Online Health Services Research Articles

Telemedicine and ethics: opportunities in India.

Prior to the Covid-19 pandemic, telemedicine was an upcoming modality of diagnosis and treatment, but was limited by inadequate guidelines and legislation. Now, during the pandemic, policy makers worldwide have found it prudent to set forth new telemedicine guidelines to ease and regulate operations. The Government of India, along with the Board of Governors (in supercession of the Medical Council of India), amended the Indian Medical Council Act, 1956, and published the Telemedicine Practice Guidelines in 2020 to lay down a framework for telemedicine practice in our country. This step will provide a medico-legal context for the delivery of online health services. However, the Guidelines in their present form only partly address the ethical aspects of telemedicine in India. Here, we briefly describe these Guidelines and highlight the ethical concerns surrounding the teleconsultation process in our country. We also suggest possible solutions to these ethical issues surrounding the practice of telemedicine.

Factors Influencing Chinese Online Health Service Use

Despite the popularity of online health services (OHSs) among patients in recent years, academic research on this phenomenon is limited. Drawing on the valence framework, the authors proposed a model to explore both the most important facilitators of OHS use intention from the perceived value perspective and inhibitors of OHS use intention from the perceived risk perspective. Data were collected from 407 OHS users through an online survey. Results showed that the inhibitors of OHS use intention include privacy risk and social risk, while facilitators include social support value, convenience value, and utilitarian value. These findings enrich the OHS literature by revealing both the inhibitors and facilitators of OHS use intention. This study also provides practical implications for platforms offering OHS in relation to effectively attracting users.

Facing the Growing COVID-19 Infodemic: Digital Health Literacy and Information-Seeking Behaviour of University Students in Slovenia.

The entire world is faced with the COVID-19 pandemic, which is also accompanied by an infodemic. This refers to the rapid spread of (accurate and false) information, mainly through internet usage increasing. Digital health literacy (DHL) is therefore important for addressing challenges related to online health information and services, as well as for navigation through the complex information landscape with huge amounts of different (and conflicting) information about COVID-19. The aim of this study is to examine the level of DHL in relation to COVID-19 in Slovenian university students and to determine online information-seeking behaviour in order to plan and prepare effective communication interventions for this sub-population. A cross-sectional survey, administered by an online questionnaire, was conducted to collect data on DHL. A total of 3621 students participated, of whom 70% were female and the average age was 22.65 years (SD = 4.65). Bivariate analyses were performed to assess the association of key characteristics with DHL. Overall, the results show that the level of DHL among students is sufficient. Most difficulties were reported in assessing the reliability of information (n = 1484, 49.3%). Approximately one third of the students (n = 847, 27.9%) reported having problems in finding information of their interest, and somewhat more (n = 900, 29.6%) reported difficulties in making a selection among all the information found. Students with a sufficient level of DHL are more likely to seek information through search engines and websites of official institutions, while students with a limited level of DHL more frequently reported using social media for health information searches. It is necessary to establish interventions for a systematic lift of the DHL and health literacy (HL) of all population groups.

The formation of patient trust and its transference to online health services: the case of a Dutch online patient portal for rehabilitation care

BackgroundTrust is widely recognized as a crucial factor in successful physician–patient communication and patient engagement in treatment. However, with the rise of eHealth technologies, such as online patient portals, the role of trust and the factors that influence it need to be reconsidered. In this study, we aim to identify the factors that contribute to trust in an eHealth service and we aim to identify the consequences of trust in an eHealth service in terms of use.MethodsThe Patient Trust Assessment Tool was provided to new outpatients of a rehabilitation center in the Netherlands, that were expected to use the center’s online patient portal. Via this tool, we assessed five trust-related factors. This data was supplemented by questions about demographics (age, gender, rehabilitation treatment) and data about use (number of sessions, total time spent in sessions), derived from data logs. Data was analyzed via Partial Least Squares Structural Equation Modelling.ResultsIn total, 93 patients participated in the study. Out of these participants, 61 used the portal at least once. The measurement model was considered good. Trust in the organization was found to affect trust in the care team (β = .63), trust in the care team affected trust in the treatment (β = .60). Both, trust in the care team and trust in the treatment influenced trust in the technology (β = .42 and .30, respectively). Trust in the technology affected the holistic concept trust in the service (β = .78). This holistic trust in the service finally, did not affect use.ConclusionsThis study shows that the formation of this trust is not unidimensional, but consists of different, separate factors (trust in the care organization, trust in the care team and trust in the treatment). Trust transfer does take place from offline to online health services. However, trust in the service does not directly affect the use of the eHealth technology.

