On March 1, 2022, 43 days have passed since the official implementation of the Administrative Measures for mutual recognition of Inspection and Inspection Results of Medical Institutions (hereinafter referred to as the Administrative Measures).
This is seen as a sign of accelerated mutual recognition of examination results between different medical institutions nationwide.
For hospitals, this helps to improve the utilization of medical resources; for doctors, it helps to improve the efficiency of diagnosis and treatment; for patients, it helps to reduce medical costs.
However, reform may be difficult to achieve immediate results. After the official implementation of the Administrative Measures, some clinicians said bluntly to the health community: "There is no impact!"
Behind this, it is not only due to the fact that in the past local exploration, clinical practice has become accustomed to mutual recognition in a small range, so it is insensitive to the implementation of the "Management Measures"; it is also trapped in that some inherent problems cannot be solved, and comprehensive mutual recognition in the short term is "unrealistic".
A number of doctors said: Mutual recognition has been done, and there has not been much change
"Realizing mutual recognition of examination results of medical institutions at the same level" is one of the important tasks of the CPC Central Committee and the State Council in deepening the reform of the medical and health system in 2009. [1] In 2015, the National Health Commission proposed an action plan to improve medical services, which listed the realization of mutual recognition of examination results as an important assessment goal. [2]
"The policy of mutual recognition of inspection results has been proposed for many years, and we have been using information technology to promote the implementation of the policy." Zhang Jie, chief accountant of a tertiary specialized hospital, told the health community that the era of chronic tumor disease is coming, and "mutual recognition" is a means to improve medical efficiency during the disease management period.
"Especially during the epidemic period, it is inconvenient for patients from other places to seek medical treatment. Repeat patients are examined locally and followed up through the Internet hospital. The indicators are good, reviewed regularly; the data is abnormal, and the treatment plan is further adjusted." Zhang Jie introduced.
According to the data, as of 2017, 86% of hospitals in the country have achieved mutual recognition of the results of the same level of examination. [3]
In non-same-level hospitals, mutual recognition is often easier to achieve under the framework of medical associations and medical communities. Especially in the close-knit medical community, after the unification of people and property, the standards are easier to unify, and the division of rights and responsibilities is clearer.
In 2017, the General Office of the State Council issued the Guiding Opinions on Promoting the Construction and Development of Medical Consortiums, which explicitly stated that "the results of examination and testing among medical institutions within the medical associations should be mutually recognized" in order to "realize the sharing of regional resources". [4]
In 2019, the Notice on Promoting the Construction of a Close-Knit County-level Medical and Health Community proposes to "promote grass-roots inspection, higher-level diagnosis and regional mutual recognition". [5]
The head of the information department of a third-class hospital once shared with the health community that in the past, patients relied on paper report sheets to see doctors, and the data was an island of information. After the formation of the compact medical community, the data sharing within the medical community was realized, and the doctors of our hospital could quickly access the examination results of patients in lower hospitals. The high-quality examination and inspection resources of higher-level hospitals can also be shared to lower-level hospitals to facilitate medical treatment at the doorstep of the people.
In addition, local cities are also actively exploring local models for mutual recognition of inspection and inspection results.
Taking Beijing as an example, since 2016, Beijing has begun to pilot mutual recognition in the Beijing-Tianjin-Hebei region, including the first batch of 132 medical institutions, including 27 clinical test results. Since then, 17 medical imaging tests have been mutually recognized, and the first batch of 102 medical pilot institutions have been opened.
The health community has learned that the local mutual recognition policy has the following characteristics: clarifying the mutual recognition institutions, listing the mutual recognition list, and confirming the mutual recognition standards. To a certain extent, it can alleviate the problem of "can't recognize" and "dare not recognize" in clinical institutions.
Therefore, when the health community asked clinicians for verification of the clinical changes since the implementation of the "Management Measures", many doctors said that mutual recognition has been done and has not changed much.
What blockage makes the doctor "unable to recognize"?
In the past, most of the policy documents on mutual recognition of inspection and inspection results were based on the discussion on the unification of inspection standards and the opening of inspection policy connection blockages.
However, in the view of Feng Zhongjun, deputy director of the Department of Clinical Laboratory and director of the Department of Infection Control of the Third Hospital of Hebei Medical University, the main body of mutual recognition should be clinicians. "In the past, a lot of mutual recognition work was actually advocated by the inspection and inspection side, and there was a lack of clinician participation, and I think this mutual recognition is not perfect and flawed."
Feng Zhongjun's observation has been clinically confirmed. Zhang Chen, an oncologist at a third-class hospital in Beijing, told the health community that since the mutual recognition of the test results in Beijing, Tianjin and Hebei has been promoted, as a clinician, he has not had much perception.
"For a while, I found that there was suddenly an asterisk on the test form, but I didn't know what the asterisk was for." Zhang Chen recalled, and later learned that the asterisk represents a sign of mutual recognition.
