On the Development and Innovation of Smart Old Age Care in China
MA Liping *
Abstract: The aging of China’s population is accelerating, and the contradiction between the growing needs of the elderly for a better life and the unbalanced and insufficient development of the existing old age care services is increasingly prominent. The advantages of smart old age care combined with the development of innovative old age care services, has initiated a new wave of development of old age care in China. Along with the intensive introduction of national policies, pilot projects and explorations have been deployed throughout the country. The current development trend of smart old age care mainly focuses on data and smart equipment. The core of the former is data collection, evaluation and utilization. The latter focuses on the use of equipment and the general control of the data platform. The innovation of smart old age care mainly includes the innovation of old age care concepts, synergy mechanisms, technology means, service modes and service content.
Keywords: smart old age care · dual trends · innovative characteristics
Artificial intelligence is a major technological development in our era, affecting national security, economic development, human rights and other aspects of the social life. Its application in the field of health and medicine is also drawing much attention. In April 2018, the General Office of the State Council of China issued Opinions on promoting the Development of “internet + Medical Health”, which clearly states that the country should promote “Internet + AI” in the provision of medical services, which has made AI a hot issue in the medical sector. At the beginning of 2019, Health News listed its Top Ten medical science and technology news in China in 2018, with “Artificial Intelligence Promotes the Rapid Development of Medical Science” one of them. And in this area, smart old age care, boosted by the internet, artificial intelligence and other technologies, is having a positive and important impact on China’s response to its rapidly aging population. Based on the analysis of the current situation of smart old age care in China, this paper explores the development direction and innovation focuses for smart old age care.
I. The Current Situation of the Development of Smart Old Age Care in China
A. Proposal of the concept of smart old age care
Domestic literature on smart old age care began appearing around 2012. At first, scholars focused on the concept of “smart”, emphasizing the realization of the intelligentization and networking of smart old age care services. At present, smart old age care in China is still in a trial stage, but it has been developing rapidly. Such provisions as wearable devices, big data, cloud services, telemedicine and so on are changing the traditional ways and habits of providing medical care for the elderly. Services such as Ali Health’s “Future Hospital” plan, Tencent’s “Intelligent Medical Care” plan, Baidu’s “Online 301”, Apple’s medical applications and so on, combined with modern internet technology elements and medical health industry resources, are providing more convenient medical services for senior citizens. All these have provided brand-new concepts and ideas for smart old age care.
At present, modern technologies such as the internet, internet of things, big data, artificial intelligence, cloud computing, blockchain and other technologies are developing rapidly. Deeply integrated with the real economy, they are widely used in various aspects of social governance and the provision of public services. Under the trends of networking, informationization and intelligentization, smart old age care enjoys tremendous development opportunities. It is the need to overcome the plight of old age care and the necessity of conforming to the development of science and technology to make full use of the favorable conditions for the development of information technology and use science and technology to assist or even replace human labor. Some scholars believe that smart old age care is a new service mode, which has embedded information technology such as the internet of things, the internet and social media networks and into old age care and realized the intelligentization of old age care. 1 However, such views may sideline the important issue of human care for the elderly which cannot be ignored in old age care.
