Service map for cognitive impairment
The online hospital is a new application combining the internet and medical field services. It is a healthcare service platform that uses the internet as a carrier which can optimise the procedures for medical treatment and make the experience of seeing a provider more convenient. From 2011 to March 2020, the State Council, the National Health Commission, the National Healthcare Security Administration and relevant local government departments issued a total of 110 internet-related policies; from these, the online hospital began to issue pilot policies in Guizhou and Yinchuan in 2015. In 2018, the General Office of the State Council issued the ‘Opinions on Promoting the Development of “Internet Plus Medical Health”’,93 which clarified the boundaries of internet medical services. Three documents including the ‘Administrative Measures for Internet Diagnosis and Treatment (for Trial Implementation)’,94 ‘Internet Hospital Management Measures (for Trial Implementation)’95 and ‘Management Standards for Telemedicine Services (for Trial Implementation)’96 formulated by the National Health Commission and the State Administration of Traditional Chinese Medicine, further clarify the online and offline business development of online hospitals. Online services include triage, guidance, consultation, referral, appointments, registration, telemedicine (including video consultation, telephone consultation, graphic consultation, electronic prescription, billing and report query), medication guidance, health consultations, posthospital follow-ups, chronic disease management and contracting with family doctors. In contrast, offline services include providing patients with places for video consultation, health consultation, medication sales, delivery relying on retail drug enterprises and various medical services carried out after establishing cooperative relations with offline medical institutions.
With the current care service needs for cognitive impairment, the vigorous development of online medical platforms establishes a whole process service system. It includes prevention, screening, diagnosis, treatment, rehabilitation, care and support for cognitive impairment. The help of online hospitals breaks through the previous geographical and time limitations of medical institutions and nursing facilities. It effectively makes online and offline connections while significantly improving service efficiency. Moreover, it can provide convenient, accessible, evidence-based and reasonable guidance for patients with cognitive impairment and their caregivers. This can relieve their stress, which supports the prevention and treatment of cognitive impairment and further improves existing service systems.
At the beginning of 2020, the Shanghai Municipal Center for Disease Control and Prevention and the new online hospital jointly developed and improved a service map for cognitive impairment, expanding the scope of institutions and visually displaying various service resources in conjunction with special research results. Its main advantages are as follows: first, this makes it easier for experts to understand the organisation’s classification, layout and bed distribution. It also ensures that citizens can inquire about the organisation’s classification and surrounding organisations and readily obtain its general information (name, address, telephone number, bed information and pricing). Second, although cognitive impairment cannot be cured, early screening, early diagnosis and early treatment are essential for effective prevention and delay of the disease progression. It was for this reason that the platform was established via online hospitals. Functional modules such as online outpatient services, follow-up, rehabilitation, education, training, nutrition consultation, psychological counselling and legal assistance were established to conduct preliminary screening and self-testing for high-risk groups. Community families and primary, secondary and tertiary hospitals were linked to achieve hierarchical diagnosis and treatment and integrate service resources such as older adult care, which makes full use of the advantages of fast and efficient online hospital interconnection. The entire process of education, screening, referral, diagnosis, treatment, rehabilitation, nursing, care and hospice care for cognitive impairment is implemented through a combination of prevention and treatment, full-time and specialised integration, medical and nursing care and traditional Chinese and Western medicine. Third, through online video courses, live broadcasts and course training, various resources can be integrated to improve the public’s awareness of cognitive impairment. For the specific difficulties of caregivers, there are currently no support services, such as psychological counselling and legal assistance. It is foreseeable that in this new era during which COVID-19 will likely continue to affect people’s lifestyles profoundly, this online and offline integration model will play a significant role in the provision of healthcare delivery.
An example of internet medicine: the Shanghai Brain Health Alliance
The Shanghai Brain Health Alliance was implemented by the Shanghai Medical Society General Medical Section in conjunction with the online hospital. This is in accordance with the spirit and requirements of WHO’s Global Action Plan for public health, which is entitled the ‘Global Action Plan on the Public Health Response to Dementia 2017‒2025’13 and the Shanghai Municipal Government’s ‘Healthy Shanghai 2030’.81 It was established by 141 relevant institutions in the city. The Shanghai Brain Health Alliance is responsible for three main tasks. The first is to improve the clinical diagnosis and treatment of cognitive impairment in Shanghai. It aims to cooperate with Shanghai’s professional medical institutions to form a network that strives towards the prevention, screening, diagnosis, treatment, rehabilitation, standardisation of in-hospital treatment and out-of-hospital long-term management of patients with cognitive impairment. Furthermore, it aims to build a complete internal and external prevention management system, first prioritising primary diagnosis, followed by referral, acute and chronic treatment, and finally integration within the medical system to achieve ‘early prevention, early diagnosis and early treatment’. This will increase the detection and effective treatment rate of disorders and improve the city’s level of standardised prevention and treatment as a whole.
The second task is to improve the level of care for patients with cognitive impairment in the city, thus improving the collaboration and integration of healthcare and civil older adult care institutions. At the individual level, caregivers are more likely to obtain professional help, education and training to improve their care ability. At the institutional level, it will be easier to get professional medical support, enhance the quantity and quality of care institutions and improve the service level of the whole industry through the establishment of the alliance.
The third task is to enhance efficiency. An online and offline integrated prevention and care system has been built based on the online hospital platform. This overcomes obstacles posed by geography and time. For example, an online cognitive map 2.0 was launched to establish an online hospital specialised disease platform to display the city’s medical and care institutions (including parts of the Yangtze River Delta) to fully implement hierarchical diagnosis, treatment, drug distribution, evidence-based training, older adult care, rehabilitation, psychological counselling and legal assistance for the convenience of residents. Through the internet media matrix of communication and operation, promotion is used to improve the societal awareness of the disease and the concept of ‘health for all’.