Since 2020, in the process of fighting the COVID-19 epidemic, public hospitals all over the country have launched Internet medical services, which has effectively improved patients’ medical experience.
According to the data released by National Health Commission, at present, there are more than 1,100 Internet hospitals in China, and 7,700 hospitals above the second level provide online services. The online appointment rate of tertiary hospitals has reached more than 50%, and 3,300 hospitals will make appointments by time to 30 minutes. More than 90% of tertiary public hospitals have realized the sharing of hospital information. The telemedicine collaboration network covers more than 24,000 medical institutions in all prefecture-level cities. 30 provinces have established Internet medical service supervision platforms.
Mobile phone follow-up, simple and quick operation.
On-line follow-up saves time and money for patients and their families, saves patients from the pain of travel and fatigue, and is conducive to postoperative rehabilitation.
"Director Chen, I have a cough. What’s the matter?"
"When the nutrition tube is placed in the throat, it will be irritating, and it is normal to cough occasionally."
"It’s been a month since the operation. Can I unplug the tube and eat by myself?"
"The nutrition tube is yours ‘ Lifeline ’ If you pull it out, there will be obstacles to eating directly. The intubation is really uncomfortable, but I hope you can bear it again … …”
This is Chen Keneng, director of the Department of Thoracic Surgery, Peking University Cancer Hospital, who is giving a follow-up visit to Ms. Li who is far away from home in Xiamen, Fujian Province through the Internet.
At the end of January this year, Ms. Li had esophageal cancer resection in Peking University Cancer Hospital, and returned home to recuperate after discharge. Earlier, Ms. Li had bought a plane ticket to Beijing and was going to Beijing for a follow-up visit. My friend said that she could make a follow-up visit online. She felt very fresh and wanted to try it, so she returned her ticket. With the help of her son, Ms. Li made an appointment with Chen Keneng’s follow-up number by using the mobile phone software of "North Swelling Cloud Medical Records" and successfully completed the follow-up visit. "It’s so convenient to return to the mobile phone!" Ms. Li told reporters through video.
How to operate the mobile phone follow-up visit? The staff of Peking University Cancer Hospital opened the "North Swelling Cloud Medical Record" to demonstrate to the reporter: On the day of the visit, the patient can log in to the "North Swelling Cloud Medical Record" 30 minutes in advance, click "Online Follow-up" on the homepage, and enter the "online consultation room" to wait for treatment. After that, the doctor will take the initiative to invite the consultation, and the patient can start the consultation by clicking "Answer". 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.
In April 2020, Peking University Cancer Hospital was granted the qualification of Internet diagnosis and treatment. Up to now, the cumulative number of online follow-up visits has exceeded 40,000, of which 22.8% have been followed up more than three times. Chen Keneng said that the patients in Peking University Cancer Hospital come from all over the country. After the initial diagnosis and operation, patients need to return to the clinic, even for many times. If you have to travel long distances to Beijing for each follow-up visit, some of them need to be accompanied by their families, which will cost a lot. Many follow-up visits don’t have to go to the scene, and they can also be solved through video. Network follow-up saves time and money for patients and their families, saves patients from the pain of traveling by boat and is conducive to postoperative rehabilitation.
Zhao Chengsong, assistant to the president of Beijing Children’s Hospital affiliated to Capital Medical University and director of the outpatient department, said that Beijing Children’s Hospital recognized the results of the mutual recognition program for children in local hospitals of the same level or Beijing, Tianjin and Hebei. After the child has finished the examination in the local hospital, the film or examination report will be uploaded to the Internet medical platform of Beijing Children’s Hospital, which can also be seen by the attending doctor.
"Ensuring the quality of medical care is the life of Internet medical care." Zhao Chengsong said that for large public hospitals, it is an inevitable trend to carry out Internet diagnosis and treatment. In order to ensure the quality of medical care, 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."
