Digitization of Healthcare Review

Investment in digital medicine in 2020 grew 45% globally and 90% in the United States, which saw a 10% decline from 2018 a year earlier. Such data leads CB^[1]. In absolute terms, investments in healthtech amounted to $26.5 billion. This is 33% of all global investments in health care. And $14.1 billion of them fell on the American market.

In Russia, according to K-Sky, which is based on open sources of information on investments in medical tech, $47.3 million was invested in digital health care in 2020, and $50.2 million in 2021. For comparison, in 2018 and 2019, the volume of investments was about three times lower.

The most popular directions among investors in the digitalization of this area in Russia are telemedicine, mobile applications and services for patients, their healthy lifestyle and longevity, medical insurance, as well as solutions using artificial intelligence.

These and some other relevant areas of digital transformation of the industry, the achievements of the Russian healthcare digitalization market and its problems, as well as development prospects are in the focus of the new TAdviser review .

How the pandemic has accelerated the digitalization of health care

The pandemic COVID-19 and the resulting lockdowns have become a test for electronic health care and ready-made digital medical services systems around the world. In conditions when many people lost the opportunity to come to see a doctor, digital medical services were at the peak of demand for both medical workers and patients. So, according to analysts & McKinsey Company, since the beginning of the pandemic, the demand for telemedicine services and virtual medical care has grown 38 times.

In March 2020, new digital medical services began to appear in Russia. So, already in April, the Russian Ministry of Health launched a chat bot that informed citizens about the epidemic situation, diagnosis and prevention of COVID-19. In St. Petersburg, since May of the same year , voice assistant Victoria began the duties of an operator to arrange calls for a doctor at home. Later, the capabilities of chatbots found application in five other Moscow clinics. And in general, both the penetration of various digital medical services and applications into the lives of Russians and the intensity of their use over the past two years have increased.

On the part of specialized regional departments and individual LPUs, there was a request for the introduction of telemedicine systems, he says. - Of course, we have to deal with spontaneously established practices, for example, consulting in instant messengers, which contradict the requirements of the law. But everything related to the remote interaction of the doctor and the patient: telemedicine consultations, remote monitoring of chronic patients, electronic prescriptions, appointment without visiting a medical organization - has become very popular.

Health informatization was initiated in Russia by the state back in 2011, and in 2017-2018 its results were rethought. Remote interaction between a doctor and a patient using information technologies was introduced into the legal field by the Federal Law of 29.07.2017 No. 242-FZ. He also allowed electronic document management in medical organizations, without specifying its legal status. And the adoption of the Decree of the Government of the Russian Federation of 5.05.2018 No. 555 "On a unified state information system in the field of health care" and the approval of the Federal project "Creating a unified digital circuit in health care based on the Unified State Information System in the field of health care (Uniform State Health Information System)" within the framework of the National Project "Health" in 2018 launched the processes of digital transformation of the industry.

The main directions of the Federal Project aimed at creating mechanisms for digital interaction of medical organizations based on Uniform State Health Information System are the introduction and development of medical information systems in all medical organizations, electronic medical document management between medical organizations and health management bodies, as well as hospital and prescriptions in electronic form.

And it must be admitted that the coronavirus pandemic has accelerated its implementation throughout Russia. So, by the end of 2020, 82.4% of all state medical organizations were connected to the Uniform State Health Information System instead of 65% of previously planned. Moreover, overfulfilling of key performance indicators is observed in all other areas of the Federal Project.

Largest IT Providers

The largest IT supplier for healthcare in Russia in terms of revenues from projects in this area in 2020 was Tsifromed (Digital Medical Services). Its revenue amounted to 5.7 billion rubles, an increase of 608% over the year. The five leaders also included CROC, RT MIS, BARS Group and AiSiEl Techno.

The total revenue of the 10 largest companies in the rating for 2020 amounted to 18.8 billion rubles. A year earlier, their total revenue was around 6.5 billion. Thus, the growth was about 192%. The indicators of all participants in the rating can be found in the table below.

The Near Future of Digital Healthcare

The national project "Healthcare" continues, within its framework a single digital circuit is being created, - comments Andrei Dyukov, head of the sales and development department of Netrika Medicine. - The benefits that its implementation provides are seen by both doctors and patients. Doctors can work with a large amount of medical data received from colleagues, patients - receive information about the medical care provided on the Unified Portal of Public Services (EPGU) and use new electronic services presented on it and regional portals.

To date, medical information systems, laboratory information systems have been introduced in 83-85% of all state medical organizations, these data were cited by Alexander Gusev, Development Director of Webiomed, a member Supervisory Board of the NBMZ Association during a round table held by Delovoy Petersburg. Recognizing that the picture of the digital transformation of budgetary medical organizations in Russia is heterogeneous, the expert noted that Moscow a number St. Petersburg of other entities RUSSIAN FEDERATION in central Russia have achieved the greatest success.

