General Secretary Xi Jinping pointed out that it is necessary to use big data to promote the protection and improvement of people's livelihood, promote "Internet + medical", etc., and continuously improve the level of equalization, inclusiveness, and convenience of public services. In recent years, Internet medical services have developed vigorously. Online consultation, telemedicine and other medical services have promoted effective allocation of medical resources. From large hospitals as the center and patients waiting for service in the past, to patient-centric and collaborative network services, Internet healthcare is accelerating the realization of the co-construction and sharing of high-quality medical resources to meet the individualized medical needs of different groups.

In Yinchuan First People's Hospital, patient Ma was found to have enlarged mediastinal lymph nodes, which basically ruled out the possibility of lung malignant tumors, but it was impossible to clarify the cause. With the help of the doctor in charge, Ms. Ma applied for the remote expert clinic of Dr. Zhong Xu from the Respiratory Department of Peking Union Medical College Hospital through the Internet consultation platform. Zhong Xu looked at the medical records uploaded by the local doctor and initially judged that the patient's problem was caused by tuberculosis. Ms. Ma said that it only took less than half an hour to see the big experts in Beijing on the Internet. If this is to go to Beijing, it will increase the cost of transportation and accommodation. Now I don’t know whether it is registered or not.

Patients run less errands

Effective allocation of resources, greatly reduced costs

Online consultation means that doctors provide diagnosis and treatment services to patients through the Internet. The doctor asks the patient's medical history in detail online, checks the necessary inspection reports, and gives a diagnosis and treatment plan. At present, online consultations are mainly based on follow-up consultations and consultations, that is, patients who have already gone to the hospital for treatment can solve the follow-up rehabilitation and treatment on the Internet; when lower-level hospitals and doctors encounter difficult cases, they can use the Internet to superiors The doctors of the hospital initiated a consultation request and obtained the diagnosis and treatment opinions of superior experts.

Liu Yinglong, chief physician of the Department of Pediatric Cardiac Surgery of Beijing Anzhen Hospital, provides post-surgery consultation services for pediatric patients through an Internet appointment appointment platform. The platform has invited tens of thousands of pediatric experts from tertiary hospitals to station, and through big data and lean medical treatment, pediatric resources can be more effectively allocated.

For patients, the first consideration for online consultation is the expert, followed by the cost. The cost of online consultation varies with the level of experts. Because Beijing and Shanghai gather the top experts in the country, the average consultation fee is also significantly higher than that of other regions. According to a survey, the average consultation fee is 147 yuan in Beijing, 138 yuan in Shanghai, and only 30 yuan in Hebei. In most online consultations, both doctors and patients are not in the same city, and the time and economic cost of seeing a doctor in different places is much higher than the average cost of online consultations.

"In the 10 years from 2006 to 2015, Internet medical care can only provide online consultation, not provide diagnosis, let alone give prescriptions. For medical care, diagnosis and treatment are the core, and Internet medical care must further provide patients with better It is more convenient, and you must enter the field of diagnosis and treatment." Said Wang Hang, founder of Good Doctor Online. At the beginning of 2015, the National Health and Family Planning Commission clarified that online consultation is a strict medical practice, and the main body of the service must be a medical institution, that is to say, a medical institution must be licensed to become a hospital in order to make further use of the Internet in the field of diagnosis and treatment. The role of. In 2016, Good Doctor Online cooperated with Yinchuan Municipal Government to build Yinchuan Smart Internet Hospital, which moved from the field of online consultation to online consultation, and accepted the full supervision of the medical management department.

Wang Hang believes that online consultations are generally suitable for three types of patients: First, follow-up patients. After the first offline diagnosis, the doctor is familiar with the patient's condition. After the patient returns home, he can communicate with the doctor online, renew the medication, and upload the inspection data through the Internet. Ask the doctor to give a diagnosis and treatment plan remotely. The second is patients who need consultation, which is also in line with the general trend of national graded diagnosis and treatment. The third is a small number of first-visit patients. Currently, only a few online first-visits for simple diseases, such as dermatitis, eczema, and acne, are open. For relatively complex diseases, Internet hospitals will arrange appropriate hospitals for examinations and face-to-face consultations for patients.

Doctors "sticky" online

Conducive to the formation of word-of-mouth, mutual promotion online and offline

Lin Zhimiao, the deputy chief physician of the Department of Dermatology and Venereology of Peking University First Hospital, registered and authenticated on the Haodafu website, and submitted the doctor’s qualification certificate, doctor’s practice certificate, title card, ID card and other documents. After completing the multi-point practice record, he became a good doctor online Yinchuan Wisdom An online practicing doctor in an Internet hospital. He said that from the current policy, multi-point practice does not require the consent of the original unit. However, he told his employer that it has become well-known on the Internet, and many patients will come here admiringly, and they will promote each other online and offline and will not affect offline work.

