Arterial network
In September 2018, the State Council issued an opinion on "Promoting Internet + Medical Health", ushering in a golden period of development for Internet hospitals. According to the statistics of the Arterial Network Eggshell Research Institute, as of April 28, 2019, the number of Internet hospitals in operation across the country has expanded to about 158.
At the advent of the industrialization window, what is the overall overview of the development of Internet hospitals? What models have been verified? How to build a real Internet hospital? On May 15, at the Internet Hospital Frontier Forum of the 2019 Primary Care Summit, many guests gave their views. The following is an excerpt from Arterial Network.
Innovative Practice of Whole Course Management Service Based on Internet
Ying *******, Director of Jinhua Downtown Hospital Information Center
Why do information management? If you use the iceberg as an example, innovation is the tip of the iceberg, and the foundation is underwater. So if the following work is not done well, it is difficult for the iceberg to stand firmly.
There is a leading group of 26 people in the informatization of Jinhua Central Hospital, which is directly under the jurisdiction of the president. There are information centers under the subordinate, including clinical department information administrators, nursing information administrators, medical technology department information administrators, administrative logistics administrators, etc. All information is exchanged with the information center through the information administrator, filtering a lot of unnecessary information. This ensures that the information work is more efficient and the things made are more in line with clinical applications.
After more than a decade of development, the Internet has been divided into three stages in the medical field:
The first stage is the self-service type, where patients can enjoy convenient Internet appointment services at home without leaving home. This is the primary stage of the Internet.
The second stage of Internet + medical care is interactive. Patients can enjoy light consultation services at home without leaving home, and this level has begun to involve the core business of medical care.
The third stage is the future development stage, which is to connect the whole process of diagnosis and treatment to home care services through Internet technology, including chronic disease management, physical examination management, etc. This realizes the diagnosis and treatment services that patients enjoy without leaving home.
The Internet hospital actually has three levels:
The first is mobile full-process payment, mobile convenient medical treatment, which is the first value system of the Internet; the second is a service system based on remote technology, which can realize remote medical treatment, online consultation, and prescription matching functions for patients; the third is disease segmentation, providing personalized medical experience according to different diseases and different groups of people, and all services are completed online and offline.
Only through these three systems can we build an Internet hospital together, which is also the future development trend of Internet hospitals.
In 2017, Jinhua Central Hospital began to build an Internet hospital. At present, there are more than 560,000 registered users. About 50% of the patients have made online appointments or paid fees and consulted through the Internet hospital.
The traditional hospital diagnosis and treatment process 4. When a patient is sick, he goes to the hospital to make an appointment for registration, treatment, medicine collection, and examination. The whole process is completed in the hospital, and then he goes home to recover. Jinhua Central Hospital hopes that through Internet + technology, patients can have a better experience in the hospital, not necessarily in the hospital. Some links are completed at home, and some are completed online, so that the medical treatment process is more efficient and the patient experience is better. Even through the guidance system, patients can be transferred to primary hospitals after surgery.
Service processes, such as pediatrics, reproductive centers, obstetrics and gynecology, internal medicine, physical examination centers, etc., are also key projects carried out by Internet hospitals.
The hospital provides some online and offline services for 32 types of diseases, such as medication guidance, medical consultation, online prescription, etc. These services are based on text information exchange, picture exchange, audio & video exchange, and are completed online.
The hospital did not change the relationship between doctors and patients, but based on the trust relationship between the two, it extended outside the hospital or online. This extension is valuable to the patient and saves time for the doctor.
Since 2015, Jinhua Central Hospital has been running faster and better for patients through information technology. In 2019, it has launched a series of innovative services, including the integration of birth services, one-window acceptance of "afterlife", and Alipay account face recognition for medical payment. Coupled with the national push for electronic health cards, combined with facial recognition technology, patients can finally get through the whole process of medical treatment with one face.
Exploration and Practice of Yinchuan Internet Hospital
Yuan Fang, Director of the Information Department of Yinchuan First People’s Hospital
What is the real problem with medical reform? It is the problem of medical resources, the imbalance of medical resources, the imbalance of supply and demand, and other issues. To do Internet + medical health is to really penetrate into the content of medical reform.