In 2016, the China Smart Old Age Care Forum was established in Beijing. More and more scholars began to pay attention to the emerging field of smart old age care. Many scholars have elaborated on the concept of smart old age care. For examples, some scholars have proposed that smart old age care refers to the use of modern science and technology such as digital information technology to support the elderly in their daily lives, help provide safety guarantees, health care, health convalescence, entertainment and leisure, learning and sharing. Smart old age care automatically monitors and even actively shares information concerning the elderly, so as to realize the friendly, autonomous, personalized and intelligent interaction between these technologies and the elderly. 2
As complex system engineering, smart old age care is difficult to describe from a single perspective. Scholars have studied smart old age care in multiple dimensions. From the technical perspective, smart old age care emphasizes the application of the internet of things, the internet, and smart technology. As a result, it is a focus of the research on smart old age care to have persistent research on the technical innovations for smart old age care. 3 In addition, there are many technical studies on products and equipment related to smart old age care, such as wearable devices, sensing equipment and so on. From the service perspective, smart old age care has broken through the limitations of traditional old age care, featuring the application of big data and thoroughly smart services; it takes full account of the actual life of the elderly to provide more professional and personalized services for them. 4 From the organizational point of view, smart old age care is centered on the elderly, with deep collaboration among families, communities, institutions and other subjects. Scholars pay more attention to the pension system participating in the three-player interaction 5 among main governments, medical and old age care institutions and enterprises, as well as the interaction and reciprocal behavior of the smart old age care service network composed of the governments, enterprises, social organizations, community committees and the elderly. 6
At present, there is no authoritative definition and unified standard for smart old age care. Neither is there a comprehensive framework for the relevant system. At present, Chinese scholars focus on the qualitative aspects of the study of smart old age, with few quantitative research studies. Moreover, qualitative articles mainly focus on the concept, existing problems, countermeasures and other aspects of old age care. Systematic research needs to be deepened. 7
At present, there are two development directions for smart old age care: driven by data intelligentization and equipment intelligentization. The former focuses on data collection, evaluation and utilization, stressing the comprehensive input of services data and comprehensive supervision of management. The latter focuses on the equipment application and the general control of the platform, focusing on the intelligence of services and the convenience of service acquisition.
B. Data centers collect data comprehensively and in real time with subsystems
The information management system collects information on the elderly, including basic statistics such as age, gender, physical conditions, and family information etc., and health statistics obtained by means of using smart medical devices. For example, through applying for the “Enjoy Life Card”, the system records data and stores
the data on a personal file. The service management system reflects the process of old age care services in real-time. When the elderly go to the old age service centers and swipe their cards to sign in, the system records the activity durations of each elder, the number of elders in each activity, and the use time of each activity room. After homebased service personnel scan the two-dimensional codes, it will send back the service sites, service duration, basic data of service objects, number of service personnel arranged, and types of service items. The service data of the second-level site are recorded uniformly by the first-level site through the information platform. The service interaction system is used to integrate and adjust the resources of all parties, and bring medical institutions, volunteer organizations and third-party service providers into the platform. The data center, combining the devices of the internet of things and internet applications, is able to offer diverse service items. The devices of the internet of things are mainly for emergency responses.
The development of the internet has enabled data to be comprehensively collected in real-time and have multi-angle utilization, so as to effectively implement offline services. By analyzing the data of the elderly in the system, it will distinguish the physical condition, economic situation and age of an elderly, so as to deliver personalized service and care programs to match the elderly person’s needs. In order to supervise the service tasks to ensure they meet the required standards, the number of service times is reflected on the service center screen in real time to supervise the level of completeness of each service for each elderly person and the level of the completion of each task. This data will be regularly transmitted to the companies’ operation departments as a reference for assessment of the companies. To spare the elderly from difficult operations, under the data-driven service type, the service personnel operate the equipment, while the elderly only need to accept the service items customized for them. As a result, it has successfully tackled the problem of the high technical difficulty of smart equipment and the slow learning and low acceptance abilities of the elderly. 8
C. Smart old age care service systems
Several service systems can be established for old age care services: 1) The old age care service declaration system. Based on the personal information provided by the elderly, it determines whether an elderly person has special difficulties and social security, which will be the prerequisite for the government to purchase services for such an elder. 2) The old age care service evaluation system. According to the existing data transmitted by the declaration system, it will automatically evaluate an elderly person’s physical condition and participation ability. The output evaluation results are divided into four grades: severe disability, moderate disability, mild disability and good ability. According to the comprehensive results, it will determine the service items (dining assistance, bathing assistance, nursing and care), monthly accessible service durations and suitable devices and other products (electronic bracelets, calling equipment, smart mattress, etc.). 3) The old age care service supervisory system. The home-based service personnel scan the two-dimensional codes installed in an elderly person’s home, and the system automatically records the location of service personnel, shows the corresponding service duration for the elderly person and starts to time it. When they leave, the service personnel scan the codes again to end the timing. The touch-screen terminal devices installed in the home-based old age care centers in each community can directly provide such items as home-based services, community services, government services and family interaction services, as well as fixed-location delivery of meals, bonus redemption and so on. It can also collate the sign-in data of the old age cards, collect activity information of the elderly, calculate the participation rate of various activities and the activity level of individual elder, adjust the types and programs of community services, and take the participation rate of activities as a reference indicator for communities level assessment.
