Home medical treatment, can Internet hospitals alleviate the difficulty of medical treatment？ Can you achieve the effect of offline diagnosis and treatment？
① Lai Jinzhi, a doctor from Peking Union Medical College Hospital, diagnosed and treated patients online. Photo courtesy of Peking Union Medical College Hospital
② The doctor of Peking Union Medical College Hospital is writing the patient’s medical record. Photo courtesy of Peking Union Medical College Hospital
③ Doctor Liu Yongtai of Peking Union Medical College Hospital has video communication with patients’ families. Photo courtesy of Peking Union Medical College Hospital
④ The staff of jiangsu province hospital Internet Hospital Office showed the mobile phone Internet hospital platform. Xinhua news agency
The concept of Internet hospital sprouted in 2011, and by the end of 2015, the first Internet hospital in China — — Wuzhen Internet Hospital was established. In April 2018, the General Office of the State Council issued the Opinions on Promoting the Development of "Internet+Medical Health", which put forward the concept of Internet hospital for the first time in the document, and made it clear that Internet hospitals must rely on physical medical institutions.
Different from the online consultation in the past — — Taking advantage of doctors’ fragmented time for consultation, it provides services of registration, payment and report inquiry. Internet hospital refers to a one-stop service platform that relies on physical hospitals, focuses on online follow-up and routine consultation, and integrates consultation, prescription, payment and drug distribution.
"The Internet diagnosis and treatment of Union Medical College Hospital is not the earliest, but we strive to do our best." Qin Mingwei, director of the telemedicine center of Peking Union Medical College Hospital, said that the hospital can provide follow-up services for some patients with common diseases and chronic diseases. At present, 27 departments including cardiology, endocrinology and dermatology have been opened to support in-hospital case review, online consultation, inspection and prescription.
Because of the epidemic, Internet diagnosis and treatment has "fired" from the small public’s field of vision to the public’s demand. According to incomplete statistics, there are now more than 1,100 Internet hospitals in China. From online consultation, appointment and registration to providing high-quality online diagnosis and treatment services, after experiencing "more doctors" and "faster prescription", how can Internet hospitals move towards "good curative effect" and "low cost", so that ordinary people can really see the disease, see it well and afford it? Obviously, there are still several unsolved problems in front of the Internet hospital.
1. Can it alleviate the difficulty of seeking medical treatment?
"Hello, Dr. Chai, I have been eating metformin, and my blood sugar is somewhat repeated. The control is not ideal. What should I do?"
"Your islet function is OK. You should keep taking metformin. I’ll give you another medicine to eat with."
"I’m quite fond of eating, including some sweets. Can I eat fruit?"
"You can eat some northern fruits in moderation. Diabetes still needs to be shut up, ‘ Sugarcane is not as sweet as both ends ’ If you want to be healthy, you must learn to avoid eating, which is indeed a ‘ Pain ’ The process of … …”
This is the scene where Chai Xiaofeng, the attending physician of endocrinology department of Peking Union Medical College Hospital, makes a follow-up visit to Mr. Bai in Jinzhong City, Shanxi Province through the network. Mr. Bai told the reporter that with the help of his family, he hung up the number of his previous doctor by using the "Peking Union Medical College Hospital" App and successfully completed the follow-up visit. "Very patient and responsible, and the advice given is very professional!"
How to operate the mobile phone follow-up visit? Hospital staff clicked on the "Peking Union Medical College Hospital" App to demonstrate to reporters: before the appointment time on the day of the visit, on the home page, "I" — — Check in the "consultation record". According to the registration order, the doctor initiates the consultation invitation in the form of short message, voice or video, and the patient can reply to the information or click answer to start the consultation. The whole process is easy to operate, even for elderly patients who can’t surf the Internet, they can easily complete it with the help of their families.
"The speed of the development of Internet medical care first depends on the development of products." Chen Qiulin, deputy director of Health Industry Development Research Center of China Academy of Social Sciences, pointed out that this is an interactive process, and product innovation and model innovation can promote system innovation.
"Online doctors are mostly young and middle-aged doctors, and offline clinics are still occupied by senior professors. In this way, regular follow-up patients can no longer occupy the source of offline clinics and leave the source to those patients with incurable diseases. This is also the optimal allocation of medical resources." Qin Mingwei said that 60% of the patients in Peking Union Medical College Hospital came from outside Beijing, and the online follow-up visit also greatly saved the time cost and round-trip expenses of patients.
"We have also opened the online and offline outpatient service conversion appointment function." According to Qin Mingwei, the patient’s condition of online follow-up is relatively stable, and there is no need for complicated medical examination or treatment. However, if the patient’s condition is found to have changed significantly and is no longer suitable for online diagnosis and treatment, he can directly arrange an appointment for an offline clinic to avoid the trouble for patients to make appointments through other channels.
