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CB0287
REV: February 21, 2024

XIAOMING ZHU

GENG LIU

YANAN LIN

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YIFAN ZHU

Zhongshan Hospital Affiliated to Fudan University:

Where Smart Healthcare Meets the Future

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On February 16, 2022, the Shanghai Municipal Health Commission unveiled the Digital
Transformation 2.0 Plan for “Convenient Healthcare” (hereinafter referred to as “the plan”), bringing the
digitalization of public hospitals within its purview to elevate the healthcare experience. Concurrently,
Zhongshan Hospital affiliated with Fudan University was entrusted with a broader mission:
establishing the “hospital of the future.”1

Zhongshan Hospital was one of China’s finest medical institutions, often topping industry
rankings. In 1992, the hospital started leveraging information systems to manage daily operations. As
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digital transformation swept across Chinese hospitals, Zhongshan Hospital pioneered smart hospital
development, earning widespread recognition from authorities and patients alike.

Advancing medical information technology faced obstacles on three fronts. First, in terms of
strategy, some management teams had limited foresight, resulting in insufficient allocation of
resources toward IT projects. Second, insufficient medical IT professionals and inadequate IT
knowledge among medical practitioners presented organizational challenges. An incomplete talent
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development program also brought underutilization of well-conceived information systems. Third,

technically, hospitals could not meet the needs of both “employees” and “patients” due to inconsistent
standards and protocols between legacy and new systems. This brought challenges in integrating data
amid concerns about data security.

Fan Jia, the President of Zhongshan Hospital and an academician with the Chinese Academy of
Sciences, assumed a pioneering role in the smart hospital initiative. Realizing this vision required
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increased investment and a robust organizational framework. Therefore, three pillars underpinned the
endeavor to build a smart hospital: “patient-friendly healthcare,” “functional resource management,”
and “smart business management.”①

① Smart hospital: an approach harnessing technologies such as cloud computing, big data, the Internet of Things (IoT), mobile
internet, and artificial intelligence (AI) to create a connected, IoT-enabled, perceptive, and intelligent healthcare ecosystem.
The smart hospital can integrate healthcare resources, streamline medical service procedures, standardize diagnosis and
treatment, enhance diagnostic and treatment efficiency, support clinical decision-making, and optimize hospital management.
It ultimately aims to offer greater convenience to patients, infuse intelligence into medical services, and enhance precision in
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hospital administration.

Professor Xiaoming Zhu, Case Researcher Dr. Geng Liu, Case Researcher Dr. Yanan Lin of China Europe International Business School, and
Secretary-General Mr. Yifan Zhu of CEIBS Healthcare Sector Research Centre prepared this case. It was reviewed and approved before publication
by a company designate. Funding for the development of this case was provided by China Europe International Business School and not by the
company. CEIBS cases are developed solely as the basis for class discussion. Cases are not intended to serve as endorsements, sources of primary
data, or illustrations of effective or ineffective management.
Copyright © 2024 China Europe International Business School. To order copies or request permission to reproduce materials, call 1-800-545-7685,
write Harvard Business School Publishing, Boston, MA 02163, or go to www.hbsp.harvard.edu. This publication may not be digitized, photocopied,
or otherwise reproduced, posted, or transmitted, without the permission of Harvard Business School.

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Fan believed that achieving the “hospital of the future” required transformations in strategy,
organization, and technology, with experiences gained from smart hospital construction as the crucial
factor. Addressing the following two key challenges was essential:

Firstly, how would Zhongshan Hospital define its own “hospital of the future?” The plan called for
an innovative facility as a distinct role model different from typical smart hospitals. This would enable

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unfettered exploration across various dimensions and types. 2 Moreover, the definition should apply
to all hospitals for future implementation.

Secondly, how to cultivate a culture suited to the hospital of the future? Zhongshan Hospital’s
digitalization journey involved a shift from altering business processes to transforming people’s
mindsets, an essential requirement for building the hospital of the future. In other words, digital
transformation ultimately needed to become part of the culture, significantly changing how people
think and behave.

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The Development of Information Technology in Chinese Public Hospitals
The year 2011 marked China’s initiation into mobile internet, leading to the gradual integration of
digital technologies such as AI and cloud computing into healthcare. The development of information
technology experienced three essential phases within the hospital system. Initially, the government
emphasized enhancing medical information technology in the 12th Five-Year Plan (2011-2015). As a
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result, regulatory standards for pharmaceuticals and telemedicine were introduced in succession,
driving the comprehensive development of medical information technology. Subsequently, the 13th
Five-Year Plan (2016-2020) shifted its focus towards building a clinical information system (CIS)
centered around electronic medical records (EMR) to enhance collaboration among multi-level
hospitals through better connectivity among medical information systems. The demand for an
integrated and standardized healthcare platform gained greater momentum with the emergence of
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COVID-19 in late 2019. Moving to the 14th Five-Year Plan (2021-2025), medical information technology,
focusing on “improving people’s lives,” was expected to develop at an accelerated pace. The primary
objective was establishing a patient-centric healthcare system and creating a smart healthcare
ecosystem.

Policies and clinical necessities primarily drove the adoption of smart technology in public
hospitals. In China, the healthcare sector, especially public medical service providers, operated within
a policy-driven framework directly overseen by the National Health Commission of the People’s
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Republic of China (NHC). Consequently, public healthcare institutions were mandated to conform to
the NHC’s guidelines regarding information technology. These guidelines encompassed rating
systems, performance reviews, and incentive mechanisms in descending order of compulsion. The
inception of the smart hospital initiative began with addressing clinical requirements, falling into three
categories based on the level of urgency: efficiency, treatment quality, and operational excellence.

Smart Hospital and Hospital of the Future

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“Smart hospital” and “hospital of the future” were two concepts emerging in the development of
medical information technology.

