Research: State procurements of software and services in informatization of health care in 2013-2016.

The Single State Information System of Health Care (SSISHC), along with telemedicine and some other the directions is one of the main drivers of development of the industry of medical information technologies. Creation and development of Uniform State Health Information System is financed from the state budget since 2011 As you know, 2011 and 2012 were devoted to the first stage of creation of a system – so-called "Basic informatization". The second stage calculated on 2013-2018 means development federal and regional segments of Uniform State Health Information System, implementation and upgrade in need of the software solutions selected at a basic stage.

General information about costs for informatization of health care

Total amount of the selected financing on purchase of the software and services in informatization of health care in Russia for 2013-2016 was 19 billion 145 million rubles. Total amount of actually signed contracts for the same period was 17 billion 352 million rubles (90.6% of the amount of financing of KP).

Distribution of the selected financing and the amounts of the signed contracts by years of observation is given in fig. 1.

Fig. 1. The selected financing and prisoners state the delivery contract software and services in informatization of health care in 2013-2016.

In 2016 from the state 4 billion 69 million rubles were selected that is 7.33% more, than previous 2015. As a result of carrying out public procurements different public contracts for the total amount of 3 billion 993 million rubles were signed that is 10.21% more, than in 2015. Thus, 2016 in comparison with the previous 2015 became year of growth of the market of informatization of health care in Russia.

The analysis of economy as a result of carrying out public procurements revealed a stable negative trend. If in 2013 as a result of carrying out tenders and auctions of the amount actually prisoners state. contracts it was succeeded to lower by 23.9% in comparison with initially selected financing, in 2016 this indicator was the minimum 1.87%.

Fig. 2. Economy of costs for informatization of health care: a share of the amounts of the signed contracts from the selected financing, %

Distribution of the amounts of the signed public contracts by types of competitive procedures for the entire period of a research is provided in fig. 3. Apparently, the vast majority of KP (57%) are carried out in the form of open auction. The second most popular option state. purchases – holding an open competition (37%).

Fig. 3. The amounts of the signed public contracts by types of competitive procedures for 2013-2016.

The same indicator based on only 2016 is provided in fig. 4.

Fig. 4. Amounts of prisoners state contract

by types of competitive procedures in 2016]]

Purchases at the only supplier in 2016 made 68.6% of all purchases at the only supplier for the entire period of observation. In comparison with 2015 the amount of the signed public contracts with the only supplier grew by 3.2 times. It confirms concerns of the head of the FAS of Russia Igor Artemyev^[1] FAS about growth of state procurements under the article "purchase at the only supplier".

Distribution of public contracts to development of projects of informatization of health care by financing sources for 2013-2016 is provided in fig. 5

Fig. 5. Amounts of prisoners state contract

on financing sources for 2013-2016]]

The same distribution, but according to only 2016 is provided in fig. 6

Fig. 6. Amounts of prisoners state contract

on financing sources in 2016]]

Apparently, now the main financing source of projects in the field of informatization of health care are regional budgets – their share in 2016 made 52%. For comparison: in 2015 regional budgets financed 60% of all prisoners state. contracts. The following main source is extrabudgetary funds which in 2016 were 21%., in 2015 this indicator was 3%. In 2016 financing from the federal budget significantly increased: it grew by 3.3 times from 5% in 2015 to 13% in 2016.

Data analysis by regions

Overall rating of regions (excepting purchases of the federal center) on the amount of all prisoners state. contracts for 2013-2016 it is presented in table 1.

Not all regions on a permanent basis finance informatization of health care, but in general the situation was in recent years aligned. In 2013 purchase of software and the corresponding services in the direction of health care was performed by 54 regions (65%), in 2014 – 80 (94% taking into account 2 new regions – the Crimea and Sevastopol), in 2015 – 77 (88%), in 2016 – 76 (89%).

Financial resources selected the greatest for purchase of the software and services in informatization of health care:

1. Moscow: 7 billion 593 million rubles or 48.96% of all market.
2. St. Petersburg: 1 billion 55 million rubles or 6.81% of the market.
3. Moscow region: 531 million rubles or 3.43% of the market.
4. Rostov region: 445 million rubles or 2.87% of the market.
5. Novosibirsk region: 363 million rubles or 2.34% of the market.

Curious fact: the first 10 regions with the maximum financing make 74.13% of all market of informatization of health care.

The greatest positive dynamics in 2016 in comparison with the previous 2015 was shown by the following regions:

1. Khanty-Mansi Autonomous Okrug: + 134 million rubles.
2. St. Petersburg: + 100 million rubles.
3. Kabardino-Balkar Republic: + 69.8 million rubles.
4. Astrakhan Region: + 44.5 million rubles.
5. Republic of Dagestan: + 44.3 million rubles.

