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OBJECTIVE To provide reference for the regulation of electronic prescription circulation under the mode of “medical science + pharmacy”. METHODS Based on evolutionary game theory， a tripartite evolutionary game model was constructed for related parties of electronic prescription circulation （government agencies， internet hospitals and third-party drug platforms） under the mode of “medical science + pharmacy”. The influential factors of the three parties’ strategy selection were analyzed and verified by simulation. RESULTS & CONCLUSIONS The strategic choices of all parties in the game were affected by the other two parties. Reducing the cost of strict supervision or increasing the punishment for the other two parties would increase the probability of strict supervision of government agencies. Enhancing reputation losses， increasing penalties， and reducing the cost difference when choosing different strategies would have regulatory and binding effects on internet hospitals and third-party drug platforms. It is suggested that government agencies can introduce diversified supervision mode and establish an integrated “intelligent supervision + traceability” system； pay attention to the construction of reputation mechanism， and promote the coordinated linkage of all parties； increase the punishment for violations， provide policy support， reduce the cost of compliance behavior to promote the high-quality development of electronic prescription circulation under the mode of “medical science + pharmacy”.
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The internet hospital highly integrates the resources of doctors, patients, hospitals and medical insurance, which is a key measure to promote the effective sharing of medical resources. At present, the types and scope of online diagnosis and treatment services in internet hospitals in China, relevant contract terms, and the responsibilities and rights of third-party network platforms needed to be clarified, and relevant legal regulations needed to be further improved. The author suggestted that the legal relationship between the online diagnosis and treatment provider, the patient and the platform should be sorted out. On the basis of the relevant provisions of the civil code and the detailed rules for the supervision of internet diagnosis and treatment ( trial), it was necessary to further clarify the types and scope of online diagnosis and treatment, improve the rights and obligations of online diagnosis and treatment contracts, prevent and control diagnosis and treatment risks, and strengthen process supervision, to provide reference for creating a healthy, orderly, and safe online diagnosis and treatment system mechanism.
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Thanks to the support of relevant national policies since 2018, Internet hospitals in China had developed rapidly. The authors sorted out the current situation of Internet hospital management and construction in China through policy document search and literature search, and found such loopholes as lack of unified supervision and process supervision, barriers between online and offline one-stop services, obsolete information interoperability and network security technology, and poor doctor-patient satisfaction and treatment efficiency. It is recommended to establish a provincial-level standardized supervision and evaluation system, explore an integrated online and offline medical service system, improve the hospital informationized operation guarantee system, promote the improvement of doctor-patient communication satisfaction system, and further promote the development of Internet hospitals in China.
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Objective To understand the utilization and satisfaction of Internet hospitals among residents in Guangdong Province,and to provide suggestions.Methods A questionnaire survey was conducted to analyze the use of Internet hospitals and the satisfaction among 601 residents in Guangdong Province.Results 69.88%of residents have used Internet hospitals,54.41%of residents used the Internet hospitals founded by large medical institutions,77.70%of residents used online registra-tion or payment services provided by Internet hospitals,and 60.23%of residents have used online consultation services,and 54.91%ofresidents have used information services about hospitals,doctors,and disease.In terms of detailed services,there was a low utilization rate of return visit and drug support of chronic diseases together with telemedicine,and no more than 20.00%of residents used the three services.75.20%of residents were very satisfied and relatively satisfied with Internet hospi-tals and their services,while residents were mainly dissatisfied with return visit and drug support of chronic diseases as well as telemedicine.Conclusion The utilization rate of Internet hospitals among residents was high,and their awareness and satisfac-tion were also high.However,there was still a problem of 15.31%ofresidents who didn't have used Internet hospitals.It is necessary to further strengthen the propaganda and improve the areas of dissatisfaction.Emphasis should be placed on return visit and drug support among patients with chronic diseases,and telemedicine to improve residents'satisfaction and utilization.