The concept of a “smart hospital” emerged due to rapid digitalization across the healthcare
industries, involving the widespread application of advanced technologies, such as the Internet of
Things (IoT), information technology, data analytics, and artificial intelligence. 3 As of the time of
writing, China did not have a unified national framework or established standards for defining the

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“smart hospital.” However, in 2019, the NHC defined three pivotal domains for this initiative: “smart
healthcare” for medical practitioners, “smart services” for patients, and “smart management” for
hospital administration. 4

Shanghai Municipal Health Commission first introduced the “hospital of the future” concept in
2022. This exploratory initiative did not offer an official definition, instead conveying its expectations:

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Beyond the capabilities of a smart hospital, the “hospital of the future” should drive the development
of digital medicine and lead its transformation in Shanghai.

Introducing Zhongshan Hospital

Established in 1937, Zhongshan Hospital was one of China’s earliest domestically founded and
comprehensively managed hospitals. It was also among the first to achieve Level-III and Grade-A

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accreditation ①. Known for its robust departments, the hospital excelled in treating heart, liver, kidney,
and lung diseases, earning a prominent reputation in China. In 2020, Zhongshan Hospital ranked third
nationwide and first in Shanghai based on Science and Technology Evaluation Metrics (STEM). It also
secured the fourth position nationally and the top spot in Shanghai for overall reputation. 5 Over the
years, the hospital nurtured three academicians for the Chinese Academy of Sciences and two for the
Chinese Academy of Engineering. At the time of writing, Zhongshan Hospital boasted a team of more
than 700 medical practitioners with senior titles.
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Over nearly 90 years of development, Zhongshan Hospital had established multiple branches. Its
headquarters covered 96,000 square meters with 2,005 approved beds, receiving nearly five million
outpatient and emergency visits each year, admitting around 190,000 inpatients, and performing
almost 140,000 surgeries. In 2021, the highest number of daily outpatient visits reached 26,000. Ten
branch hospitals, including Sheshan, Minhang, Qingpu, and Xiamen, formed the “Zhongshan
Integrated Care System.” ② Zhongshan Hospital also signed agreements with over 100 hospitals
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throughout China to collaborate in healthcare technology.

In 2021, the NHC designated Zhongshan Hospital a “National Pilot for High-Quality Development”
in collaboration with Shanghai authorities. After that, “High-quality development” became the
overarching theme guiding growth, with the “hospital of the future” initiative integrated into its vision.

The History of IT Development at Zhongshan Hospital (1992-2019)

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As early as 1992, Zhongshan Hospital started developing its Health Information System (HIS) to
tackle challenges posed by complex processes, diverse business operations, and substantial amounts
of data. A talent shortage in 1997 meant the hospital outsourced the HIS to a startup software company.

①
The classification of Classification of Chinese hospitals is a 3-tier accreditation system: primary, secondary or tertiary hospital. The criteria
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for accreditation include a hospital’s ability to, provide medical care, provide medical education, and conduct medical research. A primary
hospital (level 1) is a township hospital that contains less than 100 beds. They are tasked with providing preventive care, minimal health
care, and rehabilitation services. Secondary hospitals (level 2) tend to be affiliated with a medium size city, or county, containing 100 to
500 beds, providing comprehensive health services. Tertiary (level 3) hospitals are provincial or national level hospital, with a capacity of
more than 500 beds. Further based on the level of service provision, size, medical technology, medical equipment and management and
medical quality, these three tiers are further subdivided into 3 subsidiary levels: A, B and C.
Integrated care system (ICS) refers to a regional healthcare system that brings together medical resources in a particular geographic area.
②

It often involves a partnership between Level 3 and Level 2 hospitals, community clinics, and village health centers within the specific
region.

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When less than one-third of public hospitals had HIS systems, these forward-thinking steps laid a
robust foundation for Zhongshan Hospital’s IT advancement.

In 2004, Zhongshan Hospital’s in-house HIS officially went live, replacing the third-party legacy
system. The hospital also established a dedicated Information Center team for software development,
implementation, and maintenance. Departments or physicians needed only submit a request to the

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Information Center if they had specific requirements. The team processed requests and typically
resolved them within 1 to 2 weeks. If requests were not feasible or didn’t meet the technical conditions,
the center provided explanations and incorporated them into long-term improvements. 6

Level 3 hospitals had been gradually developing a patient-centered clinical information system
(CIS) since 2010 in response to increased demands from specific sectors and improving infrastructure.
Primary functions encompassed Electronic Medical Records (EMR), Picture Archiving and
Communication System (PACS), Laboratory Information System (LIS), Radiology Information System

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(RIS), laboratory systems, physical examination systems, and medication recommendations. In 2010,
Zhongshan Hospital started developing an integrated IT system to bolster medical services. By 2017, it
had set up Hospital Resource Planning (HRP), System Applications and Products (SAP) for
comprehensive process management, and the Chinese precision medicine database. ①

Smart Hospital Development at Zhongshan Hospital (2019-)

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From 2019, Zhongshan Hospital embarked on a journey of smartification, harnessing digital
technologies like 5G and AI to create a service ecosystem spanning healthcare applications across
various scenarios. This transition propelled smartification beyond medical services ②to encompass the
entire hospital ③and, ultimately, the field of medicine. ④

Planning
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In March 2021, Zhongshan Hospital officially integrated building a “smart hospital” into its vision
to establish a “world-class innovative and smart hospital.” President Fan outlined the “1-2-3-4 tactics”
for this initiative: “1” referred to creating a one-stop smart healthcare ecosystem. ⑤ “2” stood for the