For last 2016 39 regions (45%) increased the costs for information of health care in comparison with the previous 2015.

Perhaps, in regions on which the small or almost absent costs for informatization were revealed nevertheless this direction of work was financed, but on other sources, not being state. purchases on 44-FZ.

The population and the number of the medical organizations in regions significantly differs. Therefore the analysis of relative indicators was made. First, the average relation of actual costs on informatization of health care counting on number of inhabitants of the region was analyzed. The average on all regions value made 58 rub a year on 1 inhabitant. Leaders in this indicator were:

1. Moscow: 504 rub / 1 inhabitant (is 8.6 times more than mean value across Russia)
2. Nenets Autonomous Okrug: 402 rub / 1 inhabitant (is 6.9 times more than an average)
3. Yamalo-Nenets Autonomous Area: 298 rub / 1 inhabitant
4. Kabardino-Balkar Republic: 248 rub / 1 inhabitant
5. Altai Republic: 235 rub / 1 inhabitant

Mean value of costs for informatization of health care counting on number of health workers made 446 rub. Leaders in this indicator were:

1. Moscow: 4,303 rub / 1 medic (is 9.6 times more than mean value across Russia)
2. Kabardino-Balkar Republic: 2,267 rub / 1 medic (in 5 times more an average)
3. Yamalo-Nenets Autonomous Area: 2,168 rub / 1 medic
4. Nenets Autonomous Okrug: 2,148 rub / 1 medic
5. Altai Republic: 1,761 rub / 1 medic

Mean value of costs for informatization of health care counting on number of the medical organizations made 350 thousand rubles. Leaders in this indicator were:

1. Moscow: 4 million 446 thousand rubles / 1 MO (in 13 times more mean value across Russia)
2. Yamalo-Nenets Autonomous Area: 2 million 560 thousand rubles / 1 MO (in 7 times more mean value)
3. Khanty-Mansi Autonomous Okrug: 1 million 185 thousand rubles / 1 MO
4. Altai Republic: 1 million 174 thousand rubles / 1 MO
5. Kabardino-Balkar Republic: 1 million 170 thousand rubles / 1 MO

Certainly, the volume of the financing selected by each region on informatization of health care is not the only indicator of development of this direction, but nevertheless it is logical to assume that it the more in the region is selected financings, the better there have to be also results of informatization. From this point of view it is revealed that the best efficiency and the most profound informatization should be observed in Moscow, Yamal, the Nenets Autonomous Okrug, Altai and Karabardino-Balkaria – in these regions relative indicators on number of medical workers or the number of MO have the greatest digits.

Customers of informatization of health care

Distribution of the public contracts signed in 2013-2016 to purchase of software and services in informatization of health care by customers is provided in fig. 7.

Fig. 7. The amounts of the signed public contracts on informatization of health care on customers, 2013-2016.

Apparently, in general regional executive authorities (35%), the state medical organizations (26%), city administration or the area (15%) and federal OIV (10%) became main customers of informatization of health care for 2013-2016.

The same analysis, but by data only for 2016 is submitted in fig. 8.

Fig. 8. The amounts of the signed public contracts on informatization of health care on customers of 2016.

Apparently, gradually the market was transformed as follows: now state MO act as the basic of drivers of the industry – they are customers of state procurements of software and services in informatization in 41% of cases. The second heaviest – regional OIV, they occupy a share in 34% of all purchases. And at last federal OIV (mainly the federal Ministry of Health) perform as customers with a share in 14% of the market.

Distribution of regional OIV in 2016 is provided in fig. 9.

Fig. 9. The amounts of the signed public contracts on informatization of health care on regional OIV in 2016.

Apparently, if regional OIV acts as the customer of informatization of health care, then in most cases (74%) it is the committee (the ministry, department) on informatization. The second main regional customer from shares in 16% are committees (ministries) of health care. Thus, it is possible to draw a conclusion that the initiative among regional OIV of informatization of health care proceeds from "informatizator" today, but not from the health care.

Fig. 10. The amounts of the signed public contracts on informatization of health care on departmental customers in 2016.

A bit differents in comparison with the market of a trend on costs for informatization of health facilities are observed in the state departments. In 2013 their costs made 10 million rubles, in 2014 – 112 million rubles, in 2015 – 58 million rubles, in 2016 – 45 million rubles. Distribution of these costs by different departments in 2016 is provided in fig. 10. Apparently, at the moment the greatest attention of informatization of health care is paid in FMBA (60%).

