From prohibiting the first visit to the Internet to allowing the first visit online, more and more people are trying to "see a doctor online"
Whether the surge in demand for online consultation is safe and effective attracts attention
Recently, there has been a surge in demand for medical institutions across the country to provide medical services through online consultation.
According to the data released by the Beijing Municipal Health and Health Commission, the number of online diagnosis and treatment in many hospitals has increased significantly. For example, the maximum number of outpatient visits in a single day at the Internet clinic of Beijing Children's Hospital has reached 2,000.
So, with the surge in demand for online medical consultations, what new regulations are worthy of attention?
Who should be responsible if there is a dispute over the online consultation?
How to further strengthen supervision and make this convenience measure more reassuring and beneficial to the people?
Online prescribing for the first diagnosis of the new crown is allowed
"I found the Internet hospital column on the hospital's official account, and chose the new crown upper respiratory tract infection consultation. The doctor responded quickly, and the cost can also be directly settled by medical insurance, and the medicine will be mailed home the next day." Recently, Ms. Luo from Shenzhen said on her mobile phone The first online medical consultation and prescription was carried out on the Internet.
Ms. Luo's smooth completion of this online prescription benefited from a new policy introduced by the country recently.
On December 12, the State Council's Joint Prevention and Control Mechanism for Novel Coronavirus Pneumonia Epidemic Issued the "Notice on Doing a Good Job in Internet Medical Services for New Coronary Pneumonia", stating that medical institutions can use the Internet diagnosis and treatment platform to diagnose and treat novel coronavirus pneumonia according to the latest version. According to the relevant requirements of the plan, for patients with symptoms related to new coronary pneumonia and those who meet the "Guidelines for Home Treatment of Patients Infected with New Coronavirus", online prescriptions for the treatment of symptoms related to new coronary pneumonia are issued online, and qualified third parties are encouraged to entrust qualified third parties to deliver medicines to patients' homes .
Prior to this, according to the relevant provisions of the "Internet Diagnosis and Treatment Management Measures (Trial)" promulgated in 2018, the scope of Internet diagnosis and treatment was mainly for some common diseases, follow-up visits for chronic diseases, and "Internet +" family doctor contract services.
"Prohibition of first diagnosis on the Internet" is regarded as a basic principle in the field of Internet diagnosis and treatment.
"The "Notice on Doing a Good Job in Internet Medical Services for New Coronary Pneumonia" allows the first diagnosis of the new crown, which undoubtedly relaxes the scope of Internet diagnosis and treatment in the field of new crown treatment." The reporter said that allowing the first online diagnosis can provide residents with more convenient online medical services, reduce cross-infection, and ease the pressure on offline medical resources.
"For the current Internet diagnosis and treatment institutions, after the release of the first diagnosis and treatment of the new crown, what needs to be worried about is the supply and logistics of medicines." Deng Yong believes that in the long run, the challenge of Internet consultation lies in how to pass Technical means achieve the same effect as offline consultation.
Who is responsible for disputes arising from online consultation
In a medical damage liability dispute case concluded by the Beijing No. 3 Intermediate People’s Court, after Ms. Zhang from Hebei underwent heart surgery in a hospital in Beijing, Dr. Liang, the attending doctor, told the patient that she could enter an Internet medical platform to register and recharge after being discharged. Ask Dr. Wang for a remote consultation.
Later, Ms. Zhang felt uncomfortable taking medicine after the operation, so she asked Dr. Liang about her condition on the Internet medical platform.
Dr. Liang replied that there is no problem with the medicine and that he can continue to take it, but he did not reply to the patient's other questions.
In the middle of the night, the patient called the doctor again through the Internet medical platform, but Dr. Liang did not answer.
In the early morning of the next day, Ms. Zhang died of illness.
Whether the doctor conducting online consultation and the Internet medical platform should bear the tort liability for the damage caused by Ms. Zhang has become the focus of controversy in this case.
After the trial, the court held that, on the recommendation of Dr. Liang, Ms. Zhang spent 100 yuan to register on the Internet medical platform, and communicated with Dr. Liang on the platform. Answer the questions raised by Ms. Zhang.
Therefore, Dr. Liang's consultation for Ms. Zhang should be determined as a continuation of the hospital's diagnosis and treatment behavior, and should be recognized as a diagnosis and treatment behavior.
According to the appraisal opinion issued by the appraisal agency, the hospital's fault during and after the operation was the main cause of Ms. Zhang's death.
However, Dr. Liang did not fulfill the duty of careful attention to the patient Ms. Zhang on the Internet medical platform, did not analyze the cause of the patient's new illness and suggested that the patient go to the hospital in a timely manner, and there were deficiencies. reason.
Regarding the determination of the responsibility of the Internet medical platform, the court held that the medical platform had fulfilled the obligation of reviewing doctor registration, and pointed out in the "User Agreement" that "consultation advice is only to provide suggestive content based on the questioner's description, and cannot be used as a diagnosis or medical treatment. basis” and clearly reminded that “the doctor’s reply is only a suggestion, please go to the hospital for specific diagnosis and treatment”, so it is difficult to determine that the Internet medical platform is at fault.
"In medical dispute cases, if the registered physician on the Internet medical platform actually engages in diagnosis and treatment, then the online and offline processing is consistent, and the hospital where the registered physician is responsible is responsible. For the Internet medical platform where the doctor is located, if If the platform fails to fulfill the corresponding duty of care, and if there is negligence or fault, it constitutes a joint infringement and should bear the corresponding liability for infringement compensation.” Deng Yong also said that due to the different forms and functions of Internet medical platforms, there are also differences in the identification and supervision of their responsibilities. different.
Make online consultation more standardized
During the interview, the reporter learned that whether online diagnosis and treatment can be as effective as offline diagnosis and treatment, whether drugs can be purchased in time, and whether it is convenient to use medical insurance settlement are the focus of many patients' attention.
"In Internet medical disputes, some patients obtained different diagnosis results and took different drugs after being consulted by multiple online diagnosis and treatment entities, which caused corresponding medication safety incidents or delayed treatment. This also reflects the limitations of Internet diagnosis and treatment itself to a certain extent. Deng Yong said that when patients choose an Internet medical platform, they can mainly look at the access threshold it sets for medical personnel and the rigid conditions it provides for online medical services, such as video clarity and fluency, follow-up service quality and Factors such as the efficiency of drug logistics and distribution are compared and judged.
In the process of the rapid development of Internet medical care, related regulatory topics have also attracted more and more attention.
The "Internet Diagnosis and Treatment Supervision Rules (Trial)", which came into effect in February this year, clearly regulated some regulatory vacuums that existed in the industry before.
For example, in response to the phenomenon that some online diagnosis and treatment subjects use artificial intelligence to consult and prescribe prescriptions, the "Detailed Rules" clearly point out that when medical institutions carry out Internet diagnosis and treatment activities, prescriptions should be issued by the receiving physicians themselves, and the use of artificial intelligence to automatically generate prescriptions is strictly prohibited.
"At present, many tertiary hospitals have opened Internet hospitals, and have realized real-time settlement of medical insurance for medical treatment, which is convenient for ordinary people. However, there are also problems such as fraudulent use of other people's medical insurance cards and excessive use of medical insurance cards. It is urgent for relevant regulatory authorities to carry out comprehensive management in various ways. , to ensure that the precious medical insurance fund is really used on the 'knife edge'." Deng Yong said.
(Worker's Daily reporter: Qu Xinyue)