① CIS, Clinical Information System; EMR, Electronic Medical Record; PACS, Picture Archiving and Communication Systems;
LIS, Laboratory Information Management System; RIS, Radiology Information System; HRP, Hospital Resource Planning; SAP,
System Applications and Products, a software developed by SAP company to offer management solutions for businesses.
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② Smartification is defined by harnessing state-of-the-art technologies, such as deep learning particularly in the realm of artificial
intelligence. Hence, “smart healthcare” refers to the utilization of cutting-edge technologies such as AI for the detection of
medical conditions.
③ “Smart hospital” refers to the application of cutting-edge technologies such as AI in disease diagnosis, medical services, and
hospital management.
④ “Smart medicine” refers to the use of cutting-edge technologies such as deep learning in science development that studies
human life and combats diseases.
⑤ The smart healthcare ecosystem of Zhongshan Hospital comprised a self-developed integrated smart healthcare information
network and the extensive smartification of clinical scenarios within the facility. Patients can access smart services such as
smart guidance, smart pre-consultation, and hospital navigation through the Internet hospital integrating online with offline
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services. Additionally, the ecosystem included VR-enhanced virtual consultation rooms, IoT-powered ward systems, a
consistent digital twinning system for intensive care across branches, and next-generation digital operating rooms. Zhongshan
Hospital expanded its medical reach based on AI. For instance, the organization persisted in the R&D of AI in labs, imaging,
and treatment of special diseases. It positively impacted a larger region through regional partnership, integrated care system
and telemedicine that delivered high-quality healthcare. In addition, it leveraged smart technologies to establish a regional
laboratory network, a cloud-based 5G imaging platform for the integrated care system, and an intelligent diagnostic and
treatment system for brain disorders.

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two fundamental principles, “patient-centered” and “disease-oriented.” “3” represented the three key
dimensions: patient-friendliness, functionality, and intelligence. “4” indicated the four “Digital Twins,”
including the Patient Twin, Doctor Twin, Hospital Twin, and Management Twin. ①7 Among these
tactics, the initiative’s core centered on being patient-friendly, functional, and smart.

The foremost objective was to become “patient-friendly.” Zhongshan Hospital achieved this by

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establishing a communication channel between patients and doctors through specialized service
platforms and the Hospital Customer Relationship Management (HCRM) system. ② This channel
facilitated the application of hospital policies, offered timely feedback, and provided early warnings
using technologies such as the internet, Internet of Things (IoT), and 5G (see Exhibit 1.1)

The hospital geared “functional resource management” toward developing proficient resource
management. This approach entailed systematically managing medical resources within the hospital,
including real-time data collection to track resource utilization. Managers could access information on

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demand and dynamically allocate resources based on efficiency and urgency, such as during
epidemics, to maximize the efficiency of resource allocation across the entire healthcare ecosystem. At
the time of writing, construction of an integrated resource management system for 11 branches was
underway (see Exhibit 1.2).

“Smart business management” centered on creating a knowledge application system that operated
from the top down, with the headquarters and branches at either end. This system stored high-quality
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caregiver resources and advanced medical knowledge using technologies like AI and knowledge
graphs. The operational system was the result of decades of ongoing discussions. These resources then
cascaded downstream to partner institutions to ensure the application of Zhongshan Hospital’s
advanced medical and management knowledge, forming a consistent clinical and management
standard in healthcare. This top-down approach facilitated continuous feedback from application
scenarios to the medical group’s algorithm center through information technology and digital tools.
The ongoing data thus empowered the algorithm through iterative training, ultimately improving
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services for the downstream branches 8 (see Exhibit 1.3).

Zhongshan Hospital comprehensively upgraded its IT systems, culture, and organization to achieve
the three objectives. This process involved improvement, transformation, and integration built upon
their existing assets.

Systems
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A smart hospital necessitated a resilient, supportive, and empowering information system.

Zhongshan Hospital’s in-house IT system had been operational for almost two decades, progressing
through five distinct stages: “acquiring software and hardware,” “independent development,”
“integrated information systems for medical services,” “data collection and sharing,” and “big data
and AI applications.” At the time of writing, an integrated medical information system had been
established based on the independently developed HIS, EMR, and RIS systems, comprising nearly 200
modules.
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① The term “twin” in this context refers to the “digital twin,” also known as digital mapping and digital mirror. It entails a
comprehensive use of information technology including sensing, computing, and modeling based on physical models and
real-time data to simulate the shape, properties, behavior, and rules of the physical world. The “twin” reflects the physical
objects in the digital realm by mapping and synchronizing its state.
② Hospital Customer Relationship Management.

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However, constructing the hospital of the future required a more extensive system upgrade. So, the
hospital created two middle platforms that worked together—one for business and one for data. This
could consistently guarantee a standardized and orderly flow of data from business to the data pool,
ensuring that AI and database capabilities aligned with business needs. In doing so, the continuously
updated and stored data could bolster decision-making for business strategies and management and
further fuel business growth, establishing a closed loop from data to business. (See Exhibit 2)

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At the time of writing, a data and knowledge center integrating “medicine, education, research, and
management” had been established. This center organized and interconnected various data sets related
to diseases, services, patients, equipment, projects, standards, and regulations to generate value.

Organization
The digital transformation required a “top leadership initiative,” a mandate the Shanghai Municipal

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Health Commission enforced to digitalize public hospitals. This was because informatization extended
beyond IT infrastructure and tools; it necessitated a strong “coupling” ①between administration and
business departments. In 2020, Zhongshan Hospital established the Department of Information and
Intelligent Development (DIID). While most hospitals had IT or information departments, Zhongshan
Hospital was the first in China to create a department dedicated to coordinating intelligent
development across the entire institution. President Fan Jia and Party Secretary Wang Xin became
directors of the DIID. Vice President Gu Jianying served as Executive Deputy Director. Dr. Qian Kun,
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a Ph.D. in Computational Neuroscience with overseas experience and a former head of AI List in
operations and education, was appointed Assistant Director. Additionally, the DIID comprised the
Planning and Management Center, the Big Data and Artificial Intelligence Center, and the Computer
Network Center, which was responsible for “coordination,” “innovation,” and “basic operation,”
respectively (see Exhibit 3).

