Digital medicine is taking over America. How digital technologies will change healthcare
Modern technologies have brought changes to healthcare.In result formed on this moment concept – digital medicine. The use of digital medical devices in medical practice creates a number of advantages over traditional ones.
« In the coming phase of web services and automation You will visit the dentist as follows. You will give a voice command to your computer so that it arranges for your visit. Your computer will automatically translate your voice into a digital command. Then it will automatically check your schedule with the open dates in your dentist's schedule and offer three options to choose from, and you click on the day and time that suits you. A week before your appointment, your dentist's schedule will automatically send you an email reminder. The evening before the appointed day, the computer will generate a voice message with a reminder and will give it to you by phone.” This is an excerpt from Thomas Friedman's book The World is Flat. And what’s most interesting is that the author does not write in the genre of science fiction, but bases his forecasts on already existing realities. This is roughly how he describes the concept that is now called “telemedicine.” And automating the system for making appointments with a doctor is far from the most significant thing about it.
Remote surveys
So what is telemedicine? Very in a general sense In other words, telemedicine is a healthcare system that allows a number of medical procedures to be carried out remotely. This could be a routine examination, diagnosis, consultation and much more. This possibility is achieved through the widespread use of computer technology, specialized software and the Internet.
Of course, to a first approximation, it seems that this method of “visiting” a doctor is less effective. In the traditional worldview, the doctor must feel the patient in order to be able to talk about his illness. And in general, the majority still somehow find it difficult to perceive Email or ICQ as a full-fledged means of transmitting information. Many people don’t even know about the existence of video messengers. This means that they will not be accepted soon. Especially as working tools in such a serious matter as medicine.
However, in practice, telemedicine often proves to be much more effective than traditional medicine. This is achieved due to a number of factors, which we will discuss below.
Main advantages
Boston Consulting Group Scientists(www.bcg.com) concluded that the global average for one doctor is about 22 patients per day. Naturally, the statistics included both developed countries and those still developing. And if for the former this figure will be slightly lower, then for the latter it will increase significantly. Upon further calculations, specialists from the same company came to the conclusion that one doctor spends no more than 20 minutes of time on a patient. Again on average. And now the question. How effective can such a healthcare system be? Let's add to this that the calculations were carried out for a 40-hour work week. That is, the possibility of a doctor’s participation in specialized conferences and seminars to exchange experiences was completely excluded. And this is the main source of improving the qualifications of doctors, and, as a result, improving the quality of medical services.
Electronic medicine in numbers
On average, a doctor sees 22 patients per day
On average 20 minutes are spent per patient
A doctor should review 30–80 specialized articles daily
6% of doctors use an electronic patient record
100 thousand American doctors write digital prescriptions
Modern technologies allow see patients without leaving the office. This means that time spent traveling to the patient is eliminated. The freed up hours can be successfully spent on additional consultation. In addition, the doctor receives constant access to the global medical community, which means that in order to find out from an overseas colleague how lupus is treated, for example, you no longer need to wait for months - just turn on the computer and go online.
In addition, patients stop sit in long queues for hours. And this has a positive effect not only on their mood and nervous system. Although on them too. Imagine a huge enclosed space where the concentration of microbes per square meter is many times higher than normal. Any hospital or clinic is approximately the same biological broth. Viruses and bacteria in their carriers flock there like a river. It is while waiting your turn for an appointment that you have a chance to pick up something that you didn’t have before visiting the doctor. And this is only a small part of all the benefits that electronic medicine provides.
Recipe fore-mail
One of the elements of telemedicine is an electronic prescription. Technically, it is an electronic document with a prescription for a particular method of therapy, in particular medication. Such a document is usually equipped with an electronic signature of the doctor, which makes it possible to identify its authenticity. The main advantage of prescribing drugs in this way is not its availability. The fact is that a digital prescription is sent, as a rule, not to the patient, but directly to the pharmacy, where the patient, by presenting an identity card, can receive the necessary pills. Thanks to this, the percentage of fake documents drops significantly. As a result, we are fighting obvious and implicit drug addiction.
In addition, all recipes are registered in the electronic accounting system. Thus, the doctor himself comes under the vigilant control of the relevant departments. The mechanism makes it almost impossible to sell the “necessary” recipes “ to the right people" And open access to amphetamines, hallucinogens and other narcotic substances, which are an important source of income for dishonest doctors.
It is worth adding that, according to eHealth magazine (www.ehealthonline.org), about 100 thousand American doctors already use digital prescriptions in their practice. And from January 1, 2010, this system should become mandatory in Estonia.