D. Boost artificial intelligence medical care to promote smart old age care
In artificial intelligence scenarios, the application of advanced technologies such as image recognition, in-depth learning and neural networks are expected to solve the problem of inequality of medical services and medical resource distributions to a certain extent. At present, artificial intelligence products based on medical imaging, assistant diagnosis and treatment and disease prediction are gradually emerging. By promoting the application of medical AI, it can liberate large hospitals and experts from repetitive works. Also, it can provide assistant diagnosis and treatment for grass-root doctors and promote self-sustained health management for the elderly. In this regard, the biggest difficulty is data acquisition. Take smart diagnosis as an example. We need to integrate and compute more dimensional and on-going medical data, including gene data, pathological data, clinical data and so on. Only in this way can the machine achieve more accurate and quantitative diagnosis. 9 At present, the authenticity and validity of the data of many internet medical enterprises need to be discussed. However, as the data of hospitals are not shared, it will cost a lot to obtain truly high-quality and effective data.
E. Promote delivery of smart old age care by technology
By means of advanced technologies such as technologies of the internet and the internet of things, smart old age health care will achieve interaction with personnel, information, equipment, resources related to medical and health services, in order to ensure that people timely access to preventive and therapeutic medical services. The rapid development of new-generation information technologies, such as the internet of things, the mobile internet, big data and cloud computing provides strong technical support for smart old age care. First, the technology of the internet of things can collect, process, store, transmit and share medical, equipment, medicine, personnel, management and other information, so as to effectively manage medical materials and achieve medical safety. Second, mobile health care can be widely used in the management of medical institutions, clinical diagnosis and treatment, and other aspects, which will greatly improve service efficiency, optimize service processes and service modes. Besides, big data technology can fully tap and utilize the value of data, revitalize existing data, and then apply, evaluate and make decisions on this basis to serve the management and decision-making by hospitals. Cloud computing provides a new mode for the storage of various medical data. The establishment of a “medical cloud” will break the “information islands” and thoroughly realize the sharing of information resources and the interconnection of systems. Demand for telemedicine is increasing, which will shorten the distance between doctors and patients. 10 Meanwhile, reducing medical costs and meeting the demands of increased elderly patients are also the main driving factors for telemedicine services. Patients can use telemedicine services whether for clinical contact with doctors, or for health support such as medicine-related reminders, or for tracking health indexes such as blood pressure and blood sugar, or for receiving daily support to manage ongoing health problems. Most elderly will consider replacing the care from human clinicians with AI technology. The top four service types the people are mostly willing to accept are: 1) monitor heart conditions (such as heart rate, blood pressure, electrocardiograms and so on): 2) examine and test heartbeats and make recommendations based on the results; 3) provide customized recommendations for fitness and health according to personal preferences and health records; 4) accept blood sample tests and receive results. Robots are changing the medical world, such as increasing medical productivity and reducing conventional errors, which increase the demands for medical aid and automated robots. Meanwhile, medical robots can be used for rehabilitation, physical therapy and the development of next-generation wearable devices to support old age care, alleviate autism (i.e., enhance social skills) and simplify surgery.
With related security risks arising from information sharing, especially in health care, cyber-attacks and data leakage are the biggest hidden dangers to health data security. Block-chain-based health care systems can help deal with such challenges as data interoperability, integrity, security, portability and so on. With increasing and expanding social needs, the recent service objects of the rehabilitation health care are extended to those who recover after surgeries or illness, that is, to serve special groups such as patients with chronic diseases, lifestyle diseases, middle-aged and elderly diseases and mental disorders.
