Recently, Wang Ying, who lives in Dinglan Street, Shangcheng District, Hangzhou, came to Dingqiao District of Hangzhou Traditional Chinese Medicine Hospital to register for medical treatment in the early morning.

"Why is it bad?" Tao Yuan, the outpatient doctor, asked while skillfully guiding the patient to scan the medical insurance code. After scanning the code, Tao Yuan's computer interface displays the patients received.

"Doctor, I have had a stomachache for several days. Two days ago, I saw the prescription in other hospitals, but now it still hurts." When receiving the doctor, Wang Ying described a series of symptoms including abdominal pain to the doctor in detail. At the same time, a small plug-in of "Zhejiang Medical Mutual Recognition" appeared in the lower right corner of the doctor's computer screen.

"If the patient has mutual recognition items within one month, there will be this reminder." After the doctor issues the bill, the screen will display the words "There are mutual recognition inspection items, please review and select" mutual recognition "or" non mutual recognition ". By choosing "access report", Tao Yuan's computer quickly displayed Wang Ying's plain CT scan report of the whole abdomen in Hangzhou Red Cross Hospital a few days ago.

When a doctor receives a diagnosis, the computer screen displays a "mutual recognition" reminder. Photographed by Chen Luxun on people.com.cn

"This is the same as the test items we are going to do today." Tao Yuan slides his mouse and carefully checks the "laboratory test report" in the system. "There is no need to repeat the inspection today." Tao Yuan chose to accept the "mutual recognition" on the mutual recognition interface, and combined with Wang Ying's blood routine test results and clinical symptoms, confirmed the condition in time and issued a prescription.

"There must be a lot of people going to film at this point, but today we can't get the report, let alone let the doctor see it." According to past experience, Wang Ying calculated, and saved herself at least one day of waiting time.

In addition to less running errands and queuing, the promotion of mutual recognition and sharing of medical examination results has also reduced unnecessary expenses for patients.

"It will cost at least two or three hundred yuan to make a film. Now we can do one less inspection, which not only saves time and worry, but also saves a lot of money," said Wang Ying.

"It's all the result of machines, why not recognize each other?" As the most popular medical reform project among the people, mutual recognition of inspection and examination results between hospitals once faced difficulties: "It's not easy to recognize", and inspection and examination results cannot be accessed in real time; "Unrecognized", the standard of hospital mutual recognition has not yet formed; "Not willing to admit", medical examination is the main income of the hospital.

How to break the subject?

The reporter came to Hangzhou City Brain, which is providing data support for the mutual recognition and sharing of medical examination results.

"Hangzhou Urban Brain is an intelligent hub that gathers all kinds of data from the government, enterprises and society. Thanks to the support of its data base, we can easily and quickly call a large amount of data needed in the process of mutual recognition of medical examination results. At the same time, with the help of the capacity of the urban brain data base, these data resources can be connected at a high speed and stored safely." He Wei, director of the Planning, Development and Informatization Division of the Hangzhou Municipal Health Commission, said that with the help of the city brain, Hangzhou has built a digital application system for mutual recognition, turning "difficult recognition" into "intelligent recognition".

In addition to data non intercommunication, the disunity of standards is also a major pain point. Taking CRP (C-reactive protein test item) as an example, there are different opinions at all levels of hospitals. How should we recognize each other?

"The systems of each hospital are different, and what we need to do is to make the inspection items identifiable on different systems." This is not a simple matter, He Wei said, "We organize experts to sort out the high-frequency items most closely related to people's daily medical care, and then code them independently one by one. Finally, each mutual recognition project has an 'ID card' for medical institutions at all levels throughout the province. "

With the promotion of mutual recognition of medical examination and testing in Hangzhou, doctors can read past examination and testing results and medical records when citizens seek medical treatment in any municipal or district hospital in Hangzhou. Photographed by Chen Luxun on people.com.cn

"Uniform identification, data sharing with the pool, and second level sharing". After massive data "runs", how can we leverage reform? The reporter found that in this process, mechanism and system innovation is particularly important.

In July 2021, based on the successful pilot project in Fuyang District, Hangzhou will promote the digital reform of mutual recognition and sharing of medical examination and testing. In September of the same year, Hangzhou achieved full coverage and was officially put into operation. "In November, one day, through the data monitored by the digital cockpit of the Hangzhou City Brain Medical Examination Mutual Recognition, we found that the mutual recognition of doctors after issuing the inspection checklist was generally less, and the overall mutual recognition index of Hangzhou was not high." He Wei recalled.

