The Role of Internet Healthcare in Pandemic Control & Daily Care

By Pfizer Investment Co.，Ltd.

The outbreak of novel coronavirus pneumonia epidemic in 2020 disrupted the life and normal economic activities for the entire China society. After the severe outbreak at the beginning，the nation has been quickly mobilized and fully devoted into the total war against the epidemic with the whole population engaged. Thanks to the advantages of China’s political and governance systems，the epidemic is being contained at a speed much higher than initial estimated by many. The number of new cases drops significantly in Hubei province and particularly in regions out of Hubei. The Chinese people have had a periodical victory in this war without smoke.

However，we have made temporary sacrifices and paid the price in many other aspects in order to quickly control and block the epidemic. For example，for the sake of concentrating the medical resources to battling the epidemic，and avoiding in-hospital cross infection，many hospitals had suspended or even stop daily outpatient services，making many patients with other illnesses unable to receive timely treatment；a lot of patients with chronicle diseases or who need to take medication for long term could not make return visits，refill their prescriptions or have access to daily medications，which caused deterioration of conditions or even more serious consequences. We must prevent all kinds of secondary disasters while controlling the coronavirus pneumonia.

Relevant ministries such as the National Healthcare Security Administration have timely issued relevant documents targeting such cases to encourage the patients to seek consultation and medication access through online channels such as online inquiry and internet hospital during the coronavirus epidemic. Some regions also issued local documents to include some internet hospitals into medical insurance and reimbursement. WHO thinks these are valuable experiences worthy of learning by other nations for epidemic prevention.

Given the rapid growth of Internet technologies，e-commerce，logistics and 5G telecom in China that are leading in the Globe，the battle against coronavirus epidemic could be an opportunity for Internet diagnosis and treatment to develop and grow，making it a new normal for patients to seek daily consultation and medication access，while also being able to play a positive role in potential epidemic outbreaks in the future. For this，we recommend active explorations in the aspects below：

1 Make patient visit easier and reduce hospital outpatient traffic with internet hospital

The documents on healthcare system reform as issued by the central government in recent years all mentioned actively promoting the growth of tiered diagnosis and treatment，Internet healthcare and multi-sited practice by doctors. However，due to barriers of various kinds，the growth of Internet hospitals has been quite slow，right now it is mostly about online appointment-register and light inquiry. In the future，the medical institutions at all the categories especially the grass-root and community healthcare institutions shall be encouraged to set up Internet hospitals to handle some daily and simple subsequent consultations & refill of prescription. Through the effective diagnosis split by the Internet（online）hospitals，the patients are diverted to the different medical institutions，thus the tiered diagnosis and treatment are promoted to relieve the burden on major hospitals and enable the premium medical resources to be focused on treatment and cure of tough diseases. For chronicle patients，many times they visit the hospital just for subsequent consultation and refill of prescription，which can be achieved fully with online hospitals，to not only reduce the toil of travel but also alleviate the hospital outpatient traffic and the burden on doctors. At the same time，doctors practicing at online hospitals are also helpful for the implementation of national policy to encourage the multi-sited practice policy.

What’s more important，online hospital helps to achieve the full-process health management for patients and especially those with chronicle conditions. Different from traditional hospitals，doctors could maintain long time and real time interactive communication with patients via the online hospital，and get to know the health conditions of patients and give relevant medical advice，thus to truly realize the full-process management for patient health.

2 The online hospitals facilitate the epidemic prevention & control

The online hospital is integrated with big data system，where if many patients complain with symptom of infectious diseases in a short period of time，it may help find the emergence of an epidemic early and prevent the potential epidemic，which becomes part of the epidemic pre-warning mechanism. In case of an epidemic happening，on the one hand the daily and normal inquiries，subsequent consultation and refill of prescription could be performed for other patients via the online hospital，thus the limited medical resources with the hospitals could be focused on prevention/control of epidemic and the diagnosis/treatment of infected patients，on the other hand the conditions of the infected or the suspected patients could be understood via the online hospitals during the quarantine，to whom the relevant health advice could give，preventing the patients and non-patients from flocking to the hospitals to overwhelm the hospital and increase the risk of cross infection.

