| Objective: Based on the relationship between Internet technologies and hierarchical medical treatment,this study by investigating the current five representative institutions about “Internet + medical” analyzes the operation of related businesses and the application of Internet technologies,explores the new ways of promoting the construction of hierarchical medical treatment by Internet technologies,discovers the main dilemmas in the integration of Internet technologies and hierarchical medical treatment,and proposes the corresponding suggestions and solutions from the perspective of management.It is hoped that the findings of this survey and evaluation can provide useful theoretical support for relevant health departments in the “Internet + hierarchical medical treatment” work train of thought and management mode and promote the integration of Internet technologies and hierarchical medical treatment.Methods: The types of Internet technology,the condition of related business and the relevant achievement of five institutions including WE DOCTOR,National Medical Big Data Platform(Fuzhou),ZOE SOFT,The First Affiliated Hospital of Xinjiang Medical University and The First Hospital of Fuzhou Medical Association were investigated.The relevant information was mainly obtained by non-structural observation and semi-structured in-depth interviews with 66 persons who in charge of related business in 5 institutions(including the members of the Medical Association)to understand the actual institution's application situation of the Internet technologies,the problems encountered in the application process and the suggestions for improvement.The quantitative data of the members of The Tertiary Hospital and the Medical Association including the development condition of the Medical Association,the basic information of members of the Medical Association and et al were all imported locally through the hospital's database.The collected data was built and analyzed by Microsoft Excel.Results:(1)At present,there are mainly four types of application of Internet technology in hierarchical medical treatment in China: The first is comprehensive service based on the public health.The representative is WE DOCTOR.The second is Medical data storage and process.The representative is National Medical Big Data Platform(Fuzhou).The third is medical information platform.The representative is ZOE SOFT.The forth is remote medical treatment.The representative is CIIMs of The First Affiliated Hospital of Xinjiang Medical University.(2)The First Hospital of Fuzhou created the first medical association in Fujian Province.At present,there are 91 members,forming a three-tiered architecture system based on “city,county,and township”.By the end of 2016,the medical association has received a total of 3810 up-transfer patients and 1601 downtransfer patients.(3)At the end of 2013,The First Hospital of Fuzhou began to explore the application of Internet technologies in the construction of medical association,which mainly includes the development of online channel appointment clinics,the treatment platform of a hierarchical diagnosis,the telemedicine services and so on.(4)The First Hospital of Fuzhou has been fully implementing appointment clinics since 2016.In 2016 and 2017,the number of appointments for outpatient visits through online channels was 7248 and 24619.There was still a large gap from the total number of outpatient visits in the current year.(5)The medical association initially established the treatment platform of a hierarchical diagnosis in 2015.In 2016,a total of 2,852 patients were referred,exceeding the total number of referrals in 2013-2015,especially in the number of hospitalized referral visits.The current referral service in the medical association needs to be completed through the platform,but it still requires the referral paper.(6)As of April 2017,a total of 33 members had carried out some telemedicine services,and there were still some members had not yet started due to infrastructure and other reasons.A total of 12,534 tele-image reports and 15,880 tele-ECG reports were provided by The First Hospital of Fuzhou for the members of the medical association.The construction of the remote outpatient clinic in the medical association is gradually being improved.Conclusion: The First Hospital of Fuzhou Medical Association actively explored the application of internet technology in promoting the construction of grading diagnosis and treatment.Through referral platform and the construction of telemedicine,the medical association basically provided the online referral service and effectively improved the diagnosis and treatment ability of the primary unit and has achieved good results in the construction of hierarchical medical treatment.Through the research,the following problems still exist in the application of Internet technology in the construction of hierarchical medical treatment: The low level of cooperation with the public.The Internet infrastructure still needs improvement.The scarcity of related professionals.The top-level design is not yet complete.And put forward the following solutions and suggestions:(1)To create a good Internet clinical environment and comprehensively improve the public health literacy level.(2)Strengthening Internet infrastructure construction in the medical and health industry and breaking down “Information island” predicament.(3)To strengthen the construction of related professional talent system to improve the accessibility of Internet technology application.(4)Establishing and perfecting the relevant policies and regulations of “Internet + hierarchical medical treatment” to create a favorable policy environment for reasonable and orderly access to Internet technologies. |
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