Running an Internet Hospital in China: Perspective Based on a Case Study

Enhancing user experience in the digital service environment: A comprehensive study on the design and evaluation of internet-based healthcare products

RATIONALE

In the era of burgeoning digital technology, healthcare is a challenging transformative change towards virtual and digital platforms. Internet-based healthcare services are emerging as a popular trend within the medical area. User experience (UX) is paramount for the healthcare service, as it significantly influences experience satisfaction and fosters user viscosity. Gaining a profound understanding of users' demands and crafting services that align with their expectations is essential.

METHODS

Consequently, exploring an effective design approach for the digital healthcare service that prioritizes UX along with utilizing a comprehensive evaluation methodology to handle UX data, is of profound importance. This study introduces a design methodology for Internet-based healthcare products grounded in the UX and mental (UX-M) model. Aiming to refine the Internet-based healthcare product design by integrating insights from the experience data, it employs the Delphi-ANP and the fuzzy comprehensive evaluation to determine evaluation indexes and conduct experiential assessments.

RESULTS

The UX evaluation results of existing schemes are compared with the proposed design scheme of the intelligent guidance and internet hospital. The findings indicate that the UX evaluation of Internet-based medical services with the proposed method outperforms the existing schemes.

CONCLUSIONS

On the one hand, UX research of Internet-based healthcare products can significantly enhance service satisfaction for patients utilizing online medical treatments. On the other hand, the analysis of experience-based evaluation empowers designers to refine and improve UX design of Internet-based medical services. Such research endeavors are critical for enhancing the overall quality of service offerings and elevating user satisfaction in the digital healthcare landscape.

The Relationship Between Static Characteristics of Physicians and Patient Consultation Volume in Internet Hospitals: Quantitative Analysis

BACKGROUND

Internet medical treatment, also known as telemedicine, represents a paradigm shift in health care delivery. This contactless model allows patients to seek medical advice remotely, often before they physically visit a doctor's clinic. Herein, physicians are in a relatively passive position, as patients browse and choose their health care providers. Although a wealth of experience is undoubtedly a draw for many patients, it remains unclear which specific facets of a doctor's credentials and accomplishments patients prioritize during their selection process.

OBJECTIVE

Our primary aim is to delve deeper into the correlation between physicians' static characteristics-such as their qualifications, experiences, and profiles on the internet-and the number of patient visits they receive. We seek to achieve this by analyzing comprehensive internet hospital data from public hospitals. Furthermore, we aim to offer insights into how doctors can present themselves more effectively on web-based platforms, thereby attracting more patients and improving overall patient satisfaction.

METHODS

We retrospectively gathered web-based diagnosis and treatment data from the First Affiliated Hospital of Guangxi Medical University in 2023. These data underwent rigorous analysis, encompassing basic descriptive statistics, correlation analyses between key factors in doctors' internet-based introductions, and the number of patient consultation visits. Additionally, we conducted subgroup analyses to ascertain the independence of these vital factors. To further distill the essence from these data, we used nonnegative matrix factorization to identify crucial demographic characteristics that significantly impact patient choice.

RESULTS

The statistical results suggested that there were significant differences in the distribution of consultation volume (P<.001), and the correlation analysis results suggested that there was a strong correlation between the two groups of data (ρ=0.93; P<.001). There was a correlation between the richness of a profile and popularity (P<.001). Patients were more interested in physicians with advanced titles, doctoral degrees, social activities, and scientific achievements (P<.001) as well as other institutional visit experiences (P=.003). More prosperous social activities, scientific achievements, experiences of other institutional visits, and awards were more common among people with advanced professional titles. Doctoral degrees remained attractive to patients when data were limited to senior physicians (P<.001). Patients trusted the medical staff with advanced titles, social activities, scientific achievements, and doctoral degrees (P<.001).

CONCLUSIONS

Patient preferences for choosing a health care provider differed significantly between free and paid consultations. Notably, patients tended to trust doctors with advanced professional titles more and were more likely to seek out those with doctoral qualifications over other professional ranks. Additionally, physicians who actively participated in social events and scientific endeavors often had an advantage in attracting new patients. Given these insights, doctors who invest in enhancing their personal and professional experiences within these domains are likely to see increased popularity and patient satisfaction.

