To explore the compliance of telemedicine services on third-party platforms since the release of the“Telemedicine Supervision Rules (Trial)” in 2022.

An anonymous standardized patient method was employed to assess the compliance of diagnostic behaviors on eight well-known, large-scale third-party internet healthcare platforms in China.Diagnostic scenarios were designed around five representative clinical cases. Based on the Telemedicine Supervision Rules (Trial),20 regulatory indicators were extracted across five key dimensions—clinical practice supervision, pharmaceutical services, prescription and medical record standards, identity verification, and quality and safety oversight.

The platforms generally deviated from policy requirements in areas such as online first diagnosis, medication prescribed before diagnosis and prescription authenticity, with average compliance rates of 29%, 25%, and 10%, respectively. Some platforms were suspected of using artificial intelligence to replace doctors in consultations. Compliance was better in areas such as physician qualification certification and real-name authentication, patient real-name authentication, termination of online medical services, and prohibiting patients from being directed to other medical providers, with only a few cases of violations. The causes of compliance issues included the policy’s failure to adapt to industry development, low government regulatory willingness, weak regulatory effectiveness, and the profit-driven behavior of platforms and healthcare providers.

Third-party platforms still face varying degrees of compliance issues in medical practices, pharmaceutical services, prescription regulation, and personnel identity management. It is recommended to strengthen government regulatory functions, enforce platform accountability, improve the dynamic adjustment mechanism of policies, and enhance social supervision and industry self-regulation.