Heng Fanxiu, director of the Information Department of Peking University Cancer Hospital, believes that the smooth progress of Internet diagnosis and treatment in large hospitals is inseparable from an efficient information management system. The Internet diagnosis and treatment system of Peking University Cancer Hospital has been updated for 38 times since it was launched. Each version update is to fix loopholes and improve the efficiency and security of the system. "The hospital’s Internet medical data should be encrypted and stored on an independent server to ensure the safety of patient medical data." Heng anti-repair theory.
Prescribe drugs online and deliver them home by express delivery.
Doctors need to use electronic signature when prescribing drugs online, and pharmacists sign after passing the internal system of the hospital to ensure that the prescription is reasonable, legal and compliant.
"The medicine prescribed online in the morning arrived home by express delivery before dark, so fast!" Mr. Zhang, who lives in Tianjin, took his 8-year-old daughter with precocious puberty and used her mobile phone to use the WeChat applet — — A follow-up visit was made on the "Beijing Children’s Hospital Service Number". Doctors make prescriptions online after video consultation. After a few minutes, the pharmacist approved it.
After seeing a doctor, Mr. Zhang clicks on the button of "online drug purchase", selects the prescription to be paid, clicks on "immediate payment and delivery", selects the service of "express delivery to home" in "delivery mode", fills in the address, telephone number and other information and pays, and then completes the drug purchase process. "Simple operation and fast payment. It is also very easy to buy medicine online! " Mr. Zhang said.
In April 2020, Beijing Children’s Hospital opened Internet diagnosis and treatment service, and patients can enjoy online follow-up, online prescription and prescription drug delivery service through their mobile phones. At present, the vast majority of departments in Beijing Children’s Hospital have carried out Internet diagnosis and treatment, and the hospital is equipped with corresponding equipment to facilitate doctors to go out to the Internet clinic.
How to ensure the safety of doctors prescribing drugs online? Zhao Chengsong introduced that Beijing Children’s Hospital has established a relatively complete Internet management system and implemented an electronic signature system and a drug pre-audit system. Doctors need to use electronic signature to prescribe drugs online, and pharmacists should sign after passing the internal system of the hospital to ensure that the prescription is reasonable, legal and compliant.
How to send the medicine to the patient’s home safely and quickly after the prescription is made? Zhao Chengsong said that Beijing Children’s Hospital cooperated with China Resources Pharmaceutical Group to develop a prescription circulation platform. On the platform, the hospital is responsible for reviewing the prescription and then pushing it to China Resources Medicine. China Resources Medicine will arrange the nearest pharmacy according to the patient’s location, use professional medical logistics to send drugs and deliver them to the patient’s home in time.
In September, 2020, Peking Union Medical College Hospital’s Internet medicine distribution service 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.
Some Chinese medicine hospitals are also exploring online express delivery services for Chinese herbal medicine prescriptions. In April 2020, Longhua Hospital affiliated to Shanghai University of Traditional Chinese Medicine issued the first online prescription of Chinese herbal medicine in Shanghai. This prescription was delivered to patients’ homes in Yancheng City, Jiangsu Province free of charge within two days through the distribution system of traditional Chinese medicine decoction pieces in the hospital. Previously, Longhua Hospital has built a relatively mature distribution system for Chinese herbal pieces. The relevant person in charge of Longhua Hospital said that it will continue the free drug delivery measures in Jiangsu, Zhejiang, Shanghai and Anhui to provide more convenience for patients.
"At present, the hospital’s Internet diagnosis and treatment platform needs to be continuously improved. For example, the types of drugs in some hospitals’ Internet diagnosis and treatment platforms are not complete enough to issue laboratory tests and checklists." Zhao Chengsong suggested that in order to better serve patients, hospitals and drug distribution enterprises should strengthen cooperation, optimize the Internet diagnosis and treatment platform, provide more quality services, and further enhance patients’ sense of medical treatment.
