2020 № S5 Telemedicine technologies: prospects and limitations
In the context of rapid technological progress, the outlines of the prospects for the development of telemedicine
technologies are becoming more and more clear. At the same time, changes in the organizational, legal and economic spheres often do not keep up with technological changes. This was especially evident in the conditions of the spread of the COVID‑19 coronavirus.
The article contains an analysis of the features of telemedicine technologies application in modern conditions, prospects and obstacles that arise in this area.
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.
2020 № 3 Economic aspects of providing medical care using telemedicine technologies
The aim of the research is to study the economic aspects of telemedicine technologies application, taking into account
the experience of other countries; to develop methodological approaches to evaluating the effectiveness of telemedicine technologies; to analyze the features of evaluating the effectiveness of telemedicine technologies in the conditions of COVID‑19 coronavirus spread. Methodological approaches to evaluating the effectiveness of telemedicine technologies are proposed.
The additional costs and benefits of using telemedicine technologies are analyzed in the context of the main participants: the state, medical organizations, doctors, and patients. The additional costs of introducing telemedicine technologies are estimated in terms of their belonging to the so-called “necessary costs” or investments that have different economic content . The proposals developed by the authors allow us to more correctly assess the effectiveness of investments in the provision of telemedicine services and, thus, choose the most optimal options.
2020 № 4 Telemedicine as a tool for remote interaction with regional hospitals: 5-year experience of the National Research Center for Hematology
Significant expansion of telemedicine technologies was made possible by the adoption of the necessary legal regulation
and initiation of the national program “Healthcare”. National research centers were assigned a mission to provide advisory and methodological support to the regional hospitals.
The manuscript describes the experience of the National Research Center for Hematology in application of telemedicine technologies in order to improve the quality of specialized medical care. Progressive increase in the number of requests for telemedicine consultations was observed during the last 5 years, also due to the activities aimed at expansion of geographical coverage of telemedicine technologies and involvement of the regional doctors. In 2019 1380 requests were received from 80 regions of the Russian Federation. The largest number of requests came from the hospitals of the Central (28%) and Siberian (25%) Federal Districts. Distribution of consultations by aim, disease, regions of origin is presented in the manuscript.
Telemedicine consultations significantly contribute to the implementation of precise diagnostics and monitoring of patients with blood disorders, shortening of the time of diagnosis, timely treatment initiation, help to organize correct patient referrals, ultimately reducing the risks of treatment failure, complications and lethal outcomes. Analysis of the data accumulated in the consulting
National research center allows to assess the quality and effectiveness of medical care in the regional hospitals.
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.