To break the policy barriers of Internet + medical development, it is necessary for the administrative departments of health, health supervision, medical security and other administrative departments at all levels to strengthen the linkage between the upper and lower levels, cross-departmental consultation, and pragmatically implement the top-level design and guidance of various ministries and commissions.
Sun Jing's mother had bowel cancer.
The doctor in charge said that Sun Jing is very filial, and as long as conditions allow, she will always be by her mother's side, no matter whether it is examination, infusion or hospitalization.
But because of work, Sun Jing spends half of the year in China and half in the United States.
Unable to accompany her mother in the United States, Sun Jing turned to the Internet Hospital for help.
She downloaded the Internet Hospital App of Peking University Cancer Hospital (hereinafter referred to as Peking University Cancer Hospital) to help her mother register and inquire. Although she was thousands of miles away, she arranged her mother's medical treatment in an orderly manner.
Within half a year, Sun Jing's mother successfully returned for more than a dozen online visits and was hospitalized 6 times.
"If there is no Internet hospital, it would be impossible to accomplish this." said Wang Xiaodong, chief physician of the Interventional Department of Peking University Cancer Hospital, the attending doctor of Sun Jing's mother.
In recent years, high hopes have been placed on Internet hospitals, and policy dividends have been continuously released. There are still many patients who benefit from Internet hospitals like Sun Jing's mother.
However, on the whole, the potential of Internet hospitals has not been fully tapped.
According to incomplete statistics, among the more than 13,000 medical institutions above the second level in the country, only about 1,700 Internet hospitals have been built.
According to the "2021 China Internet Hospital Development Report" jointly released by the National Center for Telemedicine and Internet Medicine and the Institute of Health Sciences, more than 90 percent of Internet hospitals are in a "zombie state" where they are not built or just tried.
Better serve existing patients while promoting tiered care
When the Internet hospital was born, Cao Lei just entered the business.
In July 2015, the "Guiding Opinions of the State Council on Actively Promoting the "Internet +" Action" was released, encouraging the exploration of Internet + medical care.
It was in this year that Cao Lei, currently the chief strategy officer of Yuanxin Medical, a subsidiary of Yuanxin Technology Group, entered the Internet + medical industry.
At that time, it was popular to be a handheld hospital, which was to move offline processes such as registration, payment, and report checking to the mobile terminal.
Many companies are chasing after hospitals and promising to build handheld hospitals for free, and some hospitals may have several groups of representatives from Internet medical companies every day.
Few people know that winter is coming.
Due to the lack of clear norms in the entire industry, the behavior of brushing the ball has obviously become the norm to explore the profit model.
Various platforms use online doctors, medical consultations, medical customer service and other means to serve as online medical care.
These industry turmoils have caused Internet medical care to have a great psychological shadow on patients and users, almost to the point of talking about "Internet medical care", which also made the market quickly enter a cold winter in 2016.
Relevant companies either lay off staff and transform, or declare "dead".
Some hospitals suddenly discovered that the Handheld Hospital project was "unfinished".
The cold winter has enveloped the entire industry for more than a year.
Until April 2018, the "Opinions of the General Office of the State Council on Promoting the Development of "Internet + Medical Health"" was released, which clearly allowed the development of Internet hospitals relying on medical institutions.
The opinion aims to promote the implementation of the Healthy China strategy, improve the level of modern medical and health management, optimize resource allocation, innovate service models, improve service efficiency, and reduce service costs.
Subsequently, the National Health and Health Commission successively issued relevant management measures for Internet hospitals.
In August 2019, the National Medical Insurance Bureau issued a document stating that qualified Internet + medical services can be included in medical insurance.
In November 2020, the National Medical Insurance Administration issued a document to improve the medical insurance payment policy for Internet + medical services.
So far, a closed-loop policy has taken shape.
"When the first piece of ice begins to loosen, it actually means that spring has come. The policy has opened a reasonable and legal opening for Internet diagnosis and treatment. Major hospitals, especially public hospitals, have started various attempts." Cao Lei Say.
Experiments are varied.
"Apps, WeChat mini-programs, official accounts, etc., can be used as the entrance to the Internet hospital." Cao Lei introduced.
Yuanxin Technology has cooperated with hospitals for a long time to provide technical support for Internet hospitals.
As of August 31, 2021, Yuanxin Technology has cooperated with more than 340 hospitals (including more than 130 tertiary hospitals) to develop an online medical service platform, and its Tianjin Cancer Hospital Internet Hospital, which is responsible for the construction and operation, was officially opened at the end of last year.