Online payment, real-time settlement of medical insurance
"internet plus" medical services are included in medical insurance payment, and online and offline medical services are treated fairly.
Aunt Jing, who lives in Jinan City, Shandong Province, is 69 years old and suffers from high blood pressure. She usually needs to go back to the clinic regularly to get medicine. She completed the medical insurance identity verification and medical insurance binding on the "Shandong Medical Insurance Great Health" WeChat official account, and chose the Internet hospital for treatment, so she could use medical insurance to pay. "Mobile phone WeChat pays fees, medical insurance is settled in real time, and the operation is not complicated." Aunt Jing said.
In order to facilitate patients with chronic diseases to seek medical treatment, Shandong Province has established a Shandong medical insurance platform, relying on Internet hospitals to open online payment for medical insurance for Internet hospitals stationed in the platform, and medical insurance information can be verified immediately. At present, a comprehensive medical security service system of "internet plus Medical Insurance+Medical Care+Medicine" has been established in Shandong Province, which realizes the seamless connection of key links such as medical insurance certification, follow-up check-up, online prescription and delivery of medicines to home. Insured people in Shandong province can get one-stop convenient services such as online follow-up, prescription and online payment of medical insurance through mobile phones without leaving home.
For some elderly people, the mobile phone operation is not smooth, and the Shandong Medical Insurance Platform has also opened a manual customer service hotline to help patients with chronic diseases complete the first signing and follow-up service. Uncle Lin, who has been bedridden with hemiplegia for more than 20 years, used this service. Uncle Lin and his old couple only have an old man-machine machine. Uncle Lin’s daughter signed the platform for him for the first time with a smart phone and saved the hotline on the old man’s mobile phone. In the future, the elderly only need to make a phone call and wait for the medicine to be delivered at home. The medical insurance is settled online in real time, and the self-paid part is collected by the delivery staff.
In March, 2020, in order to meet the drug demand of patients with chronic diseases during the epidemic prevention and control in COVID-19, the National Medical Insurance Bureau and the National Health and Health Commission issued the Guiding Opinions on Promoting the "internet plus" medical insurance service during the epidemic prevention and control in COVID-19, clarifying that qualified Internet medical institutions provide the insured with online follow-up services for common diseases and chronic diseases, and make online electronic prescriptions and offline prescriptions, so that the insured can enjoy the medical insurance payment treatment as if they were in a physical hospital. "internet plus" medical insurance service was welcomed by patients shortly after its opening. Taking Shanghai as an example, as of June 2020, 12 medical institutions have realized online real-time settlement of medical insurance, with more than 17,800 settlement times and a total cost of 2,598,200 yuan.
In October, 2020, the National Medical Insurance Bureau issued the Guiding Opinions on Actively Promoting the Medical Insurance Payment for internet plus Medical Services, which clarified the consultation fees and drug fees incurred by patients with chronic diseases and special diseases for online follow-up, and prioritized them into the scope of medical insurance reimbursement, supported the circulation of prescriptions for medical follow-up visits in internet plus, and explored the interconnection of prescription information purchased by designated medical institutions with designated retail pharmacies.
Lu Qingjun, director of the office of National Health Commission Telemedicine Management and Training Center of China-Japan Friendship Hospital, said that the "internet plus" medical insurance payment policy made it clear that the "internet plus" medical service should be included in the specific content of medical insurance payment, and the online and offline medical services should be treated fairly, and priority should be given to ensuring the demand for follow-up visits for chronic diseases and special diseases in outpatient clinics, and supporting the circulation of purchased prescriptions, which not only facilitated patients, but also reduced the pressure on hospitals. Internet medical care has broken the time and space restrictions for patients to seek medical treatment, which has made it easy for many patients to seek medical treatment across provinces and different places, helped to promote the homogenization of medical resources, and enabled patients in remote areas to enjoy high-quality medical resources conveniently and better meet the people’s medical and health needs. (photo by Shen Shaotie)