Digital medical record
An equally important component of telemedicine became an electronic patient record (Electronic Medical Record - EMR). It describes the client's medical history, the therapy that was used for him, and general state, indications and contraindications. In addition, such a card includes information about the attending physician and other important data.
All electronic cards are posted on a specialized platform. This way, if you had to go to another doctor, it will not be difficult for him to find out everything about you from a medical point of view. Necessary information a specialist can receive it in the blink of an eye.
Do not forget that the data information about the patient is a medical confidentiality. Therefore, the EMR network also has a security system. Firstly, the hospital where the doctor works must have a license to use such software. To obtain such a license, the hospital must fulfill a number of requirements presented by the World Health Organization, including a non-disclosure agreement. Secondly, to access the data, you must enter two passwords: one is entered by the doctor, the other by the patient. This prevents the doctor from viewing medical records without the patient's consent.
The only drawback Such a network is due to its low prevalence today. For example, in Europe only 6% of doctors use it. In addition, this system is very susceptible to economies of scale. That is, the more participants the network covers, the more benefits it brings to each member individually.
24/7 doctor!
The system is very effective remote monitoring for patients (Remote Disease Monitoring - RDM). It allows you to monitor the patient 24 hours, seven days a week. It is especially useful in the case of chronic diseases, such as diabetes, heart disease, hypertension, etc.
From the client side the system is a small device that is given to the patient. The latter always keeps it with him. The device promptly reminds the patient about taking medications, the need to undergo certain therapeutic procedures, and monitors compliance with the regimen. From time to time, it also takes the necessary physiological indicators from the patient - temperature, pressure, heart rate and more. These indicators are automatically sent to the software platform installed in the hospital where the patient is being treated. Thus, the doctor is able to monitor the patient’s condition virtually continuously.
An important point is also that if deviations from the norm are detected in the patient’s parameters, the system forcibly sends a call to the attending physician.
In fact, the only drawback of RDM is its high cost. For now it is available only to a very limited circle of people. However, technology in our time is rapidly becoming cheaper and it is possible that in just two or three years every fifth inhabitant of the Earth will be connected to this system, and after ten years, it will become mandatory for use, like a compulsory insurance system.
Medical Academy
It must be said that the electronic health system In addition to the practical part, it includes a theoretical part. The theoretical elements of eHealth have taken shape in such systems as medical knowledge management (Health Knowledge Management - HKM) and consumer health informatics (Consumer Health Informatics - CHI).
Today's science in general and medicine in particular, is developing at a galloping pace. To navigate the market and generally know what is happening in the field, a modern doctor needs to read 30-80 journal articles a day. Otherwise, he risks losing clients, not being aware of the latest developments in the field of pharmacology, and generally being left out of progress. However, even this volume of information is beyond the capabilities of unemployed. In order to optimize knowledge and data in the field of medicine, the NCM system was created.
One of the most developed resources in this direction is MDLinx (www.mdlinx.com). The principle of its operation is as follows. A team of specialists daily analyzes major medical publications and studies and groups them into sections. According to the data specified during registration, these already analyzed collections of articles are sent to subscribers. Thus, each specialist receives only the information that interests him and eliminates the need to look through unnecessary things.
In addition there is a resource Medscape (www.medscape.com). It summarizes information from past conferences and symposia, maintains a database of existing drugs, which is constantly updated, and provides access to specialized literature online. Among the useful services, it is also important to note the ability to check medications for compatibility.
Consumer Health Informatics represents electronic system recording, storing and analyzing medical information. The program generates a unique organizer for each patient. The organizer includes basic physiological indicators in dynamics and strict registration of the therapeutic regimen with the sequence of necessary procedures. This system greatly simplifies the process of patient care. In addition, there are precedents when CHI became evidence in court in a case of medical negligence.
Digitized medical documents, creation electronic formats and procedures for running a practice, the use of devices and gadgets with complex algorithms to measure general indicators of body functioning are everyday phenomena of telemedicine. Like any new phenomenon, they encounter resistance and misunderstanding even among health workers.
To explain the meaning and importance of such innovations for healthcare - this is the task the organizers of the 1st international conference dedicated to the implementation of digital technologies in medical practice. This event took place in Moscow on April 20-21, 2017. It became part of the “Year of Science and Education in Great Britain and Russia” program.
New phenomenon - digital health
The concept of “digital medicine” unites a whole complex of phenomena that are, at first glance, unrelated to each other. This includes measuring parameters of the circulatory system (pulse, blood pressure) in an outpatient or home setting using the innovative Apple Watch device, and a video conference of doctors from different regions of the country or an online operation with the presence of metropolitan doctors.
