In recent years, the General Hospital of Tianjin Medical University has opened nearly 20 online services such as online follow-up consultation, special patient housekeeper, and digital film "cloud imaging". The picture shows the doctor consulting the results of the patient's imaging examination through the computer. Photo by Xinhua News Agency reporter Li Ran
Medical staff of Xuanwu Hospital of Capital Medical University demonstrate the operation of the "Pocket Xuanwu Hospital" APP (Doctor's End). This newspaper reporter Shen Shaotie photographed
Not long ago, the State Council issued the "14th Five-Year Plan for the Development of the Digital Economy", proposing to accelerate the development of Internet hospitals and promote Internet medical services such as health consultation, online consultation, and remote consultation.
In recent years, the number of Internet hospitals in the mainland has developed rapidly, from more than 100 in 2018 to more than 1,600 at present, initially forming an online and offline integrated medical service model. What conveniences does the Internet hospital bring to the masses to seek medical treatment? How to achieve high-quality development of Internet hospitals? The reporter conducted an interview on this.
Mobile phones can be followed up
Internet hospitals integrate follow-up, follow-up, and consulting services to allow patients to enjoy medical services without leaving home
"Hello Dr. Chen! I want to prescribe medicine to the elderly. Mr. Li, who lives in Chaoyang District, Beijing, prescribed medicine to his father through the "Pocket Xuanwu Hospital" mobile app of the Internet Hospital of Xuanwu Hospital of Capital Medical University. His father was over eighty years old, suffering from cerebrovascular disease, and needed to prescribe regular medication to prevent cerebral infarction. Chen Fei, attending physician of the Department of Neurology of Xuanwu Hospital, prescribed the medicine at the "Palm Xuanwu Hospital" APP (doctor's end). Chen Fei said that Mr. Li is his old patient and has prescribed drugs online more than a dozen times.
"In the past, I used to go to the hospital to get medicine, and every time I had to take a morning off, it was hard and I delayed my work." Mr. Li said that after Xuanwu Hospital opened the Internet Hospital, it can directly use the mobile phone to register for prescription drugs, and the drugs will be delivered to home the next day, which is very convenient.
Chen Fei's specialty is cerebrovascular stenting surgery, and his outpatient clinics under the line are often difficult to hang up. Since internet hospitals are not limited by the number source, patients can hang up to his number. "Most of the patients I receive need regular follow-up and medication, and patients can contact me at any time on the Internet hospital to facilitate postoperative management and follow-up." Chen Fei said.
Chen Qiulin, deputy director of the Health Industry Development Research Center of the Chinese Academy of Social Sciences, believes that internet hospitals can improve the accessibility of medical services and reduce the cost of medical treatment for patients by integrating follow-up, follow-up and consulting services to allow patients to enjoy medical services without leaving home.
At lunchtime, Xu Wei, attending physician of the Department of Endocrinology of the Three Gorges Hospital affiliated to Chongqing University, popped up a consultation message in the "Three Gorges Hospital" mobile app. Xu Wei skillfully adjusted the medication to the patient: "According to your blood routine, you need to add another pill." ”
Xu Wei introduced that some chronic diseases such as diabetes and hyperthyroidism need long-term treatment, and the dosage is adjusted on a weekly and monthly basis. Now, patients no longer need to come to the hospital regularly to register in line, and they can consult online. At present, Xu Wei receives more than 700 online consultations every month. "During the online consultation process, I found that the patient's condition was abnormal, and I could help them make an appointment for examination and hospitalization in time, which improved patient satisfaction."
Zeng Xia, director of the Internet Hospital Office of China Three Gorges Hospital, introduced that in May 2021, the mobile APP of the Internet hospital platform "Three Gorges Hospital" of China Three Gorges Hospital was officially launched, and the main users were patients with chronic diseases and patients who needed regular follow-up. The personnel of the Internet Hospital Follow-up Center will regularly arrange discharge, outpatient and physical examination according to the follow-up path and online outpatient period formulated by the doctor. The patient conducts a video follow-up or graphic follow-up with the doctor online, the doctor prescribes according to the patient's situation, and the hospital mails the medicine to the patient's home.
In order to help patients who have been bedridden for many years to carry out regular care, the Internet Hospital of China Three Gorges Hospital has also opened an online appointment nurse home nursing service. Home care includes gastric tube replacement, joint loosening training, catheter maintenance, stress injury dressing change, oxygen saturation testing, and detection of trace blood glucose.