SOCIO-CULTURAL BINOCULARS VIEW OF TELEMEDICINE IN SUB-SAHARAN AFRICA: POTENCY, PROSPECT, DEFECT AND DANGER

Sub-Saharan Africa has experienced unprecedented technological advancement, just like several other regions of the world. This improvement in technology lends credence to the proliferation of android mobile phones, laptops computers and the Internet facilities that enhance interaction on the social media which in turn generates momentous alterations in the ways the residents of the region construct their daily lives. From epidemiological perspective as well as the viewpoint of change and development, via these information technologies, rendering health-related care and services to the residents in the remote places of the region and gaining access to vital information that prompts prevention and control of diseases are now feasible unlike before the advancement. Therefore, telemedicine symbolizes a health innovation in the region. In the light of this, this paper systematically reviewed the extent to which telemedicine has gained acceptance among the residents of the region; and the socio-cultural factors and practices that promote and decelerate the general acceptance of telemedicine in the region. To accomplish the objective, the review was done meta-analytically and meta-synthetically to explore recent relevant studies. The paper discovered that reduction in the cost of gaining access to health information, harnessing online health and medical services, are among the benefits derived from telemedicine while fake online information, impoverished network service delivery, financial incapacity, theft, technical faults, underutilization of the technology devices and cyber-crime are among the factors that militate against wide acceptance of telemedicine in the region.

A Study On The Problems Faced By Elderly People While Using Web-Based Applications During Pandemic Situation

The study deals with the problems faced by elderly citizens while using the web-based applications during the pandemic situation started from January 27 2020. Most of the cities have been imposed curfew and lockdown, so that no one can come out of their house. They face many difficulties like paying the rent, electrical bill, banking transactions etc… The digital exclusion of elderly people is a significant contributor to low public e-service adoption. The situation is worrying because elderly people are a big target for many forthcoming government-supplied services, such as online health services. Governments should always aim to improve productivity and efficacy by playing an important role in a sustainable society so that publicly- based resources can be properly exploited. However, if the intended users of such services are excluded from or do not wish to use them, the sustainable implementation of public e-services is problematic. We need to know more about the views of elderly people as to why they are technologically removed to resolve this troublesome situation. Also, we present how these views can be classified and how they communicate in between as well. To increase the digital participation of elderly people, these results will serve as a framework for how to deal with these issues, which will increase their acceptance of public e- service in the long run.

Characteristics of Online Health Care Services From China's Largest Online Medical Platform: Cross-sectional Survey Study.