This also includes electronic record keeping systems in medical institutions, recording of personal medical documents (EMR) of hospital patients, and mobile applications, helping to monitor and adjust the body’s functioning. The existence and operation of all these processes is impossible without well-developed digital technologies that have been repeatedly tested in laboratory and clinical conditions.
The era of digital technologies in medicine
In the USA and in European countries, where technical and the legislative framework telemedicine is well developed, the introduction of digital technologies in healthcare is in full swing. In Russia, the pace of introduction of a new phenomenon into life is significantly lower. The UK's National Health Service is preparing to begin serial production personal devices with specifically medical functions.
An employee of this service, Dr. Ilan Lieberman, stated this at the Digital Medicine conference. Among the innovative devices will be a non-invasive glucometer that can measure the blood glucose level of a diabetic patient without damaging the skin. Based on a personal smartphone, it will be possible to have a personal DNA sequencer. We are ready to begin production of functional diagnostic devices in England in just 3 months.
Russian diagnostic gadget
The lack of a full-fledged resource base did not become an obstacle to the development of domestic telemedicine products.
A high-tech device for self-diagnosis has been created at the Russian Scientific Center for Surgery named after Academician B.V. Petrovsky.
By downloading the appropriate application to your mobile device, you can record an ECG yourself. Maria Tchaikovskaya, an employee of the center, informed the conference participants about this. However, the processing and storage of self-examination data must be done using Big Data- digital technologies created specifically for working with large volumes of information.
Unified database for telemedicine
A comprehensive system and uniform standards for working with digital technologies across a large country have not yet been created in the UK, as stated by Gary Leeming, a representative of the IT industry in medicine. Between 2011 and 2012 In the Russian Federation, the Unified Medical Information and Analytical System (UMIAS) was created and put into operation.
Her work is still far from perfect. But the very fact of the transition to new data processing and storage systems provides Russians and the entire healthcare industry with several new opportunities:
- getting rid of bureaucratic delays when preparing medical documents;
- free and quick access to a personal EHR (electronic medical record) for all registered users of the telemedicine system;
- accumulation and professional processing large volumes medical data necessary for the preparation of analytical or statistical reports.
Digital use cases
Corresponding Member of the Russian Academy of Sciences Simon Matskeplishvili, speaking at the conference, spoke about an interesting type of statistics that Google employees discovered. It turns out that a simple analysis of the frequency of user requests for specific drugs typed in search bar browser, can become an “indicator” of the likelihood of an epidemic occurring and spreading in a certain region of the planet.
S. Matskeplishvili stated that digital technologies, which are widely used in telemedicine, make possible the remote exchange of medical data between countries and continents. For example, a patient from the United States can undergo an examination at night in his home country. And survey data for decoding and description can be transferred to India, which is located in a different time zone. The patient will be able to receive the results of the examination that same night and bring them to the clinic in the morning.
Simon Matskeplishvili, being a practicing cardiologist, spoke about the use of a wearable device with biosensors by one of his patients. Using a sensitive device, it was possible to remotely monitor blood pressure in the pulmonary artery. Having promptly noticed a sharp rise in blood pressure, the doctor recommended that his patient immediately take several diuretic tablets. This saved the person from long-term hospitalization.
International statistics and experience in implementing digital technologies
The introduction of telemonitoring and counseling services in the United States alone reduced the number of hospitalizations and clinic visits by 58% (in the category of diabetes patients). In the Netherlands, statistics cite the following figures: the number of hospitalizations in hospital cardiology departments has decreased by 64%, there have been fewer visits to clinics by 39%, and the time spent in hospital treatment has decreased by 87%. 
While in other countries (USA, Israel) patients themselves, by paying taxes, participate in the development and dissemination of digital technologies and telemedicine, in Russia this mechanism does not work. Indeed, according to the law, medical services can only be provided on the basis of specialized institutions.
But medical lawyer Alexandra Orekhovich said that amendments to the law on medical care for the population have already been submitted to the State Duma of the Russian Federation. The positive aspects of using digital technologies in the pharmaceutical industry and in healthcare management systems were also discussed during the conference.
US healthcare informatization trends at HIMSS mHealth Summit
The Healthcare Information and Management Systems Society (HIMSS) conference is one of the most significant events in the world of health informatics. At the end of 2015, the HIMSS mHealth Summit in Washington attracted 38 thousand participants. The progress of the US national health informatics project affects the entire health IT market and serves as a guide for similar projects in other countries. At a meeting of the working group of IT specialists of the Russian Academy of Medical Sciences, Konstantin Chebotaev, manager for working with international clients at Medstrakh, shared his impressions of the conference, as well as interesting statistical data.
