Tianjin's "micro-medical model" under the epidemic

On the New Year's Eve, Tianjin Weiyi Internet Hospital was launched, providing free services such as free coronal treatment for new coronary pneumonia; nearly 40,000 doctors across the country have participated

Inquiry interface of Tianjin Weiyi Internet Hospital.

Since the beginning of the new year, Liu Xiuyi, deputy director of the Department of Infectious Immunology of Tianjin Hospital, has two new identities.

Putting on protective clothing and wearing a mask, she is a clinician who supports Tianjin Hospital for fever diagnosis; taking off her protective clothing and picking up her mobile phone, she is an online doctor of Tianjin Weiyi Internet Hospital's “New Crown Pneumonia Real-Time Rescue Platform”.

On New Year's Eve, under the overall command of the Tianjin Municipal Health and Health Commission, the Medical Insurance Bureau and the Municipal Information Office of the Municipal Party Committee, Tianjin Weiyi Internet Hospital went online quickly. Like Liu Xiuyi, 37,277 doctors have participated in online "anti-epidemic" doctors across Weiyi Internet Hospitals as of February 18, providing a total of 1.364 million medical consultation services.

In addition to free clinics for new coronary pneumonia, convenience clinics, psychological assistance areas and psychological care channels for chronic diseases and common diseases have also been rapidly opened. Tianjin Weiyi Internet Hospital has become the first “battlefield” in the fight against epidemics in Tianjin.

Not long ago, the National Health and Medical Commission issued a notice requiring all places to make full use of the advantages of "Internet + medical treatment" in epidemic prevention and control, and to promote the Internet diagnosis and treatment consulting service to play a more important role in epidemic prevention and control, so that the people can get timely Health assessment and professional guidance, accurately guide patients to orderly visits, effectively alleviate the pressure of hospital treatment, reduce staff gathering, and reduce the risk of cross infection.

From offline to online, from the epidemic period to conventional medical treatment, Tianjin's "micro-medical model" may become a model for reference in various places.

The citizens of Tianjin used the Tianjin Weiyi Internet Hospital to prescribe medicine at the convenience clinic, and the medicine was delivered to their home the next day.

Doctors "go live"

Liu Xiuyi entered the hospital for a fever clinic on January 25.

"In mid-January, the hospital began to provide medical staff with relevant training on infectious disease admissions and admissions throughout the hospital, so everyone was already nervous at the time and was ready at any time." Liu Xiuyi said, as the number of outpatients increased More and more, the support of a large number of doctors, she also went to the fever clinic as soon as possible.

Also on the same day, Liu Xiuyu received a call from Tianjin Weiyi Internet Hospital, hoping that she could participate in the online consultation of the "New Crown Pneumonia Real-Time Aid Platform".

"Fat clinics alternate between morning, middle, and evening shifts. Once you enter, you have to work continuously for 7 hours, sometimes up to 10 hours. Protective clothing can't be taken off." Liu Xiuyi also thought, can he be busy?

But she quickly convinced herself and decided to offer free advice online to those in need. "I am a major in immunology, and I have a better understanding of the epidemic situation. It is a good thing that I can provide more people with advice through the Internet, let them run less hospitals, and avoid the risk of cross infection. "

Yang Huiyin, who has settled in the “New Crown Pneumonia Real-Time Relief Platform” to provide online consultation, is also the director of the Jumei digestive center ward, the former attending doctor of the Integrated Traditional Chinese and Western Medicine Department of the Fifth Medical Center of the PLA General Hospital.

The 2003 experience of visiting SARS has made Yang Huiyin more vigilant against the epidemic.

"At the time, my work unit was the former 302th Hospital of the PLA. It was the only specialized tertiary infectious disease hospital in the army. We are very close to SARS and the management is very strict and formal. Therefore, we have more knowledge about infectious diseases and isolation. I will pay special attention to your understanding. "

After completing her daily work, Yang Huiyin will put most of her energy online. "You will be treated on the platform at any time before 12 pm."

For Yang Huiyin, this is also a way for her to participate in the "anti-epidemic" medical front. "There is no way to contribute to the front line, and to do my best in the rear, I feel very excited and honored inside."

Another "anti-epidemic"

There are many doctors like Liu Xiuyi and Yang Huiyin. As of February 18, there have been 37,277 doctors participating in the online "anti-epidemic" through Tianjin Weiyi Internet Hospital.

Tianjin Weiyi Internet Hospital went online quickly on New Year's Eve.

At that time, the new crown pneumonia epidemic was spreading across the country, the number of hot clinics in hospitals around the country surged, and front-line medical care entered a "ready to war" state.

