[New Practice of Governing the Country, Ningxia Chapter] ＂Internet+Medical Care＂ has achieved initial results
Text/"Outlook" News Weekly reporter Sun Bo Ren Wei
Yinchuan City, Ningxia, which is short of high-quality medical resources, is trying to meet the demand of "zero distance" contact between the masses and famous national hospitals through "Internet+medical care".
According to the reporter of Outlook News Weekly, Yinchuan has started the construction of the first Internet medical industry base in China, supporting the introduction of Internet hospital management measures, and connecting online medical services with medical insurance policies for the first time in China.
Analysts pointed out that Internet hospitals can help solve the problems of insufficient medical resources, especially the uneven allocation of high-quality medical resources. It is of great and far-reaching significance to promote the transformation and upgrading of traditional medical service model, enhance the service function of primary medical and health institutions, and explore new innovative grading diagnosis and treatment model.
However, the "license" issued by Yinchuan City to Internet hospitals is only a local administrative license, and it still lacks legal protection and institutional support at the national level. When can an Internet hospital get a real "legal identity"?
The staff debugged the consultation system on the Internet medical and health service platform (photo taken on March 24). Photo taken by Wang Peng/This magazine.
A famous hospital for famous doctors at the "doorstep"
As the capital city of national smart city pilot city, medical reform pilot city and telemedicine policy pilot province, Yinchuan City, Ningxia has been exploring and trying "Internet+medical care".
At the end of 2016, Yinchuan Smart Internet Hospital jointly established by Yinchuan City and Good Doctor Online opened. In just over 100 days, 985,000 patients were served, including 43% in the central and western regions and 6,516 local patients, about 10% of whom were critical and difficult diseases.
Ge Chunlong, medical executive director of Yinchuan Smart Internet Hospital, said that at present, Yinchuan Smart Internet Hospital has completed the multi-point practice filing procedures for 11,000 doctors. Among them, 92% are from tertiary hospitals, and 88% are chief physicians or deputy chief physicians. Some township hospitals have set up online consultation rooms to help grassroots patients consult and seek medical treatment online.
Specifically, after patients enter the "consulting room" on the mobile phone client, they can communicate with doctors through text, voice, video and other forms. For newly diagnosed patients, doctors can go to a suitable hospital for face-to-face consultation nearby, and a few common diseases suitable for online initial diagnosis can be given a diagnosis and treatment plan online; For patients who return to the clinic, doctors can make online consultation, arrange nearby examination, and prescribe drugs online, which are delivered to the door by qualified online drug suppliers; For patients with major diseases, the hospital can invite national authoritative experts for online consultation and make an appointment for local surgery.
Xia Tiantian, who is more than 6 months old, suffers from hemangioma, and the effect of local treatment for several months is not obvious. The doctor suggested going to a big hospital in Beishangguang for treatment. Parents are worried that their children are too young to withstand the twists and turns on the road. After being introduced, they contacted the authoritative experts of the Ninth People’s Hospital affiliated to Shanghai Jiaotong University School of Medicine for online diagnosis and treatment. "Doctors in Shanghai have opened a checklist for external use and heart color ultrasound on the Internet, telling us to give our children a heart color ultrasound before taking the medicine to rule out the history of serious heart disease and asthma. We hung up the expert number of Shanghai Grand Hospital at home. You don’t have to travel back and forth, at least you can save 12,000 yuan on air tickets, accommodation and catering. " Xia Tiantian’s father said.
Guo Baichun, deputy mayor of Yinchuan City, said that among the expenses for patients in the central and western regions to seek medical treatment in the Beijing-Guangzhou University Hospital, non-medical expenses such as food, housing and transportation account for about 30%-50% of the total expenses. Doctors from Beishangguang and other places join Internet hospitals for multi-point practice, which is equivalent to integrating the fragmentation time of these doctors, recreating 2-3 times of doctor resources and increasing the supply of medical resources. "These high-quality medical resources have sunk to the central and western regions where medical resources are scarce through information technology, which is convenient for local residents to seek medical treatment nearby, eliminating the need for travel and non-medical expenses in the process of diagnosis and treatment, and also has a positive effect on preventing poverty and returning to poverty due to illness." Guo Baichun said.
Revitalize grass-roots resources
The emergence and development of Internet hospitals not only re-created doctors’ resources and increased the supply of medical resources, but also made use of Internet technology to realize the sinking of high-quality medical resources and make up for the uneven distribution of high-quality medical resources.
