A Review of National and International Online Medical Systems

Health and the access to medical services are key factors in the functioning of a sustainable society. In order to provide access to medical and health services, in the conditions of digitalization and implementation of ITC technologies, it is necessary to innovate and achieve synergies between digital and medical technologies. Digitization, innovation and research should be complementary fi elds that represent the engines of a modern digital economy. In this context, the main objective of this paper is to perform an analysis on the online medical systems, both nationally and internationally. This analysis aims to identify the technologies and tools for information and prevention, existing ICT products in the medical fi eld and online medical platforms from Romania and abroad. The main aspects identifi ed in the analysis will represent the premises for designing an innovative online platform, which will aim to increase the visibility of scientifi c information, facilitate access to medical materials and provide personalized digital medical services, created by members of the innovative cluster network „For Health Dunarea de Jos”, existing in the South-East region of Romania.


ONLINE MEDICAL PLATFORMS IN ROMANIA
In recent years, Romania has seen a considerable increase in the number of online platforms off ering healthcare to users. Most of them specialize in a particular medical niche (oncology, paediatrics, etc.) or on a particular service (rate comparison algorithm, online appointments, etc.). Following a market study, the South-Eastern region of Romania does not benefi t from the same number of online medical services as the central area. Th ere are also few platforms that incorporate a wide range of health services without specialising in a single service. (e.g. Schedules, price comparison, online chat).
Mediprice is medical platform that allows users to compare medical rates. Th is medical platform was born out of the need of project developers to have faster access to the prices of medical analyses and thus, after no year of existence on the market, proved to be useful for those who chose a private medical service (Figure 1). In a Mediprice study about the most searched words on Google, one can list: "private clinics", "private hospital", "medical analyses", "where I can do MRI", "chest pain", "dental pain", "back pain". At the same time, in recent years, searches for information on medical services on a mobile device (phone, tablet) have increased by up