In order to reduce the risk of cross-infection among the people and help prevent and control the epidemic, Tianjin Municipal Health and Health Committee and Tianjin Weiyi Internet Hospital launched an online free clinic for Internet hospitals in the city, encouraging physicians in the city to provide unlimited access to Tianjin and the country in their spare time Free health consultation service.

As of 24:00 on February 13, the "New Coronary Pneumonia Real-Time Relief Platform" found 1354 suspicious cases of new coronary pneumonia, and reported the suspicious cases to the local disease control departments with the cooperation of doctors and patients.

According to Zhang Songqi, the relevant person in charge of Weiyi Internet General Hospital, through the "New Coronary Pneumonia Real-Time Relief Platform", users can consult experts for free online and conduct mental health consultation; receive "Q & A on pneumonia prevention and control of new coronavirus infection" and master professional scientific knowledge; Use convenience clinics to prescribe medicines online and enjoy home delivery services. At the same time, you can follow the epidemic situation in Tianjin and grasp the latest epidemic information.

According to its introduction, the platform free clinics and convenience clinics are free at present throughout the country. "Patients enter the New Coronary Pneumonia Real-Time Rescue Platform or Tianjin Weiyi Internet Hospital. After registration, they can choose graphic and text consultations and video consultations independently. , Telephone consultation and fill out a pre-diagnosis questionnaire to describe the condition. "

Zhang Songqi said that in order to ensure that doctors have a comprehensive understanding of the situation, patients can also choose to upload medical records, imaging reports, inspection reports, and communicate with doctors online.

As soon as Tianjin Weiyi Internet Hospital was launched, the demand for consultations from the local and all parts of the country, especially Wuhan, flooded in, and the number of consultations per minute reached 50 to 60.

On February 13, Yang Huiyin received a patient from Hubei for help.

"This is a patient who is more responsible for himself and others. He went to the hospital for a check-up after he developed cold symptoms. His blood routine and CT images showed normal, and he did not suggest the possibility of new coronary pneumonia. But the patient himself Very anxious and feels at risk of being infected. "

After detailed graphic chat and telephone communication, Yang Huiyin told the patient to treat her normally and isolate it at the same time.

Yang Huiyin said that there are not a few people who come to consult because of suspicion of their infection. "In this case, I feel that I am actually conducting psychological counseling for the other party."

Wan Nansheng, attending physician of the Department of Respiratory Diseases of the General Hospital of Tianjin Medical University, is consulting online.

Psychological care during the epidemic

In order to cope with the general psychological trauma caused by the epidemic, the "New Crown Pneumonia Real-Time Relief Platform" has specially set up a special psychological assistance area.

Tianjin Weiyi Internet Hospital, in conjunction with the Social Psychological Service Professional Committee of the China Disaster Prevention Association, the Psychotherapy and Counseling Professional Committee of the Chinese Mental Health Association, and the volunteer team, provides psychological testing services such as self-assessment and consultation to experts in the psychological assistance area.

For the most common post-traumatic stress disorder (PTSD), anxiety, and depression in the epidemic area, netizens can complete a preliminary assessment through self-assessments of 7 to 17 questions, and the self-assessment will recommend whether further consultation with a psychologist is required based on the assessment results.

It is reported that the first batch of hundreds of psychologists on-line is mainly composed of psychiatrists and psychological consultants, of which more than 20% are clinicians.

Ye Jianjie, deputy director of Wenzhou Kangning Hospital and director of clinical psychology, and his colleagues receive 20 to 40 hotline calls each day for psychological assistance. "Most of them are ordinary people who are anxious because of fear of infection, but also because of Not fit for isolation and panic. "

In order to alleviate the psychological panic of the people and guide them to correctly understand the epidemic situation and scientific prevention and treatment, on January 27, the Tianjin Municipal Party Committee's Cyberspace Information Office and the Weiyi Internet General Hospital and Tianjin Weiyi Internet Hospital launched the "Handbook of Knowledge on Prevention and Treatment of New Coronavirus Infected Pneumonia". 》 Online the "New Crown Pneumonia Real-Time Relief Platform" for free for the public.

According to the relevant person in charge of the Tianjin Municipal Party Committee's Network Information Office, the manual spreads scientific epidemic prevention knowledge in the form of pictures and texts in the first time in terms of knowledge of pathogens, transmission channels, clinical manifestations and related treatments, common sense prevention and control, and misunderstandings. As of 19:00 on February 19, the manual has been downloaded 519,000 copies.

