How the Integration of Blockchain and Electronic Health Cards Empowers the Construction of Anhui Provincial Hospital's Internet Hospital
On December 12, 2019, Anhui Province held a ceremony to award licenses to the first batch of internet hospitals and to unveil the Internet Medical Supervision Platform and the Quality Control Center. Five hospitals—The First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Hospital), The First Affiliated Hospital of Anhui Medical University, The Second Affiliated Hospital of Anhui Medical University, The First Affiliated Hospital of Anhui University of Chinese Medicine, and Hefei BOE Hospital—became the first group of internet hospitals in Anhui Province. Patients can consult with doctors via text, images, or video calls using computers or mobile phones, and schedule examinations, thereby truly achieving “medical consultations at home.”
VCBeat visited the Internet Hospital of the First Affiliated Hospital of USTC in person and observed the entire process of patients seeking medical consultation through the platform. Launched in July 2019 and officially opened in December, what are the distinguishing features of its development? How does it operate, and what was the underlying vision? What stories lie behind its establishment?
Geographically, Anhui belongs to East China; economically, it is part of China’s Eastern Economic Zone. Located in the heartland of the Yangtze River Delta, the province spans three major river basins: the Yangtze, the Huai, and the Xin’an Rivers. Anhui is also the birthplace of the Huizhou merchants, one of the three great merchant groups in Chinese history. During the Ming and Qing dynasties, with salt trade as their core business, the Huizhou merchants rose to prominence and dominated the Chinese commercial landscape.
In terms of health capacity, Anhui Province exhibits unbalanced development of medical and health services, uneven allocation of resources, and a relatively low level of medical security. Furthermore, talent resources and the infrastructure capabilities of private medical institutions are comparatively weak, and there is also a prevailing issue of “prioritizing treatment over prevention.”
According to data from the Anhui Provincial Bureau of Statistics, by the end of 2018, the permanent resident population of Anhui Province reached 63.236 million, with a total of 24,926 medical and health institutions. The total number of patient visits to medical institutions across the province (including village clinics) amounted to 297.647 million for the year. It is projected that by 2020, the urbanization rate of the permanent resident population in the province will reach 56%, while the urbanization rate of the registered population will reach 35%. At that time, the imbalance in the allocation of high-quality urban and rural medical and health resources will become increasingly pronounced against the backdrop of rapid urbanization.
As the new healthcare reform continues to deepen, Anhui Province is also seeking new breakthroughs.
In May 2017, the National Health Commission designated Anhui Province as one of the first pilot provinces for electronic health cards. In September, the First Affiliated Hospital of USTC became the first pilot institution in Anhui Province and issued the province’s first electronic health card.
In March 2018, the First Affiliated Hospital of USTC successfully passed the overall acceptance inspection for the pilot project, laying a solid foundation for the comprehensive application of electronic health cards. On May 4, 2018, the launch ceremony for Anhui Province’s electronic health card was held in Hefei, marking the full-scale implementation of the “Internet + Healthcare” initiative aimed at facilitating public access to medical services in Anhui Province.
Liu Dexia, Director of the Outpatient Department at the First Affiliated Hospital of USTC, stated that the hospital issues an average of 1,000 cards per day. Based on an average daily outpatient volume of 12,000 visits, approximately 2,000 to 3,000 patients use electronic health cards for their consultations, accounting for one-quarter of the total daily patient visits.
During the development of “Internet + Healthcare” in recent years, the “Electronic Health Card” has been the focal point of Anhui Province’s initiatives. It is precisely because of the foundation laid by the Electronic Health Card that Anhui Province has been able to advance the construction of its internet hospitals with ease and efficiency.
In January 2019, the Health Commission of Anhui Province issued the “Implementation Plan for the Three-Year Improvement Plan for Smart Healthcare in Anhui Province (2018–2020)” (hereinafter referred to as the “Plan”). The Plan stated that by the end of that year, Anhui Province would initiate the construction of a provincial-level platform for supervising internet medical services, and at least three provincial hospitals and one municipal hospital in each city would commence the development of internet hospitals. By 2020, the construction of the provincial-level supervision platform for internet medical services was to be completed, and all tertiary public hospitals across the province were to fully provide internet medical services.
On December 3, 2019, the “Administrative Measures for Internet Hospitals in Anhui Province (Trial),” issued by the Health Commission of Anhui Province, came into effect on the date of its promulgation, providing a regulatory basis for the healthy development of internet hospitals and the standardization of online diagnosis and treatment activities in Anhui Province.
Clear policies provide a regulatory framework for the establishment of internet hospitals. On December 12, five internet hospitals were officially inaugurated in Anhui Province. On the same day, the province-wide internet healthcare supervision platform was launched to ensure and standardize the quality and safety of online diagnosis and treatment services.
As one of the first five internet hospitals in Anhui Province, The First Affiliated Hospital of USTC (University of Science and Technology of China) has built an integrated online and offline service system based on its physical hospital entity. Leveraging technological advantages in artificial intelligence, big data, cloud computing, and blockchain, the hospital enables patients to access high-quality medical resources from the comfort of their homes.
