Two modes of telemedicine

In providing economical, efficient and high-quality health care services, information and communication technologies are discovering great potential and promoting a long-distance medical approach from concepts to possibilities. Telemedicine, as a combination of information and communication technologies and clinical medicine, is playing an increasingly important role in solving the challenges faced by some developed and developing countries, broadening access to health care services, and enhancing the level of health care services. The role.

After illness, people are no longer in a hurry to go out and seek medical treatment. Instead, they use their simple and portable medical equipment to detect their basic health indicators at home, connect with doctors through computer terminals, transmit test data, and interact with doctors to complete the entire process of the outpatient service. In emergencies in travel abroad, there is no longer a long history to ask. People need only present a personal medical card. All cases from birth to the present, history of allergies, are recorded, at a glance... all of this, and It is not a bridge in science fiction but a vision for the development of telemedicine in the world.

Decline in the cost of information and communications technology has given health care providers worldwide a growing interest in providing services through new methods. In 2013, American scholar Eric Top was in his new book Subversive Medical: The Revolution in Personal Health in the Age of Big Data. "The digitization of health care is already overwhelming," he said. He firmly believes that the convergence of the digital world and medicine is inevitable and that change has begun to take shape on this stage of convergence. He predicted in the book: "The enormous potential is brewing, digital devices will make medical care and disease prevention more accurate - this is a medical technology we have never seen before."

In the past 10 years, digital signals have replaced analog communication methods, the cost of information and communication technologies has rapidly declined, and global health care providers have become increasingly interested in providing telemedicine services through new methods. Eric Top believes that smart phones, cloud computing, 3D printing, gene sequencing, wireless sensors, supercomputers... these have changed things in our lives and will be innovatively integrated in the medical field. At present, foreign telemedicine is mainly used for remote consultation and treatment, medical services through video conferencing or other communication systems, computer management of medical data, and sharing of medical data through the Internet. Some Western European countries have developed and tested IC cards containing basic medical information. Get up-to-date treatment information about your patients at any hospital networked. Today, medical technology and computer network communication technology are developing rapidly. Medical information is no longer confined to the provision of “telemedicine,” but has expanded to include “distant health” and “digital health”. The concept of “Digital Hygiene” is the comprehensive electronic and informationalization of medical services. It uses the most advanced information and communication technologies to provide convenient, fast, and inexpensive medical information services to a wide range of patients.

The application of network platforms (such as e-mail, tele-consultation, and Internet conferencing) and multimedia (such as digital image and video) has shown tremendous vitality in the digitalization of healthcare, and evolved two models of telemedicine development.

The first model is a network-based medical system that mainly exists in developed countries, that is, centering on patients, transforming hospital-based medical activities into daily medical care that is directly facing the people. Physiological parameter measuring instruments such as heart rate, blood pressure, and blood glucose levels are widely used to remotely monitor patients. This development model alleviates the problem of medical care in places that are plagued with sparse population, medical institution distribution and population distribution. In the United States, the consultation center is an important institution under the umbrella of the American Champions Medical League. It consists of multidisciplinary experts and conducts federation consultations for patients on a family basis. All medical education resources in the United States have been shared online. Its leading distance education level has promoted the development of telemedicine.

The first telemedicine program launched in Norway in 1995 successfully reduced the time from discovery to treatment of acute heart disease for the first 20 years. This medical system can be used both at the patient's home and on an ambulance that goes to the hospital. The data collected by the device is transmitted to the hospital. The doctor can perform the analysis and can make a diagnosis and give an emergency treatment plan. At present, more than 100 ambulances in Norway have used this system. The treatment effect of heart patients has therefore increased by 15% to 20%.

The second model is to build a remote consultation platform nationwide. This model is the first choice for developing countries. Especially in low-income countries and limited infrastructure, telemedicine applications are mainly used to connect health care providers and specialists, referral hospitals and medical centers. The “World Health Organization: 2010: Telemedicine: Opportunities and Developments in Member Countries - The Second Global Survey on eHealth” pointed out in 2010 that “the primary concern of developing countries is basic medical care and the service level is still insufficient. Telemedicine can bring tremendous opportunities to broaden access to health care services, especially in African countries with vast territory and lack of medical personnel. Telemedicine brings good news to the people there."

The report pointed out that through the development of telemedicine, developing countries have improved their ability to organize and collect patient data, which is conducive to epidemiological surveillance. Tracking trends in public health can monitor the evolution of the disease. In addition, the preservation of network databases and electronic records involved in the provision of telemedicine services can enhance the data management capabilities of developing countries, thereby benefiting more coordination services and improving hospital follow-up and assessment capabilities.

