2020 № 1 The quality of primary direct-to-consumer telemedicine consultations (by results of testing telemedicine services)
The adoption of a number of special regulatory documents has significantly expanded the possibilities of using
telemedicine technologies in the Russian Federation. A significant number of services have appeared on the market, offering
direct-to-consumer and patient initiated telemedicine consultations. The explosive growth in the number of such services requires
a careful study of the telemedicine interaction quality. The research objective is to assess the quality of remote interaction of
participants in primary telemedicine consultations with simulated patients. For testing, we used descriptions of simulated patients
basing on real records of patients from the therapeutic department of the municipal clinical hospital. For objectification and
analysis of the telemedicine interaction process (collection of complaints, questioning, recommendations, etc.) a checklist has been compiled. Initially, the study included such services as “Yandex. Health”, “MMT (OnlineDoctor)”, “TelemedHelp”, “Doctor at work”,
“DoctorSmart”, “DocDoc”; then, for technical reasons, 2 services were excluded from the study. Two simulated patients were sent
to 4 services; as results, 8 primary teleconsultations were made. In all cases, incorrect, incomplete collection of anamnesis data
was recorded. Target diagnosis (in the form of diagnostic concept) was achieved in 25% of cases, and target prescriptions were
made in 50% of cases. A personal consultation and additional examinations were recommended in 75% of teleconsultations.
There was no continuity, drugs were somehow prescribed in 62.5% of cases. As results, an urgent development of methods of
internal and departmental quality control of medical care provided with the use of telemedicine technologies is required.
2018 № itm Telemedicine: whom, what and how to teach
This article is devoted to the issue of professional training for the new organizational-technological area of health care- telemedicine. The history of this area development in Russia, basic concepts and definitions is briefly considered. On the basis of our long-term experience, recommendations are given on training of specialists in various fields involved in the application of remote technologies for providing of medical care and professional education in medicine.
2018 № 4 Expert Telemedicine Consultations in Radiology Service of Moscow
In 2017 Moscow Research and Practical Center of Medical Radiology conducted 2678 expert telemedicine consultations (i.e., TMC) following the requests from the radiology departments in Moscow municipal hospitals. A system-integrated base for distance consultations is called Unified Radiological Information Service (i.e., URIS). Expert TMCs were performed based on their modality, i.e. 52% (1386 cases) for MR imaging, 47% (1257 cases) for CT, 1% (35 cases) for X-ray imaging. The vast majority (i.e., 96.7% cases) of all applications were received from municipal outpatient clinics, providing healthcare assistance to the adult population. 3.2% of cases of expert TMC were conducted on an urgent basis. For the first time we defined the average demand for expert TMC results of radiology studies to be equal to 4,8 teleconsultations for 1,000 CTs, 17,42 – for 1 CT scanner, 8,9 – for 1,000 MRI, 26,98 – for 1 MRI scanner
2017 № 1 Integrated telemedicine technologies for support and care patients. Worldwide trends, the results of research about informatization, technological solutions for doctors based on service ONDO.
This article analyzes mobile and telemedicine as an example of recent researches. Next – survey results from the company ONDOC: doctors – about remote consultation and diagnosis, the heads – about mobile medicine and informatization. Next – the idea about combination of mobile and electronic health. It helps in monitoring and sup- porting the patients. Author described the opportunities of complexity: the communication «doctor-patient» and clinics in ONDOC project. In conclusion – a summary about the eHealth-industry in between stage. This stage means that it carries a new approach: a complete personalization of treatment and responsibility.
2019 № 1 Project design portal teleservicing neurorehabilitation “Neyrodom”
The results of the project design of the information system for the remote rehabilitation of patients with neurological
deficit are presented. The field of research is a new direction in health care – telemedicine. The developed remote rehabilitation is the third outpatient stage of medical rehabilitation, including the necessary monitoring of rehabilitation procedures carried out at home. Software and technical implementation of interactive methods of rehabilitation, based on the author’s medical techniques. The design was implemented using modern information design and development approaches. Presents diagrams of neurorehabilitation business processes and use cases, shows the structure of the database. The article pays special attention to the design of the database and the interface part of the application.