The Planning and Management Center was formed to focus on groundbreaking business initiatives.
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It facilitated the coordination of internal departmental needs and identified novel ideas by addressing
pain points. Specifically, the center adopted a goal-oriented approach, with decision-making guided
by long-term objectives with consideration given to future impact. This approach underscored the
importance of boldly embracing the future and freeing design inspiration from the constraints of past
practices.

The Big Data and Artificial Intelligence Center focused on innovative business initiatives. It steered
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Zhongshan Hospital toward developing a comprehensive platform that employed data standards and
data quality plans. This involved constructing platforms for managing data, facilitating research,
enhancing AI capabilities, and ensuring data security. The goal was to transform medical AI
applications into an “industry chain” within the hospital context to support large-scale innovation
through AI applications. 9

The Computer Network Center is an existing team under the IT department but was going through
several transformations at the time of writing, including reorganization and talent development.
Beyond attracting high-caliber talent externally, the hospital prioritized training and developing
existing IT staff to elevate their operational skills to management levels. It also improved mentorship
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for recruits, immersing them in the medical and engineering environment. In this endeavor, the

① “Coupling” refers to the phenomenon where two or more systems or forms of motion mutually influence each other through
various interactions, and thereby forming a synergy to generate incremental force to accomplish specific tasks together.

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hospital aspired to position this center as a catalyst for future industrial development rather than
merely a supporting function.

Meanwhile, the DIID served as a bridge for integrating technology from the medical industry into
the hospital’s operational and service ecosystem. It also translated research findings into commercial
applications in collaboration with third parties. By amalgamating knowledge with operations,

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Zhongshan Hospital strived to establish itself as an international hub for medical and technological
innovation in Shanghai, focusing on breakthroughs in digital healthcare.

Culture
Over 80 years, Zhongshan Hospital had progressively shaped its core values, encompassing “rigor,
practicality, unity, dedication, innovation, and care.” 10 When establishing a smart hospital, the cultural
attributes of “innovation” and “unity (integration)” stood out.

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Innovation
Zhongshan Hospital was the birthplace of numerous pioneering achievements in the history of
Chinese medicine. These included significant milestones like the first pulmonary function testing in
China, the development of artificial blood vessels made of silk, groundbreaking open-heart surgeries,
the introduction of ECMO ① , and the creation of artificial kidneys. The hospital’s tradition of
technological innovation had been consistently upheld and promoted throughout its development.
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Innovation served as the cornerstone of digital intelligence. Zhongshan Hospital established a new
technological innovation system to fuel innovation through digital intelligence. This system centered
on four key aspects to drive and ensure high-quality innovation within the hospital: integrating
technology resources, addressing clinical requirements, fostering talent development, and inspiring
technological innovation.
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First and foremost, the hospital reorganized and reallocated technical resources. It established key
centers such as the MDT②(Multi-Disciplinary Team) Center, Cancer Prevention and Control Center,
and Imaging Diagnosis Center. At the time of writing, Zhongshan Hospital boasted 58 MDT teams.
Moreover, ongoing development efforts went toward a multi-disciplinary research and resource
platform. The objective was to integrate data from multiple modalities and disciplines through
consistent standards, safety protocols, and supporting tools, thus delivering personalized,
multidisciplinary, comprehensive, high-quality, and efficient medical services to patients. It also
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enabled scientists, statisticians, and pharmaceutical companies to conduct clinical trials and supported
medical and scientific innovation. In addition, establishing MDTs required expert evaluations, with
one criterion being the hospital’s IT capabilities. At the time of writing, several MDT outpatient
departments previously based at Shanghai headquarters were relocated to the Xiamen branch.

Secondly, the hospital conducted a comprehensive review of over 100 requirements for clinical AI
applications to enable gradual development. These immersive AI applications and scenarios covered
clinical necessities, significantly enhancing clinicians’ diagnostic and treatment capabilities. For
example, President Fan's team pioneered an AI application system for liver tumors. Incorporating
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knowledge graphs, AI-powered medical imaging, and specialized disease databases, this system
helped doctors examine diseases from multiple perspectives. It integrated Color Doppler Ultrasound

①
ECMO stands for extracorporeal membrane oxygenation.
②
MDT, which stands for Multi-Disciplinary Treatment, refers to a collaborative discussion among a team of experienced experts across
disciplines to develop personalized diagnosis and treatment plans for patients.

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data, magnetic resonance imaging, genomics, and proteomics, allowing them to efficiently and
precisely identify suspicious lesions to provide precision medicine.

Thirdly, President Fan required Zhongshan Hospital doctors to move beyond their duties as
medical professionals and evolve into “doctor-scientists” applying innovations in practice. Digital
technologies such as artificial intelligence (AI) were integrated with medical knowledge to

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revolutionize medical services, providing data and tools to support doctors in their journey to become
"scientists." In addition, each year, Zhongshan Hospital published many clinically innovative and high-
quality medical papers, with many revolving around integrating digital technology with medical
research.

Fourthly, the hospital established an open collaborative innovation platform using 5G and AI
technologies as an initial step. It could engage in partnerships with digital technology companies,
medical institutions, and the government to harness technical capabilities from the industry.

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Furthermore, the platform could commercialize outcomes, enhance operations, and add value to the
business through collaborative efforts in intellectual property management and profit sharing.
Additionally, it gave rise to or bolstered market segments, including medical big data analysis, health
management, and manufacturing of IoT monitors. This platform was a catalyst for developing the
smart healthcare industry chain and accelerating the transformation of both traditional medical
services and the healthcare industry.
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Integration
Integrating IT and business departments posed a perennial challenge for organizations undergoing
digital transformation. Departments might voice concerns that IT professionals lack an understanding
of business. At the same time, IT may think they had to “bring about disruptive change even without
having a deep understanding of healthcare.” 11 In hospitals, advancing digital and intelligent
transformation couldn’t solely rely on the “top leadership;” it necessitated the acknowledgment of the
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life-saving practices of physicians. To bridge the gap between digital experts and medical practitioners
in every business unit, Zhongshan Hospital initiated changes in its organizational culture as a starting
point.