With the spread of the epidemic, people are also seeking authoritative doubts about specific prevention and control measures in different scenarios such as work and life. On January 29, the "Q & A on Knowledge of New Coronavirus Infected Pneumonia", which was jointly prepared by the Tianjin Municipal Internet Information Office in conjunction with Weiyi Internet General Hospital and China Traditional Chinese Medicine Press, was also launched, and the focus of the epidemic was discussed in the form of a question and answer. A professional, popular interpretation.

"The appendix to the Q & A also brings together the diagnosis and treatment plan and prevention and control documents for pneumonitis infected by the new type of coronavirus issued by the National Health and Health Commission. At the same time, the Chinese and English version of the book is launched. Publications, "said the person in charge.

In addition to the psychological care of the general public, Tianjin Weiyi Internet Hospital has also opened a dedicated channel of psychological care for medical staff.

A doctor struggling at the front line of the epidemic called Ye Jiong and complained of his blame and weakness.

"He is a highly skilled doctor. At the beginning, he was very confident in treating patients. But in the face of the new enemy of the new coronavirus, he became helpless. He felt that he was a professional doctor. Sudden things suddenly become out of control and even feel worthless. "

Ye said that front-line medical personnel are facing greater pressure than ordinary people during the epidemic. "They not only need to help patients, they also need to be careful about their own protection, and also worry about the safety of their families. The impact of the epidemic, the state of long-term isolation, A stable doctor-patient relationship will cause a great psychological crisis when the concentration erupts. "

In Ye Jianjie's opinion, the benefit of online psychological assistance is that it will not cause shame or anxiety to helpers. "Doctors are a group that is less willing to show weakness and help, so we first provide a self-assessment tool for mental state. Let them judge for themselves the degree of anxiety and emotional instability. If they obviously need psychological assistance, then call the psychological assistance hotline. "

Listening and responding to helpers' emotions is the basic work of psychological assistance. Ye Agile said that the helpline opened for medical staff is specifically for them to express their emotions. In addition, the psychological assistance team will also help medical staff deal with some of their own cognitive behaviors, teach them to relax their psychological pressure, and encourage them to keep in touch with the outside world.

Patients need to fill out a pre-diagnosis questionnaire before using Tianjin Weiyi Internet Hospital.

Not forgetting patients with chronic diseases

Suffering from the sudden outbreak, there are many patients with chronic diseases.

Affected by the epidemic, some general outpatient clinics were suspended, and some patients were afraid to go to the hospital because of the risk of infection. How to revisit and renew the medicine has become a big problem that patients with chronic diseases have to face.

"Taking Hepatitis B as an example, the population of hepatitis B patients in China is very large, with nearly 70 million cases. For hepatitis B patients, antiviral therapy is a basic treatment, and antiviral drugs cannot be stopped. This becomes a very unusual period. Very contradictory. "Yang Huiyin said.

In order to cope with the medical treatment and medication needs of patients with recurrence of chronic diseases, Tianjin requires the city's general practitioners to log in to Tianjin Weiyi Internet Hospital to provide recurrence services for chronic and common diseases according to law.

On February 7, Tianjin Weiyi Internet Hospital opened an online convenience clinic on the basis of providing free online consultation and consultation services to patients, focusing on common and chronic diseases, providing citizens with online follow-up consultations, online prescriptions, and drug delivery. One-stop service.

As soon as the convenience clinic was opened, Zhang Chuanying, the attending physician of the Endocrinology Department of the Chinese Medicine Hospital of Wuqing District, Tianjin, began to have more "online" patients.

"For chronically ill patients with relatively stable conditions, there is not much difference between online re-examination and prescribing and offline, and there is no need to line up. The current epidemic period also avoids the risk of cross-infection." Zhang Chuanying said.

According to her, the process of online consultation and prescribing of patients is not complicated.

Tianjin citizens can access the “Tianjin Weiyi Internet Hospital” WeChat public account via computer or mobile phone, click “Go to prescribe medicine” in Tianjin Weiyi Internet Hospital, select relevant departments, upload and fill in medical records and medication needs, and then wait for doctors to see a doctor .

"Taking diabetes as an example, we will ask patients about their medical history for several years, what medicines they are using, how well their liver and kidney function is, whether they have a history of allergies, and whether their blood glucose control is good. Some patients may have been seen offline or uploaded. The diagnosis sheet and prescription are for doctors' reference. "Zhang Chuanying said that through these consultations, he can basically understand the patient's current condition, determine whether the medication needs to be adjusted, and issue a prescription.

