The Construction and Operational Models of Internet Hospitals in China: A Hospital-Based Survey Study

doi:10.21203/rs.3.rs-1962150/v1

Download PDF

Research Article

The Construction and Operational Models of Internet Hospitals in China: A Hospital-Based Survey Study

https://doi.org/10.21203/rs.3.rs-1962150/v1

This work is licensed under a CC BY 4.0 License

Journal Publication

published 21 Jun, 2023

Read the published version in BMC Health Services Research →

You are reading this latest preprint version

Background

China empowered and continues to empower internet hospitals, which saw an increase in their development due to the pandemic, to fight against COVID-19. The construction and operational models of internet hospitals can be categorized as self-constructed and self-managed models, self-constructed and enterprise-run models, hospital and enterprise joint-owned models, and as being hosted by a third-party platform. Despite the increasing importance of internet hospitals, there have been few systematic summaries of its construction and operational models.

Objective

The study’s primary purpose was to understand the construction and operational models of internet hospitals in China.

Methods

Data were collected from September 2020 from the internet hospital survey and hospital staff survey based on 39 medical institutions and 356 medical staff. T-tests were used to compare the continuous variables’ values. Chi-square tests were used to compare the proportions of the categorical variables. The self-perception of the internet hospitals’ services was assessed on 17 aspects using a 5-point Likert scale. A root cause analysis was used to identify the root causes and influencing factors of the current deficiencies faced by internet hospitals.

Results

Among the 39 internet hospitals, 22 (56.4%) were self-constructed and self-managed. Self-constructed and self-managed hospitals had lower percentages of professionals providing online services (P=0.006), numbers of doctors outside of the entity (P=0.006), numbers of online nurses (P=0.004), and ratio of online nurses to offline doctors as compared to other models of internet hospitals (P < 0.001). Among the 17 evaluation aspects of the medical staff’s self-perception of the internet hospitals’ services, fee transparency, fee rationality, travel cost capital, patience and responsibility, and consultation behaviors had the highest scores. The root causes included five aspects: human, channels, prices, services, and time.

Conclusions

There were differences between self-constructed and self-managed models and other models of internet hospitals. This study enriches the literature on the construction and operational models of internet hospitals and provides additional policy implications for tele-medicine management.

Internet hospital

Construction

Establishment model

Hospital-based survey

China

Internet hospitals, as an innovative approach, combine online and offline access for medical institutions to provide health services to patients [1]. Information technology is used from the hospital to the Internet to develop online medical services and health services [2]. Patients, who stay at home or go to a local clinic can consult with doctors, who are based in top-level hospitals through a website or smartphone app [3]. In China, authorized internet hospitals use internet technology to provide safe and appropriate medical care for common and chronic diseases, such as follow-up treatment or consultation. Doctors are permitted to prescribe treatment online after accessing patients’ medical records [4]. As a supplement to offline health services, internet hospitals can surmount geographical obstacles and time-related barriers. This makes it easier for patients to access medical services rapidly and conveniently.

The first internet hospital in China was developed in Guangdong Province in 2014 [5]. Initially, internet hospitals grew very slowly between 2014 and 2017. The beginning of the standardized development of internet hospitals in China may trace back to the end of 2018, when policies for comprehensive regulation were first introduced. The Chinese government thereby issued specific regulations on internet hospital management, including diagnosis and treatment, telemedicine, safety and accountability, and so on [4]. By January 2019, the number of registered internet hospitals expanded to approximately 130 across 25 provinces [1]. The outbreak of COVID-19 has accelerated the development of internet hospitals to supplement suspended in-person healthcare services during the pandemic [6–9].