F. Develop smart old age care with smart instruments and devices
The core characteristic of smart old age care is the application of smart devices. Governments can purchase smart products for community-based old age care and the elderly can use smart products for home-based old age care. Smart instruments and devices include dozens of varieties of devices for emergency rescue, health management, housekeeping services, smart positioning and so on. 11 For example, connecting information from devices, smart cloud centers integrate functions and act as emergency rescue centers, data information centers, active care centers and offline service command and dispatch centers, selecting and distributing on-demand services through an app. By bringing in various advanced devices, they can be used to meet the needs of safety monitoring, medical rehabilitation, daytime nursing, bathing and dining assistance, etc. Also, they can carry out elderly-targeted and localized modification to establish the internet of things. The home-based old age care program also includes smoke detectors, water immersion detectors, door magnets, portable emergency call buttons, camera sensors, control panels and others, which can realize multi-directional monitoring and preventive measures for the elderly at home. The all-weather smart monitoring program includes smart walking sticks, fall alarms, special smartphones for the elderly, pedometers, positioning cards, and so on to achieve real-time monitoring of outdoor activities for the elderly. Smart health care equipment, health and old age care integrated machine, smart WeChat management of blood pressure instruments, pulse oximeters, electrocardiographs, blood glucose meters, etc., used for the health management and medical assistance in community-based old age care, so as to achieve their tasks in preventive control and effectively intervene for the management of chronic diseases. For example, an old age care app can display various equipment data for their children to inquire about their well-being. The all-in button on the terminal can summon nearly 100 services needed by the elderly such as emergency rescue, medical services, telephone doctors, outpatient appointments, car-hailing services, payment services, housekeeping services and so on. Human-computer interaction is used instead of face-to-face services, with the most diverse equipment presented before the elderly, so as to make service offering more simplified, service acquisition more convenient and service experience closer.
With simpler and more suitable smart devices specially designed for the elderly, it makes old age care services more uniquely distinctive. For example, the emergency relief channels are smoother. With service terminals such as smart wearable devices, smart crutches, emergency aid devices and others, the elderly can timely and accurately communicate their needs for emergency assistance to the old age care providers, who will then provide assistance measures together with the elderly person’s children and medical institutions. Feedback of emergency demand information at the earliest moments can greatly reduce the disastrous consequences of ineffective emergency assistance for the elderly. Another example is smart health care services. Smart medical testing devices are used for dynamic monitoring of the health data for the elderly, so as to precisely link up the timely, accurate and personalized medical guidance and health service suggestions online on the service platform and with the offline health care services.
With the breakthroughs in traditional medicine and life sciences, as well as the ever-changing integration practices of medical science and technology, human beings will acquire more smart systems featuring high integration, fast operation, low cost and diverse methods. In the foreseeable future, anyone who can grasp this trend and opportunity will walk on the front-line of smart old age care in the world and make outstanding contributions to human beings in the aspects of smart old age care and improving the quality of living and life for the elderly.
II. Problems Existing in Legal Regulation of Smart Old age Care in China
At present, the specific laws, regulations and operating rules for health and medicine big data are not comprehensive or meticulous. Despite many policy documents as guidelines, the implementation and promotion of the specific systems still need to be drafted and implemented by the relevant competent departments. This inevitably leads the market vitality to “have no laws to rely on” in mining and applying big data of health and medicine. It is only “crossing the river by feeling for the stones”. To a certain extent, this has restricted the healthy development of smart old age care.
The State Standards, Safety and Service Management Measures of Big Data of Health and Medicine (Trial implementation) (hereinafter referred to as Service Management Measures) issued by the National Health Commission of China in September 2018 clarified for the first time that “big data of health and medicine” refers to data related to health and medicine generated in disease prevention and control, health management and other processes. Meanwhile, the Service Management Measures further clarify the regulatory units and responsible units of big data of health and medicine and standardized big data of health and medicine from three aspects including standard management, safety management and service management. However, the Service Management Measures are only a framework provision, with vague areas in its practical operations.
