Mobile medical services represent a contemporary concept, encompassing the use of wireless technology to deliver health services and information through mobile communication devices [1-3]. With the advent of mobile communications supported by 4G and 5G mobile networks, mobile medical services have the potential to offer health care services at any time and place, overcoming geographical and temporal barriers. Such offerings alleviate patient expenses and the inconvenience of traveling to major cities for specialized expertise [4]. In the past few years, mobile medical services have experienced exponential growth, propelled by the rapid expansion of the internet and the increasing prevalence of the internet and mobile devices such as mobile phones or smartphones [5,6]. Smartphones, ubiquitous as personal computers today, have revolutionized the communication landscape, with more than 95% of Chinese adults owning a mobile phone [7]. Such high coverage of mobile access provides an unprecedented opportunity for mobile-based health services. These devices, nearly always active and highly portable, accompany users wherever they go, facilitating real-time, on-demand communication and a wide array of service functions. High-quality, robust medical care and health system services can be fulfilled by approved internet hospitals by using mobile technology [8].

Internet hospitals have emerged as a significant trend in China in recent years due to their potential to provide widely accessible patient service delivery [9-11]. An internet hospital refers to a facility capable of delivering outpatient services through internet technologies, allowing patients to consult with doctors or manage chronic diseases through websites, mobile medical services apps, or WeChat platforms in Chinese public hospitals. Patients can receive medical consultations and send images of auxiliary examinations to the doctor through the internet. Meanwhile, the doctor can inquire about the patient’s health status and offer advice. Some of these hospitals have been authorized with Internet Hospital licenses by the local government so that they can provide additional services like online prescriptions and direct payment through government medical insurance. These hospitals are referred to as approved internet hospitals. The first officially approved Internet Hospital was launched on Oct 25, 2014, in Guangdong Province, China. Mobile medical services provided by internet hospitals have greatly diminished geographical and time constraints, thereby offering Chinese patients online access to skilled doctors and addressing the issue of long wait times [12]. Many public hospitals now offer online personal health records, enabling patients to access their own health information, refill prescriptions, schedule appointments, receive online consultations and remote diagnosis, obtain electronic prescriptions, access other health care management supports, review diagnoses or checkup reports, and make payments through mobile medical services applications (apps) or the WeChat platform [10]. The market value of Chinese internet medical services was 11.4 billion yuan (US $1.7 billion) in 2014 and 15.7 billion yuan in 2015, marking an increase of 37.7%. The user population of internet medical services users was 194.8 million in 2016, accounting for 26.6% of all internet users [11]. WeChat, launched in January 2011, is one of the world’s leading social networks, ranking fifth in terms of active users. As of 2020, it had become one of the world’s largest mobile apps, with over 1 billion monthly active users [13]. Mobile health care services represent a novel endeavor to provide patient-centric health care in China. Patient-centric health care is defined as care provision that is consistent with the values, needs, and desires of the patient. It is thought to offer numerous benefits, including better health outcomes, greater patient satisfaction, and reduced health costs [14,15]. Mobile health care services can significantly reduce patients’ health expenses by reducing transportation time and hospital waiting times. In addition, online chronic disease management allows patients to upload daily health data like weight and glucose levels, and they can receive updated instructions from doctors and nutritionists remotely. Instead of manually recording these metrics, mobile services can automatically generate graphs for easy comprehension, which will finally lead to improved health outcomes and heightened patient satisfaction. Especially from late 2019 to early 2020, an outbreak of COVID-19 swept throughout China [16]. Due to the risk of contracting COVID-19, patients are currently less inclined to visit offline clinics or hospitals. In addition, the procedure for visiting offline clinics is more complex because of the requirement for screening tests and answering questionnaires. Under such circumstances, approved internet hospitals offer numerous advantages in providing outpatient health care in China while adhering to the guidelines of the nationwide epidemic prevention and control program [17,18]. In return, internet hospitals can also help to control the COVID-19 epidemic. In terms of the COVID-19 features, rapid online reservations for nucleic acid testing and free COVID-19–related consultations are the main differentiating factors from other services. Patients who do not need regular medical consultations but only need nucleic acid testing for travel purposes, etc, can bypass many steps like registration. Furthermore, patients exhibiting abnormal body temperature, epidemic exposure history, or COVID-19–related symptoms like cough or malaise can have direct access to specialists who can give standard instructions and transfer these cases separately.

However, mobile medical programs by both approved internet hospitals and unapproved internet hospitals are still in the exploratory stage, and many problems remain to be solved, such as integrating internet-based medical services into health insurance programs, ensuring surveillance and quality control, assessing the applicability of internet diagnoses for certain diseases, addressing possible medical disputes, and evaluating long-term return on investment [10]. The proliferation of mobile medical services in China suggests a promising direction for future health care. However, to date, patient-centric mobile medical services accessed through smartphones across the country have not been systematically investigated.

The objective of this study was to provide an overview of mobile medical services accessed through smartphones in China among the top 100 hospitals ranked by the China Hospital Science and Technology Evaluation Metrics of the Chinese Academy of Medical Sciences (2019) and China’s Hospital Rankings of the Hospital Management Institute of Fudan University (2019). We conducted a cross-sectional study to describe the characteristics of China’s mobile medical services accessed through smartphones and to assess their health service capacities.