The construction and operational models of internet hospitals can be categorized as self-constructed and self-managed models, self-constructed and enterprise-run models, hospital and enterprise joint-owned models, and as being hosted by a third-party platform. This categorization is based on fund investment, technical forces, and operating management models [10]. While much information on the construction and operational models of the internet hospitals is unknown, Han et al. discussed the definition, establishment, and development status of internet hospitals through the Baidu search engine for results up until January 1, 2019 [1]. Xu et al. described the characteristics of internet hospitals from public data and assessed these hospitals’ health service capacity during the COVID-19 pandemic. The results showed that internet hospitals provided various services during the pandemic such as providing medical prescriptions, drug delivery, and medical insurance services [8]. Xie et al. reported that many of the internet hospitals were not yet accomplished and encountered various challenges, such as insufficient online doctors and an unavailability of health insurance coverage [11]. Most internet hospitals are service providers that provide online healthcare and conversely provide regular care.

A variety of internet hospitals have been implemented in China with promising prospects. However, the sustainability and further standardization of internet hospitals are still far from accomplished. To understand the status of the development of internet hospitals in China, we conducted a survey of 39 internet hospitals and 356 medical staff to analyze the construction and operational models of internet hospitals in China.

Data collection

Internet hospital survey

This survey was conducted with the support of China’s Internet Hospital Operational and Management Status and Talent Training Program. This program was run by the Chinese National Health Commission, which is comprised of 33 network members. These include all types and levels of medical institutes distributed across mainland China (Fig. 1).

There are three types of construction models and four types of operational models. We grouped construction models and operational models into four types of models based on the construction funding source, technical forces, and operational conditions of the internet hospitals. These were self-constructed and self-managed models, self-constructed and enterprise-run models, hospital and enterprise joint-owned models, and those that were hosted by a third-party platform. The definition was discussed and an agreement was reached by the network members through panel discussions [10] (Box.1).

Box.1 Types of internet hospital constructions and their operational models

Models	Definitions	Examples
Self-constructed and self-managed models	Medical institutions or enterprises invested in building their own internet hospital and operate on their own.	Peking University Third Hospital
Self-constructed and enterprise-run models	Medical institutions invested funding to build their own internet hospital and entrusted a third-party company to manage.	Affiliated Cancer Hospital of Chongqing University
Hospital and enterprise joint-owned models	Medical institutions and enterprises joint invested to build the internet hospital and manage the internet hospital together.	Eye Ear Nose & Throat Hospital of Zhengzhou University
Internet hospital being hosted by a third-party platform	Medical institutions join in an internet hospital platform which is constructed and managed by a local government or the enterprise platform to provide online health services.	Second Hospital Affiliated to Zhengzhou University

Convenience sampling was used to recruit internet hospitals across the country. The program members were first invited to complete the survey and they helped to distribute the survey to the hospitals outside of the network. The survey instrument was drafted by the study team with reference to the literature and domain knowledge input from experts within the program network members. The questionnaire was first administered in three hospitals (inside the research team) to test its acceptability and feasibility. Minor adjustments were made regarding the logic and jumps after the pretest. Finally, after several rounds of comments and revisions, a structural questionnaire was developed and approved by the program network members. The content for the hospital survey included hospital information, an internet hospital setup, a quality control plan and an evaluation, and the self-perceptions of internet hospital services. The internet hospital setup included the following aspects: an administration plan; information from online doctors, pharmacists, and nurses; regulations for quality and safety; annual operating expenditure; and annual operating revenue. The self-perception of the internet hospital services was assessed from 17 aspects using a 5-point Likert scale. Meanwhile, several open-ended questions were asked to collect information on the perceived advantages and disadvantages of internet hospitals and the attitudes toward the provision of online medical services. An online survey was created using Wenjuanxing (an online survey platform, www.wjx.com) and distributed to the program member network. Each hospital provided information once. Information on the status of the internet hospital was as of September 2020. The language used in the survey was Chinese.

