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Telemedicine law
On January 1, 2018, the long-awaited law on telemedicine came into force. Today, services in this area are regulated by Law No. 242-FZ “On Amendments to Certain Legislative Acts of the Russian Federation on the Application of Information Technologies in the Field of Health Protection.” It opens up new opportunities for patients and doctors, however, its implementation in practice in different regions of the country is not the same, due to technical difficulties. In addition, the coronavirus pandemic, which is now in its second year, has made a significant contribution to the development of telemedicine technologies.
How telemedicine technologies work today, whether everyone can use them, and how it works in practice, KP learned from leading telemedicine experts who took part in the work on the law.
“There are several typical situations in which telemedicine technologies will be most actively used,” says director of the Scientific and Practical Center for Medical Radiology of the Moscow Department of Health, chief freelance specialist in radiation diagnostics of the city of Moscow, doctor of medical sciences, professor, radiologist Sergey Morozov. – The first is a doctor-to-doctor consultation.
Most often, such consultations are required to select patients for free high-tech treatment, that is, for complex expensive operations under the MHI policy, the expert explains. – Doctors of a large medical center, where it is planned to send the patient, must consider his documentation, and for this people are forced to personally go to the commission. Now officially everything can be done remotely, without wasting time, effort and money on long trips. It is important to note that such consultations can take place both within the region and at the federal level. In addition, doctors will receive full payment at compulsory medical insurance rates specifically for remote work with patient documents, and this is an additional motivation to quickly resolve the issue of the need, conditions and urgency of hospitalization.
Telemedicine technologies
– Another convenient service that appears thanks to telemedicine is remote health monitoring. Having gone to the doctor for the initial appointment, the patient then sends the doctor information about his condition in electronic form, continues Dr. Sergey Morozov. – These can be the results of tests, examinations, as well as data from certified medical devices that are used at home: glucometers, tonometers (to measure pressure), holters (to record heart rate), etc. The doctor remotely analyzes the results and adjusts therapy , the patient’s actions, including making additional appointments, writing out an electronic prescription.
It’s important
All this is possible only after an initial face-to-face appointment with a doctor, the expert emphasizes.
– Many people are mistaken, thinking: now I can send the results of my tests to the doctor, show up on camera, and I will be diagnosed – the law does not allow this! – warns David Melik-Guseinov, director of the Research Institute for Health Organization and Medical Management of the Moscow City Health Department. – It’s another matter if a person, say, broke his arm, went to the doctor, he was x-rayed, put in plaster. Then, from time to time, it will be possible to contact the doctor to monitor the condition using telemedicine technologies, if the state of health is normal and there is no need for new manipulations. In a word, we are talking about secondary appointments or medical supervision, accompanying patients who have already been diagnosed.
Access to the best doctors
“Where the card was issued, go there,” the same thing could still be heard about the results of tests, ultrasound and other examinations. If a consultation is needed at another medical center, the patient, as a courier, must personally deliver extracts from the previous place of treatment, or even redo the tests again. Now, technologies have been legalized and clearly defined that allow you to electronically send all the necessary data from medical laboratories not only directly to the doctors who ordered the examinations, but also to other medical centers.
“This gives patients quick access to the best medical specialists,” explains radiologist Sergey Morozov. “Suppose there is no expert in the interpretation of advanced studies, such as positron emission tomography, in some hypothetical clinic. Or there are specialists in MRI, but there is no “narrow” professional in MRI of the biliary tract. Then an authorized employee of the polyclinic takes the results of the study and sends them for consultation to a doctor in another medical center. At the same time, according to the MHI tariff, the polyclinic will receive money for conducting the study, and the remaining part for the description (of the results of the examination. – Auth.) will be received by the consultant doctor who performed such work remotely. In addition to the speed of getting a response, this is an excellent opportunity to provide patients with advice from highly qualified specialists, while not forcing patients to make numerous and expensive trips.
How it works in practice
“First of all, telemedicine technologies within the framework of CHI (that is, free for patients. – Auth.) Will be developed where medical care is less physically accessible – in geographically remote areas,” says David Melik, director of the Research Institute for Health Organization and Medical Management. Huseynov.
– If we talk about every corner of our country, then new technologies will reach absolutely all polyclinics and hospitals in 10-15 years, since the “digital divide” (that is, the lack of electronic technologies in polyclinics, hospitals and the skills of health workers) has yet to be overcome. — Auth.), – emphasizes the director of the Scientific and Practical Center for Medical Radiology Sergey Morozov. – Today, about 20% of institutions, or every fifth medical organization, are connected to telemedicine services. As for the technical side, both patients and doctors upload and transfer data through special information systems with a high degree of protection: with encryption, information depersonalization, etc. All this is clearly spelled out in the law.
Question on topic
When can I contact my doctor for an online consultation?
“Doctors are obliged to provide medical care, therefore, if a patient has a desire to receive it in a telemedicine format and this type of assistance can be provided in this format, then the doctor must fulfill the patient’s wish,” explains David Melik-Guseinov. – What kind of medical services can be provided within the framework of telemedicine is already prescribed in the updated legislation, in special orders of the Ministry of Health.
Tip:To find out if there are telemedicine services in your clinic / hospital and whether it is possible to get a remote consultation specifically in your situation, the easiest way is to contact the medical insurance company that issued your CHI policy. By law, insurers are required to advise patients, including on such issues, and in practice, as a rule, they do this without any problems.
Five tips for patients
How not to run into hacks and scammers
So far, telemedicine consultations for patients within the framework of compulsory health insurance, that is, free of charge, are just beginning to be developed and launched. But commercial services in our country are already working, after the entry into force of the law they will develop even more actively, experts predict. As elsewhere, abuses and consumer fraud are possible here, so we asked experts for advice on how to ensure the reliability and quality of medical services offered via the Internet and special applications.
- Carefully read the site: it must necessarily indicate a legal entity, that is, a medical organization that provides telemedicine services. It is also important that the full names of doctors and their specialization be indicated, – emphasizes Sergey Morozov.
- According to the law, a Register of medical organizations and health workers who have the right to provide telemedicine services will be created. Make sure that the clinic and doctor you have chosen are included in this registry (it is not yet there, but it will appear in time, and you can find it by simply entering keywords into a search engine).
The Unified State Health Information System (EGISZ) includes such systems as:
- Federal Register of Medical Workers,
- Federal register of medical organizations.
They indicate organizations that are entitled to provide telemedicine services. Make sure the clinic and doctor you choose is included in this registry. In addition, medical consultations are provided through a special system implemented in the Uniform State Health Information System, with strict consideration of the conducted and planned consultations.
- Be sure to save information about all appointments made to you, take screenshots. Record all the elements of the consultation so that you have confirmation in case problems arise and you need to file a claim with the clinic for poor-quality telemedicine services. “Even if you do not go to court, but provide the clinic with all the information you recorded, this will already have a serious psychological impact, and it is highly likely that your claim will be satisfied without going to court,” says Sergey Morozov.
- Before ordering and paying, carefully read the description of the service: what exactly is guaranteed to you as part of an online consultation. It is worth being guided by common sense: in emergency and urgent situations, you should seek medical help in person.
- “Do not forget that the primary diagnosis can only be made at a face-to-face appointment,” recalls David Melik-Guseinov. “If a clinic or a doctor offers you an online diagnosis, this is an alarming signal: such actions are outside the law and may indicate dishonesty, low qualifications, etc. It is better not to contact such organizations.”