Continuance intention and digital health resources from the perspective of elaboration likelihood model and DART model: a structural equation modeling analysis

Background

Internet hospitals, online health communities, and other digital health APPs have brought many changes to people's lives. However, digital health resources are experiencing low continuance intention due to many factors, including information security, service quality, and personal characteristics of users.

Methods

We used cross-sectional surveys and structural equation modeling analysis to explore factors influencing user willingness to continue using digital health resources.

Results

Information quality (β = 0.31, p < 0.05), service quality (β = 0.19, p < 0.05), platform reputation (β = 0.34, p < 0.05), and emotional support (β = 0.23, p < 0.05) have significant positive effects on user value co-creation behavior. Additionally, user trust and perceived usefulness could mediate the association between user value co-creation behavior and continuance intention, with mediation effects of 0.143 and 0.125, respectively. User involvement can positively moderate the association between user value co-creation behavior and user trust (β = 0.151, t = 2.480, p < 0.001). Also, user involvement can positively moderate the association between value co-creation behavior and perceived usefulness (β = 0.103, t = 3.377, p < 0.001).

Conclusion

The keys to solving the problem of low continuance intention are improving the quality and service level of digital health resources, and promoting users' value co-creation behavior. Meanwhile, enterprises should build a good reputation, create a positive communication atmosphere in the community, and enhance user participation and sense of belonging.

Telehealth Care Through Internet Hospitals in China: Qualitative Interview Study of Physicians' Views on Access, Expectations, and Communication

BACKGROUND

Internet hospitals in China are an emerging medical service model similar to other telehealth models used worldwide. Internet hospitals are currently in a stage of rapid development, giving rise to a series of new opportunities and challenges for patient care. Little research has examined the views of chronic disease physicians regarding internet hospitals in China.

OBJECTIVE

We aimed to explore the experience and views of chronic disease physicians at 3 tertiary hospitals in Changsha, China, regarding opportunities and challenges in internet hospital care.

METHODS

We conducted semistructured qualitative interviews with physicians (n=26) who had experience working in internet hospitals affiliated with chronic disease departments in 3 tertiary hospitals in Changsha, Hunan province, south central China. Interviews were transcribed verbatim and analyzed by content analysis using NVivo software (version 11; Lumivero).

RESULTS

Physicians emphasized that internet hospitals expand opportunities to conduct follow-up care and health education for patients with chronic illnesses. However, physicians described disparities in access for particular groups of patients, such as patients who are older, patients with lower education levels, patients with limited internet or technology access, and rural patients. Physicians also perceived a gap between patients' expectations and the reality of limitations regarding both physicians' availability and the scope of services offered by internet hospitals, which raised challenges for doctor-patient boundaries and trust. Physicians noted challenges in doctor-patient communication related to comprehension and informed consent in internet hospital care.

CONCLUSIONS

This study explored the experience and views of physicians in 3 tertiary hospitals in Changsha, China, regarding access to care, patients' expectations versus the reality of services, and doctor-patient communication in internet hospital care. Findings from this study highlight the need for physician training in telehealth communication skills, legislation regulating informed consent in telehealth care, public education clarifying the scope of internet hospital services, and design of internet hospitals that is informed by the needs of patient groups with barriers to access, such as older adults.

Exploring Patients' Intentions for Usage of Video Telemedicine Follow-Up Services: Cross-Sectional Study

Background: Data suggest that regarding completion rates and lower readmission rates, video telemedicine follow-up is as efficient as in-person consultations. However, evidence of patients' intention to adopt such service is lacking. The objective of this study was to determine the essential factors influencing Chinese patients' intention to adopt video telemedicine follow-up. Methods: The researchers extended the technology acceptance model (TAM) by incorporating trust, subjective norms (SNs), perceived risk (PR), and perceived disease threat (PDT). A survey was conducted with 793 Chinese patients, and the collected data were analyzed using the partial least-squares approach. Results: The study revealed that trust emerged as the strongest factor influencing patients' behavioral intention (BI) to use video telemedicine follow-up, followed by SNs, perceived ease of use (PEOU), and perceived usefulness (PU). PR and PDT had no significant influence on patients' intention to adopt video telemedicine follow-up. PEOU mediated the relationship between trust, SNs, and BI, and PU mediated the relationship between trust and BI. The study also found that gender, age, and usage experience moderated certain relationships in the model. Conclusions: Our findings support the use of the extended TAM in understanding individual's motivations for using video telemedicine follow-up in China. In addition, this study contributes to the existing literature on telemedicine promotion by identifying significant mediation mechanisms. These findings have practical implications for planning, creating, and implementing improved video telemedicine follow-up services.