Through trial and error, constant improvement of the regulatory framework, the country is moving towards creating a single information space for digital health care. Since developers must ensure interaction within the framework of compulsory health insurance (compulsory medical insurance), as well as form the required reporting, they have to regularly update the systems, says Dmitry Kotokhin, Development Director of the Bear RMIS (Khost Group of Companies).

For 2020-2021. the regional medical information system "Bear" was installed in 7 regions of the Russian Federation: in the Khanty-Mansiysk Autonomous Okrug (Ugra), the Republic of Sakha (Yakutia), Amur, Oryol, Moscow, Belgorod regions, as well as in Sevastopol. Today, about 5,000 medical organizations use this system, the number of registered patients has exceeded 5.5 million people, information about which is stored in 43 million documents.

A Netrika Medicine"" implemented 4 projects to form a regional fragment of the Uniform State Health Information System, including a single information space for the exchange of medical data between medical institutions, health authorities and citizens: in,, and St. Petersburg. Murmansk Leningrad Arkhangelskaya regions She also modernized the regional fragment of the Uniform State Health Information System Krasnodar Territory in and introduced the state health information system. Novgorod region

On February 1, 2021, the Order of the Ministry of Health of Russia dated 07.09.2020 No. 947n entered into force, which determined the legal status of the medical electronic document, which was previously absent. The order, which was long awaited in the professional community of developers of software products and services for the informatization of medicine, stipulates the requirements for MIS, which are allowed to be presented for the maintenance of medical electronic document management, the procedure for signing such documents, their issuance to the patient. The order also regulates the interaction of medical information systems with the EDM (Register of Electronic Documents), the possibility of making changes to electronic documents and the terms of their storage.

The text of the order gives significant freedom in the application of certain provisions. And this is much better than including clear but difficult requirements. In many issues, everything will be decided by law enforcement practice, but so far the order makes it possible to rebuild it in the most effective way.

The expert was especially pleased that the order does not oblige medical organizations to switch to electronic document management. They can choose the tactics of introducing EDO themselves: which types of documents to translate into EDO, and which are more convenient to leave in paper.

According to Dmitry Kotokhin, before the developers of complex IT solutions in the field of digitalization of healthcare, order No. 947n opened a new front for the introduction of electronic document management in medical organizations and its integration with federal services: Uniform State Health Information System, VIMIS (vertically integrated medical information systems), RAMD, LIS (laboratory information systems), IEMK (integrated electronic medical records). The expert expects that a complete rejection of paper documents will occur within the next five years.

At the same time, Andrei Dyukov notes as a trend the understanding that the use of a medical document is limited.

The need to move to interaction between medical information systems through structured medical messages has become apparent, he argues.

In our country, its application so far slows down regulatory regulation, - he states.

Nevertheless, it must be admitted that the already existing Order of the Ministry of Health of Russia dated 07.09.2020 No. 947n provides medical organizations with the opportunity to gradually establish the exchange of electronic documents with each other, with health authorities and make them available to their patients.

Another goal outlined by the National Project "Healthcare" is the introduction of a system of electronic prescriptions in all constituent entities of the Russian Federation in 2023. Such a system should minimize the burden on doctors associated with the need to extend prescriptions for chronic patients. According to Medicata, 30% of patients apply to state clinics for this purpose. The translation of drug discharge into electronic form is convenient for all participants in the process: it contributes to the growth in demand for the service of telemedicine consultations by patients, and also has a positive effect on the availability of drugs in the regions.

This fall, it became clear that there is a movement in this direction: The administration of the Kursk region announced that by the beginning of 2022 the possibility of issuing electronic prescriptions will appear in all state polyclinics of this subject of the Russian Federation. To do this, all medical organizations of this type and all pharmacies will be connected to the Electronic Prescription platform developed by Medicata.

Medicata was the first in Russia to introduce electronic prescriptions. Since 2019, we have integrated with the largest federal MIS, thanks to which we can offer a seamless technological solution to 55 regions of Russia. We believe in the development of digital services for prescribing drugs, so we are already developing technologies for remote prescribing and managing drug therapy, testing services for delivering prescription drugs - such a comment by Boris Gorodetsky, its general director, is given in a press release dedicated to the event.

The Most Sought-After Classes of Healthcare IT Solutions and Leading Vendors

According to the TAdviser project database, among the various classes of IT solutions in the industry health care , enterprise resource planning (), ERP systems, video conferencings as well as systems electronic document management EDMS () and business process management are most in demand. It is these solutions in the TAdviser database that account for the largest number of projects completed in healthcare.