The hospital staff survey

Apart from collecting information from internet hospitals, we also conducted an individual survey for hospital staff to obtain information on their attitudes and perceptions of the internet hospitals’ services. The survey’s respondents were health professionals, who provided online services during the survey period. The development of the hospital staff survey instrument was consistent with the internet hospital survey. The questionnaire consisted of 27 items, which may be divided into four parts: 1) demographic information including age, degree, and professional title; 2) perceptions of online medical services provision including before, during, and after the online medical consultation; and 3) awareness of relevant laws and regulations of the internet hospital. The implementation of the hospital staff survey was consistent with the use of an online survey platform (Wenjuanxing, www.wjx.com) to collect the information. The language used in the survey was Chinese. All data were collected from September 2020. All participants consented to participate in the online survey. The data used for this report were provided by the program administrations.

Data analysis

Data analysis was performed using Microsoft Excel 2017 (Microsoft Corp) and the Statistical Package for the Social Sciences (SPSS) software (version 23.0; IBM Corp.). The mean and variance values were calculated for the continuous variables, and T-tests were used to compare their values. Categorical variables were described as frequencies and proportions. Chi-square tests were used to compare the proportions of the categorical variables. The significance level of α was set at 0.05. The self-perceptions of the internet hospital services were displayed by using a radar chart. Qualitative data (text answers collected by open-ended questions) on how to improve the internet hospital services were processed using thematic analysis. Two authors (X.W and W.C) closely examined the data to identify common themes that repeatedly emerged and grouped them into different themes. After the themes were determined, two group discussion sessions were held with the program network members for further discussion, commenting on, and finalizing of the thematic analysis results. Finally, we identified five dimensions (human, channels, prices, services, and time) and 17 elements that influenced hospital services. To illustrate the thematic analysis results, two authors (X.C and X.W) developed a root cause analysis diagram.

Characteristics of the internet hospitals establishment model

A total of 39 internet hospitals provided information for this analysis. Among them, 30 (76.9%) were general hospitals, nine (23.1%) were specialized hospitals, 31 (79.5%) were tertiary, eight (20.5%) were secondary hospitals, 35 (89.7%) were public hospitals, and four (10.3%) were private hospitals. Regarding the regional distribution, 18 (46.2%), four (10.3%), and 17 (43.6%) hospitals were in eastern, central, and western China, respectively. Regarding the construction and operational model, the majority were self-construction (66.7%) and self-management (56.4%), which were comprised of 22 (56.4%) self-constructed and self-managed internet hospitals (Table 1).

Table 1

Characteristics of the internet hospitals’ establishment model.
Characteristics	n (%)
Type of the host hospital
General hospital	30 (76.9%)
Specialized hospital	9 (23.1%)
Level of the host hospital
Tertiary	31 (79.5%)
Secondary	8 (20.5%)
Ownership model
Public	35 (89.7%)
Private	4 (10.3%)
Regions
Eastern China	18 (46.2%)
Central China	4 (10.3%)
Western China	17 (43.6%)
Construction model^*
Self-construction	26 (66.7%)
Co-construction	5 (12.8%)
Join to a platform	6 (15.4%)
Operational model^*
Self-management	22 (56.4%)
Third-party management	6 (15.4%)
Jointly-run management	5 (12.8%)
Enterprise-run management	4 (10.3%)
Internet hospital models^*
Self-constructed and self-managed	22 (56.4%)
Self-constructed and enterprise-run	4 (10.3%)
Hospital and enterprise joint-owned	5 (12.8%)
Being hosted by a third-party platform	6 (15.4%)
* Two internet hospitals were under development.

Characteristics of the internet hospitals’ setup

The characteristics of the internet hospital setup information are summarized in Table 2. There were statistical differences in the percentage of professionals providing online services (P = 0.006), the number of doctors outside the entity (P = 0.006), number of online nurses (P = 0.004), the ratio of online nurses to offline doctors (P < 0.001), and whether it related to the provincial regulatory platform (P = 0.033) between self-constructed and self-managed hospitals and other models of hospitals. The self-constructed and self-managed hospitals had a lower percentage of professionals providing online services. They also had a lower number of doctors outside the entity, lower number of online nurses, and a lower ratio of online nurses to offline doctors than other models of hospitals. Moreover, self-constructed and self-managed hospitals accounted for a higher proportion of whether they were connected to the provincial regulatory platform than other models of hospitals (Table 2).