After the prescription is approved, the patient can place an order for the medicine directly. After the payment is successful, the medicine will be delivered to the home on the same day or the next day. But Zhang Chuanying also reminded that patients with chronic diseases still need to go to offline clinics regularly for review. For example, diabetic patients need regular re-examination of liver and kidney function, glycated hemoglobin, urinary protein; those with retinopathy need regular re-examination of fundus.

For Tianjin citizens, a bigger advantage is that at present, the Tianjin Medical Insurance Bureau and other relevant departments are docking with the physical hospitals relying on Tianjin Weiyi Internet Hospital. In the future, patients with chronic and common diseases will prescribe medicines online, or they will be reimbursed with offline medical insurance.

With the spread of the epidemic and the strengthening of prevention and control measures in various places, the problem of difficulty in medication for patients with chronic diseases has become increasingly prominent. A liver disease patient in Wuhan also sent for help.

"Under normal circumstances, we ask the patient to review it every 3 to 6 months, but after Wuhan's control, his travel becomes very difficult. And most of the medical staff in Wuhan have come to support the frontline of the epidemic, the general outpatient clinic was suspended, and his specific medication It's not available in all hospitals. "Yang Huiyin said, which caused patients to prescribe drugs and purchase drugs.

According to its introduction, in accordance with the standards and procedures of offline hospitals, Dr. Jumei's team opened online review and prescription transfer links on Weiyi Internet Hospital, coordinated logistics channels, and successfully delivered medicines to patients at home.

Let Internet Hospitals Go Everyday

In addition to online free consultation for new coronary pneumonia, convenience clinics opened for patients with chronic and common diseases, and psychological assistance at special times, Tianjin Weiyi Internet Hospital has also launched a release mechanism for popular clinics and waiting conditions. Tianjin and the national epidemic situation also set up a dedicated page to update in real time.

"Hot fever clinics are published to the public every 2 hours through the media, the purpose is to guide fever patients to choose a medical institution reasonably, to avoid the situation of centralized consultation of fever patients." According to the relevant person in charge, this release mechanism is based on Tianjin Health The private network adopts the automatic data capture method to realize the real-time collection and automatic summary of the hotspot clinics waiting for medical institutions.

It said that it is currently constantly improving the functions of information collection, analysis, monitoring and early warning, and strive to provide a more scientific and timely basis for decision research and judgment.

The Planning Department of the National Health and Medical Commission recently held a seminar on issues related to Internet diagnosis and treatment consulting services, saying that Tianjin and other places have actively established an authoritative and unified Internet medical platform based on actual conditions, and standardized the provision of online diagnosis and consultation services for fever, cough and other symptoms. Strengthening the collaboration of online and offline medical services can better help to win the epidemic battle, and it is worthy of reference for all places.

Many doctors also believe that Internet hospitals are not only effective measures in special periods, but also worth promoting in daily patient management.

Liu Xiuyi feels that through the Internet hospital platform, doctors can establish long-term good communication with patients, especially those with chronic diseases, and ask about their condition at any time. "For example, what changes in the clinical symptoms of a patient after taking the drug, or if there are some adverse reactions, we can directly instruct him on how to deal with it. If it is a minor reaction, the patient may buy some drugs on his own, and it can be corrected; It is a more serious situation, and it is recommended to come to the hospital for treatment in time. "

"For some older patients, they prefer to maintain a long-term contact with the first-vising doctor and obtain continuous help." Yang Huiyin said that the online consultation platform can provide such a channel for patients to receive timely diagnosis and treatment without having to Only when you run to the hospital to register and line up can you see a doctor. At the same time, it can greatly relieve the front-line clinical pressure, allow patients to reduce disorderly running, and allow patients in need to go to the hospital for treatment.

However, of course, Internet hospitals cannot completely replace offline physical hospitals, and inspection and laboratory tests must be completed offline.

"Sometimes when I answer patients' questions online, I have a strong feeling that I can't make it." Yang Huiyin also said frankly that the current Internet hospital has solved the problem of consulting and prescribing patients for follow-up patients. The next step must consider opening up and The business collaboration of offline hospitals, standardization of specialist inspections and inspections, and implementation of cross-regional inspections and follow-up examinations Doctors and doctors can also check the tests and tests in time to give patients timely and professional guidance. "

"This is an ideal state for the development of Internet hospitals in the future, and it is also a very good supplement and extension to offline physical hospitals." Yang Huiyin said.

A06-A07 edition written / Beijing News reporter Jiao Wu

A06-A07 version pictures are provided by the respondents