13,000 institutions realize telemedicine.

Cloud consultation and online medical treatment
13,000 institutions realize telemedicine.

Core reading

The General Secretary of the Supreme Leader pointed out that it is necessary to use big data to promote the protection and improvement of people’s livelihood, promote "Internet+medical care", and constantly improve the level of equalization, generalization and convenience of public services. In recent years, Internet medical care has flourished, and online consultation, telemedicine and other medical services have promoted the effective allocation of medical resources. From a big hospital as the center and patients waiting for service in the past to a patient-centered and collaborative network service, Internet medical care is accelerating the realization of the co-construction and sharing of high-quality medical resources to meet the individualized medical needs of different groups.

In the First People’s Hospital of Yinchuan City, the patient Ms. Ma was found to have enlarged mediastinal lymph nodes, which basically ruled out the possibility of lung malignant tumor, but it was impossible to determine the cause. With the help of the doctor in charge, Ms. Ma applied for the remote expert clinic of Dr. Zhong Xu from the Department of Respiratory Medicine of Peking Union Medical College Hospital through the Internet consultation platform. Zhong Xu looked at the medical records uploaded by local doctors and preliminarily judged that the patient’s problem was caused by tuberculosis. Ms. Ma said that it only took less than half an hour to see the great experts in Beijing online. If you go to Beijing and increase the cost of transportation and accommodation, you still don’t know if you have hung up the number.

Patients run less errands.

Effective allocation of resources, greatly reducing costs.

Online consultation means that doctors provide diagnosis and treatment services to patients through the Internet. Doctors ask patients’ medical history in detail online, check the necessary inspection reports and give diagnosis and treatment plans. At present, online consultation is mainly based on follow-up and consultation, that is, patients who have gone to the hospital for treatment, and the follow-up rehabilitation and treatment are solved on the Internet; When lower-level hospitals and doctors encounter cases that are difficult to handle, they can initiate consultation requests to doctors in higher-level hospitals through the Internet and get the diagnosis and treatment opinions of higher-level experts.

Liu Yinglong, the chief physician of pediatric cardiac surgery in anzhen hospital, Beijing, made an appointment for face-to-face consultation through an Internet platform, and provided postoperative consultation service for pediatric patients after work. The platform has invited tens of thousands of pediatricians from top three hospitals to station in, and more effectively allocate pediatric resources through big data and lean medical care.

For patients, online consultation first considers experts, followed by costs. The cost of online consultation varies with the level of experts. Because Beijing and Shanghai have concentrated the top experts in the country, the average consultation fee is also significantly higher than other regions. According to a survey, the average consultation cost in Beijing is 147 yuan, while that in Shanghai is 138 yuan, while that in Hebei is only 30 yuan. In most online consultations, the doctors and patients are not in the same city, so the time and economic cost of seeing a doctor in a different place is much higher than the average cost of online consultations.

"In the 10 years from 2006 to 2015, Internet medical care can only be used for online consultation, but it can’t provide diagnosis, and it can’t give prescriptions. For medical care, diagnosis and treatment are the core. If Internet medical care wants to provide more convenience for patients, it must enter the field of diagnosis and treatment. " Wang Hang, founder of Good Doctor Online, said. At the beginning of 2015, the National Health and Family Planning Commission made it clear that online consultation is a strict medical behavior, and the main body of providing services must be a medical institution. That is to say, it is necessary to have a medical institution’s practice license and become a hospital in order to further play the role of the Internet in the field of diagnosis and treatment. In 2016, Good Doctor Online cooperated with Yinchuan Municipal Government to build Yinchuan Smart Internet Hospital, thus entering online consultation from the field of online consultation and accepting the full supervision of medical management departments.

Wang Hang believes that online consultation is generally suitable for three types of patients: First, patients who return to visit again. After the initial offline consultation, doctors are familiar with the patient’s condition. After returning home, patients can communicate with doctors online about their condition and renew their medicines, upload inspection data through the network, and ask doctors to give a diagnosis and treatment plan remotely. The second is patients who need consultation, which is also in line with the general trend of national graded diagnosis and treatment. Third, there are a small number of first-time patients. At present, only a few simple diseases are opened for online first-time diagnosis, such as dermatitis, eczema, acne and other minor dermatological diseases. For relatively complex diseases, Internet hospitals will arrange suitable hospitals for patients to conduct examinations and face-to-face consultations.

Doctors "stick" online

Conducive to the formation of word of mouth, online and offline to promote each other.

Lin Zhiming, deputy director of the Department of Dermatology and Sexology, Peking University No.1 Hospital, registered and certified the doctor’s real name on the website of Good Doctor, submitted the doctor’s qualification certificate, doctor’s practice certificate, professional title certificate, ID card and other documents, and after completing the multi-point practice filing, became an online practicing doctor of Good Doctor Online Yinchuan Smart Internet Hospital. He said that from the current policy, multi-point practice does not require the consent of the original unit. However, he told the employer that with the popularity on the Internet, many patients will come here and promote each other online and offline, which will not affect offline work.

