Oleg Savishchev, IT: "The health monitor" is unique service in the Russian market of telemedicine

Oleg Savishchev: As well as in other spheres of health care, business, society waiting and reality often do not match, and telemedicine - not an exception. All market participants long waited for legislative settlement, the transparent legal basis for the activity. The law appeared (242-FZ), but did not meet expectation of players of the market of commercial telemedicine, and it is, perhaps, the most important factor currently. As for availability of the Internet, now the covering of cellular networks provides the majority of territories of the country, and cloud platforms organically develop – there are practically no restraining factors.

And here regarding medical mobile devices with a possibility of wireless data transmission the situation is more difficult. Many gadgets of household purpose are presented at the market, but they cannot be used as medical devices as do not meet the official requirements for accuracy, quality and security. Producers of such devices do not aim to register the products as medical, with obligatory observance of registration procedures and certifications. It is not enough among telemedicine devices and manufactured in Russia though there are many interesting developments.

Oleg Savishchev: The majority of the Russian developments are at the level of startups. I hope that over time they will be realized in full-fledged medical devices, but so far among the Russian producers such it is not enough. From the western producers noticeable in the Russian market, it is possible to mention companies A&D, Roche, SCHILLER.

Oleg Savishchev: The Russian market of telemedicine exists for a long time, but until recently was kind of semi-legal – due to the lack of the legal basis, first of all. Is present at the market many players including associated with large business and with IT giant. I will not mention specific services not to do advertizing by one and it is unfair to bypass others. Now any of players of this market does not render a full range of telemedicine services, everyone works in the niche.

Conditionally players of the market can be separated into the following groups. First, virtual online clinics are remote consultations of patients, there are a registration and the medical license, staff of doctors. Secondly – so-called "show-windows of doctors", actually - the service aggregators offering search of doctors in different clinics. In the third – the companies offering services of remote monitoring when medical devices with data transmission channel are used, cloud data processing facilities it is frequent using artificial intelligence. And the fourth group it is possible to call conditionally "other services" is services of "the second opinion", services of storage of medical information (electronic medical records), the separate services tied to specific medical gadgets.

Oleg Savishchev: Data on the volume of the Russian market of commercial telemedicine strongly differ depending on information source, and I do not think that there is an expert opinion which would reflect the true situation in accuracy. It is connected with the fact that many players of this market – network of medical clinics, insurance companies, State Healthcare Institutions - do not select the telemedicine business from primary activity.

One digit can be given, for the general orientation: according to experts of Rostec state corporation by 2020 the Russian market of telemedicine can reach 300 billion rubles. As for international market, it will appear at the level of 44 billion US dollars by 2019, at the remaining annual gain in 17.7% (data of BBC Research and IHS). Forecasts are how right, will show time, but one is undoubted: the general trend promises rapid development of this industry.

Oleg Savishchev: Legal lack of regulation of many questions and legal collisions of the new law on which many market participants and prominent jurists already commented, - the first problem. Experts agree that the legislator, having taken a small step forward, in a hurry took two steps back. Law 242-FZ is deeply archaic and does not meet requirements of the market of telemedicine for which development it was accepted.

The second problem – lack of uniform standards of registration, acceptance, transfer, storage and processing of personal and medical data, including a huge number of medical information systems different, badly compatible with each other. The third problem which will arise in the nearest future, - issues of identification and personification (the EDS, biometric identification, etc.). And one more important problem – a conflict of interest of the medical institutions working in the compulsory health insurance system and budget regulators. There is an opinion that telemedicine consultation - less expensive service, and in comparison with internal acceptance medical institutions lose income counting on one patient.

Oleg Savishchev: The bill nominated on discussion in the State Duma on the first reading contained allowing regulations regarding a possibility of remote diagnosis and purpose of treatment. The final version of the law in which it was adopted directly prohibits to do it. Only the appearance in clinic and internal communication with the doctor allows to make the diagnosis, telemedicine communication is possible only during the period between internal surveys.

One more difficult moment in the law – it provides unambiguous identification of the personality as it is necessary to save a medical secret in the course of remote consultation. Nobody can be sure at a call by phone that the personality with whom the doctor communicates by phone, that to which she was provided. Identification of both the doctor, and the patient is provided on several channels – the highly skilled EDS, identification via the portal of state services, biometric identification.

And actually, should tell what the state absolutely correctly does that protects the patient, his medical secrecy, but at the moment there are no really working instruments of this protection. The doctor has no EDS for today neither, nor at the patient. Clinics can create the EDS for doctors, but these are additional expenses, and they are regularly required to be updated. And matter not only in lack of the EDS – still special medical information systems in which personal information could be stored reliably are required.

