The prospects for telemedicine are amazing

The main thing is that the state does not oversleep all this

Irina Reznik, Mednovosti

By the end of the year, Russians are promised telemedicine. The Ministry of Health has announced the development of a bill that will bring a legal framework for this: it will allow doctors to remotely consult patients and prescribe treatment for them, legalize video consultations and on-line professional development. The professional community supports the initiative, but they are afraid that it will break against the harsh Russian realities – the lack of funds for equipment and technology and the problems of intellectual property protection.

Telemedicine in law

The Ministry of Health is preparing a law on telemedicine, which establishes the legal basis for the use of IT in healthcare. The notification of the beginning of the development of the project "On amendments to certain Legislative acts of the Russian Federation on the use of information and telecommunication technologies in the field of public health protection and the creation of national scientific and practical medical centers" is posted on the federal portal of draft regulatory legal acts.

According to the ministry, the future law will allow "solving the most acute problems of access to medical services and the infrastructure of the healthcare system." In particular, the Ministry of Health explained, we are talking about "the use of information and telecommunication technologies for the organization of remote interaction of medical workers, as well as a medical worker and a patient." In addition, it is planned to create special registers to ensure dynamic monitoring of the condition of patients suffering from socially significant diseases. It also provides for the maintenance of a Unified state information system in the field of healthcare, defines the basics of its functioning and interaction with other systems.

Assistants of the Ministry of Health

The work is planned jointly with Yandex. This was announced at a meeting of experts of the Internet Development Institute by the CEO of Yandex in Russia, Alexander Shulgin. According to him, a corresponding working group will be formed in the next couple of weeks.

"We consider it important to develop and approve a single standard for storing and exchanging health data. This is an important condition for the development of telemedicine in Russia," Shulgin told the Kommersant newspaper. Among the main directions in this area, he highlighted the provision of patient access to electronic medical card data and the settlement of issues of identification of the patient and the doctor in the provision of telemedicine services, the ability of the patient to provide electronic consent to access and processing of information about his health.

In parallel, telemedicine will be introduced into Russian life at the Competence Center of the Internet+Medicine Working Group under the Adviser to the President of the Russian Federation on Internet Issues, German Klimenko. They are also going to legalize online consultations of doctors, as well as certify pharmacies for online trading, introduce electronic prescriptions into everyday practice and create a single open register of medical staff. It is assumed that in the near future any patient will be able to choose a doctor in a single database, and he will consult him, for example, via Skype and write out a prescription for which it will be possible to buy medicines with delivery to anywhere in the country.

"Within the framework of the meeting within the walls of the Federation Council, potential additions to the law on healthcare have already been outlined, in the coming months they will be properly drawn up and approved by the Ministry of Health. Telemedicine, which has been talked about for the last 15 years, is likely to "happen" this year!", Director of the Competence Center Evgeny Gordeev said on Facebook.

Indeed, the first documents concerning telemedicine appeared in the country 15 years ago. On December 20, 2012, Order No. 444 "On the establishment of the Coordinating Council of the Ministry of Health of the Russian Federation on Telemedicine" was issued. In March of the following year, Instruction No. 325-U "On the creation of a certification system for telemedicine centers" was issued. But then the leadership changed in the department, and the initiative was put on the brakes.

Telemedicine in the world

Telemedicine ("medicine at a distance" from the Greek. "tele" - far away, far away) was formed at the junction of several fields – medicine, telecommunications, information technology. According to the WHO definition, this is a method of providing medical services where distance is a critical factor. It is not for nothing that Norway, with its difficult geography for traditional medical care, became the first country where telemedicine began to be practiced. The second project – for sailors – was implemented in France. And today, numerous telemedicine projects are operating in many countries and international organizations, and WHO is developing the idea of creating a global telecommunications network in medicine.

Remote consultations can be conducted both by e-mail and in real time using communication channels and video equipment. Consultations – in the form of a videoconference session with the participation of doctors from different medical centers. At the same time, the potential possibilities of telemedicine are much wider than remote diagnostics. Network technologies provide the possibility of dynamic patient monitoring, documentary transmission of case histories when transferring patients from clinic to clinic, remote training of doctors, and even telemanipulation (remote control of equipment, up to surgical intervention at a distance).

The rapid development of the telemedicine market will allow to reduce healthcare costs in the future, according to the material of the analytical agency GBI Research. At the same time, the main constraint on the development of the telemedicine market remains the high cost of equipment and technologies, as well as the problems of intellectual property protection. Therefore, poor countries will not be able to benefit from the development of telemedicine in the near future, the study notes.