Pay off with fines
The current stage of informatization of American healthcare requires the installation of Electronic Health Record (EHR) systems that meet certain requirements. $14.6 billion was spent on stimulating physicians to implement EHR in 2014, and now a system of fines has been introduced for delays in implementation. About half of medical practices have already been fined 1% of their Medicare reimbursement.
The main problems faced by medical organizations are lack of coordination of requirements, lagging or ill-conceived regulatory framework, as well as inconsistency of information systems with their needs. From 2010 to 2014 the number medical organizations changing EHR solutions has tripled. According to surveys, 30% of medical service providers are not satisfied installed system electronic medical records; EHR-related lawsuits have doubled in the past two years. Customers are dissatisfied with data protection, lack of warnings, decision support, lack of support for the necessary documentation, system failures, unavailability of integration tools - especially now, when ensuring compatibility is strictly required by the regulator. From 2017, data exchange will become mandatory, cloud technologies, analytics and data protection.
Meanwhile, entering data into the information system has turned into an extremely difficult procedure for a doctor: those 30-40 fields that could be quickly skimmed on paper now require 200-300 clicks. The average doctor spends three to four hours daily on data entry and is forced to work on medical records on weekends. Therefore, many people prefer to simply pay the fine and not participate in the informatization program at all.
Internet of Medical Things, Millenniums and Uberization
The summit noted the exponentially growing use of the Internet of Things in healthcare and the birth of the Internet of Medical Things (IoMT). The main focus of mHealth is on chronic disease management. But Special attention pays attention to the growing need of patients for a “second opinion”. On average, 20% of patients in the United States are ready to use the “second opinion” service, and among cancer patients, already half are willing. In 5-20% of those who apply for this service, the main diagnosis changes as a result, and in 70-90% the therapy changes.
In addition, over the past year, interest in the use of comprehensive mHealth products with a set of included services has grown significantly: medical analytics, training, Big Data, insurance telematics, navigation, legal, financial, etc.
Insurance companies are actively exploring mHealth, exploring a new type of insured, as they must align their offerings with the changing priorities of the working population. Mobile healthcare is aimed primarily at the millennial generation, who will make up the majority of the workforce in 2015-2025. This generation is qualitatively different from the previous one in terms of thinking and worldview. If in the top three priorities of people over 45 years old, salary is in first place, medicine is in second place, and balance of work and personal time is in third place, then in the age group from 18 to 24 years old, balance is in first place, medicine is in second place, and only in third - salary. This is important to consider in risk management when calculating health insurance plans.
It is noteworthy that among the companies that will soon set the tone in the American digital medicine market, the top three in the Fortune 500 list include the CVS Health network (8 thousand pharmacies and 900 clinics in shopping centers), the insurance concern UnitedHealth Group and the trade alliance Walgreens Boots. By 2020, Walgreens Boots intends to become the primary primary care provider in the United States by opening a clinic in every store where any patient can walk in without any appointment.
“Everything is moving towards medicine being close to us, like McDonald’s or Uber, which may soon bring a doctor to our home,” Chebotaev believes.
Patient and nurse autonomy
Despite the shortage of specialists, IT is becoming one of the core competencies of medical institutions, Chebotaev noted. The share of medical institutions willing to outsource IT decreased from 93% in 2013 to 70% in 2014. There are a lot of vacancies open for IT positions in medical organizations, and after a short internship, young specialists are immediately awarded a long-term contract - a situation unheard of in other industries.
Along with the growing shortage of doctors, the autonomy of their substitutes - assistants, nurses, physiotherapists and pharmacy workers who have sufficient qualifications to replace the doctor in certain situations - is growing. According to statistics, 75% of consumers agree to receive services from physician surrogates, and 35% of doctors believe that surrogates can handle half of all requests for medical care.
Patients are also becoming increasingly informationally autonomous. The number of hospitals that provide patients with the ability to view, download and transfer personal data is growing rapidly - from 10% in 2013 to 64% in 2014. 80% of hospitals now have three ways to electronically interact with patients: making appointments, paying bills, and updating prescriptions. 57% of private practitioners share digital data with patients and 46% share personal data with other doctors. The share of patients with access to their data was 38% in 2014, 10% more than in 2013.
