Medical Quality Control as the 'Traffic Light' for Internet Healthcare: Three Key Phases Driving Online Medical Service Quality Improvement
Since the beginning of this year, internet healthcare has witnessed rapid advancement.
Currently, China has 900 internet hospitals, and 30 provinces have established regulatory platforms for internet medical services. From top-tier medical institutions such as Peking Union Medical College Hospital and Shanghai Ruijin Hospital to primary healthcare facilities in Shandong, Zhejiang, and other regions, all are actively promoting internet-based medical services. Internet medical platforms have also achieved remarkable results: Ping An Good Doctor has registered 346 million users, with daily consultations reaching 830,000.
The National Health Commission, in coordination with the National Healthcare Security Administration and more than ten other departments, has sequentially formulated and issued over ten supporting policies covering standardized management of internet-based healthcare, pricing and payment mechanisms, and personal information protection. It is widely acknowledged within the industry that the internet healthcare sector has been accelerating its development for several years.
At a recent press conference held by the State Council Information Office, Mao Qun’an, Director of the Planning Department of the National Health Commission, stated that internet healthcare must strictly adhere to the baseline for safety supervision, employ new regulatory approaches for emerging business models, carry out special campaigns to protect important data and personal information, strengthen privacy protection, and ensure medical quality and data security.
In the process of accelerating growth, medical quality and safety have become critical components that cannot be overlooked. Reviewing the measures implemented in offline settings to safeguard medical quality and safety, online platforms should at least establish a comprehensive assurance system covering pre-event, intra-event, and post-event stages.
With the emergence of internet-based healthcare, the differing channels of interaction between physicians and patients have imposed greater demands on ensuring medical quality and safety.
“It is essential to emphasize that the essence of internet-based healthcare remains medical care; only the mode of service delivery by physicians has changed.” According to Lu Qingjun, Executive Vice President of the Internet Hospital Branch of the Chinese Research Hospital Association and Director of the Office of the National Telemedicine and Internet Medicine Center at China-Japan Friendship Hospital, quality control in internet-based healthcare should first comply with existing regulations for offline practice. Furthermore, given the absence of face-to-face interactions between physicians and patients, quality control standards should be more stringent than those for offline care, incorporating additional requirements on top of the existing offline regulations.
Offline, there is a vast body of healthcare-related laws and regulations, judicial interpretations, departmental rules, and key policy provisions, which have been compiled in multiple editions of specialized reference works.
These provisions cover medical institutions and personnel, medical services, disease prevention and control, resolution of medical disputes, and criminal liability, among other areas. They feature detailed categorization and comprehensively address all aspects of medical activities, with the ultimate aim of safeguarding the quality of medical services.
Lu Qingjun introduced that the medical system has formed a comprehensive framework after decades of accumulation. In the diagnosis and treatment process alone, the "Key Points of Core Systems for Medical Quality and Safety" formulated by the National Health Commission includes 18 items, such as the first-visit responsibility system, medical record management system, and verification system.
In 2018, the issuance of three major documents, including the Administrative Measures for Internet-based Diagnosis and Treatment (Trial), established thresholds for the accreditation of internet-based diagnosis and treatment services and internet hospitals, physician credentialing, and the configuration of software and hardware. These regulations also require medical institutions providing internet-based diagnosis and treatment services to formulate systems for quality control and evaluation of internet healthcare, as well as for the management of online prescriptions, thereby implementing daily management of medical service quality.
In local policy regulations, the 2020 “Yinchuan Internet Diagnosis and Treatment Service Specifications (Trial)” specifically established a chapter on “Medical Quality Management,” covering aspects such as physician response timeliness, refund mechanisms, and complaint handling. This document was formulated by Yinchuan in response to issues encountered in practice in recent years.
It is evident that, from an institutional perspective, internet-based healthcare is gradually refining regulations in various aspects, building upon offline provisions while addressing the unique characteristics of the online environment.
