The status and challenges of online consultation service in internet hospitals operated by physical hospitals in China: a large-scale pooled analysis of multicenter data

Abstract

Background: While Internet hospitals have rapidly developed as China's dominant digital healthcare model, critical evidence gaps persist regarding operational status and challenges of their core online consultation services. This study aimed to evaluate the current status and challenges of online consultation in Internet hospitals services through large-scale multi-center business data analysis.

Methods: Retrospective analysis of 594,695 online consultations (2020-2021) from 30 Internet hospitals across 11 Chinese provinces. Descriptive analyses were conducted on counselee demographics, consultant qualifications, and order informations. A novel five-category consultation classification was applied. Multivariate logistic regression identified the inflencing factors for order, while locally weighted regression (LOESS) modeled workload-response relationships.

Results: There were 244,678 counselees (median age 29) and 5,781 providers (91.89% doctors) involved. Service are concentrated in pediatrics, obstetrics and gynecology (48.25%). Senior-title providers handled 43.79% consultations but showed reduced completion probability (OR = 0.77). The main types of consultations were re-visit (44.89%) and first visit (34.57%). Temporal patterns revealed peak consultation hours at 10:00 (8.11%) and 16:00 (7.29%), with provider response peaks at 12:00 (5.38%), 16:00 (6.61%), and 21:00 (6.63%), averaging 3.64-hour response delays. Provided medical history (OR = 2.13) could independently increase the response probability, whereas senior title (OR = 0.77) could reduce such probability. Workload-response efficiency transitioned from positive (< 78 orders) to negative correlation (> 1,700 orders), with 27.69% uncompleted orders attributed to consultant factors (75.87%).

Conclusions: Even with the increased momentum, the online consultation service still faces many challenges mainly including the relative absence of elderly patients with chronic diseases, personnel qualification issues, the imbalance of service supply and demand, the unfitness of order contents with official regulations, and the insufficient quality control of response rate and timeliness. Comprehensive measures should be carried out to promote the effectiveness of online consultation for better disease prevention and control.

Keywords: China; Digital health; Internet hospital; Online consultation; Online health care services.

Fig. 1

The process of manual classification

Fig. 2

Distribution of counselees in 44 medical departments

Fig. 3

Age distribution of counselees in 44 medical departments

Fig. 4

Distribution of consultants in 44 medical departments

Fig. 5

Distribution of orders in 44 medical departments

Fig. 6

Order time and response time of all completed orders. a The left axis represents the order time and the right represents the response time (24h format); b The probability density of waiting time. All probability density were divided into four equal parts according to interquartile, represented by different colors. The blue dash-dotted line indicates the median

Fig. 7

Order types of 44 medical departments in 2020

Fig. 8

Reasons for order incompletion

Fig. 9

Forest plot of the multivariate logistic regression model

Fig. 10

Order volume and response rate of consultants