Distribution of policy release dates
The distribution of policy release dates obtained in this study is illustrated in Fig. 3. As shown in the figure, the number of internet healthcare policies released from 2016 to 2024 exhibits significant fluctuations. On 25 October 2016, the Central Committee of the Communist Party of China and the State Council officially issued the Healthy China 2030 Planning Outline. In the following 2 months, 28 related policy documents were released. Over the next 2 years, the number of policies continued to increase, reaching a first peak in 2018 with 65 documents, indicating a growing governmental focus on internet healthcare. The number of policy releases slightly declined in 2019 and 2020, with 52 and 55 documents issued, respectively. However, in 2021, the number of policies surged to 74, reaching its peak, likely due to the increased governmental emphasis on internet healthcare in response to the coronavirus disease 2019 (COVID-19) pandemic. In the following 2 years, the number of policies returned to levels similar to those seen in 2019 and 2020.
Number of internet healthcare policy releases, 2011–2024
Topic content
By using the BERTopic model for topic modelling on internet healthcare policy texts, 27 topics were automatically generated. The optimal clustering effect and the clearest semantics were selected, resulting in eight highly significant topics. The top five keywords for each topic were extracted and visualized on the basis of their importance to the topic. Figure 4 illustrates the proportion of keywords for each topic. Topics 0, 1, 4 and 7 displayed relatively balanced keyword distributions, while topics 2, 3, 5 and 6 exhibited some variation in keyword proportions. In topic 0, “internet” had the highest proportion at 0.04, while “hospital” had the lowest at 0.02. In topic 1, “health” was the most significant topic, accounting for 0.03, while “development” had the lowest share at 0.02. In topic 2, “elderly” was the most prominent topic, with the highest proportion at 0.07, while “eldercare” had the lowest at 0.03. In topic 3, “regulation” held the highest proportion at 0.04, whereas “industry” had the lowest at 0.02. These topics reflect that internet healthcare policy texts emphasize technical applications, target audiences and regulatory issues.
The top eight topics and their subject terms
Topic hierarchy
To understand the underlying hierarchical structure of topics, the HDBSCAN hierarchical clustering algorithm was used to cluster the relationships between topics and visualize the results, as shown in Fig. 5. The clustering results provide a clear representation of the connections between different topics at various levels. For example, topic 0 (internet healthcare services) and topic 3 (regulation and oversight) are closely connected; the 2022 guidelines for the supervision of online diagnosis and treatment services from the National Health Commission set specific regulations for Internet healthcare services, covering aspects such as medical institution supervision, personnel oversight and quality safety management. Topic 1 (traditional Chinese medicine and health) and topic 4 (rural and township health centres) are directly related. In 2022, the National Administration of Traditional Chinese Medicine issued the notification, Development Plan for Traditional Chinese Medicine Informatization during the 14th Five-Year Plan, which promotes the deep integration of traditional Chinese medicine health services with the internet. In the same year, the State Council’s Office issued the Development Plan for Traditional Chinese Medicine during the 14th Five-Year Plan, calling for strengthening traditional Chinese medicine departments in primary healthcare institutions and striving to equip all community health service centres and township health centres with traditional Chinese medicine clinics and practitioners. Topic 2 (eldercare) and topic 9 (traditional Chinese medicine rehabilitation) are directly related. Research indicates that traditional Chinese medicine nursing has unique advantages and has been widely used in clinical practice, playing an indispensable role in rehabilitation care [15]. In 2019, the National Health Commission’s “Internet Plus Nursing Service Pilot Program” focussed on providing nursing services such as chronic disease management, rehabilitation care and specialized care to the elderly, disabled or terminally ill patients. Topic 5 (child healthcare) and topic 17 (traditional Chinese medicine health) have an indirect relationship. The National Health Commission’s “Healthy Children Initiative (2021–2025)” emphasized strengthening children’s traditional Chinese medicine services while leveraging various internet communication platforms to conduct online child health assessments and guidance.
