospital of Beijing Medical University. He is a major attendant of the China Hospital Information System (CHIS) of the China 8.5 Project. He can be reached at The Section of Medical Statistics, People's Hospital of Beijing Medical University, No.11 of XiZhiMenNei Street, Western District, Beijing 100044, P.R.China. E-mail: huangf@mail.bjmu.edu.cn
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