The imperative to nurture interdisciplinary talents was a unifying force for the two departments,
encouraging mutual learning. Digital experts were motivated to deepen their understanding of medical
knowledge. For example, annual town hall meetings evolved into idea exchanges with subspecialty
debriefing sessions. At the time of writing, Zhongshan Hospital housed over 200 subspecialties, with
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each frequently introducing new technologies. These cross-disciplinary brainstorms proved highly
inspiring, particularly for colleagues from the DIID who progressively gained insights into medical
knowledge and logic through their active participation. These annual meetings developed into a
cultural tradition at Zhongshan Hospital, symbolizing integration and innovation. Additionally,
Zhongshan Hospital organized similar knowledge-sharing events for staff from different departments,
including academic lectures and popular science talks hosted by the Research Department and the
Communist Youth League Committee.

Zhongshan Hospital also worked on helping practitioners acquire digital skills through research
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and training. This initiative empowered them to utilize digital tools for knowledge storage. For
instance, AI training often encountered challenges due to a shortage of medical experts available for
annotations. The DIID implemented a cloud-based collaborative annotation system for medical
imaging, supporting electrocardiography (ECG), vascular ultrasound, and coronary catheterization to
tackle this issue. Doctors could annotate images while tending to patients, streamlining the process and
improving efficiency.

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Furthermore, some young doctors with coding skills could even assist the DIID with their work. In
reciprocation, the DIID introduced a no-code development platform to facilitate the doctors’
participation. There were also efforts to equip the outpatient department with medical information
specialists who liaised between clinical management and IT functions. They adeptly translated
business requirements into technical language and assessed the technical needs of frontline
practitioners. At the hospital level, position transfer was encouraged. An illustrative case was the

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former director of the Computer Network Center, who was originally an orthopedic surgeon. A
physician from the emergency department also served in the center on a temporary basis for several
years. The hospital remained open to cross-disciplinary appointments, encouraging doctors interested
and skilled in digital technology to move into the digital technology department. In summary, these
actions aimed to achieve deeper and more comprehensive integration.

By developing “AI + medical scenarios” applications, Zhongshan Hospital harnessed the

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advantages of its independently developed business systems to “immersively” integrate AI
applications into real medical settings. A specialized hospital team pioneered this endeavor with
support from universities, research institutes, and technology companies. They formed a collaborative
“cross-functional team” comprising clinicians, AI algorithm engineers, and big data engineers. These
initiatives removed the barriers to applying AI in healthcare, such as the scarcity of interdisciplinary
talent, the shortage of high-quality datasets, and the need for closer integration with real-world
healthcare scenarios.
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Zhongshan Hospital established a framework for the smart hospital initiative in which the DIID
took a central role, with all departments actively engaged. For instance, clinics, laboratories, and
research centers contributed raw data, knowledge, and expertise while also benefiting from data
services, AI, software, and analysis. The Administration Office and the Medical Affairs Department
also gained empowerment in management, processes, standards, notifications, and meetings. The
Equipment and Materials Department, in collaboration with the Asset Management and Tendering
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Office, provided support for equipment procurement, data asset management, and tendering
processes.

The DIID notably evolved from “mechanical” support to “organic” advisory, making key strategic
decisions and guiding digital transformation. This transformation followed a “top-down” approach to
close the loop from design to execution, feedback, and optimization, departing from the conventional
“demand and response” model prevalent in hospitals.
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Smart Hospital Achievements

Building the hospital of the future was a long-term endeavor with no defined conclusion. Aligned
with Shanghai Municipal Health Commission directives, Zhongshan Hospital initiated the journey by
first laying the foundation. Across the three key domains—smart healthcare, smart management, and
smart service—Zhongshan Hospital accomplished significant breakthroughs that distinguished it from
earlier informatization. This marked the hospital’s entry into a new era of digitalization.

Smart Healthcare
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As a prominent public hospital, Zhongshan Hospital’s AI adoption garnered significant industry

attention. Initially, it deployed AI in various fields within the hospital, including pathology,
ultrasound, medical imaging, and nuclear medicine. The process commenced with creating a database
to store historical patient information, diagnostic procedures, analysis, and assessments, all organized
and categorized before being imported. Second, AI-assisted assessments were integrated into the

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database. At the time of writing, under the guidance of the Big Data and Artificial Intelligence Center,
Zhongshan Hospital developed and explored AI applications in areas like liver diseases, neurological
disorders, and diabetes.

The Liver Cancer Department's “Liver Cancer AI Application” comprised early-stage liver cancer
screening, knowledge graphs of liver diseases, AI-based imaging, diagnosis and treatment

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recommendations, and prognosis analysis. This application initially harnessed extensive health check-
up data to predict cancer risks. During the mid-stage, it provided comprehensive evaluations based on
a patient’s pathology images and clinical data, aiding in diagnosing and assessing risk levels and
severity. Later, it offered multimodal analysis of post-surgery reports to assist physicians in making
medication decisions as well as predicting patient survival and recurrence rates. The application
seamlessly integrated AI into every phase of a patient’s journey, from pre-diagnosis to diagnosis, and
ultimately post-diagnosis, bringing substantial enhancements in healthcare.

