Internet medical ≠ telemedicine, advisory services not prohibited

August 29, the National Health and Family Planning Commission in its official website issued "on the promotion of medical institutions telemedicine services," (hereinafter referred to as the "opinion"), which clearly stated: non-medical institutions may not carry out telemedicine services, to prohibit doctors from private telemedicine. But not long ago, mobile medical representative "Spring Rain Doctor" has just received 50 million dollars of financing, clove Garden on September 2 to get Tencent 70 million U.S. dollars in the C-round investment, this regulation is issued, whether the current telemedicine "brake"? A number of relevant agencies in the Beijing News interview said that the current services are limited to medical advisory services, not the scope of the health planning system is prohibited by the telemedicine category, but also some doctors say that telemedicine does have a potential loophole, but "one-size-fits-all" is not in line with the actual situation.

New

Non-medical institutions may not carry out telemedicine services

Telemedicine first entered the public view should be in the 90 's, the first time in our country doctors through the network and global medical experts long-distance consultation of college students thallium poisoning events, with the progress of technology, today's telemedicine has become more convenient. A number of similar services based on the Internet platform are also in full swing, not long ago, mobile medical representative "Spring Rain Doctor" has just received 50 million dollars of financing, clove garden in September 2 to get Tencent 70 million U.S. dollars in the C-round investment, for the rapid development of the Internet medical, Wei planning "opinion" issued, causing concern. August 29, the National Health and Family Planning Commission in its official website issued "on the promotion of medical institutions telemedicine services," the clear point out that non-medical institutions may not carry out telemedicine services, to prohibit the doctor privately telemedicine.

As for the contents of telemedicine service, the opinion indicates that telemedicine service is a medical activity in which one medical institution (Inviter) invites other medical institutions (invitees) to provide technical support for the medical institutions by means of communication, computer and network Technology (hereinafter referred to as information technology). Medical institutions use information technology to provide medical services directly to patients outside the health care institutions, which belong to telemedicine services. Tele-medical services include: remote pathological diagnosis, remote medical imaging (including imaging, ultrasound, nuclear medicine, ECG, EMG, EEG, etc.) diagnosis, tele-monitoring, tele-consultation, tele-outpatient, remote case discussion and other provincial health and Family Planning Administrative Department of the other items stipulated.

In the National Health Planning Commission September 11, the regular press conference, in response to the introduction of the "opinion" and related issues, the National Medical and Family Council, the health Care and nursing department director Li Dachuan said that relying on information technology to carry out telemedicine services is to improve the level of primary health care, One of the effective ways to solve the problem of medical treatment for people in the grassroots and remote areas. In recent years, the Central and national Health and Family Planning Commission has also taken many measures, the establishment of the long-distance medical relationship between some hospitals, has played a very good effect, but with the wide use of telemedicine services, the national level needs of telemedicine management norms, implementation procedures, responsibility identification, supervision and management to make clear provisions.

Li Dachuan also said that as technology progressed, the scope of telemedicine services has been greatly expanded, remote pathological diagnosis, remote imaging diagnosis, remote monitoring and other new telemedicine services have been widely used, the original management requirements are no longer adapt to the current development of telemedicine services, the actual requirements need to carry out new norms.

Discussion

Telemedicine and the concept of Internet medical care are different

The introduction of the "opinion" to limit the scope of telemedicine to the medical institutions, for the current internet-based, mobile phone applications, such as the basis for service providers, and where to go? In this connection, Zhong, Deputy secretary General of China Hospital Association, said that the first thing to distinguish between telemedicine and the current variety of Internet medical treatment. Telemedicine participation at both ends of the medical institutions, the use of the Internet and other forms of transmission of some image information, and so on, the focus is remote consultation, exists between doctors and medical institutions.

The essential difference between Internet medicine and this that is, telemedicine between medical institutions and doctors can determine the diagnosis and treatment, while Internet medical care does not involve diagnosis and treatment, can be regarded as a universal education of medical information, "for example, through the Internet to understand some diseases, but this is limited to science, not for diagnosis and treatment." ”

Institutions

Network medical care is limited to health counseling

For the services carried out, the reporter confirmed spring rain related responsible person, said the other, spring rain is currently carried out by the service is health counseling, in fact, does not belong to the scope of remote treatment. According to the definition of telemedicine in the opinion of the National health planning system, doctors in the spring rain platform to provide only a simple health consultation, a lot of content belongs to the knowledge of communication. And for the recent spring rain launched the difference between the Air hospital, the other side explained that the Air Hospital service is the extension of health counseling services, mainly extended service media, such as the increase of telephone functions and rich service time, such as phased long-term consultation.

