hi I'm Xianghua Ding. I'm an associate
professor from Fudan University. The paper
I am presenting today is called "getting
the healthcare we want: the use of online
as the doctor performs in practice". so
first, what is online "ask the doctor"
platforms, or ATD platforms. Today, when we
talk about ICT mediated healthcare
services, we mainly talk about it as
part or extension of traditional
healthcare systems. That means it's a
mediation between patients and their
existing healthcare providers, either in
the form of emails or dedicated web
portals
however, ATT is different from these ICT
mediated healthcare services in that
it provides access to unknown
health professionals and so it's a
mediation beyond the existing patient
provider relationship. Today ATD
platforms have been introduced into many
countries in the world but their
impact so far has been still limited
due to the issues of scale. Because most
of these problems operate as free
services funded by government agencies
or nonprofit organizations, so there is
only a limited number of healthcare
professionals to answer questions, making
it challenging for them to answer these
questions in a timely manner. However, in
recent years in China, we observed
The emergence of large-scale free-market AtD
platforms and this slide shows some of
the most popular AtD platforms in China.
And to take Haodf and ping an good doctor
as an example, it is reported that there
are over thousands of doctors to answer
questions from over 50 million patients
per month, and there are over
200 thousand doctors to answer question from over
300 thousand patients every day on
Ping An Good Doctor. So they are really getting
popular. Most of these platforms...they
provide some very similar
functionalities, although each probably
has its own unique features. So here we
use WeDoctor as an example to show how
these platforms work. So on the left is
the main page,
users can choose what kind of channels to use
for online consultation. With
the Express channel, users can often get
their questions answered pretty
quickly with a low price and sometimes
even for free, but they can't
choose which doctor to answer their
questions, and with the doctor Channel,
users can choose, from a list of doctors
to choose which doctor to answer their
questions with the price set by the
doctor, but they sometimes have to wait for
the doctor to answer their questions. And
what's unique with WeDoctor is they
also provide a bidding channel which
allows users to set a price and allow
multiple doctors to big for their
questions. In the middle is a doctor's
page. It shows all kinds of information
of the doctor including title, department,
the affiliated hospital, response rate,
the average response time, price, and so
on. And many doctors also share their
popular science articles online or
Past medical cases for their users
to read. And so given the popularity of
these ADT platforms in China, we decided
to conduct a study to mainly answer
the following research questions:
First, how AtD services are
actually incorporated into people's
health care practices, and how do people
deal with the potential risks as AtD
services do not involve in-person
checkups. So this study was mainly
conducted in China, and the health care
system in China is very different from
the health care systems in most of
Western countries. Mainly most people still
don't have their own family
physicians or primary care physicians, so
when they have any health or medical
issues, they will just walk into a
hospital and will be assigned a doctor
at the registration desk. And hospitals in
China are classified into a ranking
system of primary, secondary, and tertiary
hospitals, with tertiary hospital
considered to be the best and each
category is a further
divided into three levels: A,B, C, with tertiary A
or 3A hospitals commonly
considered as the best hospitals in
China and of course most of these best
hospitals are located only in big cities.
And for the study we conducted
semi-structured interviews with 12
patients who have used the AtD services.
So it's mainly from a patient's
perspective. And we used the grounded
theory approach for the analysis of our
data. Based on the study, our main
finding was that our participants had a
very clear awareness of the strengths
and limits of these AtD platforms, so instead
of relying on AtD for healthcare
directly, they used AtD cautiously
and strategically to ensure, and many
times combined with offline healthcare
resources, to ensure more reliable and
cost-effective healthcare. So next I will
talk in more details how they make
strategical choices online and how they
strategically integrate online and offline
healthcare resources. So first of all
when they go on an AtD platform, the first
a choice they need to make is which
channel that we would use for online
consultation. And with the study, we
found that usually when they have very
simple questions or very minor health
issues or when they are looking for
quick responses, they will go for the
free express, you know sometimes
cheaper, express Express Channel,
just as shown in this quote: "I
input the question and then then the
platform randomly assigned a doctor to
answer because my question was very
simple so I don't think I needed to
designate a particularly famous doctor
to answer it." On the other hand, if they
are facing very complex issues or very
complex diseases, they would prefer the paid
doctor channel for more reliable
answer, as shown in this case: "it's not
cheap for sure, but I was very anxious
about this matter, so I wanted to find a
good service and a reputable experience
the doctor. If the service is free then
the doctor is probably junior and
experienced so I didn't dare to use it."
Sometimes they will use a high price
as a way to ensure the high quality of
answers. Once they decided to use a
doctor channel, how would they choose from a
list of doctors? From the study,
we found it was common that they would use the
information including the official ranking, and the
local reputation of the
hospital as well as the titles, reviews,
and other information of the doctor to
make a choice, as illustrated in this
quote: "first of all it should be a 3A...
the second is, if the doctor has treated
similar diseases, how much experience
the doctor has, whether the overall
patient reviews are good, and whether the
doctor's expertise matches the health
condition I'm consulting about."
