From smart medicine to mobile medicine, from telemedicine intervention to the implementation of medical Internet of things, as an emerging industry with high expectations, medical Internet of things is quietly affecting people’s lives. As the most widely used system affecting the public, the clinical information system, intelligent mobile clinic, operation teaching, drug tracking, intelligent security system, patient accident alarm and rescue system, wireless positioning system, wireless temperature monitoring, intelligent ward and other industrial types driven by the medical Internet of things are showing a trend of cluster development.
With the overall promotion of the new medical reform in China, the medical Internet of things has also received continuous support from the state and local governments. At present, the development of medical Internet of things industry in China focuses on supporting the development of Internet of things system in the fields of family and community telemedicine, real-time health monitoring of inpatients, circulation and management of medical devices, etc.
Data show that there are about 300000 medical institutions in China, including more than 190000 hospitals; Among them, there are 150000 private medical institutions, accounting for 51% of the total number of medical institutions, and about 9000 private hospitals, accounting for 3% of the total number of hospitals. For hospitals, because it involves the management of instruments, equipment, materials, drugs and a large number of personnel and patients, in order to ensure the quality of medical treatment, hospital management has already become the focus of attention of the government, health departments, the public and other aspects.
Especially in recent years, the failure of the last medical reform in China makes people fully realize that whether the management and control of the hospital is scientific or not will directly affect the future development of the hospital. Without scientific medical quality management, the overall development of the hospital will become water without source and wood without root. At the same time, the personnel system reform and medical system reform of public institutions are also putting forward clear requirements for hospitals. In this case, how to break through the three difficulties of hospital logistics management, medical safety management and medical equipment management has become a strategic choice to ensure the hospital to get rid of the shackles of cumbersome management.
Problem 1: hospital logistics management
Hospital logistics covers the daily operation and management activities of all business departments in the hospital. These include:
(1) Transfer of hospital documents and archives, including medical records, doctor’s prescriptions, inspection reports, medical fee bills and accounts, etc（ 2) Delivery of medical materials, including drugs, medical equipment, sterile medical materials, surgical instruments, etc（ 3) Delivery of medical specimens, laboratory specimens, pathological specimens, etc（ 4) Hospital logistics transmission, including the procurement of various auxiliary materials, loading and unloading, storage, supply, etc.
The logistics system of the hospital involves the large-scale import and export of drugs, instruments, equipment and reagents, so if the logistics management of the hospital is wrong, it will greatly affect the stability of medical quality. For example, in 2013, the annual flow of Peking University People’s Hospital reached 3 billion yuan, while the total flow of 44 hospitals managed by the health and Family Planning Commission exceeded 100 billion yuan. Generally speaking, hospital logistics in China is still in the stage of functional logistics management, such as simple material procurement, warehousing, transportation and supply. These logistics functions lack organic connection with each other. Hospital logistics network design is not good, such as the majority of domestic hospitals use a huge full-time transport team, trolleys and special elevators make the flow of people and logistics mixed together. Inefficient delivery of goods.
The medical Internet of things is to connect drugs, instruments, equipment and reagents with the Internet through radio frequency identification, infrared sensors, global positioning system laser scanners and other information sensing devices according to the agreed protocol for information exchange and communication, so as to realize intelligent identification, positioning tracking, monitoring and management.
The drugs in drugstore or hospital pharmacy can be managed by RFID technology. By deploying wireless sensor network and affixing RFID tags on valuable drugs or dangerous drugs, the real-time information of drug batch, storage time, storage rack location, quantity, delivery time, destination, patients and doctors using drugs can be obtained, so as to classify, store, distribute and manage drugs Audit and follow up. In this way, through the medical Internet of things, we can realize the whole process traceability of drugs in the circulation link, and can automatically track the management of high-value consumables. It can be said that the application of medical Internet of things in the hospital logistics transportation system can not only effectively connect the logistics warehouse and the front-line departments of the goods transmission channel, reduce the various uncertainties in the process of manual transmission, but also greatly promote the transformation of the work in the logistics link to standardization. For example, the medical Internet of things can monitor the temperature of cold chain products. By setting the temperature sensing electronic tag, during the cold chain transportation of vaccines and other items, the temperature sensor will convert the temperature change into an electronic signal at regular intervals, and the RFID chip will sense and record the signal. After arriving at the destination, the staff can scan the card reader at the electronic label, and then get the temperature change of the vaccine in the refrigerator during the whole transportation.
Problem 2: medical safety management
The complexity of medical safety management is shown in the following aspects: specialization and complicated interpersonal relationship; The relationship between doctors and nurses, patients and medical technology is complex; Personnel composition is the most technology and knowledge intensive group; Management procedures, skills and methods are complex and diverse, and the cost of coordination is high; At the same time, the quality assurance depends on the double management of doctors’ self-discipline and system compulsion. In the traditional way of medical safety management, it can only be managed and controlled by manual post setting and staffing. Due to the mobility of post personnel, a wide variety of drugs, too many medical service links and other factors, medical safety can not be guaranteed, thus aggravating the confusion of functions, management and personnel division.