Table 2

Characteristics of the internet hospitals’ setup^‡.
	Total	By models
Characteristics	n (%) / Mean (sd)	Self-constructed and self-managed n (%) / Mean (sd)	Other models^* n (%) / Mean (sd)	P^†
Administration department of internet hospital
Number of medical institutions with independent internet hospital management departments	18 (46.2%)	11 (28.2%)	7 (17.9%)	0.748
Number of administrative staff	9(5)	6 (4)	10(6)	0.133
Online doctors
Number of online doctors	172(255)	182 (295)	153 (170)	0.745
Number of doctors in the entity	336 (372)	373(434)	270 (222)	0.413
Number of doctors in outside of entity	7(19)	4(12)	31(46)	0.006
Percentage of professionals providing online services	29.2 (26.0)	21.4 (21.2)	44.9 (28.3)	0.006
Online pharmacists
Number of online pharmacists	14(23)	13 (26)	16 (12)	0.706
Number of pharmacists in the entity	30 (50)	30 (59)	33 (26)	0.873
Number of pharmacists in outside of entity	1 (2)	0	1 (2)	-
The ratio of online pharmacists to offline doctors	0.2 (0.3)	0.2 (0.3)	0.3 (0.3)	0.094
Online nurses
Number of online nurses	21(49)	10 (42)	64 (53)	0.004
Number of nurses in the entity	309 (420)	248 (444)	432 (349)	0.201
Number of nurses in outside of entity	3(11)	0	3 (11)	-
The ratio of online nurses to offline doctors	< 0.1 (< 0.1)	< 0.01(< 0.1)	0.2 (0.1)	0.001
Regulations for quality and safety
Whether it is interconnected with HIS\LIS\PACS data of offline hospitals	29 (74.4%)	19 (48.7%)	10 (25.6%)	0.071
Whether it is connected with the provincial regulatory platform	28 (71.8%)	19 (48.7%)	9 (23.1%)	0.033
Whether the diagnoses and prescriptions are electronically signed by the doctors	34 (87.2%)	20 (51.3%)	14 (35.9%)	0.636
Whether all patients have electronic medical records	34 (87.2%)	19 (48.7%)	15 (38.5%)	1.000
Are all prescriptions reviewed by pharmacists	34 (87.2%)	20 (51.3%)	14 (35.9%)	0.636
Annual operating expenditure
Less than 500 000 Yuan	23 (59.0%)	14 (35.9%)	9 (23.1%)
500 000 to 1 million	10 (25.6%)	6 (15.4%)	4 (10.3%)	0.593
Above 1 million	6 (15.4%)	2 (5.1%)	4 (10.3%)
Annual operating revenue
Less than 500 000 Yuan	23 (60.0%)	15 (38.5%)	8 (20.5%)
500 000 to 1 million	5 (12.8%)	1 (2.6%)	4 (10.3%)	0.214
Above 1 million	11 (28.2%)	6 (15.4%)	5 (12.8%)
^‡ Information of the status of internet hospital was collected as of September 2020. Numbers of people were rounded to the nearest whole number.
* Other models included self-constructed and enterprise-run model, hospital and enterprise joint owned model, and hosted by a third-party platform.
† The t test was used to compare values of continuous variables. The Chi square test was used to compare proportions of categorical variables.
Abbreviation: HIS refers to Hospital Information System; LIS refers to Laboratory Information System; PACS refers to Picture Archiving Communication System.

