The status and challenges of online medical consultation service provided by Internet hospitals in China: A large-scale pooled analysis of multicenter data (Preprint)
Authors: Yang Ming , Yan Yiwei , Xu Zhong , Liu Hongli , Ran Jing , Zheng Yingbin , Cai Zhefeng , Liu Zhengwei , Gong Kai 
Published: April 2023

BACKGROUND

With the rapid development of Internet hospitals in China, online medical consultation service based on Internet hospitals has become the main form of online diagnosis and treatment. However, it is relatively difficult to assess the present state of online medical consultation service objectively with insufficient multicenter data.

OBJECTIVE

To explore the current status and main challenges of online medical consultation service.

METHODS

The business data of online medical consultation generated in 2020 and 2021 were retrospectively collected from 30 Internet hospitals nationwide. The counselee information (including gender, age and department), service information (including occupational category, professional title and department) and order information (including time information, consultation type, completion status and department) were descriptively analyzed. 286,767 consultations in 2020 were manually classified into five types according to a newly proposed classification method. Multivariate logistic regression model was conducted to explore the risk factors affecting order response. Moreover, locally weighted regression (LOESS) was applied to explore the relation between order volume and response rate.

RESULTS

A total of 594,695 online consultations were involved in this study. There were a total of 244,678 counselees with median age at 29 years (IQR 24-35 years) including 78,615 (32.13%) males and 166,063 (67.87%) females, and 5,781 consultants including 1,083 (18.73%) seniors, 1,703 (29.46%) sub-seniors, 1,903 (32.92%) intermediates and 1,092 (18.89%) juniors. The amount of responded orders in three departments including pediatrics, obstetrics and gynecology accounted for 48.25% of total. The consultants with senior, sub-senior, intermediate and junior titles received 260,444 (43.79%), 215,309 (36.20%), 91,608 (15.40%) and 27,334 (4.60%) consultations respectively. The peak timing of consultation was 10:00 (n=34,861, 8.11%) and 16:00 (n=31,366, 7.29%); the peak timing of response was 12:00 (n=25,170, 5.38%), 16:00 (n=28,405, 6.61%) and 21:00 (n=28,515, 6.63%). The average waiting time for completed orders was 3.64 hours. In 2020, the number of orders for first visit, re-visit, health consultation, process consultation and irrelevant contents were 99,123 (34.57%), 128,722 (44.89%), 48,999 (17.09%), 9,294 (3.24%) and 629 (0.22%). Regarding uncompleted orders (n=164,662, 27.69%), 75.87% (n=124,929) were for consultant reasons, 12.45% (n=20,507) were for counselee reasons and 11.68% (n=19,226) were for system reasons. The provided medical history (OR=2.13, 95% CI: 2.08-2.19, p<0.001) could independently increase the probability of completion, whereas senior title (OR=0.77, 95% CI: 0.76-0.79, p<0.001) could reduce such probability. For the relationship between response rate and order volume, the correlation was positive when order volume was less than 78, and turned to be negative when order volume was more than 1,700.

CONCLUSIONS

Even with the increased momentum, the online medical consultation service still faces many challenges mainly including the imperfection of access rules and practice regulations, the inconsistence of the intended design and the practical applications, and the insufficient quality control of response rate and timeliness. Comprehensive measures should be carried out to promote the effectiveness of online consultation for better disease prevention and treatment.