By Ma Yuan & Ma Jun

Research Report Vol.20 No.3, 2018

Online medical service means the provision of such services as health education, disease prevention and treatment and online prescription by using Internet technology, and the new medical model of assisting diagnosis with AI technology. It breaks the “enclosing wall” of traditional hospitals, expands the service radius and blazes a new path for widening the access to medical care at the grassroots level. Recently we conducted a survey of more than ten online medical organizations in Beijing and Yinchuan, and found that while online medical service has become a hot area of innovation, the auxiliary systems are far from complete and regulatory innovation has to catch up quickly.

I. Online Medical Service is a New Model Complementary with Traditional Medical Services

As Chinese residents have more health demand, there is a growing trend in recent years that patients are transferred from rural areas to cities and from grassroots hospitals to level-3 ones, which reveals the shortage and uneven distribution of high-quality doctors. Online medical organizations provide a model whereby the doctors and patients can communicate across regions “screen to screen”, which complements the traditional “face-to-face” model and has primarily formed its unique features in many aspects.

As a new type of medical organization, online medical organization has become a platform matching doctors with patients. In the traditional medical model, which features the “doctor - hospital (clinic) - patient” pattern, the hospital (clinic) is the center and the patient registers and finds the doctor for face-to-face diagnosis at a fixed location. But in the online medical model which features the “doctor - online platform - patient” pattern doctors from different places can provide online medical services for patients from different places. Compared with traditional hospitals, the online platform provides “online medical information service” and other services like online payment, or, in other words, it provides the online space for doctor-patient communication. It is a new type of online medical organization different from the brick-and-mortar type.

Like traditional medical organizations, online medical organization should strengthen the doctor qualification inspection and daily management. The Law of the Peoples Republic of China on Medical Practitioners requires doctors to pass the national exam and obtain the qualification and practicing certificate. Online medical platform should set conditions for the doctors to join in. For instance, they should be doctors-in-charge or have higher titles and have worked for more than five years, and should provide their qualification certificate, practicing certificate, ID card and bank card information. The platform will check with the medical organization where the doctor used to work in and organize mock exams for professional evaluation in order to ensure the quality and competence of the doctors. At present, some platforms have close to 200,000 doctors, who accounts for 6% of all medical practitioners in China. The platform is also trying to establish the doctor credit system and blacklist system.

Online medical organizations specialize in health consultation and the subsequent visit for common and chronic diseases, forming online-offline complementarity with traditional medical organizations. Its services include diagnosis, test and treatment. With the development of telemedicine, diagnosis can now be realized online, and treatment plan for common disease like skin disease can be provided online based on remote observation. For the hundreds of millions of patients of chronic diseases[]①, such as cardiac-cerebral vascular disease, diabetes and cancer, who have been to the hospital for first visit, they can contact the doctor online for follow-up visits. For blood disease and bone disease, the patients can reserve tele-consultation with experts based on the blood and urine test, CD and NMR results from the local hospital, thus saving the cost of traffic, accommodation and nursing. In particular, the online platform boasts wide coverage and precise information offering, and has obvious advantages in health education and medical consulting for the patients[]②.

Online medical organizations empower the traditional medical system by providing AI-assisted diagnosis system and big data-based analysis and solutions. The doctor’s competence depends on the accumulation of knowledge and experience, and those in remote areas have uneven skills. With the breakthrough in assisted diagnosis technology, the accuracy rate of AI-assisted diagnosis system has reached 90%, 95% and 97% for the early screening of esophagus cancer, pulmonary nodule and diabetic retinopathy, and some enterprises have worked with grassroots hospitals to lower the misdiagnosis rate. Besides, the online medical platforms have gathered millions of doctors, hundreds of millions of patient cases and their feedback, providing the data foundation for disease analysis, monitoring, prevention and policy formation with big data technology.

II. Progress on Online Medical Regulation System and its Challenges

The medical regulation system was established because of the serious information asymmetry among the doctors, hospitals and patients. To ensure medical security, the current medical regulation system urges and guides medical organizations to fulfill their responsibility for doctor management, regulation of diagnostic and treating behaviors, and medical quality management. But the new model of online medical service poses a challenge to the local regulatory system, which should be reshaped urgently.

The series of policies implemented on a trial basis earlier accumulated experience for online medical regulation. Regarding telemedicine, the National Health and Family Planning Commission (NHFPC) issued the Opinions on Pushing Medical Organizations to Provide Telemedical Services in 2014, which encouraged medical organizations to invite others to provide diagnostic and treating support through information technology, and required them to improve the measures of ensuring medical quality and security, so as to push quality medical resources down to grassroots levels. Regarding multi-point medical practice, NHFPC issued the Notice on Printing and Distributing Several Opinions on Promoting and Regulating Multi-point Medical Practice by Doctors in 2014, which specified the conditions for multi-point practice (e.g. mid-level title and five-year practicing experience), explored registration management, and defined the boundary of HR management and medical responsibility, making it possible for doctors to provide medical services online. Regarding tiered diagnosis and treatment, the General Office of the State Council issued the Guiding Opinions on Promoting the Tiered System of Medical Diagnosis and Treatment, which proposed to stimulate the vertical flow of medical resources with IT means, starting with the tiered diagnosis and treatment of common diseases, frequently-occurring diseases and chronic diseases. These policies indicated that the nation is paying attention to institutional establishment and IT application in order to push medical resources downward and make their distribution more efficient.

But we noticed that some irresponsible doctors may abuse or take advantage of the online medical model because it means separation of the doctor and patient and communication happens in the virtual space. Detailed rules or requirements are lacking at the moment as to how to regulate the activities on the online medical platform, related to diagnosis and treatment, e-prescription, medical quality, accidents and disputes, and privacy protection, while motivating its innovative development. These are reflected in the following aspects.

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