BackgroundInternet hospitals in China are in great demand due to limited and unevenly distributed health care resources, lack of family doctors, increased burdens of chronic diseases, and rapid growth of the aged population. The COVID-19 epidemic catalyzed the expansion of online health care services. In recent years, internet hospitals have been rapidly developed. Ping An Good Doctor is the largest, national online medical entry point in China and is a widely used platform providing online health care services.ObjectiveThis study aims to give a comprehensive description of the characteristics of the online consultations and inquisitions in Ping An Good Doctor. The analyses tried to answer the following questions: (1) What are the characteristics of the consultations in Ping An Good Doctor in terms of department and disease profiles? (2) Who uses the online health services most frequently? and (3) How is the user experience of the online consultations of Ping An Good Doctor?MethodsA total of 35.3 million consultations and inquisitions over the course of 1 year were analyzed with respect to the distributions of departments and diseases, user profiles, and consulting behaviors.ResultsThe geographical distribution of the usage of Ping An Good Doctor showed that Shandong (18.4%), Yunnan (15.6%), Shaanxi (7.2%), and Guangdong (5.5%) were the provinces that used it the most; they accounted for 46.6% of the total consultations and inquisitions. In terms of department distribution, we found that gynecology and obstetrics (19.2%), dermatology (17.0%), and pediatrics (14.4%) were the top three departments in Ping An Good Doctor. The disease distribution analysis showed that, except for nondisease-specific consultations, acute upper respiratory infection (AURI) (4.1%), pregnancy (2.8%), and dermatitis (2.4%) were the most frequently consulted diseases. In terms of user profiles, females (60.4%) from 19 to 35 years of age were most likely to seek consultations online, in general. The user behavior analyses showed that the peak times of day for online consultations occurred at 10 AM, 3 PM, and 9 PM. Regarding user experience, 93.0% of users gave full marks following their consultations. For some disease-related health problems, such as AURI, dermatitis, and eczema, the feedback scores were above average.ConclusionsThe prevalence of internet hospitals, such as Ping An Good Doctor, illustrated the great demand for online health care services that can go beyond geographical limitations. Our analyses showed that nondisease-specific issues and moderate health problems were much more frequently consulted about than severe clinical conditions. This indicated that internet hospitals played the role of the family doctor, which helped to relieve the stress placed on offline hospitals and facilitated people’s lives. In addition, good user experiences, especially regarding disease-related inquisitions, suggested that online health services can help solve health problems. With support from the government and acceptance by the public, online health care services could develop at a fast pace and greatly benefit people’s daily lives.

Rural use of health service and telemedicine during COVID-19: The role of access and eHealth literacy.

The COVID-19 pandemic has driven a greater reliance on telemedicine, yet rural access, use, and satisfaction with telemedicine and the role of eHealth literacy are unknown. Using a cross-sectional design, 279 (70.6% female) western rural Canadians completed an online survey. The majority of participants reported access to telemedicine, but nearly 1/5 lacked access to online or virtual mental health services. The majority of participants had used health care services following the declared COVID-19 pandemic in North America, and just under half had used telemedicine. Telemedicine satisfaction scores were higher among participants who had used video (M = 4.18) compared to those who used phone alone (M = 3.79) (p = 0.031). Telemedicine satisfaction and eHealth literacy were correlated (r = 0.26, p = 0.005). Participants did not want telemedicine to replace in-person consultations. Telemedicine practice requires that rural residents have the resources, ability and willingness to engage with remote care.

Role of digital health in improving physical and mental well-being during COVID-19 pandemic

IntroductionDue to the COVID-19 pandemic, there is a steep rise in the acceptance of telemedicine and digital health, including increased interest in pursuing mental health treatment through telepsychiatry. Digital health helps following social distancing measures and increases the health outcomes.ObjectivesTo see the role of digital health in improving physical and mental well-being during COVID-19 PandemicMethods This study is a part of a large global project where 240 people inquired advice on phone app during COVID-19-Pandemic. Later on, a short study was conducted on the same population through survey to evaluate the effectiveness of digital health/tele-mental health. We also searched PubMed, Google Scholar, PsychInfo, and Medline for words “Digital Health, Tele-mental health, COVID-19-Pandemic”. Reviewed 40 articles and included 3 in this review1,4,5.Results We received a total of 98 responses. 65.6% people reported that online health resources are helpful in relieving pandemic-induced anxiety/stress, 66.2% reported to continue online health services after pandemic, 37.7% noted that digital health saves times in waiting areas, 46% reported lack of physical interaction with doctor as a disadvantage of digital health, and 40.3% reported comfort in using tele-mental health. Our literature review has shown barriers like privacy concerns and technological issues1. Provision of tele-psychiatry is safe and effective in continuity of mental health care.4,5Conclusions There has been an increased inclination towards digital health during any disaster. During COVID-19-Pandemic, digital health has increased access to mental health care and reduced risk of infection. The drawbacks include poor patient-doctor relationship, reimbursement concerns, and lack of confidentiality.

