Real-World Utilization of a Hospital-Integrated Internet Hospital in Henan Province, China: A 1-Year Observational Study

Background: China's hospital-integrated Internet Hospital model embeds virtual outpatient care within hospital information systems, pharmacy workflows, and regulatory oversight structures. However, encounter-level evidence on real-world utilization, operational efficiency, online prescribing, and repeat use remains limited. Objectives: The objective of this study is to describe the first-year utilization, service efficiency, prescribing safety, and continuity-of-care potential of a hospital-integrated Internet Hospital in Henan province, China. Methods: We conducted a retrospective observational study of all online consultation orders generated from November 1, 2023, to October 31, 2024, at a large tertiary hospital. Deidentified data from consultation logs, prescribing modules, and pharmacy systems were descriptively analyzed. Key measures included order outcomes, consultation type and modality, patient-level repeat use, response time, online prescribing, prescription review outcomes, and ratings. Results: A total of 90,006 online consultation orders were generated; 54,389 (60.4%) were completed, 32,720 (36.4%) were cancelled, and 2,897 (3.2%) expired because payment was not completed. Most cancellations occurred before physician acceptance. Text-based consultations accounted for 83,833 orders (93.1%). Virtual Consultations accounted for 78,313 orders (87.0%) and did not permit prescribing; Virtual Follow-up Consultations accounted for 11,693 orders (13.0%) and had a higher completion rate (74.3 vs. 58.4%). Among 49,724 unique patients, 16,554 (33.3%) generated two or more orders. Median response time was 93.4 minutes (interquartile range: 12.4-345.5). Prescriptions were generated in 491 orders (0.55%); 359 patients paid for medication orders, and 118 prescriptions required physician modification after initial automated review. No legally restricted controlled drugs were prescribed online. Ratings were submitted for 5,820 orders (6.5%). Conclusion: The platform primarily served as a hospital-governed digital entry point for consultation and triage, with a controlled follow-up pathway for selected prescription renewal. It demonstrated feasibility but also highlighted preacceptance cancellations, long-tailed response times, limited older-adult use, and expert-heavy workload as priorities for optimization.