When Yinchuan City was doing Internet + medical health, it made an overall exploration in eight aspects according to the document No. 26 issued by the State Council.
The first is to apply the means and methods of the Internet to explore the whole process of medical services, integrate all medical resources, such as outpatient process reengineering and inpatient process reengineering, and provide a new medical service model for all patients. This is Internet + medical services.
The second is Internet + remote diagnosis and treatment. Hospitals combine Internet + remote expert outpatient clinics to achieve the integration of diagnostic systems, treatment systems, and chronic disease management systems.
Others include Internet + drug supply, Internet + medical care combination, Internet + medical education and popular science, Internet + family doctor contract, Internet + public health, etc.
After the integration of the eight aspects, we can truly enhance the primary medical service system.
When doing Internet + medical health in Yinchuan City, the overall idea is to integrate the regional ecology and extend it to health services, eventually forming a healthy ecology and innovation, that is, the innovation of medical service methods.
The three supports involved include connectivity support, policy support, security and regulatory support.
In the innovative service model, the real Internet idea is to build a mechanism. An egg is broken from the inside to give birth to new life. If an egg is broken from the outside, the egg will be completely broken. So, really let the Internet + medical health, the new medical model go on, and be self-driven is a point of view that has been discussed. It is impossible for four people to play mahjong and everyone wins. But it can be done with four people playing mahjong to satisfy everyone.
Through Internet thinking, as well as new means and medical reform methods, one is to satisfy the common people, the other is to satisfy the government, the third is to satisfy doctors and make doctors more free. Fourth, a multi-party win-win model.
In terms of regional medical integration, the Yinchuan model is not just a hospital’s Internet + medical care, but a whole Yinchuan city’s Internet + medical care.
One can imagine that in the future, there will be only one hospital in Yinchuan City, and all medical institutions will be one hospital, sharing all resources, including hardware resources, software resources, and various medical service resources.
The concept of Internet + regional medical service system, horizontally speaking, is to build a medical critical remote consultation center, that is, a national remote expert outpatient clinic, according to the type of disease that is difficult and severe and the patient’s area.
Ningxia is located in the northwest region, the economy is underdeveloped, the population is small, and high-quality medical resources are even more scarce. For ordinary people in Ningxia, it is difficult to see experts in Beijing, Shanghai and Guangzhou.
With "Internet +", ordinary people didn’t have to leave Ningxia Province. The First People’s Hospital of Yinchuan City put experts from all provincial capital cities on the platform to solve the problem of outpatient clinics for major diseases in the county.
Ordinary people in the county do not need to leave the county, but directly conduct remote expert outpatient clinics and consultations through provincial expert outpatient clinics. Ordinary people can even enjoy expert services in Beijing, Shanghai and Guangzhou across the country, and truly achieve preliminary screening and grading diagnosis and treatment of diseases.
In addition, Yinchuan online 24-hour outpatient clinic has realized the 24-hour shift scheduling of local experts, providing medical services for grassroots, community service centers, community service stations and village doctors, and empowering village doctors to achieve real medical care.
Vertically, the regional medical service system has opened up the process of pre-consultation, in-consultation and after-consultation, standardized the online post-consultation management, online follow-up mechanism, and the cooperation mechanism between comprehensive doctors and family doctors. From top to bottom, the model comprehensively empowers the grassroots and exports medical service capabilities to the grassroots. Telemedicine is not just an information method, but a concept of service system.
In addition to remote outpatient clinics, Yinchuan City has also made some explorations in terms of examination and diagnosis. For example, it has developed a remote diagnosis center, a chronic disease management center, and a specialty treatment center. Through MDT, the three centers have jointly empowered chronic disease management and family doctors through a remote diagnosis and treatment system and remote outpatient clinics.
The Yinchuan family doctor model is a 1 + X model. 1 refers to each service object, and X is X service models and service teams. Through the X service model, we will provide disease services and health services for all served groups. Through this architecture model, we will fully empower the grassroots and export medical service capabilities.
At present, there are generally two types of Internet hospitals: the first is that physical medical institutions build Internet hospitals through Internet means; the second is that third-party companies and offline physical medical institutions cooperate to build Internet hospitals.
