AI open prescription?Is 250,000 doctors reliable online?

"Which doctor is right?"

Earlier this year, Xia Liang, who lives in Changde, Hunan, was troubled by oral ulcers for a while. Affected by the epidemic at the time, he decided to find the cause and solve the pain through online consultation.

However, a few doctors he asked gave several completely different diagnostic results, which confused Xia Liang and questioned the accuracy of online consultation.

Such experience is not a case. According to the 49th "China Internet Development Statistics Statistics Report" released by the China Internet Information Center this year, as of December 2021, the size of my country's online medical users reached 298 million, a year -on -year increase of 38.7%. With the rapid development of the Internet diagnosis and treatment, chaos such as misdiagnosis of white consultation, first medicine, AI prescriptions, and diagnosis and treatment accidents have also arrived, becoming a "dark thunder" buried in the industry.

In response to the above problems, the regulatory measures to block lightning discharge continued to advance. From the 2018 State Health and Health Commission and the State Administration of Traditional Chinese Medicine issued the "Administrative Measures for Internet Diagnosis and Treatment (Trial)", which clearly stipulates the online re -diagnosis of medical institutions, to the recently announced "Internet Diagnosis and Treatment Regulatory Detailed Rules (Trial)" to ensure that "separate air intervals is separated from the air, "The diagnosis and treatment is transparent and standardized, and a network that guarantees the quality of the Internet diagnosis and treatment.

Frequent online consultation

Diagnosis results

Xia Liang recalled to a reporter from the Rule of Law Daily that the first doctor in his online consultation at that time was a dentist at a three hospital. After showing the self -timer oral photos and the text describing the relevant symptoms, the doctor diagnosed it as "oral ulcers caused by the fire", saying that "take some anti -inflammatory drugs, drink plenty of water, and rest well." Prescription, ask it to buy medicine offline.

After taking anti -inflammatory medicine for 3 days, no improvement was taken. Xia Liang chose 3 doctors on the other two platforms for consultation. The graphic and text provided was consistent with the previous diagnosis: some doctors believed that it was "tastitis caused oral ulcers", some doctors diagnosed "oral inflammation", and doctors said they were "Candida infections."

These three doctors prescribed different medicines for them, making Xia Liang confused.

He did not dare to take medicine easily, and then went to a offline hospital in the city to see the diagnosis: Candida infection caused by antibiotics. The condition was relieved after the right medicine.

A senior doctor in a Beijing Stomatological Hospital told reporters that it is not difficult to judge for the dentist. limitation.

"During the offline consultation of the dental doctor, in addition to observing the oral condition and inquiring the condition, they will also press and touch to comprehensively judge the results. The online consultation doctor can only use the picture and text, which is difficult to accurately judge, not to mention the opening The prescription is prescribed. "The doctor explained. In his opinion, patients can upload films shot by offline hospitals and issued pathological reports during online consultation to review, re -consultation or consultation, but they cannot be the first consultation.

In recent years, "Internet+Medical Health" has developed rapidly. From Internet hospitals to clear common diseases and chronic diseases, Internet consultation can be reimbursed from online medical insurance. From online drugs to core diagnosis and treatment to Internet medical insurance, localities have actively supported the comprehensive development of online medical care, building the basis for the growth of online medical users.

At the same time, like Xia Liang, there are many doctors on the same condition online, but it is not uncommon to get the results of a variety of diagnosis.

Zhang Xingze, a third -year student in Beijing, claims to be a "person who loves illness". In recent years, he has often used an online consultation platform to experience the mixed taste -particularly convenient but not reliable.

The most impressive one was that he had some little red dots in his skin, which was extremely itchy. In order to solve the problem quickly, he opened an online consultation app and chose a doctor with "professional label" in the dermatology department. 109 yuan for diagram. As a result, the doctor told him that he might have a skin disease, and it is recommended to buy the corresponding drugs for treatment. Later, he went to the offline hospital for a detailed examination, and the result was that he was allergic to pineapple.

"The convenience of online consultation is convenient, but the description of the disease is generally limited to text and pictures, and it is prone to misdiagnosis or diagnosis." Zhang Xingze said.

Several people interviewed in the industry agreed that the diagnosis and treatment of "separation" is not suitable for all patients. The review of common diseases and chronic diseases is the positioning of Internet diagnosis and treatment for a long time. However, for the re -consultation, the industry has always lacked specific standards, leading to some regulatory vacuum.

