With a simple tap on the screen, waiting for consultation, online prescriptions, and home delivery… Currently, six medical institutions in Beijing, including Peking Union Medical College Hospital, Fuwai Hospital, and Xuanwu Hospital, offer “Internet + Health Insurance” services. “Internet diagnosis and treatment” has become increasingly popular in recent years; what can it actually achieve? Reporters found that it is not as simple as hospitals launching their own apps; behind it lies a wealth of exploration and practice by medical institutions, as well as strategic planning for the future.
Experience: Medications and Receipts Delivered Across Thousands of Miles
Mr. Liu, a cardiovascular patient in Xinjiang, registered through the “Zhangshang Fuwai Hospital” app, uploaded his previous examination data, and quickly received detailed guidance from experts in Beijing. Due to the lack of local medications, Fuwai Hospital carefully packaged all the required medications, along with the prescription and receipts, and mailed them over two thousand kilometers to his home.
Ms. Fu, who lives in Yanshan and has visual impairments, utilized the upgraded “Beijing Yanhua Hospital” app to independently complete her online consultation without any assistance, making medical care no longer the biggest challenge in her life.
Mr. Wang, who suffers from cerebral infarction and hypertension, was treated at Xuanwu Hospital and his condition stabilized after discharge. Recently, he noticed he was running out of medication and used the “Zhangshang Xuanwu Hospital” app to inform his attending physician of his condition and request a refill. This request was quickly fulfilled. Even more surprisingly, the delivery person not only brought the medications to his doorstep but also carried a health insurance payment terminal, allowing Mr. Wang to settle the payment directly with his health insurance card, eliminating the need to visit the hospital for payment. Similarly, through this app, patients who had trouble sleeping could initiate consultations late at night and receive responses from doctors by four in the morning…
Cross-regional, barrier-free, real-time settlement, and available around the clock… With the wings of technology, many hospitals in Beijing have been continuously increasing their exploration of internet diagnosis and treatment services in recent years. Various previously unimaginable medical scenarios are gradually becoming a reality. More encouragingly, since March 2 of this year, when Beijing Yanhua Hospital first launched online diagnosis and treatment with health insurance reimbursement, five other hospitals, including Fuwai Hospital, Beijing Changfeng Hospital, Xuanwu Hospital, China-Japan Friendship Hospital, and Peking Union Medical College Hospital, have joined this initiative. The collaboration between online diagnosis and health insurance has given the entire process a more comprehensive and profound significance.
Regulation: Video Verification of Patient Identity and Full Record of Online Communication
To enjoy the convenient online diagnosis and treatment services, patients and hospitals may only be separated by a simple app. However, to create a good communication “window,” each hospital has conducted long-term and complex considerations and deliberations.
“It’s definitely too late to rush things at the last minute,” said Li Jia, deputy secretary of the Party Committee at Xuanwu Hospital. As early as 2018, Xuanwu Hospital began designing the functional modules of its official app and refining specific processes. By the end of 2019, the app officially started to be used, integrating various functions such as guiding consultations and appointment scheduling.
Other hospitals that have implemented “Internet + Health Insurance” services have similar situations. “Actually, the network technology is not an issue; it was just that we hadn’t done it in the medical field before,” said Yang Weixian, deputy director of Fuwai Hospital. “Driven by the pandemic, Beijing has also introduced corresponding policies to add online consultation functions to the app, and even subsequent health insurance reimbursements, which can be said to be a natural progression.”
From a safety perspective, it has been found that currently, all hospitals’ online diagnosis and treatment platforms only accept follow-up patients. Prescriptions must be reviewed by pharmacists before dispensing, ensuring that the quality of service is no different from that of physical hospitals.
In terms of identifying follow-up patients, Fuwai Hospital’s criteria are slightly broader than those of other hospitals. “Even if the first visit is not at our hospital, as long as the patient has undergone formal treatment or examination for cardiovascular issues in the past and can provide data such as electrocardiograms or echocardiograms, they will be considered a follow-up patient,” Yang Weixian explained. As a specialized cardiovascular hospital, a significant portion of Fuwai Hospital’s patients are referred from other facilities. Since the launch of online consultations, among nearly ten thousand consultations, 55.3% have been from out-of-town patients, fully reflecting the hospital’s specialty.
In terms of information regulation, all hospitals have implemented measures such as video verification to ensure patient identity. Additionally, all online communications between patients and doctors can be fully recorded. “For example, if a doctor tells a patient, ‘You can just register with me, and I’ll give you a quick response,’ and then the patient registers again, I can give you another quick response,” Li Jia illustrated. Since consultation fees can be settled in real-time through health insurance, doctors are also financially incentivized, which in some respects can be considered a form of insurance fraud. “We have considered how to regulate similar situations, and we can say that we have thought it through very thoroughly.”
Consultation: Doctors Utilize ‘Fragmented’ Time, Hospitals Switch Seamlessly Between Online and Offline
Investigations reveal that the “Internet + Health Insurance” services of the six hospitals are generally consistent in terms of safety and regulation. However, they each explore different models for specific operational aspects based on actual conditions.