At present, the specialized Internet hospital cooperated by Yinchuan First People’s Hospital and Weiyi Orthopedics can be called the 2.0 version of the Internet hospital. Compared with the 1.0 version, there are four advantages:
The first is to deeply integrate with third-party companies online and offline, with informatization and electronic health cards as the core; the second is to introduce professional managers’ operation and management ideas to break through the management ideas and patterns of traditional hospitals; the third is to use Internet thinking to provide patient service experience; the fourth is to provide a professional and personalized doctor service system.
In addition, the hospital cooperates with third parties, one is to stimulate the ability, such as internal ward transformation, performance plan transformation, doctors, assistants, operating rooms, teaching distance, etc. The second is architectural innovation, such as exploring the combination of GPO and hospital, clinical pathways and medical insurance control costs. The third is to introduce Internet ideas for hospital brand marketing, which is the Internet Hospital 2.0 model.
Internet deeply empowers to build a new ecosystem of primary care
Yang Jianchun, Executive Director of Wuzhen Internet Hospital
What is the core of being a hospital? Without medical insurance and third-party payment support, it is impossible to develop an industry independently. No country’s medical care is entirely paid for by patients themselves.
In order to develop, break through and replicate on a large scale, Internet hospitals must have medical insurance support and third-party payment to pay for the medical services provided by Internet hospitals. But in our country, this is a very challenging thing.
The third stage of the Internet hospital is to connect medicine, medicine and insurance. If you want to become a large-scale medical provider, you must obtain medical insurance support from all parts of our country. After WeDoctor took down its first license in 2015, it raced across the country to gain online access to medical insurance and access.
In this regard, what Internet hospitals need to do is to form close collaboration with the local medical system and the local pharmaceutical industry chain, and generate value through quantitative comparison. In this way, hospitals not only do not waste medical insurance resources, but also save the outflow of medical insurance users.
Facing grass-roots medical institutions, WeDoctor integrates advanced medical technology, allowing local hospitals to enjoy good medical services in first-tier cities without leaving home. Help local hospitals improve their technical level, help local families contract services, and make family doctor services and health gatekeepers real.
In cities, WeDoctor has also established its own general practice base, hoping to establish a health management system with health gatekeepers, active health maintenance, and extend diseases to health management. By paying the price difference, it can reduce local medical insurance expenses.
Through the pharmaceutical trading platform, WeDoctor directly connects with industrial and medical institutions as well as medical insurance. Completely break the original system of first-level, second-level, and third-level agents and middlemen. At present, WeDoctor has undertaken the construction of the medical insurance bureau’s pharmaceutical integration platform. Help them establish an anti-fraud monitoring system based on the whole process of medical insurance.
WeDoctor solves the price difference through the decline of medical technology, and forms a closed-loop service of the pharmaceutical industry chain through the centralized bidding of drugs to circulate transaction costs, making it possible for Internet medical services to break through on a large scale.
Around Western medicine, Wuzhen Internet Hospital has standardized its technology and made it a barefoot doctor system in the 21st century, assisting in prescribing and assisting in diagnosis for primary medical institutions. Now, more than 1,200 hospitals across the country have been connected, and more than 80,000 patients are received every day.
In terms of experts, Wuzhen Internet Hospital works closely with more than 1,000 doctor groups across the country, turning their professional technology into products, and promoting the medical alliance system to form cooperative relationships with hospitals across the country. All data is formed into a core carrier through cloud HIS, maximizing time and value.
The last mile of "Internet + Medical Health"
Chairperson of Chunyu Doctor, Zeng Baiyi
When building an Internet hospital, everyone should actually consider where the traffic is coming from. Is it coming from the original location of the hospital or from another location?
Dr. Chunyu believes that medical services should be placed closer to users in a more suitable setting, providing services to users in such a setting. By taking root in such a setting, traffic will naturally increase.
To build trust, there are two main points: one is to continue to provide reliable services; the other is to be closer to the user, appearing frequently around him, so that he can see and touch your service.
For the past eight years, Chunyu has been providing online services. Since last year, there have been some offline attempts, such as building a health website with real estate developers. This is one of the ways to get close to users and build trust offline. The core of this is the Chunyu family doctor service based on trust relationships.