According to Yang Yinxue, president of the General Hospital of Ningxia Medical University and president of Ningxia Internet Hospital, the uneven distribution of medical resources and insufficient quality resources, the incomplete construction of the four-level medical system at the provincial, city, county and township levels, and the lack or lack of human resources are a major problem facing the current medical reform. Taking graded diagnosis and treatment as an example, it is difficult because the staffing of primary medical and health institutions cannot meet the people’s demand for medical treatment. "For example, Helan County, a suburb of Yinchuan, has 260,000 people and only over 1,100 medical staff. Among them, there are less than 30 deputy chief physicians, and the shortage of human resources in mountainous counties is even more serious. "
This means that in order to achieve 90% of patients in the county by 2020, grass-roots medical institutions need to establish convenient and rapid consultation channels with famous doctors and hospitals, and improve the service level through technology sharing.
An interview with the reporter of Outlook News Weekly learned that Ningxia Internet Hospital, which was jointly established by Micro-medicine and General Hospital of Ningxia Medical University, is building a graded diagnosis and treatment platform in the northwest region. It can not only make patients feel at ease to stay in the local area for medical treatment, but also make use of the local idle medical resources. Lun Ziyi, the relevant person in charge of Ningxia Internet Hospital, said: "Relying on the main platform of micro-medicine, Ningxia Internet Hospital has sunk the experience of top experts to the grassroots level to help grassroots doctors improve their professional ability. At present, more than 40 groups of experts led by experts from the General Hospital of Ningxia Medical University have settled in Ningxia Internet Hospital to provide team medical services for the masses and promote graded diagnosis and treatment. "
In addition, Internet hospitals also explore new modes of doctor collaboration to promote the efficient distribution of medical resources. On some Internet hospital platforms, tertiary hospital experts build disciplines vertically and form discipline teams with primary doctors, who share medical experience and knowledge with them.
Sun Tao, president of Ningxia Medical University, believes that this cooperation mode can realize a new model of graded diagnosis and treatment among team members, including first consultation, referral and consultation. Let experts concentrate on scientific research and teaching, and grass-roots doctors undertake more tasks of first diagnosis and outpatient service, so that limited medical resources can be rationally utilized.
At present, in Yinchuan Smart Internet Hospital, 53 nationally renowned experts have established cooperative relations with local hospitals to provide linkage support for the construction of their key disciplines. Ningxia Internet Hospital has established an online and offline "discipline alliance" through cross-regional discipline co-construction, and 10 interdisciplinary consultation centers led by academicians provide consultation services for people in Ningxia and Northwest China.
The application of "discipline alliance" and telemedicine has brought convenience to local people. Lao Dong, a 67-year-old patient from Changxin Township, Helan County, was consulted at Ningxia Internet Hospital for suffering from the left femoral intertrochanteric fracture. The First People’s Hospital of Helan County connected with experts from Ningxia Medical University General Hospital and Shanghai Changhai Hospital. The three-party remote consultation confirmed the 3D orthopedic surgery plan for him, and the diagnostic ability of local doctors was effectively improved during the consultation.
Tian Yonghua, director of the Yinchuan Municipal Health Planning Commission, said that the development of Internet hospitals will also help improve the management effect of chronic diseases. With the help of the Internet platform, grassroots doctors, community doctors and family doctors who undertake the diagnosis and treatment of chronic diseases can be effectively connected with specialists, who can make follow-up, management and guidance online, popularize and upgrade professional knowledge to grassroots doctors, and realize personalized management of patients through electronic health records, big data analysis and other tools to provide support for clinical decision-making.
Establish rules and regulations for internet hospitals
Under the new layout of exploring "Internet+medical care" in Yinchuan, up to now, Yinchuan has signed contracts with 17 enterprises related to Internet medical services, such as Good Doctor, Micro-medicine, Lilac Garden, Peking University Medical Information and Dr. Chunyu, and conducted centralized pilot projects by establishing industrial bases to explore the development path, supervision system, risk prevention measures and supporting policies of the "Internet+medical care" industry.
In view of the lack of corresponding industry supervision regulations and standards, there is a regulatory vacuum in Internet hospitals. Based on the relevant national laws and regulations, Yinchuan issued a series of policies this year to support and standardize Internet medical services, taking the lead in filling the regulatory gap in domestic Internet hospitals.