2020 № 2 Telemedicine and COVID-19: quality of patient-initiated teleconsultations in case of acute respiratory disease
There is a global increase in demand for direct-to-patient telemedicine consultations due to COVID-19 pandemic. We made a quality assessment of the patient-initiated consultations in case of acute respiratory viral infection symptoms (COVID-19). There are 20 teleconsultations of 2 simulated patients in 10 the most popular telehealth services. An incomplete history of the disease was recorded in 50.0% of cases, incomplete allergy anamnesis – in 60.0%, and epidemiology anamnesis – in 35.0%. Information on chronic illnesses (critical for COVID-19 suspected situations) is fully collected only in 50.0% of cases. Due to defects in the history taking the target diagnostic concept was achieved in 30.0% of teleconsultations, target actions were recommended in only 35.0%. Telemedicine services did not provide continuity of medical care. In 60.0% of cases, medications were prescribed, including injectable antibacterial agents, which completely contradicts not only the legislation, but also the accepted international methods and practices of distance counseling. The quality of the direct-to-patient telemedicine services remains unsatisfactory. There is no effective quality control and quality assurance systems.
2018 № 2 «Cross-reporting» as a way for sub-speciality teleradiology
There is an original telemedicinebased approach for a subspeciality reporting of a radiology examinations at primary level facilities. This approach allows to increase quality of «neuroradiology» reporting at children. The level of discrepancies decreased from 42,0% to 20,0%.
2020 № 2 Personal telemedicine. Prospects for implementation
This article is devoted to the introduction of one of the most promising areas of telemedicine – personal telemedicine. A number of definitions are given, and some aspects of implementation are briefly considered. Based on the analysis of foreign experience and the current situation in Russian healthcare, the necessary steps are considered for the implementation of this direction.
2020 № 2 Legal problems of telemedicine technologies application in the context of fighting the spread of COVID-19 coronavirus
The purpose of the research is to analyze the legal problems of using telemedicine technologies, taking into account the experience of other countries; to assess the limitations of using telemedicine technologies in preventing the spread of COVID-19 coronavirus; to develop approaches to overcome existing restrictions in this area.
The authors consider the system of legal relations that arise between various participants in the provision of telemedicine services, focusing on international experience in this field.
On the example of the Russian Federation, the analysis of legal restrictions for the development of telemedicine technologies, which are typical for other countries, is carried out. A number of common problems of implementing telemedicine technologies are identified, as well as the specifics of legal regulation of telemedicine services in the Russian Federation.
Measures are proposed to overcome a number of legal restrictions in the use of telemedicine services related to licensing, labor legislation, etc.
2020 № 3 Procedure for conducting telemedicine consultations in the subjects of the Russian Federation
In the article, the authors analyze trends in the development of telemedicine in the subjects of the Russian Federation,
and also conclude that the formation of the system is carried out at different rates. Determine that one of the main stages of development is the formation of a legal framework dedicated to this area. Based on the analysis of legal acts of the subjects of the Russian Federation on the implementation of telemedicine consultations, the authors present a General algorithm for conducting telemedicine consultations, as well as reflect current problems and form proposals for their solution.
2017 № 3 Organizational telemedicine
Scientific bases of organizational telemedicine as a new direction of application of information and telecom- munication technologies in the system of citizens’ health protection are developed. The terminology, principles and role of telemedicine in the field of organization of public health and public health are defined. The advantages of using organizational telemedicine for improving the organization of medical care in the system of national and departmental health of the Russian Federation are shown. A new view of telemedicine as a tool for maneuvering health resources is proposed for the rapid change in the volume and level of medical care in the interests of a broad contingent of the population. The integrative role of organizational telemedicine in the integrated application of various information technologies in health care is shown
2015 № 2 About the definition and classification of telemedicine services
The definition of telehealth. Describes a set of criteria for the classification of telemedicine services and proposed their classification. The rules of naming telemedicine services for inclusion in the Nomenclature of medical services.
2017 № 1 About telemedicine «patient to Doctor».