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Objective:To analyze the online patient experiences in a public hospital′s internet hospital, and explore the influencing factors, for references for improving the online patient experiences and promoting the high-quality development of internet hospitals.Methods:Gender, age, visiting department, patient experience score, and evaluation text of patients in a public hospital′s internet hospital in 2022 were obtained. The patient experience scores were adopted the Likert 5-level scoring method. Intergroup comparisons were conducted by chi-square test and F-test. Word segmentation processing and word frequency statistics were used to extract high-frequency words in the evaluation text of dissatisfied patient experiences, and semantic network analysis on these high-frequency words was performed. Results:A total of 4 273 patients were included in this study, with a patient experience score of (4.1±1.6) points. Among them, 74.9% (3 199 cases) rated 5 points (very satisfied), and 19.5% (835 cases) rated 1 point (very dissatisfied). There was no significant difference in online patient experience scores among patients of different genders ( P>0.05), while patients of different ages or departments had different patient experience scores ( P<0.05); The top 10 high-frequently words of dissatisfied evaluation were doctor, answer, examination, limited help, ignoring, waste, refunding, registration fee, perfunctory, and closing.In the high-frequency semantic network of dissatisfied evaluations, high-frequency words such as doctor, answer, waste, examination, limited help, and ignoring were strongly correlated with each other. Conclusions:Most patients in an internet hospital were very satisfied with the online patient experience, but nearly 1/5 of the patients were very dissatisfied. The age and department affected the online patient experiences. The dissatisfied evaluations were mainly related to the attitude and professional competence of physicians, as well as the convenience of internet hospital platform and its diagnosis and treatment services.
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Objective:To construct an evaluation index system of perceived service quality for Internet hospitals, and to provide references for scientific evaluation and effective management of such hospitals′ service quality.Methods:Thanks to literature review and expert interviews, an index system was initially built based on the Brady and Cronin model.From August to November 2021, Delphi expert consultation method was used in three rounds of correspondence questionnaire survey, and experts were consulted to assess the importance, familiarity and judgment basis of these indexes. The importance of the indexes was expressed by ± s, and the weight value of each index was calculated using analytic hierarchy process fuzzy comprehensive evaluation method and SPSS Au software. Results:The evaluation index system of perceived service quality for such hospitals included 3 level-1 indexes, namely environmental quality, interaction quality and result quality; and 10 level-2 indexes, namely software platform, service support, social factors, attitude, behavior, professional quality, service effect, service efficiency, service cost, satisfaction; and 30 level-3 indexes. Among these indexes, result quality of level-1 indexes scored the highest weight value(0.337); Software platform, professional quality, service support and attitude of level-2 indexes scored a higher weight values, respectively 0.119, 0.119, 0.109 and 0.109. Of level-3 indexes, reputation of Internet hospitals, service attitude of their doctors and doctor-patient communication skills of doctors online scored a higher weight values, respectively 0.102, 0.057 and 0.055.Conclusions:The index system for Internet hospital perceived service quality evaluation built in this study proved scientific, contributing positively to guiding Internet hospitals to improve their quality and safety management.
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Internet hospitals played a huge role in meeting patients’ medical needs during the COVID-19 pandemic. As a new service model, it also brings new challenges to medical ethics. This paper analyzed the three key elements of behavior: actors, behavior process and action result, and found that apart from ethical challenges such as medical security, data security and privacy protection, different types of Internet hospitals show diversity due to different actors involved. The first type of Internet hospital represented the conflict of interest of doctors brought by the integration of offline and online working modes. The second type showed the challenge of fairness in medical treatment brought by the demand of personalized service provided by medical staff in public medical institutions. The third type manifested the medical security challenges brought by doctors with varying technical levels in an open platform environment. Combined with the current ethical governance of science and technology and the digital transformation of society, this paper put forward some countermeasures and suggestion, such as further clarifying the boundaries of rights and responsibilities of relevant subjects of Internet platform, formulating the code of conduct requirements for medical staff in Internet hospitals, and supervising doctors’ medical practice in Internet hospitals.