Application of Internet hospitals for first-visit patients with COVID-19 during the pandemic in China

BACKGROUND

There has been controversy over whether to carry out online medical inquiries and electronic prescription for first-visit patients. While Internet hospitals have become crucial to ensure providing online diagnosis and prescription needs for first-visit COVID-positive patients.

OBJECTIVE

We describe the results and advantages of online medical treatment during the coronavirus disease 2019 (COVID-19) outbreak and analyse the results and advantages of online medical treatment.

METHODS

Data were collected from the patients who received online medical inquiry services through the COVID-19 Special Section of our Internet hospital. The user demographic characteristics, user behaviour, clinical symptoms and medical records were collected. Baseline data of offline outpatient patients were also collected.

RESULTS

A total of 16 173 online medical inquiries were included. The daily online outpatient service volume reached a peak of 2446 person-times. The median age was 29.92 years (SD 15.59), ranging from 20-39 years (n = 8870, 54.84%). A total of 89.20% (n = 14 426/16 173) patients had epidemic-related symptoms. Moreover, 23.35% of the people were diagnosed as COVID-19-positive through antigen or nucleic acid testing. Furthermore, 86.61% (14 008/16 173) of the patients visited our hospital for the first time or had no offline physical outpatient service record within the past 3 months. The demand for medical inquiries was mainly for drug dispensing, followed by medication guidance and disease diagnosis. And 2.07% (334/16 173) of the patients needed to go to the offline hospital for further treatment.

CONCLUSION

The service model of the COVID-19 Special Section based on Internet hospitals provided the public with the necessary medical support during the COVID-19 outbreak. It provides a reference for future pandemics or public health emergencies.

Cardio-oncology in China

OPINION STATEMENT

Cardio-oncology is going under rapid development in various areas across an increasing number of provinces in China. However there are still a myriad of challenges that need to be overcome in order to ensure its gradual and consistent expansion. The Cardio-Oncology Knowledge Transfer Model (KTM) forms the basis to allow exponential development of effective cardio-oncology services. This would ensure the implementation of precision-based practice while dynamically evolving cardio-oncology to integrate both Western and Chinese medical practices to become an official clinical sub-speciality in its own right in China, for the ultimate benefit of the patient.

The Current Status of the Use of Internet Hospitals for Outpatients With Pain: Retrospective Study

BACKGROUND

The national "Internet +" policies and the emergence of internet hospitals have created a new direction for the management of pain outside of the hospital. Nevertheless, there are no consolidated studies conducted by pain physicians on the current state of internet hospital-based online medical services used by patients with pain outside of a hospital setting.

OBJECTIVE

In this retrospective study, we aimed to examine the status of the use of internet hospitals by patients who experience pain. Moreover, we identified the factors that influenced patients' decisions to make an online visit through the internet hospital.

METHODS

Detailed information was collected online and offline from outpatients with pain at the information technology center of West China Hospital of Sichuan University from February 2020 to April 2022. Binary logistic regression analysis was conducted to identify the determinants that influenced patients' decisions to make an online visit to the internet hospital.

RESULTS

Over a 2-year period, 85,266 pain-related clinic visits were recorded. Ultimately, 39,260 patients were enrolled for the analysis, with 12.9% (5088/39,260) having online visits. Both online and offline clinics had a greater number of visits by women than men. The average age of patients attending the online clinic was 46.85 (SD 16.56) years, whereas the average age of patients attending the offline clinic was 51.48 (SD 16.12) years. The majority of online clinic visitors (3059/5088, 60.1%) were employed, and one of the most common occupations was farming (721/5088, 14.2%). In addition, 51.8% (2635/5088) of patients who participated in the online clinics lived outside the hospital vicinity. Young (odds ratio [OR] 1.35, 95% CI 1.01-1.81; P=.045) and middle-aged (OR 1.98, 95% CI 1.81-2.16; P<.001) patients, employed patients (OR 1.11, 95% CI 1.04-1.18; P=.002), nonlocal patients (OR 1.57, 95% CI 1.48-1.67; P<.001), and the ordinary staff (OR 1.19, 95%CI 1.01-1.39; P=.03) were more likely to have the intention to choose online visits through the internet hospitals.

