Post：2020/05/04
In 2002, the first case of SARS was confirmed in Guangdong Province, China. Since then, the epidemic of severe acute respiratory syndrome (SARS) broke out, causing global panic with its high infection rate and mortality rate, leading to the death of 774 patients, including medical staff. The first case in Taiwan was found in February 2003. On April 24, 2003, Taipei Municipal Hoping Hospital was closed due to an outbreak of nosocomial infection.
All the observation and analysis reports clearly pointed out that despite the full-scale implementation of control measures, the cases that cannot be diagnosed in real time were still the major crevice in epidemic prevention of nosocomial infection and spreading to other medical institutions and communities. These clustering cases will cause high morbidity and mortality, even lead to the closure of medical institutions, and, even worse, cause the block of large or small-scale exchanges between the whole city, the country and the international community.
Based on the confirmed cases of SARS and COVID-19, it can be concluded that exposure and contact in medical institutions accelerate the spread of the disease, which poses a great threat to medical resources and energy, and directly impacts the primary defense line to maintain public health.
In July 2013, CDC published the book "Ten Years of Life and Lessons from SARS ", which put forward suggestions and expectations for the reform and future direction of domestic infectious disease prevention and control system. Experts such as Yong-Feng Chang, director of the First Research Institute of the Chung-Hua Institution for Economic Research, and Shan-Chwen Chang, President of the National Taiwan University Hospital, all said that a sound epidemic prevention system, the combination of first-class command centers and epidemic prevention personnel, and the implementation of emergency drills were the key to epidemic prevention.
As follows, the author expressed his ideas and opinions on the technology epidemic prevention based on the contact and understanding of the medical related projects undertaken by IISI, and by quoting the relevant contents of "Ten Years of Life and Lessons from SARS".
Comprehensive preparation and construction of epidemic prevention information network
In the face of the emerging diseases that may continuously appear in the future with even higher infection rate and mortality rate and pose a major threat to the public health, the construction of a rapid and effective information acquisition and notification mechanism has become an urgent issue. Mobilization, informatization, professionalization, popularization and internationalization are the five major concepts that must be adhered to in the construction of epidemic prevention; and big data, new technology and active quarantine are the key to the success of the first stage of COVID-19 epidemic prevention. At present, we may take advantage of the fact that Taiwan is still confident and has relatively complete epidemic prevention organizations and energy to start reviewing the inadequate points and considering corresponding improvements, so as to be fully prepared for more severe challenges in the future.
At the beginning of the epidemic, the government quickly mobilized all agencies to participate in epidemic prevention, with the expectation of collecting immediately the data under the control of the authorities, so as to quickly acquire the public information for the purpose of tracking or re-tracking, reminding the medical units about people’s travel history, collecting the information of entry health declaration, tracking management of people under home quarantine and concentrated quarantine, analyzing the trend of epidemic situation, precise epidemic prevention etc.. However, due to the quite different business managed by various authorities, it is difficult to implement the definition, screening, transmission, integration and presentation of various data. In particular, the need to produce the results of data analysis in a very short period would increase the participants’ physical and mental pressure in the development of information systems, functional testing and stress testing.
The central and local governments have considerable experience in disaster response in the cases of typhoons or torrential rain that often attack Taiwan in the summer. More importantly, because of the long-term and repeated disaster prevention on level-1 and level-2 disasters, Taiwan has accumulated rich practical experience, and the related disaster prevention information platform and system must be highly linked and complete. However, epidemics do not happen so frequently, so epidemic prevention experience and corresponding drills are relatively limited. Therefore, it is important to establish the epidemic prevention information network, which should include, but not limited to, the following supporting items：
There are many units that need to be mobilized for epidemic prevention, including: the central epidemic command center established for epidemic prevention, the MOHW, the CDC, the Central Health Insurance Agency, the Bureau of Health Promotion, the Immigration Department of the Ministry of the Interior, the Consular Affairs Bureau of the Ministry of Foreign Affairs, the health, social and even village offices of the local governments in various counties and cities, and even the continuously expanding long-term care bases, medical institutions, and related medical material manufacturers, drug stores, etc. In order to be able to deploy ahead of time, integrate important information, and effectively prevent and control the epidemic, it is particularly important to establish a data linkage mechanism for the above-mentioned units and a communication platform for the units and the public！
Formulate the data interface standards and related specifications between the above-mentioned units and agencies as the common language for communication among all units. The content of the interface shall include the identification of the source and the destination, the data item, data format, interface timing and frequency, status feedback of the data sending and receiving end, corresponding processing and contact window information, etc.
Once the epidemic prevention mechanism is started, each system or integrated platform must be able to receive and process a large amount of data from multiple parties in a very short time. An important issue for all units to face and improve is that whether their software and hardware configuration and host specifications of the relevant information system are sufficient to load and improve various tasks, while still maintaining good performance and stable operation quality.
