Internet Hospital Research Articles

Digital Health Technologies Respond to the COVID-19 Pandemic In a Tertiary Hospital in China: Development and Usability Study.

BackgroundThe outbreak of COVID-19 has caused a continuing global pandemic. Hospitals are integral to the control and prevention of COVID-19; however, they are facing numerous challenges during the epidemic.ObjectiveOur study aimed to introduce the practical experience of the design and implementation of a web-based COVID-19 service platform at a tertiary hospital in China as well as the preliminary results of the implementation.MethodsThe web-based COVID-19 service platform was deployed within the health care system of the Guangdong Second Provincial General Hospital and Internet Hospital; the function of the platform was to provide web-based medical services for both members of the public and lay health care workers. The focal functions of this system included automated COVID-19 screening, related symptom monitoring, web-based consultation, and psychological support; it also served as a COVID-19 knowledge hub. The design and process of each function are introduced. The usage data for the platform service were collected and are represented by three periods: the pre-epidemic period (December 22, 2019, to January 22, 2020, 32 days), the controlled period (January 23 to March 31, 2020, 69 days), and the postepidemic period (April 1 to June 30, 2020, 91 days).ResultsBy the end of June 2020, 96,642 people had used the automated COVID-19 screening and symptom monitoring systems 161,884 and 7,795,194 times, respectively. The number of general web-based consultation services per day increased from 30 visits in the pre-epidemic period to 122 visits during the controlled period, then dropped to 73 visits in the postepidemic period. The psychological counseling program served 636 clients during the epidemic period. For people who used the automated COVID-19 screening service, 160,916 (99.40%) of the total users were classified in the no risk category. 464 (0.29%) of the people were categorized as medium to high risk, and 12 people (0.01%) were recommended for further COVID-19 testing and treatment. Among the 96,642 individuals who used the COVID-19 related symptoms monitoring service, 6696 (6.93%) were symptomatic at some point during the monitoring period. Fever was the most frequently reported symptom, with 2684/6696 symptomatic people (40.1%) having had this symptom. Cough and sore throat were also relatively frequently reported by the 6696 symptomatic users (1657 people, 24.7%, and 1622 people, 24.2%, respectively).ConclusionsThe web-based COVID-19 service platform implemented at a tertiary hospital in China is exhibited to be a role model for using digital health technologies to respond to the COVID-19 pandemic. The digital solutions of automated COVID-19 screening, daily symptom monitoring, web-based care, and knowledge propagation have plausible acceptability and feasibility for complementing offline hospital services and facilitating disease control and prevention.

Determinants of Patients' Intention to Use the Online Inquiry Services Provided by Internet Hospitals: Empirical Evidence From China.

BackgroundInternet hospitals show great potential for adequately fulfilling people’s demands for high-quality outpatient services, and with the normalization of the epidemic prevention and control of COVID-19, internet hospitals play an increasingly important role in delivering health services to the public. However, the factors that influence patients’ intention to use the online inquiry services provided by internet hospitals remain unclear. Understanding the patients’ behavioral intention is necessary to support the development of internet hospitals in China and promote patients’ intention to use online inquiry services provided by internet hospitals during the prevention and control of the COVID-19 epidemic.ObjectiveThe purpose of this study is to identify the determinants of patients’ intention to use the online inquiry services provided by internet hospitals based on the theory of planned behavior (TPB).MethodsThe hypotheses of our research model were developed based on the TPB. A questionnaire was developed through patient interviews, verified using a presurvey, and used for data collection for this study. The cluster sampling technique was used to include respondents with chronic diseases. Structural equation modeling was used to test the research hypotheses.ResultsA total of 638 valid responses were received from patients with chronic diseases. The goodness-of-fit indexes corroborated that the research model was a good fit for the collected data. The model explained 45.9% of the variance in attitude toward the behavior and 60.5% of the variance in behavioral intention. Perceived behavioral control and perceived severity of disease had the strongest total effects on behavioral intention (β=.624, P=.004 and β=.544, P=.003, respectively). Moreover, perceived convenience, perceived information risk, emotional preference, and health consciousness had indirect effects on behavioral intention, and these effects were mediated by attitude toward the behavior. Among the four constructs, perceived convenience had the highest indirect effect on behavioral intention (β=.207; P=.001).ConclusionsPerceived behavioral control and perceived severity of disease are the most important determinants of patients’ intention to use the online inquiry services provided by internet hospitals. Therefore, internet hospitals should further optimize the design of online service delivery and ensure a reasonable assembly of high-quality experts, which will benefit the promotion of patients’ adoption intention toward online inquiry services for health purposes. Perceived convenience, emotional preference, and perceived risks also have effects on behavioral intention. Therefore, the relevant quality control standards and regulations for internet hospitals should be further developed and improved, and the measures to protect personal information should be strengthened to ensure the patient safety. Our study supports the use of the TPB in explaining patients’ intention to use online inquiry services provided by internet hospitals.