INTRODUCTION
Analysing the deployment of previous industrial revolutions: steam, electricity and information technology, it becomes indisputable that the fourth industrial revolution is when digital technology begins to integrate with the physical and biological one 1 .
Two defi ning stages can be seen on how industries are transformed. Th e fi rst change is the proliferation of digital technologies that bridges the gap between the physical and virtual worlds. Open Source platforms, serviced through mobile apps, allow us to do everything quickly and conveniently. Th e second change infl uences the business model. Being stimulated by modern technology, companies have gone from company/supplier-centered communication to customer/user-centered communication. As users get used to the convenience of these new business models, even the most stable industries will have to develop their off erings. One of the industries infl uenced by the wave of digital technology is the medical industry whose effi ciency and accessibility is invaluable at the social-economic level 2 .
A study by McKinsey & Company -an internationally recognized company with the aim of global consulting management, deals with the impact of digitalization of health in public perception. Th ere is the perception that patients are resistant to digital systems, as they intervene directly in their relationship with the doctor. Th ere is also the suspicion of relatively low use of health services, if they involve a digital component. However, the survey shows that these reluctances are due to the fact that digital health services do not meet the population (patient) direct needs, or are presumed to be of poor quality. On the other hand, more than 75 percent of respondents want to use digital healthcare services, as long as these services meet their real needs and have a high level of professionalism. In addition, more than 75% of all patients expect to use digital healthcare services in the near future 3 .
Romania ranks 28 th in the European Union in the DESI-Digital Economic and Society Index, calculated by the European Commission, but has a very high potential for development in this area. Th e SANINFO project, managed by innovative cluster "For Health Dunarea de Jos", existing in the South-East region of Romania, aims to encourage the future of the medical system, in the digital environment, whereby to speed up the communication, information, treatments and medical responses, in case of the trauma 4 .
One of the factors infl uencing the performance of healthcare systems is technological progress and its InfoMaterna.ro is an online platform dedicated to parenthood, especially mothers. Th is platform is the fi rst Romanian portal dedicated to women, with 100% content provided by doctors. Th e project kicked off with the launch of the campaign celebrating 10,000 babies born in MedLife maternity units ( Figure 5) 8 .
By the way the information is structured, this platform accompanies the woman from the moment she wants to get pregnant, is pregnant and is due to give birth, as well as during the recovery and care of the baby, all the information directly provided by specialists.
Th e site is structured in three categories: Women's Health, Maternity and Beauty, the content being made entirely by a team of doctors from MedLife. Women who want to have a baby can access information on ovulation monitoring, recommended pregnancy tests or types of birth (natural, caesarean or water birth), and those who have already given birth will receive advice on how to in which they can successfully breastfeed in the long term, healthy recipes for extra pounds or communication techniques for the best possible relationship with their child.
Planeta Roz is a platform specialised in providing information about breast cancer. Th rough this plat-to 30%. At the information level, the fi rst tool of Romanians remains www.google.ro. Mediprice platform currently collaborates with more than 80 private clinics both in the country and abroad, platform users having access to information on certain discounts of registered clinics, depending on their seasonality 5 .
Doctor's Advice is a centralizing platform of medical information in Romania. Th e Doctor's Advice (sfatulmedicului.ro) platform is the largest medical information hub in Romania, launched 15 years ago, being taken over by the private company Medlife. Established 15 years ago, sfatulmedicului.ro is among the top sites dedicated to the health segment in Romania ( Figure 2). Th e platform has a monthly average of over 3.2 million unique users, or more than 12 million impressions. In addition to the information service, users access the medical self-assessment service and online interpretation of analyses on this platform (Figure 3 Doclandia is a subscription based platform for medical information. Doclandia.ro, the online platform through which Romanians have unlimited information from doctors, attracted 6,000 subscribers and 656 doctors specializing in internal medicine and family medicine. Th e platform is a complementary system for classical medicine through which users can get in tou-    Parents Foundation, at Cluj Children's Hospital is a fi rst in Romania 10 .
Asociaţia Limfom is a platform dedicated to patients with lymphomas. Th e main objectives of the platform and its application are to inform patients medically correct and to create the largest community of lymphoma patients in Romania. Th e online platform www.asociatialimfom.ro contains structured information, medically verifi ed and several other main sections, including the Forum and the 'Ask the Doctor' section 11 . Th e forum was designed to unite patients, encourage them to share their experiences and to be able to interact easily, thus forming the largest community of patients with lymphoma in Romania. Regarding the section "Ask the doctor", those diagnosed have access to advice received from haematology specialists. Moreover, on this platform there is also a database of doctors and hospitals in each county, so that all patients can quickly fi nd the place where they can go to consult.
WebMedic is an interactive medical platform. Th rough the online platform WebMedic.ro, patients can receive medical responses from doctors and university professors, personalities of the medical world from the most important clinics and university centers in Romania 12 .
form, Romanian women diagnosed with breast cancer receive free of charge, support, information, medical advice, psychological counselling and legal advice 9 .
PlanetaRoz.ro informs women about everything that means prevention, diagnosis, symptoms and treatment of breast cancer. Moreover, they can come into contact with the project's collaborating doctors, renowned specialists in the fi eld of oncology and other complementary fi elds through interviews conducted in collaboration with them. Also, by accessing the chat module implemented on the platform, anyone can discuss in real time with the M.A.M.E. Association's advisors who will take their questions, send them to the doctors and get back with specialized responses ( Figure  6).
PEDITEL 1791 is a pediatric call center. THE PEDITEL 1791 service is a service dedicated to parents who need professional medical advice for their children's health. Emergency pediatric medical advice by telephone works around the clock, being served by a pediatrician or doctor with emergency specialization. Call pediatric center PEDITEL 1791 is callable by the formation of the short number 1791, a number with standard tariff , without surcharge, to which responds a paediatrician or trained in emergency medicine. Th e service, initiated and implemented by the Romanian

