What did the Hunan Fundus Disease Alliance do right for the ophthalmology free clinic of “far water is difficult to save near fire”?

June 6 this year is the 27th National Eye Care Day.

The Ophthalmology Department of the Second Xiangya Hospital of Central South University conducted a special free clinic on this day. In the teleconsultation center of the Second Xiangya Hospital, doctors screened and diagnosed eye diseases for the grassroots through telemedicine.

Although this year’s free clinic team did not go to the grassroots hospital, it completed more tasks than in previous years – at the same time, it provided eye disease patients thousands of miles away, such as Lixian Traditional Chinese Medicine Hospital, Cili County Traditional Chinese Medicine Hospital, and Longshan County People’s Hospital. diagnosis.

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On the National Eye Care Day in previous years, limited by time and distance, the expert team could only choose one community or village or town for free diagnosis, with limited effect.

Under the mode of AI and remote consultation, more and more people enjoy expert-level medical resources.

The expert team of the Department of Ophthalmology of the Second Xiangya Hospital is connected with patients in many county hospitals in the form of remote consultation, and uses the Eagle Eye Airdoc retinal imaging artificial intelligence system to take pictures and screen the eye disease patients in the grassroots area, and assist the doctors in the county hospitals. Diagnose eye disease.

Overloaded free clinic, far water can’t save near fire

For Professor Luo Jing, the National Eye Care Day on June 6 is a special day.

As the chairman of Hunan Fundus Disease Specialist Alliance, the director of the Ophthalmology Teaching and Research Office of the Second Xiangya Hospital, and the head of the Retinopathy Center, Professor Luo Jing would lead the team to the grass-roots community or village for free clinics on this day in previous years.

Free clinics are not an easy task. Due to the limited number of medical teams and the long-term unmet medical needs of many grassroots patients, there is an endless stream of patients received during free clinics every year.

Professor Luo Jing has a deep memory of one of these experiences. It was in a community near Meixi Lake in Changsha, far away from the Second Xiangya Hospital. You can only insist on completing the free clinic activities in the strong wind.

After the day’s free clinic activity, Professor Luo Jing caught a bad cold. “The doctor’s running back and forth is the second thing. The most important thing is that the number of patients that such free clinic activities can help each time is too limited.”

At present, there are very few fundus doctors in China.

According to Professor Luo Jing, ophthalmology diagnosis and treatment requires very high theoretical knowledge and clinical skills mastered by doctors. It takes at least ten years to train a mature ophthalmologist, and fifteen years for a mature surgeon.

These mature ophthalmologists are almost all concentrated in provincial and municipal hospitals, and there are very few doctors who can diagnose and operate fundus diseases in the county.

For the screening and treatment of the huge group of patients with fundus diseases at the grassroots level, it is far from enough to rely on occasional free clinics by provincial experts. How to quickly improve the ability of grassroots eye health services has become a daunting task for national eye health work.

The “14th Five-Year” National Eye Health Plan also clearly pointed out that the fundus photography screening technology should be gradually covered in primary medical and health institutions, explore the establishment of a service model of “primary screening and higher-level diagnosis”, improve the ability of eye disease diagnosis and treatment, and promote high-quality ophthalmology. Medical resources expand and sink.

Therefore, Professor Luo Jing has been thinking about how to realize the hierarchical diagnosis and treatment of fundus diseases for many years.

What to rely on to support hierarchical diagnosis and treatment?

The Ophthalmology Department of the Second Xiangya Hospital of Central South University has a strong technical strength and professional team, including more than ten fundus disease experts.

Since 2017, Professor Luo Jing and colleagues have been committed to promoting hierarchical diagnosis and treatment, and organized a cross-regional medical alliance, which basically covers all cities and counties in Hunan Province, and a total of 206 hospitals have joined.

At that time, Professor Luo Jing and his team of experts carried out standardized training on the diagnosis and treatment of glaucoma, cataract, fundus diseases and other eye diseases for grass-roots doctors. Experts from provincial hospitals provided one-to-one assistance to grass-roots doctors, and also held relevant academic conferences to help Primary doctor for advanced study.

