How to better ensure the quality of online diagnosis and treatment?

　　Xinhua News Agency, Beijing, June 20th.

　　Xinhua News Agency "Xinhua Viewpoint" reporters Dong Ruifeng, Ai Fumei and Huang Xiao

　　The "Internet Diagnosis and Treatment Supervision Rules (Trial)" jointly formulated by the General Office of the National Health Commission and the State Administration of Traditional Chinese Medicine was recently announced.

"Internet + medical health" has developed rapidly in recent years, effectively integrating medical resources and improving patients' medical experience.

Regarding social concerns such as prescription review, privacy protection, and diagnosis and treatment quality control in Internet diagnosis and treatment, what regulatory provisions have been made in the detailed rules?

What diseases can I see online?

Must meet the conditions for follow-up

　　In 2018, the General Office of the State Council issued the "Opinions on Promoting the Development of "Internet + Medical Health", and Internet diagnosis and treatment experienced a large-scale growth.

By the end of 2021, there will be more than 1,700 Internet hospitals nationwide.

　　"Space" treatment is not suitable for all patients.

The follow-up of common diseases and chronic diseases has been the positioning of Internet diagnosis and treatment for a long time.

However, there has been a lack of specific standards in the industry for what constitutes a follow-up visit, leading to some regulatory vacuums.

　　The detailed rules announced this time require that patients should provide medical records with a clear diagnosis, such as outpatient medical records, inpatient medical records, discharge summaries, and diagnosis certificates, etc., and the receiving physicians should retain relevant information and judge whether they meet the conditions for follow-up visits.

　　"The standard is more operable." Chen Qiulin, deputy director of the Health Industry Development Research Center of the Chinese Academy of Social Sciences, believes that there are clear regulations on which diagnostic materials should be provided by patients and who should judge whether they meet the conditions for follow-up visits.

　　On December 14, 2021, doctors from Tianjin Medical University General Hospital conducted online follow-up visits for patients.

Photo by Xinhua News Agency reporter Li Ran

　　The detailed rules also require that when a patient's condition changes, the doctor judges this visit as the first visit, or there are other circumstances that are not suitable for Internet diagnosis and treatment, the receiving doctor should immediately terminate the Internet diagnosis and treatment activities, and guide the patient to a physical medical institution for treatment.

　　"Give doctors more professional authority." Yu Xinle, deputy director of the Zhejiang Provincial Health and Health Commission, said that the detailed rules further clarified the service boundary and supervision boundary from the perspective of ensuring safety, and refined the relevant requirements, which is conducive to the standardization and standardization of Internet diagnosis and treatment services.

Can you buy prescription drugs without a prescription?

It is strictly forbidden to "medicine first"

　　Buying medicines first, then formulating medicines, and even automatically generating prescriptions by artificial intelligence software - such operations on some Internet medical platforms have been exposed many times.

　　The rules announced this time stipulate that prescriptions should be issued by the receiving physicians themselves, and the use of artificial intelligence to automatically generate prescriptions is strictly prohibited.

Prescription drugs shall be sold, dispensed and used on the basis of a physician's prescription.

It is strictly prohibited to provide a drug to a patient before a prescription has been issued.

　　The detailed rules also stipulate that doctors need to carry out real-name authentication before receiving medical consultations to ensure that they provide medical services.

Other personnel, artificial intelligence software, etc. shall not fraudulently use or substitute doctors to provide diagnosis and treatment services.

The competent health departments at all levels shall be responsible for supervising the personnel who conduct Internet diagnosis and treatment in the medical institution.

　　"Quality and safety are the eternal themes of the medical industry." Shu Ting, director of the Medical Informatization Research Department of the Hospital Management Institute of the National Health Commission, said that any behavior that challenges the bottom line of medical quality under the guise of the Internet is a blasphemy to the safety of patients' lives. .

　　On the one hand, it is to strengthen the supervision of prescriptions, and on the other hand, it is to explore more convenient online follow-up and renewal prescriptions.

In the No. 1 Hospital of Ningbo City, Zhejiang Province, the Internet hospital platform has opened the entrance of chronic disease refills.

After the patient applies, the team of full-time doctors will renew the prescription according to the actual situation, and the patient can usually receive the medicine at home on the same day.

"According to the requirements of the detailed rules, it will bring more convenient and efficient online diagnosis and treatment to patients in the construction of the Internet hospital." said Sun Jie, president of the hospital.

How to monitor the quality of diagnosis and treatment?

Online and offline integration

　　Is the quality supervision of online diagnosis and treatment consistent with that of offline diagnosis and treatment?