After years of hard work in Internet hospitals, Cao Lei concluded that Internet hospitals have two main functions: one is to better serve the existing patients in the hospital, providing services such as online follow-up visits, electronic prescriptions, online payment, and drug delivery; Primary medical institutions will sink the high-quality resources of large hospitals and promote hierarchical diagnosis and treatment.
"Enhancing the clinical service capabilities of hospitals at all levels and facilitating the masses to see a doctor is the core value of an Internet hospital," said Lu Qingjun, director of the Office of the National Center for Telemedicine and Internet Medicine and director of the China-Japan Friendship Hospital Development Office.
Since Peking University Cancer Hospital launched an Internet hospital, the chief physician of the Interventional Department, Chen Hui, no longer sees offline patients every Tuesday morning, but sits in front of the computer to make videos with patients.
The patient sat at home and chatted with Chen Hui about his condition through the camera of his mobile phone.
"In the past, patients from other places came to Beijing to see a doctor, and they had side effects after going home. They couldn't even ask the doctor. It took money and time to come from other places after registration. "Chen Hui said.
Inspections also save time and effort.
"For example, if a patient needs a CT examination for a follow-up visit, he must first register to the hospital to find a doctor to see a doctor, make an appointment for the examination, and then go to the hospital on the day of the examination. With the Internet hospital, patients can go to the hospital for follow-up visits and appointments directly online, and then go to the hospital after an appointment. , just run once." Wang Xiaodong said.
"When we were young, we had to go to the train station to buy train tickets, but we might not be able to buy them. Now we can buy tickets online and go to the station on the day of the train. Seeing a doctor in an Internet hospital is as convenient as buying tickets online." Peking University Cancer Hospital Heng Fanxiu, director of the Information Department, said.
A patient with primary liver cancer who was in the same city as his attending doctor also opted for online follow-up.
The patient's family said: "It is convenient to go online, it is difficult to park at the hospital, and there are many people. Sometimes nucleic acid testing is required."
In addition to providing online follow-up services for patients, the China-Japan Friendship Hospital Internet Hospital Platform also allows primary medical institutions (medical alliances) to "check in" free of charge.
Lu Qingjun explained: "At present, many grassroots medical institutions do not have the ability to build Internet hospitals, so we provide Internet hospital platforms and management mechanisms to allow them to carry out Internet diagnosis and treatment. At present, more than 2,400 medical institutions have settled in. But there are more than 1 million grassroots hospitals in China. Medical institutions have a long way to go to achieve the goal of serving medical institutions across the country.”
Public hospitals enter the game strongly, but are trapped in institutional barriers
At the beginning of 2020, the new crown virus was raging.
Non-local patients could not enter Beijing, and the hospital controlled the flow of people to prevent cross-infection, and the outpatient building of Peking University Cancer Hospital cooled down.
Behind the cooling is pent-up demand.
The patient needs to be re-visited, to get medicine, to be checked... The patient is in a hurry, and the hospital is also in a hurry.
"Many hospitals try to do online consultation, but this is not a diagnosis and treatment, it is just a tickling-style emotional soothing." Heng Fanxiu said.
Responding to the urgency of the public, the policy has made another move - giving the green light to the approval of Internet hospitals, encouraging online diagnosis, prescribing, and sending medicines.
A large number of public hospitals have obtained practice licenses for Internet diagnosis and treatment in 2020, and Peking University Cancer Hospital is one of them.
In order to launch an Internet hospital as soon as possible, Hengfan Xiu and his team often stayed up until the middle of the night until the app was officially launched in June 2020.
One and a half years later, the number of online outpatient visits at Peking University Cancer Hospital exceeded 120,000, accounting for 12% of the total outpatient volume.
Online diagnosis and treatment revenue exceeds 150 million, accounting for about 9% of the total outpatient revenue.
Heng Tan Xiu is happy and looking forward to it: "There is still a lot of room for growth."
According to the "2021 China Internet Hospital Development Report", 1,004 Internet hospitals will be built in my country in 2020, an increase of over 400% compared with 197 in the previous year.
Among them, Internet hospitals initiated by public hospitals accounted for nearly 70%.
According to Arterial Network data, about three-quarters of the 146 Internet hospitals built from January to April 2021 will be led by public hospitals.