Evaluating the Readiness of Mobile Technology with Respect to e-Heath for Medication in Saudi Arabia: An Integrative Perspective.

ObjectiveThe objective of this study was to evaluate the readiness of Saudi Arabian patients towards the adoption of the e-health system through the use of mobile phones.MethodsIn this research, a cross-sectional survey was carried out using a self-administered structured questionnaire. According to the results, 354 people viewed the questionnaire and 129 respondents were selected to assess the adoption of the e-health system in Saudi Arabia. The data were collected during February–March 2020.ResultsMore than half of the respondents (63.6%) were women and almost half of the participants (48.0%) were married. Most of the surveyed patients suffered from cardiovascular diseases and diabetes. Almost all the participants (99.0%) had their personal mobile phone and used the Internet on these devices. Most of the participants did not trust or believe in online health services or online medical consultations and did not spend money on contracting health services through mobile phones. It is suggested that the lack of motivation to adopt the e-health system may be due to fear of privacy violations, fear of loss of personal data and information, lack of technical support, and mistrust in doctors who frequently use their cell phones to distract themselves during work-hours.ConclusionThe results of this study revealed that the population of Saudi Arabia is reluctant to adopt the electronic e-health system promoted in the Saudi Vision 2030 strategic plan. To change this behavior, it is necessary to develop awareness campaigns and strategies that suggest the importance of using e-heath in the Saudi Arabian healthcare system. Additionally, it is essential that the network administrator implement procedures to protect the confidentiality and security of patients’ medical records.

Telehealth services support community during the COVID-19 outbreak in Iran: Activities of Ministry of Health and Medical Education.

The Coronavirus disease 2019 (COVID-19) outbreak has been ravaging Iran and other countries with increasing morbidity and mortality. The pathogen spread rapidly and the outbreak caused nationwide anxiety and shock in Iran. To combat the COVID-19 epidemic, the Ministry of Health and Medical Education (MOHME) of Iran introduced several policies and activities, including the use of tele-health services. This letter to the editor uses anecdotal and other records to provide a summary of the activities of MOHME during the COVID-19 outbreak in Iran from February 1 to March 31, 2020. In this commentary, we reviewed the MOHME information site and extended the recommendations offered by MOHME via presenting the existing challenges and a roadmap of the necessary policy requirements. The existing evidence demonstrates that tele-health should have been rapidly implemented as it presents an effective mode of service delivery to reduce morbidity and mortality and decrease the burden on healthcare providers and the health system during the COVID-19 outbreak.

Δυναμική Λίστα Χειρουργείου μέσα από μια Ηλεκτρονική Προσέγγιση

Introduction: The Surgery Waiting List establishment, three years ago, at the National Health System (NHS) was a project limited in recording the problem, that is to say at the constant flow issue of patients from rural areas to the large urban hospitals and the long waiting times for surgical procedures. The rapidly changing healthcare sector requires a continuous innovation and quality improvement of health- care services delivery. To this direction, Cloud Computing technology adoption contributes crucially, providing access in data information at anytime and from any- where. Moreover, enables healthcare organizations to meet up with new requirements for data exchange and to ensure the proper management of resources. Purpose: We aim to use Cloud Computing technology for shorten waiting times for surgical procedure and to propose the creation of a platform, which provides realtime access to the Surgery Waiting List and collaborates with the existing online health services in country. Material - Method: We examined the Surgery Wait- ing Lists of various hospitals and observed that these are presented by a static form, are not updated on a regular basis, and do not reflect the progress of the pro- cedure. After studying the data contained in the lists, according the provisions of the Ministry of Health, we designed the proposed, dynamic Surgery Waiting List. Moqups software was used to simulate the application. The platform is developed in Cloud Computing, with accordance of law and the Regulation EU 2016/679 (GDPR). The Cloud Analyst software helped us for simu- lation in operation. Results: The dynamic Surgery Waiting List we propose offers the monitoring of waiting times in real time, with automatic updates. The benefits of using cloud computing services is that resources are provided on-demand and deliver faster processing of data. Conclusions: The results were encouraging and we are of the opinion that the implementation of the proposed Platform of Surgery Waiting List is possible. The advantages can be summarized in the dynamic interac- tion between patients and healthcare providers and in the available options that patients could have for faster treatment.