Good Doctor online editor Horon also said that the current good doctors provide three main aspects of the service: first, the information class, such as patients can inquire through the online way, to understand the country's three hospital doctor visits. In addition, the good Doctor also has the comment system, resembles the doctor's public comment network, second is the free on-line consultation service. Patients need to submit some cases online, such as X-ray, B-ultrasound, blood test results, and the third is paid telephone consultation.

Good Doctor online Vice President Hepo told the Beijing News reporter, the Wei Planning Institute on Telemedicine Services, "opinion" clearly defines what is telemedicine services, good doctor online is not a medical institution, also does not provide the above defined services, does not provide network-based diagnosis, diagnosis and treatment services. Good doctor Online services are based on the network platform, the realization of patients to inquire doctors out of the information, reading doctors wrote science articles and other information services, in addition, doctors and patients outside the hospital counseling and exchange services. The service is limited to consultation based on illness, and does not involve diagnosis and treatment.

"Solemn reminder: Because can not face the patient, unable to fully understand the condition, the above recommendations for reference only, specific diagnosis and treatment please go to the hospital under the guidance of the Doctor" this message, good doctor on the line every doctor and patient consultation can be seen behind. When the doctor provides the service for the patient, the good doctor on-line will have the system prompt, "because cannot face the patient, cannot fully understand the condition, recommends that you only provide based on the patient condition opinion suggestion, does not allow involves the diagnosis, the prescription and so on behavior".

Hepo told reporters that a good doctor online for each doctor and patient counseling, every article published by doctors have strict audit. If a false medical advertisement is involved, the prescription is defined by a medical legal expert: Clear drug name and dosage, only to be called on the prescription, if in the guidelines for the treatment of medication, doctors in the consultation to respond to patients according to the guide to give the introduction and recommendations, do not calculate the prescription behavior), the content of the scope of the consultation we first take shielding measures, Communicate with doctors and patients and delete them. Regarding telemedicine, this is the service of medical institutions to medical institutions.

Advisory services Risk Discussion

Keep the doctor's qualification in focus

In Health consulting services, due to the particularity of the industry, the consultants should also have the appropriate knowledge, but because of the online form, the two sides do not exist face-to-face communication, but for the platform that side of the doctor, how to ensure that its qualification is the platform to consider the important content. The asymmetry of information between the two sides seems to make consultants lose the ability to evaluate, if there is a mistake, the consequences can be imagined.

In this regard, the spring rain in the interview, said the quality of service from the control of the quality of doctors, "we ensure that all doctors are from more than two hospitals attending the above level of doctors." We also have user evaluation and feedback mechanisms to ensure the professionalism of the service. Since our problems are divided within the scope of health counseling, the interaction is multiple, and the doctor can understand the user's various situations as thoroughly as possible. ”

It is understood that the current number of doctors in spring 40,000, the relevant officials said, doctors from the national level of more than two levels of hospital attending the level of doctors, of which more than 60% of the three deputy director level above the doctor. The platform internal review mechanism is called "three cards and one card mechanism", that is, a physician's qualification certificate (to ensure the ability to practise medicine), a medical certificate (to ensure that a hospital is affiliated), an identity card (to ensure that the same person), a bank card (to ensure that others do not use), "Finally we will call the department to confirm that the doctor is indeed "Horon introduced, on the good Doctor's website, about seventy thousand or eighty thousand of the doctors, these doctors about 90% of the national three-Jia Hospital deputy high above the doctor."

Hepo told the Beijing News reporter, good Doctor online service doctors have 70,000 (home page has posted, can be real-time inquiries), to three or more hospital doctors mainly, three a hospital deputy chief physician above the qualifications accounted for about 70%. The doctor submits the service application, first must pass the identity examination, the good doctor on-line may through the Doctor practice certificate, with the hospital/department check and so on method confirmation its qualification.

Doctor's status cannot be confirmed.