For instance, how do doctors conduct consultations through the app? Beijing Yanhua Hospital perhaps exemplifies the seamless integration of online and offline services most thoroughly—”Patients open the app, and if they register through the ‘Video Consultation’ module, they are making an online appointment, while if they register through the ‘Appointment Registration’ module, they are making an offline appointment. Once both methods fill the doctor’s appointment slots, registration stops,” said Shao Xuecai, deputy director of Yanhua Hospital.
When doctors are on duty, the first patients are those who come in person, followed by online patients, for whom the doctor switches to the online platform for video consultations. “The only difference in the entire process is whether the patient comes to the hospital or not,” Shao Xuecai admitted. Considering that video consultations are just starting and the volume is not very high, they have not differentiated between online and offline queues. Of course, this model requires customer service to contact online patients in advance to inform them of the approximate consultation time and remind them to pay attention to the invitation information to enter the consultation room promptly, ensuring a smooth consultation process.
Xuanwu Hospital and Fuwai Hospital focus on utilizing doctors’ “fragmented” time, adopting a combination of voluntary participation and incentives, requiring doctors to register on the app’s “doctor side.” When a patient initiates a consultation, doctors receive notifications and can respond to patient needs during their free time. Currently, more than 200 doctors from both hospitals have registered on the doctor side.
For each registration, the “valid period” for patient consultations is 48 hours. If the doctor does not respond within that time, the registration fee will be refunded. Yang Weixian explained that this is because online consultations are primarily for follow-up patients with chronic conditions, whose situations are not urgent. Additionally, some follow-up patients may need to undergo examinations after inquiries, and if the results come in during that time, they can directly show them to the doctor without needing to register again.
Currently, Xuanwu Hospital limits the number of appointment slots available for each doctor per day for online consultations, while Fuwai Hospital does not impose such limits, which may be optimized as development progresses. “Currently, the total number of online consultations across the hospital is about twenty to thirty cases per day, and we haven’t heard of any doctor being overwhelmed,” Yang Weixian stated. In the future, if certain doctors experience excessive consultation volumes, they will consider team-based approaches to share the workload.
In the medication delivery segment, both Yanhua Hospital and Xuanwu Hospital have chosen to partner with SF Express, with delivery personnel carrying payment terminals to deliver medications while settling health insurance payments. Notably, Yanhua Hospital launched a free home delivery service during the pandemic, and since March 2, over 170 cases of medication have been delivered to patients without charging delivery fees.
Fuwai Hospital has implemented an extended prescription delivery service, allowing health insurance patients to have medications delivered to nearby pharmacies associated with health insurance. When patients go to pick up their medications, they can settle payments at the pharmacy. For self-paying patients or those needing receipts for reimbursement, the hospital can package medications, prescriptions, and receipts and mail them via EMS.
According to media reports, Changfeng Hospital has partnered with Dingdang Pharmacy to leverage its smart pharmacy and logistics delivery system to provide either pharmacy pickup or home delivery services.
Outlook: Saving Medical Resources and Expanding Coverage from Follow-up to First Visit Patients
After implementing “Internet + Health Insurance” services, hospitals have also summarized future challenges and areas for improvement. For example, the medications available at external pharmacies may not fully match those at hospital pharmacies, and there are certain limitations in logistics delivery. However, the most frequently mentioned issue remains the medical habits of the general public.
Will patients feel secure with doctors on the other side of the screen? Shao Xuecai admitted that changing perceptions cannot happen overnight and must be cultivated through sustained effectiveness. “Under the premise of a clear diagnosis, follow-up patients who come to the hospital are mostly there just to get prescriptions; online consultations are a way to save medical resources.”
In Yang Weixian’s view, especially in major cities like Beijing, Shanghai, Guangzhou, and Shenzhen, many patients seen in tertiary hospitals are referrals. “From equipment to basic technology, there is a nationwide push for standardization. Internet diagnosis and treatment is about replacing tasks that can be done online with in-person consultations, which is risk-free and very convenient.”
His ideal scenario for chronic diseases like cardiovascular issues is as follows: patients first use online consultations to understand whether they have any diseases. If the doctor suspects a condition, they will recommend the patient undergo relevant examinations. These examinations can be completed at primary hospitals, and there may be no need to travel to Beijing. Once a disease is confirmed, the doctor can guide the patient on how to intervene, and if it is necessary to visit Fuwai Hospital for in-person consultation or hospitalization, an appointment can be made, and a corresponding green channel will be arranged.
Li Jia further envisions that in the future, online consultations will not only cover follow-up patients but also first visit patients, meaning that internet diagnosis and treatment platforms will truly evolve into parallel entities with physical hospitals. “This also depends on how far technology can develop. It is already possible to remotely control robots to perform surgeries. Will it be possible in the future to develop tools that can perceive changes in patients’ physical signs just like human hands? It’s truly exciting to think about.” (Reporters Wei Jing and Song Xi)