Text and pictures provided/Zhang Jinjian
By September 24th, the number of confirmed cases in COVID-19 was as high as 3 1889768, and the death toll had exceeded 970,000. The epidemic situation is fluctuating, although it has slowed down slightly, but the epidemic situation in India, Brazil and other countries is still tragic. Fortunately, in Taiwan Province Province, Qixin has been fighting the epidemic all over the country, and the epidemic situation is relatively stable. Under the epidemic situation, many people are worried about the risk of infection when they go to medical institutions, so that the number of people who go to special medical institutions for medical insurance is immediately reduced. According to the statistics of the health insurance department, from June to June this year, compared with the same period of last year, the overall outpatient volume decreased by 8.1%(15.56 million person-times).
In addition, according to the analysis of medical insurance death surrender data, there were 86,252 deaths in June this year, which was 1 .49% lower than the 87,533 deaths in the same period last year. In other words, although people reduced the number of medical visits during the epidemic, it did not cause more deaths. Facing the threat of epidemic situation, washing hands frequently, wearing masks and keeping social distance greatly reduced the probability of disease transmission, and even the phenomenon that China people like to go to the hospital for medical treatment was reduced.
During this period, I also witnessed the strict control measures of the hospital. The number of accompanying family members and visiting relatives and friends has decreased, and the number of mild patients has also decreased. However, in the face of chronic diseases and some acute and severe patients (including cancer), we still have to take care of them wholeheartedly and cannot discount them. Has our medical behavior changed? How to deal with and adjust these people who really need to see a doctor urgently needs to be seriously faced and solved. The following points are discussed with readers.
Epidemic prevention and medical care should be given consideration. How to give consideration to both?
The epidemic has not only brought a serious impact on the global economy, but also seriously affected the epidemic prevention, quarantine, diagnosis and treatment and nursing of medical systems around the world, and the medical response measures in various countries have changed greatly. Under the severe test of strict epidemic prevention and uninterrupted medical treatment, digital technology plays a key role in how to accurately manage medical institutions and how to reassure patients about treatment, which is testing "* * * units", "medical institutions" and "patients and their families". As far as epidemic prevention is concerned, epidemic prevention can be implemented through mobile phone positioning, mask map and emergency notification system; In terms of medical treatment, several advanced countries, including Europe, America, Japan, South Korea and Taiwan Province Province of China, have urgently loosened the relevant regulations on telemedicine (which used to be limited to outlying islands and remote villages), so that isolated or specific patients can receive telemedicine at home to avoid the risk of nosocomial infection.
According to the definition of the World Health Organization, the so-called telemedicine is a kind of "using interactive video and ICT (information and communication technology) technology to carry out medical care behaviors including diagnosis, treatment and consultation, as well as the transmission of health education and medical consultation". In short, "telemedicine" refers to transforming the traditional "face-to-face" physical consultation between doctors and patients into "online (or digital) interaction", including the use of remote communication tools such as video or voice calls, e-mails and short messages.
Germany and France are relatively mature in this respect, and they are both included in the national insurance plan. Italy cannot implement telemedicine in this respect, because there is no insurance payment, which may be one of the reasons why the Italian epidemic is difficult to control. As for the protection of personal privacy, Taiwan Province Province, Germany, France, Japan, South Korea and the United States all added new provisions in the bill to reduce unnecessary panic. The main services of telemedicine include: (1) virtual consultation, (2) digital auscultation, (3) digital pharmacy and (4) remote nursing, which can digitize medical behaviors and replace some physical medical models. How to combine IOT devices? Generally speaking, it is beneficial to improve the quality of medical care and reduce the waste of medical resources to ask the doctor online first and then go to the hospital when necessary. In addition, Chengda Hospital can also use artificial intelligence technology (AI) to interpret pneumonia lesions in a short time and list them on the website of the World Health Organization, which attracts worldwide attention and can be described as the light of Taiwan.