INTERNA TIONAL ONLINE MEDICAL PLATFORMS
Th e PatientsLikeMe is a digital platform from USA, Boston that allows those suff ering from conditions such as Parkinson's or depression to connect with others, share their experiences and better understand their treatment options and results 14 .
Th e MotherKnows is a digital platform from USA, which maintains children's records and health records, including immunizations, growth charts and operations, and is an advantage for any parent 15 .
At Brigham Women Hospital from Boston, USA, the patients with specifi c chronic diseases requiring frequent visits are now able to have consultations with doctors online. After 600 virtual visits, BWH calculated that doctors had saved 200 hours. Furthermore, 94% of the patients surveyed were satisfi ed with the program and 74% felt that their relationship with their doctors had been improved 16 .
Medicitus.com, the information platform for French-speaking peoples where there is no subscription for patients, but they enjoy free access to the network of doctors registered with the National Council of the Order of Physicians 17 .
WebMedic .ro is a project initiated by ARCMed -Romanian Association for Medical Counseling, in partnership with ROmedic.ro. Th e project off ers the facility to choose from a generous list of prestigious doctors, who provide online medical advice directly by email. Th e mechanism is simple: the user creates an account on the www.webmedic.ro, chooses from the list the doctor from whom he wants a response, fi lls in a medical fi le with information and details on the health problem, after which he sends the question. It may also upload, where appropriate, fi les with medical analyses, paraclinical examinations and images representative of his condition.
SpitalOnline.ro is a live doctor-patient chat platform. Romanian doctors launched the fi rst online hospital in Europe, supported by specialists from the UK, the virtual health unit being the fi rst live doctor-patient chat platform. Specifi cally, the project is a quick alternative to classic medical consultations through which patients will be able to benefi t from medical services, 24 hours a day, off ered in 30 specialties. A total of 150 doctors are involved in the project. SpitalOnline.ro aims to respond to this need of patients to be able to communicate at any time with their doctor, to ask questions and to receive answers even outside the classic consultation program 13 .    Th e problem is felt more intensely in rural areas (15.8% of people aged 15 and over were unable to consult a specialist doctor, compared to 12.5% of urban people). Of the social categories that would have needed a specialist consultation but could not perform it, pensioners are distinguished by the highest frequency, 30.1% of whom face the impossibility of participating in a medical consultation, despite imminent health problems that occur with advancing age. Th ey are followed by the unemployed and farmers (over 12%).
More than three quarters of those who were unable to consult a specialist doctor stated as the main reason the material situation which did not allow them to carry out the consultation. Th e second reason for not making a visit to a specialist doctor is that people have neglected the health problem that would have required the consultation, waiting for the problem to be resolved on its own (6.3% of the people who would have required a consultation). Th e third reason in order of frequency of occurrence is the distance too large or the lack of means of transport, declared with a higher frequency by people from rural areas (7.3% compared to 0.8% in urban areas).
In conclusion, the digitalisation should be a constant process in healthcare. Th is should provide tolls and instruments that helps the medical personnel and patients, and will engage the stakeholders in an information ecosystem, that should provide better healthcare services for persons, families, communities and populations in general.
Th e platform Neurinfo.org refers to human and neuro-informatics imaging in vivo, especially in the case of diseases of the nervous system. It is open to a broad community of medical and scientifi c users at regional, national and international level 18 .

CONCLUSIONS
European countries have made a signifi cant impact on health services to the population, but there are still large inequalities, both between countries and within each system. Life expectancy at birth in the Member States of the European Union (EU) has increased by more than fi ve years, on average, since 1990, although the gap between the countries with the highest and lowest life expectancy remains around eight years. Th ere are also persistent inequalities within countries, between people from diff erent socio-economic groups, with people with higher levels of education and income who enjoy better health and who live longer years than the most Disadvantaged. Th ese disparities are linked to several factors, including some outside the health care system, such as the environment in which people live, lifestyle and individual behaviours, as well as diff erences in access to and quality of care.
Th ere are currently 56,295 health facilities in Romania, from hospitals, offi ces and specialist clinics, to pharmacies and analysis laboratories, and of these, 75% are private, according to a study based on data from the National Institute of Statistics (INS) and presented by the Romanian Health Alliance and the Patronage of Private Medical Service Providers. According to the National Statistical Institute, the development of the private medical system has expanded 60 times since 1997 in terms of medical units and staff employed. So it is that, by 2014, the number of beds in private medical facilities had increased from 63 to almost 5800. At the same Figure 14. Medicitus platform 17 . Figure 15. NeuroInfo platform 18 .