Throughout 2016, the legislative initiatives on inclusion of telemedicine into everyday medical practice were actively discussed. During the discussion, besides the classic telemedicine segment «doctor-doctor», telemedicine segment «patient-doctor» was highlighted, it is a new direction, hardly described in the literature. This area covers a wide range of issues, associated with remote human interaction with the health system (including the Internet, medical gadgets, personal monitors and others). In the article, there was an attempt of the holistic description of telemedicine segment «patient-doctor» with an emphasis on the most popular technologies, as well as their technological and organizational features that allow for the integration of remote interaction with the patient in a overall information space of healthcare.
2020 № 3 Digitalization of healthcare in the Russian Federation: myth or reality?
“Digitalization of society” is a completely new way to describe the modern state of affairs within the global trend of
creating a digital world. “Issues, concerning digitalization are to be considered strategically important for the country” – pointed
out in the messages of the President Vladimir Putin to the Federal Assembly. In November 2016 President of the Russian Federation proposed “to launch a large-scale system for the developing new kind of the economy for a new technological generation– the digital economy”. Consequentially, the “strategy of development of information society in 2017–2030” was introduced in accordance with the law. The overall aim of the healthcare digitalization is to provide the maximum number of residents with medical services, to ensure the availability of medical care in any conditions in any region. The development and implementation of digital technologies, as well as their promotion in various areas of clinical practice are important tasks as well. The article reports the results of a review of scientific publications, regulatory documents, as well as other information sources (including foreign sources). Following digital healthcare tools are considered: telemedicine technologies, mobile applications, websites and information platforms of medical organizations.
2018 № 4 Radiology information system of the Krasnodar region: development of the reference clinical and diagnostic center for breast pathology
In order to increase the availability and quality of specialized oncological care for the population of the Krasnodar Territory, the clinical and diagnostic Center of breast pathology was created. Teleradiology is one of the most efficient way for remote consultations. The article contains a description of the methodology for organizing the work of the Reference Center using telemedicine technologies via Radiology in-formation system of the Krasnodar Territory (RIS). DICOM modalities in diagnostic departments, local PACS in medical facilities are the part of regional RIS and also include 2 mammography units located in interterritorial oncological dispensaries. Every month new mammography exams are delivered to local PACS, which determines the relevance of their remote consultation. To fully operate the Reference Center as key participant in the system of teleradiology consultations, it is necessary to create a complex diagnostic information system in the regional clinical oncology dispensary. This is one of the results of the paper. The use of a unified system increases the efficiency of the information technologies in a remote mammographic screening and also allows standardizing and formalizing activity of a radiologist according to recommendation such as BIRADS, facilitates and speeds up the routine work of the radiologist, improves the quality of radiology interpretation, provides to radiologist effective help, using computeraided diagnostic
2016 № 2 Development of a telemedicine expert system for generation of doctors letters based on laboratory tests
The paper presents the results of the development and implementation of an expert system that automatically generates doctors’ letters based on the results of laboratory tests. Medical knowledge is expressed using a first order predicate based language. The system was implemented and evaluated in the Helix laboratory service.
2017 № 3 From PACS to teleradiology
This article is about the current situation of the distribution and exchange of medical images. Today PACS is familiar to medical facilities and it is widely used system in radiology departments, but the “teleradiology” term still has difficulties with interpretation. When digital medical images are printing on a film and then transfer to other specialists, this way of exchange becomes more and more expensive and inefficient. That’s why the problem of acquisition, dis- tribution and getting access to the results of the diagnostic studies still actual. Another problem is the lack of qualified radiologists in the regions of Russia, due to the uneven population density; competent specialists are concentrated in regional centers. Therefore performing of urgent remote consultation is an actual problem too. In this article have been defined perspectives of advancement of the teleradiological systems, that began to appear due to PACS implementa- tion in radiology departments. The purpose of this scientific research is to develop the methods of teleradiology systems organization for consultations using PACS and telemedicine networks created in the regions. Factors influencing the quality of teleradiology consultations were discussed in article. Prerequisites for the development and implementation of such socially important systems, as a regional teleradiology system were defined