This model has not only been copied to many units in other provinces, but has also become the basis for the ophthalmology team of the Second Xiangya Hospital to build a new model of eye health in Hunan in 2021.

However, in the follow-up work, Professor Luo Jing found that the ophthalmology department of the primary hospital was too weak to undertake the first diagnosis of fundus diseases.

As a result, grassroots patients still flock to provincial hospitals, and Professor Luo Jing still sees a large number of patients with fundus diseases every day.

The model of hierarchical diagnosis and treatment has always been difficult to implement. What should be the key core problems and solutions?

In 2021, after the active communication between the medical experts from the Department of Ophthalmology of the Second Xiangya Hospital and the Hunan Provincial Health and Health Commission and relevant government departments, various state and county-level hospitals in Hunan will receive a grant from the Hunan Health and Health Commission to further promote the province. The ophthalmology capacity building project of county-level public hospitals covers 190 medical institutions in the province.

First, Professor Luo Jing and his team of experts conducted standardized management of these institutions, led the student team to investigate the ophthalmology diagnosis and treatment capabilities of these medical institutions, found out the details of team building, technical capabilities and medical equipment, and formed a written report to give feedback to Health and Health Commission and other relevant departments.

Secondly, the Hunan Fundus Disease Specialized Alliance was established, chaired by Professor Luo Jing, and the vice-chairman units were established in all prefectures and cities in Hunan Province, and then all county-level medical institutions under the jurisdiction were established to establish tertiary diagnosis and treatment of ophthalmic diseases. network.

Third, through AI technology and a tertiary diagnosis and treatment network, a full-process eye disease management platform including remote consultation, AI-assisted diagnosis, and medical training will be built.

In August 2020, the retinal imaging artificial intelligence system product developed by Eagle Eye Technology has obtained the Class III medical device certificate of the State Food and Drug Administration. Therefore, fundus disease is the best entry point at present.

In December 2021, Eagle Eye Technology was officially listed on the Hong Kong stock market, becoming the first domestic medical imaging AI stock.

“Eagle Eye Technology is a listed company with industry-leading technology accumulation. By cooperating with such a medical AI company, we can more effectively promote the construction of the project.”

After a year of on-the-spot research and project construction, the expert team finally proposed to change the traditional support model and explore a new model of eye health in Hunan that “focuses on county areas, three-level linkage of provinces, cities and counties, and rural areas surround cities”.

They decided to start with diabetic retinopathy, improve the communication and linkage between hospitals at all levels in the form of remote consultation, and promote the implementation of graded diagnosis and treatment of fundus diseases.

Diabetic retinopathy (hereinafter referred to as sugar net) is a complication of diabetes and one of the common fundus diseases. More than 30% of diabetic patients will develop retinopathy, which will lead to disability and blindness if not detected and intervened in time.

This time, with the promotion and guidance of the government, the hierarchical diagnosis and treatment of fundus diseases has finally achieved remarkable results. After the barriers between hospitals at all levels have been opened, the diagnosis of fundus diseases such as sugar net has become more convenient.

However, the goal of Professor Luo Jing and his team is not limited to this. The hierarchical diagnosis and treatment of other ophthalmic diseases will also be put on the agenda, such as myopia prevention and control, glaucoma, etc., gradually covering all ophthalmic diseases.

The Department of Ophthalmology of the Second Xiangya Hospital promoted the hierarchical diagnosis and treatment of eye diseases in Hunan Province twice in 2017 and 2021, but achieved different results.

In the view of Leifeng.com, the key winners and losers are remote video consultation and AI technology introduced into the eye disease screening and diagnosis link.

AI, builds a technical “highway” for grassroots doctors and patients

If remote consultation can optimize the graded diagnosis and treatment of fundus diseases in Hunan Province, then AI technology has greatly improved the efficiency of graded diagnosis and treatment.

This year’s National Eye Care Day is very different from previous years. The Ophthalmology Department of the Second Xiangya Hospital launched a remote consultation activity with the theme of “a photo of the fundus, early knowledge of eye disease”. Professor Luo Jing and experts sat in the remote consultation center. The patient can be diagnosed.