For each class of IT systems implemented in certain industries, the TAdviser database allows you to identify the most popular solutions and vendors of these products. See the charts below for which companies develop the systems most commonly implemented in health care.

The top 10 most commonly implemented classes of IT systems in healthcare, according to TAdviser, include BI solutions. According to experts, the direction of BI and big data analytics in healthcare is actively developing. This uses both industry best practices and new technological capabilities. The focus of the methodological base for the development and implementation of such intellectual solutions is scientific research centers and institutes.

According to Sergei Shestakov, CEO of the Luxms group of companies, there are several development drivers here. This is the emergence and growth of sanitary and epidemiological threats, the implementation of state programs in the field of health and public administration, an increase in quantitative and qualitative indicators of the provision of medical services, as well as the total digitalization of the industry. For example, many Muscovites already use an electronic medical record and receive laboratory results in electronic form.

But there are also factors that restrain this process.

I will begin with the fact that the implementation of BI solutions in medical institutions requires large resources: temporary, financial, personnel. Since mistakes in medicine are expensive, we have no right to them. In this work, we are faced with shortcomings in the technology of collecting, storing and processing medical data, while we are obliged to ensure their privacy at all stages. In addition, in conditions when a significant part of the medical capacity is involved in the fight against the COVID-19 pandemic and fewer resources remain to work with serious chronic diseases, work with registers is of particular importance, "says Sergey Shestakov.

As an example of the implementation of the BI-project of the Luxms Group of Companies, he cited the creation of an information and analytical module "Control of health indicators of the city of St. Petersburg," designed to promptly provide health managers with up-to-date and reliable information on key issues of medical care in the city. The project was commissioned by St. Petersburg MIAC.

In 2021, we solved the most difficult task of controlling the routing of patients. BI capabilities were required for daily operational work to track the correctness of filling the system with patient routing data. We are meeting the customer halfway, because we understand that we are helping to comprehensively solve the problems of situation control, digitalization and data-based management, - commented the General Director of Luxms Group of Companies.

As effective medical data management will be essential for the digitalization of healthcare, it can be assumed that the BI market and big data analytics in this area will become one of the fastest growing and will develop at the same pace as the entire Big Data market.

As for the developers of medical information systems, here the TAdviser database also allows you to distinguish leaders in the number of projects implemented. In total, as of January 2022, TAdviser has information about 226 projects for the implementation of such systems. The leaders are K-MIS, BARS Group and 1C.

Technologies and Solutions with Perspective

The electronic prescription service mentioned above is a natural and reasonable addition to telemedicine consultations, the number of which has increased since the beginning of the pandemic and government centers, health service providers, and private clinics. The first solved the problem of remote monitoring of patients with coronavirus who were on outpatient treatment. The second and third means of telemedicine supported patients with chronic diseases, forced to observe a home regimen for several months. For example, in the Renaissance Clinic, the number of telemedicine consultations increased 8 times, that is, up to 10 thousand doctor-patient sessions per month. Such figures were cited by Aleksei Obraztsov, its general director.

And although the current legislation (Federal Law of 29.07.2017 No. 242-FZ) allows such remote interaction of health workers with patients or their legal representatives for secondary admission or for collecting a history preceding primary admission, it turned out to be useful for many patients. Telemedicine consultations helped them build the optimal route between the clinic's specialist doctors, and if it is private, save money. So, only in the system "Medved.Telemed." for 2020-2021, more than 50 thousand consultations were held in order to provide assistance to 17.5 thousand patients. Endocrinologists practiced telemedicine more often than other specialists. They accounted for 40% of all these consultations. In second place in terms of the frequency of online appointments are district pediatricians and therapists with the same shares of 20%. Another 10% of telemedicine consultations during this period were conducted by obstetricians-gynecologists.

As for geography, out of 9 constituent entities of the Russian Federation in which the Bear system operates. Telemed, "the absolute leader by a wide margin is the Republic of Yakutia, in which 65% of all remote consultations were held.

Most of the work during consultations in this format takes place outside the video communication session, - notes Andrei Dyukov. - It consists in the consideration of medical data and patient's documents, therefore, now in parallel with the introduction of telemedicine services in the regions, there is an active introduction of the entire range of information systems that facilitate and speed up this process.

We believe that clinical guidelines should reflect how, in which nosologies remote counseling can be used. Doctors should not be afraid to use this format in their activities. It is also necessary to think over the economic levers of motivation for doctors, tariffs, popularize new services in the regions in which they are available, train doctors and patients to use them, the expert says.