How to get medicine in an Internet hospital? It is understood that in September last year, the Internet medical drug distribution service of Peking Union Medical College Hospital was officially launched. In order to make the express delivery arrive more accurately, the hospital selects high-quality drug delivery contractors and signs long-term cooperation agreements. National non-medical insurance patients can enjoy the "peer-to-peer" delivery service of drugs to their homes after returning to Peking Union Medical College Hospital online, and can inquire about prescriptions and medication guidance on the mobile phone client of Peking Union Medical College Hospital. If in doubt, they can also consult with Concord pharmacists online.
There are hundreds of millions of patients with chronic diseases in China. The diseases are incurable and have many complications, which need long-term medication and health management to control. "I saw 25 patients in the morning according to the regulations. In fact, I often saw more than 40 patients. Half of them may be unnecessary to see. " Sun Xiaodong, deputy director of the Department of Ophthalmology of Shanghai First People’s Hospital, said that 70% ~ 80% of chronic diseases can be consulted in Internet hospitals.
According to Lu Qingjun, director of the Office of National Health Commission Primary Telemedicine Development Guidance Center, large hospitals have the ability of technological innovation and academic leadership. After establishing an Internet hospital and forming a mature platform, they can be shared and transferred to the primary level. "In the future, I believe that all medical institutions have the opportunity and ability to use the Internet platform to carry out Internet medical care."
Mao Ying, dean of Huashan Hospital of Fudan University, hopes to further rationalize the relationship between public hospitals and Internet hospitals such as third-party medical institutions, and at the same time, open the scope of practice and the autonomy of subjects and prices of Internet hospitals in public hospitals. "At present, online follow-up dispensing in public hospitals is limited to ordinary clinics, and expert clinics and special needs clinics have not been liberalized."
"The positioning of our Internet hospital is very clear from the beginning, that is, to achieve graded diagnosis and treatment, to leave patients at the grassroots level, and to sink high-quality medical resources to the end, to send medicines to the people at the grassroots level, to standardize management, to implement education, and to minimize medical expenses." Li Guanming, deputy secretary of the Party Committee and vice president of the Second People’s Hospital of Guangdong Province, said.
2. Can you achieve the effect of offline diagnosis and treatment?
Behind the rapid development of Internet medical care is the rigid demand for people’s livelihood. In the face of Internet hospitals, many people have questions: Can remote video see the symptoms clearly? If you don’t take a film and check your blood, can you diagnose it?
In fact, Internet hospitals at this stage are not "cloud consultation" but "cloud follow-up". "Many patients have already seen a doctor in a physical hospital, and all the tests that should be done have been done. On the one hand, online follow-up is to understand the progress of the disease, on the other hand, it is to prescribe drugs and adjust drugs. More patients go to ‘ Cloud ’ It is to consult a doctor’s professional opinion. If further examination or surgery is needed, the doctor will inform the patient to transfer to a physical hospital for treatment. If it is impossible to see a doctor, how to deal with it temporarily. " Shu Yongqian, director of jiangsu province hospital Cancer Center, pointed out that this kind of consultation is more like the pre-examination and triage of primary medical institutions, focusing on judging the severity of patients’ symptoms, and forming a service order of graded diagnosis and treatment with offline entity hospitals. On the Internet hospital platform, you can directly return to the clinic and issue an electronic prescription to buy drugs.
At present, the technical means of online diagnosis and treatment are relatively mature. Internet hospitals have made great progress in mobile ward rounds, mobile nursing, full link of monitoring equipment, remote first aid, remote consultation, medical teaching, surgical robots and remote surgery.
In April last year, sir run run shaw hospital cooperated with Zhejiang Unicom and Huawei Company to set up a 5G Innovation Center. By sorting out more than 2.5 million electronic medical records in the hospital, it led the development of a general clinical intelligent decision-making system, and built a medical knowledge map covering more than 600,000 ontological logical logical associations. Based on the current medical knowledge base and reasoning model, this AI reasoning engine can infer and push the symptoms, signs, medical history and examination results of patients with an accuracy rate of 90%.
"Now there are no technical problems in the development of Internet hospitals. The real bottleneck is how doctors really devote themselves to Internet hospitals. Internet hospitals are not ‘ Light consultation ’ Upgrade and revision. " Zhang Qiang, a well-known vascular surgery expert, suggested the establishment of internet diagnosis and treatment, from fragmented services to exclusive customized services, from no standard to full quality control.
Cui Yong, vice president of the China-Japan Friendship Hospital, said: "To ensure a high degree of consistency between online and offline, this also puts high demands on doctors. It is necessary to learn to use Internet technology to carry out diagnosis and treatment. " In this regard, Zhao Chengsong suggested that doctors should be trained on the Internet to improve their online diagnosis and communication skills. "Internet medical care is not exclusive to young doctors. Experienced experts should take the lead in embracing the Internet so that more patients can enjoy quality medical resources." Zhao Chengsong said.
National Health Commission explicitly requested that Internet diagnosis and treatment activities should not be carried out for the first-time patients, which was based on medical safety considerations. In the future, which projects can be "tested" for initial diagnosis?