CONCLUSIONS

Internet hospitals are flourishing as a more efficient and promising method of pain management and follow-up for patients with pain outside the hospital. People with pain who are young, working, and not in the vicinity of hospitals are more likely to visit internet hospitals.

Investigating Factors Influencing Medical Practitioners' Resistance to and Adoption of Internet Hospitals in China: Mixed Methods Study

BACKGROUND

The swift shift toward internet hospitals has relied on the willingness of medical practitioners to embrace new systems and workflows. Low engagement or acceptance by medical practitioners leads to difficulties in patient access. However, few investigations have focused on barriers and facilitators of adoption of internet hospitals from the perspective of medical practitioners.

OBJECTIVE

This study aims to identify both enabling and inhibiting predictors associated with resistance and behavioral intentions of medical practitioners to use internet hospitals by combining the conservation of resources theory with the Unified Theory of Acceptance and Use of Technology and technostress framework.

METHODS

A mixed methods research design was conducted to qualitatively identify the factors that enable and inhibit resistance and behavioral intention to use internet hospitals, followed by a quantitative survey-based study that empirically tested the effects of the identified factors. The qualitative phase involved conducting in-depth interviews with 16 experts in China from June to August 2022. Thematic analysis was performed using the qualitative data analysis software NVivo version 10 (QSR International). On the basis of the findings and conceptual framework gained from the qualitative interviews, a cross-sectional, anonymous, web-based survey of 593 medical practitioners in 28 provincial administrative regions of China was conducted. The data collected were analyzed using the partial least squares method, with the assistance of SPSS 27.0 (IBM Corp) and Mplus 7.0 (Muthen and Muthen), to measure and validate the proposed model.

RESULTS

On the basis of qualitative results, this study identified 4 facilitators and inhibitors, namely performance expectancy, social influence, work overload, and role ambiguity. Of the 593 medical practitioners surveyed in the quantitative research, most were female (n=364, 61.4%), had a middle title (n=211, 35.6%) or primary title (n=212, 35.8%), and had an average use experience of 6 months every year. By conducting structural equation modeling, we found that performance expectancy (β=-.55; P<.001) and work overload (β=.16; P=.005) had the most significant impact on resistance to change. Resistance to change fully mediated the influence of performance expectancy and partially mediated the influences of social influence (variance accounted for [VAF]=43.3%; P=.002), work overload (VAF=37.2%; P=.03), and role ambiguity (VAF=12.2%; P<.001) on behavioral intentions to use internet hospitals. In addition, this study found that the sex, age, professional title, and use experience of medical practitioners significantly moderated the aforementioned influencing mechanisms.

CONCLUSIONS

This study investigated the factors that facilitate or hinder medical practitioners' resistance to change and their behavioral intentions to use internet hospitals. The findings suggest that policy makers avoid the resistance and further promote the adoption of internet hospitals by ensuring performance expectancy and social influence and eliminating work overload and role ambiguity.

Factors associated with delayed first ophthalmological consultation for primary glaucoma: a qualitative interview study

Background

Glaucoma has an insidious onset with non-specific early symptoms, often leading patients to delay in seeking help. However, postponing the first ophthalmological consultation can result in delayed diagnosis and treatment, with adverse effects on vision. This study explored the factors associated with delayed first ophthalmological consultation in patients with primary glaucoma, with the overarching aim of informing measures to reduce delayed consultation and avoid the consequent adverse outcomes.

Methods

We adopted a phenomenological approach. Semi-structured interviews were conducted with patients admitted to a tertiary eye hospital in Tianjin, China, from January 2021 to April 2021. Data were analyzed by Colaizzi's seven-step method.

Results

We identified 46 patients with primary glaucoma who delayed their first ophthalmological consultation for various reasons. There were four major themes and 16 sub-themes. The major themes were as follows: (1) occult symptoms that are difficult to identify; (2) insufficient knowledge and understanding of glaucoma-related risks and harm; (3) perceived difficulties in accessing medical care; and (4) inadequate support system.

Conclusion

In order to avoid patient delay and consequent irreversible damage to the visual field in patients with primary glaucoma, it is essential that medical staff identify symptoms more effectively, change habitual medical behavior of the patients, adopt a medical union model, and promote the use of a social medical support system to address practical difficulties in delivering adequate care.