The integrated information network should include: Disease monitoring and notification, epidemic prevention and inspection network, border quarantine network, epidemic prevention material preparation, information communication platform, etc. Transparent, open and real-time information is the key to prevent the outbreak and spread of the epidemic, and the scope of information coverage should include all the above-mentioned networks.
The relevant mechanism must regularly check whether the data of each system is concatenated and synchronized, that is to say, regular drills must be conducted. At the same time, relevant units should be gathered through meetings to communicate the abnormalities of the epidemic prevention platform or to exchange and discuss the relevant improvement and optimization opinions, so as to ensure that the relevant specifications are carried out continuously and refinement and adjustment can be made timely. Taiwan's epidemic prevention actions and achievements in COVID-19 have been recognized by the international community. Taking preventive measures in advance and the epidemic preventive awareness of the public are regarded as the key factors for the effectiveness of the epidemic prevention. Therefore, early monitoring, accurate control of the epidemic situation and forward-looking deployment are the key to reduce the impact of the epidemic on the society and the country.
Most medical services in the world are conducted by doctors making face-to-face consultation, diagnosis and treatment with the patients. The emergence of COVID-19 has put a major challenge for such medical service mode. Existing hospitals and government agencies understand the convenience and benefits of providing diagnosis, consultation, health management and even nursing care through telemedicine.
Telemedicine will play an important role in the diagnosis and treatment of epidemic diseases
The "Telecom Diagnosis and Treatment Method" issued by MOHW on May 11, 2018 extended the scope of application from the original remote areas to the care object and mode of telemedicine, including the tracking of acute inpatients within 3 months, institutional residential long-term care residents with chronic prescriptions in medical institutions, family physicians integrated care related, remote and home-based care objects, and non-Taiwanese patients who plan to be or have been treated by their own countries’ medical institutions and overseas patients who have not participated in the national health insurance can make use of telemedicine services to receive doctor's diagnosis. According to the market forecast by Global Market Insights in 2019, the compound growth rate of telemedicine from 2019 to 2025 will reach 19.2%.
Because of the accessibility of medical services in Taiwan, the public have high access to medical services. In the current situation, the probability of large-scale application of telemedicine may not be too high, but it can still have its effect in special situations such as epidemic. The future vision is to apply and combine the rapidly developing technologies like 5G transmission, positioning and image recognition, mobile application technology and artificial intelligence science to break through the limitation of traditional time and space for medical treatment, so as to make telemedicine another medical choice for the public. The following is a list of relevant supporting practices on the telemedicine service process in Taiwan (Figure 2) and the applicable situation for the development of telemedicine (Figure 3) for consideration and planning of relevant professionals.
Introduction of telemedicine services in Taiwan
In order to develop telemedicine in Taiwan, the applicable scenarios can be divided into the following three modes according to the application field and participants:
Doctors can provide remote consultation service for inpatients through telemedicine mechanism outside the hospital. This service must allow doctors not only to have video dialogue with inpatients or on-site medical staff, but also to remotely view and operate or even log in to the Hospital Information System (HIS).
Doctors in the hospital can provide remote consultation service for residents in remote care institutions. This service must enable the whole process to be carried out just like in the hospital. That is to say, in addition to video consultation and other basic mechanism, it must still meet the current requirements of medical certification with health insurance card in Taiwan. Because doctors are providing consultation service in hospital, what they operate is HIS system.
Doctors in the hospital can provide long-distance consultation service for the public in remote rural health centers. People in remote rural areas can interact with doctors in the hospital on their own, and when on-site medical staff of remote health centers is required to assist in diagnosis and treatment, doctors and medical staff at both ends can directly exchange medical professional opinions.
Summary
For the central authorities, the risk awareness and concept of prevention technology will also be improved after this epidemic. Based on a complete and unimpeded epidemic prevention information network and from the perspective of medical service energy, COVID-19 actually poses a stress test on the whole medical service industry, which means that when an epidemic occurs, the importance of hospital routine procedures will be reduced to concentrate on dealing with more serious cases or a large number of patients. Obviously, the medical institutions are the important defense lines for epidemic prevention. How to strictly control the epidemic situation in medical institutions, so as to ensure the medical energy of medical institutions and protect the medical staff and public from the threat of nosocomial infection, telemedicine may be a safer and more appropriate new type of medical services in the present and future facing the changing emerging infectious diseases. Dr. Li-Min Huang, director of the pediatric infection department of National Taiwan University Hospital, once said in an interview with the domestic media that in order to stop the epidemic situation, it is necessary to keep the hospital's nosocomial infection control, thoroughly implement the implementation of infection control, and protect patients and the self-protection of front-line medical staff. In the future, when faced with major infectious diseases, it is necessary to switch doctor consultation to telemedicine.