Cui Yong believes that we can "test the water" from the field of skin diseases. "Most skin diseases can get good diagnostic information through naked eyes or simple equipment (such as dermatoscope). At present, ‘ Skin image application framework network ’ It can also achieve information exchange well and can be used for telemedicine and Internet diagnosis and treatment. " Cui Yong said.
"In the future, diseases that can be accurately diagnosed through intuitive information collection may be considered for online initial diagnosis." Cui Yong pointed out, however, critical illness and incurable diseases are definitely not suitable for online initial diagnosis, and diseases that need to be examined and tested generally need to go to medical institutions or third-party service institutions (provided that a mutual recognition system for examination and test results is established).
In this regard, Yuan Li, director of the wuhan union hospital Clinic Office, also agreed. She said that online consultation and offline consultation are not a substitute, but more are extended services before and after the hospital to reduce the economic and time burden of patients and timely inform patients of the most authoritative and most suitable popular science knowledge. At present, online consultation in wuhan union hospital is divided into two categories: health consultation and follow-up consultation. Doctors will give corresponding suggestions according to the information provided by patients, but the diagnosis, diagnosis and treatment of diseases still need offline consultation and examination.
3. Can online medical insurance settlement be popularized?
0.02 seconds to extract historical medication information, and 2 minutes to complete identity verification and medical insurance binding … … In April last year, Shandong Province’s Internet medical insurance big health service platform was launched, and key links such as medical insurance certification, follow-up check-up, online prescription, and drug delivery to home were seamlessly connected. Shandong became the first province in China to fully open and support online medical insurance settlement for Internet diagnosis and treatment.
Mr. Zhang from lanshan district, Linyi City became the first beneficiary. "As long as in ‘ Shandong Medical Insurance Great Health ’ After completing the medical insurance identity verification and medical insurance binding in WeChat official account, you can use medical insurance payment by choosing an Internet hospital for treatment. " Mr. Zhang is 54 years old and suffers from coronary heart disease. He usually needs to make regular follow-up visits to get medicine. "It’s so convenient now! Seeing a doctor at home can also be settled by medical insurance and delivered to the door. "
According to incomplete statistics, since 2015, the state and local governments have issued more than 100 policies and regulations on Internet medical care, which have gradually covered "medical — Medicine — Risk "field. In response to the issue of medical insurance reimbursement in Internet hospitals, the relevant person in charge of the National Medical Insurance Bureau said that it will improve the price formation mechanism of "Internet+medical care" services, adhere to the basic principle of reasonable price comparison between online and offline similar services, incorporate medical expenses into medical insurance, and implement online direct settlement.
"The insured person is designated in this overall planning area ‘ Internet plus & rsquo; The medical and drug expenses incurred by the prescription issued by the medical service follow-up visit can be paid according to the existing treatment policy of offline medical insurance. With the prescription of designated medical institutions, you can also take medicine at local designated pharmacies. " Xiong Xianjun, director of the Medical Service Management Department of the National Medical Insurance Bureau, said.
Lu Qingjun believes that the "internet plus" medical insurance payment policy clarifies that the "internet plus" medical service is included in the specific content of medical insurance payment, online and offline medical services are treated fairly, and priority is given to ensuring the demand for follow-up visits for chronic diseases and special diseases, and supporting the circulation of purchased prescriptions, which not only facilitates patients, but also reduces the pressure on hospitals.
"Internet hospitals need links of various elements. Under the premise of high-quality diagnosis and treatment services, medical services, medicines, insurance, etc., the real Internet diagnosis and treatment will appear in the cooperation and exploration between doctors and third parties. With the enhancement of patients’ willingness to pay at their own expense and the intervention of commercial insurance, Internet hospitals will have a stronger ‘ Vitality ’ 。” Zhang Qiang said.
Although Internet hospitals provide many conveniences for patients to seek medical treatment, the difficulty of supervision has also become a major pain point that hinders its development. The reporter noted that the third-party Internet hospital platform is characterized by "e-commerce", and the use of traffic to sell drugs has become a common model, and Internet hospitals have become Internet medicine.
Yinchuan is the "pioneer area" of Internet medical exploration in China. During the two sessions this year, Commissioner Ma Xiuzhen, director of Ningxia Health and Health Commission, pointed out in his proposal that drug sales revenue is an important source of profit for some commercial Internet hospitals. Due to the lack of motivation to supervise over-medication, doctors may be encouraged to prescribe more drugs, or even collude with pharmaceutical companies to promote online drug sales, leading to over-medication. At present, the regulatory authorities have not yet established a regulatory system for excessive drug use for online diagnosis and treatment, and violations have an upward trend. Therefore, it is suggested to implement "separation of medicine" online.
To this end, Chen Qiulin reminded that in the future, the Internet hospital supervision platform should dynamically monitor online diagnosis and treatment services, and carry out medical technology evaluation and health economics evaluation, especially for services to be included in medical insurance payment, it should monitor the changing trend of online and offline medical care and analyze its substitution and complementarity.
(Reporter Cui Xingyi)