Is it the doctor's unconsciousness to recognize each other, or is there a problem with data transmission? In order to find out the real reason, the Hangzhou Municipal Health Commission convened a meeting of relevant hospitals overnight to discuss.

"From the data, the mutual recognition of some hospitals is not positive enough. What is the specific reason?"

"At present, the mutual recognition plug-in will pop up when receiving a patient, but some doctors will choose not to recognize each other, and then they will directly issue a bill and skip the mutual recognition link."

"Why choose not to recognize each other? What's the difficulty?"

"The work of mutual recognition is quite complicated, which increases the workload of some doctors." "If it cannot be reflected in the incentive mechanism, the enthusiasm of doctors is not obviously improved."... The participants directly raised the difficulties of reform implementation.

After the meeting, the difficulties were solved one by one through field research. "On the one hand, we actively promote the promotion and training of medical personnel; on the other hand, doctors have precious time between visits, so we study how to use technical means to make doctors operate more simply." He Wei introduced, "From the digital empowerment, after accurately identifying the billing items, the dominating screen reminds doctors to carry out mutual recognition. After clicking 'mutual recognition', they can't continue billing. If you choose 'no mutual recognition', you need to explain the reason."

He Wei told the reporter that the closed-loop management mechanism of this system has optimized the friendliness of doctors' operation. While reducing the burden on doctors, it has also made medical behavior more standardized and ultimately benefited both doctors and patients.

The patient took blood for test in the hospital. Photographed by Chen Luxun on people.com.cn

In addition, in order to fully mobilize the enthusiasm of hospitals, Hangzhou has successively issued the Operating Rules for Mutual Recognition and Sharing of Medical Insurance Settlement of Medical Examination and Test Results in Hangzhou, and the Administrative Measures for Sharing Performance Assessment and Special Work Incentive of Medical Examination and Test in Hangzhou (Trial). It is clear that the per capita inspection and testing fees (including the actual inspection and testing fees that meet the scope of medical insurance expenses and the "inspection and testing mutual recognition" inspection and testing fees) of the insured personnel of the municipal basic medical insurance in relevant medical institutions have decreased over the same period of the previous year, of which "inspection and testing mutual recognition" The total cost of examination and testing shall be temporarily allocated to relevant medical institutions from the total annual budget of the medical insurance fund of each medical institution by the municipal medical insurance agency at the rate of 50%.

"At the same time, the hospital has also adjusted the performance appraisal policy for medical personnel, so that the hospital can implement the 'mutual recognition of examination' into the performance incentive system for departments and medical personnel. While encouraging hospitals to participate in reform, it also ensures the income of medical personnel." He Wei introduced.

At present, the reform of mutual recognition and sharing of medical laboratory examination has covered 251 medical institutions in Hangzhou, and 427 examination results (including 107 examinations and 320 examinations) have been mutually recognized among hospitals. Since the implementation of mutual recognition, the city has accumulated 3.0306 million mutual recognition items, saving 100.6794 million yuan in medical insurance funds and personal expenses of patients.

Behind this paper of "mutual recognition" is Hangzhou's efforts to get through multiple cross sectoral data such as health care, medical insurance, finance, market supervision, and more importantly, it is an innovative achievement of Hangzhou's urban brain enabling urban governance.

Hangzhou City Brain Operation Command Center workbench. Photographed by Zhang Yongtao on people.com.cn

"Hangzhou Urban Brain is not only the application of digital technology, but also the essence of digital reform. It is an innovation of governance concepts and a change of governance ideas." The relevant person in charge of Hangzhou Municipal Bureau of Data Resources Management introduced, "Relying on the urban brain, Hangzhou has created the first 'mutual recognition of medical examination' scenario in the country, effectively promoting the rational and efficient use of medical and health resources, reducing the burden of medical care for the masses, and improving the temperature of medical services. It is an effective exploration for common prosperity to achieve 'the sharing of high-quality inclusive public services throughout the life cycle of people'."

The reporter learned that at present, Hangzhou Urban Brain has iteratively upgraded to version 2.0 with the core of "one network for all", "one network for unified management" of urban operation, and "one network for co governance" of social governance. It will focus on the complex problems of megacities, focus on the "urgent difficulties and anxieties" of enterprises and the masses, provide them with digital system solutions, and adhere to "difficult and correct" things, Export "Hangzhou experience" for the modernization of megacities. (Zhang Feiran, Dai Qian, Wang Zhen, Ge Taiyi, Fang Peng Yimeng, Zhang Yongtao, Chen Luxun)

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