The Internet provides a new means to complete medical treatment, and the laws and regulations that were previously applicable to offline medical activities are also applicable online, and the difficult problem is how to supervise Internet medical treatment, clarify the rights and responsibilities of all parties, and pursue responsibility for violations of laws and regulations found.
The positioning of Internet medical treatment is light consultation, and its scope of application is the diagnosis and treatment of mild symptoms and the confirmation of efficacy. However, the primary pursuit of the consultation of complex diseases is the accuracy of the consultation, not the convenience. Therefore, Internet medical care is an auxiliary to offline in-depth diagnosis and treatment, and it needs to be efficiently coordinated and integrated with offline medical care, so as to exert overall efficiency in their respective runways.
Text |"Lookout" Newsweek reporter Yu Xue and Wei Yuhong.
Doctors at the Imaging Center of the People's Hospital of Hualong Hui Autonomous County, Haidong City, Qinghai Province, diagnose patients with DR remote digital imaging (taken on November 30, 2023) Photo by Zhang Long This publication.
Since the autumn and winter of 2023, there has been a high incidence of respiratory infectious diseases such as influenza A, influenza B, and mycoplasma infection, and offline hospitals are overcrowded, and many patients have to spend hours in long queues in hospitals for treatment due to fever and cough. "If I have a follow-up visit, I will go directly to the doctor online, saving time and effort. A patient told this reporter.
The offline medical experience of many patients who "queue for hours and see a doctor for a few minutes" is also the reason why Internet medical treatment has increasingly penetrated people's lives in recent years. According to the 52nd Statistical Report on the Development of China's Internet Network released by the China Internet Network Information Center in August 2023, as of June 2023, the number of Internet medical users in China has reached 36.4 billion people, accounting for 33 percent of the total number of Internet users8%。At the same time, there are more than 3,000 Internet hospitals nationwide, and more than 25.9 million people have been provided with Internet diagnosis and treatment services.
Online diagnosis and treatment platforms are developing rapidly, but the quality of diagnosis and treatment is still difficult for patients to rest assured. Recently, Ms. He from Zhejiang reported to ** that she consulted a doctor whose scope of practice was marked as "respiratory medicine" on an Internet medical platform because of a severe cough, and after following his advice to take medicine, Ms. He felt that her condition was aggravated, and she called ** to the hospital where the doctor was located, but found that she was a massage department rather than a respiratory physician.
Ms. Ho's experience during the online consultation was not an isolated case. On the one hand, the development of Internet medical treatment is in full swing, and on the other hand, some online consultation platforms have repeatedly exposed doubts about doctors' qualifications, wrong division of the scope of medical practice, and illegal first consultations. How to Hold Accountability for Internet Medical Violations? And how to balance the convenience, efficiency, safety and reliability of medical treatment?
Online and offline are equally responsible.
Internet medical care generally follows the principle of integrated development and supervision of online and offline.
In recent years, China has successively issued normative documents such as the Administrative Measures for Internet Diagnosis and Treatment (Trial), the Administrative Measures for Internet Hospitals (Trial), the Management Standards for Telemedicine Services (Trial), and the Detailed Rules for the Supervision of Internet Diagnosis and Treatment (Trial).
Zheng Xueqian, vice president of the China Health Law Society, told Outlook Newsweek that the relevant normative documents make it clear that Internet hospitals should be established on the basis of physical medical institutions that have obtained the "Medical Institution Practice License". At the same time, physicians carrying out internet diagnosis and treatment activities shall obtain corresponding practice qualifications in accordance with law, have at least 3 years of independent clinical work experience, and obtain the consent of the medical institution where they are registered.
At the same time, the Measures for the Administration of Internet Hospitals (for Trial Implementation) clearly state that if medical institutions and medical personnel violate laws and regulations such as the Law on Medical Practitioners, the Regulations on the Administration of Medical Institutions, the Regulations on the Handling of Medical Accidents, and the ** Regulations in the course of carrying out Internet medical services, they shall be dealt with in accordance with the relevant laws and regulations. This means that no matter whether the diagnosis and treatment behavior occurs on or offline, it will be punished with the same responsibility. Zheng Xueqian said.