The detailed rules announced this time give a positive answer, requiring that Internet diagnosis and treatment be incorporated into the overall medical service supervision system based on physical medical institutions.

　　According to the detailed rules, the process and results of Internet diagnosis and treatment must be completely recorded, and the circulation of key information such as medical records and prescriptions should be traceable, so as to ensure that the entire process of Internet diagnosis and treatment is within the scope of monitoring and protection by regulations.

　　"Internet diagnosis and treatment behavior has the same effect as offline diagnosis and treatment behavior." Zhao Wei, deputy director of the National Center for Cardiovascular Diseases and vice president of Fuwai Hospital of the Chinese Academy of Medical Sciences, explained that the diagnosis and treatment, quality control, supervision, complaints and data occurred on the Internet. Sharing and other behaviors must rely on physical medical institutions to ensure the integration of online and offline.

　　Lu Qingjun, director of the National Center for Telemedicine and Internet Medicine and director of the China-Japan Friendship Hospital Development Office, believes that Internet hospitals should clearly position themselves as operators of medical institutions, which is an important role for companies that set up independent Internet hospitals. convert.

　　In reality, some places are exploring the establishment of Internet diagnosis and treatment service standards.

In 2021, Ningxia will try to establish an Internet hospital bad practice behavior point system, that is, according to the type and circumstances of bad practice behavior, different grades of points will be given at one time, and the results will be used as the basis for Internet hospital verification.

How is privacy protected?

Clarify the relationship of rights and responsibilities

　　While Internet diagnosis and treatment has brought a lot of convenience, the issue of privacy information leakage has also attracted much attention.

　　The detailed rules clearly require that medical institutions should establish systems such as network security, data security, personal information protection, and privacy protection, and sign agreements with relevant partners to clarify the rights and responsibilities of all parties.

　　Regarding the protection of patient privacy, some places have issued relevant policies.

The Measures for the Management of Bad Practice Behavior Points of Internet Hospitals issued by Ningxia stipulates that if Internet hospitals "have not properly kept patient information, illegally trade or leak patient information", or "have not taken effective measures immediately when patient information and medical data are leaked", etc. , will be scored 12 points at one time.

This means that the Internet hospital will start the verification process in advance and give a 1 to 6 month suspension of verification.

　　It is understood that Ningbo No. 1 Hospital has added "three insurances" to the weak links of privacy protection such as patient's past medical records and health files based on the actual situation in the hospital: First, doctors can view the patient's detailed medical history, historical prescriptions, etc. information; second, two-way virtual phone calls between patients and doctors during telephone consultation; third, encrypted storage of telephone recordings, video records, and doctor-patient interaction content, and background access permissions are approved layer by layer to fully protect the privacy of doctors and patients.

　　Shu Ting said that the detailed rules have more detailed elaboration on issues such as medical record retention, platform data, privacy protection, and information security, which are of high concern. These requirements point out the direction for the specific implementation of the next step of supervision.

How to develop more healthily?

Draw a red line, and at the same time formulate an implementation plan based on the actual situation of each place

　　Under the guidance of policies to vigorously develop Internet diagnosis and treatment and smart hospitals, Internet hospitals have developed rapidly in recent years, especially during the epidemic.

　　The mobile terminal interface of Jiangsu Provincial People's Hospital Internet Hospital Platform.

Photo by Xinhua News Agency reporter Ji Chunpeng on February 7, 2020

　　Zhao Wei believes that the rules clarify the regulatory requirements for Internet diagnosis and treatment of medicine, medical treatment, technology, etc., and promote the "homogenization" of Internet diagnosis and treatment and physical institution diagnosis and treatment services, so that Internet diagnosis and treatment will return to the essential positioning of "serious medical care".

　　Wang Hang, founder and CEO of Good Doctor Online, believes that this document was released during the rapid development of the industry, and practitioners should follow the idea of ​​"serious medical care" to further promote the healthy development of Internet diagnosis and treatment services.

　　"The business volume of Internet hospitals is currently uneven. Some are very busy, while others are similar to 'zombie' hospitals with single functions." Yu Xinle said that while standardizing management, relevant training should be strengthened to guide suppliers to better match Social needs.

It is necessary to establish a professional supervision team, including medical management experts and experts in informatization and big data.

　　Shu Ting said that considering the uneven development speed of various regions, while the detailed rules delineate the bottom line and red line, localities can also further formulate implementation plans based on their own actual conditions to promote the healthy development of Internet diagnosis and treatment.