In the meantime, telemedicine consultations are unprofitable for doctors, since the tariffs for face-to-face and online appointments differ significantly, and not in favor of the latter. Not all budget clinics have the technical equipment necessary to connect to the service. In addition, most of the consultations - 80% - are carried out by doctors not online, but in chats and, often, after work, since time is not allocated for them during reception hours.

To increase the effectiveness of telemedicine consultations through the "doctor-patient" line, digital devices for objective control of the state of health of the latter are needed, with the function of connecting to the Internet. And here telemedicine closes with the second promising direction - medical mobile devices (gadgets) and applications for a healthy lifestyle and longevity.

These devices should be available to the patient, regularly used by them, and close the entire range of parameters that can be measured to assess the state of health, - Elena Kirilenko, founder, general director of KELEANZ Medical LLC, formulated the requirements for such devices at the round table of Delovoy Petersburg.

And in this area, the regulator has yet to solve the problems with the registration and certification of such mobile devices as medical devices, possibly simplified, with a set of tests confirming their effectiveness, with verification. The emergence of devices for objective control of health parameters, certified and approved by the Ministry of Health of Russia, will open for new participants a fairly free niche of remote pre-trip inspections of taxi drivers, public transport, drivers of electric trains and long-distance trains, said Maxim Ryukhin, executive director of System Technologies.

No less important than such devices are software tools for interpreting data received from them on the side of a medical organization. And this requires predictive analytics systems, algorithms and mathematical methods for processing big medical data and other artificial intelligence technologies.

Medical information systems and services using neural networks, machine learning computer vision and some other innovations today around the world are at the peak of interest of both developers and their clients. According to Markets And Markets, the global artificial intelligence (AI) market in AI healthcare will grow from 4.9 billion dollars USA in 2020 to US $45.2 billion by 2026. The average annual growth of the market is 44.9%. In the world, about 3 thousand offer startups their products and services in this area.

Compared to humans, algorithms have significant advantages: they are not subject to emotions, do not need breaks and vacations and learn faster. All this gives reason to expect from the use of artificial intelligence in medicine to curb the exponential growth in the volume of medical data, to help doctors make the right clinical decisions with high accuracy, to solve integration problems.

Today, digital medicine already uses algorithms with the ability to recognize speech (we wrote about chat bots working in the Ambulance service above) and images, or rather the results of all existing radiation diagnostics methods - X-rays, mammography and fluorography, CT, MRI and some others. In Russia, there are already several innovative companies that develop effective mathematical processing methods that allow you to accurately and quickly find deviations from the norm in them, for example, neoplasms. These include Botkin.AI, Celsus, SberMedAI.

The neural network assigns to the image the degree of lung damage from CT 1 to CT 4. Our algorithm has proven itself positively in several regions of Russia, - said I. Zuk.

More complex applications of artificial intelligence in medicine are considered systems for supporting medical decision-making. The task of this class of MIS is to assist the doctor in making a clinical decision based on the results of the analysis of patient data and available scientific medical information.

An example is the forecast analytics platform Webiomed. It identifies risk factors for diseases, predicts the likelihood of complications or even death of the patient, and then forms individual recommendations for preventing the disease. Currently, this SPPVR is successfully used in the Yamalo-Nenets Autonomous Okrug, the Kirov Region, in Kondopoga and in Petrozavodsk.

In the context of a shortage of time allocated for the appointment of one patient, doctors of budgetary medical organizations today really need such intellectual support. At the same time, experts say that SPPVR, like all the achievements of information technologies used in medicine, is just a tool, and you need to understand how to use it and why.

Like any remedy used in medicine, artificial intelligence technologies must obey the principle: "Do no harm." At the same time, due to the novelty of the AI sphere, regulation is still in the formation stage, states Igal Zuk. According to him, SberMedII, as an integrator of ecosystem solutions using artificial intelligence technologies, takes into account the Federal Law of 24.04.2020 No. 123-FZ. This regulatory act introduces an experimental legal regime of preferential regulation for five years to create conditions for the development and introduction of AI technologies in Moscow. It and the Law "On Personal Data" (July 27, 2006 No. 152-ФЗ) are aimed at the development and further use of AI achievements in the capital.

{{quote 'The introduction of artificial intelligence technologies in medical organizations requires joint decisions of doctors, developers and managers at different levels, but, in general, significant barriers, technological or administrative, we have not identified, - notes I. Zuk. }}

Conclusion

Players in the healthcare digitalization market recognize the rules of the medical community, make efforts to ensure that their systems are understandable and simple for doctors, have a friendly interface, and are also easily customized to their wishes. And since they have a clear understanding of the specifics of this area, they are able to help Russian medicine not only survive the digital transformation, but get out of its crucible with an updated, facing the patient and mastering all the most modern means for its treatment.

Notes