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In August 2019, Zhongshan Hospital introduced the first “Smart Outpatient for Brain Disorders” in
China. Patients could book appointments with the smart outpatient service, receiving consultations
from neurologists and “AI doctors” who assessed brain disorders via automatic analysis of a patient’s
gait, facial expressions, speech, and verbal responses. The AI doctor also offered intelligent
interpretations of imaging results, achieving a diagnostic specificity rate of up to 95%. This system was
implemented in 66 hospitals, benefiting over 100,000 individuals.
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The development of the AI cardiologist was spearheaded by Ge Junbo, the Director of the
Cardiology Department at Zhongshan Hospital and an academician of the Chinese Academy of
Sciences. The AI cardiologist passed the National Examination for Medical Practitioners, allowing them
to manage chronic diseases, diagnose, and even perform surgery. For instance, minimally invasive
cardiac surgery utilized a real-time 3D imaging navigation system powered by AI and augmented
reality to enhance surgery precision. Furthermore, annotating data from wearable devices, remote
ECGs, echocardiograms, CTA, DSA, IVUS, and OCT allowed the AI cardiologist to monitor a patient’s
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condition from its initial onset, follow up on disease prevention, management, and recovery through
smart applications. The system thus closed a loop for comprehensive lifecycle management. 12

Regarding brain disorders, the AI doctor could deliver precise diagnoses and treatments for brain
lesions by accurately segmenting a patient’s brain and calculating the volumes of each region.
Zhongshan Hospital also secured China’s first patent for intelligent image processing of acute cerebral
infarction. This technology facilitated the rapid and accurate identification of infarction lesions,
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providing standardized results within minutes. Compared to traditional image processing, which often
took hours to days to identify a disease without consistent standards, intelligent assessment yielded
more consistent and superior results than clinicians.

Zhongshan Hospital also pioneered several acclaimed AI applications, encompassing the AI

evaluation system for pulmonary nodules, endoscopy AI, and AI medical image quality control.

Smart Services
In 2021, Shanghai initiated a city-wide digital transformation of convenient healthcare involving all
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public healthcare institutions in the city that offered seven major services, including precise
appointment scheduling, intelligent pre-consultation, interconnected health records, streamlined
payment, electronic medical records (EMR), electronic discharge instructions, online applications for
nucleic acid tests and COVID-19 vaccines, and smart emergency services. Beyond these seven
scenarios, Zhongshan Hospital proactively applied digital technologies to over a dozen other areas.

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Smart pre-consultation and precise appointment system: Zhongshan Hospital, which handled up
to 26,000 daily outpatient visits, implemented a smart pre-consultation and precise appointment
system. Patients could customize appointments by answering simple questions about their symptoms
and uploading relevant medical history, ultrasound, and pathological reports through the appointment
app. This allowed for precise assignment to a specific caregiver, alleviating common challenges such
as difficulty recognizing the disease or not knowing which department or doctor to consult. Patients

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were initially directed to the outpatient department for routine post-operative follow-ups, with
necessary tests conducted before referring them to specialist clinics. Moreover, appointment time could
be specified down to the minute. An intelligent time-based guide and triage system in waiting rooms
ensured the sequential calling of patients. Patients also needed to check in again after receiving tests.
After implementing the system, the average waiting time fell to approximately 27 minutes, effectively
solving an issue in which patients “waited for 3 hours only for a 3-minute consultation.”

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Smart parking, smart access, and in-hospital navigation: To address parking issues around the
hospital, Zhongshan Hospital collaborated with nearby buildings to secure additional parking spaces.
The hospital established a local monitoring center to oversee and manage parking data, offering
multiple payment options for various scenarios, a comprehensive electronic invoice system, and a
contingency plan for network disruptions. For smart access, the system and terminals streamline
crowds during epidemiological checks at the entrance, ensuring faster access to medical services and
precise control of incoming and outgoing traffic. Moreover, indoor positioning technologies such as
mobile internet, IoT, and Bluetooth facilitated in-hospital navigation. These technologies created
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building and floor models, enabling patients to precisely locate their desired destination with real-time
guidance. This solution addressed navigation challenges within the hospital, reduced patients’
concerns about getting lost, and enhanced their overall experience.

Multi-disciplinary services based on clinical diagnosis: Zhongshan Hospital leveraged AI to

improve clinical diagnosis by offering comprehensive disease coverage in one location. One example
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was establishing the Pan-Vascular Management Center in collaboration with Wusong Central Hospital,
in Shanghai’s Baoshan district. This center provided “one-stop” and “multi-disciplinary” diagnosis
and treatment for patients in the district, eliminating the need for them to visit different departments
for vascular issues related to the heart, brain, and legs. 13

Interconnected and mutually recognized health records: Zhongshan Hospital enabled connectivity
between diagnostic and treatment data with all public hospitals in Shanghai. When a patient had the
same tests conducted at another medical institution within 14 days, a pop-up window would appear
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on the workstation to prompt doctors to acknowledge the results. Physicians could access
interconnected health records and receive real-time reminders to control medical expenses. This
approach simplified the patient’s healthcare journey, reduced the risk of repeated blood tests and X-
rays, lowered financial burdens, and made the use of medical resources more efficient. Zhongshan
Hospital was recognized as a top performer in terms of the number of users for recognition services,
according to local statistics. ①

Electronic medical records: Zhongshan Hospital implemented standardized electronic medical

records (EMR) using secure technologies like electronic seals and signatures. These collected data for
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disease-specific quality control and could flexibly accommodate clinical research requirements. At the
same time, the hospital integrated electronic doctors’ orders and clinical pathways with disease-specific
modules, supported by quality management functions such as antibiotics, surgery grading, medical

① Shanghai Shenkang Hospital Development Center was responsible for the investment, management, and operation of state-
owned assets within municipal-level public hospitals in Shanghai, as well as overseeing government-operated healthcare
initiatives. The key obligations entailed budgeting, asset management, planning, and performance reviews of hospital leaders.

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insurance eligibility, and critical value alerts. For patients, EMRs and electronic medical insurance
records eliminated the need to carry physical documents while enabling doctors to access a patient’s
complete medical history at any time for comprehensive assessments.