Interestingly, patients began to worry noticeably less about issues of confidentiality and information security: in 2014, this problem was relevant only for 18% of patients, whereas a year earlier 28% were concerned about it.
Financial breakthrough
The real breakthrough came in the financing of telemedicine. In 2015, parallel licensing of doctors was allowed in 11 states, and almost immediately new category doctors who work only remotely in remote patient monitoring systems across several states. And this class of specialists will grow very quickly, Chebotaev noted. The vast majority of telehealth services provided by GPs last year were appointment management and prescription renewal (86%), urgent care, maternity and newborn consultations, home monitoring, chronic disease management and mental health care.
Since 2015, Medicare began paying insurance reimbursements for telemedicine and mHealth services: for 20 minutes of interactive communication with a patient who is not present in the doctor’s office, the doctor has the right to receive $46 once a quarter. Payment for the remaining sessions is made from other sources by agreement with patient. In addition, starting from 2016, the largest conglomerate of private insurers Blue Cross and Blue Shield intends to pay for sessions of virtual consultation with a doctor, which gives hope to clinics that do not have enough funds to develop mobile medicine and do not participate in the Medicare program. The list of reimbursed telemedicine calls includes recovery from a concussion, identifying a patient’s response to a prescribed drug, monitoring a patient after discharge from the hospital, etc.
In addition, large insurers continue to experiment with financial incentives for patients, giving them daily rewards for using wearable devices and data transfer. The accumulated amount can be deducted from the monthly insurance payment or used in loyalty programs of retail chains.
Contact centers and outsourcing
Practice has shown that doctors in an outpatient clinic or hospital do not have time to process mHealth data and communicate with patients remotely after face-to-face interaction with a patient. Therefore, the patient, in order to receive remote services, interacts with the medical contact center.
One of the most developed areas of remote medical services is teleradiology. There are more than 500 teleradiology centers in the United States, but remote consultation, analysis of medical images and histological slides are easier to develop in less expensive countries. The growing flow of patients and shortage of specialists is creating an increase in demand for teleradiologists outside the country and those who can work at night. Conclusions and decisions can only be made by a doctor with a local license, and remote centers do only a preliminary analysis. Therefore, providers of diagnostic services that require the opinion of highly qualified experts resort to outsourcing or export their specialists to other countries, where a team of local doctors is formed around them.
Among the largest participants in the teleradiology outsourcing market are the American companies Nighthawk Radiology Services and Teleradiology Solutions and the Indian Wipro, which provides round-the-clock image interpretation for 30 non-specialized and four specialized hospitals.
Advice from experienced people
When developing approaches to the implementation of telemedicine technologies, Massachusetts General Hospital specialists recommend immediately building strategic priorities and starting implementation with less complex and more in-demand clinical profiles, choosing those that are ready to accept mHealth, and departments where the use of these technologies will be justified. Carefully selected tools should be implemented in close collaboration with clinicians and quality specialists, and a permanent telemedicine staff should be allocated, without splitting physician shifts between in-person and remote appointments. Getting regular feedback patients should plan ahead. In addition, it is necessary to closely monitor the digital medicine market and look for modern integrators.
Digital technologies are one of the priorities for the development of the healthcare sector around the world; this market increases by a quarter every year. The process can provide breakthroughs in access and quality of services without increasing health care costs. Therefore, the development of digital medicine is carried out with the active participation of the state. Russia is no exception, where several world-class information and analytical projects are already being implemented.
The size of the global digital medicine market last year, according to Global Market Insights, reached $51.3 billion. By 2024, it is expected to more than double, to $116 billion.
Key directions for the development of digital medicine in the short term:
- Implementation of electronic medical records.
- Development of the “connected patient” concept – condition monitoring and provision of medical services using built-in smart devices.
- Telemedicine.
The main advantages of healthcare digitalization:
- Financial – cost savings by reducing contacts between patients and doctors and modernizing the organizational system for providing services.
- Social – increased availability of quality medical care.
- Professional – improving the quality of services by reducing the number of medical errors, developing predictive medicine, and increasing the efficiency of clinical trials.
Technological aspects of the digital revolution in healthcare.
- The introduction of electronic medical records and devices for remote patient monitoring is largely due to the use of Big Data.
- Remote patient monitoring and telemedicine depend on network availability and the development of Internet of Things technologies.
- In the long term, the use of 3D printing technologies to create skin and organs is expected to increase.