Many public hospitals gradually have this awareness - "pulling" their own doctors scattered on third-party platforms back to their own platforms.
But the pull is obviously not strong enough.
The biggest obstacle lies in the cross-regional payment policy for prices and medical insurance.
"The state has issued relevant policies on Internet hospital service pricing, reimbursement, payment, etc., but these policies have not been effectively implemented in the provincial and municipal medical insurance co-ordination areas." Lu Qingjun said.
Pricing has put public Internet hospitals in a lot of trouble.
The first is that the cost of medical services is generally low.
For example, in Shandong Province, an Internet hospital charges only 6 yuan for a registration fee for a follow-up visit.
Pricing is too low to cover costs, hospitals are overburdened, and physicians are discouraged.
On a third-party platform, the reporter saw that the deputy chief physician of breast surgery in a tertiary hospital is priced at 499 yuan for a 15-minute telephone consultation.
According to industry insiders, in this case, doctors can "vote with their feet."
A relevant person in charge of a tertiary hospital in Beijing told reporters that due to the low pricing of medical service fees in Internet hospitals, the enthusiasm of doctors is not high, and the hospital does not force doctors to receive online consultations, and its Internet hospitals are in a state of loss and basically idle.
There are also "one-size-fits-all" pricing, with the price of the expert and regular numbers being the same.
Heng Fanxiu said: "Hospitals do not rely on this money to generate income. But pricing is a steel scale, which measures the value of doctors' labor, and there should be differences. Moreover, a unified price is not conducive to patient diversion."
However, public Internet hospitals are subject to policy constraints, and pricing can only be made according to regulations.
The same goes for medical consultation.
Because medical consulting services are not items on the national medical insurance catalog, medical insurance does not price them.
At the same time, hospitals cannot set their own prices, otherwise relevant departments will issue huge fines in the name of "arbitrary charges".
"So, public Internet hospitals either do medical consultation for free, or they don't. Many hospitals think it's better not to do it." Lu Qingjun said helplessly, "Public hospitals and their Internet hospitals that were originally most qualified and capable of doing medical consultation, but Due to fee restrictions, medical consultation and medical guidance services cannot be provided. Patients can only turn to the medical consultation platform built by enterprises, and it is difficult to guarantee the credibility and scientificity of information.”
The market is fueling the flames, and the Internet hospital is in chaos
According to the existing regulations, there are only two types of Internet hospitals: Internet hospitals of physical medical institutions; Internet hospitals established independently by physical medical institutions.
Either way, Internet hospitals must rely on physical medical institutions.
Enterprises participating in the construction of Internet hospitals can only act as technology suppliers.
"However, driven by the huge interests of financial operations, some Internet hospitals are used as 'licenses' for capital operations, and there are many illegal actions." Lu Qingjun said.
For example, some Internet companies relying on primary-level medical institutions to obtain Internet hospital practice licenses have led the construction, operation and management of Internet hospitals, trying to turn hospitals into "enterprises", and even relying on Internet hospital qualifications to carry out "prescribing medicines and then supplementing prescriptions". ”, conduct Internet first consultations in the name of consulting in disguised form, prescription monopoly price increases and other illegal acts.
In addition, some companies provide unprofessional technical docking solutions, which brings potential risks to hospital data security, business performance of production systems, and patient privacy protection.
"Many companies want to grab the entrance, race track, and financing, but to really build an Internet hospital requires long-term accumulation and precipitation in business and technology." Cao Lei said bluntly.
As some companies are keen to staking their horses, the true face of Internet hospitals has become blurred.
"Because, many concepts about Internet hospitals have been confused." Lu Qingjun said.
Industry insiders are pinning their hopes on powerful oversight measures to curb the above-mentioned chaos.
At present, most provinces and cities across the country have established Internet hospital supervision platforms. The National Health and Health Commission has issued the Internet hospital industry access norms and rules, and the "Internet Diagnosis and Treatment Supervision Rules (Draft for Comment)" has also been publicly solicited from the whole society. .
However, the capabilities of provincial-level supervision platforms are uneven, and there is a general lack of supervision and law enforcement.
"Who will manage? Who will punish? How much? The power and scope of law enforcement for health supervision and market supervision are not clear." Lu Qingjun said, "Now there are supervision and management provisions, but no supervision and law enforcement mechanism. If there is only law and no police, Can it stop crime?"