Topic cluster
Topic spatial distribution
To visualize the concentration of internet healthcare policies among topics, core topic groups and the number of outlier topics, the model.visualize-topics() function was used to convert topic vectors into two-dimensional vectors and generate a scatter plot of the thematic space distribution, as shown in Fig. 6. Each circle represents a topic, with the size of the circle indicating the frequency of the topic across all documents. The distance between circles is determined by the semantic relatedness between different topics; the closer the distance, the higher the semantic association between the topics. The results demonstrate that internet healthcare policies can be grouped into six thematic clusters, with two clusters near the centre representing core topic groups and the other four clusters as outlier groups. The larger area of the points in the two core topic groups suggests that most internet healthcare policy topics are concentrated around the core groups.
Topic spatial distribution
Topic similarity
To explore the synergistic relationships between topics, cosine similarity between each topic and the others was calculated and used to construct a similarity matrix. The thematic similarity heatmap was then generated, as shown in Fig. 7, where the intensity of colour indicates the level of similarity between topics – the darker the colour, the higher the similarity. The results reveal that the similarity between topics 0 and 20 is higher than that between topics 21 and 26, suggesting that the first 21 topics share more concentrated semantics and likely belong to the core topic groups, while the latter six topics have more dispersed semantics and may be more related to the outlier groups.
Document spatial distribution
To analyse the thematic content by displaying the distribution of documents within each topic, the model.visualize_documents() function was used to generate a visualization of the Internet healthcare policy document-to-topic distribution, as shown in Fig. 8. The distance between points reflects the semantic similarity of documents, while the colour of the points represents the topic they belong to. This visualization provides insight into the specific policies covered under each topic, which assists in further refining the topic clusters for this study.
Documents–topic distribution atlas
Dynamic topic model
Dynamic topic modelling (DTM) is a technique used to analyse changes in topics over time. In BERTopic, DTM is executed by calculating the c-TF-IDF for each topic and time period. Figure 9 illustrates the trend of different topics from 2016 to 2024. Among these, topic 0 (internet healthcare services) consistently maintained a high frequency each year, peaking in 2018 before gradually declining. In contrast, the distribution of other topics, such as topic 2 (eldercare), remained relatively stable, indicating that policy development in these areas progressed more slowly and did not experience significant shifts in priority.
Visualization of topics over time
Topic cluster
On the basis of the thematic space distribution, topic similarity and document space distribution results, as well as manual selection of the most optimal clustering results and clearest semantics, the internet healthcare policy texts were ultimately categorized into five thematic clusters. The results are presented in Table 1.
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Regulation of internet medical services
The thematic cluster includes seven topics, such as Topic 0: Internet healthcare services and Topic 3: Regulation and supervision. These topics focus on the safety, reliability and rationality of internet healthcare practices, as well as the development and improvement of relevant standards and norms.
Cases of unregulated behaviour in internet healthcare have repeatedly sparked public outcry, with numerous media outlets exposing problems within the industry [16]. In response, national and local health administration departments have developed and issued policies to oversee and manage internet healthcare services, including the eligibility for entry, treatment process and service orientation. They also intervene and restrict medical practices that endanger patient health and safety [17, 18]. In 2018, the National Health Commission released the Interim Measures for the Management of Internet Hospitals, outlining specific directions for the admission and standardized management of Internet healthcare services. In 2022, the National Health Commission and the National Administration of Traditional Chinese Medicine jointly issued the Interim Measures for the Supervision of Internet Diagnosis and Treatment, further clarifying the rights and responsibilities of internet hospitals and regulatory plans. However, gaps remain in existing regulatory policies as internet healthcare rapidly evolves. Different online platforms and hospitals providing Internet healthcare services are subject to different administrative authorities for entry review and regulation, which may lead to inconsistencies in policy implementation due to varying interpretations and execution [19]. Additionally, there is a lack of guiding documents and industry standards for the use and management of electronic medical records and medical insurance in internet healthcare services, which complicates regulation [20].