In collecting big data of smart old age care, the collection of personal information generally follows the provisions of the Network Security Law that “it shall follow the principles of legality, legitimacy and necessity, publicize the collecting and using rules, make clear the purposes, modes and scope of collecting and using information, and with the consent of the owners of information”. “Personal information unrelated to the services provided shall not be collected. Personal information shall not be collected or used in violation of the provisions of laws, administrative regulations or the agreement between the two parties.” However, there are still different opinions on whether the health and medicine data formed through disease diagnosis and treatment, health consultation and so on belong to patients or to medical institutions or health consultation institutions. This leads to the existence of gray areas in the collection and use of health and medicine data in this part and may also lay hidden dangers for the further development and application of big data of smart old age care in the later period. In view of this, in collecting big data of health and medicine, we should strictly control the flow of collecting information, and obtain effective authorizations from relevant units and individuals of big data of health and medicine in an all-round way. Meanwhile, we shall well standardize the management of data collection. 12
For the storage and protection of big data of health and medicine, the Service Management Measures clearly requires that “responsible units should have data storage, disaster recovery backup and security management conditions that meet the requirements of the relevant provisions of the State and strengthen the storage and management of big data of health and medicine.” “Responsible units should build a credible network security environment according to the requirements of the national network security grade protection system, strengthen the construction of the security guarantee system related to big data of health and medicine, enhance the security protection capability of key information infrastructure and important information systems, and ensure the safety and controllability of key information infrastructure and core systems of big data of health and medicine.” “Centers and related information systems of big data of health and medicine should carry out grading, filing, evaluation and other works.” Effective on 1 June, 2017, the Network Security Law also introduces a hierarchical protection system for network security and focuses on the protection of “key information infrastructure.” In the key information infrastructure business decision table of the National Network Security Inspection Operational Guidelines, “the operation of hospitals and other health institutions, disease control and first aid centers” in the “medical industry” are identified as key businesses. Meanwhile, in Regulations on the Safety and protection of key information infrastructure (Draft for public Opinions) issued on July 10, 2017, units in the field of health care will also be included within the scope of protection of key information infrastructure. Considering that the later development and application of big data of health and medicine focus on the field of health care, it is suggested that relevant enterprises and institutions should strictly implement the storage requirements and security hierarchical protection system of big data of health and medicine, and focus on the protection thereof, so as to improve the storage and protection of big data of smart old age care.
For the application of big data of health and medicine, Article 42 of the Network Security Law stipulates that “Network operators shall not divulge, tamper with or destroy the personal information they collect, and shall not provide personal information to others without the consent of the owners of information, unless such information is too unidentifiable to belong to a specific individual or to be recoverable. For this reason, big data of health and medicine can be legally applied without the consent of the owners of the information after being legally collected and desensitized. This undoubtedly effectively reduces the legal obstacles to the practical application of big data of health and medicine and provides an effective institutional guarantee for the deep mining and research and development of big data of health and medicine.
Informatization is the first condition in the development of internet health care and smart old age care and the infrastructure of the industry. Internet diagnosis and treatment, internet hospitals and remote diagnosis and treatment are good entry points for services. From the current situation of medical reform in recent years, the problem of unclear rules and “rights, responsibilities and interests” always exists. 13 At present, the emphasis on “the information technology attribute” of internet health care is also due to the actual needs of the industry development. It is absolutely not the real internet health care, let alone the ultimate business form of internet health care. After a series of normative documents about the strategy of “internet + healthcare” have been finalized, the internet smart old age care industry based on the solid foundation of “hospital informatization” will have a real chance to explore the future.
III. Innovative Concepts of Smart Old age Care in China
The essence of smart old age care is innovation. It is a process in which modern technologies are applied to old age care services and in which various new services are constantly emerging and widely used in the society. 14 In its development trend, smart old age care presents the following innovative concepts.