Heng Fanxiu also said that the Internet hospital supervision platform is mainly used for access registration and transmission of basic data, and there are indeed deficiencies in substantive supervision methods such as on-site review and administrative punishment.
The road to Internet hospitals is not clear, and many hospitals are looking at the crossroads between building and not building Internet hospitals.
In this regard, Lu Qingjun explained: "The local policy supporting measures for the development of Internet hospitals have not followed the central policy in time, and the Internet hospital supervision and law enforcement body is absent, and the existing policies are difficult to effectively implement, which restricts the large-scale and standardized development of Internet hospitals in my country. "
Getting out of the predicament requires the joint efforts of the government and the hospital
Experts believe that the most urgent task for the development of Internet hospitals is to get out of the dilemma of "can't build" and "build but not use".
From a government perspective, Lu Qingjun suggested that local governments improve supporting measures as soon as possible.
"One is that the local access policy cannot be too strict. If the provincial access standard exceeds the national access principle, it is unreasonable. The second is to adjust the Internet + medical related prices in a timely manner. The basic principles of the policy, combined with the actual situation, scientifically calculate the cost of construction, operation and maintenance of Internet hospitals, so that the pricing can cover the cost and fully reflect the respect for the labor value of doctors."
In response to Internet + non-medical services, experts said that relevant departments should establish a pricing mechanism for non-profit medical institutions to carry out non-diagnosis and treatment behaviors such as medical consultation, implement the policy of "decentralization, control and service", and transfer the pricing power of non-diagnostic service behaviors to service providers. party, and coordinate with the medical insurance department and the health supervision and management department.
At the same time, the local government should actively assume the responsibility of supervision.
Lu Qingjun believes that the supervision of the process of Internet + medical treatment should be performed by the health supervision department of the registered place of the Internet hospital to perform the responsibility of supervision and law enforcement, and to strengthen the practice management responsibility of the physical medical institutions that the Internet hospital relies on.
"To break the policy barriers of Internet + medical development, it is necessary for the administrative departments of health, health supervision, medical security and other administrative departments at all levels to strengthen the linkage between the upper and lower levels, cross-departmental consultation, and pragmatically implement the top-level design and guidance of various ministries and commissions." Lu Qingjun said.
From the hospital level, experts emphasized that hospital managers should take overall consideration.
"The premise of an Internet hospital must be safety." Heng Fanxiu said that the safety of diagnosis and treatment ranks first, and the first diagnosis was not included in the Internet hospital because of safety considerations.
Data security is also very important. Diagnosis and treatment data must be connected to the Internet, and there are many data interfaces to prevent information leakage.
A good top-level design is the key to an Internet hospital.
"my country's policy system on the construction of Internet hospitals is relatively complete. Hospitals must follow the baton, find out their positioning, fill in shortcomings, and do a good job in cost and quality control. Optimize the user experience." Cao Lei emphasized, "The construction of an Internet hospital is not a simple informatization project. The hospital leader must coordinate the participation of all departments, and cannot be thrown to the information center as a hand-holding clerk."
Heng anti-xiu agrees with this.
When Peking University Cancer Hospital built an Internet hospital, experts from different departments and departments often discussed together: what needs of patients and doctors and how to use the Internet hospital to meet them.
When receiving patients online, occasionally the computer freezes or even goes black.
Chen Hui hopes to continuously improve technology and optimize the Internet hospital system.
Lu Qingjun emphasized: "Hospital managers must have enough courage to make technological innovations, and fully consider the advantages and risks of technology. Can the face be used as a key? It cannot be used when it violates the principle of confidentiality. Can it be used as a key? Direct connection between HIS and external systems? When interfering with the working state of HIS, it is necessary to avoid these risks. Technical issues have been figured out before use. In addition, the managers of Internet hospitals must be pragmatic and not engage in data fraud.”
Cao Lei sighed that in the wave of Internet hospitals in recent years, some people have seen the trend, some people have seen resistance, and some people are looking forward to policies, "In any case, in the foreseeable future, it is an inevitable trend for public hospitals to promote the high-quality development of Internet hospitals. ."
In the ups and downs, Wang Xiaodong firmly believes that no matter what form a hospital exists in, medicine faces not only diseases, but also human emotions and humanity. The humanistic care of medicine will not be absent, and the original intention of medicine cannot be forgotten.
(Sun Jing is a pseudonym in the report)
Produced by Deep Eye Studio
Written by: Dai Xiaopei, our reporter
Planning: Liu Li