In Russia, two information platforms are leading projects in the field of digitalization of the healthcare sector:
- Unified State Information System in the field of healthcare (Uniform State Health Information System). It will connect the information systems of all medical organizations and relevant departments, and will allow maintaining unified electronic medical records and registers of people with certain diseases. Currently, medical information systems have been implemented in 83 regions, in which electronic medical records of 46 million patients are maintained, there is an opportunity for electronic recording to the doctor, etc. This year it started working in pilot mode Personal Area“My health” on the public services portal.
- Unified Medical Information and Analytical System of Moscow (UMIAS), which has been operating since 2012. The number of portal users exceeds 9 million patients and 10 thousand medical workers. On the portal you can make an appointment, receive a referral for examination, and sick leave and a medical record. 97% of prescriptions issued in Moscow are electronic. Moscow is the only metropolis in which all clinics are united into a single system.
The state is developing education and professional retraining taking into account the digitalization of healthcare.
- In 2016, on the basis of the First Moscow State Medical University named after. THEM. Sechenov created the country's first department of information and Internet technologies in medicine. It is planned to open similar departments in other universities.
But there are problems that hinder the implementation of information technology in medicine.
- In the field of legislation, the process of adaptation to new technological realities is just beginning. In May, the government approved a bill on telemedicine, which will allow for the provision of remote medical care - holding consultations, consultations, monitoring the health of patients at a distance, issuing electronic prescriptions and certificates. The application of the law will be tested first in a number of “pilot” regions, and then implemented throughout the country.
- Another problem is related to the technological factor, namely the insufficient level of integration in single network and a shortage of connections to high-speed Internet networks for both doctors and patients. It is planned to connect all state medical organizations to the Uniform State Health Information System by 2025. At the same time, the implementation of the project to eliminate the digital divide, which involves connecting to the Internet for residents of rural, remote and hard-to-reach areas, is still facing objective difficulties in financing.
Currently, the Ministry of Telecom and Mass Communications, together with the Presidential Administration and a group of experts, are working on the Digital Economy project.
This work is being carried out on the basis of clause 2 of the List of instructions of the President of the Russian Federation for the implementation of the Address of the President of the Russian Federation to the Federal Assembly of December 5, 2016 No. Pr-2346. In it, by July 1, 2017, the Government was instructed to develop and approve the “Digital Economy” program, providing for measures to create legal, technical, organizational and financial conditions for the development of the digital economy in Russia and its integration into the economic space of the member states of the Eurasian economic union.
A little about the term “Digital Economy”
On May 9, 2017, by his decree No. 203, the President of the Russian Federation approved the “Strategy for the development of the information society in the Russian Federation for 2017 - 2030”, http://kremlin.ru/acts/bank/41919. It defines the digital economy as “ activities in which the key factors of production are data in digital form, the processing of large volumes and the use of analysis results of which compared to traditional forms management can significantly increase efficiency various types production, technology, equipment, storage, sale, delivery of goods and services».
The concept of “Digital Economy” is not a Russian invention, it is actually an already established global development trend. Back in 2014, Gartner gave the following definition: “ “digital business” is a new business model covering people/business/things, scalable globally for the whole world through the use of IT, the Internet, and all their properties, involving effective personal service to everyone, everywhere, always».
Boston Consulting Group analysts believe that digitalization is the use of online opportunities and innovative digital technologies by all participants in the economic system - from individuals to large companies and states.
The World Bank understands the digital economy as “ a new way of economy based on knowledge and digital technologies, within which new digital skills and opportunities are formed in society, business and the state" At the same time, they believe that it is necessary to understand this phenomenon very broadly, which does not just affect the ICT industry, but deeply transforms all types of human activity.
In general, the meaning of this concept is that the future of any developed country is determined by its economic potential. And any economy of the future is a digital (electronic) economy and there can be no other economy. Accordingly, in our country they understand this and are trying to move to a new level, to look at the next planning horizon. If previous version « Information Society"was viewed rather as a reduction in the digital divide, as the penetration of IT into various spheres, including social and cultural, and as infrastructure development - something new option prioritizes the development and diversification of the economy, competitive access to the international level, the creation of new jobs and even new markets.
What's being done now
To fulfill the instructions of the President, the Ministry of Telecom and Mass Communications by its Order No. 120 dated March 16, 2017 “ On the creation of an interdepartmental working group under the Ministry of Communications and mass communications of the Russian Federation on the preparation of the draft program “Digital Economy”» created the corresponding working group and approved the “Regulations” on its work.
The group included 135 members, including heads of federal executive authorities, directors of the largest domestic IT companies and universities, and well-known experts. Minister of Communications and Mass Communications N.A. was appointed head of the working group. Nikiforov.