The First Affiliated Hospital of USTC (Anhui Provincial Hospital), founded in 1898, is a Grade A tertiary general hospital. It covers a total area of 1,158 mu (including planned area), with a built-up area of 476,800 square meters. The hospital currently comprises the Main Campus, the South Campus (Anhui Cardiovascular and Cerebrovascular Hospital), the West Campus (Anhui Cancer Hospital), the Infectious Disease Hospital (Hefei Infectious Disease Hospital), and the Minimally Invasive Medicine Center. In 2017, Anhui Provincial Hospital was designated as “The First Affiliated Hospital of University of Science and Technology of China.”
According to reports, the First Affiliated Hospital of USTC recorded 4.27 million outpatient visits in 2018, and this figure reached 4.91 million from January to November 2019. The average daily outpatient volume on weekdays was 12,000 visits, with the highest single-day outpatient volume reaching 15,000 visits.
“With a large volume of patients and crowded outpatient departments, the establishment of an internet hospital enables complementary advantages between online and offline services, thereby enhancing patient satisfaction while reducing the complexity of hospital management,” said Liu Dexia. This also reflects the original intention behind the First Affiliated Hospital of USTC in building its internet hospital.
Internet hospitals are categorized into hospital-led models and enterprise-hospital joint venture models, depending on the entity responsible for their establishment. The internet hospital of the First Affiliated Hospital of USTC is led by the hospital itself. Leveraging its traditional offline strengths, its business ecosystem focuses more on core medical services, including pre-consultation online consultations and appointment registration, during-consultation online visits and prescription issuance and review, and post-consultation medication delivery (via physical pharmacies and pharmaceutical e-commerce platforms).
The entry point for the Internet Hospital of the First Affiliated Hospital of USTC is available on the WeChat official account “First Affiliated Hospital of USTC (Anhui Provincial Hospital).” The WeChat platform supports one-click authorization and binding of the in-hospital electronic health card. The Internet Hospital’s system is interconnected with that of the physical hospital, allowing physicians to access patients’ medical records upon patient authorization. Currently, the Internet Hospital provides online consultation services across more than ten departments, including Internal Medicine, Endocrinology, Rheumatology and Immunology, General Surgery, Orthopedics, Obstetrics and Gynecology, and Cardiology. The hospital plans to gradually expand online consultation services to additional departments.
Liu Dexia emphasized that online consultations are only for patients with common diseases and chronic disease follow-up visits. If first-time patients seek online consultations, doctors can only provide health consultation services and cannot make diagnoses or prescribe medications. To ensure service quality and safety, the First Affiliated Hospital of USTC has strict selection requirements for online physicians.
Under the premise of voluntary participation by physicians in internet-based diagnosis and treatment services, the Internet Hospital of the First Affiliated Hospital of USTC selects physicians registered at the hospital who hold the title of attending physician or above and have more than three years of specialized clinical experience. To ensure the continuous operation of the internet hospital, the First Affiliated Hospital of USTC implements a shift scheduling system while encouraging eligible physicians to conduct online consultations, provided that such activities do not interfere with their outpatient duties.
After selecting the department and physician for consultation, patients can initiate a consultation dialogue with the physician via text-and-image or video communication. By entering symptom information in advance through an intelligent pre-consultation system, patients help physicians conduct more efficient intake assessments. Physicians may also access electronic medical records and laboratory/test reports upon patient authorization to assist in diagnosis.
Physicians at the First Affiliated Hospital of USTC are conducting video consultations (photo by reporter)
Finally, after the consultation, physicians can quickly issue prescriptions online. Upon pharmacist review and CA certification, an electronic prescription is generated. Patients can view prescription details, make online payments with delivery via express courier, or pay at the hospital pharmacy for immediate pickup. Currently, prescriptions issued by the Internet Hospital of the First Affiliated Hospital of USTC are valid only at its in-house pharmacy.
Xu Bing, Director of the Information Center at the First Affiliated Hospital of USTC, stated that the hospital will leverage blockchain technology to build a prescription circulation platform based on policy compliance. The aim is to integrate pharmacies, drug administration authorities, health departments, insurance companies, judicial institutions, and other stakeholders into this platform. This initiative seeks to meet patients’ medication needs while also facilitating daily regulatory oversight by drug supervision authorities.
To safeguard the quality of medical care and uphold safety standards in the emerging landscape of internet-based healthcare services, the Anhui Provincial Internet Medical Service Supervision Platform—led by the Health Commission of Anhui Province and supported technically by Tencent—was officially launched alongside the establishment of five licensed internet hospitals in Anhui Province.
The regulatory platform, based on the Measures for the Administration of Internet-based Diagnosis and Treatment (Trial), the Measures for the Administration of Internet Hospitals (Trial), and the Specifications for the Management of Telemedicine Services (Trial), interfaces with the internet hospital information platform to achieve comprehensive, real-time supervision covering access applications, the entire diagnosis and treatment process, and service quality. All medical institutions conducting internet-based diagnosis and treatment activities must maintain full-process records that are traceable and provide data interface access to regulatory authorities.
