JMIR Publications

ABSTRACT

Background:

Telemedicine services have been developing rapidly worldwide. Following the 2018 policy enabling telemedicine for follow-up patients, this service model has gradually gained popularity in China. However, little has been done to understand the policy’s implementation across different types of medical institutions or to evaluate its effectiveness.

Objective:

This study aims (1) to investigate the patient eligibility assessment process in various types of institutions for telemedicine services in Beijing, (2) to elucidate institutions’ rationale for adopting such approaches, (3) to analyze differences between policy and practice, and (4) to provide references for the development of telemedicine services.

Methods:

This mixed-methods study involved 36 medical institutions in Beijing, determined through an integrated approach incorporating both the Pareto principle and convenience sampling based on the volume and quality of telemedicine services in 2023. The study was conducted in two phases. First, quantitative analyses were conducted based on the questionnaires collected from each institution's contact to gather assessment process and patient prerequisites. Subsequently, qualitative analyses were conducted based on the interviews with each institution’s contact to acquire considerations of such practice.

Results:

The total telemedicine service volume of the 36 institutions was 968,786, accounting for 89.5% of the total service volume in Beijing. In practice, the assessment process usually included two stages. In the first stage, as for assessment approaches, 86.2% (25/29) non-profit, tertiary hospitals and 14.3% (1/7) for-profit institutions automatically assessed patient eligibility, while others did it manually. The assessment was based on the scope of previous visit location, diagnosis of previous visits, and visit interval. As for the scope of the previous visit location, 22 hospitals required patients to have previous visits to the same hospital. As for diagnosis, seven hospitals required patients to have the same diagnosis. As for visit intervals, 11 hospitals required it to be within six months. The second stage assessment was conducted by physicians. Compared with policy requirements, non-profit hospitals had stricter requirements on the scope of previous visit locations. Primary drivers of the discrepancies included distrust in the medical results provided by other institutions, and difficulties in handling medical disputes involving other institutions.

Conclusions:

This pioneering multi-center, mixed-methods study specified the patient eligibility assessment process for telemedicine services in Beijing. Discrepancies between practice and policy were found in prerequisites for telemedicine services. The key factors contributing to these variations included the ambiguity of policies and different priorities across institution types. Our findings recommend enhancing policy clarity, relaxing telemedicine regulation for new patients, and strengthening telemedicine supervision to improve telemedicine services.