Spring Rain Family Doctor Service provides users with family health management services in the form of health consultants. Spring Rain creates health consultants to do two main things: one is an emotional comforter; the other is a medical translator. Make friends with the user and distribute his medical needs to specialists to solve his problems.
With online consultation as the foundation and family doctors as the hub, Dr. Chunyu has established a hierarchical diagnosis and treatment service that belongs to the Internet.
Unlike the national first-level hospitals, second-level hospitals, and third-level hospitals, Dr. Chunyu starts from user requests to help users obtain health at the lowest cost.
Why choose a community? Dr. Chunyu’s judgment on the general trend of medical care is that the future of medical care is the migration of patient-centered medical service scenes. Hospitals are suitable for providing more sophisticated services, including expert diagnosis and treatment, difficult disease examinations, and major surgeries. And ordinary medical services will be migrated to the most suitable scenarios, such as the Internet.
The community medical service point is the first public area where users go outside, and it can host many medical services.
The core feature of Dr. Chunyu’s community health station is that there is temperature, and there will be Dr. Chunyu’s family health consultant, adhering to the online 4A service concept and standards to provide services. The back end has strong system support, allowing him to understand users and ensure that users feel warm.
The second is light assets (strong operation). Spring Rain Health Station is a small front-end and large back-end system. The front-end requires very few staff and equipment. Spring Rain’s core advantage is that it has strong medical resource scheduling, distribution and operation capabilities behind it. The front-end of the entire small station is small, but it provides a lot of services, which really solves many problems for the common people.
Third, it is easy to expand, allowing it to quickly land in grass-roots communities and large-scale real estate projects. From the establishment to the operation time of the health station, it takes about 15 days. Dr. Chunyu cooperates with many real estate developers in a variety of forms.
Spring Rain Health Station is located in the Spring Rain system and is positioned as an offline experience store for Spring Rain online services. Users can experience various services provided by Spring Rain Online in the health station, such as online consultation, family doctor, expert doctor, Internet diagnosis and treatment, and green channel for medical treatment.
Dr. Chunyu hoped that by landing on a small website and at a low cost, he could stick with users, establish a deep relationship with them, and let them know that their problems could be solved here. This was a very important goal of Dr. Chunyu.
As of 2018, Dr. Chunyu has established 61 health stations across the country, covering 9 provinces across the country, and medical services cover more than 20,000 households.
Internet + smart hospital, to build the hospital inside and outside the internet service bus
Zhai Xuelian, Vice President and Chief Strategy Officer of Zhuojian Technology
In recent years, the number of Internet hospitals has risen sharply. Zhuojian Technology builds a product system of Internet + hospital services with the doctor team as the core. Although it does not involve the most important business services in the hospital, almost all businesses and scenarios related to the Internet of Hospital Unicom are involved.
The ability of Zhuojian’s Internet hospital platform to radiate medical services is provided by the hospital. In addition to facing public hospitals, it also faces the Internet + medical alliance solution, which connects offline hospitals and primary medical institutions, unifies beds and medical technology resource pools, and realizes two-way referral in the process. There are also online and offline integrated solutions for doctor education to solve the problems of traditional medical education and deepen the reform of clinical medical personnel training.
Zhuojian’s products cover the entire Internet + medical chain and various role industries, called Rubik All in One. Through integration capabilities, Zhuojian currently has four flagship products:
Among them, Rubik C is a cloud management platform for clinics/communities. Large chain pharmacies can clinicalize their flagship stores. They reach and serve the people around them by turning pharmacies into clinics. The ability to provide medical care to pharmacies to solve problems such as customer retention and growth.
Rubik T is an open API for Internet hospitals in small and medium-sized hospitals. The open information platform built through the saas-like app store has a strong appeal for secondary hospitals and communities. They want to find relevant software, just like the Apple market, choose the APP application on it, install it on their service account or Mini Program, and install it immediately. Rubik T provides open APIs to help such users build mini Internet hospitals faster and cheaper.
Rubik U and Rubik S are standard Internet hospitals and super Internet hospitals, respectively.