But Zhang Chen believes that even if there is a policy, from a clinical point of view, many times he still cannot recognize each other. "Many tests are set menus, for example, the lung cancer tumor markers in our hospital are 5 items, and some hospitals are 6 or 7 items. Even if there are several mutual recognitions, the clinic cannot open a bill."
For this phenomenon, Feng Zhongjun explained that when each hospital formulates a portfolio of testing projects, it will comprehensively consider the advantages of the hospital, patient characteristics and clinical needs. It is unlikely that the project portfolio of hospitals will be fully aligned. Therefore, the above-mentioned phenomenon of "mutual recognition of difficulties" will occur.
In addition, whether the clinical ability to recognize the test results depends on multiple factors.
Zhang Chen introduced that inspection and inspection are divided into subjective inspection and objective inspection. Among them, objective examination mainly relies on objective facts, and it is easier to achieve clinical mutual recognition. Subjective examination is closely related to the doctor's personal experience and medical technology, and it is often difficult to recognize each other clinically.
"Ultrasonography is a subjective examination, and clinical mutual recognition is difficult to achieve." Zhang Chen said that for example, CT, MRI, molybdenum targets in breast examination, etc., are objective examinations, and if patients bring original image data, we will be willing to refer to the results.
Zhang Chen shared that there were once patients from other places who came to the hospital with the B ultrasound examination image of the outer hospital, but because the image was not clear enough, for medical safety reasons, it was necessary to request a re-examination and re-examination.
Some newer tests, such as genetic testing, take into account the reputation, volume, and professionalism of service providers. "If it's a large genetic testing company we've worked with, we generally recognize the data. But if it is a small company that is not named, the clinic cannot recognize it."
Timeliness is also a factor affecting mutual recognition. "The preoperative examination cycle of the tumor is long, and it may be that one set of examinations has passed, and two or three weeks have passed. Past test results cannot be used for clinical surgery. Therefore, the examination before the operation can not be less."
Since the new medical reform, a number of assessment indicators have been intended to control unreasonable medical expenses.
Many clinicians are also reluctant to allow patients to do more unnecessary tests.
"Too expensive tests, such as PET-CT for 10,000 yuan a time, we can definitely save money." Zhang Chen said that this kind of examination with a lot of money, large radiation and relatively accurate data does not need to be repeated by patients. But some of the cheaper and faster-changing inspections can certainly be reviewed. "For example, an electrocardiogram, a 20-dollar thing, to keep you safe."
Medical risks make doctors "afraid to admit"
Previously, many analyses pointed out that after the implementation of the "Management Measures", mutual recognition can affect the proportion of drugs, and then affect the performance of the department.
The proportion of drugs refers to the proportion of drug revenue to all medical revenues. Examinations and tests are medical service revenues, and a reduction leads to a decrease in total revenue. In the case of the same molecule, the denominator decreases and the proportion of drugs increases.
However, Zhang Jie's personal experience from a well-known specialized hospital in a new first-tier city is that mutual recognition of examination and test results has been implemented for many years, and it will not be greatly affected by hospitals that have been gradually standardized.
In addition, in the Administrative Measures, it is also clear that mutual recognition and the reform of medical insurance payment methods will be combined, and "the total budget of the region and the total budget of individual medical institutions will not be reduced due to mutual recognition". Combined with the incentive mechanism of "balance retention", hospitals may be more motivated to participate in mutual recognition.
"When clinicians and laboratory doctors stop worrying about hospital income and personal income, I think this job will be easy to do." Feng Zhongjun said.
Economic factors aside, what worries doctors the most is the medical risk after mutual recognition.
Feng Zhongjun still remembers a medical dispute that occurred in 2011: According to the Southern Metropolis Daily, Ms. Yuan and her husband underwent an intrauterine transfer of embryos at the Shenzhen Zhongshan Urological Hospital, but after more than 3 months of pregnancy, the baby was miscarried due to syphilis. Ms. Yuan believed that the failure to screen for syphilis before pregnancy caused the child to miscarry and took the hospital to court. However, the hospital believes that the reason why syphilis screening was not done is that the hospital directly recognized that Ms. Yuan's HIV antibody measurement and syphilis TRUST test at Yichun Maternal and Child Health Hospital on April 14, 2011 were negative results according to the 2010 Notice of the Ministry of Health on Strengthening the Construction of Medical Quality Control Centers and Promoting mutual recognition of examination results of medical institutions at the same level. [6]
Feng Zhongjun clearly remembers that one of the reasons why the court found that the hospital had medical fault was: "The document of the Ministry of Health is a guiding document and has no legal and administrative effect."
"This is a wake-up call for the clinic. Clinical patients cannot easily trust the test results of other hospitals. Clinicians need to improve their level and ability to diagnose and treat." Feng Zhongjun reminded.
Medical risks are still the "tight curse" in clinical mutual recognition. Zhang Chen mentioned that patients who come to the oncology department are often not the first to be diagnosed. During the treatment of the disease, it is necessary to see the patient's past examination report. This is also a sign of responsibility to the patient. But in practice, doctors still tend to let patients do the examination.
