This article is excerpted from issue 451 of The New York Times

Article and photo by Zhang Jinjian

As of September 24th, the number of people diagnosed with C.N.C.P. worldwide is 31,889,768, and the number of people who have died exceeds 970,000, with the epidemic fluctuating and slowing down a bit. In Taiwan, it is very fortunate that the whole country is working together to fight against the epidemic, and the epidemic is considered to be relatively stable. Under the epidemic, many people are worried about the risk of infection if they go to medical institutions, so the number of visits to health insurance-approved medical institutions has immediately become less. According to the Health Insurance Administration, the overall number of outpatient visits from January to June this year decreased by 8.1% (15.56 million visits) compared to the same period last year.

In addition, analyzing the data from health insurance deaths and discharges, there were 86,252 deaths from January to June this year, compared to 87,533 deaths in the same period last year, a decrease of 1.49%. In other words, although there were fewer visits to the doctor during the epidemic period, there were no more deaths as a result of the epidemic.





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I have also witnessed the strict control measures in hospitals during this time, with fewer family members accompanying patients and fewer relatives and friends visiting patients, and fewer patients with minor illnesses. However, in the face of chronic illnesses and some patients with acute and serious illnesses (including cancer), we still need to take care of them wholeheartedly, and not to discount them, so have we changed our medical behaviors? For these people who really need to see a doctor, how to respond and adjust, it is urgent that we seriously face and try to solve the problem, the following sub-division of several levels with the readers to discuss.

Epidemiology and health care should be balanced, how to do both?

In addition to the severe impact of the epidemic on the global economy, the healthcare system in every country in the world has been severely impacted in terms of prevention, quarantine, diagnosis, and care, and each country's healthcare response has changed dramatically. In the epidemic prevention tense, medical treatment without interruption under the severe test, medical institutions how to manage the precise, in the patient side of how to free from worry and peace of mind in the clinic, in the test of the "*** unit", "medical institutions" and "medical patients and their families", in this process, digital technology plays a key role. In terms of epidemic prevention, through cell phone positioning, mask maps, and emergency notification systems, epidemic prevention can be implemented as a gatekeeper; in terms of healthcare, several advanced countries including Europe, the United States, Japan, South Korea, and Taiwan have urgently loosened regulations related to long-distance care (which used to be limited to outlying islands and remote villages), so that home quarantine or specific patients can receive long-distance diagnosis and treatment at home, avoiding the risk of nosocomial infections.

According to the World Health Organization's definition, telemedicine is the "use of interactive video and ICT (Information and Communication Technology) technologies for diagnosis, treatment, and counseling, as well as for health education and the delivery of medical information. health education and the transmission of medical information". In short, "telemedicine" refers to the conversion of traditional "face-to-face" physical consultations between physicians and patients into "online (or digital) interactions", including the use of video or voice calls, e-mails, newsletters, and other telecommunication tools.

Germany and France are more mature in this area, and are included in the national insurance program, while Italy has no insurance coverage in this area, and is unable to implement telemedicine, which may be one of the reasons why it is difficult to control the epidemic in Italy. As for the protection of personal privacy, Taiwan and Germany, France, Japan, South Korea and the United States have new norms within the bill to reduce unnecessary panic, telemedicine, the most important services include: (1) virtual clinic, (2) digital audiology, (3) digital pharmacy, (4) telemedicine and other four scenarios, so that the medical behavior of the digitization of the medical, can be replaced by part of the physical health care model, how to combine with the Internet of Things devices, the implementation of digital diagnostics and medical care. Related assistance. Generally speaking, online first ask the doctor, if necessary, then go to the hospital, has to improve the quality of care, reduce the waste of medical resources and other benefits. In addition, the use of Artificial Intelligence (AI) technology at the National Cheng Kung University Hospital allowed for the diagnosis of pneumonia in a short period of time and was listed on the World Health Organization's website, which has received worldwide attention, and can be considered a light of Taiwan.

