There are new ways for public hospitals to play with the network

The Internet hospital led by the public hospital has been launched in large quantities during the new crown epidemic, played an important emergency function, and after experiencing the initial test period of slow reception and low efficiency in the follow-up normal operation, it has found a refined operation method to improve quality and efficiency, but the problem of limited resources of professional physicians cannot be avoided online.

How to make the Internet hospital truly empower medical treatment, rather than becoming an optional decoration under the impetus of policies? Some hospitals are actively exploring paths: making the Internet hospital an Internet tool platform, personalizing and "customizing" all kinds of gadgets that improve efficiency and manage patients for the doctors of the hospital, rather than transferring offline consultations to online.

In addition to the efforts of public hospitals, some local management departments have tried to open up the information interconnection channel between medical institutions through online channels, and carry out more accurate medical resource coordination and doctor-patient matching.

A

status quo

The volume of offline diagnosis and treatment in public hospitals has dropped sharply, and Internet hospitals have continued to be online

Since the outbreak of the new crown epidemic two years ago, the number of diagnosis and treatment in public hospitals and offline hospitals has dropped significantly.

Statistics from the National Health Commission show that in the first 11 months of 2020, the total number of medical and health institutions in the country fell by 11.5% compared with 2019.

The volume of offline diagnosis and treatment in Guangdong Province has also stopped the growth trend and decreased significantly. In 2020, the total number of medical institutions in Guangdong Province (727 million visits) decreased by 18.5% compared with 2019, and in 2019, this number increased by 5.5%.

The decrease in offline diagnosis and treatment is accompanied by the increase in the number of Internet hospitals and online diagnosis and treatment. At the beginning of 2018, there were only more than 100 Internet hospitals in China, and three years later, in early 2021, China has built more than 1100 Internet hospitals, and in the first half of 2021, about 500 new ones have been added, reaching more than 1600.

In Guangdong, the number of Internet hospitals at the end of 2021 has reached 251, double that of 2020.

The pace of development has not been consistent across regions. According to the "2021 China Internet Hospital Development Report", by the end of 2020, the 10 provinces with the largest number of internet hospitals built in China are Shandong, Guangdong, Jiangsu, Zhejiang, Hainan, Sichuan, Shanghai, Ningxia, Chongqing, Hunan, of which more than 100 are in Shandong, Guangdong and Jiangsu, of which nearly 70% are public hospitals as the main force in construction.

Since 2021, public hospitals are still accelerating admission. In addition to doubling the number of Internet hospitals in Guangdong, Beijing, as the largest gathering place for high-quality medical resources, officially approved a number of Internet hospitals dominated by public hospitals in 2021. With the rapid entry of large offline public hospitals, the public's trust and awareness of public hospitals are increasing. According to the Internet Hospital Awareness and Satisfaction Questionnaire Survey conducted by the Nandu "Internet + Medical" Research Group in June 2021, among different types of Internet hospitals, the internet hospitals that respondents have experienced the most and are most satisfied with are the Internet hospitals of large general hospitals, and 82.6% of the respondents clearly state that they will give priority to the Internet hospitals of the physical hospitals they have treated.

It can be seen that the users of public hospital Internet hospitals have a strong relationship with offline patients in hospitals, and the functions of Internet hospitals are regarded by patients as part of hospital information services.

B

contradiction

Doctors have limited energy Medical resources are also scarce online

The supply of medical services will eventually fall on the doctor, online and offline can only rely on the same class of people, the scarcity of medical resources itself is also highlighted online: the doctor's energy is limited, online reception can only be carried out in fragmented time, inevitably there is a problem of slow reception, low efficiency of treatment, and many Internet hospitals have "built but not used" situation, becoming the "zombie hospital" in the mouth of experts.

Nandu reporter's experience evaluation of more than 70 Internet hospitals in Guangdong Province in August 2020 showed that only about half of the more than 70 hospitals were able to successfully complete consultations, and of the successful consultation cases, less than half could get a response from doctors within 1 hour. Senior doctors who can spend all day to receive online treatment can receive up to about 20 people a day, and the reception efficiency is only half of that of ordinary outpatient clinics in half a day.