Choose the medicine first and then prescribe the prescription

AI prescribed prescription patients to buy medicine

In addition to consulting, purchasing prescription drugs are another feature of "Internet+medical and health" convenience. However, the reporter found in the survey that some Internet medical platforms use the operation method of "buying medicines first, and then automatically generating prescriptions by artificial intelligence software".

Xie Li, who lives in Huaihua, Hunan, bought her 4 -year -old child in the early 2020s to buy Pudi Lan Anti -inflammatory oral liquid. At that time, the doctor opened a prescription for him. In March of this year, because the child had similar symptoms again, she tried to buy this medicine on a online medicine platform, and soon she was transferred to the "online consultation" section by the platform. After uploading the prescription two years ago, the "physician" sent her to buy a link.

Recently, after the reporter's ordering platform, the prescriber leftloxacin capsule was given, and the platform prompted "Please select the offline diagnosis of the disease". The reporter randomly checked a few items in the "disease bar". The "prescription/medical record/inspection report bar" was empty, and confirmed that "the disease has been diagnosed and used the medicine, and there is no history of allergies, no related contraindications, and adverse reactions. ", Soon passed the verification. After submitting the list, the system jumped to the consultation section. A few seconds later, there was a "physician" consultation and sent several information. Among them, the first article emphasized that "Internet medical treatment only provides medical services for retracting users", and the subsequent information is confirmed whether there is a history of allergies or in a special specialty or in special specialty. period. After the reporter responded to "None", it was less than 2 seconds.

Beijing resident Yang Mu has also had such experiences. He wondered if the doctor was really practicing the doctor: "When buying prescription medicines on the ×× platform, there is no difference between the other party and the robot. In the second, he agreed and did not give any professional opinions at all. "On one occasion, he deliberately tried to describe some situations that did not want to buy drugs to adapt to the disease.

Some people with the Internet medical industry are supporting: if it is a regular Internet hospital, an electronic prescription for doctors with qualified doctors, there should be doctors' signatures and Internet hospital electronic chapters. "It is not ruled out that some small Internet medical platforms still have used artificial intelligence, robots and other tools to automatically generate prescriptions. Some large platforms will use AI and other tools to assist doctors for consultation. Come on. "

Deng Yong, a professor at the Department of Law Department of Beijing University of Traditional Chinese Medicine, told reporters that in order to ensure the safety of patients' medication, the "Prescription Administrative Measures" and "Regulations on the Review of Medical Institutions" in China clearly stipulated that after the doctor prescribed the prescription for the patient during the diagnosis and treatment activities, the pharmacist should conduct it. The review, but the relevant specifications did not explicitly prohibit the act of "automatic generation prescription".

"The law can not be prohibited. If the specifications are not clear, local practice will be chaotic. In reality, some platforms choose the" AI opening prescription, customers directly take medicine 'models, skip the traditional prescription opening and review links. Turning the prescription directly into a 'medicine ". This kind of behavior seriously violated my country's drug management system, and also laid a hidden risk hazard for patients." Deng Yong said.

Whether the huge number of admission is true

Who will supervise online doctors

For the online consultation, the doctor answered several times as a complete consultation, whether the doctor's vision displayed on the platform is deficient, and whether the diagnosis content of the patient's diagnosis is true to the doctor ... The reporter interviewed Beijing, Tianjin, Hunan, Hunan More than 10 people in other places found that these are also the main problems that trouble them.

Hao Yingrui, a second -year student in Beijing, has a deep understanding of this. She often uses online diagnosis, but so far, it is not clear how many questions doctors answered to meet the charging standards. "At the beginning, there were a few questions that were considered free consultation, but as long as you spoke, even if a question, such as a word, thank you or hello. After the free number of times is used, the doctor has just entered the topic. In order to understand more information, you You can only pay the membership members. After paying the money, the doctor will ask information about the test results. Sometimes, after a circle, you can finally let you go to the offline hospital for consultation. "

Before the online consultation, first look at which doctor's consultation is on the platform, and then determine which doctor will consult. This is the practice of Zhang Dao and knife in Qufu, Shandong, because in her opinion, the doctor's consultation A lot of quantity means that he is welcomed by patients with strong medical skills. However, she noticed that the number of doctors marked on the online consultation platform was as much as tens of thousands or even hundreds of thousands of doctors, and I couldn't help questioning if the data was true.

On the online consultation platform, the reporter used dermatologists as a retrieval object and found that the number of dermatologists with the largest number of online consultations on the platform was 250,000. Suppose the average online consultation time is 10 minutes, and the online consultation time is about 41,667 hours. If the year is endless, the 10 years is 3650 days. Hour.

