JMIR Publications

ABSTRACT

Background:

As a promising solution in bridging the unbalanced distribution of medical resources across metropolitical cities and remote regions, telemedicine is in rapid development with support from the recent advances in telecommunications and information technologies. Henan province of China which has about 100 million population is a representative region suffering from such a ‘healthcare divide’, thus, it takes a proactive approach to develop a regional collaborative platform for telemedicine services driven by top-tier provincial hospitals.

Objective:

This study aimed to identify the key influencing factors that impact the current operationalization and effectiveness of telemedicine services in a representative province (i.e., Henan) of China and provide insightful references for the future operation of collaborative telemedicine platforms in developing regions.

Methods:

We analyzed service reports from the performance management system of telemedicine services in Henan province for the entire year of 2020. The analyzed reports cover a comprehensive set of aspects including administrative procedures, device configurations, service types, and medical practitioner/patient feedback on telemedicine services delivered by medical institutes in Henan province. Using descriptive statistical techniques and graphical methods, we analyzed vital influencing factors (e.g., management competency, configuration of devices, capacity of institute, coverage of service types, and efficacy of service) for telemedicine services provided by medical institutes at different tiers. We also used generalized linear model (GLM) and multiple linear regression (MLR) model to analyze the correlations between service volume, service efficacy, and the times of medical training received by practitioners from lower-tier hospitals through the provincial collaborative telemedicine platform.

Results:

Among the 89 tier-3 hospitals and 97 tier-2 hospitals involved in the collaborative telemedicine platform, 73.03% and 56.70% of them established standardized management procedures for telemedicine services, respectively. Furthermore, 58.43% of tier-3 and 45.36% of tier-2 hospitals operated a dedicated department managing telemedicine services. Surprisingly, as the major method of communication in telemedicine services, 89.89% and 93.81% of video conferencing by tier-3 and tier-2 hospitals are hosted through professional hardware terminals than generic computers. In the available service category, teleconsultation is the dominant type with its average annual service volume per institute at 173 and 60 for tier-3 and tier-2 hospitals, respectively; whereas the available fundings, management competency, the number of connected upper-tiers, and the number of professional staff are the key deterministic factors for the service volume at each hospital. After teleconsultations by tier-3 and tier-2 hospitals, 73.33% and 62.05% of patients get their medical conditions significantly better, respectively. We observed that the service efficacy is positively impacted by the management competency, financial motivating measures for participating staff, the number of connected upper-tiers and lower-tiers, and the number of participating doctors.

Conclusions:

In Henan province, a representative developing region of China, telemedicine services provided by hospitals are primarily delivered via professional hardware conferencing terminals. Teleconsultation, medical tele-education, and telediagnosis are the major service types. In general, tier-3 hospitals have larger service volumes than tier-2 ones. However, most of the medical institutes have been identified with the problems of management incompetency and lack of professional/technical staff, which is particularly true for tier-2 hospitals. In addition, apart from improving the effectiveness of currently available telemedicine services, enriching the service category such as remote emergency care and telesurgery to better serve the need of society is also an important future perspective. Clinical Trial: Null