Internet Healthcare Policy Analysis, Evaluation, and Improvement Path: Multidimensional Perspectives

Internet healthcare is a crucial component of the healthcare industry's digital transformation and plays a vital role in achieving China's Healthy China strategy and promoting universal health. To ensure the development of internet healthcare is guided by scientifically sound policies, this study analyzes and assesses current policy texts, aiming to identify potential issues and inadequacies. By examining 134 national-level policy documents, utilizing multiple research methods, including policy bibliometrics, content analysis, and the PMC Index Model, the study investigates policy characteristics, distribution of policy instruments, and evaluation outcomes related to internet healthcare. The study findings reveal that internet healthcare policies place emphasis on enhancing service quality, driving technological innovation, and promoting management standardization. Although policy instruments align with the current stage of internet healthcare development in China, they are plagued by imbalances in implementation. While policies are generally well-formulated, there are discernible discrepancies among them, necessitating the reinforcement and refinement of certain provisions. Hence, it is imperative to strategically optimize the amalgamation and implementation of policy instruments while concurrently endeavoring to achieve a dynamic equilibrium in policy combinations. Furthermore, policymakers should diligently refine the policy content pertaining to its nature and effectiveness in order to fully maximize policy utility.

Development and validation of the health literacy environment scale for Chinese hospitals from patients' perspective

Introduction

While the research on improving individual health literacy by promoting individual skills and abilities is increasing, less attention has been paid to the complexities of the healthcare environment that may influence patients' ability to access, understand, and apply health information and health services to make health decisions. This study aimed to develop and validate a Health Literacy Environment Scale (HLES) that is suitable for Chinese culture.

Methods

This study was conducted in two phases. First, using the Person-Centered Care (PCC) framework as a theoretical framework, initial items were developed by using the existing health literacy environment (HLE) related measurement tools, literature review, qualitative interviews, and the researcher's clinical experience. Second, scale development was based on two rounds of Delphi expert consultation and a pre-test conducted with 20 hospitalized patients. Using 697 hospitalized patients from three sample hospitals, the initial scale was developed after item screening and its reliability and validity were evaluated.

Results

The HLES comprised 30 items classified into three dimensions as follows: interpersonal (11 items), clinical (9 items), and structural (10 items) dimensions. The Cronbach's α coefficient of the HLES was 0.960 and the intra-class correlation coefficient was 0.844. The confirmatory factor analysis verified the three-factor model after allowing for the correlation of five pairs of error terms. The goodness-of-fit indices signified a good fit for the model (χ²/df = 2.766, RMSEA = 0.069, RMR = 0.053, CFI = 0.902, IFI = 0.903, TLI = 0.893, GFI = 0.826, PNFI = 0.781, PCFI = 0.823, PGFI = 0.705). The item-content validity index ranged from 0.91 to 1.00, and the scale-content validity index was 0.90.

Conclusion

The HLES had good reliability and validity and provides a patient perspective tool for evaluating HLE and a new perspective for improving health literacy in China. That is, healthcare organizations make it easier for patients to access, understand, and use health information and service. Further studies about the validity and reliability of HLE should include other districts and different tiers or types of healthcare organizations.

The effect of using internet hospitals on the physician-patient relationship: Patient perspective

BACKGROUND

Internet hospitals are rapidly developing in China. Despite many studies regarding internet hospitals, there has been little further research that evaluates the impact of using internet hospitals on the physician-patient relationship during outpatient visits.

METHODS

We developed a questionnaire based on the patient-doctor relationship questionnaire (PDRQ-9) to survey the physician-patient relationship. A sample of 505 patients who sought medical services from offline physical or internet hospitals was selected by convenience sampling. Multiple linear regression analysis was performed to determine whether the use of internet hospitals during outpatient visits was associated with the physician-patient relationship.

RESULTS

Internet hospital users gave significantly lower scores than nonusers in total physician-patient relationship scores (P =.01) and in the 5 items of "My physician helps me" (P <.001), "I trust my physician" (P =.001), "My physician understands me" (P =.002), "My physician and I agree on the nature of my medical symptoms" (P =.01), and "I can talk to (communicate with) my physician freely" (P =.005). Multiple linear regression results showed that the use of internet hospitals during outpatient visits influenced the physician-patient relationship. And after controlling for other patient characteristics, the use of internet hospitals decreased the physician-patient relationship scores by 11.9%.

