Digitalization of Healthcare Review

Investment in digital medicine in 2020 increased by 45% in the world and by 90% in the United States, where a year earlier there was a 10% decrease compared to 2018. Such data cites CB^[1]. In absolute terms, investments in healthtech amounted to $26.5 billion. This is 33% of all global investments in health. And $14.1 billion of them came from the American market.

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

The most popular directions for 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 current areas of digital transformation of the industry, the achievements of the Russian market of healthcare digitalization and its problems, as well as development prospects are in the focus of a new review by TAdviser.

How the pandemic accelerated the digitalization of health care

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

In Russia, from March 2020, new digital medical services began to appear. 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 to be the operator for making calls to the doctor at home. Later, the capabilities of chat bots were used 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 has increased.

A request for the introduction of telemedicine systems appeared from relevant regional departments and individual LPUs, he says. - Of course, you have to fight spontaneously established practices, for example, consulting in instant messengers, which contradict the requirements of the legislation. But everything related to the remote interaction of the doctor and the patient: telemedicine consultations, remote monitoring of chronic patients, electronic prescriptions, appointment registration without visiting a medical organization has become very popular.

Healthcare informatization was initiated in Russia by the state back in 2011, and in 2017-2018 its results were rethought. The remote interaction of the doctor and the patient using information technologies was introduced into the legal field by the Federal Law of 29.07.2017 No. 242-FZ. He allowed electronic document circulation in medical organizations, without specifying its legal status. And the adoption of the Decree of the Government of the Russian Federation dated 5.05.2018 No. 555 "On the Unified State Information System in the Field of Health Care" and the approval of the Federal project "Creating a Single Digital Circuit in Health Care on the Basis of the Unified State Information System in the Field of Health Care (Uniform State Health Information System)" in the framework of the National Project "Health" in 2018 year launched the 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 documentation between medical organizations and health management bodies, as well as hospital and prescriptions in electronic form.

And admittedly, the coronavirus pandemic accelerated its implementation throughout Russia. Thus, 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 ones. Moreover, exceeding the key performance indicators is observed in all other areas of the Federal Project.

Major IT Providers

The largest IT provider for healthcare in Russia in terms of income from projects in this area for 2020 was the company Cifromed. Its revenue amounted to 5.7 billion rubles, an increase of 608% over the year. The top five also included companies Krok, RT MIS, BARS Group and AyCIel Techno.

The total revenue of 10 largest rating companies for 2020 year amounted to 18.8 billion rubles. A year earlier, their total revenue was at 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 Unified 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 can receive information about the provided medical care on the Unified Portal of Public Services (EPSU) 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, Director of Development of Webiomed, a member Supervisory Board of the Association of NBMZ during a round table held by Business Petersburg. Recognizing that the picture of the digital transformation of budget medical organizations in Russia is heterogeneous, the expert noted that they have achieved the greatest success, and Moscow a number of St. Petersburg other entities RUSSIAN FEDERATION in central Russia.

Through trial and error, continuous improvement of the regulatory framework, the country is moving towards the creation of a single digital health information space. Since developers must ensure interaction within the framework of compulsory medical insurance (MHI), as well as generate the required reports, they have to regularly update the systems, said Dmitry Kotokhin, development director of RMIS "Bear," (GK "Host").

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

And "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 St. Petersburg, Murmansk, Leningrad and Arkhangelsk regions. She also modernized the regional fragment of the Uniform State Health Information System in the Krasnodar Territory and introduced the state health information system of the Novgorod region.

On February 1, 2021, the Order of the Ministry of Health of Russia dated 07.09.2020 No. 947n came into force, which determined the legal status of a medical electronic document that 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 IIAs that are allowed for 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 REMD (Register of Electronic Documents), the possibility of amending electronic documents and their retention dates.

The text of the order gives considerable freedom in the application of certain provisions. And this is much better than including clear but difficult requirements. In many matters, law enforcement practice will decide everything, 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 implementing EDO themselves: what 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 healthcare digitalization, 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), REMD, LIS (laboratory information systems), IEM. 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 in the industry that the application of the medical document is limited.

The need for a transition to interaction between medical information systems through structured medical messages has become apparent, he says.

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

Nevertheless, it must be recognized 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 exchange electronic documents with each other, with health management bodies and make them available to their patients.

Another goal outlined by the National Project "Healthcare" is the introduction of an electronic prescription system 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 to chronic patients. According to Medicata, 30% of patients turn to state clinics for this purpose. The electronic transfer of drug discharge is convenient for all participants in the process: it contributes to the increase in demand for telemedical consultations with patients, and also positively affects the availability of medicines in the regions.

In the fall of this year, it became clear that there was a movement in this direction: the Administration of the Kursk Region announced that by the beginning of 2022 the possibility of issuing electronic prescriptions would appear in all state clinics of this subject of the Russian Federation. For 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 recipes. Since 2019, we have been integrating with the largest federal IIAs, 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 prescription drug delivery - such a comment by Boris Gorodetsky, its general director, is given in a press release dedicated to the event.