Direct-to-patient services available in the internet hospitals

Online consultation and follow-up visits were the two items with the highest proportion of available direct-to-patient services in the internet hospitals. This was followed by the provision of electronic prescriptions, drug delivery, and health education. Moreover, “health education” showed a significant statistical difference between self-constructed and self-managed hospitals and other models of hospitals (P = 0.008). Self-constructed and self-managed hospitals had a higher percentage of health education. In addition, for drug delivery, a marginal statistical difference was observed between self-constructed and self-managed hospitals and other models of hospitals (P = 0.057) (Table 3).

Table 3

Available services for patients in the internet hospitals^†
	Total	By models		P
Classification	n (%)	Self-constructed and self-managed n (%)	Other models^* n (%)	P
Online consultation	29 (74.4%)	17 (43.6%)	12 (30.8%)	0.721
Follow-up visit	24 (61.5%)	15 (38.5%)	9 (23.1%)	0.508
Electronic prescription	21 (53.8%)	14 (35.9%)	7 (17.9%)	0.206
Drug delivery	21 (53.8%)	15 (38.5%)	6 (15.4%)	0.057
Prescribe examination	6 (15.4%)	5 (12.8%)	1 (2.6%)	0.206
Make an appointment for examination	5 (12.8%)	4 (10.3%)	1 (2.6%)	0.363
Referral to the physical hospital	4 (10.3%)	3 (7.7%)	1 (2.6%)	0.618
Health education	17 (43.6%)	14 (35.9%)	3 (7.7%)	0.008
^† Information of the status of internet hospital was collected as of September 2020.
^* Other models refer to self-constructed and enterprise-run model, hospital and enterprise joint owned model, and hosted by a third-party platform.

Self-scoring of internet hospital services

The average self-score was 4.12 ± 0.19. As shown in Fig. 2, among the 17 evaluation items, the top five in the average score were fee transparency, fee rationality, travel cost capital, patience and responsibility, and consultation behaviors. The items with the lowest scores were insurance coverage, consultation channel, quality of notification, online query results, and problem solving.

The root causes for improving internet hospitals’ services

The root causes survey identified five dimensions or factors that influenced internet hospital services: human, channels, prices, services, and time (Fig. 3).

Principal findings

Our hospital-based survey study outlined the construction and operational models of 39 internet hospitals in China from September 2020. The results showed that the self-constructed and self-managed model was the major type among the four construction and operational models of internet hospitals in China. It is worth noting that the percentage of professionals providing online services, the number of doctors outside the entity, number of online nurses, and the ratio of online nurses to offline doctors of self-constructed and the self-operated internet hospitals were significantly lower than those of other models. The reasons may be that doctors’ technical levels, hospital departments, and workloads were different between the self-constructed and self-managed models and that of other models of internet hospitals [12]. For the different types of internet hospitals, stakeholders had different supporting content and responsibilities.

There was no difference between the self-constructed and self-managed models and other models on the availability of direct-to-patient services in internet hospitals, except for health education. The self-constructed and self-managed internet hospitals invested funds, constructed technical forces, and operated services themselves [13]. Moreover, perceived behavioral control and perceived severity of disease were reported to be the most important determinants of patients’ intention to use online inquiry services provided by the internet hospitals [14].

The professional technology of medical services determines the indispensability of the doctors. With the support of information technology, internet hospitals promoted the balance of medical resources and improved the convenience and efficiency of medical services. As medical service providers, doctors may be willing to use the platform only if they endorse internet hospitals, and thereafter make the most of the platform. To fully understand the medical staff’s cognition toward internet hospitals, it is necessary to investigate the medical staff. We found that internet hospitals’ services were doing well regarding fee transparency, fee rationality, travel cost capital, patience and responsibility, and consultation behaviors. Online consultation is critical to increase patients’ trust and satisfaction. Doctors should be aware of patients’ intention to offline visit following online consultation. Good communication is beneficial for developing good doctor-patient relationships [15 16].

