Abstract
Dear Editor,
From the end of 2019 to early 2020, an outbreak of COVID-19 spread throughout China and soon became a global concern (The Lancet, 2020). Currently, it has spread to over 9 million people in over 210 countries and territories around the world.
Peking Union Medical College Hospital (PUMCH) has been ranked first for 10 consecutive years according to the “Best Hospital ranking” in China. PUMCH initiated the prevention and control of COVID-19 immediately after the outbreak and dispatched a total of 186 medics in three batches to support the fight against outbreak of COVID-19 in Wuhan. After months of fighting COVID-19, we found that Internet technologies are one of the most pivotal measures. Here we would like to summarise the current work and share our experience.
First, for the healthy public who are nervous about the epidemic, we made home quarantine tips, self-isolation guidance, personnel prevention guideline and medical education videos for COVID-19, sending them regularly through our epidemic information dissemination platforms, including official mobile Application, WeChat official accounts and other social medias (https://weibo.com/pumchdoctor, etc.). We also provided online mental counselling to comfort nervous people and release their mental anxiety and stress (Yang et al., 2020). These measures played a significantly auxiliary role in assisting the Chinese government and National Health Commission channels to reduce the social panic and promote social distancing during the pandemic, and reduced misinformation in some sense.
Second, for those patients with various chronic diseases requiring constant medical services, we adopted a free online clinic, which provided regular follow-up, medication prescriptions and contactless drug delivery. In China, both public hospitals and community health services take joint responsibility for continuing management of chronic conditions. However, quarantines and restrictions on the movement of people and social gatherings inevitably created barriers to treatment for these patients, most of whom were susceptible populations. Over 50,000 patients received free online remote consultations (see Figure 1), which was not only convenient for patients but also reduced the risk of cross infection, compared to seeing doctors offline. Recently, through cooperation with express services, we are working on delivering drugs directly to patients’ homes.
Dynamic changes of the online remote consultations conducted by our hospital from February 10 to May 15.
Third, for patients who actually developed fevers or coughs, we conducted online counselling to acquire necessary information, including the epidemiological history, present history, symptom characteristics to identify and stratify the possible risks for COVID-19 virus infection. For those low-risk patients, we gave professional advice on self-management of care and treatment and conducted follow-ups. For high-risk patients, we strongly recommended they attend the offline fever clinic immediately, where they would first be screened for COVID-19.
Fourth, for patients whose conditions genuinely required offline clinic visits, we designed the Intelligent Pre-sorting Electronic Pass System (Figure 2). This new system was mainly used for information registration and epidemiological screening of patients, patients’ families, accompanying persons and other visitors entering hospital. The collected information included health status, travel history and whether they had contacted people from high-risk areas like Wuhan. These pieces of information, with present illness details, provided through mobile Apps by patients themselves prior to the visit could, through EMRs, be automatically made available to physicians, thus reducing the visit time, to mitigate exposure risk in the consultation room. If the patient had been to a fever clinic within the previous month, an automatic warning would pop up from the outpatient EMR system for a thorough inspection and careful differential diagnosis with COVID-19. Furthermore, we also connected our hospital database with the health status code system run by the Chinese Government, based on big data and national mobile operator systems, which ensured the authenticity of a patient’s journey in the previous 2 weeks. Patients would receive either a green, red or yellow code on the hospital pass. For patients assigned a red code (meaning high risk), special staff would escort them to the fever clinic on a designated route. For patients with a yellow code (moderate risk), hospital entrance inspectors would be aware of the need for further inspection. Patients with a green code would be allowed to enter the outpatient area. Until 30 June 2020, over 1,020,000 patients had used the Pre-sorting Electronic Pass System in our centre. In addition, radiologists could complete 75% of computed tomography scan reports at home by VPN, cloud desktop, plus Certificate Authority and digital signatures. By conducting these measures, we minimised the potential risks of COVID-19 contact exposure for both patients and hospital staff. In terms of data and privacy security, we strictly obeyed the “Act on the Protection of Personal Information of China.” We obtained approval from all patients before we collected their travelling information from the mobile operator systems. In addition, all sensitive and important data, including name, phone number, ID number of patients, were stored and transmitted through information encryption.
Pre-sorting Pass Permit (illustrating version) in our centre.
Last, for patients in Wuhan hospital (Sino–French New City Branch of Tongji Hospital) supported by the PUMCH dispatched medical team, we conducted close and frequent real-time telemedicine consultations with multidisciplinary experts, using 5G technique. The close cooperation between the Beijing campus and Wuhan team through the Internet effectively facilitated work in the following ways: (i) we organised experts from various departments at the Beijing campus to discuss the diagnosis and treatment of seriously ill patients with our Wuhan team (Figure 3) (Ma et al., 2020; Zhang et al., 2020a). For example, our clinical immunologists in Beijing participated in multi-rounds of multidisciplinary team discussions on the anti-inflammation management of COVID-19 patients and provided important professional advice (Zhang et al., 2020a); (ii) our administration work was quickly adjusted according to the findings on the remote round. For instance, PUMCH adjusted the dispatch plan and sent cardiology experts in the second batch of medical team to Wuhan as soon as we realised through online discussion that COVID-19 viral infection was a potential contributing factor or cause of myocardial injury (Jing et al., 2020); (iii) through close remote cooperation between Wuhan and the Beijing campus, many scientific research projects were conducted to identify significant mechanisms of COVID-19 virus function. Our findings of antiphospholipid antibodies in COVID-19 patients (Zhang et al., 2020b) were exactly the results of both the guidance of the senior experts in Beijing campus and the implementation of the research plan by junior doctors working in Wuhan. This cooperation via telemedicine between not only hospitals but also between our main campus and staff dispatched to the multiple health facilities was made possible through videoconferencing software programs. In this way, junior staff at the frontline could report on dynamic changes in the condition of COVID-19 patients and receive guidance from senior physicians and support from other departments in real time.
Multidisciplinary real-time telemedicine consultation using 5G technique between the Beijing Campus and the Wuhan dispatched team.
Both the online clinical system and the Pre-sorting Electronic Pass System were newly developed for the solutions supporting outpatient clinics during this COVID-19 pandemic, at the cost of around USD$500,000 and USD$100,000, respectively. In addition, we found that these information technology strategies (e.g. online clinic, patients pre-sorting system, teleconference) significantly improved the working efficiency of medical management and the control of hospital infection, and therefore will continue to be applied and optimised in the post COVID-19 era. In summary, we offer our experience here in adopting Internet technologies into the pre-hospital, intra-hospital and inter-hospital service in the fight against the epidemic, for the benefit of other hospitals around the world that are still currently involved in the COVID-19 pandemic. We hope it will be useful not only for COVID-19 but also for possible similar outbreaks in the future, although we all hope this never happens.
Footnotes
Declaration of conflicting interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