On the topic of healthcare, the working group includes:
- M.Yu. Samsonov, Director of the Medical Department of R-Pharm JSC
- O.E. Karpov, General Director of the Pirovgov Center of the Federal State Budgetary Institution “National Medical and Surgical Center named after. N.I. Pirogov", Ministry of Health of the Russian Federation
- O.V. Simakov, General Director of Health Modeling Technologies LLC
The working group was tasked with developing recommendations and proposals on approaches to the formation of the Digital Economy program, its structure, activities and targets.
On April 25, the Ministry of Telecom and Mass Communications, in its letter No. NN-P13-070-9602, sent out the draft Program and asked until May 3, 2017 to agree on it or send proposals for changing it. The general part of this document states that the “Digital Economy of the Russian Federation” program pursues the goal of transitioning to a qualitatively new level of use of information and telecommunication technologies in all spheres of socio-economic activity.
The software provides:
- adaptation of the regulatory legal framework to new types of relations, new objects and subjects of the digital economy,
- creation of infrastructure, technologies and platforms that ensure the receipt, storage and processing of the volume of data that is created in the digital economy,
- ensuring non-discriminatory access to data, subject to ensuring the legitimate rights and interests of subjects and data owners,
- training of qualified personnel,
- security information security,
- development of applied solutions for a new quality of use of information and telecommunication technologies in the field of state and municipal government.
1) Government regulation;
2) Information infrastructure;
3) Research and development;
4) Personnel and education;
5) Information security;
6) Public administration;
7) Smart city;
8) Digital health.
About the Digital Health project
We are, of course, interested in the “Digital Health” section. The justification for the project states:
"The healthcare systems of Russia and almost all, both developed and developing countries of the world, are faced with problems of a systemic nature. Most existing healthcare systems were created 100-200 years ago under different social and economic conditions. In addition, there has been a leap in the development of high-tech medical care, the creation of wearable means of monitoring physiological parameters, as well as implantable medical devices and remote monitoring tools.
This means that healthcare systems require not just modernization, but the creation of new innovative digital healthcare systems based on new technologies and management methods that meet modern conditions .
A new model of the healthcare system must be created and begin to function in parallel with existing system, gradually taking over its functions. This approach will minimize the losses of the transition period and provide the population with quality medical care during the transition period. The new model places special emphasis on preventive medicine and a personalized approach. The creation of a new healthcare model is based on the development of the so-called. “digital” medicine, which makes it possible to collect and process, including remotely, large volumes of data at the population level to make informed, optimal strategic decisions, and identify new directions for development"
According to the draft Program, the implementation of Digital Health should lead to:
- citizens are provided with timely, necessary and high-quality medical care using digital medical services by doctors, patients, healthcare managers of all levels and forms of ownership;
- accessible, convenient, effective and high-quality medical services contribute to an increase in the average life expectancy of the population of the Russian Federation to 76 years, an increase in the active and working age of citizens to 5-6 years after reaching retirement age.
As a result of the implementation of the Digital Health program:
1) Citizens of the Russian Federation will be provided with accessible medical care at the place of need, meeting the criteria of timeliness, personalization, preventiveness, manufacturability and safety;
2) The productivity and efficiency of using material, human, information and other resources and data in the provision of medical services will be increased (by 2025 by at least 30%), while maintaining the quality of medical care for all patients in accordance with regulatory documents Ministry of Health of Russia.
3) An ecosystem of digital healthcare will be created in Russia through the transfer of innovative solutions to medical organizations and support of domestic start-up companies in this area.
To achieve these goals, it is proposed to do the following: tasks:
Create regulatory conditions for the development of digital health, including:
1. Create a system of state regulation of digital health care
2. Develop a system of government support measures for digital healthcare, including stimulating the transition of medical organizations (MOs) to the formation, use and processing of legally significant electronic medical and organizational documents, use of digital health services
3. Ensure continuity and quality of medical care for citizens of the Russian Federation by providing medical personnel involved in the process of providing medical care and patients with access to legally significant electronic medical information located in the IEMK Uniform State Health Information System (subject to the consent of patients to the processing of medical information in in electronic format), regardless of the form of ownership of the medical organization providing medical care
4. Determine procedures for providing medical care using registered medical equipment intended for providing medical care using digital healthcare and medical decision support systems that interact with it.