Mexico started earlier and nearly half of the states have popularized teleconsultation. The government attaches great importance to hospitals and enterprises. It also strongly supports Dario, a 50-year-old resident of a rural village in Nuevo León, northern Mexico. In May last year, he had frequent headaches and went to a local hospital. However, doctors could not find out the cause after repeated diagnosis. Since the hospital was a local telemedicine networked hospital, after contacting the Telemedicine Management Center of the Metropolitan Hospital of Monterrey, the capital of Nuevo Leon, Metropolitan Hospital arranged a televideo consultation for him to receive radiological images and tests of patients through the Internet. Information and so on. Experts repeatedly inferred that Dario had a rare brain tumor and arranged for Dario to go to Monterrey for medical treatment. Earlier, the operation was a success. Dario has now fully recovered. According to Pedro, a doctor at the Metropolitan Hospital of Monterrey, this is just one of the many telemedicine cases in the hospital. The state of Nuevo Leon is an area where telemedicine was introduced earlier. At present, the state has established a telemedicine management center. Interconnected with 6 state hospitals in Quanzhou and 4 health clinics to provide local residents with telemedicine services.

Telemedicine in Mexico started in the late 1980s and early 1990s. According to Andrian Bacheco, director of the Telemedicine Department of the National Center for Advanced Technology Research in Mexico, Mexico, like many developing countries in the world, is facing The overall backwardness in the level of medical development and the unequal distribution of medical resources. According to statistics, about 26% of people live in remote rural areas, and the country’s high-quality medical resources and experts are concentrated in large cities. The medical resources in remote and inaccessible areas are scarce and lack basic medical and health services. Telemedicine can Help eliminate geographical barriers, provide better and higher-quality medical services through information technology and advanced medical equipment, thereby lowering the threshold of medical services and benefiting more ordinary people.

The National Institute of Advanced Technology in the Health System, a specialized agency of the Mexican Ministry of Health, officially launched the National Tele-Information Medical Development Program in 2000. The program is divided into three focus areas: tele-consultation, telemedicine education, and establishment of a nation-wide patient information database. After several years of development, as of 2012, 32 states in Mexico have already had long-distance consultations in 14 states, and 23 states have popularized distance education. Apart from the government’s attention, this development has also received strong support from hospitals and companies. For example, the Southern Medical Center, one of the best private hospitals in Mexico, began telemedicine cooperation with a Mexican hospital in March 2006. Every Monday On Fridays, regular consultations are conducted by experts from different departments on a daily basis to provide more accurate diagnosis and higher quality medical services to people in remote areas. At the same time, the time required for registration and visits is reduced, and time and cost are saved. At present, the hospital's internal medicine, dermatology, neurology, orthopedics are involved in this remote consultation project. The Slim Health Development Center, a non-profit organization under the Slim Group, the largest telecommunications company in Mexico, has also launched a health program for pregnant women and newborns. This project makes use of the group's network platform to connect its medical treatment centers established throughout the country with related equipment, so as to conduct real-time monitoring and prenatal inspection of local pregnant women, and transmit data to professional physicians for monitoring and analysis. Results are analyzed and evaluated remotely. At present, the project has established 30 maternal and child reception centers in 12 states in Mexico. The high-level medical team sponsored by the group has provided a total of 720,000 medical services, and 810,000 women and babies have benefited from it.

Bacheco stated that while the development speed of telemedicine in Mexico is fast, there are still many problems and challenges. First, many basic medical care points lack the necessary infrastructure such as the Internet and cannot access the telemedicine network. In addition, many equipment lacks maintenance and lack of professional and technical personnel. Because a patient may be diagnosed by several doctors at the same time, the responsibility of the doctor needs to be further clarified, and the new medical treatment methods also have a certain degree of influence on the sense of security and trust between doctors and patients. To this end, he said that in the process of the development of telemedicine, we must focus on the future, formulate long-term development plans, and determine the allocation of relevant equipment and personnel according to local conditions so as to avoid wasting medical resources.

Africa has become an important means to make up for the lack of medical resources in African countries. International doctors' support for African countries is particularly valuable. Many African countries are lagging behind and difficult to see in remote areas. Some places have to go for several days to find a large hospital. According to a survey conducted by the World Health Organization, African countries generally have 25 doctors per 100,000 population, while of the 48 African countries surveyed, there are 25 doctors serving 10 million people in the country. Africa accounts for 24% of the world’s total, but medical workers only account for 3% of the world’s total. Africa’s medical expenditures account for only 1% of the world’s total. Telemedicine has become an important means to make up for the serious shortage of medical resources in African countries.