In terms of implementation, physicians are the core providers of internet-based medical services, making their entry thresholds particularly critical. The National Health Commission stipulates that only physicians with at least three years of independent clinical work experience may engage in online diagnosis and treatment activities. Some local health commissions and healthcare institutions have raised this requirement to five years to ensure the safety of online services. Internet healthcare platforms enhance medical quality and capabilities by actively recruiting senior physicians and those from tertiary (Grade 3A) hospitals to join their networks. Meanwhile, companies such as Ping An Good Doctor and JD Health have established their own in-house physician teams; notably, Ping An Good Doctor’s proprietary physician team has grown to over 1,800 members.
The improvement of regulations has enabled the industry to adhere to rules and follow orderly procedures, thereby achieving “ex-ante” safeguards. During the implementation of medical practices, corresponding measures are also in place for quality control.
Medical institutions establish medical affairs departments to organize and manage clinical operations, medical quality, and medical technologies. “Over the past two decades since the rise of healthcare informatization, the application of various technologies, such as Hospital Information Systems (HIS) and electronic medical records, has provided valuable support for medical quality control,” said Lu Qingjun. He noted that the greatest convenience brought by information technology lies in its ability to rapidly record and track the diagnosis and treatment process, facilitating the summarization of experience and the identification of issues.
The application of AI in the medical field has opened up new possibilities for medical quality control. Given that medical knowledge is both extensive and complex, a single symptom can often point to multiple potential etiologies. Conventional rule-based recommendation systems frequently fail to cover all such possibilities. In contrast, NLP-based Clinical Decision Support Systems (CDSS) can handle complex medical logic, provide physicians with probability distributions of potential diagnoses based on patient conditions, and be seamlessly integrated into electronic medical records. Currently, AI-powered intelligent medical record systems are being rapidly deployed in healthcare institutions.
Internet healthcare, having already achieved digitalization, can strengthen quality control through process optimization and the application of new technologies. For instance, Ping An Good Doctor has implemented an AI-assisted diagnosis and treatment system, comprising an intelligent critical care monitoring system, an AI-powered assisted consultation system, a rational drug use monitoring system, and an intelligent medical safety monitoring platform. This integration not only enhances the efficiency of medical services but also improves their quality.
The necessity and rationality of diagnostic and treatment practices are of paramount importance, but they rest on a fundamental prerequisite: authenticity, which encompasses both the verification of patient identity and the genuineness of the clinical encounter. In-person medical visits require real-name registration; patients must provide valid identification documents starting from the appointment scheduling stage, and physicians may re-verify patient identity during the consultation. Meanwhile, patients can also confirm whether they are being treated by the attending physician themselves by referring to publicly available information within the healthcare facility.
“Online consultations lack face-to-face interaction. Is the physician logging into the account to provide care actually the intended provider? Is the patient submitting the questions truly the individual in question? Could there be cases of mistaken identity? Both parties face challenges in identity verification,” stated Lu Qingjun. In such scenarios, technical measures must also be employed to achieve identity verification.
In response, medical institutions have generally implemented real-name authentication during the registration process, and patients are required to present their ID cards for further verification during consultations. Solutions offered by health IT companies such as Yi Fuzhen can ensure the authenticity of prescriptions and the traceability of the consultation process. Furthermore, facial recognition technology has been widely adopted in sectors including finance, security, and access control, aligning closely with the requirements of online healthcare scenarios. It is expected to be applied in the future for online identity verification of both physicians and patients.
The measures at the first two levels are primarily aimed at preventing risks from occurring. However, there is always a certain probability that risks will materialize. Once they do, how can the losses for both doctors and patients be minimized? In offline settings, insurance products such as physician liability insurance and medical accident insurance can provide risk protection for both parties.
In the realm of internet healthcare, similar safeguard measures have gradually emerged within the industry. Examples include DXY’s “Dingxiang Renyi” mutual insurance plan and Weimai’s home-visit medical service guarantee program, covering various aspects of internet healthcare services.
