Five dynasties era
According to the users and service methods, "Internet+medical services" can be divided into three categories:
The first category is telemedicine. Medical institutions use medical personnel registered in their own institutions and information technologies such as the Internet to carry out remote consultation and remote diagnosis.
The second category is Internet diagnosis and treatment activities. Medical institutions use their registered medical staff and Internet technology to directly provide patients with some common and chronic diseases for follow-up visits and family doctor contract services. It is also clearly stipulated that internet diagnosis and treatment activities should not be carried out for newly diagnosed patients.
The third category is Internet hospitals, including Internet hospitals as the second name of entity medical institutions, and Internet hospitals independently set up by entity medical institutions.
Internet hospitals can use doctors registered in this institution and other medical institutions to carry out Internet diagnosis and treatment activities, and Internet hospitals can provide patients with some common and chronic diseases for follow-up visits and family doctor signing services. In addition, when a patient visits a physical medical institution and the attending doctor invites other doctors to consult through the Internet hospital, the consultant can directly issue a diagnosis opinion and prescribe.
Among them, the second and third categories belong to medical institutions providing services to patients directly through the Internet.
It is worth noting that the Administrative Measures for Internet Diagnosis and Treatment (Trial) stipulates that doctors who carry out Internet diagnosis and treatment activities should obtain corresponding professional qualifications according to law and have more than 3 years of independent clinical work experience.
Entry procedures and supervision
Internet hospitals can apply for setting up according to the procedures for setting up medical institutions. Internet hospital, as the second name of entity medical institution, is applied by entity medical institution and registered as required. A medical institution that has obtained the Practice License for Medical Institutions intends to set up an Internet hospital, and its issuing authority shall handle the practice registration in accordance with the relevant provisions of the Regulations on the Administration of Medical Institutions and the Detailed Rules for the Implementation of the Regulations on the Administration of Medical Institutions.
In order to ensure the medical quality and safety bottom line of the new format of Internet medical service, it is required to establish a unified supervision platform in the whole province before allowing Internet hospitals to enter. All medical institutions that carry out Internet diagnosis and treatment activities must be traceable and open their data interfaces to the regulatory authorities.
Clarify the legal responsibility relationship
The three documents clarify the subject of legal responsibility: the subject of Internet diagnosis and treatment is the entity medical institution that provides Internet diagnosis and treatment services. Internet hospitals must first make a request to the local health administrative department, and the landed physical medical institutions and Internet hospitals share the responsibility. The sharing of legal responsibilities between them will bear their respective responsibilities according to the agreement.
Telemedicine services are divided into two categories, one is called remote consultation and the other is called remote diagnosis. At present, remote consultation is widely used, and the invited party only provides suggestions for diagnosis and treatment, and the final decision-making power for diagnosis and treatment is still in the inviting party, so the corresponding legal responsibilities are borne by the inviting party.
At present, many large hospitals are establishing medical associations, in which remote diagnosis is used to solve the problem of insufficient ability of grassroots talents, that is, "primary inspection, superior diagnosis". In this case, both the inviter and the invitee should bear legal responsibility.
Online consultation does not belong to the scope of Internet diagnosis and treatment.
There is indeed a cross between online disease consultation and online disease diagnosis and treatment, but online disease consultation does not belong to the category of Internet diagnosis and treatment.
Internet diagnosis and treatment means that doctors diagnose diseases through information technology such as the Internet and propose treatment plans. If you only provide disease counseling and give some advice such as eating less salt and exercising more, there is no clear diagnosis and treatment, which belongs to the scope of counseling. If you make a clear diagnosis of the disease, tell the patient what medicine to take, or go to the hospital for some treatment, it belongs to the category of diagnosis and treatment, and should be managed according to the management methods of Internet diagnosis and treatment.
How to judge the first-time and second-time patients
Through the regional health information platform and electronic medical record database being established, the docking of electronic medical records and residents' electronic health records can be realized. When conducting online follow-up and prescribing drugs, doctors must master the corresponding medical records of patients, and make it clear that patients have made a definite diagnosis of one disease or several diseases in physical medical institutions, so as to provide follow-up services for the diseases that have been clearly diagnosed.
If you can't find any patient's medical records, you can only recommend the patient to see a doctor in a physical medical institution. After the establishment of electronic medical records, if the next time it is an online follow-up visit for a clearly diagnosed disease, the doctor can provide him with corresponding online services.