BUILDING ONLINE AND TELEPHONE PSYCHOLOGICAL FIRST AID SERVICES IN A LOW RESOURCE SETTING DURING COVID-19: THE CASE OF KOSOVO

The COVID-19 pandemic and the measures brought for prevention of infections are associated with considerable psychosocial and psychological morbidity in the general population. Providing continuous mental health services during the pandemics is a challenge worldwide, especially in low- and middle-income countries (LMICs). This paper reports on the strategies and activities taken to protect public mental health during the COVID-19 pandemic in Kosovo. This included establishing online and phone psychological first aid services and developing psychoeducational videos and webinars. The paper concludes with several lessons learned during the process of establishing and maintaining these interventions, such as: initial political endorsement is crucial to gain and maintain the momentum of services; continuous training of volunteers is crucial for both addressing the needs/problems, which arise during the process of work and maintain the motivation of volunteers; promotion of the services is crucial; academic curricula training mental health professionals should include digital mental health related courses and manualization on how to establish this kind of services in midst of crisis is crucial in order to ensure quick operationalization when needed again especially in LMIC settings. The interventions developed provide opportunity for further research especially by evaluating the impact of the services and exploring how online and provision of mental health and psychoeducation services online could help to cover services gap in times of isolation, limited movement and situations similar to pandemics in settings with limited mental health services and resources. The situation with pandemics with COVID 19 is still far from ending. Future waves of infections and restriction could again spike the mental health and psychosocial and psychological strain of the general population, therefore being prepared in provisions of psychological first aid and other mental health services online is crucial.

\u201cWill you hear my voice?\u201d: to engage older patients online, listen to them about their lives offline

The scope of health information and health care services available online is rapidly expanding. At the same time, COVID-19 is causing vulnerable elders to reconsider in-person provider visits. In that context, recently published research by Y. Mizrachi et al. examining obstacles to the use of online health services (OHS) among adults age 50 and up takes on new importance. An iconic Israeli song begins, “Will you hear my voice?” (Hebrew Songs. Zemer Nugeh (Hatishmah Koli), 2020). What makes Mizrachi et al.’s findings particularly intriguing, despite several caveats, is the manner in which they demonstrated a commitment to genuinely listen to individual voices. The researchers spoke “openly and bluntly” with interviewees as peers and were rewarded with “specific, well-defined and applicable answers with the potential to be used.” The most striking findings came in candid answers that went beyond the factors intrinsic to the online offerings and addressed important factors in what regular Internet users often refer to as IRL (“in real life”), such as support from family. The necessity of avoiding preconceptions about the most effective manner to engage patients underscores the importance of patient and family advisory councils (PFACs). PFACs, increasingly being adopted by health care organizations globally, provide an ongoing ability to listen and respond to the “patient voice.” Effectively addressing obstacles to older adults’ use of the full range of online health resources will require the involvement not just of health plans and government, but also of voluntary organizations, providers, families and others integral to users’ offline “real lives.” Sustained, focused listening must be a central part of that effort.

COVID-19 Pandemic Accelerates Need to Improve Online Patient Engagement Practices to Enhance Patient Experience.

The COVID-19 pandemic has led to rapid change in health care, accelerating the use of digital health services, including telehealth. Moreover, growth in value-based care has compelled consumers to become more engaged in care processes. It has also provided opportunities to enhance patient experiences by increasing patients’ access to online health information and services. This study assessed online patient engagement practices for 6 common patient touchpoints by reviewing the websites of the top 32 hospitals, including the top 10 children’s hospitals. The great majority of these hospitals provided some information related to these patient touchpoints. However, the scope and extent of task automation varied significantly and many options were not convenient. Based on this study, it is clear that patient experience can be enhanced by improving online patient engagement, particularly during the current global pandemic.