In order to improve the online diagnosis and treatment quality and service level of Internet hospital practitioners, standardize their practice behavior, and ensure the safety of patients seeking medical treatment, Yinchuan has established an access and rating system for Internet hospital practitioners, which puts forward clear requirements for online doctors’ clinical work experience, practice scope, professional titles, etc., and will implement an assessment, grading and withdrawal mechanism for online doctors.
Medical care involves life, health and personal privacy, and quality and safety are important prerequisites for developing "Internet+medical care". Tian Yonghua said that medical practitioners certified in Yinchuan Internet Hospital must have at least 5 years of offline clinical work experience and obtain intermediate titles after obtaining the qualification of medical practitioners; The medical services provided by online doctors must be consistent with their scope of practice and professional skills, and obtain the corresponding prescription rights of Internet hospitals.
Internet hospitals will also evaluate the online activity of doctors, the number of consultations, the accuracy and rationality of diagnosis and treatment, complaints and medical disputes, honest service and patient satisfaction. The rating will be linked to the standard of doctors’ medical fees, professional title evaluation and exit mechanism. For example, doctors should participate in or carry out discipline training twice a year; Online time is not less than 7.5 hours per month, consultation is not less than 40 person-times, and diagnosis and treatment is not less than 10 person-times; The deviation between the patient’s appointment time and the actual time of providing consultation or diagnosis and treatment services is less than 8 hours; The diagnostic accuracy and rationality of online follow-up visit and initial visit are not less than 90% and 70% respectively.
In addition, Yinchuan is the first time in China to connect online medical services with medical insurance policies, and conduct a pilot project of co-ordinating online consultation fees with accounts in limited areas and quotas. On the basis of the relevant system requirements of the state and autonomous regions, it also took the lead in implementing online and offline electronic mutual recognition and management of electronic prescriptions in Internet hospitals in Yinchuan.
According to reports, insured employees in Yinchuan can use social security card personal account funds to pay online medical expenses; To participate in urban workers’ medical insurance and urban and rural residents’ medical insurance, the annual maximum payment limit of online outpatient co-ordination is 120 yuan and 50 yuan respectively, and the reimbursement ratio of outpatient medical expenses within the scope of "Three Catalogs" of basic medical insurance is 50% and 40% respectively, and the maximum payment amount for each time is 8 yuan and 5 yuan respectively. The reimbursement of medical expenses for online outpatient co-ordination per person per day is limited to one time.
For the information security issues involved in the "Internet+Medical" service process, Yinchuan City requires that all the servers, service process data and patient health files of Internet hospitals be placed or stored in the Smart Yinchuan Big Data Center, and the ports should be opened to the regulatory authorities. Using the characteristics of online traces, data collection, mining and analysis are carried out to realize real-time, traceable and dynamic supervision of Internet hospitals by regulatory authorities.
In the past two years, the development of "Internet+medical care" service has been proposed in relevant national documents, but at present, there is still no official definition and national identity recognition of Internet hospitals. Some people in charge of Internet medical enterprises in Yinchuan admitted that the innovation of policies and the breakthrough of systems in Yinchuan City have pushed the development and management of Internet hospitals forward a big step towards institutionalization, but the "license" issued by Yinchuan City to Internet hospitals is only a local administrative license, and only the legal guarantee and institutional support at the national level can more effectively promote their sustained and healthy development.
During the two sessions of the National People’s Congress this year, some deputies to the National People’s Congress and CPPCC members also suggested improving the top-level design of "Internet+medical care" service, and formulating relevant laws and regulations on the establishment, supervision and multi-point practice of doctors in Internet hospitals, so as to provide legal protection for the healthy and orderly development of "Internet+medical care" service.
There are also some grass-roots managers who suggest that at present, the conditions for the unified introduction of relevant policies by the state are not yet available and need to be piloted. They suggested the introduction of licensing regulations, allowing some cities with mature conditions to be used as national pilots to accumulate experience and samples for the development of Internet hospitals.
Tian Yonghua said that Yinchuan has the institutional support of big data technology support and management policies, and has the conditions to provide test samples for the national regulatory authorities and the development of Internet hospitals across the country. "We have found a way to develop Internet hospitals, but if we want to go further and feel more at ease, we still hope to have a national ‘ Reassuring pills ’ 。” (End)
[Editor: Zhang Jielong]