CONCLUSIONS

Our findings suggest that the current use of internet hospitals could not significantly enhance the physician-patient relationship during outpatient visits. Therefore, we should work on improving physicians' online communication skills and strengthening the level of trust between physicians and their patients. Policymakers should also pay close attention to the gap of the physician-patient relationship between internet hospitals and offline physical hospitals.

Determinants Influencing the Adoption of Internet Health Care Technology Among Chinese Health Care Professionals: Extension of the Value-Based Adoption Model With Burnout Theory

BACKGROUND

The global COVID-19 pandemic has been widely regarded as a catalyst for adopting internet health care technology (IHT) in China. IHT consists of new health care technologies that are shaping health services and medical consultations. Health care professionals play a substantial role in the adoption of any IHT, but the consequences of doing so can often be challenging, particularly when employee burnout is prevalent. Few studies have explored whether employee burnout influences the adoption intention of IHT in health care professionals.

OBJECTIVE

This study aims to explain the determinants influencing the adoption of IHT from the perspective of health care professionals. To do so, the study extends the value-based adoption model (VAM) with consideration for employee burnout as a determining factor.

METHODS

A cross-sectional web-based survey using a sample of 12,031 health care professionals selected through multistage cluster sampling from 3 provinces in mainland China was conducted. The hypotheses of our research model were developed based on the VAM and employee burnout theory. Structural equation modeling was then used to test the research hypotheses.

RESULTS

The results indicate that perceived usefulness, perceived enjoyment, and perceived complexity positively correlate with perceived value (β=.131, P=.01; β=.638, P<.001; β=.198, P<.001, respectively). Perceived value had a positive direct effect on adoption intention (β=.725, P<.001), perceived risk negatively correlated with perceived value (β=-.083, P<.001), and perceived value negatively correlated with employee burnout (β=-.308, P<.001). In addition, employee burnout was negatively related to adoption intention (β=-.170, P<.001) and mediated the relationship between perceived value and adoption intention (β=.052, P<.001).

CONCLUSIONS

Perceived value, perceived enjoyment, and employee burnout were the most important determinants of IHT adoption intention by health care professionals. In addition, while employee burnout was negatively related to adoption intention, perceived value inhibited employee burnout. Therefore, this study finds that it is necessary to develop strategies to improve the perceived value and reduce employee burnout, which will benefit the promotion of the adoption intention of IHT in health care professionals. This study supports the use of the VAM and employee burnout in explaining health care professionals' adoption intention regarding IHT.

The impact of the COVID-19 pandemic and related policy responses on non-COVID-19 healthcare utilization in China

We investigate the impact of the COVID-19 pandemic and related policy responses on non-COVID-19 healthcare utilization (i.e., different types of outpatient care) up to October 2020 in China. Using an administrative database from a large prefecture-level city, we find that both direct exposure to the COVID-19 pandemic and the strict containment policy responses led to reductions in outpatient care utilization. The largest decline during the lockdown was observed in preventive care visits, which nevertheless recovered to pre-pandemic levels 2 months after the lockdown. The disruptions in prenatal care visits could not be offset by the recovery later on. Chronic care and emergency department visits had not returned to pre-pandemic levels as of October 2020, which may be driven by extended days' supply of prescription medication, increased use of telemedicine, and improved health-protective behaviors. In the reopening period, there were increases in visits for mental and sleep disorders, especially among children, and for medical abortion. Among health facilities at all levels, primary care facilities saw the least reductions in total outpatient visits. Our results emphasize the need for strategies to ensure access to urgent or essential care services when managing the current epidemiologic transition and future crises.

Utilization of, satisfaction toward, and challenges for Internet-based healthcare services provided by primary health institutions: Evidence from China

Background

The rapid development of "Internet plus healthcare" in China has provided new ways for the innovative development of primary healthcare. In addition, a series of favorable policies have been issued to promote Internet-based healthcare services in primary health institutions.

Objective

The aim of this study was to describe the utilization of, satisfaction toward, and challenges faced by Internet-based healthcare services provided by primary health institutions in China.

Methods

A self-designed structured questionnaire was employed to collect related data in January 2022 through Credamo. The questionnaire mainly included sociodemographic characteristics, health-related information, utilization of, satisfaction toward, and challenges faced by Internet-based healthcare services provided by primary health institutions. Descriptive analysis was used to describe the sociodemographic characteristics, utilization, satisfaction, and challenges by subgroups. The Wilcoxon rank-sum test was carried out to examine the differences in satisfaction with Internet-based healthcare services between participants who ever received these services and those who did not. A multiple logistic regression model was also used to examine the factors influencing the utilization of Internet-based healthcare services provided by primary health institutions.

