National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
National Telemedicine Center of China, Zhengzhou, Henan, China.
JMIR Mhealth Uhealth. 2020 Oct 23;8(10):e18426. doi: 10.2196/18426.
Telemedicine has been used widely in China and has benefited a large number of patients, but little is known about the overall development of telemedicine.
The aim of this study was to perform a national survey to identify the overall implementation and application of telemedicine in Chinese tertiary hospitals and provide a scientific basis for the successful expansion of telemedicine in the future.
The method of probability proportionate to size sampling was adopted to collect data from 161 tertiary hospitals in 29 provinces, autonomous regions, and municipalities. Charts and statistical tests were applied to compare the development of telemedicine, including management, network, data storage, software and hardware equipment, and application of telemedicine. Ordinal logistic regression was used to analyze the relationship between these factors and telemedicine service effect.
Approximately 93.8% (151/161) of the tertiary hospitals carried out telemedicine services in business-to-business mode. The most widely used type of telemedicine network was the virtual private network with a usage rate of 55.3% (89/161). Only a few tertiary hospitals did not establish data security and cybersecurity measures. Of the 161 hospitals that took part in the survey, 100 (62.1%) conducted remote videoconferencing supported by hardware instead of software. The top 5 telemedicine services implemented in the hospitals were teleconsultation, remote education, telediagnosis of medical images, tele-electrocardiography, and telepathology, with coverage rates of 86.3% (139/161), 57.1% (92/161), 49.7% (80/161), 37.9% (61/161), and 33.5% (54/161), respectively. The average annual service volume of teleconsultation reached 714 cases per hospital. Teleconsultation and telediagnosis were the core charging services. Multivariate analysis indicated that the adoption of direct-to-consumer mode (P=.003), support from scientific research funds (P=.01), charging for services (P<.001), number of medical professionals (P=.04), network type (P=.02), sharing data with other hospitals (P=.04), and expertise level (P=.03) were related to the effect of teleconsultation. Direct-to-consumer mode (P=.01), research funding (P=.01), charging for services (P=.01), establishment of professional management departments (P=.04), and 15 or more instances of remote education every month (P=.01) were found to significantly influence the effect of remote education.
A variety of telemedicine services have been implemented in tertiary hospitals in China with a promising prospect, but the sustainability and further standardization of telemedicine in China are still far from accomplished.
远程医疗在中国得到了广泛应用，使大量患者受益，但目前对远程医疗的整体发展情况还知之甚少。
本研究旨在通过全国性调查，明确中国三级医院远程医疗的实施和应用现状，为未来远程医疗的成功拓展提供科学依据。
采用概率比例规模抽样法，从全国 29 个省、自治区、直辖市的 161 家三级医院中收集数据。采用图表和统计检验比较远程医疗的发展情况，包括管理、网络、数据存储、软硬件设备以及远程医疗的应用。采用有序逻辑回归分析这些因素与远程医疗服务效果的关系。
约 93.8%（151/161）的三级医院开展了企业对企业模式的远程医疗服务。使用最广泛的远程医疗网络类型是使用率为 55.3%（89/161）的虚拟专用网络。只有少数几家三级医院没有建立数据安全和网络安全措施。在参与调查的 161 家医院中，有 100 家（62.1%）通过硬件而不是软件进行远程视频会议支持。医院实施的前 5 项远程医疗服务是远程会诊、远程教育、远程医学影像诊断、远程心电图和远程病理学，覆盖率分别为 86.3%（139/161）、57.1%（92/161）、49.7%（80/161）、37.9%（61/161）和 33.5%（54/161）。远程会诊的平均年服务量达到每家医院 714 例。远程会诊和远程诊断是核心收费服务。多变量分析表明，采用面向消费者的模式（P=.003）、获得科研基金支持（P=.01）、服务收费（P<.001）、医疗专业人员数量（P=.04）、网络类型（P=.02）、与其他医院共享数据（P=.04）和专业水平（P=.03）与远程会诊效果有关。采用面向消费者的模式（P=.01）、研究资金（P=.01）、服务收费（P=.01）、设立专门的管理部门（P=.04）和每月进行 15 次或更多次远程教育（P=.01）显著影响远程教育效果。
中国三级医院已开展多种远程医疗服务，前景广阔，但远程医疗在我国的可持续性和进一步规范化仍远未实现。