Notably, one month prior to the official launch of the Internet Hospital, Tencent, in collaboration with the First Affiliated Hospital of USTC and its medical consortium, pioneered the “Electronic Health Card + Blockchain” solution in Anhui Province. This initiative established a regional healthcare blockchain platform that organizes regional node systems in a decentralized manner, using the Electronic Health Card ID as the primary patient index to connect regulatory authorities with healthcare institutions.
The Electronic Health Card utilizes national standard QR code technology and State Cryptography Administration (SM) algorithms to generate a unique, nationwide dynamic electronic health QR code for each resident. Upon registration, the Electronic Health Card is linked to the resident’s ID card information and verified through facial recognition. For foreign nationals and individuals without an ID card, identity verification is conducted through manual backend review based on facial records and submitted identity information. Each Electronic Health Card can be linked to the medical information of up to five patients.
This solution is designed, on the one hand, to support cross-institutional health information sharing and utilization, and on the other hand, to facilitate the development of a prescription circulation platform.
Xu Bing further illustrated how this solution facilitates cross-institutional information sharing through a specific case. A patient had visited Hospital A three times and Hospital B twice, and chose the First Affiliated Hospital of USTC for their sixth visit. If Hospitals A and B share interoperable electronic health cards with the First Affiliated Hospital of USTC and all participate in the consortium blockchain of the Internet Hospital Platform, the First Affiliated Hospital of USTC can, upon patient authorization, access the patient’s previous five medical records. This enables clinicians to better understand the patient’s condition and improve diagnostic accuracy.
The integration of blockchain technology with electronic health cards provides healthcare institutions with a rapid and secure information channel, enabling the secure circulation and full-process traceability of electronic prescriptions.
Medical institutions uniformly aggregate their prescriptions to the Provincial Health Commission’s data center for authorized use. This approach raises concerns regarding time costs and data security, while also necessitating administrative intervention. With the integration of blockchain technology, each hospital serves as a node on the blockchain, enabling independent storage of prescription data. When a hospital needs to access such data, it can do so upon patient authorization, effectively reducing costs and improving operational efficiency. Furthermore, the inherent traceability and immutability of blockchain ensure the security of prescription records.
Meanwhile, Xu Bing also pointed out the challenges of promoting the application of electronic health cards based on blockchain.
First, “the card itself is free, but the cost of upgrading hardware equipment is high.” Due to the high density of electronic health cards, stringent requirements are imposed on card-reading hardware. Legacy card-reading systems and hardware infrastructure require updates and retrofitting. Second, the greater the number of members in a blockchain consortium chain, the more effective information sharing becomes. However, due to issues such as non-standardized data, achieving large-scale data sharing remains a challenging problem.
From the outset of its initial planning, the First Affiliated Hospital of USTC envisioned building an internet hospital platform rather than a standalone internet hospital. Other hospitals wishing to launch internet hospital services can register directly on this platform and simply staff it with certified physicians and clinical departments.
Next, the First Affiliated Hospital of USTC will gradually expand its internet-based medical services, such as by adding more online consultation departments and enlarging its team of physicians.
"In addition, the First Affiliated Hospital of USTC will upgrade its Hospital Information System (HIS) to standardize all previously unverified accounts, using electronic health cards as the primary index and linking them as closely as possible to patients' medical records. 'The First Affiliated Hospital of USTC has already established an Internet Hospital team. The main task for 2020 is to refine the overall architecture of the Internet Hospital and further improve its various functions.'"
“Horizontal and Vertical Integration” is the overarching strategy for Anhui Provincial Hospital in building its internet hospital.
“The Horizontal Axis” refers to the comprehensive integration of the entire internet-based diagnosis and treatment process. Beyond online consultation services, it extends upstream to health management and downstream to the integration of medical care with elderly care. Liu Dexia introduced that the First Affiliated Hospital of USTC will leverage blockchain technology to build a robust internet hospital, providing home-visit services for patients with disabilities and dementia, as well as enabling online appointments for family doctors and community services through the internet hospital platform. Additionally, the First Affiliated Hospital of USTC will use physical examinations as an entry point to expand the coverage of electronic health cards to a broader population.
“The first vertical axis” aims to establish an orderly tiered diagnosis and treatment system by promoting the integration of medical resources across different levels of care. Xu Bing introduced that the Internet Hospital of the First Affiliated Hospital of USTC will gradually incorporate its medical consortium members into the internet hospital platform.
The First Affiliated Hospital of USTC is the first hospital to implement Tencent’s “E-Health Card + Blockchain” solution, and it has currently demonstrated a positive development trend. It is understood that with the deep integration of E-Health Cards and blockchain technology, Tencent will continue to facilitate the rapid replication and implementation of innovative E-Health Card applications in other hospitals across Anhui Province, further promoting the nationwide adoption of this solution.