How to completely control diabetes?

China's first face recognition medical insurance online payment hospital, commercial insurance online direct compensation hospital, Hubei's first Internet-based hospital and other achievements are all attained by Central Hospital of Wuhan. Recently, Zuo Xiuran, Director of Information Department of Central Hospital of Wuhan, has been invited to share their latest practical achievements—the construction of an Internet-based online to offline (OTO) integrated diabetes management platform. This is also the first comprehensive diabetes management station in China.

The dual pressure of "chronic disease management + tiered

diagnosis and treatment" calls for innovations in the business model

At present, chronic disease management in China is faced with challenges such as the enormous number of patients, high pressure from economic costs, and low awareness of health management. Specifically, the incidence of metabolic diseases represented by diabetes increases year by year globally. At present, over 100 million patients in China suffer from diabetes, with a prevalence rate of 11.6%. As indicated by a joint study by International Diabetes Federation and Chinese Diabetes Society, China has up to RMB 173.4 billion in costs directly related to diabetes, accounting for nearly 13% of China's total medical expenditure. Diabetes management plays a significant role from an economic perspective.

Compared with developed countries such as Europe and the United States, due to poor self-management awareness of Chinese citizens, the risk of complications is much higher than abroad. In recent years, the focus of diabetes treatment in China has shifted from a "fire-fighting" emergency medical model to a "urban reconstruction" chronic disease management model. People have begun to realize that the management of diabetes is not based on treatment, but on intervention beforehand.

Secondly, the policy of tiered diagnosis and treatment puts forward higher requirements for the development of large public hospitals and requires hospitals to further adapt. However, the reality is that public hospitals and grass-roots units are two main stakeholders. It is difficult to steadily sink medical resources. Meanwhile, we are also pondering over how hospitals should develop and make breakthroughs?

In this regard, we shall advance with the changing times, make overall arrangement in advance, and realize the collaborative management of chronic diseases through innovations in business model and leading of information technology.

Innovative business model: OTO integrated management

of chronic diseases inside and outside the hospital

At present, many applications for diabetes management are available in the market. However, most of them provide patients with short-term paid remote instruction in the form of free admission of doctors. But why do many patients uninstall it shortly after downloading and use? The key is the durability and authority of the medical resources involved.

In the hospital, in addition to the basic diagnosis and treatment, our next focus is how to extend services to the post-hospital instructions.

Central Hospital of Wuhan has built an Internet-based OTO integrated diabetes management platform and established a diabetes health management station with three characteristics: strengthened management, path management, and collaborative management. Its innovations lie in forming a comprehensive management team, establishing a new diagnosis and treatment model, and putting the concept of OTO integrated management of chronic diseases inside and outside the hospital and the policy spirit of tired diagnosis and treatment into practice.

Informatization is a fast path

for patients to manage diabetes

Only the innovations in the model are not enough. Its landing must be supported by information platforms.

The first is to create intelligent "digital medical care", aiming to liberate medical care labor and return time to patients. Now, doctors can make the rounds of the wards while standing in the station, and use their phones to input medical records directly at bedside. Besides, the system implements mobile nursing care, including a full-closed intelligent infusion management system and clinical mobile terminals, and provides nurses with a more convenient way of working. The ultimate goal is to free up more time for medical staff to participate in home management after patients are discharged and to interact with community doctors.

The hospital has implemented applications such as a fully-closed intelligent infusion management system and clinical mobile terminals to provide nurses with a more convenient way of working.

The second is the OTO integrated diabetes management system inside and outside the hospital. The construction of the entire system is centered on the following six aspects: active prevention and detection of patients with abnormal blood glucose; evaluation and analysis of health management; personalized target values for patient management; intelligent collection and analysis of blood glucose data; continuous blood glucose management files; remote online communication.

Active warning to identify patients with abnormal blood glucose in the hospital: We hope to build Department of Endocrinology into a unified diabetes diagnosis and treatment center, and provide services for patients with abnormal blood glucose in the hospital like the Medical Laboratory. We focus on the indicators of diabetes and blood glucose abnormalities, and extract all relevant data into the system in real time. If the blood glucose of patients in other departments exceeds the set range, the system will actively prompt that a patient in a certain department has abnormal blood glucose and may require consultation.

Evaluation and analysis of health management: Based on various indicators, questionnaires and test results, the system can assess the risk of complications of patients, and formulate the corresponding instructions on diet and exercise. This is a major feature of the health management station. We print an evaluation and analysis report for each discharged patient.

Personalized target values for patient management: Once a patient exceeds the target range, doctors and nurses will receive reminders and carry out timely intervention.

Intelligent blood glucose management: In the future, either Nurse Digital Assistant (NDA) or various types of medical equipment will develop towards intelligence. We hope that the built platform will not be bound with any glucose meter. Instead, a set of equipment data collection platforms uniformly integrated by heterogeneous equipment is built to provide a unified data services interface to various systems such as electronic medical records and nursing systems.

Continuous blood glucose management files: The continuity is mainly reflected in that the blood glucose data of patients in all departments of the hospital is shared and under unified management. After being discharged from hospital, the patients' blood glucose data will also be synchronized to the system in real time, and can also be integrated into the resident electronic health records.

Remote online communication is mainly used to solve communication problems. The first is the communication between patients and doctors. When a patient is discharged from the hospital, the doctor will formulate a complete set of personalized diabetes management plan. After returning home, the community doctor will follow this plan and offer instructions to the patient. At the same time, the plan will be adjusted at any time according to the changes in the disease during the period. Through continuous PDCA, this system can provide a complete set of solutions related to the progress of the patient's conditions.

NDA is used in the hospital to collect blood glucose information at bedside and upload it in real time. Outside the hospital, patients can communicate with doctors at any time through Lachesis Medical Interworking App.

The third is to build an online collaborative medical service platform. Although closed-off management is carried out on patients in the station, in effect, the whole platform is open. We have developed four applications to realize online medical services and tiered diagnosis and treatment. One is online medical services, which provides patients with online health consultation in forms of audio and video; the second is tiered diagnosis and treatment, which is collaboration between the hospital and the medical alliance, including remote medical record sharing, remote joint clinics, online appointment and referral, etc. The third is health management, which uses diabetes as a pilot to achieve four tires of collaboration among individuals, families, communities, and hospitals. The fourth is a remote diagnosis center where grassroots doctors can use the remote diagnosis system to obtain guidance for remote diagnosis from higher-level hospitals.

This project has achieved good results. We conducted a comparative analysis of 300 people, respectively monitored the weight, BMI, trunk fat, and visceral fat indicators of male and female patients before and after hospitalization, and found that the effect was very obvious. Each index declined: the total cost of a patient's single hospitalization decreased by about 27.3%; the proportion of medicines decreased by about 34.5%; 60.7% of patients had less dosage of medicines; 21.5% of patients took less types of medicines; 10.53% of patients stopped using hypoglycemic drugs, and the blood glucose control rate reached 83.7%.

Leverage commercial insurance to join chronic

disease management, and explore a new all-win model

At present, Central Hospital of Wuhan has realized online payment of medical insurance and online direct compensation of commercial insurance. However, the most ideal model of commercial insurance should be the participation in the prevention of chronic diseases. For example, if a patient purchases a complication prevention insurance, the commercial insurance agency will pay for the service charge of the doctor in the medical institution so that the doctor can directly participate in patients' daily health management. In this way, patients will receive professional services to prevent complications; insurance companies will pay less; medical expenses will be reduced, thereby achieving all-win. This is also the follow-up service model we are exploring.