Recently, Ping An Good Doctor has launched the "Comprehensive Peace-of-Mind Guarantee for Online Healthcare," providing protection for both doctors and patients. For doctors, the product offers medical professional liability insurance for internet-based healthcare services. Both Ping An Good Doctor’s in-house physician team and external partner physicians are covered with an insured amount of RMB 1 million. For patients, the product addresses key concerns such as physician credentials, consultation response speed, quality of diagnosis and treatment, and medication safety. Specifically, the platform guarantees the authenticity of physicians’ displayed profiles, ensures prompt responses from physicians after users initiate consultations, provides liability coverage for the accuracy of expert diagnoses upon completion of consultations, assures medication quality and delivery timeliness, and safeguards personal privacy throughout the entire process.
It is evident that insurance coverage is expanding from protecting physicians to covering patients, thereby achieving more comprehensive role inclusion. For physicians, such products help create a more favorable environment for online practice and strengthen their incentive to engage in digital healthcare services. For patients, these offerings further alleviate concerns about seeking medical care online. In its article titled “User Base Growth: Internet Healthcare Enters a New Phase of Rapid Expansion—How to Address the New Round of Challenges?”, VCBeat previously explored how to further cultivate user habits in the post-pandemic era. It now appears that full-process consultation protection services provided by companies such as Ping An Good Doctor represent one effective approach to deepening patient trust and fostering habitual use.
“Attention should be paid to the fact that a corresponding credit reporting system must also be established when using insurance products for risk protection.” Lu Qingjun believes that this is an important foundation for the sound operation of insurance coverage.
How Significant Is the Management of Medical Quality and Safety to the Industry? The National Healthcare Security Administration’s Recent New Policy on Insurance Payment for Internet-Based Medical Services Also Emphasizes This Point.
Under the new medical insurance policies, regulatory measures for “Internet+” medical services shall be strengthened. The intelligent audit and monitoring system for medical insurance shall be employed to conduct real-time oversight of settlement details, pharmaceuticals, consumables, medical service items, and outpatient medical records associated with “Internet+” medical services. Audio and video verification methods shall be utilized to authenticate the identity of physicians providing “Internet+” medical services.
These all impose more detailed requirements on internet-based medical consultation practices.
Lu Qingjun is one of the experts who participated in the formulation of policies for medical insurance payment in internet healthcare. In his view, although a series of policies have strengthened safety supervision, their promotional effect on the industry far outweighs their restrictive impact. “This is akin to establishing traffic rules, installing crosswalks and traffic lights; only when vehicles and pedestrians each follow their designated paths can traffic flow smoothly. The same principle applies to the healthcare industry: only when all medical institutions practice in full legal and regulatory compliance can the industry as a whole operate in an orderly manner. Therefore, these regulations serve to protect the industry.”
Lu Qingjun stated that the new medical insurance policies are formulated based on offline management and operational systems. They aim to regulate non-compliant practices while encouraging lawful professional conduct. Regardless of whether institutions are public or private, the policy maintains a supportive stance toward all legally compliant practices.
Indeed, the new medical insurance policy also indicates that localities may start with outpatient services for specific chronic and serious diseases and gradually expand the scope of medical insurance coverage for “Internet+” medical services related to common and chronic conditions. In conjunction with pilot programs for direct settlement of outpatient expenses, efforts will be made to explore direct cross-regional settlement for “Internet+” medical services, drawing reference from offline practices. Meanwhile, the high level of comprehensiveness of this new policy will accelerate its implementation by local medical insurance authorities.
All of this indicates that policies are gradually expanding the scope and intensity of support for the industry, premised on ensuring medical quality and safety as well as the security of the national healthcare insurance fund. As stakeholders in the industry, all parties have a responsibility to exercise strict self-discipline under regulatory guidance, thereby paving a smoother and broader path forward.