Zhong explained that, in terms of content, Internet medical platform to provide for the adjustment of medication, diagnosis and other content involved in the scope of treatment, which is irregular, even if only to provide medical advice, "this way there are some security risks, first of all, we can not determine the consultation of the doctor's identity, even if the opening account is a real doctor, But given the existence of Internet thefts, we are not sure. ”

May be "misdiagnosed" only by description

Whether the future Internet medical care can intervene the possibility of telemedicine, Zhong told reporters, only by patient description is difficult to accurately determine the condition, and the patient's description itself may be inaccurate, unprofessional, the provision of scientific services understandable, but once involved in the scope of diagnosis and treatment is not appropriate. "Even in-person communication with the doctor there is a possibility of misdiagnosis, not to mention the form of online communication." ”

One of the three hospitals in Beijing, a department director, who declined to be named, said although the use of technical means to achieve a number of inspection data, image data transmission, but only by doctors and patients online communication mode or there are some problems, there is indeed a possibility of misdiagnosis, "each patient's situation is different, And the patient's description lacks a certain degree of professionalism, because the two sides did not meet face-to-face, not detailed or improper description of the possibility of misleading doctors. ”

With regard to Internet health care, Zhong said that the provision of peripheral services outside the service is normal, including consultation with doctors, registration services and other portable services, but the provision of medical services is not acceptable. "Generally speaking, just like the current public comment network, you can search the restaurant evaluation, ordering meals and other food peripheral services, but the network is always impossible to replace the chef's function." ”

Hot questions

The rule of telemedicine is to eliminate the risk of medical safety

Q days ago, the National Health Planning Institute on the management of telemedicine services, the development of telemedicine to limit the main body to the medical institutions, whether it means that the spring rain, good doctor, Clove garden, such as Internet medical treatment is excluded, can not carry out telemedicine services?

Li Dachuan (National Health and Family Planning Commission, Medical and Nursing service Director, Hospital Authority): The former Ministry of Health in 1999 has issued a notice on strengthening the management of telemedicine consultation, the notification specification is only remote consultation management, with the progress of technology, the scope of telemedicine services have been greatly expanded, Remote pathological diagnosis, remote imaging diagnosis, remote monitoring and other new telemedicine services are widely used, the original management requirements are no longer adapt to the current development of telemedicine services, the need for new norms.

To this end, the National Health and Family Planning Commission recently issued "on the promotion of telemedicine services," the advice, here on telemedicine services, some of the requirements, made a number of deployments. This request should be said that fully embodies the health and family Planning Administration of information technology in the field of application of the importance of the application of information technology to improve the convenience of medical services, convenient for patients to seek medical care is very important role. But medical service is a service which is closely related to the people's life and health, and all the elements of medical service, such as the equipment and equipment relying on personnel, organization, technology and Medical service, need to be strictly regulated. This is the particularity of medical service and the special nature of medical law, it is also the common practice of all countries in the world.

In addition, the Medical Practitioner Act requires physicians to examine and investigate themselves before implementing preventive health care measures, and not to make a decision without a physician's personal examination. This kind of examination activity includes the visual, touch, knock, listen to all kinds of activities, for medical institutions to carry out tele-consultation services, we require medical institutions as the responsibility of the subject, this is because if the patient only through the online interrogation, through the patient to provide information on the diagnosis and treatment of the risk of medical security. In order to ensure the patient's medical safety and medical quality, but also to ensure the rights and interests of both doctors and patients, we stipulate that physicians must be in the medical institutions, through the medical institutions of telemedicine facilities to other patients to provide medical services, the legal liability subject is also the medical institution where the physician. This is our basic consideration of the specification of telemedicine services.

Q Online Doctor service based on Internet or app model brings a lot of convenience to people who seek medical attention, but is there a regulatory problem? is the policy "one-size-fits-all" appropriate?

Li Dachuan: We are also aware of this situation, in our notice on the issue of telemedicine services, we also mentioned that the situation and problems encountered in the implementation process can be reflected to the national Health and Family Planning Bureau, the Hospital Authority, we will collect views and suggestions from the masses and all over the world, Timely to revise and improve the regulations on the management of telemedicine services, so as to ensure the quality of medical care, medical security, protect the legitimate rights and interests of both doctors and patients, and can fully utilize the positive role of information technology in medical services.

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Foreign telemedicine system is relatively perfect

The global telemedicine market is expected to reach $36.3 billion trillion by 2020, according to a new market study, the US news agency reported September 5. It is also reported that in some developed countries, the use of telemedicine helps patients shorten the time of hospitalization and the amount of emergency outpatient service. Research has pointed out that the development of telemedicine plays a key role in patients ' benefit and the sustainability of the medical system. The foreign telemedicine system can provide patients with the latest monitoring and some health training. Through the transmission of information between hospitals and community centres, telemedicine systems can provide easy access to patients who can monitor their own illnesses, with specially trained personnel responsible for monitoring results and providing tele-health services.