In short, the collaboration between AI and humans can reduce healthcare labor, including simulation training, assisting in clinical decision-making, intelligent diagnosis, disease prediction, and even help with image interpretation. Secondly, with the development of the Internet of Things (IoT), Artificial Intelligence (AI), and 5G technology, continuous physiological monitoring will become easy, and the management of chronic diseases and sub-health states will be more efficient. In the future, "decentralized" health care will become mainstream, and in fact, the outbreak of this epidemic is a living example of the digital transformation that drives health care.

In short, AI (artificial intelligence) and human collaboration can reduce healthcare labor, including simulation training, assisting in clinical decision-making, intelligent diagnosis, disease prediction, and even helping with image interpretation. Secondly, with the development of the Internet of Things (IoT), Artificial Intelligence (AI), and 5G technology, continuous physiological monitoring will become easy, and the management of chronic diseases and sub-health states will be more efficient. In the future, "decentralized" healthcare will become mainstream, and in fact, the outbreak of this epidemic is a living example of the digital transformation that drives healthcare.

Has medical behavior changed?

In addition to telemedicine and digital transformation, the past anomaly of frequent visits to hospitals, too many family members accompanying patients, and too long stays in hospitals has also changed significantly as a result of this outbreak. Other things such as online counseling, online learning, online teaching, and videoconferencing have also become more prevalent.

How to sustain the implementation depends on ***, medical institutions and the national public to have *** the same understanding, and to formulate substantive measures and norms, otherwise the epidemic will return to the original situation after the return to the original point, there will be no lessons learned, and good medical practice can not be turned into the norm.

Telemedicine in the United States can be used as a reference

Taking the United States as an example, which is a leader in the development of telemedicine globally, before the outbreak of the epidemic in the United States mainland, Medicare had already been providing some of the telemedicine program benefits, such as physicians can upload photographs of the patient to conduct an assessment, etc.; with the outbreak of the epidemic and the rise of the temperature, President Trump announced that he would expand the liberalization of Medicare telemedicine services to allow users and healthcare providers to communicate with each other. President Trump announced the expansion of Medicare telemedicine services to allow users to communicate with healthcare providers using communication software such as FaceTime, Facebook Messenger, Google Hangouts, or Skype for telemedicine. In response to this new coronavirus outbreak, the FDA issued an emergency measure on March 20, 2020, relaxing the use of remote monitoring devices previously used in healthcare facilities, such as electronic thermometers, oximeters, respiratory monitors, electrocardiograms, non-invasive sphygmomanometers, electronic stethoscopes, and some software (e.g., EKGs) to assist with clinical decision support.

In response to the outbreak of the disease, the Ministry of Health and Welfare expanded the scope of application of the original < Communication Diagnosis and Treatment Methods > on February 10th and February 19th, 2020, to allow for communication diagnosis and treatment of home isolation or home quarantine in conjunction with quarantine and prevention of epidemics, and to relax the use of medical institutions and first-time patients. However, with the epidemic slowing down, it is still uncertain whether telemedicine can be expanded to become a new option for the general public, and this will be a concern for the medical profession and the general public.

The role of telemedicine in the epidemic and the challenges it faced Robin Ohannessian, a French telemedicine expert, pointed out in the JMIR Journal of Public Health that the use of telemedicine in France during the epidemic, using a mature vedio consultation, functioned quite well. Technological advances, high speed internet and mass spread of *** artphone, reasonably priced and paid for by the state, making the epidemic, although tight, lack of medical manpower, but allows patients to get very effective vedio consultation at home. The conceptual framework and flowchart are as follows:

While telemedicine has the advantage and promise of being widely used in this epidemic, there are still many challenges and dilemmas that telemedicine faces, seven of which are listed below:

How to integrate telemedicine into the internationally-recognized guidelines for the management of public **** health outbreaks.

The norms and payment mechanisms for telemedicine need to be well-defined and successfully implemented in each country's public health outbreak.

As each country's epidemic is different, with varying degrees of severity in each region, the development of a concrete flowchart that includes clinical guidelines, patient triage, automated counseling questionnaires, and patient telemonitoring systems will need to be tightly bounded and defined.