The analysis of a subject of public procurements on informatization of health care

Distribution of public procurements by a subject of the competitive procedure is provided in fig. 11. Apparently, in 75% of costs for informatization for last 4 years is a purchase of different services. The remained 25% are a purchase of the software.

Fig. 11. The amounts of the signed public contracts on informatization of health care in a subject state. purchases in 2013-2016.

Allocation of costs on services in informatization is provided in fig. 12, and allocation of costs on purchase of software – in fig. 13. Apparently, the main costs when purchasing services fall on technical support of the bought earlier different software products (48% of all services). The second most important direction of works is implementation of the different software (22%).

Fig. 12. Purchase costs of services in informatization of health care in 2013-2016.

Fig. 13. Software purchase costs for informatization of health care in 2013-2016.

In 2016 the subject of state procurements was almost completely transformed to purchase of services: 96% of all costs were the share of them. Purchase of software made "only" 160 million rubles, from them 130.6 million rubles are an additional purchase of licenses (81.5%), 29.1 million rubles – custom developments (18.1%) and 0.4 million rubles – the choice and delivery of software (0.4%). Allocation of costs on services in informatization of health care in 2016 is provided in fig. 14.

Fig. 14. Purchase costs of services in informatization of health care in 2016.

Today the main article of costs (34% of all services) is technical maintenance of the purchased earlier information systems. The average cost of technical maintenance of one information system in a year falls gradually: in 2014 it made 1 million 354 thousand rubles, in 2015 - 1 million 81 thousand rubles (decrease by 20.1% in comparison with previous year), in 2016 – 1 million 25 thousand rubles (decrease by 5.1% in comparison with previous year).

The second heaviest expensive part is a maintenance in general of the created earlier regional segments of Uniform State Health Information System most of which often make a complex of the different software products integrated among themselves, including quite often different producers. In 2014 the average cost of such contract was 50 million rubles. In 2015 it "failed" by 10 times and was already 4 million 598 thousand rubles, and the number of contracts for technical maintenance of all regional Uniform State Health Information System segment in general – increased twice. In 2016 average cost was already 5 million 874 thousand rubles (growth by 27.7%), and the number of the signed contracts in this direction grew by 8 times.

State procurements on informatization of health care and import substitution

Last 2016 was characteristic entry into force since January 1, 2016 of legislative prohibition on the admission of the goods coming from the foreign state and the works performed by foreign persons for the purposes of implementation of purchases – what is called "import substitution".

In Article 14 of Part 3 of Federal law No. 44-FZ "About a contract system in the field of purchases of goods, works, services for ensuring the state and municipal needs" it is said that "… for the purpose of protection of bases of the constitutional system, ensuring defense of the country and security of the state, protection of domestic market of the Russian Federation, development of national economy, supports of the Russian producers with regulatory legal acts of the Government of the Russian Federation are forbidden the admission of the goods coming from the foreign states, works, services according to executed, rendered by foreign persons and restrictions of admission of the specified goods, works, services for the purposes of implementation of purchases".

Order of the Government of the Russian Federation No. 1236 of 11/16/2015. "About establishment of prohibition on the admission of the software coming from the foreign states for the purposes of implementation of purchases for ensuring the state and municipal needs" explained how this prohibition is regulated: for this purpose in Russia "The unified register of the Russian programs for electronic computers and databases" is created (further – the Register of the Russian software). By point 2 of the specified Resolution No. 1236 it is established that if some program providing is absent in the Register of the Russian software, but at the same time in it there are similar solutions, then it is forbidden the admission of such programs for the purposes of implementation of purchases for ensuring the state and municipal needs.

In practice these legislative restrictions mean the following: if the Customer carries out a procedure for procurement of software according to No. 44-FZ and the type of the software necessary for it is presented in "The register of the Russian software" - it should assume that before purchase of the request only according to those solutions that is in the Register. If the Customer carries out purchase of services, then such services can be purchased only the Russian company.

To analyze state procurements on informatization of health care regarding import substitution, all software participating in the conclusion of public contracts regarding existence or absence it in "The register of the Russian software" was analyzed. Last time data on this indicator were updated at the end of March, 2017, results are provided in fig. 15. Apparently, at the time of writing of a research only 47% of software which can will be applied in informatization of health care, is present at Register. In total in Register there were 119 different solutions for application in health care (general-system software and the systems of universal application do not enter this indicator).