In summary, the regulation of internet healthcare services remains a key focus for future policy design. Moving forward, national and local health administration departments should establish clear guidelines for the overall direction of internet healthcare development and provide detailed regulations that specify responsibilities and strengthen the operability of policy implementation to ensure the protection of patients’ health and legal rights.
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Internet-based traditional Chinese medicine eldercare and child healthcare
The thematic cluster includes eight topics, such as Topic 1: Traditional Chinese medicine and health and Topic 2: Eldercare, which focus on advancing the efficient use of internet healthcare platforms to deliver eldercare, child health services and more, thereby enhancing service capabilities and coverage.
With the increasing challenges of an ageing population and rising rates of chronic diseases, there has been growing demand for traditional Chinese medicine services [21]. In October 2019, the National Health Commission issued the Several Opinions on Further Promoting the Development of Integrated Medical and Elderly Care, highlighting the unique role of traditional Chinese medicine in preventive care and chronic disease management. It also emphasized the promotion of suitable traditional Chinese medicine techniques and services, the strengthening of community-based integrated medical and eldercare services and the healthy development of the traditional Chinese medicine sector. Additionally, the government has actively promoted the development of internet-based traditional Chinese medicine services. Utilizing internet platforms enables broader coverage and provides safe, effective and convenient traditional Chinese medicine services to more people [22]. In 2018, the National Administration of Traditional Chinese Medicine issued the Guiding Opinions on Promoting the Integration of Traditional Chinese Medicine Health Services and Internet Development, emphasizing the need to strengthen information services for traditional Chinese medicine rehabilitation. It advocates for using cloud computing, big data and mobile internet technologies to promote the establishment of digital rehabilitation systems in traditional Chinese medicine medical institutions, offering specialized traditional Chinese medicine rehabilitation medical and nursing services.
However, current policies predominantly focus on promoting technological advancement and may overlook the challenges faced by the service recipients themselves. The elderly population, who have a higher likelihood of suffering from various diseases and greater needs for traditional Chinese medicine care, often face mobility limitations and other obstacles to in-person visits. Utilizing internet-based medical services can provide an effective solution. Nonetheless, the proportion of elderly individuals who can use internet and information technology remains relatively low [23], and national and local policies lack robust guidelines and standards for the design of internet healthcare products to accommodate the elderly, hindering the promotion and application of internet-based traditional Chinese medicine services. For children, the National Health Commission and the National Administration of Traditional Chinese Medicine issued the Interim Measures for the Management of Internet Diagnosis and Treatment, which require confirmation of the presence of a guardian and relevant professional medical personnel when prescribing internet-based children’s medications for children under 6 years old. However, verifying the presence of the child’s guardian and accurately supervising the situation in real time during the implementation process can be challenging [24], and children may face difficulties in using internet healthcare services due to a lack of familiarity with the process or limited comprehension.
In summary, the ultimate goal of using internet healthcare platforms for traditional Chinese medicine to provide eldercare and child health services is to expand service coverage and accessibility. Thus, future policy design should not only advance technological development, but also address the needs and challenges of service recipients by offering solutions and clear guidelines to enhance the usability and applicability of internet healthcare. This includes promoting internet healthcare products tailored to the habits and needs of vulnerable populations, thereby bringing health and wellbeing to a wider audience.
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Internet medical security assurance
The thematic group includes two topics, Topic 11: Data security and Topic 13: Network security, focussing on ensuring the security, integrity and availability of patient information while clarifying standards for data collection, storage, transmission and processing.
The 2020 National Health Commission’s “Basic Healthcare and Health Promotion Law of the People’s Republic of China” mandates that medical providers have an obligation to protect citizens’ personal health information and should establish sound information security systems and safeguards. Research indicates that due to the “transparency” of online information, patient data in internet healthcare is exposed to multiple parties, including medical institutions, healthcare professionals and internet companies, significantly increasing the risk of data breaches [25]. In response, in 2022, the National Health Commission and several other departments jointly issued the Measures for the Network Security Management of Medical and Health Institutions, which emphasized the need to protect data confidentiality, integrity and availability through data encryption and backup technologies. These measures strengthen the security protection across the entire data lifecycle, including collection, transmission, storage, usage, exchange and destruction.
