Novel coronavirus (2019-nCoV)–infected pneumonia is caused by the 2019 novel coronavirus [1]. On February 11, 2020, the World Health Organization (WHO) announced the names “coronavirus disease 2019” (COVID-19) for the disease and “severe acute respiratory syndrome coronavirus 2” (SARS-CoV-2) for the virus. According to existing studies, SARS-CoV-2 is closely related to severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS⁃CoV). All three viruses can cause severe symptoms of pneumonia. SARS-CoV-2 is usually found in respiratory secretions and transmitted by droplets (eg, by sneezing and saliva) but can also spread by contact. Its virulence is weaker than SARS⁃CoV, but its transmissibility is higher than SARS⁃CoV. SARS-CoV-2 can spread from person to person, and the general population is susceptible to infection. It is also contagious during the latency period [2-5]. According to the National Health Commission of the People’s Republic of China, it had received reports of 72,528 cumulative confirmed cases of COVID-19 from 31 provinces (autonomous regions and municipalities directly under the central government) and Xinjiang Production and Construction Corps, by 24:00 on February 17, 2020. Other countries, including Thailand, Japan, Korea, and the United States had also reported COVID-19 cases [6-9]. It is difficult to monitor COVID-19 due to its high transmissibility, unclear route of transmission, and atypical symptoms. COVID-19 has posed enormous challenges to China's public health [2].

During the COVID-19 outbreak, nonurgent visits may cause overcrowding in hospitals [10], which not only adds to the burden of hospital staff but also dramatically increases the risk of infection spread. There may be severely adverse consequences for both patients and hospitals, making pandemic control even more difficult. On the other hand, as a major public health event, the COVID-19 pandemic not only endangers people's life and health but also causes psychological stress and anxiety. Active prevention and monitoring of the public’s psychological behavior is an integral part of a reasonable response to public health emergencies. Telemedicine is a health service discipline that combines modern communication, electronic technology, computer networks, and medicine [11]. Telemedicine can overcome geographical barriers, increase the number of people served, and provide online clinical support for patients [12,13]. This novel health service model has great potential for disease prevention and treatment as well as patient nursing during epidemiologic outbreaks [14].

Henan Provincial People's Hospital has opened the COVID-19 online outpatient clinic via the connected smart health service center platform, which provides smart health solutions for patients. The platform has already achieved 5G coverage and combines the internet with medical technology to successfully connect Henan Provincial People's Hospital to online hospitals. Online health services provided to patients include appointment, diagnosis and treatment, payment, quality control, follow-up, hierarchical diagnosis and treatment, emergency rescue, healthy management, public services, logistics, health education, and remote vital signs monitoring. Here, a retrospective analysis was performed to analyze the outcomes and advantages of telemedicine in the context of the COVID-19 outbreak in China.

A retrospective analysis was carried out using data from all patients who received remote diagnosis and treatment via online consultation services provided by our hospital from January 24 to February 17, 2020. During this period, 132 clinicians from Henan Provincial People's Hospital provided online outpatient consultation services to address COVID-19 concerns. These clinicians were from the Department of Infectious Diseases, the Respiratory Department, the Department of Critical Care Medicine, and the Department of Psychology and Psychiatry. They were divided into 5 teams: 2 teams provided consultation services for adult patients (adult team), 1 team for pediatric patients (pediatric team), and 2 teams for patients with psychological problems (psychological team; Figure 1). Online inquiry, consultation, and suggestions were provided to patients for concerns related to COVID-19 and the services were free of charge. Meanwhile, the hospital offered offline noncontact drug delivery services following online ordering and payment.

In order to consult with a clinician, patients can scan the official QR (Quick Response) code or follow the WeChat public account HNFYSY1904, which directs them to the expert consultation interface and allows access to the online outpatient consultation. Alternatively, patients can directly search our health service website to access the consultation page. Following the prompts, the patients click on the “Consult” button in the lower right corner, then input personal information and a description of symptoms, and start the consultation (Figure 2). The patients can choose real-time communication or online messaging for inquiry and consultation. The patients can interact with the clinicians online via voice, text, photo, and video (Figure 3).