Russian practice

The Russian project can also break about these harsh realities. The news is actively discussed on professional forums. And the general opinion is that telemedicine is long overdue, but it is possible that for Russians it will remain "Kashpirovsky on TV." Information security issues are very difficult to solve in our country, and chronic underfunding of healthcare has long been a commonplace. And only the doctors themselves, who are not used to working on naked enthusiasm, will be able to "pull out" the project.

Moreover, private medicine is actively mastering information technologies. These are electronic personal cabinets of patients, remote decryption of "digitized" survey data, and the "second opinion" service, when the results of these studies are sent to highly qualified specialists, including foreign ones.

Federal research centers are also trying to use modern information technologies. Many of them consider medical documentation sent over the Internet by patients from all over the country, conduct remote consulting of doctors. The leading centers have interactive learning departments and conduct workshops with live discussion. But the trouble is that all this is almost not developing, since the legal framework has not yet been brought under remote technologies.

Meanwhile, in Russia, with its territory and population density, the development of telemedicine is determined by the geography of the country itself. According to the Ministry of Health, technologies that have no legal force are de facto practiced in many regions of the country. As Olia Artemova, Deputy director of the Department of Information Technologies and Communications of the Ministry of Health, reported at the October meeting of the round table "Telemedicine: issues of functioning", today remote medical services are already provided in 68 subjects of the Russian Federation "in the formats: doctor-doctor, doctor-patient", although their "legislative consolidation is not yet available." "We are waiting for proposals from the subjects of the Russian Federation, federal institutions and the expert community," the official said.

"It is impossible for any IT company to provide services for connecting doctor Ivanov with patient Petrov"

Such proposals have already been received by the Ministry of Health. According to Alexey Starchenko, President of the National Agency for Patient Safety and Independent Medical Expertise, the expert community "supports the patient's right to telemedicine observation." "For example, we have long demanded the creation of an information system for monitoring pregnancy in rural areas, which is different from pregnancy in the city," Starchenko said. – It is difficult to travel to consultations from the village both logistically and physically. A rural lifestyle, domestic work does not allow a pregnant woman to relax. In order to timely identify abnormalities in the development of the fetus and provide appropriate assistance, automatic monitoring programs for its condition are needed. Another vulnerable category in rural areas is the elderly. They need automatic programs for monitoring the function of the heart muscle, breathing, and so on."

Lyudmila Bokova, Deputy Chairman of the SF Committee on Constitutional Legislation and State Building, notes how important the introduction of telemedicine is for the doctors themselves, who will have the opportunity to consult with more experienced colleagues hundreds of kilometers away when making complex diagnoses or during operations. In her opinion, remote consultation in emergency cases, which can save a person's life, should have the status of a full-time consultation of doctors.

Meanwhile, the law should not just legitimize remote consultations, but also regulate the relationship between all participants in the process, give them legal guarantees, says Alexey Panov, managing director of the Center for Medical Law LLC, a medical lawyer. For example, when a CRH doctor somewhere in the outback consults with a leading regional clinician, the final decision should still be made by himself - because the responsibility will always remain with the attending physician.

As for the remote relationship of a doctor with a patient who does not have special knowledge in the field of medicine, the law should be "extremely strictly regulated requirements for the admission of a doctor to the possibility of such consultations."  "There should be not just a man in a white coat on the other side of the screen, but a really qualified specialist who has access to this particular information activity," the expert believes. – Because within the framework of such a status, the doctor does not treat, but actually provides information to the patient, which is actually done at regular consultation receptions."

And, of course, after the "telepresence", the patient must have adequate documentation. "It is not enough to remember or even write down everything that the doctor said – some kind of electronic form must be approved, which will be provided to the patient after a remote consultation."  In addition, the law must determine the place of permanent storage of this information. "During regular consultations, everything is recorded in the medical documentation, which, among other things, is considered during control checks," Panov explains. – By analogy with this, there should be strictly fixed places where all the arrays of information voiced by the doctor are placed. And there should be extremely limited access to them."

In general, all telemedicine communication channels should be under the control of the state, which guarantees the security and confidentiality of all information, the expert believes. "There should be no anarchy when any IT company can provide such services by connecting doctor Ivanov with patient Petrov," the expert says. – In this area, I am for the monopoly of the state. 

In general, the prospects for telemedicine, in my opinion, are amazing. Taking into account the possibility of remote data collection about the patient's condition and monitoring it online, there is a great future for this direction. The main thing is that the state does not oversleep all this."

Portal "Eternal youth" http://vechnayamolodost.ru  20.04.2016