Suggestions for future efforts

First, the construction of an internet hospital involves multiple departments. Therefore, it is necessary to mobilize all the departments to coordinate and cooperate. The preferred solution is to establish an independent internet hospital management department, which is more conducive to mobilization and coordination. If an independent management department is not currently implemented, it is suggested that the medical manager, who is responsible for the main management assume the management role and bear the corresponding responsibilities. Meanwhile, it is also recommended that a service management system for internet hospitals be established. This may be considered from three aspects: quality and safety, process standardization, and information security [17]. Among them, patient safety and the risk of treatment errors are important. Medical errors suggest weaknesses in complex systems. To reduce the risk of harm, more emphasis should be placed on recognizing risk factors, ensuring effective communication with patients, heightening situation awareness, strengthening management and standardized operation, and guaranteeing quality [18].

Second, the connection between internet hospitals and provincial internet medical service supervision platforms are the most important conditions for the application and approval of internet hospital qualifications. The implementation of third-level information security protection in the information system is an additional important condition on this aspect. Writing medical records and prescriptions are the requirements of the core diagnosis and treatment component of internet hospitals [19]. Medical or third-party institutions should continue to expand other information businesses to meet the requirements for qualification access.

Third, to strengthen information security management, hospitals should continuously improve the level of information; effectively standardize the use, collection, development, and ownership of data; strictly verify the identity and access rights; steadily improve the level of data encryption; and preferably ensure the integrity, confidentiality, and availability of information [20]. Moreover, cloud computing and security mechanisms can be combined to improve the security and operability of information systems [21 22].

Fourth, internet hospitals should manage the entire cycle of health, supplement the relatively limited business functions of offline physical medical institutions, and provide convenient services for patients. Functional businesses should be continuously expanded according to the demand. Moreover, it is important to strengthen health professionals’ professional knowledge and to introduce multidisciplinary talent in information technology.

Limitations

Several limitations should be considered when interpreting the results. First, internet hospitals have been increasing during the COVID-19 pandemic. However, the construction and operational models of these hospitals are relatively stable in China because the regulation of internet hospital establishments has not yet changed. Second, this study only investigated these hospitals’ medical staff to evaluate the service capacity of these hospitals. It is also necessary to conduct research from the patients’ perspective, on the satisfaction of medical services provided by the internet hospitals and to analyze the implementation in the current situation [14 23].

Comparison with Prior Work

Few studies have reported the construction and operational models of internet hospitals. Cui et al. focused on the implementation, application, and influencing factors of telemedicine [13]. Jiang et al. studied the characteristics of online consultations and inquiries through China's largest online medical platform [24]. Using the social exchange theory perspective, Ren et al. examined the effect of doctors' internet-based service quality on their economic returns during the COVID-19 social restrictions [25]. Another study discussed the policy interventions, development trends, and service innovations of internet hospitals in China, based on a documentary analysis and qualitative interview studies [26].

Internet hospitals redefine the concept of medical service provision through telemedicine technology. This has made it possible to have targeted and tailored medical interventions for various types of counselees. It is indispensable not only for COVID-19 but also for health services. The study revealed that the self-constructed and self-managed model is the dominant internet hospital model in China, while the differences between these internet hospital models may influence the quantity and quality of the online healthcare services. Certain challenges still need to be overcome to improve the operational model of internet hospitals. More longitudinal studies are required to study the construction and operational models of internet hospitals. Nonetheless, this study may provide useful information for policymaking and guidance for further internet hospital practice in China.

COVID-19

Coronavirus disease 2019

Acknowledgements

The authors are deeply grateful to the participants in this study who made this work possible.

Authors’ contributions

All authors contributed to the design and execution of the study. Xinxia Wu and Xuejiao Chen analyzed and interpreted the data. Xuejiao Chen wrote the main manuscript. All authors revised the manuscript and approved the final version for publication.