On the morning of June 6, several ophthalmologists, including Prof. Wei Wei, Prof. Jiang Wenmin, Prof. Liu Xiao, and Dr. Xie Manyun, stood in front of the big screen, and connected to Lixian, Cili, Longshan and other places thousands of miles away from Changsha through the cloud. Ophthalmologists and local people assisted the team of Director Sun Jun of Lixian Hospital of Traditional Chinese Medicine, Director Xie Qiong of Cili County Hospital of Traditional Chinese Medicine, and Director Peng Han of Longshan County People’s Hospital to carry out free eye disease screening in the local area.

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In one free clinic, experts can provide screening and diagnosis for multiple grass-roots hospitals in different regions at the same time, so that more patients with fundus diseases can be treated in time.

Professor Luo Jing introduced that in this free clinic, the hospital used the Eagle Eye Airdoc retinal imaging artificial intelligence system, and grass-roots medical staff can collect images after simple training, and fundus photography takes less than 1 minute.

After the photo is taken, the system immediately transmits the image to the ophthalmologists of the Second Xiangya Hospital, and the doctor can make a timely diagnosis of the patient’s condition based on the image.

During the free clinic, a 49-year-old woman in Li County was immediately identified with diabetic retinopathy by artificial intelligence technology after taking a fundus photo. The diagnosis result was uploaded to the ophthalmologist of the Second Xiangya Hospital thousands of miles away. Severe proliferative diabetic retinopathy, the patient needs immediate treatment, and the opinion is immediately returned to the local ophthalmology director Sun Jun.

A 19-year-old myopic patient in Longshan found highly myopic retinopathy through fundus photography, and a 78-year-old man in Cili found age-related macular degeneration after taking pictures…

In just one morning, ophthalmologists from the Second Xiangya Hospital completed eye disease screening for more than 500 local people in three counties thousands of miles away.

Director Sun Jun from Lixian Hospital of Traditional Chinese Medicine said, “With a photo of the fundus, the eye disease has long been known. The artificial intelligence technology combined with the remote consultation model is so good that it was unimaginable before. For us at the grassroots level, it solves our problems. A big problem that can be popularized as a routine operation in the future.”

Director Xie Qiong of Cili Traditional Chinese Medicine Hospital and Director Peng Han of Longshan County People’s Hospital also said that this new model combining artificial intelligence and remote consultation technology is very suitable for grassroots, efficient and convenient, and can save the medical expenses of local people.

In Professor Luo Jing’s view, the necessity of medical AI for grassroots hospitals is self-evident. It can assist inexperienced grassroots doctors in diagnosing eye diseases and save manpower and material resources.

“Many patients with eye disease are already very severe and irreversible when they start treatment because they are not detected in time, resulting in severe visual impairment.”

The Eagle Eye Airdoc retinal imaging artificial intelligence system can identify a variety of fundus diseases, even for a few rare diseases, the system can also identify the abnormal state of the patient’s eye.

Professor Luo Jing has a child patient with congenital eye disease. It is only in the screening of Eagle Eye Airdoc retinal imaging artificial intelligence system that the disease can be treated in time before the disease deteriorates.

There are also many patients who find out that they have serious chronic diseases only after the eye complications of diseases such as diabetes and high blood pressure are found in the fundus screening, and can be treated in time to avoid life-threatening diseases.

However, even if AI can better support the efficiency system of hierarchical diagnosis and treatment, it is subject to the renewal of concepts, equipment conditions, and the ability of basic technicians, and the popularization of medical AI has a long way to go.

In order to understand the acceptance of AI technology by grassroots doctors and patients, Professor Luo Jing visited hospitals one by one, “We must do the cultivation of AI technology step by step.”

In the recent grassroots training in Huaihua, Changde and other places, she also explained AI technology as a key content to improve the acceptance of AI technology by medical workers.

Fortunately, both primary-level doctors and patients are willing to try this new diagnosis and treatment model.

Advanced technologies such as artificial intelligence and telemedicine have built a practical “highway” for the grassroots where high-quality medical resources and fundus doctors are scarce.

Note: This article was jointly interviewed by the People’s Daily Health Client and Leifeng.com. Thank you for the support of the People’s Daily Health Client.

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