BMJ takes a trip inside the ‘Great Firewall of China’


A UK-based publisher of medical and scientific content is using Alibaba Cloud’s Shanghai-based public cloud infrastructure to give Chinese physicians access to its Best Practice tool.

Providing high-quality healthcare to the world’s largest national population, at a time while it is rapidly aging, is a huge challenge.

It’s no wonder then that the government of the People’s Republic of China has put in place various measures to boost the number of physicians in training in recent years, in order to take care of its 1.4 billion people.

But there is still much work to do: as recently as 2013, the number of physicians per 10,000 people in China stood at 14.6, as compared with 24.2 in the US and 27.7 in the UK, according to a study published last year by academics at Brown University in the US and Fudan University in Shanghai.

That makes China – and its population of over 2.1 million practicing physicians – a fertile market for UK-based medical and scientific publisher, the British Medical Journal (BMJ). Its product Best Practice, an online decision-support tool for use by medical staff at the point of care, is popular in China, but giving access to that tool to those that need it, when they need it, has been a problem in the past, according to BMJ chief digital officer Sharon Cooper.

What stood in the BMJ’s way was the Great Firewall of China. In other words, Chinese online access to Best Practice was often blocked or too slow when it was hosted in the UK. Still, Cooper and her team have found a way to address this, with the help of BMJ’s managed service provider Datapipe (currently being acquired by Rackspace, in a deal expected to close before the end of 2017).

Great Cloud of China

Today, the Mandarin version of Best Practice is hosted locally in Shanghai on Alibaba Cloud, the cloud services of China’s ecommerce giant. (Alibaba Cloud, incidentally, was last year ranked third behind Amazon and Microsoft and one step ahead of Google in the worldwide IaaS public cloud services market, according to Gartner – but it’s on a mission to dominate the market, and now has 15 data centres worldwide, nine of which are outside China.)

This Chinese BMJ Best Practices is managed by Datapipe staff based in China and linked directly to BMJ’s core infrastructure. Basically, this gives BMJ all the benefits of public cloud infrastructure, but located in China and set up in a way that satisfies the requirement of the Chinese authorities, which are particularly stringent when it comes to the healthcare sector, according to Cooper.

What this means in practice is that the UK-based BMJ team now has oversight of a hybrid multi-cloud solution, enabling it to roll out new releases, updates and bug fixes to Best Practice in exactly the same way as it does with a product held in its AWS infrastructure, for example. In fact, Datapipe’s experience and on-the-ground expertise in China was one of the main drivers of its contract with BMJ, which kick-started a significant Agile and DevOps makeover at the publisher. Says Cooper:

The big thing here is that we can run everything through one single pane of glass, and be able to deploy really easily when we make a change in Best Practice, because those changes run straight through to the China-hosted Mandarin versions. This is vital, because we make a lot of changes to Best Practice each week – adding new content, adding new functions, fixing any bugs. It fits in with our new approach to digital because we can continually deploy those changes through our established automated processes.

We’re not a big organization and we don’t have big teams to do anything, so it’s all about trying to reduce the manual effort involved in work but still working in this agile, automated continuous delivery kind of way. What we didn’t want was to build a big team out in China to manage a lot of infrastructure, but working with Datapipe, we can see everything we have in Alibaba Cloud just as if it was in the UK.

Slow and steady

It took little more than a week to have that infrastructure up and running, she adds. That’s a great deal quicker than it took to get all the paperwork completed and licenses in place to publish in China, which took around 18 months, she says.

So what’s next for BMJ in China, where there’s clearly such a need for the content it publishes? According to Cooper, Best Practice is the first BMJ product to be rolled out in this way, using local Alibaba Cloud resources, but it certainly won’t be the last. Other learning products will surely follow, she says, but are still subject to the long sales cycles that characterize deals between BMJ and hospitals or medical schools. Cooper says:

What we also expect to see more of is our Chinese team creating local products tailored to suit the very specific needs of the local market. That’s certainly part of our future plans. And we will start to roll out some of our journals, in association with Chinese publishers and medical associations.”

We want to go relatively slowly and be absolutely sure of what we’re doing. This is a market that’s hard to navigate. The rules are different, the ways in which you are allowed to trade are different. We’re a conservative organization, and we’ll take a cautious approach to this market, but we’re very confident that we have the foundation in place to roll out new content and services as and when we see a clear appetite for them.

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