A. Innovation of the people-oriented old age care concept
The traditional old age care model is mainly based on humans providing services, relying on the experience of the service providers, supplemented by simple instruments, with limited service content and modes. The elderly can only receive services passively, lacking autonomy and initiative. Smart old age care utilizes modern science and technology to provide various personalized service items, create space for the elderly to operate and choose health services on their own, and comprehensively meet their needs. Smart devices are used to monitor the situation of the elderly, including their movement, health indicators, consumption behavior and so on, so as to have specific understanding of the security, physical conditions, interests and preferences of the elderly. Smart old age care should start from the unique living habits and service needs of each elderly person, mobilize government, institutions, communities and enterprises to design old age care service items for each elderly person within a reasonable budget to make it possible to build a scientific, effective, personalized and complete old age care service system that fully reflects the idea of being “people-oriented” 15 . Traditional old age care is only about “care”, while smart old age care integrates old age care, old age assistance and old age engagement, and realizes the change of the elderly from passive receivers to active choosers of health care services. The innovation of the old age care concept runs through the smart old age care and promotes the continuous improvement of the old age care services. Through technological innovation and service innovation, we can also realize the implementation of the old age care concept and promote the closed-loop operation of smart old age care.
B. Innovation of collaborative mechanisms of pluralistic integration
While traditional old age care lacks information communication meaning it is difficult for all parties to cooperate effectively, smart old age care breaks down the barriers between different subjects. Longitudinally, smart old age care achieves the functional division among different levels by means of data systems. At the city level, smart old age care data centers should be set up to focus on the analysis of the data concerning the elderly, old age care institutions and the old age service providers and operators. Data should be utilized to formulate old age care policies, supervise old age care institutions, screen old age care service providers and evaluate old age care work. At the district level, a unified smart old age care platform should be established to implement the old age care policies at the city level and determine the old age care subsidy standards for the elderly in that jurisdiction.. Downwardly, it focuses on the guidance and supervision of old age care services. Horizontally, smart old age care is helpful to realize the deep collaboration among various old age care subjects. Governments no longer cover various old age care services. By purchasing services through tendering and bidding, governments shift their emphasis of work to policy support and market supervision. Old age care service providers carry out professional operation and are responsible for the operation and management of the smart old age health information platform. There are not only the old age care service operators’ own resources as the main service mode, but also the old age service mode of integrating old age resources across society. It also highlights the subjectivity of the elderly. The elderly provide personal information for systematic evaluation to obtain customized services. Meanwhile, the elderly can also evaluate services and provide feedback. While operating independently to play its own role and function orientation, each subject is linked to the smart old age care information platform and becomes part of the whole.
C. Innovation of technological means with the integration of science and technology
The use of the internet, internet of things and big data to assist the development of old age care showcases the “smartness” of smart old age care. 16 The internet, internet of things, big data, cloud computing, block chain, artificial intelligence and other technologies and other modern technologies are integrated to support the services and management needs of the elderly. From the perspective of demands, it is to collect a series of data and detailed service needs of the elderly by utilizing the internet’s functions in collecting, storing and disseminating information. From the viewpoint of supply-demand docking, it is to establish a community-based or home-based old age care service information platform by utilizing the internet’s ability to timely share and exchange information. 17
With the internet of things realized and collection of data real time and dynamic, the exchange of data between the self-organizing network and the external environment can be achieved, 18 so as to monitor the vital signs of the elderly and facilitate treatment decision-making, chronic disease management and early warning against risks. Cloud computing can quickly process the rich information of big data. Its application in smart old age care is mainly embodied in analyzing various types of old age related data, in order to find out the data relationships, explore the needs of the elderly, help the elderly to make decisions, and provide personalized services for the elderly. The application of big data in smart old age care is mainly through the internet of things, the internet, the old age care service system and other network platforms for the elderly, as well as terminals such as smartphones and wearable devices, together with various sensors and monitoring equipment installed in old age care institutions. 19 Jointly promulgated by China’s Ministry of Civil Affairs, Ministry of Industry and Information Technology and National Health Commission, The Action plan for the Development of Smart Health and Old Age Care industry (2017-2020) also emphasizes the use of the internet of things, cloud computing, big data, smart hardware and other new-generation information technology products to realize “the smart health and old age care industry”. The Action Plan provides guidance for the research and development of key technologies for the smart old age care industry.