South Africa is an earlier country in Africa that established telemedicine systems. South Africa's KwaZulu-Natal health care sector materials said that the initial South African national telemedicine plan was divided into three phases. It plans to set up a national telemedicine research center, which will be in the Free State of South Africa for five years from 1999. Six provinces such as Mpumalanga and other six provinces have established 28 important sites with capabilities ranging from teleradiology, telepathology, and remote ultrasound, and established effective links between web sites in different provinces.

South Africa's mobile network is growing rapidly and is the largest telecommunications market in Africa. According to the 2012-2016 Strategic Plan published by the South African Medical Research Council, mobile health care has become an important part of telemedicine, and the board of directors has worked closely with the health department to use mobile health care as an important tool for solving problems in remote areas. . Deloitte & Touche estimates that with the drop in handset prices, the coverage of smartphones in Africa will increase from around 2% in 2014 to 30% in 2020. South African media reported that a certain number of young South Africans are at the forefront of developing health applications. A mobile phone application developed in 2012 can be used to detect skin cancer, while an application developed by a young man in Cape Town can take pictures of the human eye and compare changes in the pupils of different photos to find out that the person is affected by drugs and alcohol. The level of influence.

In Africa, the promotion of telemedicine can not be separated from the support of macro strategic plans and sufficient funds, but the effects of input and electronic health are not yet equal. A 2010 report from the South African Ministry of Health stated that only 32 of the 86 telemedicine sites in South Africa at the beginning of the year were operational, less than half of the total. The health information systems in South Africa have been lacking in coordination with each other. As the Ministry of Health does not have funds specifically for e-health, funds for supporting e-health systems are mostly funded by local governments. Investment in different regions varies greatly. The South African Electronic Health Strategy 2012-2016 states that a strong national e-health strategy is extremely important for the coordination of different projects.

The shortage of medical experts has become an important challenge for the development of telemedicine in Africa. Remote diagnostic guidance can improve the capabilities of assisted medical personnel. However, many African countries have a limited number of medical personnel trained each year, and many fields lack experts. Under such circumstances, international doctors’ international support is particularly valuable. It has been reported that the "Mobile Health Alliance", an international organization that promotes mobile health services, has decided to move its headquarters from the United States to South Africa in 2014 and is committed to further narrowing the gap between telemedicine in Africa and the rest of the world. At the same time, the South African Medical Research Council, Stellenbosch University, Cape Peninsula University of Technology and others are all engaged in research on electronic health. The KwaZulu-Natal University Nelson Mandela Medical College was opened in 2002. The Department of Telemedicine trains graduate students in the field of telemedicine to cultivate talent for the province and even the whole country.

China’s level of development has surpassed Canada, Japan, and other countries to ease the “difficulty of seeing a doctor” and reduce excessive medical treatment. At the same time, it is also an effective training tool. It has obvious advantages in responding to emergencies. In 1995, the concept of “telemedicine” entered. The vision of the people. At that time, an emergency letter of appeal was sent from Peking University to the world through the Internet. He hoped to rescue a young university student with a rare illness and dying. Within 10 days, nearly a thousand e-mails from all over the world have come in succession, refreshing the traditional face-to-face medical treatment concept of the Chinese people: If you do not leave your home, you can seek medical advice.

In 1997, the first telemedicine center in China, the People's Liberation Army General Hospital (301 Hospital), established the Telemedicine Center. At the very beginning, there were more restrictions on software and hardware. The display device was an old-fashioned TV set. There were only two rooms in the center and two doctors.

With the growing demand for telemedicine in China and the acceleration of technical means, experts’ resources are constantly being enriched. In the past five years, China’s telemedicine has developed rapidly, more and more hospitals have been launched, and more and more hospitals have been covered. Department. Today, only 301 hospitals conduct more than 30 ECG consultations per day, reaching 100 cases for many times, more than 4900 consultations per year, and 220 classes for distance education.