In addition to patients’ registration, inquiry, payment, graphic consultation and video consultation, prescription issuance, and drug distribution in Internet hospitals, super Internet hospitals can take out the hospital’s whole-process integrated appointment resource pool, and through the integrated appointment method, put the number source, bed, medical technology, X-ray or other resources in this pool, so that all medical capabilities can be pre-positioned. This way, the hospital can easily improve efficiency and patients can have a better medical experience.
In addition, on this basis, Zhuojian also has a Rubik S + product, which can provide intelligent whole-process health management. It provides intelligent all-weather management before and after consultation. Through disease screening, intelligent triage, intelligent follow-up, chronic disease management and other capabilities, during the intelligent follow-up process, it is guaranteed that patients’ online and offline medical treatment is the same experience, and online and offline are seamlessly connected to extend the value of medical services. Online and offline can be seamlessly connected, and all files are handled by doctors, so as to achieve the management application of the whole life cycle.
Application of artificial intelligence in Internet hospital
Director of Intelligent Information Research Office, Guangzhou Women’s and Children’s Medical Center Data Center, Liu Guangjian
The informatization foundation for the interconnection of people, things, and data, Guangzhou Women’s and Children’s Medical Center first built an information integration platform to connect more than 50 databases in the hospital, allowing patients to collect, connect, and connect every bit of data generated during the entire medical process, from registration to entry.
After building an Internet hospital, the hospital will also connect the content of the Internet hospital, so as to achieve a patient-centered mobile hospital. Including hierarchical diagnosis and treatment appointment registration, medical insurance mobile payment, as well as patient sign information collection, doctor-patient interaction, intelligent navigation, inpatient services and other scenarios.
Patients can learn about their condition in a timely manner and experience the considerate service provided by their doctor during their visit.
In terms of the execution of doctor’s orders, it used to be paper-based, but now it can be completed by scanning the code through full electronicization. The hospital has also established a closed-loop management system, including data generation, pre-event prevention, in-event monitoring, and post-event traceability, to ensure the improvement of the quality of medical services.
In terms of a unified platform for multidisciplinary consultation, text audio & video sharing and data sharing between patients and experts and different hospitals are realized. For doctors, not only can they log in on the computer, but also a mobile landing terminal is developed.
In terms of decision support system, it is mainly divided into two parts: one is to establish a full-process clinical auxiliary decision-making system CDSS, a knowledge base system of 7 categories and 35 subcategories, which can provide information and decision assistance when doctors make diagnosis and treatment behaviors. Second, based on multi-modal data such as historical electronic medical records and medical images, different artificial intelligence models are trained and embedded in information systems to realize intelligent triggering to provide decision support to healthcare workers in a seamless way.
Taking the hospital "Mimu Bear" smart family as an example, there are currently imaging bears, auxiliary bears, inquiry bears, and guide bears, so as to realize the remodeling and replication of top medical resources.
The background of the intelligent consultation bear design is that after the patient has registered, there is a queuing process before entering the consultation room. During this time, parents are more anxious on the one hand, and on the other hand, if the doctor comes to the consultation room for consultation, the doctor has to temporarily write medical records, which compresses a lot of consultation time.
If artificial intelligence products are used to record this information, conduct preliminary consultations, and form intelligent electronic medical records, doctors can save time and communicate better with patients.
Since May 2018, the total number of patient visits to the bear has been 64,000, and the total number of doctors served has been 33.
Measuring the value of internet hospitals
From the speeches of many guests, it is not difficult to see that no matter what kind of technology or business model is used, a true Internet hospital must possess at least three capabilities.
First, whether to form a true aggregation and refinement of medical technology. Whether it can have an impact on the medical supply side through platforms, systems, and AI.
Second, whether it is possible to improve the service efficiency of the medical industry. This includes improving the efficiency of patient hospitalization, improving the doctor-patient system, improving capital flow, information flow, and service flow. It can be quantified and has numbers as standards.
Third, whether to optimize the medical experience of ordinary people. Has the hospital created a good humanistic medical environment and truly implemented it into the medical experience?
If an Internet hospital does not have these three points, it will be difficult to take root in the service system and generate true core values for the common people and doctors.