D. Innovation of efficient and smart service modes
At present, the supply capacity of China’s old age care industry is seriously inadequate, with insufficient human resources for community-based and home-based old age care. However, the traditional old age care services rely too much on human services and management, which is problematic as there is slow quality improvement, low service efficiency, high human resource cost and other aspects. Smart old age care brings smart products into old age care solutions, replacing human resources with equipment, and connecting personnel with platforms. By simplifying service-providing procedures and reducing information transmission delays, the elderly can access services in less time, while the service personnel can provide services faster and at lower cost. At present, smart products in various places are mainly divided into two categories. The first category is comprehensive data platforms, including data acquisition platforms, service deployment platforms, and emergency response platforms. The second is terminal equipment for the elderly market, mainly for daily living, rehabilitation care, and safety supervision. Supported by platforms and devices, it provides conditions for interconnection of information and improves the old age care service efficiency. Striving to build a standardized system of old age care services, many demonstration bases for smart old age care have released core standards such as infrastructure standards, service standards, service personnel management standards, home-based service standards, the construction and management standards for service information platforms of old age care service enterprises, the standards for information management for the elderly, among other things for smart home-based old age service and care centers.
IV. Major Suggestions on the Development and Innovation of Smart Old Age Care in China
A. A goal orientation of “basic needs”
In view of the huge demand for high-end old age care services, the supply of old age care services should not only emphasize the instrumental rationality of the subjects, scopes and modes of supply, solve the problems such as “who to supply”, “what to supply” and “how to supply”, but also pay more attention to the value criterion of the dignity and basic needs of the elderly, that is, the problem of “supply for whom”. The input of public services should give priority to enhancing the ability to guarantee the quality of life of the elderly. But only after meeting their most urgent needs should the scope and level of public services be gradually expanded. Starting from the basic needs of the elderly is the key to ensuring the effectiveness of old age care services. First of all, we should establish an accurate demand survey mechanism to clarify the differences between different regions. Providers of old age health services should conduct pre-market research and home research, and carry out city-wide, town-wide or district-wide network questionnaire surveys to form preliminary demand hierarchies. These also be flexibly adjusted according to the post-service effects. Second, the identification of the demand hierarchies of the elderly should be combined with the feedback of the supply content to change any supply dislocation. The elderly should be categorized according to the demand hierarchies for old age care services. The elderly of different categories should be provided with different basic old age services, so as to pay attention to the precision with which services are provided to avoid a supply demand imbalance. Focusing on the basic needs of the elderly does not mean abandoning the pursuit of high-end old age care services. The notion of “taking basic needs as the first goal” is to focus on reality instead of being too far-sighted. It is not fixing on satisfying the basic needs of the elderly, which will stagnate the innovation in the field of smart old age care services.
B. A key task of “bridging the smartness gap”
The all-around, all-weather and three-dimensional smart old age care model envisioned is an integration of high-end information technology. However, the front-line users are not so “smart”. Limited by their life experience and physical conditions, the elderly learn slowly and have a common psychology to accept new science and technology slowly. It gives rise to “a smartness gap”. In view of this, first of all, smart- phones, wearable devices, emergency alarms and other smart terminal products should be designed with simplicity as the main feature, with enlarged fonts, improved sound and prominent functional buttons, so as to reduce the operational difficulties of smart products, enhance the self-ability sense of the elderly, enable them to skillfully use smart products under the guidance of the interaction systems of products. Research and development enterprises and relevant service personnel should help the elderly to correctly understand and master the uses of the smart products. Second, the smart product research and development companies should arrange staff to first explain how to use their companies’ products to community staff, volunteer service teams and children of the elderly by regular targeted lectures and demonstrations. These people can then explain to the elderly in depth how to use the products. Through repeated teaching, the elderly can master the operation methods faster. Attention should be paid to the group characteristics of the elderly. Learning strategies such as retelling strategies, elaborate processing strategies and organizational strategies should be combined to purposefully formulate relevant programs. Publicizing the advantages of smart services and improving the learning efficiency of the elderly. 20 In addition, for those elderly who cannot use smart products independently because of their physiological conditions, other people who master the operation methods of smart products should be responsible for their use, thus sparing the elderly from operating the product while still enabling them to directly access convenient care services, so that smart products could render universal care for every elderly person.