With the growth of operational experience and the changes in the epidemic situation, public hospitals have more experience in improving the operational efficiency of Internet hospitals. According to the statistics of the Eggshell Research Institute, about 55% of the Internet hospitals use fragmented time to receive treatment, 38% of the hospitals and offline outpatients are scheduled synchronously, and the doctors are full-time to receive treatment during the scheduling time, and in 5% of the cases, the hospital adopts a compromise method, and the online outpatient time is extended by several hours compared with the offline ordinary outpatient clinic, that is, extended to about 21:00 to 23:00 in the evening, which is convenient for office workers to see a doctor online, or convenient for the elderly to be accompanied by young people.

The institutional allocation made by the hospital has transferred part of the medical resources to the online, and the efficiency of online treatment has also been continuously improved under the improvement of various technologies and systems, but mitigation is not equal to radical treatment, in the Internet hospital dominated by public hospitals, the incentive mechanism for doctors is a difficult problem to solve.

In terms of the most critical fees, in 2021, under the trend of online and offline integrated management, the policy is becoming stricter, the space for adjusting the online consultation fees of Internet hospitals is narrowing, although there is no clear price limit for health consulting services that do not open prescriptions, but many hospitals will adjust the prices of online services, including health consultation and online follow-up, to the same level as offline in order to avoid risks. The cost of a few yuan, more than ten yuan, and twenty yuan at a time cannot attract busy doctors to take the initiative to go online. Only a very small number of hospitals and doctors with a high comprehensive level dare to prescribe more than 100 yuan of consultation fees.

C

Persistence and breakthrough

Medical embraces the Internet and exerts the tool attributes of the Internet

After a year or two of testing the water, the above problems of Internet hospitals have been exposed, in 2021, more and more hospitals realize that the value of Internet hospitals is not to move offline diagnosis and treatment to online, but more to provide pre- and post-diagnosis services to patients through the Internet: there is a certain triage function before diagnosis, and after diagnosis, Doctors can use Internet tools to assist doctors in patient follow-up, at the same time, the accumulation of Data on the Internet is conducive to doctors expanding their personal influence, carrying out some science popularization, interaction, Innovative work such as personal branding. Of course, to a certain extent, it can also increase the reasonable income of doctors.

Based on this, providing specialized tools and platforms for pre- and post-diagnosis service needs has become a further development direction for Internet hospitals after completing the "on-line".

For example, the "Pocket Zhongshan First Hospital" APP created by Guangzhou Zhongshan First Hospital is an APP that integrates various information tools for cloud diagnosis and treatment with offline diagnosis and treatment, and the optimization of the APP mainly revolves around the closed-loop management of the doctor's full diagnosis and treatment cycle, and creates various Internet gadgets around the needs of doctors, for example, in patient follow-up, mastering patient first-hand information, improving diagnosis and treatment efficiency, etc., in the online management of peritoneal dialysis patients and some special neuroendocrine tumor patients, Doctors who are good at this field have the needs of online management of patients, and Internet hospitals can assist in team management.

The First Affiliated Hospital of Jinan University is also embracing the Internet in practice, in the second half of 2021, the hospital piloted to open the outpatient registration port and WeChat video number, which can be directly registered when watching the video, so that the "traffic" of popular science videos can achieve accurate triage and diversion, and also allow patients and doctors to match more accurately.

"It is worth pointing out that Internet hospitals are not simply moving medical services from offline to online, but changing the behavior of users, including doctors and patients," said Chen Qiulin, deputy director of the Health Industry Development Research Center of the Chinese Academy of Social Sciences, who has been paying attention to the internet + medical health field in recent years, and he has emphasized this view on many occasions.

In addition to the "tool" attribute, the Internet is also a public platform for information sharing and product standardization, and in 2021, more and more medical institutions are aware of this and make more efforts in information sharing between hospitals.

At a time when all hospitals are actively building Internet hospitals and smart hospitals, management departments should actively do a good job of "navigators", formulate standards from top to bottom, exchange information, and make overall plans to avoid duplicate construction and provide collection and promotion services.

As Chen Qiulin said, "The construction of Internet hospitals in public hospitals should avoid the waste of public resources caused by repeated construction, which is also an important opportunity to force the interconnection of medical and health information."

Producer: Nandu Health Alliance "Internet + Medical" Research Group

Coordinator: Yin Lai, Wang Daobin, You Mani

Written by: Nandu reporter Li Wen