Grassroots patients benefit
The combination of remote consultation and follow-up diagnosis can timely discover and treat new diseases, so that patients' lives and health are more secure
"When buying medicines, I can also connect with experts from top three hospitals by video to consult the condition, but I really didn't expect it!" Residents of Gaosuntang Street in Wanzhou District, Chongqing City, have old problems with leg pain and have not found the cause. He came to the Gaosuntang store of ZTE Pharmacy, sat in front of the computer, and conducted a video follow-up consultation with the general practitioners of the Three Gorges Hospital.
"Since the installation of the Internet hospital terminal, many elderly people in the community have come to the pharmacy to find an 'online doctor' for consultation." Liu Xuemei, a staff member of ZTE Pharmacy, told reporters that seeing a doctor in a pharmacy is not only free, but also very convenient, and some residents come down from upstairs, which is more convenient than going to the community hospital.
The reporter saw that the pharmacy has specially opened an area, which is convenient for customers to see a doctor and can protect privacy. The remote reception point is equipped with computers, cameras, headsets, consultation tables and chairs, and there are patterns such as the logo of the remote reception point of the Three Gorges Hospital on the wall, which is simple and generous, and the specification is eye-catching. It is understood that the Three Gorges Hospital has selected two larger chain pharmacies in Wanzhou District, ZTE and Hongda, as remote reception points, and the first batch of 59 pharmacies has carried out online follow-up services for customers. At present, the average daily online follow-up consultation in pharmacies has reached more than 300 person-times.
How to further give full play to the advantages of Internet hospitals and benefit more grassroots patients? The Three Gorges Hospital and the village doctor linked up to set up an Internet hospital terminal in the village clinic. At the Guanba Village Clinic in Longju Town, Wanzhou District, village doctor Li Xiaojian is instructing villagers to use the Three Gorges Hospital's networked hospital terminal computer. "Sometimes when we encounter a condition that we can't determine, we will also contact the doctors of the Three Gorges Hospital to ask questions, which greatly facilitates the villagers to seek medical treatment." Li Xiaojian said.
Zhang Xianxiang, president of the Three Gorges Hospital affiliated to Chongqing University, introduced that the Three Gorges Hospital will continue to expand the coverage of Internet hospitals so that more patients can see the disease at home. At the same time, we will increase the linkage with pharmacies and village doctors, and lay out Internet hospital terminals in surrounding districts and counties to benefit more people.
Internet hospitals have effectively solved the problem of seeking medical treatment for patients with difficult and critical illnesses and complex diseases in remote areas. Lao Wang, who lives in Jinzhai County, Anhui Province, suffers from rheumatoid disease, and his condition recently deteriorated, and after treatment at the local hospital, his condition was not controlled. Within two days, Lao Wang was unconscious and did not cooperate with the physical examination. Through the Internet telemedicine platform, local doctors asked Chen Xiaoping, deputy director of the Department of Endocrinology at the China-Japan Friendship Hospital in Beijing. Chen Xiaoping organized joint remote consultation and follow-up consultation between experts in the Department of Rheumatology and Immunology, Endocrinology and Respiratory Experts of China-Japan Friendship Hospital to diagnose Lao Wang as a brain injury caused by severe hyponatremia, accompanied by mild lung infection. After systematic and standardized treatment, Lao Wang quickly recovered and was able to work in the field.
Cui Yong, vice president of the China-Japan Friendship Hospital, introduced that one of the characteristics of the hospital's Internet hospital is the combination of telemedicine and Internet diagnosis and treatment, which combines the improvement of grass-roots diagnosis and treatment capacity building with the convenience of the people. Telemedicine is aimed at patients with critically complex diseases in grass-roots institutions, and Internet diagnosis and treatment is for patients with confirmed cases. Some patients who return to the clinic may have a worsening condition during the follow-up consultation, and if they cannot rush to a large hospital for treatment in a short period of time, they are likely to delay treatment. Through the combination of remote consultation and follow-up consultation, with the assistance of local doctors, new diseases can be discovered and treated in a timely manner, so that the life and health of patients are more secure. At present, the Internet hospital system of The China-Japan Friendship Hospital has connected nearly 6,000 medical institutions across the country, including more than 580 medical and nursing institutions, and implemented more than 13,000 remote consultations.