Conduct research and development, including:
5. Create a digital health ecosystem
6. Carry out a phased transfer of medical digital technologies (technological solutions, platforms, products) that have successfully completed tests or are in a state of high degree readiness for adaptation and implementation in medical organizations that do not have expensive medical equipment in operation
7. Approve the program for the creation and implementation of the latest domestic technologies
8. Create an institute of “national champions” based on domestic start-up companies in the field of digital health with the prospect and support of entering the foreign market
9. Develop and ensure implementation, as well as applied use in clinical practice on an ongoing basis intelligent systems medical decision support, or pilot projects using predictive modeling methods
Create required personnel in digital health:
10. Review and ensure regular updating of educational programs of specialized secondary, higher and additional education medical specialists and administrative workers, taking into account the digital transformation of processes in the healthcare sector and the need to have the skills to use modern information technologies in professional activities
11. Form business incubators and accelerators with a focus on the development of digital health technologies
12. Implement pilot projects and create scientific-educational and scientific-production clusters on the basis of federal government budgetary institutions̆ Ministry of Health of Russia (National Medical Centers of the Ministry of Health of Russia)
13. Develop mechanisms to encourage medical workers to use digital health services within the digital health ecosystem
Create infrastructure digital health, including:
14. Create a data-centric cloud platform that provides access to personnel of medical organizations to information about patient health indicators and electronic medical records in the IEMK Uniform State Health Information System (with the consent of the patient), as well as depersonalized data, taking into account compatibility and security requirements
15. Create a system of access for authorized medical workers (as part of a single information space healthcare system) to the patient’s IEMK information for the provision of medical care in all medical organizations of the healthcare system, regardless of the form of ownership
16. Ensure the integration of digital medical services with automated processes for providing medical care and electronic document management systems of the Ministry of Defense
17. Implementation of highly reliable unified system identification (including biometric) individuals, participants in interaction, in order to personalize the provision of all types of medical care, control the targeting of medical services, taking into account information security measures
An experienced reader who is well acquainted with the Uniform State Health Information System project may say that, in essence, “Digital Health” is a “Unified State Health Information System on steroids,” but this is still not the case. Yes, in the “Concept for the creation of the Uniform State Health Information System” and the “Development Road Map” there are activities and even specific services and components of the Uniform State Health Information System that are constantly mentioned in “Digital Health” (federal IEMK, for example). But still, the Uniform State Health Information System is precisely a departmental information system that was created and is being developed to solve primarily departmental, and therefore internal, tasks: increasing the efficiency of healthcare management, creating services for citizens, automating medical organizations. In essence, the Uniform State Health Information System is an internal tool that is gradually polished and penetrates into the depths of healthcare to every workplace of a doctor and nurse. It does not imply any radical reforms and restructuring of healthcare, but rather aims to “get the most out of” the format and principles of work that have already developed in it.
“Digital healthcare” is, first of all, an attempt to create conditions for the future transformation of the principles of organizing healthcare and providing medical care based on modern digital technologies, where as a starting point you can take the framework of the Uniform State Health Information System and modernize and clarify further directions of its development in the necessary accents, the main of which - support for medical decision-making, reasonable optimal use of available resources, increasing productivity and quality of work.
If we try to summarize what is written in the draft Program, then to take into account the principles and directions of development of “Digital Health” it is necessary:
1. Continue work on the priority (in relation to the paper version) implementation of the electronic medical record (EMR)
2. Ensure the implementation of legally significant electronic document management and electronic signature
3. Develop normative and reference information, ontologies, glossaries, etc.
4. Develop the patient’s personal account “My Health”
5. Continue work on creating and filling the federal service of the Unified State Health Information System and connecting medical organizations (all forms of ownership, not just state-owned) and citizens to it (which is already provided for by “My Health” on the EPGU)
6. More actively develop and implement medical decision support systems (MDSS)
7. Develop the direction of personalized monitoring of patient health
8. Develop telemedicine
9. Develop training/retraining programs for medical personnel in IT, as well as programs to encourage the implementation of IT in everyday practice.
10. Ensure monitoring of healthcare informatization
11. Develop the direction of medical technology and equipment with the introduction of IT, switch to simplified and accelerated registration of new digital developments for healthcare and their inclusion in the licensing of medical activities.
Well, that's a good thing. We are now waiting for the completion of the discussion and official approval of the program.
P.S. autumn 2018. Unfortunately, as the “Digital Economy” was being developed, the “Digital Health” project did not find support and was not ultimately approved. Instead, the Ministry of Health developed a federal project “Creating a unified digital outline based on the Uniform State Health Information System”, which is essentially similar to “Digital Health Care”, but differs in that there are no SPVRs, innovative digital developments or personalized monitoring of patient health.