AI can't be treated! Internet healthcare has entered the era of strong supervision, and these platforms are facing shocks

The internet medical field is undergoing an unprecedented transformation.

A few days ago, the "Internet Diagnosis and Treatment Supervision Rules" that have attracted much attention from the industry ended soliciting opinions from the public and are expected to be issued as soon as possible. "This is the first official detailed document after the trial implementation of the three major management measures in the field of Internet medical care in 2018." Liang Jialin, secretary general of the Value Medical Consultant Expert Committee, told First Finance.

The previous three major management measures were the Measures for the Administration of Internet Diagnosis and Treatment (Trial), the Measures for the Administration of Internet Hospitals (Trial) and the Specifications for the Management of Telemedicine Services (for Trial Implementation), which covered the fields of diagnosis and treatment management, hospital management, and remote service management.

Under the background of the new round of strong supervision, what adjustments are faced to the development of Internet medical-related institutions and enterprises? What kind of model should new technologies and new products be integrated into the Internet medical market?

The era of strong regulation is coming

Internet hospitals in the general sense include Internet hospitals established by public hospitals, as well as Internet medical platforms operated by Internet companies "backdoor" public hospitals.

According to the "2021 China Internet Hospital Development Report", as of December 31, 2020, 1,004 Internet hospitals have been built nationwide, an increase of nearly 500 compared with 2019. Many industry insiders said that this is very much related to the surge in demand for online registration and telemedicine among patients during the new crown epidemic.

"The formulation of the above-mentioned detailed rules and documents is the release of the strong regulatory signal of Internet medical care." Zhao Heng, a partner at latitude Health, a medical strategy consulting firm, told reporters, "In addition to continuing to emphasize that only follow-up consultations can be made, no first diagnosis, and the establishment of a provincial-level Internet medical service supervision platform to supervise Internet medical activities in the jurisdiction, the detailed documents also focus on medical institutions, personnel, business and quality and safety." ”

For example, Article 6 of the detailed rules mentions that "medical institutions shall have special departments to manage the medical quality, medical safety, pharmaceutical services, information technology, etc. of Internet diagnosis and treatment, and establish corresponding management systems."

In addition, Article 7 mentions that "internet hospitals, as the second name of entity medical institutions, are verified at the same time as the entity medical institutions; Internet hospitals that rely on the entity medical institutions to obtain the "Medical Institution Practice License" alone are verified once a year".

"Under the above provisions, medical institutions need to establish special departments to supervise the whole process of operation of Internet hospitals, and the audit needs to be carried out once a year." Zhao Heng said that this also means that local health authorities at all levels should establish evaluation and withdrawal mechanisms for Internet medical institutions in accordance with the Regulations on the Administration of Medical Institutions and their implementation rules.

Zhao Heng stressed that this series of regulations actually clarifies that the supervision of Internet hospitals must be carried out in accordance with offline physical medical institutions, "Which has almost no impact on physical hospitals, but it will bring greater impact to platform-based Internet hospitals, especially once a year." ”

Industry experts also agree that regulators should pay more attention to the performance evaluation of follow-up Internet hospitals, so as not to cause a huge waste of financial funds, which can also provide a reliable environment for the open sharing and compliant use of medical data.

How should the specific assessment be carried out? Liang Jialin, secretary general of the Value Medical Consultant Expert Committee, said in an interview with reporters that on the one hand, it is necessary to enhance the enthusiasm for data sharing. For example, drawing on the terminology of the field of foreign trade, between different data subjects in the field of medical informatization and medical insurance informatization, the concepts of data surplus and data deficit are introduced, and the data sharing value (output) is greater than the import value (input) as "surplus", and vice versa as "deficit", ranking within the same industry and unit.

On the other hand, Liang Jialin suggested that the utilization rate of information engineering should be improved. Internet hospitals of public medical institutions, their financial appropriations, medical insurance payments, etc., must be linked to the actual utilization rate of information engineering.

"That is to say, it is not only necessary to assess the access rate of different businesses such as clinical and operational departments to Internet hospitals, but also to assess the consistency of the distribution law of diagnosis and treatment volume, cash flow, pharmaceutical logistics and Internet hospital data, so as to ensure that the establishment of institutions, business launches, and data empowerment can ultimately be transformed into patient health effects." Liang Jialin said.

Online and offline quality control integration

The strong supervision of the actual business of Internet medical treatment is also reflected in the standardization and safe operation of patient electronic medical records.

Article 19 of the detailed rules mentions that "the electronic medical record information generated by medical institutions in the process of carrying out Internet diagnosis and treatment shall be shared with the electronic medical record system of the entity medical institutions on which they rely, and the entity medical institutions relying on them shall carry out online and offline integrated quality control"; "Internet diagnosis and treatment medical record records shall be managed in accordance with the relevant provisions of the outpatient electronic medical records, and the graphic dialogue, audio and video materials, etc. in the process of diagnosis and treatment shall be traced and traceable throughout the process, and the data interface shall be open to the provincial supervision platform, and the preservation time shall not be less than 15 years".