In hardware, the current telemedicine network in the country can already achieve graded telemedicine. Ordinary common disease consultation in the province, with the province as a unit and the country's largest hospital to achieve docking. Xinjiang has already achieved Xinjiang's remote medical coverage and networked with Sichuan Huaxi Hospital. If necessary, it can apply for remote medical help in Sichuan. In the future, rural health care will be extended step by step to township hospitals. After years of development, 301 Hospital's telemedicine has gradually moved from the initial telephone and narrow-band consultations to broadband and satellite consultations. From the original point-to-point service, it gradually expanded to point-to-multipoint or even multipoint-to-multipoint service, achieving a narrow band. With the wide range of broadband network construction, terrestrial networks and satellite communications coexistence, “World Connect” is a comprehensive application of telemedicine platforms.

In software, the updated telemedicine platform has been able to implement the latest features such as CT, real-time transmission of nuclear magnetic resonance data and real-time demonstration of courseware. In 2010, 301 Hospital developed a telemedicine platform with independent intellectual property rights and was open and shared.

Why should we vigorously promote the development of telemedicine? Zhang Meikui, director of the 301 Hospital Telemedicine Center, told this reporter that telemedicine can fundamentally alleviate the perilous problem of “difficulty in seeing a doctor”. He believes that the objective cause of “difficulty in seeing a doctor” is the uneven distribution of medical professionals. The emergence of telemedicine broke through the time and space constraints of traditional medical treatment. In addition, telemedicine is an effective remote training tool that can help grass-roots doctors grow rapidly.

“When I used to go to the grassroots level with the Medical Experts Group, I felt that my patients had very limited help in dealing with patients in the long-distance visit. Remote technology not only allowed me to help more patients, but also provided clinical services for a large number of primary care units. Demonstration, sharing and disseminating their medical experience will eventually help more patients.” Yang Shiming, chief physician of the ENT Hospital's Department of Otolaryngology, told a reporter quite emotionally after finishing a teleconsultation.

Telemedicine makes the visit more transparent. Zhang Meikui told the reporter bluntly that for the problem of over-medical treatment, the doctors of the two parties in the teleconsultation discuss the condition of the disease remotely, and the entire treatment process is more transparent.

Telemedicine is also an important means to deal with emergencies such as emergency, difficult and dangerous. After the Wenchuan earthquake, the Yushu earthquake, and the Lushan earthquake, there were telemedicine workers. On December 6, 2013, according to the arrangements of the General Administration of Health and the Ministry of Health, the 301 Hospital Telemedicine Center, the Air Force General Hospital, and Changhai Hospital of the Second Military Medical University were remotely connected to the ship Heyuanzhou and carried out a Humanitarian remote assistance in the disaster-stricken area was used to treat three Filipino patients. In 2013, there were 93 cases of remote consultations and surgical guidance for the earthquake-stricken area in the remote earthquake center in Lushan, Sichuan, and Luan County, Gansu, in Gansu. The service scope of the center has been radiated to the islands, border guard posts of the armed forces, and remote and underdeveloped urban and rural areas. The 24-hour response has been achieved.

Remote consultation can achieve secondary distribution of medical resources. At present, the utilization rate of medical equipment in grass-roots hospitals is less than 40%. Medical equipment in key hospitals in the country is generally overloaded. Remote consultations have saved more patients from roadworks, opting for local medical check-ups and spreading congestion in several key hospitals across the country. The number of people visiting the hospital improved the rate of hospital visits and equipment usage. During the interview, experts also pointed out that the remote consultation must be normalized, otherwise it will also cause waste of medical resources. This requires not only changes in the concept of medical care of ordinary patients, but also the improvement of the quality of the entire grass-roots doctor team, and the improvement of telemedicine policies, standards, and norms.

With the continuous advancement of medical informationization, the future of telemedicine will achieve a system of community-based hospitals, township hospitals, county-level cities, and tertiary hospitals. Telemedicine's innovative services - remote clinics, remote wards are also exploring. In the future, "carry out remote consultations anywhere, anytime" can be realized not only on the patient side but also on the doctor side.

"It must be realized that telemedicine is still a green subject for China." Zhang Meikui told reporters that the software systems currently used in hospitals are incompatible, the information transmission channels are different, and the application hardware and software are inconsistent. They have already communicated and communicated. Some difficulties have arisen, and the problem of inconsistent medical standards and technical standards has become more prominent. As the support and support of telemedicine, expert resources are very important. The team of telemedicine personnel needs to further strengthen management. “Due to the strong domestic demand and the attention of relevant departments, China’s telemedicine level has now surpassed Canada, Japan and other countries, and foreign researchers visited are very amazed. Under the leading role of leading medical institutions in China, China’s telemedicine will There will be considerable progress." Zhang Meikui said.