PNS14 Investigation of Physicians’ Digital Activities on Mitigating the IMPACT of Covid-19 in China

COVID-19 outbreak caused a global health crisis and posed public health challenges. During the outbreak, digital technologies were widely used to enhance prevention measures. Kantar in association with CphMRA, conducted a survey to understand the use and role of digital health tools among Chinese physicians during the epidemic. A cross-sectional online survey was conducted from February 29th to March 5th in 2020, using convenience sampling to collect physician behaviour in terms of digital activity and participation in internet hospitals. Logistic regression was used to analyse the digital activity data, and mixed model was used to analyse the internet hospital practice including online diagnosis and treatment before and during the outbreak. This study included 28.3% residents, 35.5% doctors-in-charge and 36.2% chief/vice-chief physicians from 30 provinces (n=3691). In total, 79.5% of respondents engaged in digital activities to enhance public health/medical education and communication such as webcasting, case sharing, and patient management. The results also show that physicians practising in higher level hospitals (p<0.001) as well as those working in fever clinics (p<0.05) were significantly more likely to use digital tools. Moreover, 66.1% respondents registered with internet hospitals and 22.8% of whom had registered new accounts during the outbreak. The number of online medical service during the outbreak was significantly higher (29.1 patients/week, 95% CI: 7.5∼50.6) than that before the outbreak. The physicians in lower level hospitals and those registered more internet hospital accounts were significantly more likely to conduct online medical services (p<0.05). Additionally, 75.1% of the online prescriptions were delivered to patients’ doorsteps, with higher incidence in more serious epidemic regions (P<0.01). Digital technology was extensively used to enhance public health strategies and mitigate the impact of COVID-19 by improving medical education, communication, and ensuring continuity of health services for patients while preventing unnecessary hospital visits.

The Internet Hospital Plus Drug Delivery Platform for Health Management During the COVID-19 Pandemic: Observational Study.

BackgroundWidespread access to the internet has boosted the emergence of online hospitals. A new outpatient service called “internet hospital plus drug delivery” (IHDD) has been developed in China, but little is known about this platform.ObjectiveThe aim of this study is to investigate the characteristics, acceptance, and initial impact of IHDD during the outbreak of COVID-19 in a tertiary hospital in South ChinaMethodsThe total number of and detailed information on online prescriptions during the first 2 months after work resumption were obtained. Patients’ gender, age, residence, associated prescription department, time of prescription, payment, and drug delivery region were included in the analysis.ResultsA total of 1380 prescriptions were picked up or delivered between March 2 and April 20, 2020. The largest group of patients were 36-59 years old (n=680, 49.3%), followed by the 18-35 years age category (n=573, 41.5%). In total, 39.4% (n=544) of the patients chose to get their medicine by self-pickup, while 60.6% (n=836) preferred to receive their medicine via drug delivery service. The top five online prescription departments were infectious diseases (n=572, 41.4%), nephrology (n=264, 19.1%), endocrinology (n=145, 10.5%), angiocardiopathy (n=107, 7.8%), and neurology (n=42, 3%). Of the 836 delivered prescriptions, 440 (52.6%) were sent to Guangdong Province (including 363 [43.4%] to Shenzhen), and 396 (47.4%) were sent to other provinces in China.ConclusionsThe IHDD platform is efficient and convenient for various types of patients during the COVID-19 crisis. Although offline visits are essential for patients with severe conditions, IHDD can help to relieve pressure on hospitals by reducing an influx of patients with mild symptoms. Further efforts need to be made to improve the quality and acceptance of IHDD, as well as to regulate and standardize the management of this novel service.

Effects of Internet Hospital Consultations on Psychological Burdens and Disease Knowledge During the Early Outbreak of COVID-19 in China: Cross-Sectional Survey Study.