Interestingly in some cases, our
participants also care very much about
the doctor's age, gender and communication
styles. For example, in this case, this
participant had some sensitive issues to
consult so he checked their profile page,
profile picture, to see their gender and
age because he preferred to communicate
with a young male doctor. In terms of
online diagnosis or recommendation, we
found that our participants assessed
the online suggestions very cautiously.
They used various strategies to
cross validate the suggestion, such as
using multiple platforms or using
offline medical visit and other means to
compare, as shown in this quote: "I used
all these three platforms at the same
time, considering it's online consultation,
without face-to-face interactions with
doctors, and it's about health issues, I
believe it's necessary to compare so I
could decide on the best course of
actions. In another case, this participant
still decided to visit a nearby
community hospital after online
consultation, just so that she could
compare the different suggestions from
online and offline.
Although AtD provides a convenient means
for them to get consultation, it is still
limited in that it cannot provide
medical tests or
medicine. So in the study, we found that many
times our participant had to combine
online and offline healthcare resources
to achieve a cost effective healthcare.
For example, for some regular check-ups,
our participants would go to a local
nearby hospital to get tested and then
we'll send the test result over to a
remote doctor from a 3A Hospital to
get online consultation, so this way they
can achieve a cost-effective cure, as put
it by this participant:"Doctors in the
community hospitals have limited
expertise, compared to those online
doctors from 3A hospitals, but it's
(the local community hospital) a great
place first to get medical tests, which
we cannot do on those AtD platforms."
More commonly,
we found our participants will combine
offline pharmacy stores and online
healthcare resources, healthcare
resources, to make sure that the medicine
they get from a pharmacy is
appropriate for them to take. More commonly,
our participants emphasized to us that
AtD was not directly used for care but
mainly used for care navigation, in
terms of for them to find the right
hospital or the right time for a doctor
visit.
For example, this quote shows such...
such a case: "It is not helpful for
treatment but helpful to seek
healthcare services for treatment. It is
mainly to reduce the blindness, not for
diagnosis or treatment. For diagnosis or
treatment, we must go to the hospitals
for face-to-face diagnosis. The online
doctor, maybe it was in fact his
assistant, tells me whether they could
treat it and when the doctor would be
available and etc." Sometimes they use
the AtD to decide on when to see a
doctor because many times they are busy
and they want to know whether it's okay
for them to wait or not. For example, it is
shown in this case:" There was once my
husband had a headache and I consulted online
for him. The doctor said 'you'd better
go to hospital and don't delay.' So we
asked for leave from work and went
to the hospital the next day."
So in
that case, when it's an urgent issue,
they had to go to see the doctor right
away. More interestingly, we found many
participants suggested that AtD was
very helpful for them to learn and for
self-education of medical issues,
especially important before they go to
see an offline doctor. And this quote
explained why that was the case: "After
all, the offline medical visit is very
short. The 9th Hospital in Shanghai is
always so crowded, people wait for a whole
day and may only have three to five
minutes of consultation, so you need to
have a clear goal and prepare your
prepare your questions and ask quickly.
Learning online gives me a direction with
my questions as you have studied." Many
participants actually read, actually read,
popular science articles on ATD
platforms before they went to see the
doctors offline. And interestingly, our
participants also suggested that
when learning was concerned, online
consultation was probably more effective
than offline consultation, because it
seems that doctors online are usually
more patient, probably because it's based
on the time of their choice, as shown in
this quote:" In fact, the time you can
communicate with a doctor online is
longer than the offline. You can put more
than 10 minutes with a doctor online." So
what this study brought fore is a kind
of patient agency and a kind of work by patients
and their health care givers for more
reliable and cost effective care. So this
is... As we are emphasizing more and
more on self-management,
much more work needs to be carried out by
patients and their caregivers outside of
clinic settings, so our work... this study
highlights such a work that they need
to carry out and has now been uncovered
in previous research. And more so, the
particular health care system this study
was situated
also helps to highlight a number of
values of AtD. For example, if we
understand the unequal distribution of
healthcare resources, we'll understand
better why people combine online and offline
healthcare resources to get more
reliable and cost effective care. And if
we know that most of them do not have
primary care physicians or family
physicians, we understand why they will
use AtD to get a better control and to
reduce blindness. And if we understand
that their offline clinical session is
very short we will understand better why they
Will use AtD for online learning before
they go to see a doctor offline. So with
this study, we'd like to call for broadening
the scope of inquiry into patients' work
to include the whole process patients
and their caregivers go through in order
to gain reliable healthcare service in a
cost-effective manner. We believe that's
the main value these AtD platforms to
provide and this is also the main
direction we can explore further to
design online health care services. So
with this, I'd like to say thank you and if
you have any more questions, feel free to
contact me with this email address. Thank
you!