C. Establish a data protection mechanism for the elderly
At present, in China, users’ data are mostly collected through various sensors on smart old age mobile service platform. However, due to the small scale of the platforms, lack of data interconnection among platforms and other reasons, a great deal of data cannot be developed in depth, as a platform’s data is just used by the platform itself, which forms “data islands”. Meanwhile, data owners may peddle information for commercial purposes, presenting huge risks to the security of the personal information of the elderly. At present, the legislation concerning the protection of privacy rights of electronic data information is scattered and lacks pertinence. Some problems are regulated by policy documents and lack sufficient protection.
To protect the data privacy of the elderly, a comprehensive data protection mechanism should be established. Firstly, led by the government, with the departments of civil affairs, health, human resources and social security and others carrying out the top-level design and centralized management, so as to build a unified cloud platform for smart old age care and realize the interconnection and consistency of the old age data. Second, laws, regulations and policies should be promulgated to strengthen data protection and management, implement credibility management, ensure authorized and reasonable uses of data and guarantee information security. Such mechanisms as the signing of non-disclosure agreements, pre-use authorizations, and real-time monitoring should be established and perfected for the purpose of data security. 21 Legislation should be perfected to clearly define the rights and responsibilities of all parties. The privacy of the information of the elderly should be included in the scope of privacy protection. Legislative protection clauses on data infringement should therefore be added.
D. Establishment of an incentive mechanism for government evaluation
It is of great significance for the healthy development of smart old age care to determine the evaluation criteria, a results corresponding reward and punishment mechanism, the evaluation departments and other factors. In selecting the evaluation criteria, governments should consider the operation of the frontline old age care service providers, the provision of multiple services, including home-based services, food safety, activity participation, crisis management and so on, listen to the opinions of frontline staff, and make localized adjustment with reference to international standards for old age care services, so as to establish scientific quantitative indicators. In establishing the reward and punishment mechanism, governments should adopt competitive differentiated subsidies to provide different amounts of operating funds for different hierarchies to promote the internal competition of old age care service institutions. Meanwhile, governments should raise the threshold of market access for service providers. After formulating a standardized service evaluation mechanism, governments should regularly supervise the service status and implement the evaluation results into the reward and punishment mechanism for service providers. To perfect the supporting guarantee system for smart old age care, the offices for the aged in the civil affair departments should take charge of the assessment task. A special supervision department should be established to manage the participants of the old age care service in collaboration with the health department and the social security department.
All in all, with the development of healthcare in China, the application and development of big data of smart old age care in practice is gradually expanding and deepening. However, the lack and incompleteness of relevant laws, regulations and policy systems have seriously impacted the steady and rapid development of the undertaking of smart old age care. It is suggested that relevant laws and regulations should be promulgated to provide legal and policy guarantees for smart old age care. We should strictly regulate the market access of the internet medical industry and smart old age care, and further standardize the internet medical smart old age care market. In applying big data and artificial intelligence of smart old age care, the principle of prudent, strict and rational utilization should be upheld to standardize their application and effectively promote the sustainable development of the smart old age care industry.
(Translated by PAN Yingzhao)
* MA Liping (马莉萍), Associate Professor and Doctor of Law, Law School, Shandong University.
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