BackgroundCoronavirus disease (COVID-19) has become a global threat to human health. Internet hospitals have emerged as a critical technology to bring epidemic-related web-based services and medical support to the public. However, only a few very recent scientific literature reports have explored the effects of internet hospitals on psychological burden and disease knowledge in major public health emergencies such as the COVID-19 pandemic.ObjectiveThe aim of this study was to explore the role of internet hospitals in relieving psychological burden and increasing disease knowledge during the early outbreak of the COVID-19 pandemic.MethodsThis survey was conducted from January 26 to February 1, 2020, during the early outbreak of COVID-19 in China. The platform used for the consultation was the WeChat public account of our hospital. To participate in the study, the patient was required to answer a list of questions to exclude the possibility of COVID-19 infection and confirm their willingness to participate voluntarily. Next, the participant was directed to complete the self-report questionnaire. After the internet consultation, the participant was directed to complete the self-report questionnaire again. The questionnaire included sections on general information, the General Health Questionnaire-28 (GHQ-28), and the participant’s worries, disease knowledge, and need for hospital treatment.ResultsThe total number of internet consultations was 4120. The consultation topics mainly included respiratory symptoms such as cough, expectoration, and fever (2489/4120, 60.4%) and disease knowledge, anxiety, and fear (1023/4120, 24.8%). A total of 1530 people filled out the questionnaires before and after the internet consultation. Of these people, 1398/1530 (91.4%) experienced psychological stress before the internet consultation, which significantly decreased after consultation (260/1530, 17.0%) (χ21=1704.8, P<.001). There was no significant difference in the number of people who expressed concern about the COVID-19 pandemic before and after the internet consultation (χ21=0.7, P=.43). However, the degree of concern after the internet consultation was significantly alleviated (t2699=90.638, P<.001). The main worries before and after consultation were the dangers posed by the disease and the risk of infection of family members. The scores of the self-assessment risk after the internet consultation were significantly lower than those before consultation (t3058=95.694, P<.001). After the consultation, the participants’ knowledge of the symptoms, transmission routes, and preventive measures of COVID-19 was significantly higher than before the consultation (t3058=–106.105, –80.456, and –152.605, respectively; all P<.001). The hospital treatment need score after the internet consultation decreased from 3.3 (SD 1.2) to 1.6 (SD 0.8), and the difference was statistically significant (t3058=45.765, P<.001).ConclusionsDuring the early outbreak of COVID-19, internet hospitals could help relieve psychological burdens and increase disease awareness through timely and rapid spread of knowledge regarding COVID-19 prevention and control. Internet hospitals should be an important aspect of a new medical model in public health emergency systems.

Role of pharmacists during the COVID-19 pandemic in China-Shanghai experiences.

The roles and contributions of pharmacists in Shanghai during the coronavirus disease 2019 (COVID‐19) pandemic are described in this report. Five pharmacists have been appointed as members of an expert interdisciplinary health care team tasked with taking care of all adult patients with COVID‐19 in Shanghai in a designated hospital, the Shanghai Public Health Clinical Center (SPHCC). They work with pharmacists at SPHCC, having responsibilities that include drug supplies, dispensing, pharmacy intravenous admixture services (PIVAS), prescription audits, medication reconciliations, pharmacotherapy, therapeutic drug monitoring, and patient education. Due to the pandemic, pharmacy operations in all hospitals are modified to adhere to guidelines for infection risk mitigation and personnel protection. Community pharmacies serve as the public access point to health care and medical supplies, providing services beyond dispensing and medication counselling. The establishment of internet hospitals (telehealth facilities) provide new opportunities for delivering pharmaceutical care and working with health care professionals. Pharmacists also participate in evaluating new treatments and keeping health care teams informed of new findings for potential treatment considerations. In response to the critical need for health care professionals in Wuhan, 68 pharmacists from different parts of the country went there to work with the local pharmacists. Through assuming new roles and adapting existing practice, pharmacists have acquired invaluable experiences for future practice advancement. In order to assume these responsibilities effectively, pharmacists need to be equipped with the necessary skills for meeting the evolving health care challenges.

The Internet Hospital as a Telehealth Model in China: Systematic Search and Content Analysis.

BackgroundThe internet hospital is an innovative organizational form and service mode under the tide of internet plus in the Chinese medical industry. It is the product of the interaction between consumer health needs and supply-side reform. However, there has still been no systematic summary of its establishment and definition, nor has there been an analysis of its service content.ObjectiveThe primary purpose of this study was to understand the definition, establishment, and development status of internet hospitals.MethodsData on internet hospitals were obtained via the Baidu search engine for results up until January 1, 2019. Based on the results of the search, we obtained more detailed information from the official websites and apps of 130 online hospitals and formed a database for descriptive analysis.ResultsBy January 2019, the number of registered internet hospitals had expanded to approximately 130 in 25 provinces, accounting for 73.5% of all provinces or province-level municipalities in China. Internet hospitals, as a new telehealth model, are distinct but overlap with online health, telemedicine, and mobile medical. They offer four kinds of services—convenience services, online medical services, telemedicine, and related industries. In general, there is an underlying common treatment flowchart of care in ordinary and internet hospitals. There are three different sponsors—government-led integration, hospital-led, and enterprise-led internet hospitals—for which stakeholders have different supporting content and responsibilities.ConclusionsInternet hospitals are booming in China, and it is the joint effort of the government and the market to alleviate the coexistence of shortages of medical resources and wasted medical supplies. The origin of internet hospitals in the eastern and western regions, the purpose of the establishment initiator, and the content of online and offline services are different. Only further standardized management and reasonable industry freedom can realize the original intention of the internet hospital of meeting various health needs.