Obstacles to using online health services among adults age 50 and up and the role of family support in overcoming them

BackgroundUsing Online Health Services (OHS) could benefit older adults greatly and could also reduce the burden on the health system. Yet invisible obstacles or barriers appear to impede mass adoption of these services among this population group. The aim of the current research is to provide a qualitative picture of these invisible obstacles and to profile their main features, with special attention to the role of family members in supporting OHS use among this population group.MethodsThis qualitative study entailed a series of in-depth, semi-structured, open phone interviews conducted with 31 individuals age 50 and up in Israel, who constituted a sample of OHS users and non-users among older adults.ResultsFour major themes and primary observations emerge from our data:While older adults are aware of OHS to some extent, they often do not fully understand the specific benefits of using these services;Older adults need to acquire much more experience with OHS use. OHS user interfaces still have a long way to go for older adults to feel comfortable using them. People age 50 and up seem to be less concerned about privacy and security issues than about seemingly more trivial issues such as recovering forgotten passwords;Family members can play key roles in helping older adults adopt OHS by providing technical support as well as encouragement;Older adults have worthwhile recommendations for innovations and policy improvements that would facilitate wider adoption of OHS.ConclusionsThe results of the current study reveal important nuances regarding the importance of awareness, user interface and experience for OHS use among older adults, as well as the critical role of family members in OHS adoption. Based on these findings, we recommend the following: expanding advertising on media channels to emphasize the benefits of OHS use; improving HMO websites to make them more user-friendly for older people; developing HMO-run community OHS guidance programs geared to older people to reduce the gap between required skills and user competencies, thus enabling older people to benefit from OHS use.

Peran Perceived Usefulness dan Perceived Risk sebagai Variabel Pemediasi pada Pengaruh Perceived Ease of Use dan e-WOM Negatif terhadap Niat Pembelian Para Pengguna Aplikasi Layanan Kesehatan Halodoc

Competition in the business world today is increasingly fierce in the era of globalization. Information technology can shift the way of practice and change the way of thinking in the business world. The rapid development of technology makes the economy also increasingly developing. One of them is the innovation in the field of online health services. This study aims to examine the effect of perceived ease of use and negative EWOM on purchase intentions with perceived usefulness and perceived risk as mediating variables in Halodoc health service application users in East Java. This study uses 200 samples with non-probability sampling techniques and the method used is a judgmental sampling. The data collection method is done by distributing questionnaires online. The data analysis technique used in this study is the path analysis technique. Based on the results of research conducted, it was found that perceived ease of use has a positive effect on purchase intentions with perceived usefulness as a mediating variable, and negative EWOM has no effect on purchase intentions because perceived risk does not mediate between these relationships in Halodoc health service applications. Based on these results, it is recommended that Halodoc health service application makers pay attention to the ease of use of the application and the benefits that can be felt by consumers and prospective consumers when using the application so that a positive EWOM is formed to reduce the risks that exist in the application and have an impact on purchase intentions towards health services in the application.

Attitudes of rural communities towards the use of technology for health purposes in New Zealand: a focus group study.

ObjectivesExamine attitudes to using online health and wellness services, and determine what barriers may exist to this in two rural communities in New Zealand.DesignA thematic analysis informed by a social constructivist paradigm explored the attitudes of youth and adults to give voice to these communities. Eighteen focus groups—nine in each region—were held for an hour each, with between three and nine participants in each group.SettingTwo rural areas at the Northern and Southern ends of New Zealand were chosen. In each area, we partnered with a local health centre providing primary care services. Three localities were identified within each region where we conducted the data collection.ParticipantsParticipants were youth aged 12–15 years, aged 16–20 years and adults over 21 years. Overall, 74 females and 40 males were recruited. Recruitment occurred through schools, community organisations or personal contacts of the facilitators, who were youth workers in their respective communities. Ethnicity of the participants was representative of each area, with a higher percentage of Māori participants in Northland.ResultsEight themes were identified which described participants’ attitudes to technology use in healthcare. Themes covered accessibility, cost, independence, anonymity and awareness issues: technology makes health information easily accessible; access to technology can be limited in rural communities; technology can reduce the cost of healthcare but it is too expensive for some; technology increases independence and autonomy of people’s own health; independent healthcare decisions come with risks; anonymity encourages people to seek help online; technology can help raise awareness and provide peer-support for people with health issues; technology impacts on social relationships.ConclusionsParticipants—particularly youth—were generally positive about the role of technology in healthcare delivery, and interested in ways technology could improve autonomy and access to health and wellness services.