Results

A total of 10,600 residents were included in the final analysis, of whom 5,754 (54.3%) were women. Overall, 51.3% (5,434) of the total participants ever used Internet-based healthcare services provided by primary health institutions. Among those who used Internet-based healthcare services, the most widely used services were procedure-related consultation services (63.7%). The satisfaction among those who ever used it was significantly higher than that among those who did not (84.7 vs. 45.4%; p-value < 0.001). One of the biggest challenges (69.3%) expressed by the residents was that it was difficult for the elderly to use Internet-based services, followed by community doctors with low capacity of providing primary care online (49.0%) and residents were worried about the information security and privacy protection (48.5%). Younger people, people with lower education levels, and people with chronic diseases were significantly more likely to use Internet-based healthcare services provided by primary health institutions (P < 0.05).

Conclusion

Among 10,600 residents surveyed in China in 2022, more than half of the people used Internet-based healthcare services provided by primary health institutions, and most of them were satisfied, although subgroups significant differences existed. The most common use was procedure-related (e.g., online registration and result query), and several challenges of using Internet-based healthcare services exist (e.g., information safety and usage among elderly people). Therefore, it is important to further improve Internet-based primary healthcare services based on the population perception of achieving healthy China in 2030.

Developing a Capsule Clinic-A 24-Hour Institution for Improving Primary Health Care Accessibility: Evidence From China

Telehealth is an effective combination of medical service and intelligent technology. It can improve the problem of remote access to medical care. However, an imbalance in the allocation of health resources still occurs. People spend more time and money to access higher-quality services, which results in inequitable access to primary health care (PHC). At the same time, patients' usage of telehealth services is limited by the equipment and their own knowledge, and the PHC service suffers from low usage efficiency and lack of service supply. Therefore, improving PHC accessibility is crucial to narrowing the global health care coverage gap and maintaining health equity. In recent years, China has explored several new approaches to improve PHC accessibility. One such approach is the capsule clinic, an emerging institution that represents an upgraded version of the internet hospital. In coordination with the United Nations, the Yinzhou district of Ningbo city in Zhejiang, China, has been testing this new model since 2020. As of October 2022, the number of applications in Ningbo was 15, and the number of users reached 12,219. Unlike internet hospitals, the entire process-from diagnosis to prescription services-can be completed at the capsule clinic. The 24-hour telehealth service could also solve transportation problems and save time for users. Big data analysis can accurately identify regional populations' PHC service needs and improve efficiency in health resource allocation. The user-friendly, low-cost, and easily accessible telehealth model is of great significance. Installation of capsule clinics would improve PHC accessibility and resolve the uneven distribution of health resources to promote health equity.

Patients' choice preferences for specialist outpatient online consultations: A discrete choice experiment

Background

Internet hospitals are multiplying with solid support from the Chinese government. In internet hospitals, specialist outpatient online consultations (SOOC) are the primary services. However, the acceptance and utilization rates of this service are still low. Thus, the study of patients' choice preferences for SOOC is needed.

Objective

To analyze the choice preference of patients' SOOC via a discrete choice experiment, understand the influence of each factor and promote the development of internet hospitals.

Methods

Via a discrete selection experiment, a total of 162 patients from two general hospitals and three specialized hospitals in Beijing were selected for the questionnaire survey. The choice preferences were analyzed by conditional logit regression.

Results

From high to low, patients' willingness to pay (WTP) for the attributes of SOOC is as follows: doctors' recommendation rate (β highly recommend = 0.999), the convenience of applying SOOC services (β Convenient = 0.760), the increasing ratio of medical insurance payment for online services compared to offline (β Increase by 10% = 0.545), and the disease's severity (β severe = -3.024). The results of the subgroup analysis showed differences in patient choice preference by age, whether the patients had chronic diseases, income, and medical insurance types.