Dredge the blockage points
Accelerate the landing of medical insurance settlement nationwide, so that patients who go to the Internet hospital to see a doctor can also enjoy medical insurance reimbursement
According to the "Statistical Report on the Development of China's Internet Network" released by the China Internet Information Center, as of June 2021, the number of online medical users in the mainland is as high as 239 million, and the demand for Internet medical treatment is growing. However, the management and operation of Internet hospitals are not optimistic. The "2021 China Internet Hospital Development Report" jointly released by the National Telemedicine and Internet Medicine Center and the health community pointed out that while the number of Internet hospitals is growing rapidly, less than 10% have truly achieved effective operation, and more than 90% are in the state of construction without use or shallow taste.
Lu Qingjun, director of the National Telemedicine and Internet Medicine Center and director of the Development Office of the China-Japan Friendship Hospital, believes that there are still blockages in the management and operation of Internet hospital services in some public hospitals. For example, the top-level design is not perfect, the business scope is not clear, the doctor's access supervision and online diagnosis and treatment training are insufficient, the lack of standardized Internet medical service processes and diagnosis and treatment specifications, the single business type, and the lack of special services. There are also some Internet hospitals that lack good software and hardware technology, and the experience of patients and doctors is not good.
Liang Zhigang, director of the Information Center of Xuanwu Hospital, said that the current Cost Compensation Mechanism and Incentive Evaluation Mechanism of Internet Hospitals in public hospitals are not perfect, and it is impossible to effectively mobilize the enthusiasm of hospitals and doctors to continue to carry out online diagnosis and treatment business. Compared with offline outpatient clinics, the pricing of medical service fees in Internet hospitals is low, such as Shandong Internet Hospital only charging 6 yuan for follow-up visits, and Beijing municipality charges 50 yuan uniformly.
Lu Qingjun analyzed that from the patient's point of view, on the one hand, the patient's understanding of Internet diagnosis and treatment is insufficient, and it still needs a process to cultivate the habit of seeking medical treatment. On the other hand, at present, most Internet hospitals can only achieve medical insurance reimbursement within the scope of their provinces, and patients from other provinces cannot enjoy medical insurance reimbursement, which greatly restricts patients from choosing Internet consultation.
How to dredge the blockages of Internet hospitals? Lu Qingjun believes that the construction of Internet hospitals must combine the functional positioning of the hospital itself and the actual situation of the region, highlight the characteristics, and avoid homogeneous competition. It is necessary to strengthen the operation and management of Internet hospitals, promote the integration of online and offline, realize the management of the whole cycle of patient diseases and the whole process of medical treatment, and improve the medical experience of patients.
Lu Qingjun suggested that the online charging system and the performance incentive mechanism for medical staff should be improved. Internet diagnosis and treatment charges and offline diagnosis and treatment fees should correspond, and different service prices should be formulated for doctors at different levels, fully reflecting the labor value of doctors. Establish a performance incentive evaluation mechanism for doctors, and give certain performance subsidies to doctors participating in Internet diagnosis and treatment.
Liang Zhigang believes that the landing of medical insurance settlement nationwide should be accelerated, so that patients who go to Internet hospitals can also enjoy medical insurance reimbursement. At present, online diagnosis and treatment is mainly for patients with common diseases and chronic diseases, most of whom have electronic prescription and medication needs. Now that the circulation of electronic prescriptions has been realized, the cross-regional medical insurance settlement of patients is also in place. If Internet hospitals can achieve medical insurance reimbursement like offline hospitals, more patients will choose online diagnosis and treatment.
Zhang Xianxiang suggested that breaking down regional barriers and encouraging tertiary hospitals to set up remote reception points in the countryside is equivalent to moving large hospitals to the doorsteps of villagers, coupled with 5G mobile communication technology and the release of various wearable devices such as remote imaging, remote ultrasound, remote ECG, etc., to achieve the synchronization of grass-roots inspection and superior diagnosis, improve the medical service capacity of township health centers and village clinics, so as to achieve the goals of solving serious diseases in the province, solving common diseases in cities and counties, and solving headaches and brain fever in villages. Reduce the occurrence of poverty return to poverty due to illness.
People's Daily ( 2022-02-11 19th edition)