How telemedicine integrated into China’s anti-COVID-19 strategies: case from a National Referral Center

Introduction

The spread of the coronavirus disease (COVID-19) has caused an unprecedented demand for medical services, illuminating the worldwide inefficiencies of the current healthcare systems. Without a known cure for the disease, it became necessary for affected countries to maximise the efficiency of their healthcare delivery methods. To optimise their current systems, Chinese public officials ordered the integration of telemedical infrastructure into hospital systems as a part of the anti-COVID-19 response strategy.1 This report aims to present the framework for which the integration of telemedicine technology occurred at the West China Hospital of Sichuan University (WCH).

WCH is one of the largest single-site hospitals in the world and a leading medical centre in China. It is a tertiary public hospital located in Western China with more than 4300 inpatient beds, 3 fever tents and outpatient clinics that can accommodate over 20000 patients per day. The centre has more than 5000 healthcare professionals whose specialties span over 40 departments, including internal medicine, respiratory, paediatrics, radiology and laboratory medicine.

The imbalance in high-quality healthcare services between urban and rural areas still persists in China, especially in western provinces.2 To increase access to high-quality medical care and providers, WCH acts as the hub organisation and provides long-distance medical education and consultations to subordinate medical institutions, or spoke hospitals3 (660 spoke hospitals in 183 cities throughout western China). We present the utilisation of telemedicine technology in the specific context of the COVID-19 pandemic and postulate takeaways for global healthcare systems.

Methods

On 21 January 2020, the government of Sichuan Province launched the first-level emergency response to COVID-19 and designated WCH as an emergency response hospital. On 22 January 2020, an eHealth emergency committee was established at WCH to plan, guide and coordinate the transferring of in-person healthcare services to Huayitong, a telemedicine mobile application created by WCH in 2015. WCH quickly assembled a team of clinical experts (named the ‘COVID-19 online team’) from the respiratory, intensive care unit (ICU), nephrology, endocrinology, infection, cardiology, gastroenterology and radiology departments to further develop the mobile application.

One week later, the updated app was launched, synergising online consultations and e-prescription delivery. To encourage its adoption, the government and the hospital publicised the app on social media and waived consultation fees for all users. On 24 February 2020, a 5G dual gigabit network was established in WCH, covering all connected spoke hospitals designated for COVID-19. Additionally, technology specialists at WCH were employed to coordinate scheduling for teleconsultation appointments and the departments of Information Technology and Management set clinical guidelines for accommodating physicians to the online platform.

Through utilising the updated version of Huayitong on 1 February 2020, WCH began virtually providing triage, consultations (consultations scheduled through appointments and emergency consultations performed within 24 hours of request), education, rounds, CT scanning, treatment and follow-ups.

This research obtained approval from the Institutional Review Board of WCH.

Results

Discussion

Through this analysis, it is apparent that telemedicine technologies are a legitimate mechanism for screening, triaging and treating patients with COVID-19. As echoed by other reports,4 the online platform has reduced the number of in-person visits to WCH, thereby minimising face-to-face contact among patients and clinicians and decreasing the transmission of the virus. Furthermore, limiting in-person visits reduced the scarcity of medical resources, such as personal protective equipment, which benefitted both patients and physicians.

Though there was a significant decrease (46%) in in-person visits to WCH compared with 1 February–1 April 1, 2019, we cannot assume that this was a direct consequence of telemedicine as it is expected that patients may choose to not seek medical attention for non-critical health conditions during a pandemic. However, the monthly average of online non-COVID-19 visits increased nearly fivefold, from 3400 to 16 338 during this 2-month period, indicating that patients are switching from in-person visits to telemedicine services at increasing rates.

Across the globe, the acceptance of telemedicine as a safe, convenient, time-saving, labor-saving and cost-saving healthcare delivery method has risen, and, accordingly, medical institutions have increased its availability, allowing more care to be provided to patients at a distance.5 6 Nevertheless, when discussing the integration of telemedicine into healthcare systems, it is important to consider the barriers that may prevent successful adoption.7–13

First, only 8.1% (447 of 5517) of physicians at WCH used the telemedicine platform. A recent physician survey at WCH identified the following potential challenges: lack of time, insufficient authenticity and reliability and underdeveloped policies.9 Considering that respiratory, infectious disease, intensive care and emergency medicine providers already have heavy workloads, incentives may be necessary to encourage physicians’ engagement. Furthermore, more training programmes and further development of guidelines may be integral in facilitating physicians’ transition to online healthcare delivery methods.9 14

Second, patients play a key role in the effectiveness of their telemedical care. Therefore, hospital adoption strategies must prioritise the user-friendliness of their platforms. This can be achieved through involving and communicating with patients during the platform’s development process, which unfortunately did not occur for Huayitong. Furthermore, older patients, while most reliant on healthcare services, are less likely to use telemedical applications.8 Therefore, hospitals must ensure that access to online assistance is available for patients, such as those from older cohorts, that lack technological proficiency, in order to successfully care for patients from all demographics. Along with prioritising user-friendliness and providing access to technical assistance, it is compulsory that patients are well aware that online healthcare services exist. Therefore, advertising for platforms must be done through mediums that will reach all age groups and demographics, not just social media.

Finally, as telemedicine grows in popularity, it is paramount that data safety and privacy are ensured.15 Security, ownership, storage and traceability of patient data must be deliberated, especially for newly built online platforms that were implemented quickly due to the urgency of COVID-19. In the case of WCH, when patients registered in Huayitong, they signed a consent form that indicated that all the data would be stored at WCH and used only for medical purposes. Moreover, collaboration with regulatory agencies and government remains vital. For WCH, telemedicine services have been connected with and supervised by the provincial medical supervision system since 2019, which has helped protect the security of data.

Additionally, further technical issues remain restricting the use of telemedicine, including lack of data synchronicity and interoperability due to the heterogeneity of EMRs system for each hospital. Thus, generalisable methods for securely interoperating data from EMRs and patient report outcomes need rigorous exploration.16–20 Moreover, in accordance with the suggestions of prior research, evaluation methods must be established for telemedicine technologies so that high standards of care are upheld.21

This study presents the extent to which telemedicine technology was used by a national referral centre during a pandemic. This paper addresses how both patients with COVID-19 and without COVID-19 can benefit from the use of telemedicine and highlights important concerns regarding data security and interoperability. Through this information, global healthcare systems, especially in low-income and middle-income countries, can be introduced to the breadth of capabilities of telemedical technology and begin to implement and further develop these practices.