The reform of Chinese medicine began in 1985, and it has been 30 years since this year. Nowadays, China's medical reform has entered the deep water area, the old problems have not been solved, and new problems have arisen. "Internet +" quickly became a popular word in the society after Premier Li Keqiang presented the "two sessions" in the country. Which industry the Internet is added to will become a hot spot. Standing on the Internet, what opportunities and challenges will be ushered in by medical institutions, how can the Internet be added to medical care, and how is it going to happen? With these questions, the reporter came to Shanghai. Children's Hospital, fortunately, together with Dean Yu Guangjun to discuss the changes and changes in the medical treatment after the Internet. Internet + medical or medical + internet Reporter: There is no hotter word than the Internet at the moment. Where is the Internet+ where there is a new look, what changes will it bring to the medical service sector? Yu Guangjun: The Internet has brought three major changes to medical services. First, it leads to changes in the relationship between doctors and patients. Traditional doctor-patient relationship, doctors are more active, and patients are relatively passive. With the Internet, patients are more likely to access information and participate more in the entire medical activity, which is called patient-engagement in foreign countries. Second, the relationship between doctors and hospitals has also undergone subtle changes. In combination with multi-point practice, doctors will pay more attention to the creation of personal brands, and hospitals will become more and more platform-oriented. Third, the relationship between the patient and the hospital has changed. The patient was originally concentrated in the hospital for medical treatment. In the future, there will be a combination of online and offline medical treatment. Some diseases can be diagnosed and treated remotely and online. Reporter: These three changes have now occurred? Yu Guangjun: No, these changes did not happen in 1-2 years. Maybe there are more people talking about these two years, but the change will not be so fast. From a long-term perspective, this is a development trend. Reporter: You just mentioned that the Internet will bring about changes in doctor-patient relationship, doctor-to-hospital relationship, and patient care mode. Under such circumstances, what is the difference between hospital training for medical staff in the future? Yu Guangjun: For medical staff, we must first learn how to use modern Internet and mobile Internet means to improve the efficiency and quality of medical services. Second, we must also tell them that the use of such means to provide medical services may exist. Safety and risk. For example, some doctors may use the Internet for online consultation and consultation, and even use remote means to deal with it. In the process, let doctors understand the limitations of using the Internet and mobile Internet. Due to the special nature of medical treatment, it is difficult for some diseases to be diagnosed in this way. It still needs further examination. It requires multi-disciplinary consultation. It cannot be treated with a simple look. It is necessary for doctors to have sufficient safety and risk. control. Reporter: Indeed, the Internet will bring a new model to doctors. However, there is a view that the Internet will be subverted like a traditional department store, and future doctors may be replaced by artificial intelligence. What do you think? Yu Guangjun: I don't agree with the first one. The complexity of a large number of diseases cannot be judged entirely by artificial intelligence. The development of medicine will show an individualized trend in the future. Chinese medicine also pays attention to syndrome differentiation. From this perspective, there is still a distance between artificial intelligence and doctors. Second, it is impossible for artificial intelligence to completely replace people. The difference between artificial intelligence and people will go through a very long process to reduce it, at least for the foreseeable two or three decades. However, there are some developments in artificial intelligence. Doctors also use artificial intelligence to make judgments at work. For example, when you are diagnosed, you can look at the knowledge base. You can use Da Vinci robots for surgery. Medicine is a special person. Object, this is still no way to replace it. Reporter: If you must talk about subversion, what do you think will be the real disruptive change in the hospital? Yu Guangjun: In fact, the subversive changes have now been seen. First of all, in the link of the medical service, whether it is an appointment for paid hospital discharge, the services other than the non-core medical business are the most easily subverted and changed. Because this piece has the strongest commonality with other service industries. The second change involves the core service approach. Online consultation or remote consultation will change the core of the medical service itself. This has changed. Medical consultation APP development needs to be standardized Reporter: At present, some platforms can help patients to consult on certain diseases. This form is called “light consultationâ€. What do you think of the concept of “light consultationâ€? Yu Guangjun: “Light consultation†is actually an online medical consultation behavior. Because there is no clear legal provision in this section, it is still a relatively vague area, and it is also on the edge of the law. We are also discussing with the Health Planning Commission whether or not to confirm the nature of this behavior. I think it is a professional behavior, because there is a licensed doctor to provide advice, so as to obtain the fee, but this professional behavior is not compared with the traditional professional behavior, but the advice he provides is also professional behavior. Extension should be recognized as a professional behavior. If it is a practice, it is subject to the "Practitioner's Law" and the "Regulations on the Administration of Medical Institutions". Reporter: What do you think of the development prospects of such platforms? Yu Guangjun: From the perspective of development prospects, I think it should be further regulated. Now it is a disordered state, and there is no way to control its quality and safety. For example, if the medical consultation is wrong, the doctor has to bear the corresponding responsibilities and obligations. In theory, these doctors provide services through an institution or platform, and charge fees. If there is any error or misleading, they should bear legal responsibility. And not just the doctor to bear, this platform should also bear. The nature of this type of platform has changed. It is essentially a medical advisory body or health management agency. The Internet is just one of its means. First, it should supervise its medical counseling behavior, followed by its information security supervision. In the long run, if there is no corresponding mechanism as a guarantee, the day when the quality problem is exposed, the blow to the industry may be fatal. Reporter: On the road to the medical industry , the development of Ali Health is very good. Last year, the “Future Hospital†program was launched. Yu Guangjun: Frankly speaking, I have different opinions on the three-step strategy of Ali Health's “Future