A total of 124 tertiary public hospitals from the 2 ranking lists of the top 100 hospitals were included in this study. We identified 60 active approved Internet hospitals, mostly concentrated in Shanghai and Guangdong. Mobile medical services primarily included appointment scheduling and registration, online medical guidance systems and consultations, online prescriptions, medication delivery services, online test reports, online payments, chronic disease management, and health education etc (more details in Table 1). Overall, 98.39% (122/124) of the hospitals offered appointment scheduling and registration services and provided health education online; 76.61% (95/124) of the hospitals supplied online test reports; and 58.06% (72/124) of the hospitals provided online consultations. In addition, 49.19% (61/124) of the hospitals offered online prescriptions; among these hospitals, 88.52% (54/61) also provided home delivery services using third-party delivery companies. A total of 45.97% (57/124) of the hospitals launched medical guidance systems based on artificial intelligence technology. Only 6.45% (8/124) of the hospitals offered chronic disease management modules under the monitoring and management of experienced medical teams.

We mapped the geographic distribution of hospitals among the top 100 hospitals rankings that offered more than 6 smartphone-accessible mobile medical services (Figure 1). These hospitals were predominantly concentrated in Shanghai, Beijing, and Guangdong (Figure 2). Shanghai had the highest number, with 18 hospitals providing more than 6 mobile medical services, followed by Beijing with 7 and Guangdong with 6. The number of hospitals in other provinces ranged from 1 to 4, highlighting significant regional disparities in the availability of mobile medical services across China. Beijing housed 25 of the top 100 hospitals in China, the largest number among all provinces, yet it had only 3 approved internet hospitals. Conversely, Shanghai demonstrated a higher concentration of approved internet hospitals (Figure 2).

In addition, we sought to identify the differences in overall health care and mobile health care service apps for patient-centric services between approved internet hospitals and unapproved internet hospitals. The chi-square test revealed significant discrepancies in the availability of numerous vital functions between the 2 categories. Among the 124 hospitals examined, 48% (60/124) of the hospitals were registered internet hospitals. Compared with unapproved internet hospitals, a higher proportion of approved internet hospitals provided online consultation (29.69% vs 88.33%, r=43.741; P<.001), test reports (62.5% vs 91.67%, r=14.703; P<.001), and chronic disease management services (1.56% vs 11.67%, r=5.238; P<.05).

From Shanghai Sixth People’s Hospital, an approved internet hospital, we extracted the workflow of medical processes through a smartphone and drew a sequence diagram for this hospital function (Figure 3). Patients with common chronic diseases should first confirm that the hospital can provide medical services for that disease, which means that the disease is included in the list. Upon confirmation, patients can update their current status to doctors online instead of visiting the clinic. The light gray area in Figure 4 shows the process of an online visit by patients with common chronic diseases. Next, patients can choose a doctor online and schedule appointments for online consultations. Similar to the offline procedure, patients register on the appointment day, complete payment, and fill out basic charts detailing their concerns, previous diagnoses, and medication history. Doctors diagnose and provide medical advice after the appointment through text, images, and voice messages, with the option to offer online prescriptions directly. The dark gray area in Figure 4 illustrates the process of how patients receive treatments and purchase prescription drugs online. After receiving the online prescriptions from the doctor, pharmacists handle the electronic prescriptions. Then, patients confirm the prescriptions and make payments online. In certain approved internet hospitals, patients with health insurance can use their insurance account after registration, after which prescribed drugs can be delivered home by a third-party logistics company cooperating with the hospital. Alternatively, drugs can be picked up at the hospital pharmacy. Patients receive electronic bills after online visits. Shanghai Sixth People’s Hospital is covered by social health insurance, issuing the first electronic receipt on June 23, 2020. For patients with conditions not catered to by internet hospitals, the system allows online doctor selection and appointment scheduling for offline visits. Meanwhile, internet hospitals can also provide health consultations to patients before offline clinic visits, providing advice without prescription issuance for medical safety considerations.

Based on the data we obtained, we constructed flowcharts for the offline and online hospital scenarios and summarized the treatment processes of the existing internet hospitals based on the doctor-patient interactions (Figure 3). Patients can receive consultations online before going to the hospital to enable the doctors to collect relevant health information and understand their current issues. If the patient needs to visit the hospital, they can undergo a more comprehensive and reliable consultation to assist in triaging. Next, patients can choose to register online or visit the hospital for an initial examination. After the first visit, patients can choose either online or offline options for evaluating disease prognosis, treatment effects, and further treatment. Furthermore, subsequent visits that require examination and laboratory tests need to be done offline. Therefore, the 2 areas are divided into online and offline options and colored in white and gray, respectively (Figure 3). Patients may also opt for in-home diagnosis and treatment options.

We also created an architecture chart of a typical approved internet hospital to demonstrate the fundamental structure of internet hospitals, detailing the full range of services offered, from appointment scheduling to ongoing health management (Figure 4). The system usually provides services to patient clients, doctor clients, and hospital clients. Patient clients mostly use messaging applications such as WeChat on mobile platforms, while doctor clients and hospital clients use more advanced functions and are mainly accessed through PCs. The services provided by approved internet hospitals can be divided into 5 categories: preoffline visits, online medical services, pharmacy services, payment-related services, and provision of health management information. In the preoffline visits module, patients can schedule appointments for offline clinics and request diagnostic tests (eg, COVID-19 tests) at home, which substantially lowers the risk of infection typically associated with community hospital settings. In addition, patients can use the online medical guidance system to determine which department they should visit. Approved internet hospitals offer a wide range of online medical services, including consultations, test report reviews, diagnosis, and prescription issuance. Due to the rapid development of logistics companies in China, internet hospitals can not only sell prescription drugs online but also provide door-to-door drug delivery services. In terms of payment-related services, patients can download invoices and pay bills directly through smartphones. An increasing number of approved internet hospitals have established partnerships with health insurance companies, allowing patients to use their insurance benefits online. Furthermore, because of the global reach of modern social media, internet hospitals can perform health education more effectively and assist patients in improving self-management practices. Some hospitals have specialized medical teams to support patients with chronic diseases, ensuring timely management of their conditions.