Funding

This study was supported by the Key-Area Research and Development Program of Guangdong Province (2020B0101130020) and the Doctoral Workstation Foundation of Guangdong Second Provincial General Hospital (2021BSGZ010).

Availability of data and materials

The dataset of this study will be made available upon reasonable request of the corresponding author.

Ethics approval and consent to participate

This approval of our study was obtained from the Ethics Committee of Guangdong Second Provincial General Hospital. All participants provided written informed consent form for the various aspects of data collection. It was also implemented in accordance with the principles and regulations of confidentiality and privacy.

Consent for publication

Not applicable.

Conflict of Interest

The authors declare that they have no conflicts of interest.

Han Y, Lie RK. The Internet Hospital as a Telehealth Model in China: Systematic Search and Content Analysis. 2020;22(7):e17995 doi: 10.2196/17995[published Online First: Epub Date]|..
Hirose J, Wakata Y, Tagi M, et al. The role of medical informatics in the management of medical information. J Med Investig. 2020;67(1.2):27–9. doi:10.2152/jmi.67.27[published Online First: Epub Date]|.
Tu J, Wang C, Wu S. The internet hospital: an emerging innovation in China. The Lancet Global health. 2015;3(8):e445-e46. doi:10.1016/s2214-109x(15)00042-x[published Online First: Epub Date]|.
Measures for the administration of internet diagnosis and treatment (for trial implementation). National Health Commission of the People's Republic of China. 2018 Jul 17. Secondary Measures for the administration of internet diagnosis and treatment (for trial implementation). National Health Commission of the People's Republic of China. 2018 Jul 17. http://www.gov.cn/gongbao/content/2019/content_5358684.htm.
Guangdong Network Hospital officially launched [in Chinese]. Youdeyi. 2020 June 1. Secondary Guangdong Network Hospital officially launched [in Chinese]. Youdeyi. 2020 June 1. http://www.youdeyi.com/newinfo.html?M_type=1&id=1.
Gong K, Xu Z. Internet Hospitals Help Prevent and Control the Epidemic of COVID-19 in China. Multicenter User Profiling Study. 2020;22(4):e18908. i: 10.2196/18908[published Online First: Epub Date]|. : ; ): do.
Sun S, Yu K, Xie Z, et al. China empowers Internet hospital to fight against COVID-19. J Infect. 2020;81(1):e67–8. doi:10.1016/j.jinf.2020.03.061[published Online First: Epub Date]|.
Xu X, Cai Y. Assessment of Internet Hospitals in China During the COVID-19 Pandemic: National Cross-Sectional Data Analysis Study. 2021;23(1):e21825 doi: 10.2196/21825[published Online First: Epub Date]|.
Zhuang Q, Sun G, Zhang F, et al. How Internet technologies can help hospitals to curb COVID-19: PUMCH experience from China. 2021;50(1–2):95–98 doi: 10.1177/1833358320946674[published Online First: Epub Date]|..
Wu XX, Wang XT, Li HX, et al. Investigation and Analysis of Operation of Different Types of Internet Hospitals. China Digit Med. 2021;16(4):18–21.
Xie X, Zhou W. Internet Hospitals in China. Cross-Sectional Surv. 2017;19(7):e239. i: 10.2196/jmir.7854[published Online First: Epub Date]|. : ; ): do.
Li Y, Yan X. Provision of Paid Web-Based Medical Consultation in China: Cross-Sectional Analysis of Data From a Medical Consultation Website. 2019;21(6):e12126 doi: 10.2196/12126[published Online First: Epub Date]|..
Cui F, Ma Q. Implementation and Application of Telemedicine in China: Cross-Sectional Study. 2020;8(10):e18426 doi: 10.2196/18426[published Online First: Epub Date]|..
Li D, Hu Y. Determinants of Patients' Intention to Use the Online Inquiry Services Provided by Internet Hospitals. Empir Evid China. 2020;22(10):e22716. i: 10.2196/22716[published Online First: Epub Date]|. : ; ): do.