The Most Sought-After Healthcare IT Classes and Leading Vendors

According to the TAdviser Project Database, Enterprise health care Resource Planning (ERP ERP), Systems, video conferencings and electronic document management EDMS Business Process Management (BPM) are among the various classes of IT solutions in the industry. It is these solutions in the TAdviser base that account for the largest number of projects implemented in healthcare.

For each class of IT systems implemented in specific industries, the TAdviser database identifies the most popular solutions and vendors of these products. See the diagrams below for which companies are developing the systems most frequently implemented in the field of health protection.

According to TAdviser, the Top 10 most commonly implemented classes of IT systems in healthcare also includes 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 are research centers and institutes.

According to Sergey Shestakov, general director 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 care and public administration, an increase in quantitative and qualitative indicators of the provision of medical services, as well as total digitalization of the industry. For example, many Muscovites already use an electronic medical card and receive the results of laboratory studies in electronic form.

But there are also constraints to this process.

Let's start with the fact that the introduction of BI solutions in medical institutions requires a lot of resources, temporary, financial, personnel. Since mistakes in medicine are expensive, we are not entitled to them. In this work, we are faced with shortcomings in the technologies for collecting, storing and processing medical data, while we are obliged to ensure their privacy at all stages. In addition, in conditions where a significant part of the medical capacity is involved in the fight against the COVID-19 pandemic and less resources remain to work with serious chronic diseases, work with registers becomes especially important, "says Sergey Shestakov.

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

In 2021, we solved the most difficult task of monitoring patient routing. BI capabilities were required for daily operational work to track the correctness of filling the system with patient routing data. We are going to meet the customer, because we understand that we are helping in the complex to solve the problems of situation control, digitalization and data-based management, "commented the general director of Luxms Group of Companies.

Since effective medical data management will be important for healthcare digitalization, it can be assumed that the BI and big data analytics market 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 developers of medical information systems, the TAdviser database also allows you to distinguish leaders in the number of projects implemented. In total, as of January 2022, TAdviser has information on 226 projects for the implementation of such systems. The leaders are K-MIS, BARS Group and 1S.

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 both government centers, medical service providers, and private clinics since the beginning of the pandemic. 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 who were forced to observe a home regime 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 Alexey Obraztsov, its general director.

And although the current legislation (Federal Law No. 242-FZ of 29.07.2017) allows such remote interaction of medical workers with patients or their legal representatives for secondary admission or for a diagnosis prior to primary admission, it has proved useful to many patients. Telemedicine consultations helped them build the optimal route between doctors-specialists of the clinic, and in case it is private, save. So, only in the Medved system for 2020-2021, more than 50 thousand consultations were held in the Medved system 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 telemedical 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. Telemedad, "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, "said Andrei Dyukov. - It consists in the consideration of medical data and patient's documents, so now in parallel with the introduction of telemedicine services in the regions there is an active introduction of the whole spectrum of information systems that facilitate and accelerate 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 through the economic levers of motivation of 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 tariffs for face-to-face and online appointments differ many times, 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 chat rooms 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 monitoring of the health of the latter with the function of connecting to the Internet are needed. 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 accessible to the patient, regularly used by them and close the entire range of parameters that can be measured to assess the state of health, "formulated the requirements for such devices at the Business Petersburg round table Elena Kirilenko, founder, general director of KELEANZ Medical LLC.

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

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

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

Compared to a person, algorithms have significant advantages: they are not susceptible 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 curbing the exponential growth of medical data, helping doctors make the right clinical decisions with high accuracy, solving integration problems.

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

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

The more complex application of artificial intelligence in medicine is considered to be systems for supporting medical decision-making. The goal of this class of IIAs is to help the physician make a clinical decision based on the results of patient data analysis and available scientific medical information.

An example is the Webiomed predictive analytics platform. It identifies disease risk factors, 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, Kirov Region, Kondopog and Petrozavodsk.

In conditions of insufficient time allocated for the appointment of one patient, doctors of budgetary medical organizations today very much 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 tool used in medicine, artificial intelligence technologies should obey the principle: "Do not harm." At the same time, due to their novelty, the regulation of the AI sphere, states Igal Zuk, is still under formation. According to him, SberMedAI 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 for five years an experimental legal regime of flax regulation to create conditions for the development and implementation of AI technologies in Moscow. It and the Law "On Personal Data" (July 27, 2006 N 152-FZ) are aimed at the development and further use of AI achievements in the capital.

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

Conclusion

Healthcare digitalization market players recognize the rules of the medical community, make efforts to make their systems clear and simple for doctors, have a friendly interface, and are also easily customized to suit their wishes. And since they have a clear understanding of the specifics of this sphere, they are able to help Russian medicine not only survive the digital transformation, but come out of it burned updated, facing the patient and mastering all the most modern means for its treatment.

Notes