National Health Planning Commission promulgated the "Opinions about the medical institutions to promote telemedicine services" (hereinafter referred to as "Opinion") defined the scope of telemedicine, regulate medical practices among hospitals, it proposes to carry out only in the vertical level hospitals and United Christian Hospital. This means that with telemedicine, the level of diagnosis and treatment in the county and the countryside will be greatly improved. However, what is the attitude of primary medical institutions to telemedicine? Is there any ability to carry out telemedicine? Is it difficult to carry out telemedicine at the grassroots level? How to overcome? A few days ago, the author conducted a survey in 14 township hospitals and 4 county-level medical units in a county in northern Henan.
According to the survey, 500,000 people in the county are facing the Zheng River across the river, and one-third of the population lives in the Yellow River Beach. The traffic is not convenient. The 14 township health centers in the county have 4 medical staff with high-ranking and high-ranking titles, 6 sets of color ultrasound (each worth 300,000 yuan), 5 sets of computer radiography, CT, MRI, high-spirited super, and all biochemicals are zero; In addition to the county hospitals, there are Hitachi HV900 (worth 3.6 million yuan), double-row spiral CT, DR, 7180 biochemical and high-precision medical equipment . Other hospital medical equipment are outdated or used equipment, the county About 1800 beds. According to the county's new rural cooperative statistics, in 2013, the county was hospitalized with 50,867 people, and the transfer rate (provincial and municipal hospitals) was 16.46%, of which the township health center's rate of conversion was 6.2% (mainly transferred to county-level hospitals); township health center color ultrasound The annual usage is more than 15,000 person-times and the CR is about 19,000 person-times.
The economy is backward, traffic in some areas is blocked, the rate of transfer is high, and the lack of high-level medical personnel is enough to prove that it really needs the patronage of telemedicine. But what about the reaction and status quo at the grassroots level?
The concept of telemedicine is unknown
The majority of grassroots people in the county do not know what telemedicine is. Whether it is welcome and willing to carry out telemedicine is self-evident; one-fifth of the 14 township hospitals only know the meaning of nouns, most of them do not know the remote. Medical professional connotation and operation methods; 10 township health chiefs do not pay attention to telemedicine, 4 central township health directors believe that telemedicine is irrelevant to primary health care centers, because their functional positioning is basic medical services, except poisoning In addition to traumatic emergency treatment, other critically ill patients and incurable diseases will not come to the clinic. It is of little significance to carry out telemedicine, and the actual level is limited, and it is unable to cooperate with telemedicine services.
Poor medical equipment, low medical skills
14 township hospitals only have routine medical examination equipment, and can not provide pathological section, DR, CT and other telemedicine necessary equipment, naturally can not carry out telemedicine in township hospitals; only one hospital in the county color ultrasound, ECG, CT 7180 Biochemical can provide medical information that can be consulted by provincial and municipal medical experts for remote diagnosis. However, due to equipment quality or skill problems, the quality of telemedicine data provided is difficult to fully reach the superior hospital experts. Claim. For example, the positive rate of large medical equipment inspection is below 60%. In addition to over-examination, the main reason is that the medical skills of the operators are low. Nearly 85% of the medical technicians are non-professionals, and the technical age has more than 20 years of work experience. The number of professional medical technicians is zero.
Software and hardware are far from telemedicine requirements
14 township hospitals can not provide electronic medical records. Only county hospitals can implement HIS to dock with remote hospitals in higher-level hospitals, but they lack professional staff in telemedicine. Without a corresponding medical system, none of the 19 medical units joined the hospital. The joint support unit is only a symbolic free clinic and a young resident doctor. There is no telemedicine platform.
No good medical management system
At present, the medical income of grassroots public hospitals in the county are almost all from the new rural cooperatives, especially county-level hospitals. The preparation, personnel expenses, equipment purchase, and infrastructure construction are all from the participants' medical expenses. To carry out telemedicine, the invitee must first consider the technical benefits, but also consider the risk. Therefore, it is only natural to link telemedicine to paid services. Considering that telemedicine remuneration and legal asylum are currently not covered by specific regulations, the state has not issued specific laws and regulations to explain how medical accidents caused by telemedicine are handled. Therefore, once telemedicine is to be implemented, the lower-level hospitals will either pay the invited labor costs or increase the number of referrals, otherwise it will be difficult to maintain. However, if the invited party fails to comply with the graded diagnosis and treatment system and the patient is not transferred, the business volume of the primary hospital will be reduced and the income will be reduced. In this regard, the responsible persons of county-level hospitals have a wait-and-see attitude toward telemedicine. They said that without policy measures, county-level hospitals will not actively take the initiative to reach telemedicine projects.
This shows that the current management mechanism of public hospitals at or above the county level does not undergo major reforms, and the profit-making operations behind public welfare are difficult to discharge the worries of the inviting parties. This will inevitably affect the design purpose of telemedicine. As with the medical association, there will soon be a loose operating state.
A glimpse of the whole leopard. The medical status and awareness of telemedicine in a county in Henan Province is sufficient to show that in order to allow telemedicine to settle at the grassroots level, especially in poor areas, it is necessary to break the current stalemate in the medical management mechanism. The government must not only give strong support to policies and financial resources, improve the level of primary medical care and medical technology, change the backward situation of medical equipment, but also introduce the implementation rules for telemedicine as soon as possible, so that the marketization and circulation of medical resources can change the trend of public hospitals. Advantages, the introduction of corresponding laws and regulations to protect telemedicine, with specific incentives and constraints to allow provincial, city and county medical institutions to link up and down. While increasing telemedicine education, we will build a scientific, reasonable, feasible, and remote medical platform that can be accepted and enjoyed by hospitals. Only in this way, grassroots people can enjoy quality medical care in large hospitals through telemedicine without leaving home. Service, solve their "expensive medical treatment" one day earlier.
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