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Internet medicine is not a concept of jurisprudence. China's current medical law system mainly focuses on main qualifications of the participants who conduct diagnosis and treatment. This paper focuses on several business models of the core element （diagnosis and treatment） in internet medicine， namely： online health consultation provided by internet medical platform， online diagnosis and treatment by internet hospital， and certain artificial intelligence（AI） medicine products that are specialized for diagnosis and treatment. This paper summarizes the development of these three business models， and analyzes the main problems in their development， including the legitimacy identification of online consultation， the dilemma of the development of internet hospitals， the impact of insufficient sample data on the development of medical AI， and the reverse restriction of regulatory difficulties to the development of internet medicine. The next step of developing internet medicine is to broaden the scope of internet diagnosis and treatment on the premise of medical safety， which will be based on the improvement of current regulatory system. It is urgent to build early risk warning system and supervision/ management mechanism for internet medicine.
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Internet hospital is an online service, diagnosis and treatment platform that relies on the traditional hospital, and it can connect doctors and patients through Internet, providing patients with the whole process of medical service through the integration of online and offline services. To construct children's Internet hospital, the following measures were adopted: Using Internet technology, we constructed a whole process online and offline child service platform; using the concept of health closed-loop management, we carried out core medical service such as online diagnosis and treatment; and based on telemedicine technology, the collaborative medical interaction service between doctors was achieved. We also created our own platform to ensure information security and children's medical experience with the help of system data interaction and cloud technology. Besides, an Internet hospital management system was established to ensure medical quality and safety. The children's Internet hospital can improve not only the medical service efficiency, but also the children's medical experience.
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ObjectiveAs a new mode and format of health care service, Internet hospital has created a convenient and efficient medical treatment channel for patients and promoted more access to high-quality medical resources. In order to better identify patients′ service demands of Internet hospitals and thus meet people′s diversified health needs, refined classification management of service demands of Internet hospitals is implemented by KANO model, so as to promote the improvement of service quality of Internet hospitals and enhance patient satisfaction as well.MethodsBased on the analysis ideas of KANO model, 300 patients were randomly selected from the social pharmacy of an Internet hospital for questionnaire survey and service demand survey.ResultsIn the KANO requirement attribute classification of Internet hospital service items, there were 6 items belonging to charm attribute, 10 items belonging to expectation attribute and 5 items belonging to necessity attribute. Service items corresponding to expected attributes and necessary attributes account for more than 70% of Internet hospital services.ConclusionThe application of KANO model to the service demand survey of Internet hospitals can effectively improve the service management level of Internet hospitals, and the continuous improvement of service quality of Internet hospitals requires regular monitoring of service demand changes.
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Taking building the Affiliated Hospital of Qingdao University into Internet hospital as an example,the paper expatiates on the significance,detailed scheme of building public hospitals into networked hospitals,including aspects like business process,system architecture,management and application,pointing out that the building of Internet hospital is able to promote the reasonable utilization of quality medical resources.
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Clarifying the legal status of internet hospital and the legal relations around of it are of great impor-tance to solve disputes caused by internet medical treatment. Practically,the legal status of internet hospital is sub-ject to change depending on the type of business. In the case of"Ningbo cloud hospital",which is an intermediator of medical in remote consultation;it is one party of the medical contract in physical inspection and examination. It may be one party of medical contract or act as a service platform in remote clinic;and in online registration it is trus-tee of hospital and has no legal relationship with patients.
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After the current situation of Internet medicine in our country was described from the aspects f policy support and mobile Internet-related technologies, the 4 construction models and 4 applications models of Internet medicine in our country were pointed out, and suggestions were put forward for the sustainable and healthy develop-ment of Internet medicine, namely promoting Internet medical service, strengthening guidance of relevant legisla-tions and policies, working out scientific management criteria, and establishing rational supervision organizations.