In addition, the "Detailed Rules for the Implementation of the Regulations on the Administration of Medical Institutions" stipulates that if a medical institution uses health technicians to engage in diagnosis and treatment activities other than its own specialty, it shall be treated as the use of non-health technicians. "This means that you can't practice medicine across specialties and fields, both online and offline. Zheng Xueqian said.
However, compared with offline medical services, the qualifications of online doctors are "adulterated", illegal first diagnosis, illegal drug use and other behaviors are more hidden, and it is more difficult to investigate and deal with them, for example, some Internet medical platforms have classified "nephrology" doctors as "internal medicine" doctors, and the division of "granularity" is coarse, or "oncology radiologist" is equivalent to "medical oncologist" and other misclassifications, and the accountability measures need to be further clarified.
The relevant person in charge of an Internet medical platform said that the platform can only verify the qualification certificates provided by the doctors themselves, and there is currently a lack of effective restraint measures for doctors. "Although some platforms enable facial recognition technology and require doctors to 'brush their faces' before going to the clinic, there is also the possibility that doctors will leave after brushing their faces and be replaced by another person. Therefore, while the platform strengthens the review, it is also important for the doctors themselves to fulfill their responsibilities. The person in charge said.
**Feng Wenmeng, a researcher at the Institute of Public Administration and Human Resources of the Development Research Center, told this reporter that the Internet only provides a new means to complete medical behaviors, and the laws and regulations that previously applied to offline medical behaviors also apply online. "For offline medical institutions, China has formed a relatively complete regulatory system, and the difficulty lies in how to supervise Internet medical treatment, clarify the rights and responsibilities of all parties, and pursue responsibility for violations of laws and regulations, which are not clear enough. ”
Taking AI consultation as an example, the Detailed Rules for the Supervision of Internet Diagnosis and Treatment (Trial) promulgated in February 2022 stipulate that AI software shall not replace the physician himself to provide diagnosis and treatment services. However, it is difficult for patients to distinguish between the doctor himself or the artificial intelligence software that provides the treatment. In response to the question of some patients that "the doctor responds too quickly, whether it is an AI consultation", there is still a lack of necessary supervision means.
Taking the first diagnosis in violation of regulations as an example, the Measures for the Administration of Internet Diagnosis and Treatment (for Trial Implementation) clearly states that Internet medical platforms shall not carry out Internet diagnosis and treatment activities for first-time patients. However, some Internet medical platforms have evaded the legal responsibility for the first diagnosis in violation of regulations by marking "only providing medical consulting services" and "replies for reference only" in hidden places.
In this regard, Zhou Shenglai, director of the Healthy China Leadership Research Center at Tsinghua University School of Medicine, said that if doctors prescribe for patients' conditions in online diagnosis and treatment activities, it is a diagnosis and treatment rather than medical consultation.
Why is online medical care positioned as "light consultation"?
According to the reporter of this magazine, although compared with offline consultation, patients have various concerns about the qualification of doctors and doubts about the diagnosis and treatment results through the Internet medical platform, but the public's demand for convenient medical treatment is still very strong.
Especially since autumn and winter, there has been a high incidence of respiratory diseases in many places across the country, and some patients are worried about the long queue time for offline medical treatment, and the gathering of patients is easy to cause cross-infection, so they prefer online consultation.
With the gradual understanding, contact and even reliance of the public on Internet medicine, many interviewed experts said that it is urgent to clarify the understanding of the function and positioning of Internet medicine and ensure its reasonable use.
From Zhou Sheng's point of view, the positioning of Internet medical treatment is light consultation, and its scope of application is the diagnosis and treatment of mild symptoms and the confirmation of curative effects. "If a patient suffers from an incurable disease and relies on the Internet to seek medical treatment, it is a misunderstanding of the positioning of Internet medicine. It is unlikely to be the subject of medical services. ”
In other words, Internet medical care is an auxiliary to offline in-depth diagnosis and treatment, and needs to be efficiently coordinated and integrated with offline medical care, so as to exert overall efficiency in their respective runways.