Zhang Yuming, director of the Medical Big Data Research Center (East China) of the Chinese Academy of Information and Communications Technology, told reporters that the electronic medical records of medical institutions are the core part of the troika (medical, service, management) of Internet hospital construction, and are also an important symbol of "patient-centered". The entire detailed document also clarifies once again that for online diagnosis and treatment services, there must be the same quality control requirements as offline hospitals.

Zhang Yuming further said that under this provision, the infrastructure, information systems, and electronic medical records required for the integration of online and offline hospitals need to be upgraded, "For example, the original hospital's internal CS architecture (server-client) system will face 'cloud' transformation, which is an opportunity for medical informatization to transform and upgrade, and also lay a solid foundation for the interconnection, interoperability and mutual recognition of medical information." ”

As one of the first hospitals to pass the 7th level of "Electronic Medical Record System Application Level Grading Evaluation" in China, the reporter learned from Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine that the hospital divided the application of patient electronic medical records into three levels: data collection, information sharing, and decision support.

Among them, in terms of information sharing, ward doctors can carry out medical order opening, closed-loop management, patient 360-degree view viewing, critical value management, etc.; decision support, the application of electronic medical records has also been able to provide help for VTE (venous thrombosis) intelligent prevention and treatment, atrial fibrillation management, medical imaging auxiliary decision-making and other functions.

"In the future, the application of clinical decision support systems must be scenario-based, including outpatient, emergency, and inpatient; pre-diagnosis, diagnosis, diagnosis, and post-diagnosis; diagnosis and treatment services, and medical record writing." Shu Ting, director of the Medical Informatization Research Department of the Hospital Management Research Institute of the National Health Commission, said.

So, what is the impact of electronic medical records on the Internet medical platform when it is opened online and offline? Zhao Heng said that in fact, the Internet medical platform and the physical hospital do not have actual business cooperation, the former is only the use of the latter to obtain a license. Therefore, once the strong regulatory requirements are opened up, because the quality control is dominated by offline hospitals, the data of the Internet medical platform must be handed over, which will produce obvious compliance pressure on the platform.

How new technologies are carried out

In the process of daily diagnosis and treatment, how to carry out some new technologies and models involving Internet medical treatment in an orderly manner?

For example, Article 13 of the above-mentioned detailed rules requires that "doctors must undergo real-name authentication before receiving treatment to ensure that they are treated by themselves." Other personnel, artificial intelligence software, etc. must not fraudulently use or substitute for physicians to receive treatment. The competent departments of health at all levels shall be responsible for supervising and supervising the personnel carrying out Internet diagnosis and treatment in the medical institution."

Zhao Heng said that for offline hospitals, their own Internet hospital business volume is not high, rarely need artificial intelligence to reduce costs, only Internet medical platforms will use AI on a large scale to replace doctors.

"Previously, most of the services provided by Internet medical platforms were free. Under the provisions of the detailed rules, the cost of the existing Internet medical platform will be greatly increased, and it cannot be compensated by other revenue improvements, which will affect the profit level of the Internet medical platform. Zhao Heng said.

How can I be sure that the doctor is attending the consultation? Zhang Yuming said that some new technologies and new models can be applied, "for the identity of both parties to the diagnosis and treatment, the authenticity and credibility of the diagnosis and treatment results, tamper-proof, a variety of real-name identity identification, blockchain and other technologies will play a role."

In Zhang Yuming's view, although AI will play an increasingly important role in medical services, this must operate under strict requirements such as quality control, data security, and privacy protection, "The adoption of new technologies and new models must follow the verifiable, traceable, and auditable logic of trial, trial, verification, and then gradually copy and promote." ”

How can the application of new technologies and models ensure the security of Internet medical operations?

Zhang Yuming believes that under the trend of online and offline hospital integration, the network architecture of "5G + cloud network integration" can build a new generation of hospitals that can be controlled independently and internally exchanged data to reduce the use of the Internet public network. He said that in this way, in addition to ensuring that the core business system and medical data run and flow inside the hospital private network, supplemented by the setting of DMZ (isolation area) between the internal and external networks, the external network data encryption mechanism and other means can realize the network security of the hospital's internal and external network exchanges.

Lu Qingjun, director of the Office of the National Telemedicine and Internet Medicine Center, believes that there are still many challenges in Internet medicine. First of all, in terms of policy systems, many places have not been able to improve the relevant systems such as quality control, supervision, price, and medical insurance; in terms of process specifications, the service processes of some models are unreasonable, and the diagnosis and treatment specifications are not perfect. Secondly, Internet hospitals lack effective operation, and some physical hospitals have not established efficient and market-oriented operating mechanisms.