Conclusion

Both price and nonprice attributes influence the choice preference of SOOC for patients. Among them, patients are more inclined to choose SOOC when doctors highly recommend it, when it is convenient to apply, when medical insurance increases by 10%, and when disease severity is mild. The current findings show the government and medical institutions formulate auxiliary policies and welfare strategies by clarifying core attributes and adjusting the levels of different attributes to improve patients' acceptance of SOOC. The utility of SOOC and the further development of internet hospitals are radically promoted.

Artificial intelligence-based internet hospital pharmacy services in China: Perspective based on a case study

Background: Recently, internet hospitals have been emerging in China, saving patients time and money during the COVID-19 pandemic. In addition, pharmacy services that link doctors and patients are becoming essential in improving patient satisfaction. However, the existing internet hospital pharmacy service mode relies primarily on manual operations, making it cumbersome, inefficient, and high-risk.

Objective: To establish an internet hospital pharmacy service mode based on artificial intelligence (AI) and provide new insights into pharmacy services in internet hospitals during the COVID-19 pandemic.

Methods: An AI-based internet hospital pharmacy service mode was established. Initially, prescription rules were formulated and embedded into the internet hospital system to review the prescriptions using AI. Then, the “medicine pick-up code,” which is a Quick Response (QR) code that represents a specific offline self-pick-up order, was created. Patients or volunteers could pick up medications at an offline hospital or drugstore by scanning the QR code through the window and wait for the dispensing machine or pharmacist to dispense the drugs. Moreover, the medication consultation function was also operational.

Results: The established internet pharmacy service mode had four major functional segments: online drug catalog search, prescription preview by AI, drug dispensing and distribution, and AI-based medication consultation response. The qualified rate of AI preview was 83.65%. Among the 16.35% inappropriate prescriptions, 49% were accepted and modified by physicians proactively and 51.00% were passed after pharmacists intervened. The “offline self-pick-up” mode was preferred by 86% of the patients for collecting their medication in the internet hospital, which made the QR code to be fully applied. A total of 426 medication consultants were served, and 48.83% of them consulted outside working hours. The most frequently asked questions during consultations were about the internet hospital dispensing process, followed by disease diagnosis, and patient education. Therefore, an AI-based medication consultation was proposed to respond immediately when pharmacists were unavailable.

Conclusion: The established AI-based internet hospital pharmacy service mode could provide references for pharmacy departments during the COVID-19 pandemic. The significance of this study lies in ensuring safe/rational use of medicines and raising pharmacists’ working efficiency.

Attitudes and perspectives of 534 Chinese pediatricians toward internet hospitals

BACKGROUND

Internet hospitals introduced in China have effectively reduced service time and space, promoted high-quality pediatric medical resources to grassroots areas, solved the contradiction between supply and demand of pediatric medical resources, and met patients' increasing multi-level and diversified medical service needs. However, pediatricians' attitudes toward and satisfaction with the use of internet hospitals remain unknown.

OBJECTIVE

This study aimed to investigate pediatricians' knowledge of, use of, and satisfaction with internet hospitals in order to identify major issues in internet hospital development, and to understand pediatricians' attitudes and opinions on the construction, development, and use of internet hospitals.

MATERIALS AND METHODS

A total of 625 pediatricians in 17 public tertiary hospitals in Shanghai were surveyed from November 1-30, 2021. Five hundred and thirty four pediatricians completed the survey, and the response rate was 85.44%. Pediatricians' baseline demographic data were collected and information about their use of and satisfaction with internet hospitals.

RESULTS

About 70.22% (375/534) of pediatricians knew about internet hospitals and about 54.68% (292/534) use internet hospitals for patient consultation, diagnosis, and treatment. Utilized services mainly focused on online consultation (271/292, 92.81%), online follow-up consultation (174/292, 59.59%), and health sciences (111/292, 38.01%). Online services were provided by 69.18% (202/292) of pediatricians for less than 1 h a day, and 75.00% (219/292) responded to fewer than five patient consultations online every day. Pediatricians' overall satisfaction with internet hospitals was low (3.59 ± 0.92 points), user experience, systems functions, operation processes, service prices, and performance rewards of internet hospitals were main influencing factors. Pediatricians are enthusiastic about further development of internet hospitals, with 87.83% (469/534) willing to provide services on the internet hospital platform.

CONCLUSION

Most pediatricians view internet hospitals favorably and are eager to contribute to the development of online diagnosis and treatment services. The development of internet hospitals will be more strongly supported by improving pediatricians' satisfaction and mobilizing their enthusiasm and initiative to participate in internet medical services.