As for identification via the portal of state services, it is complicated too, and regarding biometrics the law advances the market – this technology was not widely adopted yet. Thus, 242-FZ allows to hold remote medical consultations, but as identification of the personality cannot be carried out, consultations actually too cannot be held.

Oleg Savishchev: Who both can, and identifies, and protects. Actually still many market participants work with violation of this law. As for our service "Health Monitor", we work directly with treatment and prevention facilities, and we have a situation more or less safe in this plan. We do not process personal data, we only transfer and we store, but – we store is depersonalized. The agreement on storage and personal data processing consists between the patient and clinic. So we observe the law.

Oleg Savishchev: The subject of PPP in telemedicine is not solved finally yet. At the moment we do not get under the scheme of PPP as we render an information service based on own IT platform, and IT are not included in subject of the agreement within PPP and the concessionary agreement for today. It, of course, in many respects slows down development of the IT industry. I will note that now the law on PPP is supplemented and improved, expected that changes will be accepted next year.

Oleg Savishchev: In the market of mass services the main consumer is citizens of working-age, with active living position and steady income. These are the people who do not have serious problems with health, but needing periodic medical consultation. Roughly speaking – patients of commercial clinics. There is also another, the clients, less attractive and rather small in the context of commercial telemedicine, are the people having the set diagnoses of chronic diseases and which are not needing permanent condition monitoring of health. The age any, is more often – mature and even elderly, and, as a matter of fact, it is patients of the public medical institutions.

Oleg Savishchev: Because they, as a rule, already set the diagnosis. They need recipes on free drugs, periodic inspections for the purpose of correction of treatment, drugs, but not remote consultations are necessary. Commercial telemedicine is focused on people who do not want to waste time for visit of the clinics wishing to make everything quickly according to a modern rhythm of life. Having felt temporal impairment of health, they have an opportunity without leaving a workplace to call the doctor and to consult.

Oleg Savishchev: Those who have a policy of VHI provided by the employer as an additional bonus are knowledgeable and quite ready.

Oleg Savishchev: In this sector of telemedicine serious work, and of course is conducted already long ago, it is a prerogative of the state health facilities. New technologies in this case only supplement traditional approaches to treatment and prevention of diseases. As a result also receiving services even in those areas where there are no medical and obstetrical centers and medical personnel as such though in scales of the market it is an insignificant share became possible. The Health Monitor service participates in similar projects. For example, we work in Khanty-Mansi Autonomous Okrug where in huge territories sometimes it is the only way quickly to get medical advice. I will note that there is one more sphere where medical services are hardly accessible and telemedicine it is demanded, are the ships, airplanes, field camps and other places of compact accommodation.

Oleg Savishchev: Directly we do not work with patients, our clients – medical institutions. Under the agreement with them we as provider provide service of remote monitoring of health using telemedicine devices and also remote consultation and storage of medical information.

The solution represents service for control of vital indicators of human health, automatic mnogourovny and omnichannel response to critical changes of parameters for the purpose of further correct selection of drugs and treatment. At the same time "The health monitor" provides remote interaction of doctors, patients and the medical organization. I will note that "The health monitor" at the moment is the unique solution in the Russian market of telemedicine.

Oleg Savishchev: The technology of processing of Big Data and partly – artificial intelligence is used, for example. Accumulating state-of-health data of the patient, analyzing them, we receive a certain fashion, i.e. an average parameter value of regulation, inherent in this person, in different life situations. And if afterwards a system notices a critical aberration, it will automatically issue warning which will be received by both the patient, and the doctor. If neither the doctor, nor the patient reacts to warning, the call of disturbing services and their departure into place where there is a patient joins. On this case we have a service of disturbing reaction which use registers in SLA, including information on relatives whom it is possible to contact.

Oleg Savishchev: The service uses the cloud platform of own development meeting all state requirements of storage and processing of personal and medical data. Servers on which the platform is placed are highly productive, fault-tolerant and most protected. As for devices, now their about ten, in plans by the end of the year to provide support not less than twenty.

Devices of different function, register a set of parameters, the main requirement – presence at the device of wireless link of data transmission. In our plans to give the main preferences to domestic products as among them there are modern interesting solutions, but still many of them as I already spoke, at the level of startups. New devices are integrated into a system by our engineers and programmers, and receive a permanent registration in a system after careful testing on bench model, and after kliniko-technical approbation. Our platform provides to producers of devices access to API for the easiest integration.

Oleg Savishchev: Real projects in our portfolio are available, of course. For today we covered our service all Moscow region, actively we work on its distribution in Moscow. Investment opportunities of the company act as a certain restriction, we buy medical devices on the means then we provide them in lease to medical institutions with which the agreement is signed. Therefore spasmodic expansion in our case cannot be, we develop evolutionarily.