So, how does the medical Internet of things solve the problem of medical safety management?
Medical Internet of things can play an important role in clinical operation of doctors, waiting time of patients, key departments, management of key medical links, ventilator and equipment related infection, perioperative management and other links, and enhance the medical safety management of hospitals.
For example, in the operation process, we can standardize the management of the operation process, increase the perioperative medical safety, and prevent surgical errors. For critically ill patients, the whole process of blood products can be tracked to improve the safety of blood use. The application of intelligent drug management can ensure the safety of drug use and eliminate drug delivery errors.
In addition, in the traditional working mode, doctors or nurses need to carry a lot of medical records and record the medical order information by hand. This is not conducive to the improvement of the efficiency of ward round, but also prone to errors due to input and identification. Through the medical Internet of things, doctors can get more accurate, timely and comprehensive information of patients through portable handheld computers with wireless internet access function, so that patients can get timely and accurate diagnosis and treatment.
Doctors and nurses can effectively monitor the ward and patients in real time through the medical Internet of things monitoring system, so that doctors or patients’ families can always grasp the treatment situation of patients. For example, doctors and nurses can track and master the physiological status of patients with RFID wristbands at any time through wireless sensor networks. The hospital can also track the location of patients, drugs and medical waste, and determine the location of patients, which can ensure that patients can get timely rescue and treatment in case of sudden illness. The medical Internet of things can even locate medical waste, clarify the responsibilities of hospitals and transportation companies, and prevent illegal dumping of medical waste and causing hospital environmental pollution.
Problem 3: medical equipment management
There are more than 1000 kinds of medical instruments and equipment in hospitals, and the fixed assets of medical equipment account for a large proportion of the total fixed assets of hospitals. With the continuous expansion of the scale of the hospital and the continuous innovation of the types of hospital equipment, the increasing number of equipment, the equipment department for equipment management process is more and more complex. For example, the location of some mobile devices can not be tracked in real time, so it takes time and effort to find the devices; It can not accurately count the utilization rate, time and status of equipment, which is not conducive to management; The management of users is not enough, including the Department, position, name and contact information of the borrower; There are still some idle equipment can not be found and recovered or lent in time, and the utilization rate of equipment is low.
So, how does the medical Internet of things solve the problem of medical equipment management?
Like the management of medical related goods, the ultimate goal of medical equipment management is to make the medical equipment in a good running state and ensure the maximization of the social, technical and economic benefits of the hospital.
Through RFID technology, on the one hand, the hospital can record the situation of medical equipment users, including the Department, position, name, contact information, etc; It can also register the inventory status of the equipment, and track the status of the equipment, including quantity, whether to be repaired, whether to be maintained, service life, equipment price, manufacturer information, after-sales service, and instructions for use; At the same time, the medical Internet of things is connected with the information security system of the equipment department, which can let managers know its history, use time, users, use location, fault records, etc., and according to these data, realize the regular maintenance of equipment, realize the electronic equipment files, improve work efficiency, realize the supervision of equipment use, so as to ensure the utilization rate of equipment.
It can be said that the equipment management system of Baoli hospital based on the Internet of things technology has the characteristics of good practicability, high stability, strong expansibility and easy to use; Using this system can effectively do a good job in the management of basic medical equipment, greatly improve the work efficiency of medical staff, reduce hospital operating costs and improve hospital operating efficiency. In addition, with the medical Internet of things as the media, through the connection of things and things, things and people, the hospital can control and manage the physical assets to the greatest extent. Through RFID tag, bar code, two-dimensional code reading sensor technology, as well as 3G communication, intelligent terminal, we can realize the functions of intelligent storage and delivery of medical items, asset inventory, repair and loss reporting, department management, anti-theft and alarm.
According to a series of documents issued by the general office of the State Council in early 2014, such as “key tasks of deepening health system reform in 2014” and “measures for supervision and administration of Internet food and drug trade”, “12th Five year development plan of Internet of things” and “12th Five Year special plan of medical device technology industry”, China will strive to establish a unified medical information sharing platform in the future, And the development of large-scale, cluster of intelligent medical industry chain, strengthen the construction of medical sensor equipment and other intelligent medical infrastructure.
At the same time, local governments have recently issued documents to support the development of medical Internet of things industry. For example, in the opinions of Chongqing Municipal People’s Government on accelerating the development of the Internet of things, telemedicine has become one of the key application demonstration fields of the Internet of things in Chongqing. At present, more and more regions have begun to use perception technology to strengthen the management of medical devices, drugs and medical processes, and carry out new intelligent medical and health services and applications based on community and family, so as to realize low-cost intelligent medical system.
The total scale of the medical service market should have a significant growth, but the growth rate may lag behind the total scale of the Internet of things market. The reason for this inference is that the Internet of things industry is still in its infancy, the industrial chain and business model are not mature enough, and the development of the Internet of things market mainly depends on the support of the government.
Editor in charge: lq6