Chang YW, Hsu PY, Wang Y, et al. Integration of online and offline health services: The role of doctor-patient online interaction. Patient Educ Couns. 2019;102(10):1905–10. doi:10.1016/j.pec.2019.04.018[published Online First: Epub Date]|.
Palen TE, Ross C, Powers JD, et al. Association of online patient access to clinicians and medical records with use of clinical services. JAMA. 2012;308(19):2012–9. doi:10.1001/jama.2012.14126[published Online First: Epub Date]|.
Wadhwa S, Saxena A, Wadhwa B. Hospital information management system: an evolutionary knowledge management perspective. Int J Electron Healthc. 2007;3(2):232–60. doi:10.1504/ijeh.2007.013103[published Online First: Epub Date]|.
Leonard MS. Patient Safety and Quality Improvement: Reducing Risk of Harm. Pediatr Rev. 2015;36(10):448–56. quiz 57 – 8 doi: 10.1542/pir.36-10-448[published Online First: Epub Date]|.
Spyropoulos B, Botsivali M, Tzavaras A, et al. Supporting in- and off-Hospital Patient Management Using a Web-based Integrated Software Platform. Stud Health Technol Inform. 2015;210:439–43.
Chen HY, Wu ZY. Security Privacy and Policy for Cryptographic Based Electronic Medical Information System. 2021;21(3) doi: 10.3390/s21030713[published Online First: Epub Date]|.
Sadoughi F, Erfannia L. Health Information System in a Cloud Computing Context. Studies in health technology and informatics 2017;236:290 – 97.
Tahir A, Chen F. A Systematic Review on Cloud Storage Mechanisms Concerning e-Healthcare Systems. 2020;20(18) doi: 10.3390/s20185392[published Online First: Epub Date]|..
Li P, Luo Y. Patients' Perceptions of Barriers and Facilitators to the Adoption of E-Hospitals: Cross-Sectional Study in Western China. 2020;22(6):e17221 doi: 10.2196/17221[published Online First: Epub Date]|..
Jiang X, Xie H. Characteristics of Online Health Care Services From China's Largest Online Medical Platform. Cross-sectional Surv Study. 2021;23(4):e25817. i: 10.2196/25817[published Online First: Epub Date]|.. ( : do.
Ren D, Ma B. Effectiveness of Interactive Tools in Online Health Care Communities. Social Exch Theory Perspective. 2021;23(3):e21892. i: 10.2196/21892[published Online First: Epub Date]|.. ( : do.
Lai Y, Chen S. Policy, Interventions, Development Trends, and Service Innovations of Internet Hospitals in China: Documentary Analysis and Qualitative Interview Study. 2021;23(7):e22330 doi: 10.2196/22330[published Online First: Epub Date]|.

Download PDF

Journal Publication

published 21 Jun, 2023

Read the published version in BMC Health Services Research →

Reviewers agreed at journal
19 Sep, 2022
Reviewers invited by journal
19 Sep, 2022
Editor invited by journal
07 Sep, 2022
Editor assigned by journal
15 Aug, 2022
First submitted to journal
14 Aug, 2022

You are reading this latest preprint version

The Construction and Operational Models of Internet Hospitals in China: A Hospital-Based Survey Study

Status:

Journal Publication

Version 1

Abstract

Figures

Introduction

Methods

Data collection

Internet hospital survey

The hospital staff survey

Data analysis

Results

Characteristics of the internet hospitals establishment model

Characteristics of the internet hospitals’ setup

Direct-to-patient services available in the internet hospitals

Self-scoring of internet hospital services

The root causes for improving internet hospitals’ services

Discussion

Principal findings

Suggestions for future efforts

Limitations

Comparison with Prior Work

Conclusions

Abbreviations

Declarations

Availability of data and materials

References

Status:

Journal Publication

Version 1