Despite existing policies that strictly regulate how internet healthcare institutions handle patient information and the adoption of privacy policies by various internet healthcare platforms for the collection, processing and use of patient data, research shows that privacy policies on different platforms vary greatly in quality. Issues related to reducing user cognitive load and ensuring information security persist, making it difficult for users to understand policies and leading to potential misuse of information without users’ knowledge [26]. Therefore, future policy direction should focus on enhancing the standardization of internet healthcare platforms’ privacy policies. Additionally, efforts should be made to educate patients about personal information safety, encouraging individuals to actively participate in strengthening self-regulation to ensure proper use and protection of patient privacy [27].
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Internet medical health education and popularization of science
The thematic group comprises three topics: Topic 18: Health education, Topic 25: Oncology diagnosis and treatment and Topic 26: Ophthalmology and eye diseases. These topics focus on effectively using internet technology and platforms to promote the dissemination of medical knowledge and health education, thereby enhancing the public’s health literacy and understanding of medical information.
Internet healthcare plays a crucial role in health education and promotion. The 2018 State Council’s Guiding Opinions on Promoting the Development of “Internet + Medical Health” emphasized the need to strengthen “Internet + medical education and public service”. For patient groups, health education can improve understanding of diseases and treatment importance, leading to higher health knowledge levels and better patient habits, ultimately enhancing treatment outcomes [28]. For the general public, the internet can effectively leverage expert resources, facilitating the dissemination of popular science information and increasing health knowledge awareness to promote healthy behaviour [29]. However, the thematic group consists of topics numbered 18, 25 and 26, indicating a lower priority and a lack of emphasis in relevant policy documents. Additionally, the limited time doctors spend on online consultations in internet healthcare affects the quality of health education content [30].
Thus, there is a need to strengthen the importance of health education and promotion in internet healthcare and to clarify support for these areas. Encouraging and guiding relevant institutions and individuals to participate actively is essential. Furthermore, it is crucial to control the quality of information shared on platforms to prevent the spread of false or misleading information. Cross-sector collaboration should be promoted, inviting healthcare, education and technology sectors to work together on internet healthcare education and promotion, driving its progress to a higher level.
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Internet-based guidance for treatment and rehabilitation of infectious diseases
The thematic group encompasses two topics: Topic 8: Epidemic prevention and control and Topic 10: Patient treatment. These topics focus on leveraging internet technology to enhance the efficiency and effectiveness of infectious disease prevention efforts while also providing patients with comprehensive and personalized rehabilitation guidance.
During the ongoing COVID-19 pandemic, internet healthcare has rapidly expanded to alleviate the strain on in-person hospital treatment, reduce crowding within hospitals and lower the risk of cross-infection [31]. In 2020, the National Health Commission issued several documents, such as the Notice on Strengthening Information Technology Support for COVID-19 Epidemic Prevention and Control, which emphasized the importance of promoting online medical services. Additionally, the National Health Commission’s Guiding Opinions on Implementing “Internet + Healthcare” Medical Insurance Services during the COVID-19 Pandemic incorporated eligible “Internet + ” healthcare services into medical insurance payment scopes, helping to reduce the financial burden for patients using online healthcare services.
With the shift in COVID-19 prevention strategies and the increase in home-treated patients, the advantages of internet healthcare have become even more pronounced. In 2022, the State Council issued the Notice on Providing COVID-19 Internet Healthcare Services, which noted that medical institutions could use online consultation platforms to prescribe treatment for patients exhibiting COVID-19-related symptoms who are staying home according to the Guidelines for Home Treatment of COVID-19. In the post-pandemic era, contagious diseases such as influenza and bronchial pneumonia may continue to intermittently surge. Utilizing the internet to provide medical services remains crucial for controlling and treating infectious diseases and alleviating pressure on hospitals [32], and it is expected to remain a key focus of future policies.
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