Feng Wenmeng said that the reason why the current positioning of Internet medical care is light consultation and the auxiliary of offline medical treatment is because its primary pursuit is the convenience of consultation, and the primary pursuit of consultation for complex diseases should be the accuracy of consultation rather than convenience. "Patients go to offline medical institutions for face-to-face consultations, and doctors diagnose their conditions through sight, touch, percussion, and hearing, which can better ensure the accuracy of the consultation results. ”
Medical treatment is inseparable from the warmth that doctors attach to the technical means in the process of diagnosis and treatment, so that patients can also give full trust to doctors when entrusting their health. Doctors are not only scientists, but also 'artists' who understand the individual needs of their patients. Zhou Shenglai believes that no matter how developed the network technology is, the offline medical treatment with face-to-face contact between doctors and patients is still irreplaceable, and it is the main position of medical services, which requires better clarification of the boundaries and norms of Internet medical care to ensure that it is not biased and good.
The future of online "light consultation".
In order to make people's medical treatment more time-saving and labor-saving, Zheng Xueqian suggested that some common diseases that do not require special examinations should be considered for online first consultation.
Zhou Shenglai suggested further unleashing the potential of Internet medical institutions and relying on the professionalism of public medical institutions to bring more high-quality services to Internet medical care. "At present, some public medical institutions are unable to release more efficiency and vitality in the field of Internet medicine due to outdated management mechanisms, and they need to work the compatibility of Internet technology and management mechanisms in the future. ”
For example, Zhou Shenglai said, public medical institutions can coordinate doctors' scheduling time in terms of resource allocation to ensure that most doctors can consult online and offline. "Doctors should not be allowed to choose only one of the diagnosis and treatment methods, but should integrate online and offline diagnosis and treatment services to promote the homogeneous development of Internet medical and offline diagnosis and treatment services. ”
In addition, Zhou Shenglai also said that he can rely on big data, cloud computing and other technologies to extend the medical service scenarios of public medical institutions, fully tap and activate the value potential of medical data, improve decision-making efficiency, improve patient medical experience, and enhance the group operation ability of public medical institutions.
The healthy development of Internet medicine is inseparable from the escort of strong supervision. Zheng Xueqian advocated building a regulatory mechanism for Internet medical treatment from four aspects: first, the Internet diagnosis and treatment platform should build a supervision system to ensure that the diagnosis and treatment records can be identified, retained and queried, that is, to ensure that the whole process of Internet diagnosis and treatment is traceable and traceable; Second, the data of the platform supervision system needs to be open to the regulatory authorities to ensure that the regulatory authorities can verify the qualifications of doctors and the standardization of diagnosis and treatment activities in real time. Third, it is necessary to clearly determine the rules and boundaries of violations, and use intelligent technology to monitor and capture cross-border behaviors. Fourth, build a monitoring and feedback system, so that the regulatory authorities can monitor the problem and the feedback platform will rectify it.
A number of interviewed experts also pointed out that Internet medical treatment should not only meet the demands of patients for convenient medical treatment, but also always adhere to the premise that safety is the premise of convenience. "Promote the efficient cooperation and in-depth integration of online and offline medical care, so that the two can work together to play an overall role in their respective runways, so that people's demands for convenient and safe medical services can be balanced and guaranteed." ”
With the in-depth development of the fourth industrial revolution led by information technology, communication technology, big data and artificial intelligence, the great value of Internet medical care is undoubted in the longer term dimension. However, how to maintain a balance between convenience, efficiency, safety and reliability of Internet medical services, it is necessary to carry out overall planning and layout in combination with the positioning of Internet medical services, accelerate the informatization, standardization and integration of management institutions and medical institution platforms, and clarify the boundaries of rights and responsibilities of different subjects, so as to provide patients with more high-quality and multi-dimensional services.
Outlook 2024 No. 06).