Information technology to manage the COVID-19 Pandemic: Expansion of a technical structure based on practical experience in Kashmir

Background: The coronavirus disease (COVID-19) epidemic made a tremendous challenge to the global health system, and governments have taken active preventive and control measures. The health informatics community in Kashmir has actively taken action to mechanical health information technologies for disaster monitoring, detection, early alert, prevention and measures, and other help full tasks Objective: The aim of this study was to develop an informative technique framework to respond to the COVID-19 from a health informatics perspective. Methods: In this study, we collected health information technology–related information to understand the actions taken by the health informatics community in Kashmir during the COVID-19 outbreak and developed a health information technology structure for epidemic response based on health information technology–related methods and measures. Results: Based on the structure, we review certain health information technology practices for managing the outbreak in Kashmir, describe the highlights of their application in detail, and discuss critical issues to consider when using health information technology. Technologies employed include mobile and web-based services such as Internet hospitals and other valuable apps, big data analyses (including digital contact tracing through QR codes or epidemic prediction), cloud computing, Internet of things, Artificial Intelligence (including the use of drones, robots, and intelligent diagnoses), 4G telemedicine, and clinical information systems to facilitate clinical management for COVID-19. Conclusions: whole experience in Kashmir shows that health information and technologies play a important role in responding to the COVID-19.

Using Information Technology to Manage the COVID-19 Pandemic: Development of a Technical Framework Based on Practical Experience in China.

BackgroundThe coronavirus disease (COVID-19) epidemic poses an enormous challenge to the global health system, and governments have taken active preventive and control measures. The health informatics community in China has actively taken action to leverage health information technologies for epidemic monitoring, detection, early warning, prevention and control, and other tasks.ObjectiveThe aim of this study was to develop a technical framework to respond to the COVID-19 epidemic from a health informatics perspective.MethodsIn this study, we collected health information technology–related information to understand the actions taken by the health informatics community in China during the COVID-19 outbreak and developed a health information technology framework for epidemic response based on health information technology–related measures and methods.ResultsBased on the framework, we review specific health information technology practices for managing the outbreak in China, describe the highlights of their application in detail, and discuss critical issues to consider when using health information technology. Technologies employed include mobile and web-based services such as Internet hospitals and Wechat, big data analyses (including digital contact tracing through QR codes or epidemic prediction), cloud computing, Internet of things, Artificial Intelligence (including the use of drones, robots, and intelligent diagnoses), 5G telemedicine, and clinical information systems to facilitate clinical management for COVID-19. ConclusionsPractical experience in China shows that health information technologies play a pivotal role in responding to the COVID-19 epidemic.

Determinants of non-prescription antibiotic dispensing in Chinese community pharmacies from socio-ecological and health system perspectives.

Although non-prescription antibiotic dispensing (NPAD) has been officially forbidden by the Chinese government since 2004, it is still a common practice throughout the country. In this study, we use China as an example to explore the determinants of NPAD within the framework of its health system from a socio-ecological perspective. A mixed-method combining the simulated client method (SCM) and key informant interviews conducted in Zhejiang, Hubei, and Sichuan provinces was adopted. 73.3% of the SCM interactions engendered NPAD (91.7% through antibiotic requests vs. 55% through consultation) in Chinese community pharmacies; a much higher rate than the global average. At the intrapersonal level, NPAD was found to be driven by profits from selling non-prescription antibiotics and traditional Chinese medicine. At the interpersonal level, NPAD was driven by fierce competition in the community pharmacy market and by customers' unreasonable expectations. At the institutional level, it is easy for community pharmacies to evade the Food and Drug Administration's (FDA) supervision by obtaining unsupervised and fake prescriptions, refusing to give customers sale receipts, and hiding their antibiotic supplies and sale records. At the policy level, the low cost of violating the prescription-only antibiotic sale regulation and poor FDA supervision facilitated NPAD. The Chinese health system has thus failed to establish and regulate a diverse network of pharmacies for patients to fill their prescriptions; few antibiotic prescriptions are transferred from hospitals to community pharmacies. Education campaigns to increase awareness about the risks of self-medication with antibiotics among the general public, recognizable standardize prescriptions for customers to fill their prescriptions in community pharmacies, regulations on Internet and private clinic doctors' antibiotic prescribing behaviors, electronic tracking and tracing system to purchases and sales data of antibiotics and other prescription drugs, increasing cost of violating the prescription-only regulations for antibiotics sales are expected interventions to reduce NPAD.