Internet medical treatment has changed the relationship between doctors and hospitals. Dr. online celebrity has formed a brand on the Internet and promoted a discipline in reality. Dr. Shang Aijia from 301 Hospital focuses on the relatively rare complex spinal cord diseases. After forming a good reputation through the Internet consultation platform, the number of patients with spinal cord diseases who come to see a doctor has greatly increased.

The "stickiness" of the Internet to doctors lies in matching the most suitable specialists for patients, which is equivalent to the "triage desk" of hospitals. Doctors can find the cases they want to see most by online consultation, which reduces the helplessness of big experts to see minor problems and accumulates effective cases. Many experts lamented that the number of effective cases seen in the previous year was not as good as that in the current month. This is the power of "Internet+medical care".

According to the doctor’s professional expertise, the Internet consultation platform sets professional labels, marks the academic direction, and screens specialized cases from patients, so that doctors and patients can match accurately and avoid anti-aircraft guns hitting mosquitoes.

In order to accumulate professional cases and improve their own level, doctors need to use the platform to improve their popularity. At the same time, in order to prevent patients from affecting their reputation due to bad reviews, they will pay more attention to the details of their work. A doctor said that it used to be word of mouth, but now it depends on the internet. In addition to medical skills, we must maintain a good attitude online and offline in order to get online praise.

Another reason why doctors are willing to "stick" on the Internet is to improve work efficiency and avoid duplication of work. Good doctor website groups patients with similar diseases, and doctors send popular science articles directly to the corresponding groups to help patients understand disease knowledge and cooperate with treatment. A doctor lamented that the same content was said at least 50 times before, and many patients didn’t know it. Now, just say it online once.

Whether online consultation is reliable depends on whether the doctor is reliable. Some Internet consultation platforms implement the registration and certification system of "three certificates and one card" for doctors who have settled in. The so-called "three certificates and one card" means that the doctor registration platform must provide the doctor qualification certificate, practice certificate and ID card to identify the identity and qualification of doctors, and at the same time provide bank card information to ensure the authenticity of doctor information; Some platforms adopt the invitation system, which requires that the doctors stationed in the platform must be doctors with the above titles in the tertiary hospitals. At the same time, they will be supervised by random sampling, calling questions from time to time or auditing exchanges. If there are medical quality problems, doctors will be removed at any time.

From the statistical data, the proportion of misdiagnosis on online platforms is much lower than that off-line. Doctors will only give judgments based on certain evidence when they diagnose online. If there is no corresponding examination result, doctors will only give advice on diagnosis and treatment online. The online platform can be traced back to the whole process. If it is a problem of medical quality, invite a third party to arbitrate and evaluate the doctor and identify the responsibility. Once the platform finds that the doctor has unreasonable behavior, it will resolutely deal with it.

Supervision is not relaxed

Electronic records have "traces" to follow, and the credit system is being improved.

Internet medical treatment breaks the space limitation, and many people think that Internet medical treatment is too risky. In fact, where is the legal subject who bears the medical responsibility? This is the urgent problem to be solved.

Gao Jiechun, director of the Institute of Hospital Management of Fudan University, believes that Internet medical care will not change the doctor-patient relationship because of the carrier. Doctors have never been the subject of law, and the subject of law is hospitals. In the past, doctors had medical disputes, and hospitals had to bear the responsibility. Now, doctors have medical disputes in Internet hospitals, so Internet hospitals should bear the responsibility. There is no difference in legal responsibilities between Internet hospitals and physical hospitals.

The patient accepted the online consultation service and was particularly worried about privacy disclosure. In terms of privacy protection of users’ personal information, Internet medical institutions should protect it, and do not disclose it to the outside world or use it for other purposes without the permission of users. In the event of user privacy disclosure, the platform should bear relevant responsibilities in accordance with the law. As for medical supervision, Gao Jiechun said that online medical history is the most difficult to be tampered with. Any modification of electronic medical history will leave traces in the background, which is the most authentic and objective medical record.

The development of Internet hospitals is unstoppable, and the difficulty of supervision cannot be ignored. The experience of Yinchuan is worth learning. Including Good Doctor Online Yinchuan Smart Internet Hospital, there are 17 Internet hospitals in Yinchuan, which has become the largest Internet hospital industry gathering place in China. Yinchuan has successively issued six documents, including "Management Measures for Internet Hospitals in Yinchuan City (Trial)", to regulate and supervise Internet hospitals, and built the first relatively complete system supervision system on Internet hospital management in China, giving Internet hospitals the same policy treatment as physical hospitals.

"The healthy development of Internet hospitals is inseparable from the construction of a sound credit system." The relevant person in charge of Yinchuan City said that it is necessary to establish credit files for operators, doctors and patients of Internet hospitals, establish a blacklist system, increase the exposure of dishonesty, strengthen joint punishment for dishonesty, enhance the deterrence of credit management, and build a credit system that "benefits the trustworthy everywhere and makes the untrustworthy unable to move". (Reporter Wang Junping)