Internet medical care has changed the relationship between doctors and hospitals. Internet celebrity doctors have formed a brand on the Internet, driving a discipline in reality. Dr. Shang Aijia from a hospital focuses on relatively rare complex spinal cord diseases. After a good reputation among patients through the Internet consultation platform, the number of patients with spinal cord diseases has greatly increased.

互联网对于医生的“黏性”在于，为患者匹配最适合的专科医生，相当于医院的“分诊台”。医生在线上问诊，能找到他们最想要看的病例，减少了大专家看小毛病的无奈，积累了有效病例。不少专家感叹，以前一年看的有效病例不如现在一个月多，这就是“互联网+医疗”的威力。

互联网问诊平台根据医生职业所长，设置专业标签，标注学术方向，从患者中筛选专科病例，让医生和患者精准匹配，避免高射炮打蚊子。

医生为了积累专业病例、提高自身水平，需要借助平台提高知名度，同时为了避免患者给差评影响美誉度，也会更加关注自己的工作细节。一位医生说，以前靠口口相传，现在靠网络。在医术之外，在线上线下都要保持良好的态度，才能得到网上的好评。

医生愿意“黏”在网上的另一个原因是为了提升工作效率，避免重复劳动。好大夫网站对同类疾病的患者进行分组，医生把科普文章直接发到相应群组，帮助患者了解疾病知识、配合治疗。一位医生感叹，同样内容以前至少说50遍，还有好多患者不知晓，现在只要在网上说一次就可以了。

在线问诊靠不靠谱，关键是看医生是否靠谱。部分互联网问诊平台对入驻的医生实行“三证一卡”的注册认证体制，所谓“三证一卡”，是指医生注册平台必须提供医师资格证、执业证书和身份证进行身份和医师资格的认定，同时提供银行卡信息，确保医生信息的真实性；部分平台采取邀请制，要求入驻平台的医生必须是三甲医院主治以上职称的医生，同时以随机抽查、不定时对问诊问题发起呼叫或者审核交流的方式进行监督，如果有医疗质量问题，医生随时会被下架。

从统计数据看，线上平台误诊占比远比线下低，医生在线诊断，只有基于确定的证据才会给出判断，如果没有相应的检查结果，医生在线上只会给出诊疗建议。在线平台全程可以追溯，如果是医疗质量的问题，邀请第三方仲裁评价医生，对责任进行认定。平台一旦发现医生有不合理的行为，也会坚决处理。

监管不放松

电子记录有“迹”可循，信用体系正在完善

互联网医疗打破空间限制，很多人认为互联网医疗风险太大。其实，承担医疗责任的法律主体在哪里？这才是迫切需要解决的问题。

复旦大学医院管理研究所所长高解春认为，互联网医疗不会因为载体改变医患关系。医生从来不是法律主体，法律主体是医院。以往医生出现医疗纠纷，医院要承担责任，现在医生在互联网医院发生医疗纠纷，那么就应该是互联网医院来承担责任。互联网医院和实体医院承担的法律责任没有差异。

患者接受了网络问诊服务，特别担心隐私泄露。在用户个人信息隐私保护方面，互联网医疗机构应予以保护，非经用户许可不对外泄露，不做其他使用。如果出现用户隐私泄露，平台要按照法律规定承担相关责任。而对于医疗监管问题，高解春说，线上的病史是最难被篡改的，任何一个电子病史的修改，后台都会留下痕迹，这才是最真实、最客观的医疗记录。

互联网医院发展势不可挡，监管难度不容忽视，银川市经验值得借鉴。包括好大夫在线银川智慧互联网医院在内，银川市签约落户的互联网医院达17家，成为国内规模最大的互联网医院产业聚集地。银川陆续出台了《银川市互联网医院管理办法（试行）》等六个文件，来规范和监管互联网医院，建成了国内第一个关于互联网医院管理较为完整的系统监管体系，给予互联网医院与实体医院同等的政策待遇。

“互联网医院健康发展，离不开完善的信用体系建设。”银川市有关负责人说，对互联网医院的经营者、医生、病患等建立诚信档案，建立黑名单制度，加大失信行为曝光力度，强化失信联合惩戒，增强信用管理威慑力，构建一个“让守信者处处受益，让失信者寸步难行”的信用体系。