Challenges of facing coronavirus disease 2019: Psychiatric services for patients with mental disorders

As a public health emergency of international concern as declared by the World Health Organization (WHO), the current outbreak of coronavirus disease (COVID-19) in China has captured the world's attention.1 The global COVID-19 outbreak can now be characterized as a pandemic, and the number of confirmed cases all over the world has increased to 416 686 as of 04:34 hours, 26 March 2020, according to data released by the WHO.1 International journals for general medical and specialty fields are working closely with experts across the globe to raise comment and provide advice on measures to protect mental health in this epidemic.2, 3 We have enormous respect for those who have most recently published the latest content on this new virus; however, it is time for a change in focus. In addition to the challenges faced by medical professionals and the general public, the mental health services for patients suffering from mental disorders have several challenges to face. To this end, a guideline document was recently issued by the government of the People's Republic of China with respect to strengthening the management of treatment for patients with severe mental disorders during the outbreak of COVID-19.4 Afterwards, an expert consensus on the managing pathway and coping strategies for patients with mental disorders during prevention and control of the outbreak of a serious infectious disease (novel coronavirus pneumonia) was published by the Chinese Society of Psychiatry together with other psychiatry-related academic organizations.5 However, we are under challenging conditions to effectively deal with the realistic problems in the psychiatric domain caused by the COVID-19 outbreak. A nationwide epidemiological survey reported that the lifetime prevalence of any psychiatric disorder is 16.6% in China.6 Many patients need ongoing support in outpatient clinics, and many require repeated readmissions to inpatient wards, and vice versa. Psychiatrists assess patients, advise them and their guardian, and provide long-term treatments at hospitals. The difficulty in maintenance treatment of individual patients with mental disorders is currently increased for several reasons. First, under strict control due to the epidemic, most of the general hospitals in Hubei province and elsewhere are temporarily unable to care for psychiatric patients to lower the possibility of COVID-19 transmission. Second, because of the need to establish special wards for patients who have a fever, specialized hospitals have had to reduce the number of ordinary hospitalizations. Third, patients undergoing hospitalization and outpatients seeking help or undertaking follow up have had to discontinue their treatment due to suspended public transport in a number of areas. At present, there are few measures as to how long maintenance treatment in mental disorders should last after an episode. Failure to directly resolve these problems prevents us from achieving our goal, despite its importance in the clinical management of mental disorders. Given that many more medical comorbid factors occur in patients with mental disorders, another challenge is addressing the effects of medical comorbidity in patients; for instance, respiratory diseases are more common in schizophrenia patients than in the general population, and patients with schizophrenia and concomitant influenza or pneumonia have higher mortality rates (see Wang et al.7 for a review). There so far appears to be no attention paid to these vulnerable individuals, that is, psychiatric patients with comorbid COVID-19. Here, we would like to share response suggestions. The World Health Assembly in 2013 endorsed an action plan, the WHO's ‘Comprehensive Mental Health Action Plan 2013–2020.’8 A key recommendation is to shift services from institutions to the community, highlighting the steps required to provide appropriate psychiatric services for patients in the current COVID-19 epidemic. In addition to this, the development of artificial intelligence techniques in clinical settings, attempts to speed up constructing the framework of online consultation and Internet hospitals, and the provision of telemedicine are all valuable. As a fundamental component of mental health services, psychiatric health-care professionals based in large top-class tertiary hospitals play critical roles in the comprehensive health of the population with mental disorders. This can be leveraged through large data analyses and harnessed via updated clinical practice guidelines and algorithms to improve policy-making. The COVID-19 epidemic has now spread across China and affected the world for almost 3 months. It poses many problems not only with the provision of psychiatry care, but also public health, prevention and control, preclinical and clinical research, health policy, and even health law. We are writing to draw attention to the challenges regarding maintenance treatment and concomitant COVID-19 in patients with mental disorders. The positive response is increasingly expected to explore and address the issues that affect patients with mental disorders on the basis of available evidence. The authors declare no conflicts of interest.

Internet Hospitals Help Prevent and Control the Epidemic of COVID-19 in China: Multicenter User Profiling Study.