In a word, the cooperation between AI (artificial intelligence) and people can reduce medical manpower, including simulation training, assisting clinical decision-making, intelligent consultation, disease prediction and even helping image interpretation. Secondly, with the development of Internet of Things (IoT), artificial intelligence (AI) and 5G technology, continuous physiological monitoring becomes easier, and the management of chronic diseases and sub-health status will be more efficient. In the future, "decentralized" medical care will become the mainstream. In fact, this epidemic is a living example of the digital transformation of health care.
In a word, the cooperation between AI (artificial intelligence) and people can reduce medical manpower, including simulation training, assisting clinical decision-making, intelligent consultation, disease prediction and even helping image interpretation. Secondly, with the development of Internet of Things (IoT), artificial intelligence (AI) and 5G technology, continuous physiological monitoring becomes easier, and the management of chronic diseases and sub-health status will be more efficient. In the future, "decentralized" medical care will become the mainstream. In fact, this epidemic is a living example of the digital transformation of health care.
Has medical behavior changed?
In addition to telemedicine and digital transformation, the abnormal phenomena of frequent visits to hospitals, too many accompanying patients' families and too long hospitalization time have also changed significantly. Others such as online consultation, online learning, online teaching and video conferencing are becoming more and more common.
How to carry it out continuously depends on the understanding of * * * *, medical institutions and the people of the whole country, and it is necessary to formulate substantive measures and norms. Otherwise, after the epidemic, we will recover to the original state and return to the original point, and we will not get the lessons we deserve, and good medical behavior will not become the norm.
Telemedicine in the United States can be used for reference
Take the United States, a leading country in telemedicine development in the world, as an example. Before the outbreak of the epidemic in the United States, medical insurance had provided some telemedicine project benefits, such as doctors can evaluate photos uploaded by patients. With the outbreak and warming of the epidemic, President Trump announced the expansion and relaxation of medical insurance telemedicine services, allowing users and medical institutions to use communication software such as FaceTime, Facebook Messenger, Google Hangouts or Skype for remote diagnosis and treatment. In response to this new type of coronary pneumonia epidemic, the US FDA issued emergency measures on March 20, 2020, relaxing the remote monitoring equipment originally used in medical institutions. Such as electronic thermometer, oximeter, respiratory monitor, electrocardiogram, non-invasive sphygmomanometer, electronic stethoscope and some software (such as ECG software) that can assist clinical decision support. , can be used for home measurement, through remote medical monitoring and automatic data transmission, reduce the risk of infection when people go to the hospital, and at the same time reduce the burden of medical staff and medical institutions.
In response to the epidemic, the Ministry of Health and Welfare has also expanded the scope of application of the original "Communication Diagnosis and Treatment Measures". Home isolation or home isolation with quarantine and epidemic prevention conditions can carry out communication diagnosis and treatment, and relaxed the use regulations for medical institutions and newly diagnosed patients. However, as the epidemic situation slows down, it is still uncertain whether telemedicine can be expanded into a new option for the general public in the future, which will become a topic of concern for medical practitioners and the whole people.
The role and challenge of telemedicine in this epidemic, Robin Ohannessian, a French telemedicine expert, pointed out in JMIR Journal of Public Health that France used telemedicine in this epidemic and adopted mature video consultation, which played a very good role. Due to the progress of science and technology, there are high-speed internet and widely used mobile phones (mass communication *** artphone), and the price is reasonable, which is paid by the state. Although the epidemic situation is tense and medical manpower is insufficient, patients can get very effective video consultation at home. The conceptual framework and flow chart of telemedicine in COVID-19 are as follows:
At the time of this epidemic, although telemedicine has its advantages and wide application prospects, it still faces many challenges and difficulties. There are seven projects here:
How to incorporate telemedicine into internationally recognized guidelines for handling public health epidemics?
When the public health situation in every country is tense, the norms and payment mechanism of telemedicine must be clearly defined and implemented smoothly.