For some suspected patients or patients with mild symptoms in home quarantine，their health status could be accessed any time via the online hospital，so that relevant medical instruction and prescription could be given online. Thus we could effectively management the patients in home quarantine，and timely master the conditions of patients. Once their health status starts to deteriorate，we can timely take further measures while cutting the risk of infection for the community workers who drop in.

For the patients healed and discharged from the hospital，regular subsequent consultation and follow-up visit could be done via the online hospitals to prevent recurrence.

3 Set up the efficient offline medicine distribution system

Though Internet hospital could deliver online inquiry，diagnosis and prescription，the medicine distribution needs to performed offline. In China，the logistic industry has developed rapidly in recent years，including the high-speed growth of multiple professional medicine distribution enterprises. The online hospitals could be integrated with professional pharmaceutical distribution carriers，so that the prescriptions acquired by patients online can be quickly sent to relevant pharmaceutical distributors. After the patients complete the e-payment online，the medicines could be delivered to their home as soon as possible；meanwhile the electronic prescription could be directly sent to the patients who could purchase the drugs by themselves from retail drugstores.

With the growth and maturity of many new technologies，gradual exploration on robotic medicine delivery and/or drone delivery as the faster and more convenient pharmaceutical distribution model should become a trend and possibility.

4 Medical insurance coverage of online hospitals

Currently，China’s basic medical insurance program mostly covers the physical hospitals and part of the drugstores. Online hospital must line up the pathway of medical insurance reimbursement in order to grow. During this coronavirus pneumonia epidemic，some provinces including Hubei have already extended the medical insurance coverage to part of the online hospitals. We recommend to take this as an opportunity and gradually expand the scope of online hospitals under medical insurance to cover not only the Internet hospital run by offline hospitals but also those that are completely online，and line up the channel or pathway of online/offline for medical insurance reimbursement. Thus we could relieve the burden on patients and help to divert more patients to the online hospitals.

For online diagnosis and treatment，it is also very important to prevent insurance fraud. It could be realized by proven face recognition function to ensure the online inquiry individual is consistent with the medical insurance cardholder. The medical insurance authority could also randomly review online prescriptions，once any insurance fraud behavior is identified，the certification of online inquiry/diagnosis for the offender（s）would be revoked，and even the certification of the offending online hospital could be canceled.

5 Psychological coaching via the online hospital in the epidemic

During the epidemic control and prevention，Internet hospitals could play an important role in online psychological counseling. Patients or suspected patients are prone to having different psychological problems during the long-term quarantine，which would cause detriment to the control and prevention of epidemic. Online psychological counseling could be leveraged to make the patients or suspected patients to actively cooperate with home quarantine. The patients healed may experience problems of social discrimination and difficulty in integrating into society，online psychological counseling could also help in these aspects. Moreover，online hospitals could also play an active role in publicizing the epidemic prevention/control knowledge and personal hygiene knowledge.

The growth of online healthcare needs to be taken as a step-by-step process and not in a rush. Relevant authorities should timely issue the codes and supporting documents to standardize the Internet healthcare for healthy and orderly growth，thus providing a guideline for the industry to follow. The public health authority may lead and join with the medical insurance，market supervision and regulatory，the Internet administration authorities to draft the normative documents together，and shortlist a couple of hospitals with certain certification and Internet technical basis in each area for early pilot，and gradually expand the scope based on the pilots. The medical institutions should also be actively encouraged to partner with Internet players to introduce advanced technology and platform of Internet and big data，and build online hospitals with elaborate functions.

It is recommended to leverage this coronavirus epidemic control and prevention as an opportunity to actively promote the growth of Internet healthcare，and make it normalized after the epidemic in order to further elaborate the medical and public health system，and lay down a solid foundation for tackling the epidemic more effectively in the future.