EEG, Internet medical promising: the United States gradually loose telemedicine

On May 27, 2017, Texas Governor Greg Abbott passed the state's telemedicine legislation (the Senate bill SB1107 and the House bill HB2697), abolishing the doctor's ability to meet only face to face with the patient Provision of telemedicine services.

As the last of the 50 states to abolish this provision, the Texas Telemedicine Act allows a remote telecom company, such as Teladoc, American Well, Doctor on Demand, and MD Live, to extend its remote video business to The US market.

Strictly speaking, telemedicine operations in Arkansas and Idaho are still limited because the two states still have restrictions on telephony services.

Texas is the second largest state in the United States, is also the largest state in the South, the passage of the bill, its significance lies not only for telemedicine to open a new market, more importantly, the people of Texas to enjoy more diversified medical services. In addition, the bill also marks the end of the two-year trial between Teladoc and the Texas Medical Council, becoming a landmark antitrust case in the US healthcare industry.

US telemedicine applications and barriers

In fact, the US telemedicine has been carried out for nearly 20 years, although the rapid development, but the use is still very limited, neurology, radiology and emergency department to use more. US Veterans Hospital because of the lack of medical staff, in some departments such as emergency department, radiology, telemedicine is widely used.

Last year, an article in the New England Journal of Medicine gave a comprehensive introduction to the development of telemedicine in the United States. American doctors because of their practice in the environment and geographical location is different, for the use of telemedicine and development awareness is not the same. For example, doctors in remote areas of small and medium-sized hospitals will feel that "telemedicine is constantly infiltrating and expanding" because, in addition to remote stroke medical care, remote intensive care, remote infectious disease consultation and remote dermatology consultation and so on in their side continue to emerge, They themselves will be directly involved in telemedicine.

In the Caesar Medical Group, the application of telemedicine services including telemedicine is more extensive, including the exchange of doctors and patients, according to the needs of patients to do diagnosis to improve efficiency and quality of service; chronic disease management; health education, disease prevention and tumor screening (Eg, patients with heart failure discharged from the hospital), to improve the quality of long-term care of chronic diseases, to reduce hospitalization and prolong life; communication between doctors; for remote dermatology services; by the designated registered nurses and patients, Implement the patient to correctly understand the current medication, to help patients with medical advice and reduce medical errors.

The development of telemedicine in the United States encounters medical insurance payments, clinical, legal and social barriers. In 2012, Medicare spent $ 5 million on telemedicine services, which accounted for less than 0.001% of Medicare's total expenditure. Clinical barriers include the quality of the relationship between doctors and patients, the quality of the examination and the quality of treatment. Legal barriers include state licensing and medical practice, and the responsibility for certification and medical practice also limits the use of telemedicine. Previously, Texas asked the first online to see the doctor just one aspect. The biggest obstacle may be social factors, the gap between digital technology, geographical location and socioeconomic status, the availability of telematics, affecting the development of telemedicine.

There are currently three interrelated trends that constitute the contours of existing telemedicine. The first major trend: the expansion of the coverage of medical services, so that telemedicine can be widely used in order to seek medical treatment and ultimately reduce costs; the second largest trend: telemedicine from emergency response to include emergency treatment and chronic diseases; Trends: extending telemedicine from hospitals and affiliated clinics to the use of home and mobile medical devices.

Internet + health care promising

For my country, I think that exploring the Internet + health care services has an important role in improving the patient's medical experience, improving the efficiency and quality of medical services and improving the accessibility of resources in resource-poor areas. "Internet +" is one of the prerequisites for achieving an integrated health service that covers life-cycle prevention, treatment, rehabilitation and health management.

Optimize the medical service process, improve the medical experience. For example, through the Internet booking registration, although can not increase the amount of medical services, but can reduce the patient line waiting in line time. The use of mobile App, integrated health management, self-diagnosis and medication, registered guide, waiting for diagnosis, diagnosis, treatment, pay medication, slow disease and rehabilitation management, optimize the service process, to provide patients with integrated service experience, The quality of service of the organization. Such changes do not involve medical services themselves, but the quality of care is not only clinical quality, quality of service is also an important dimension, there is evidence that the improvement of quality of service has a positive effect on improving clinical quality.

Develop telemedicine, and improve access to resources in resource-poor areas. Through B2B, B2C and other remote consultation, can greatly enhance the remote, rural and other resources is relatively scarce areas of service accessibility. Some subjects such as dermatology, mental psychology, pathology, imaging diagnosis, remote service is entirely possible to replace face to face treatment. In other words, the vertical areas of medicine may form a new service model. In addition, the development of telemedicine education and training, but also help to enhance the service capacity of primary doctors.

Improve disease prevention and control mode, and promote medical and medical service coordination. Mobile Internet technology based on chronic disease management, if proved more cost-effective, then it is possible to improve, replace the traditional model. As more healthy data can be collected to further upgrade the disease prevention and control model, synergies between physicians and specialists, between medical institutions and public health institutions are technically easier.

Online + line service can improve efficiency. If the doctor and the patient have been online opposite the establishment of the relationship between the diagnosis and treatment, part (chronic disease) referral can be completed through the Internet. "The State Council's guidance on actively promoting the" Internet + "action clearly states that" active exploration of Internet extension medical advice, electronic prescription and other network health services applications "provides a basis for this attempt.

In the long run, "Internet + health care" brought about two changes, one is the traditional relationship between doctors and patients change, this change is from point to line changes. As the mobile Internet, Internet of things technology, the development of intelligent devices, the relationship between doctors and patients may become continuous, uninterrupted, intelligent. At the same time, patients in the future will be more involved in disease management and treatment process, is no longer a simple passive participation. Another change is the impact of large data on medicine. Through the large data analysis application, to promote the whole life cycle of prevention, treatment, rehabilitation and health management of integrated health services, is the future of health services management of the new trend. Gene science, the development of digital medicine, will bring more accurate, personalized medical services. This change will be a far-reaching change in the medical model that will change the prerequisites for our discussion of many issues.