Fig. 15. The software applied in informatizations of health care of Russia and existence it in "the Register of the Russian software"

Distribution of systems by types (appointment) is provided in fig. 16. Apparently, it is the is best of all in Register medical information systems for automation of the medical organizations (MIES MO) are provided: 51 solutions or 43%. The second popular type is radiological information systems and PACS: such systems there are 21 solutions or 18%. The third in rating version is the regional medical information systems (RMIS): such systems in Register there are 19 products or 16%. These 2 types of software – MIES MO and RMIS are standardized in terms of requirements to their functionality from the Russian Ministry of Health today. For them are developed and approved at the level of the Ministry "Standard requirements".

Fig. 16. Types the software for informatization of health care in "The register of the Russian software"

Further the following analysis was made: each public procurement as a result of which the public contract on acquisition of software or services and corresponding to software which was applied to accomplishment of terms of the contract was signed is analyzed. Date of public procurement to date of inclusion of the "won" solution in "The register of the Russian software" was compared. If at the time of summing up the competitive procedure the relevant decision really was available in Register - that such purchase was noted by statistical sign "The solution was present at the Register". If at the time of the declaration of purchase the won solution was not placed in Register yet - that such sign was disconnected. In an analysis result of all public procurements in 2016 the data provided in fig. 17 were obtained.

Fig. 17. General distribution state. contracts for informatization of health care on existence of the applied solution in "The register of the Russian software"

Fact of carrying out in itself state. purchase on any solution which is absent in Register - is not violation of the current legislation. First, yet there is no explicit legislative prohibition on purchase of different services depending on that, there is used for rendering this service (for example, technical support) a product in Register or not. Secondly, even if procurement of software is conducted, but not services – that and here Order of the Government of the Russian Federation No. 1236 of 11/16/2015 provides an opportunity to prove need of purchase of software which is absent in Register. Nevertheless all main cases of purchases of software in terms of import substitution were separated into 2 scenarios:

• Acquisition of a new system. Authors of a research consider that in this case the customer was obliged not to allow to the procedure state. purchases of the solution which were absent at the time of the choice of the winner in Register. Purchase of the new systems, in particular different types of MIS which were absent in Register - should not be.
• Development of already used system (for example, additional purchase of licenses or acquisition of add-on modules). Such cases were perceived as reasonable preserving of the solution even if it also does not consist so far in Register as certain investments from the state were already spent for initial purchase and implementation of such system. Authors of a research consider that such purchases are proved and can take place.

For the analysis of purchases of software and observance of requirements of import substitution were investigated corresponding state. contracts. Only 2 explicit violations consisting in contract signature on delivery of one of medical information systems to the amount of 407 thousand rubles though at the time of purchase this system in Register was absent were as a result revealed, but there were already similar solutions of other producers. Repeated cases when the customer signed the public contract on other types of purchases of software (generally – delivery of additional licenses) which was absent in Register were revealed and in general we regard them as reasonable. Results of this analysis are provided in fig. 18.

Fig. 18. Purchases of software for informatization of health care and its existence "The register of the Russian software" at the time of the declaration of the competitive procedure, 2016.

Analysis of the companies market participants

Distribution of the signed public contracts to delivery of software and services in informatization of health care for 2013-2016 depending on the contractor is provided in fig. 19.

Fig. 19. The amounts of the public contracts signed in 2013-2016 on informatization of health care by types of the contractor, rub.

Apparently from fig. 19, the principal amount of the signed contracts (35%) fell on the large IT companies and the system integrators implementing the projects through the whole country. The second place (28%) – at different business companies where bulk is made by the regional IT companies. A third the place (19%) – at specialized developers whom the IT companies working mainly at the market of informatization of health care treat.

The same indicator, but according to only 2016, is provided in fig. 20. In general the structure of distribution of public contracts between different market participants in 2016 did not change in comparison with the entire period of observation.

Fig. 20. The amounts of the public contracts signed in 2016 on informatization of health care by types of the contractor, rub.

The rating from the 10 first companies in the sector "Large federal IT company (integrator)" based on 2015-2016 is given in the table below. Last 2016 the main leaders (Lanit, CROC, Rostec) improved financial performance of work in the market of informatization of health care.

The analysis of financial performance on specialized developers is based on more complex structure. In this group rather big difference between the amounts state is characteristic. contracts which are signed with some developer and the amounts according to solutions of this developer which are applied finally to fulfillment of requirements state. contract. This difference is caused by the fact that often relevant companies use the partners for accomplishment of different projects. In that case amount state. contracts on the developer will be less, than the amount on developed by him solutions. To consider this feature and to estimate financial effectiveness not only under direct contracts, and according to all won competitive procedures, 2 indicators were analyzed: the amounts of Civil Code signed according to solutions of this developer and separately the amounts of direct groups of companies with it. Results of rating are given in the table below.