During telemedicine consultations, we defined mild illness as follows: fever below 38℃ and no history of epidemiological exposure. Patients with a fever greater than 38℃ or with a history of epidemiological exposure were advised go to the hospital immediately. For mildly symptomatic patients and those with symptoms like cough, nasal congestion, fatigue, diarrhea, etc, our procedure was to provide medication guidance, recommend home isolation, and regular temperature monitoring. In cases where the temperature exceeds 38℃ or symptoms worsen, we recommended patients to visit a hospital for treatment.

At the end of the remote consultation, the platform will automatically open an electronic questionnaire, which the patients have the option to fill. The questionnaire includes star ratings and open answers. A minimum of 1 star represents high dissatisfaction, and a maximum of 5 stars represents high satisfaction. Four stars and above represent satisfaction. Following this, patients can input their own opinions and suggestions.

Since the online outpatient consultation service first began on January 24, 2020, online remote diagnosis and treatment and offline drug delivery services have been provided nonstop every day from 8:00 to 22:00. Patients’ personal information is stored on the connected smart health service center’s cloud-based platform, which ensures data safety. All statistical analyses were performed using SPSS 18.0 software (IMB Corporation). Categorical variables were expressed as absolute and relative frequencies and percentages.

The study protocol was approved by the ethics committee of Henan Provincial People's Hospital (Zhengzhou, China).

In total, 4589 patients received remote diagnosis and treatment via the COVID-19 online outpatient clinic. Among them, there were 1940 (42.3%) males and 2649 (57.7%) females. The youngest patient was aged 78 days, and the eldest was 85 years old. In terms of age, 320 patients were aged <20 years, 2007 patients were aged 20-29 years, and 1707 were aged 30-39 years; the latter 2 groups accounted for 80.9% (n=3714) of the sample. Additionally, 315 patients were aged 50-59 years, and 50 patients were ≥60 years. Most patients (n=3898, 84.9%) came from Henan Province; 691 (15.1%) patients came from other provinces. During the epidemic, all patients with suspected COVID-19 received by a hospital were referred to a fever clinic. A total of 4561 patients were treated in the fever clinic of our hospital. Among them, there were 2375 (52.1%) male patients and 2186 (47.9%) female patients.

From January 24 to February 17, 2020, the daily number of online outpatient visits first increased and then decreased, reaching its peak on January 28 when the daily number of online outpatient visits reached 612. Following this, the second peak occurred on January 30 when visits totaled 495. This number gradually decreased afterward. Between February 15-17, the daily number of online outpatient visits remained at 25-35, with minimal change. The number of offline noncontact drug delivery orders following online payment first increased and then stabilized. The total number of offline noncontact drug delivery orders was 873. As shown in Figure 4, after February 12, the daily number of noncontact drug delivery orders exceeded that of online outpatient visits before gradually stabilizing.

By February 17, the 5 expert teams had provided remote consultation services for 4589 patients (Table 1). In total, the 2 adult teams provided consultations to 4399 adult patients, accounting for 95.86% of the sample; the pediatric team provided consultations to 80 (1.74%) pediatric patients; and the 2 psychological teams provided psychological counseling for 110 (2.40%) patients (Table 1). The content of the consultations was classified according to the symptoms concerned (one patient might have one or more symptoms), including fever, headache, cough, fatigue, nasal obstruction, sore throat, nasal obstruction, and diarrhea. The most common symptom that patients initiated a consultation for was fever (n=2383 patients), followed by cough (n=1740), nasal obstruction (n=794 patients), fatigue (n=503), and diarrhea (n=276). Among the 110 patients who received psychological counseling, 7 patients reported psychological stress and anxiety due to their history of epidemiological exposure. The remaining 103 patients had no history of epidemiological exposure.

Among the 4589 patients who received remote consultation services, 310 patients were advised to go to the hospital for further examination due to fever greater than 38℃, and 301 patients were advised to visit a hospital for further examination because of a history of epidemiological exposure and other symptoms. In total, 985 patients responded to the satisfaction questionnaire, of whom 98.1% (n=966) were satisfied with the service (rated as 4 stars or above). They praised the doctors for their rich experience, professional answers, dedication to their work, timely response, and patience. In the 110 cases of psychological counseling, 47 cases provided feedback, and the proportion of satisfaction ratings greater than 4 stars was 100%.