BackgroundDuring the spread of the novel coronavirus disease (COVID-19), internet hospitals in China were engaged with epidemic prevention and control, offering epidemic-related online services and medical support to the public.ObjectiveThe aim of this study is to explore the role of internet hospitals during the prevention and control of the COVID-19 outbreak in China.MethodsOnline epidemic-related consultations from multicenter internet hospitals in China during the COVID-19 epidemic were collected. The counselees were described and classified into seven type groups. Symptoms were recorded and compared with reported patients with COVID-19. Hypochondriacal suspicion and offline visit motivation were detected within each counselees’ group to evaluate the social panic of the epidemic along with the consequent medical-seeking behaviors. The counselees’ motivation and the doctors’ recommendation for an offline visit were compared. Risk factors affecting the counselees’ tendency of hypochondriacal suspicion and offline visit motivation were explored by logistic regression models. The epidemic prevention and control measures based on internet hospitals were listed, and the corresponding effects were discussed.ResultsA total of 4913 consultations were enrolled for analysis with the median age of the counselees at 28 years (IQR 22-33 years). There were 104 (2.12%) healthy counselees, 147 (2.99%) hypochondriacal counselees, 34 (0.69%) exposed counselees, 853 (17.36%) mildly suspicious counselees, 42 (0.85%) moderately suspicious counselees, 3550 (72.26%) highly suspicious counselees, and 183 (3.72%) severely suspicious counselees. A total of 94.20% (n=4628) of counselees had epidemic-related symptoms with a distribution similar to those of COVID-19. The hypochondriacal suspicion (n=2167, 44.11%) was common. The counselees’ motivation and the doctors’ recommendation for offline visits were inconsistent (P<.001) with a Cohen kappa score of 0.039, indicating improper medical-seeking behaviors. Adult counselees (odds ratio [OR]=1.816, P<.001) with epidemiological exposure (OR 7.568, P<.001), shortness of breath (OR 1.440, P=.001), diarrhea (OR 1.272, P=.04), and unrelated symptoms (OR 1.509, P<.001) were more likely to have hypochondriacal suspicion. Counselees with severe illnesses (OR 2.303, P<.001), fever (OR 1.660, P<.001), epidemiological exposure history (OR 1.440, P=.01), and hypochondriacal suspicion (OR 4.826, P<.001) were more likely to attempt an offline visit. Reattending counselees (OR 0.545, P=.002) were less motivated to go to the offline clinic.ConclusionsInternet hospitals can serve different types of epidemic counselees, offer essential medical supports to the public during the COVID-19 outbreak, reduce the social panic, promote social distancing, enhance the public’s ability of self-protection, correct improper medical-seeking behaviors, reduce the chance of nosocomial cross-infection, and facilitate epidemiological screening, thus, playing an important role on preventing and controlling COVID-19.

Analysis on the Construction and Operation Mode of Internet Hospitals

Internet + medical health have become a national key strategy, and the industries of medical information have ushered in new development. Internet hospitals have broken through the limitations of diagnosis and treatment. Diagnosis, doctor’s education, family doctors, and post-hospital tracking have been introduced to the Internet hospital system, the whole process of medical management service including ‘health management, diagnosis, in-hospital, rehabilitation’ has been gradually established, and coordinating to the medical resources, family doctors and channels of medicine, to realize the real circulation of medical resources. The authors screened six Internet hospitals and comprehensively analyzed their construction and operation modes, with a view to providing reference for the construction of Internet hospitals.

A Profile of eHealth Behaviors in China: Results From a National Survey Show a Low of Usage and Significant Digital Divide.

Background: The widely accessible Internet has boosted an enthusiasm for eHealth in China, but we know little about eHealth behaviors in the general population.Objective: To assess the prevalence of eHealth behaviors in general Chinese population and identify the predictors of digital divide.Methods: A nationally representative survey was administered in 2016–2017 with a sample size of 4,043. Five eHealth behaviors were assessed: search health information, communicate with healthcare providers, connect with patients of similar health conditions, buy medicine, and make doctor's appointment online. Multivariate logistic regression was employed to assess the independent relationship between eHealth behaviors and key demographic variables.Results: About 33% of participants have ever searched health information online, and the prevalence of other eHealth behaviors was less than 10%. The adoption of eHealth behaviors was significantly associated with younger age, more education, higher income, and urban residence. By contrast, gender, employment status, health insurance, and health status were not associated with eHealth behavior.Conclusion: The adoption of eHealth behaviors in the general Chinese population was low, and a significant digital divide exists. We caution against the speedy development of Internet hospitals and call for more resources allocated to bridge digital health divide.

Internet-Based and Mobile-Based General Practice: Cross-Sectional Survey.