Apparently from the table, among specialized developers it is possible to select 2 different approaches to project implementation. Some companies actively use partnership and sign not all contracts with the customer directly. Leaders in such approach are the Post Moder Technology company (which is entering into the Armada group and having developed partner is), the K-MIS company (which is actively working with RAMEK-VS and too having own regional partners) and also SofTrust. Contrary to them some developers try to sign the most bigger number of own direct contracts. Joint venture .automated workplace, AIT-HOLDING, Medotrade and some other treat their number.

In table 4 dynamics of prisoners state is analyzed. contracts according to solutions of specialized developers for 2013-2016.

For market leaders of 2013 was the most difficult in terms of financial performance. This feature rather all is connected with the fact that in 2013 terms of the guaranteed technical support since the conclusion primary state did not expire yet. contracts for the choice of systems for creation of regional segments of Uniform State Health Information System which were mainly played in 2012. Besides, in 2013 there were obligations for completions and rendering implementation services which are already financed previous 2012. Therefore indicators of 2013 at the level were much lower, than in 2011-2012. Having completed the undertaken obligations, the companies began to conclude state more widely. contracts for technical maintenance of the delivered products in 2014 and therefore some of developers considerably improved the results.

In 2015 and 2016 the different companies showed different dynamics, but here it is necessary to consider feature of budget cycles and structure of public contracts and obligations for them. That some companies improved the indicators in one of the last 2 years, and some worsened – is not reliable and objective characteristic of stability and dynamism of the companies. It is quite possible that these results were affected just by features of signing of the contracts: for example, a part of developers signed serious big contracts in recent months 2015 and respectively, these amounts were reflected in balance of this year. But accomplishment of obligations and payment under these contracts de facto began in 2016. Therefore in terms of digits in the table can there will be an impression above that the companies worsened the indicators in 2015 and improved in 2016 (or on the contrary) – but actually their work and functioning are stable and reliable, just actual receipt of revenue cannot be traced according to the portal state. purchases.

The analysis of the applied medical information systems

Today in informatization of the state health care of Russia the 260th is applied different the software product. In fig. 21 distribution of the signed public contracts in 2013-2016 by types of the applied software is provided. Owing to especially large volume of financing – these 2 groups of the solution were selected for the regional segments created by JSC Rostelecom and also EMIAS of Moscow in separate indicators.

Fig. 21. Types of the applied software in informatization of health care, 2013-2016.

Distribution of regional medical information systems is provided in fig. 22. If to assume that EMIAS of Moscow and the solution of JSC Rostelecom it agrees the classification accepted for this time treat rather regional medical information systems, then this class software is the leader in financing – for 2013-2016 10 billion 612 million rubles or 61% of all costs for informatization are spent for such solutions. The unconditional leader among the Russian regional MIS is EMIAS of Moscow – 61% of the spent means among RMIS or 37% of all volume state are the share of this system. purchases on informatization. Regional MIS JSC Rostelecom firmly takes the second place: for 4 years 1 billion 997 million rubles or 11.48% of all state were spent for it. purchases.

Fig. 22. State. purchases of regional MIS in Russia in 2013-2016.

The overall rating of regional MIS is given in the table below.

The second place is taken by the different medical information systems intended for automation of separate health facilities. Costs for this type of software made in 2013-2016 4 billion 609 million rubles or 27% of all state. purchases. The vast majority (89%) of costs in this category was the share of different medical information systems of the medical organizations (MIES MO) which number for the period of observation made 160 systems. The second place is taken by laboratory information systems (6%), the third (3%) – software products for automation of pharmaceutical activity.

Fig. 23. State. purchases of MIS for automation medical the organization

in Russia in 2013-2016]]

The rating leading MIES MO is given in the table below.

The rating of the laboratory information systems (LIS) is given in the table below.

Main outputs

In general informatization of health care, at least regarding the software and the corresponding services for public sector, is the market about 4-5 billion rubles a year. In 2015 the volume of this market was significantly reduced – by 44.4% to the size of 3.6 billion rubles, in 2016 showed growth in 10%.

Financing of informatization of health care is performed mainly at the expense of regional budgets, extrabudgetary funds and compulsory health insurance.

Lately this market in general was created both on its participants, and on a range of the proposed and demanded solutions. Mainly this market is made by the regional systems from shares of 61% and also medical information systems of office level from shares of 27%. Specialized solutions, such such as laboratory or radiological information systems, solutions for ambulance or provision of medicines have no significant share in the market, each of such types of solutions occupy less than 1%.

It is possible to carry Rostelecom, Netrika, BARS Group (Rostec), JV .automated Workplace, Post Modern Technology, K-MIS and SofTrust to the most active players of this market.

* the Research is prepared by K-MIS company.