Hospitalâ€. Reporter: Tell me what you think. Yu Guangjun: The first step is to establish a platform for mobile services. In fact, it is to transform from the outside, to play the strengths of electronic payment, and to use Alipay to make payments. I think Alipay can be used in Shanghai, but the space is not big, or it is not suitable. For patients, paying for the app with Alipay, if you go to each hospital to download an app, the patient is burdened, WeChat may be more convenient than APP. Our hospital has also developed a similar APP, but we prefer WeChat. From the actual implementation results, WeChat has more than 12 million followers, but the APP may not even be 10,000. From this point, Alipay Payment may be a little worse than WeChat payment. The second step is to change the overall ecology of medical services, focusing on the implementation of electronic prescriptions, which is currently not realistic. First of all, after the drug prescription is transmitted online, the bidding does not take into account that buying a drug is not the same as buying a taxi. Buying a drug is a matter of life and health is not a simple bidding. Drug safety is the primary consideration. Second, in the absence of a solution to the hospital's compensation mechanism, it is very difficult for the hospital to let the drug sell a lot of outflows. It is not impossible to cancel the drug add-on or let the drug sales go out, but the price of the same medical service should be raised. If the price of medical services is not improved and the drug income is taken away, there will be problems in the operation of the hospital. Third, it is not convenient for patients. It is most convenient for patients to take medicine in hospitals. To buy drugs at pharmacies, we must consider transportation costs. Also, in essence, the price of drugs in the hospital, if you do not consider the 15% bonus, the price should be lower than the pharmacy, because the first drug in the hospital does not have to pay the rent, the second does not need to pay taxes. . Shanghai has conducted investigations, and the price of medicines in most hospitals is lower than that of pharmacies. The third step, it says that building a platform for health management based on big data is still far away, and this kind of health management is not just an Internet company can do. It is also true that health management agencies do it, not Internet companies. Reporter: It may still be a technology platform. Yu Guangjun: Yes, so our hospital has also developed the APP, but the main push is to use WeChat as a platform to improve the service process and service experience, and strengthen the interaction between doctors and patients. Of course, we are also doing some specialist APPs, in the short term. If Ali does not change its strategy, our hospital will not consider cooperation. Informatization improves medical treatment Reporter: As far as I know, the Children's Hospital has practiced Internet medical and mobile medical treatment very early. Can you introduce the details? Yu Guangjun: The first establishment is a diversified reservation system, including the use of websites, telephones, WeChat, and self-service machines to make appointments. Second, on the internal process, a one-stop intravenous infusion is made. After the patient pays the fee, he can go directly to the infusion place. Third, this year's pre-diagnosis test, improve the level of pre-examination, reduce the number of patient queuing, which is also welcomed by patients, which is also a typical example of process optimization. Also, using information technology to solve medical quality and safety problems, because children's illness changes faster, we have made some reminders of critical values. For example, after some inspection reports come out, we can use information technology to upload to the tube bed. Doctor there. Because pediatric medication involves doses, allergies, etc., we have made a drug safety reminder, if the doctor opens the wrong, promptly reminded through the computer system. Encouraging policies for children's medication Reporter: "The lack of medical care and medicine is not safe" is the status quo of pediatric development. At present, there are not many children's special medicines for children's hospitals? Yu Guangjun: Compared with adults, there are still relatively few children's dosage forms, which is a very common problem in children's drug application. Because many pharmaceutical companies are not willing to add children's dosage forms or do clinical trials for children when they produce products, which causes children to use drugs to make some adjustments according to their body weight. This is a problem in this aspect, and it is also a problem that the country is currently encountering in children. one. In the United States, the FDA has introduced a policy. If the drug factory adds a clinical trial for children, it can extend the patent protection period. Through this incentive drug company to do clinical trials, we now also call for appropriate incentive policies at various levels through various channels. Otherwise, children will have no drug availability and medication safety problems, because children are not equal to the shrinking adults. During the growth and development process, many organs and functions are immature. In this process, if you simply follow the scale Reduced, there may be problems. Reporter: Yes, child medication safety has always been a topic of social concern. To study and solve this problem, we need data to support it, but some hospitals have reported that they have refused to apply for this data from Shanghai Shenkang Hospital Development Center. You have worked in Shanghai Shenkang Hospital Development Center. You think Shanghai Shenkang What is the reason for the hospital development center's refusal? Yu Guangjun: The main reason for the Shenkang Hospital Development Center is the issue of privacy information, which involves data for each patient. Second, worrying about the tendency of commercialization, will the hospital separate the drug of a certain brand for market analysis and then sell the data to the company. Third, worry about the unified side, only the sales of pharmaceutical companies. Reporter: Today is a big data era. Reasonable use of data can even bring new breakthroughs in solving problems. What do you think should be balanced in terms of data disclosure and security? Yu Guangjun: I feel that we should study and develop some systems to solve the problem of data disclosure and utilization. First, we need to resolve the ownership of the data. Second, under what circumstances, the use of data is compliant. Third, what kind of responsibility the user has to bear. As far as I know, the National Health and Family Planning Commission is also convening some expert meetings to promote the guidance of big data applications. When I participated in the discussion, I proposed that data disclosure is a two aspect of privacy protection. Protecting data security is not open, nor does it mean that when it comes to publicity, it does not care about privacy and data security. How to grasp a degree according to our situation, at the same time define the scene, define the authority, have certain accountability and The actual institutional regulations can be tracked.
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Yu Guangjun: Is there a future for "Internet + medical care"?
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