On the day of the release of the Administrative Measures, the health industry interviewed lawyer Daniel Zhang, founder of the medical legal team of "Medical Law Hui", for the first time: "After the first medical institution misdiagnosed, after the mutual recognition of the results, it does not mean that the second hospital will also misdiagnose." Daniel Zhang lawyer also mentioned that if the second hospital fails to fulfill its duty of medical care and relies too much on the results of auxiliary examinations to cause misdiagnosis, resulting in damage to patients, it needs to be held responsible. [7]
Sung down? Reform, push this department from behind the scenes to the front
After the inspection results are mutually recognized, some people "sing down" to inspect the inspection department. This is mainly based on the logical judgment that repeated inspections are stopped and the overall amount of inspection inspections becomes smaller.
Are the examination and inspection departments of the hospital really "not popular"? Maybe not.
Article 20 of the Administrative Measures proposes that "medical institutions with the capacity may open examination and examination clinics". This means that the functions of the inspection and inspection department are changing.
Zhang Jie introduced that in the past, the positioning of the inspection and inspection department was the doctor's assistant, the core customer was the doctor, and the department only did relevant examinations on the patients according to the doctor's requirements to assist the doctor to judge the patient's disease status. However, in the diversification and specialization of inspection and inspection methods, its disciplinary attributes are getting stronger and stronger.
"Pathology and ultrasound are the fist products of big hospitals. The county hospital can't do it, and sends the pathology data specimen to a high-level hospital to do it. A pathology department that serves doctors throughout the province not only does difficult MDT consultations, but also exports pathological diagnostic capabilities." Zhang Jie's observation precisely reflects that under the change of functions, the inspection and inspection department is in a more important position.
"In the past, doctors watched films and were very confident. Now he'll say, listen to the director of NUCLEAR magnetism."
On February 28, 2022, on the eve of the official implementation of the Administrative Measures, the outpatient clinic of the Department of Clinical Laboratory of Zhejiang Provincial People's Hospital was officially opened. The scope of diagnosis and treatment includes laboratory consultation, supplementary examination, examination services for receiving specimens sent to other hospitals, recommending experts, joint outpatient clinics, and does not provide prescribed drugs and clinical diagnosis and treatment services, and does not receive first-time patients.
Zhou Yonglie, director of the Inspection Center of Zhejiang Provincial People's Hospital, introduced that the department will receive some inspection items that cannot be completed by foreign hospitals, and in the past, these patients often did not know which department to hang up when they went to the hospital, or hung up an expert number just to open a test list. More importantly, in addition to issuing laboratory tests, the outpatient clinic of the inspection center also undertakes the interpretation of some difficult reports, analyzes the test results from the perspective of professional inspection and testing, and provides new ideas for doctors to diagnose and treat. [8]
Therefore, the opening of a laboratory clinic can not only shorten the time of such patients, but also save the registration resources of other departments.
Feng Zhongjun also believes that from the laboratory point of view, the patient's test results are analyzed, diagnosed, and consulted services are the real meaning of the inspection clinic, and the inspection and inspection ability can be more exerted.
"But there's also a problem here, the function of the laboratory physician is not clear, and there is still a long way to go." Feng Zhongjun said.
(At the request of the interviewee, Zhang Jie and Zhang Chen are pseudonyms)
Resources:
[1] The Opinions of the CPC Central Committee and the State Council on Deepening the Reform of the Medical and Health System http://www.gov.cn/gongbao/content/2009/content_1284372.htm
[2] Notice of the Health and Family Planning Commission and the Chinese Medicine Bureau on Printing and Distributing the Action Plan for Further Improving Medical Services (2018-2020) Guo Wei Yi Fa [2017] No. 73 http://www.gov.cn/gongbao/content/2018/content_5299607.htm
[3] Transcript of the regular press conference of the National Health and Family Planning Commission on February 7, 2018 https://wjw.hubei.gov.cn/zfxxgk/fdzdgknr/qtzdgknr/hygq/202008/t20200807_2753328.shtml
[4] The Guiding Opinions of the General Office of the State Council on Promoting the Construction and Development of Medical Consortiums http://www.nhc.gov.cn/bgt/gwywj2/201704/7a3d51eac83f4d418d45c9b452f397c4.shtml
[5] Notice on Promoting the Construction of a Compact County-level Medical and Health Community Guowei Grassroots Letter [2019] No. 121 http://www.nhc.gov.cn/jws/s3580/201905/833cd709c8d346d79dcd774fe81f9d83.shtml
[6] IVF abortion Maternal sued the hospital for 180,000 claims Southern Metropolis Daily https://gd.qq.com/a/20130423/000034.htm
[7] After 80 days, the boots landed! This document, which has a profound impact on medical institutions across the country, comes the health community https://mp.weixin.qq.com/s/NEnaz3ZSecGS4HmKnbln4g
[8] The first clinical clinic in Zhejiang Province opened! Https://mp.weixin.qq.com/s/lmmgYsfIzdkd2PyuchzOCg of The Inspection Center of Zhejiang Provincial People's Hospital
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