Mobile payment: Insured patients could use various mobile payment channels after completing
online real-name verification for the “Medical Insurance Electronic Certificate.” They could also receive

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electronic invoices through mobile payment, ensuring a “no-card” experience throughout their
healthcare journey. Patients in stable conditions could also access their medications within 3-5 minutes
for follow-up appointments at Zhongshan Hospital.

Smart Management
Zhongshan Hospital developed a framework involving “one headquarters with multiple branches,”
with consistent management needed for a new model of intelligent, efficient, integrated, and

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collaborative telemedicine that could be replicated. This presented a significant challenge and an
excellent opportunity to demonstrate effective smart management.

Established in October 2020, the Yangtze River Delta (Shanghai) Smart Internet Hospital was a
collaborative effort between Zhongshan Hospital and Qingpu district, Shanghai. It was the first smart
internet hospital in the Yangtze River Delta demonstration zone and pioneered online cross-city
medical insurance settlement in China. The hospital leveraged its 5G-powered Data Collaboration and
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Innovation Platform of the Integrated Care System to offer various applications, including remote
outpatient, multi-disciplinary consultations, ultrasound, imaging, laboratory tests, pathology, and
smart wards. These services adhered to the “Zhongshan Standard” with easy access to residents in the
demonstration zone and Qingpu district. The hospital also ensured real-time connectivity for diagnosis
and treatment data, enabling patients to receive remote ultrasound from doctors at the Xuhui district
HQ.
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Zhongshan Hospital's AI hub enabled these services, consistently offering a suite of eight essential
functions for both physicians and patients. These functions encompassed caregiver support, patient
services, online consultations, prescription management, health monitoring, and appointment
guidance, through which remote consultations, two-way referrals, remote diagnoses, and distance
education were made possible. Serving as an invaluable “plug-in,” the hub helped other branches
swiftly adopt Zhongshan Hospital’s capabilities, positively impacting various regions and healthcare
facilities.
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In addition to consistent diagnostic and treatment services for patients, Zhongshan Hospital’s smart
healthcare management extended to quality control in medical imaging. By February 2022, the hospital
had fully automated real-time quality control for over 36,000 cases, including 2,800 cases at the Xiamen
branch. This automated system identified and addressed images that did not meet quality standards,
enabling timely corrections and improvements in healthcare delivery. 14

Future Challenges: Bridging Two Worlds

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The plan described the “hospital of the future” as the following:

“First, smart healthcare should enable hospital transformation, integrating multiple branch
hospitals, connecting with homewards, and establishing a digital hospital twin. Second, medicine
transformation should emerge via smart research, translating medical research into concrete
applications, developing medical equipment, and promoting interdisciplinary collaboration among the
industry, education, and research. Third, service transformation shall be achieved through smart

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healthcare, including managing chronic diseases, rehabilitation, and caregiving. Fourth, management
transformation should utilize smart management, which can support integrated operations of multiple
branches, intelligent interactions between buildings, streamlined management, and standardized
medical management.” 15

The “four transformations” aligned with the four “digital twins” (Patient Twin, Doctor Twin,

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Hospital Twin, and Management Twin) under the “1-2-3-4 tactics” of Zhongshan Hospital. First, the
“Patient Twin” referred to the digital twinning of patients based on health records and consultations,
with real-time updates from wearable health devices. This allowed doctors to see a complete picture of
a patient’s conditions in real time, enabling early screening, alert, diagnosis, treatment, and post-
treatment follow-up for complete lifecycle health management. Second, the “Doctor Twin” was a
digital twinning of doctors constructed using Zhongshan’s medical knowledge database, medical
terminology database, and smart Q&A system. It could assist doctors in analyzing complex multimodal

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medical data and performing tasks such as interpreting images, providing smart guidance, assisting in
pre-consultation, and managing medication. Third, the “Hospital Twin” and “Management Twin”
leveraged IoT technology to synchronize real-time data regarding water, electricity, supplies, and staff
within the hospital to a smart management platform. This enabled monitoring and management of
issues on fire, medication, supply, and turnover. Additionally, digital twinning empowered
autonomous smart robots to perform medical tasks like medical waste transport, inpatient
management, and outpatient data collection. 16 The four “digital twins” encompassed all three major
areas of smart hospital development (smart healthcare, smart services, and smart management) while
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standing at a more advanced stage.

Zhongshan Hospital had acquired extensive and profound experience in the three critical areas of
the smart hospital initiative and was progressing toward achieving the four "digital twins." The
hospital’s history of adopting IT and digitalization demonstrated that each technological advance and
application led to substantial improvements in service delivery, healthcare outcomes, and management
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efficiency. The vision of the “hospital of the future” marked by the four “digital twins” promised to
herald transformative changes at Zhongshan Hospital that would exceed what could be imagined (see
Exhibit 4).

As Zhongshan Hospital progressed toward becoming the “hospital of the future,” it had navigated
the transformation of its business and processes. Nevertheless, it was crucial to understand that, as the
adage suggests, reaching the final leg of a journey signifies being only halfway there. Advancing from
this stage presents even greater challenges. The concept of the four “digital twins” represented a
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comprehensive effort to replicate, extend, and enhance the physical world of Zhongshan Hospital into
the digital realm. This endeavor posed significant technological challenges in modeling a complex
system with intricate relationships and interactions. However, the most formidable challenge was
changing how people think and behave. Essentially, it meant that a good doctor now had to flexibly
navigate between the physical and virtual worlds. IT projects alone would not suffice for achieving this
transformation. Instead, it required individuals to adapt to both the physical and digital realms
simultaneously.
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 Zhongshan Hospital Affiliated to Fudan University: Where Smart Healthcare Meets the Future CB0287

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Exhibit 1: Three Perspectives of the Smart Hospital Initiative at Zhongshan Hospital