The epidemic situation in each country is different, and the severity in each region is also different. How to formulate a set of concrete and feasible flow charts, including clinical guidelines, patient triage, automatic consultation questionnaire, patient remote monitoring system, etc., should be strictly defined and standardized.
How to transform the traditional mode into a public acceptable telemedicine mode (including outpatient remote consultation, online expert consultation and remote patient monitoring system, etc.). ).
How to educate people with appropriate and concise toolkits or instructions, so that people can know and understand the related matters of telemedicine, so as not to cause panic and complaints instead.
All data collection and analysis should be fully communicated between medical institutions and epidemiologists to gain knowledge and cooperation.
All research or results related to epidemic diseases should be based on "empirical medicine", conform to ethical norms, and protect the privacy of patients.
What changes have taken place in the field of medicine and health after the outbreak?
(1) After the epidemic, the application of "big data thinking" and "big data application" in urban and rural governance in China's counties and cities will be paid more attention: after the test of this epidemic, the traditional governance methods will be accelerated, and the big data governance covering major disease early warning, big health management, local industrial development management, industrial supply chain integration and many other links will be continuously strengthened and will develop in a more refined and transparent direction.
(2) The acceleration of scientific research and innovation brings new development opportunities: In response to this epidemic, national and local * * *, research institutions and related enterprises will launch brand-new scientific research and development plans, which can accelerate the derivation of new technologies or new products in a short time and further promote the transformation of scientific and technological achievements into substantive services.
(3) The integration of Biotechnology (BT) and Information technology (IT) has entered a new realm: during the epidemic spread in COVID-19, digital technologies such as mobile Internet, 5G, artificial intelligence and virtual reality appeared. It has been widely used in medical and health industries such as virus traceability, drug research and development, epidemic situation judgment, diagnosis and treatment, and further promotes the development of new fields such as telemedicine, intelligent medical robots, intelligent research and development, and intelligent medical care, so as to realize personalized precise health or precise medical care.
There will be three major changes in the digitalization of biomedical industry.
Mr. Su Jiarui, the host of KPMG Anhou Jianye Health Care and Biotechnology Industry Service Team, believes that there will be three major changes and development trends in the digitalization of biomedical industry in the future:
(1) Changes in communication between doctors and patients: Because of avoiding close contact, many examinations, activities, meetings and medical treatments will be reduced or cancelled as much as possible, and online learning, online consultation, online meetings or telemedicine will be switched.
(2) Changes in medical behavior: How to diagnose, prescribe, deliver drugs and pay fees by remote and digital methods during home isolation, and the establishment of relevant laws, regulations and systems will be the focus of digital health IT development in the future.
(3) Changes in medical ecology: How to establish the connection between medical big data and industrial information, the expansion of online and physical channels, how to establish a medical ecosystem and innovative industrial models are also the future direction of change.
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As Professor Li, director of health insurance, publicly stated on August 16 this year, the epidemic swept the world and the people of Taiwan were United as one. All measures were deployed in advance, and the epidemic prevention work was very successful. The role of community pharmacies has been emphasized. Through the "mask real name registration system", the "mask chaos" was lifted and the contribution of community pharmacies was witnessed. The implementation of "separation of medicine" in the future should be expected. In addition, from 20 17, * * * actively promoted "graded medical care", which was fully demonstrated during this epidemic and achieved the expected results. Large medical centers are allowed to focus on the treatment of "urgent, serious, difficult and rare" refractory patients, while clinics and regional hospitals take over mild cases and perform their respective duties. In the future, they will focus on prevention and health care, and minimize medical care unless necessary.
In a word, information and communication technology, biotechnology and medical technology have made great progress in 2 1 century. How to integrate and cooperate is bound to make a comeback in the future big health industry. The establishment of decentralized preventive medicine, graded medical care and intelligent health should be the main trend of medical care in the future.