BackgroundGlobally, mHealth is increasing as a promising technology for promoting the quality of health care. Thus, a growing number of internet hospitals have been established in China to avail all its advantages. However, no study has investigated the service scope and patient satisfaction of the internet hospital to date.ObjectiveThe objective of our study was to explore the features of outpatients in general practice, the disease information, and the satisfaction through an internet rating site.MethodsWe collected data from the internet hospital of the First Affiliated Hospital, Zhejiang University between February 2016 and February 2017. Patients visited Web-based clinic via a computer or smartphone. The data included patients’ demographic characteristics, disease information, and patients’ comments.ResultsWe enrolled 715 patients with 365 health-related problems. All health conditions involved diseases ranging from internal medicine, surgery, gynecology and obstetrics, pediatrics, dermatology, ophthalmology, stomatology to emergency. Among them, 63.1% patients (451/715) visited traditional hospitals for further management, 25.3% (181/715) had prescriptions, laboratory, or imaging examination appointment, 1% (9/715) used emergency service, and 10% (74/715) needed routine follow-up. All patients received health education. Almost all patients gave positive feedback and 4-5-star rating.ConclusionsThe internet hospital is suitable for all health conditions with high satisfaction only when patients have the access to internet via a computer or smartphone.

PCN88 - Improving Access to Healthcare Services Through An In-Depth Understanding of Telemedicine in China

A very large population size, coupled with an imbalance of healthcare resource allocation, has created a major issue for access to healthcare in China. The aim of this study is to improve patient access to healthcare services based on a detailed understanding of patient and physician attitudes towards telemedicine. A large scale primary research project was conducted in China to understand the digital life of physicians and patients. 10,325 physicians from 32 specialties, and 1,412 patients covering 16 disease areas were surveyed throughout 2017. Additionally, a real-world telemedicine data set of more than 40,000 online breast cancer physician consultations between 2016-2017 was provided by Chunyu Doctor, one of the largest telemedicine platform in China. Survey results indicated that 77% of physicians had a very positive view of the “internet hospital” (a concept of combining tele-medicine with community hospitals) and 75% of physicians believe that the internet hospital has a positive future. The real-world breast cancer online consultation data further illustrated that both physician’s technical titles, and the prestige of their associated hospitals, plays a statistically significant role in determining patient’s choice for physician online consultation regarding serious diseases (R-squared=0.59, p-value=0.0004). This study highlights the impact of internet technology on healthcare delivery. Physicians are overwhelmingly positive regarding the development of telemedicine. The breast cancer consultation records clearly revealed patient’s preferences when seeking medical advice from healthcare professionals regarding a serious disease. A better understanding of physician and patient digital behavior will help with the optimization of telemedicine and improve patient access to healthcare resources.

Understanding the Role of Mobile Internet-Based Health Services on Patient Satisfaction and Word-of-Mouth.

With the rapid advancement of Web 2.0 technologies, Internet medicine, and mobile healthcare, the influence of the use of patient-oriented Mobile Internet-based Health Services (MIHS) on patient satisfaction and the electronic word-of-mouth (WOM) of health service agencies is becoming the focus of the academic research community. Many large hospitals, including some Internet hospitals, have provided various online healthcare service platforms that enable patients to expediently consult with physicians and obtain healthcare services in an online to offline format. The purpose of this study is to analyze the main mechanisms of how the features and users’ experiences of MIHS influenced patient satisfaction and continuous use behaviors of the system to generate additional WOM dissemination behaviors. Based on post-adoption behavior and Expectation Confirmation Model of Information Technology Continuance (ECM-IT), this study conducted an empirical study through data collection from users (patients) from a large hospital providing online healthcare services. A total of 494 pieces of data were collected and analyzed using SmartPLS2.0(SmartPLS GmbH, Hamburg, Gernmany). The results show that: (1) patient satisfaction with MIHS and their intentions to continue use of MIHS have significantly positive influences on WOM; (2) patient satisfaction with MIHS is positively influenced by perceived usefulness and confirmation of MIHS performance expectations; (3) and patient intentions to continue use of MIHS are also affected by some technology factors, such as facilitating conditions and perceived risk, as well as some subjective feelings, such as perceived usefulness and perceived interactivity. The results of this study provide important implications for both research and practice of public health.

PHP74 - Improving the Quality and Efficiency of Care Delivery Through In-Depth Understanding of the China Healthcare Digital Landscape