For these issues, some relevant persons in charge of the platform told reporters that these years they have been exploring "quality control". "For example, doctors answered several times as a complete consultation; Doctors are supervised; how to ensure that the volume of visits is true; who is responsible for misdiagnosis or prescribing the wrong medicine. "

"The core question is that who is responsible for the diagnosis of doctors online. Doctors in offline hospitals are supervised by the Health and Health Commission of various places, and hospitals and departments will also conduct standardized management; online doctors are relatively independent." Senior doctor of a Beijing Stomatological Hospital said the above.

Regulatory policies have been landed one after another

Better to ensure the quality of diagnosis and treatment

The large -scale growth of Internet diagnosis and treatment began in 2018. This year, the General Office of the State Council issued the "Opinions on Promoting the Development of" Internet+Medical Health ", which aims to improve the level of medical and healthy management. As of the end of 2021, there were more than 1,700 Internet hospitals across the country.

Over the years, in order to regulate the Internet diagnosis and treatment behavior, the "Internet Diagnosis and Treatment Measures (Trial)", "Administrative Measures for Internet Hospital (Trial)", "Regulations for the Management of Remote Medical Services (Trial)" and other standardized documents are successively introduced. The qualifications of medical institutions, employees' qualifications, equipment facilities guarantee, and service process specifications are proposed. Especially after the release of the "Detailed Details (Trial)" jointly formulated by the National Health and Health Commission and the State Administration of Traditional Chinese Medicine in June this year, it was highly anticipated by the public. This detail makes detailed provisions of social concerns such as prescription review, privacy protection, and diagnosis and treatment in the Internet diagnosis and treatment.

For what diseases can be seen on the Internet, the detailed requirements must meet the re -examination conditions: patients should provide medical records with clear diagnosis when consulting, such as outpatient medical records, hospitalization medical records, discharge summary, diagnosis certificate, etc. Whether it meets the re -diagnosis conditions. When the patient's condition changes, the doctor's judgment is judged by the doctor as the first diagnosis or other unsuitable Internet diagnosis and treatment, the doctor of consultation should immediately terminate the Internet diagnosis and treatment activities and guide the patient to go to the physical medical institution.

Deng Yong believes that these standards are more operable and given doctors more professional permissions, further clarifying the service boundary and regulatory boundaries, which is conducive to the standardization and standardization of Internet diagnosis and treatment services.

Regarding whether the quality supervision of online diagnosis and treatment is consistent with offline consultation, the rules have given a positive answer: Relying on physical medical institutions, incorporating Internet diagnosis and treatment into the overall medical service supervision system.

You can buy prescription medicines without prescriptions. Details are strictly prohibited from "first medicine and then": the prescription should be prescribed by the consultant himself. It is strictly forbidden to use artificial intelligence and other automatic prescriptions. The prescription drug should be sold, adjusted and used by the doctor's prescription. It is strictly forbidden to provide medicines to patients before prescription.

In Deng Yong's view, it is particularly worthy of recognition. "It is in line with the main theme of the current Internet diagnosis and treatment of 'returning to serious medical care', which helps the industry's development back to the right track of" protecting the people's health and well -being ".

He also pointed out that the provisions of "the use of artificial intelligence and other automatic generation prescriptions" must be taken into account, and multiple factors must be considered, such as the status of artificial intelligence such as artificial intelligence. Like some assistant physicians, they are the subjects that have not obtained prescription rights. The relevant provisions of the current "Prescription Administrative Measures" and "Regulations on Management of Medical Institutions" are still insufficient. The particularity of the main body, for automatic prescriptions such as artificial intelligence, etc., should be directly held accountable as the "use of non -sanitary technicians '" as the "use of non -hygiene technicians'."

Deng Yong believes that he should also clarify the rules of responsibility. "At present, during the Internet diagnosis and treatment, the rights and responsibilities between medical institutions and doctors are still adjusted through contracts, and there is no clear legal provision. For multi -practice physicians, in the process of contract signing, medical institutions are often in an advantageous position. If the contract stipulates that the number of improper prescriptions will cause damage, the medical institution shall be mainly borne by the doctor after the compensation of the medical institution, then the medical institution has substantially avoided the risk of compensation for damage liability.

It is also indispensable to improve the pharmaceutical traceability system. Deng Yong proposed that relevant departments should increase the review of the authenticity of the prescription source, establish a strict review system for prescription source, and improve laws and regulations on prescription sources. Use the advantages of the Internet to make full use of the QR code identification function to do a good job of online and prescription review. At the same time, the transaction records and transaction evidence are completely retained to ensure that supervision can trace the roots.

Source: Rule of Law Daily

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