Analysis of special ehealth service for corona virus disease 2019 (COVID-19) pneumonia

To analyze how governments, hospitals and information technology(IT) companies use Internet technology to provide online health services during the early stage of corona virus disease 2019 (COVID-19) epidemic in January 2020 in China, and then provide suggestions and coping strategies for the later stage and post-epidemic time. We searched for information on ehealth services related to the outbreak of COVID-19 in China. The sources of information were mainstream search engines such as Baidu and the popular interactive social platforms such as Webchat. The keywords were "Internet+pneumonia", "Internet clinic", "pneumonia online clinic" and so on. The time of information was from January 20 to February 3, 2020. The key information was extracted and encoded by two persons back-to-back. The coding information included: name of organization provider, launching time, location of provider, service items, user, health workers engaging in the service, and so on. The coded information was entered and analyzed with SPSS 24.0 and Excel. There were totally 57 projects launched by local governments, hospitals and IT companies. Most of them were launched from January 24th to 27th, the hospital and government projects services regionally, especially in eastern provinces. In this study, 90.48% of the enterprises and 100.00% of the hospitals had online fever clinic and consultation services for COVID-19, 66.67% of the enterprises and 37.04% of the hospitals serviced derivative health problems. Only a few projects provided tele-medical consultation. There were individual projects that provided online health management for home quarantine people. Physicians were the main force of various projects. In some hospital projects, there were also nurses, pharmacists and professional technicians to provide featured consultation. Ehealth is useful and helpful for the health care system to rapidly cope with health demand during instantaneous and post epidemic time. Regional distribution of ehealth is unbalanced. There are institutional and technical feasibilities for the emergency application of Internet technology. However, community health centers seldom provide ehealth or connect with tertiary hospitals with Internet. Therefore, all kinds of providers within healthcare system should promote emergence ehealth. Tele-medical diagnosis and referral should be developed by local governments during COVID-19. The application of "Internet+medical treatment" in community medical institutions and synergy among various institutions should be promoted.

Research on User’ Continuous Usage of Online Healthcare Services From the Perspective of Affect Appeal

Based on the extended ECM-ISC continuous usage model and integration of the CAC model, a model that illustrates users’ continuous usage of online healthcare services is developed from the perspective of affect appeal by introducing satisfaction and worry variables. The factors influencing users’ continuous usage of online healthcare services in China are closely investigated in the paper. Based on the results of E-mail and Wen Juan Xing website online survey, the empirical analyses of the continuous usage of online healthcare services in China are conducted, utilizing SPSS and AMO. Through the screening of the questionnaires, 521 of the 600 questionnaires are valid. The main results of this study are as follows. Service quality, expectation confirmation degree, privacy concern, satisfaction degree, and continuous use intention are positively correlated with expectation confirmation degree, satisfaction degree, concern, and continuous use intention and continuous use behavior, respectively, while concern and continuous use intention are negatively correlated. It is found in this paper that both satisfaction and concern have a direct impact on users’ continuous use intention and continuous use behavior, and the effect of concern becomes increasingly prominent. Besides, service quality and privacy concern are the core variables affecting satisfaction degree and concern. Based on the above research results, this paper suggests to strengthen the security of user privacy information, and meanwhile, improve the quality of online doctors, which can promote users’continuous use intention and continuous use behavior, and thus further improve the efficiency of the use of health services online and quality medical resource allocation, as well as reduce hospital time and economic cost.