To gain a detailed understanding of patient and physician behavior in China’s digital healthcare environment, with the aim of improving the quality and efficiency of care delivery. A large scale primary research project was conducted in China to understand the digital life of physicians and patients. 10,325 physicians from 32 specialties, and 1,412 patients covering 16 disease areas were surveyed in 2017. The survey was administered via mobile platform and/or online, with most of the survey data collected via mobile platform. Survey results indicated that physicians and patients spent a similar amount of time online (29 hours per week). While physicians spent 55% of their online time on professional activities, patient dedicated 26% of online time to health-related activities. The top-ranked online activities for physicians were ‘medical knowledge’, ‘search’ (literature and data) and ‘use of professional medical software’. Patients’ top three healthcare related online activities were ‘reading medical education material’, ‘searching for medical product information’, and ‘looking for free online medical consultations’. Regarding tele-health, 77% of physicians had a very positive view of the “internet hospital” (a concept of combining tele-medicine with community hospitals) and 75% of physicians believe that internet hospital has a positive future. Data demonstrated that 93% of the initial treatments that patients received were prescribed by physicians, while 23% of patients self-selected treatment. 47% of the patients had made requests to their physicians for certain product prescriptions, with 17% of patients had successfully influencing physicians’ prescribing decisions. The information from this large-scale survey depicts the digital life of physicians and patients. A better understanding of physician and patient digital behavior will help us to optimize medical information delivery and enhance patient-physician interactions. Leveraging the efficiency and speed of online and mobile platforms may be a crucial factor in improving healthcare delivery.

Internet hospital in China: a cross-sectional survey

BackgroundInternet hospital is rapidly developing in China because it has the potential to provide widely accessible outpatient service delivery via internet technologies. To date, China's internet hospitals have not been systematically investigated. We aimed to describe the characteristics and to assess the health-service capacity of China's internet hospitals. MethodsFor this cross-sectional study, we searched Baidu to identify internet hospital up to March 20, 2017, using search terms “Internet hospital”, “web hospital”, or “cloud hospital”. All internet hospitals in mainland China were eligible for inclusion if they have been officially registered. FindingsWe identified 68 internet hospitals, of which 43 have been put into use and 25 are under construction. Of the 43 established internet hospitals, 13 (30%) were in hospital information stage, 24 (56%) were in web-ward stage, and six (14%) were in full internet hospital stage. Patients accessed outpatient service delivery via website (n=32, 74·4%), app (n=18, 42%), or by an offline medical consultation facility (n=16, 37%) from the internet hospital. 25 of the internet hospitals (58%) asked doctors to deliver health services at a specific web clinics, whereas 18 hospitals (42%) did not. The consulting methods included video chat (n=26, 61%), telephone (n=8, 19%), and graphic message (n=12, 28%), whereas 13 (30%) internet hospitals do not offer online consultation at present. Only six internet hospitals are included in the coverage of health insurance. The median number of doctors available online was zero (IQR 0–5; range 0–16 492). The median consultation fee was ¥20 (IQR ¥0–200; range ¥0–1000; about US$2·90). InterpretationInternet hospitals provide convenient outpatient service delivery. However, many of the internet hospitals are not yet mature, with various issues such as a scarcity of online doctors and incomplete coverage by health insurance. China's internet hospitals are heading in the right direction to improve how health service is effectively provided, but much more remains to be done. FundingNational Key Research and Development Program of China (2016YFC1000102, 2016YFC1000307) and National Natural Science Foundation of China (81602854).

Internet Hospitals in China: Cross-Sectional Survey.

BackgroundThe Internet hospital, an innovative approach to providing health care, is rapidly developing in China because it has the potential to provide widely accessible outpatient service delivery via Internet technologies. To date, China’s Internet hospitals have not been systematically investigated.ObjectiveThe aim of this study was to describe the characteristics of China’s Internet hospitals, and to assess their health service capacity.MethodsWe searched Baidu, the popular Chinese search engine, to identify Internet hospitals, using search terms such as “Internet hospital,” “web hospital,” or “cloud hospital.” All Internet hospitals in mainland China were eligible for inclusion if they were officially registered. Our search was carried out until March 31, 2017.ResultsWe identified 68 Internet hospitals, of which 43 have been put into use and 25 were under construction. Of the 43 established Internet hospitals, 13 (30%) were in the hospital informatization stage, 24 (56%) were in the Web ward stage, and 6 (14%) were in full Internet hospital stage. Patients accessed outpatient service delivery via website (74%, 32/43), app (42%, 18/43), or offline medical consultation facility (37%, 16/43) from the Internet hospital. Furthermore, 25 (58%) of the Internet hospitals asked doctors to deliver health services at a specific Web clinic, whereas 18 (42%) did not. The consulting methods included video chat (60%, 26/43), telephone (19%, 8/43), and graphic message (28%, 12/43); 13 (30%) Internet hospitals cannot be consulted online any more. Only 6 Internet hospitals were included in the coverage of health insurance. The median number of doctors available online was zero (interquartile range [IQR] 0 to 5; max 16,492). The median consultation fee per time was ¥20 (approximately US $2.90, IQR ¥0 to ¥200).ConclusionsInternet hospitals provide convenient outpatient service delivery. However, many of the Internet hospitals are not yet mature and are faced with various issues such as online doctor scarcity and the unavailability of health insurance coverage. China’s Internet hospitals are heading in the right direction to improve provision of health services, but much more remains to be done.