How to move from the traditional approach to a telemedicine model that is acceptable to the public (including outpatient teleconsultations, online specialist consultations, and telepatient monitoring systems).

How to educate the public with appropriate and concise toolkits or manuals so that the public recognizes and understands what telemedicine is all about, so as not to create panic and complaints instead.

All data collection, analysis, and communication between healthcare providers and epidemiologists should be done in order to gain **** understanding and cooperation.

All outbreak-related research or presentation of results should be based on "empirical medicine" and in accordance with ethical codes, and patient privacy should be protected.

What are the changes and opportunities after the epidemic in medicine and health?

(1) After the outbreak, urban and rural governance in China's counties and cities, utilizing "big data thinking" and "big data application" will be more emphasized: After the test of the outbreak, the traditional way of governance will be accelerated to change, covering early warning of major diseases, big health management, management of local industrial development, integration of the industrial supply chain, etc., and the governance of big data will be strengthened, and towards a more refined and transparent direction. refinement and transparency.

(2) Accelerated scientific research and innovation brings new opportunities for development: In response to the epidemic, the state, local ***, research institutions, and related enterprises will launch new science and technology research and development programs, which will accelerate the derivation of new technologies or products in a short period of time and further promote the transformation of scientific and technological achievements into substantive services.

(3) Biotechnology (Biotechnology, BT) and information technology (Information technology, IT) integration into a new realm: during the spread of the new coronary pneumonia epidemic, the mobile Internet, 5G, artificial intelligence, virtual reality, and other digital technologies, and in the traceability of the virus, drug development, The rise of digital technologies such as mobile internet, 5G, artificial intelligence, and virtual reality, and their wider application in virus tracing, drug research and development, diagnosis and treatment, and other pharmaceutical and healthcare industries to promote the development of new fields such as telemedicine, intelligent medical robots, intelligent research and development, and intelligent medical treatment, in order to achieve personalized precision health, or precision medicine.

There will be three major changes in the digitization of the healthcare industry

KPMG Anhou Jianye healthcare and biotech industry services team moderator Mr. Su Jiarui believes that the digitization of the healthcare industry, there will be three major changes in the future and development trends:

(1) Changes in the way doctors and patients communicate with each other: Because of the avoidance of close contact, many inspections, activities, meetings, and medical treatments are minimized or eliminated. The new technology will be able to provide a more efficient way of communicating with patients and their family members.

(2) Changes in medical behavior: During home isolation, how to use telemedicine and digital diagnosis, prescription and delivery of medicines, and payment, the relevant regulations and systems will be the focus of the future development of digital health (Health IT).

(3) Changes in the healthcare ecosystem: How to establish a link between healthcare big data and industry information, the expansion of online and physical channels, and how to establish a healthcare ecosystem and innovative industry models are also the direction of change in the future.

Conclusion

As the Director of Health Protection, Prof. Li Bozhang, publicly stated on August 16th of this year, the New Crown Epidemic is sweeping the world, and in Taiwan, all people are united in their efforts, and all measures are deployed ahead of time, so that epidemic prevention is very successful, and the function of community pharmacy is obvious, and through the "real-name system for face masks" and the elimination of the "face mask mess", the contribution of community pharmacy has been witnessed, so that in the future, the realization of "medicine separation" can be expected. In the future, we should be able to look forward to the implementation of the "separation of the pharmaceutical industry". In addition, the "hierarchical medical care" that has been actively promoted by *** since 2017 has been fully demonstrated during this epidemic and has yielded the expected results, allowing large medical centers to focus on treating "urgent, serious, difficult, and rare" patients, while clinics and regional hospitals will take over the less serious cases, each with their own responsibilities, so that in the future, emphasis will be placed on preventive health care, and, unless necessary, visits to the doctor should be minimized to reduce healthcare expenditures.

In short, information and communications technology, biotechnology, and medical technology have all made great strides in the 21st century, and how to integrate and collaborate will inevitably lead to a reversal of the healthcare industry in the future, with "decentralized" preventative medicine, hierarchical healthcare, and the creation of smart healthcare being the main trends in healthcare in the future.