Exhibit 1.1: Patient-friendly Management

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Exhibit 1.2：Functional Resources Management

No
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Exhibit 1.3：Smart Business Management

Resource managers Resource users

(outpatient office, operating （Internal medicine,
room administration, etc) surgery, etc）

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Resource allocation

 Schedule shifts;
 Reserve beds;
 Assign operating rooms;
 Schedule shifts for
medical technology
>Provide real-time data departments
Record usage
（usage rate, ROI, idle time）
>Support decision-making

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>Smart recommendation

Medical resources
(beds, staff, supplies,
equipments, etc)
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Source: The figure was created by the case writer based on the image provided by Zhongshan Hospital Affiliated to Fudan
University

Exhibit 2: Upgrading Systems: Dual Middle Platforms

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Application Business applications Data applications

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Generate data Support application Support application

New business logic

Middle Platform New data intelligence
(scheduling center, settlement
center, etc) (indicators, algorithms, etc)

Data governance

Data Big Data AI Platform: Database +

Knowledge Base
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Source: The figure was created by the case writer based on the image provided by Zhongshan Hospital Affiliated to Fudan
University

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Exhibit 3: Upgrading Organization: Top Leader Initiative

DIID

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Big Data and Artificial Intelligence
Planning and Management Center Computer Network Center
Center

Administration Cloud resources Administration

Servers, server
Standard Secuirty room, network

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management

End-user support
and maintenance
Initiatives
Data service

Data service
Operation
Software
development

Software
operation and
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maintenance

Source: The figure was created by the case writer based on the image provided by Zhongshan Hospital Affiliated to Fudan
University

Exhibit 4: Zhongshan Hospital’s Future Journey towards the Hospital of the Future
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Existing In-house IT Digital Hospital of the

•Technology partnership Transformation Future
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agreements: 100+
•Medical visits: 4.6 •Hospitals: 10 •Cross-city service
million/year •Technology partnership: •Digital twin
•Functional modules: 188 Coverning the Yangtze River
•Technological innovation
Delta Zone
•Storage capacity: 1 •Smart application
Terabyte+ •Patients: 20 million/year
•Functional modeles: BU
designed based on middle
platforms
•Storage: cloud-based
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Source: Zhongshan Hospital Affiliated to Fudan University

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Endnotes:

1 Shanghai Municipal Health Commission, etc. Notice on Issuing the Digital Transformation 2.0 Plan for “Convenient Healthcare”
in Shanghai. 2022-02-16[2022-03-13]. https://www.shanghai.gov.cn/gwk/search/content/7aa19db8864a41a39d111039617a
49a7

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2 Ibid.
3 Banu Calis Uslu, Ertug Okay, & Erkan Ursun. Analysis of factors affecting IoT-based smart hospital design. Journey of Cloud
Computing,67, 2020-11-26[2023-1027]. https://journalofcloudcomputing.springeropen.com/articles/10.1186/s13677-020-
00215-5
4 VBDATA.CN. The Direction of Smart Hospital Construction is Set: Official Response from the National Health Commission! 2019-03-
22[2022-03-25]. https://www.cn-healthcare.com/articlewm/20190322/content-1048120.html
5 Hospital Management Institute, Fudan University. 2020 National Comprehensive Hospital Rankings. 2021-11-20[2022-03-24].

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http://www.fudanmed.com/institute/news2020-2.aspx
6 Chen Rong. The Thrills of Replacing HIS. The Journal of China Computer Users. 2005（6）：30-31.
7 President Fan Jia: Zhongshan Hospital should take the lead in building “Fudan University as the First!” 2021-12-13[2022-03-
25]. https://www.cn-healthcare.com/articlewm/20211211/content-1294443.html
8 Transwarp. Qian Kun from Zhongshan Hospital Affiliated to Fudan University: The Construction of Smart Hospitals in the
Era of Healthcare powered by Big Data. 2021-08-06[2022-03-25]. https://www.sohu.com/a/481741679_100108623
9 Tang Wenjia. “AI Doctors” Are on Duty! Zhongshan Hospital Affiliated to Fudan University Creates A Smart Hospital with
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Nearly 90 AI-powered Clinical Applications. 2019-08-20[2022-03-26]. https://wenhui.whb.cn/third/baidu/201908/20/28457
3.html
10 Introduction on Zhongshan Hospital Affiliated to Fudan University. Official Website of Zhongshan Hospital Affiliated to
Fudan University. https://www.zs-hospital.sh.cn/zsyy/n33/n39/n53/n106/u1ai110.html
11 Qin Shuo and Chen Tianxiang. Boundless: The Growth of Ping An in China. Beijing: CITIC Publishing Group. 2020:224-233.
12 Gu Yong. The “Hospital of the Future” Empowered by “Zhongshan Intelligence.” 2021-05-14[2022-03-27]. https://zy
k.jssvc.edu.cn/2021/0514/c1521a174634/page.htm
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13 Tang Wenjia. A District-level Top in CMI Ranking! Wusong Central Hospital under the Management of Zhongshan Hospital
in Baoshan District Truly Benefited People. 2021-10-13[2022-03-28] https://www.sohu.com/a/494842019_120244154
14 Gu Yong. Creating a New Benchmark for Healthcare in Public Hospitals: Sheshan Branch of Zhongshan Hospital Launched
“Smart Lifecycle Initiative” Today. 2022-02-25[2022-03-29]. https://www.jfdaily.com/news/detail?id=455696
15 Shanghai Municipal Health Commission, etc. Notice on Issuing the Digital Transformation 2.0 Plan for “Convenient Healthcare”
in Shanghai. 2022-02-16[2022-03-
16 What icon technology did this hospital leverage to win the highest-level award in the domestic 5G application field? 2022-01-
No

12[2022-03-29] https://www.cn-healthcare.com/articlewm/20211219/content-1297245.html
Do

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