Alexey Ostroushko, CIO clinics "Be Zdorov": I would not like to depend on vendors

Alexey Ostroushko: Among the priority areas of development, we are currently focusing on solutions using artificial intelligence (AI) and cloud technologies. The company currently has seven different AI models, and in terms of cloud technologies we use a hybrid approach - a combination of third-party data centers from large providers and data centers within the Ingosstrakh group of companies. At the same time, we are heading for the priority use of private clouds in our own data centers.

So, within the framework of the group, one own data center has already been built, it was recently launched. Part of our computing power from data centers of external providers will be transferred to it, several racks with equipment will move in 2025. And the second corporate group data center is planned to be launched in 2027. This approach will ensure greater security of our data.

Infrastructure is one of the largest areas of investment we have now. Due to the construction of data centers, this area also includes quite large costs for network communications. In addition, significant investments require updating the fleet of equipment, including server solutions. At the same time, in addition to updating the iron park and creating its investment sites, the infrastructure also requires due to the fact that it is expanding.

And in addition to infrastructure and artificial intelligence, the third major area of ​ ​ investment is investment in employees, team formation and training. Since it is people who are the basis of success, and humanity is one of the key values ​ ​ of our company.

Alexey Ostroushko: First of all, this is due to the growth of our network. So, during 2025 we plan to open 4 more clinics of the network, and all of them need equipment. At the same time, the network of clinics "Be Healthy" has been purchased for 20 years, some of the equipment has been purchased for a long time, so now investments are also required to update the park. Our company has established standards for the terms of use of various equipment, in accordance with them, we decommission old equipment every year and purchase new ones. Partially expanding the infrastructure also requires the development of the use of AI in the company.

Alexey Ostroushko: Here I would separately talk about software and hardware. We are gradually trying to increase the share of decisions of both. Regarding the first, since we belong to the field of medicine, where there is laboratory diagnostics, we were initially closer to domestic software than in the average company of the non-medical market. Therefore, we have previously used specialized medical software of such, for example, classes as MIS, LIS. At the system software level, imported products are still present to a small extent: for example, in one large medical system, we use the MSQL DBMS. But in general, at the level of application software, import substitution is about 80-85%.

At the workstation level, so far about 15% of our workplaces use Russian software - operating systems and office packages. We do not completely translate them, because there is no urgent need. Regarding server operating systems and virtual machines: about 30-40% of virtual machines have already been transferred to Russian software. As for the "hardware," while we mainly continue to use the same import solutions that we used before. The alternatives that are now on the market are either too expensive - about 200 thousand rubles per workstation, or are not completely import-substituted, but simply represent a rebranding of well-known brands. Therefore, as alternatives, we rather consider the technique of Asian manufacturers - it is cheaper.

At the network equipment level, we mainly use Huawei equipment. This was a well-known brand until 2022, and now it has simply strengthened its position in the Russian market.

Alexey Ostroushko: We have a rather strong internal development. There is our own mobile development team - we are betting on this, because the market, especially marketplaces like Ozon and Wildberries, teaches the consumer to use a mobile application for everything, and not a classic web page.

We also develop our own development of a medical information system, internal portal solutions. There are several players on the market offering large MISs. But they are more "sharpened" for certain business processes, and we need flexibility and the ability to receive the necessary changes quickly, and not in a few months or a year. Or even the vendor may refuse to make the changes we need.

And given the fact that we are now also actively developing according to the franchisee model, our entire infrastructure is increasingly going into the internal circuit, and we would not want to depend on vendors. Thus, our investment in development is large, and the team will only increase in the future - in order to have the maximum speed of business changes - from idea to implementation. This allows, among other things, to be faster than other medical institutions in the implementation of many initiatives that give competitive advantages. For example, before everyone else, integrate with the MAX messenger.

It is important that when expanding the team, we do not limit ourselves to recruiting employees in Moscow, but also cover other cities, including Vladivostok, Yekaterinburg, Voronezh, etc. We try to recruit strong developers throughout Russia.

Alexey Ostroushko: We do not have this kind of cooperation now. We have a number of contractors with whom we work very closely. For example, in the direction of non-transcript entry of medical records, when a doctor, without using a keyboard, speaks the necessary records with his voice. In such projects, we are a landfill for developers to introduce various new models, we say with them that we are the first, unique and have a gap of six months, and that prices for us will be the most attractive. And then they can broadcast this decision to the open market. But we also look at different teams in terms of the prospects for M&A - the acquisition, acquisition of a stake, as well as in terms of the prospects for a joint partnership. We are considering various schemes, and now negotiations are underway with some solution providers, but we cannot advertise the names of specific companies yet.

Alexey Ostroushko: We are still "pioneers" in this regard. So far, we cannot disclose all the details, but I can say that this is a small company that specializes in the medical business and the use of AI. We were attracted to their innovation and speed of development. Such fast companies are of interest to us in the first place.

Alexey Ostroushko: In our work, we use all the most promising AI models at the moment. Among them are those associated with the medical record control system. On average, 2-5% of medical records and protocols are currently checked in medicine, and 95% of protocols do not pass expert verification, because in large clinics, clinical centers there are very large volumes of protocols and appointments. The classic system is a random check of maps, and the new system involves processing 100% of the protocols using advanced AI models. Thanks to these decisions, the protocols are assessed and analyzed, possible inaccuracies are "highlighted," and then, after eliminating the comments, only those protocols that require attention are sent to doctors for re-verification. That is, the doctor does not view "manually" all incoming protocols with a quality assessment of 70 to 100 points. This makes it possible to significantly relieve the burden on medical personnel when performing routine operations.

AI models used in this way make it possible to achieve a high level of quality control of medical protocols. And then people are already included, doctors undergo additional training, mastering new skills for themselves in working with models of artificial intelligence, which definitely does not replace a medical specialist, but becomes his reliable assistant, relieving the excess load.

The second is the decision support system (SPMS), when, based on complaints, history and accompanying information, the AI doctor "highlights" the alleged diagnoses. In our case, we are talking about several alleged diagnoses. Due to the fact that in our clinics there are no strict restrictions on the time of patient admission, as part of an integrated approach to studying medical history, the doctor first applies his medical expertise when studying each clinical case, and then the AI system gives him hints on the diagnosis. And, as our practice shows, in some cases, after receiving an assessment from AI, the doctor subsequently focuses on some additional details and adjusts his diagnosis.

The third direction is radiology. Here AI is used to analyze X-ray and CT images, it "highlights" some pathologies on them. And if there is a system for storing images, which are usually found in large companies, it is possible to retrospectively view and study all the pictures that were taken before for several years, and if something was missed at the time of X-ray or CT, then call the patient again and invite him for further examination if necessary. I believe that these three AI models are necessary for every medical organization.

Alexey Ostroushko: In my opinion, from the point of view of regulation, there are no strong difficulties. In the case of companies with state participation, for example, they look at the registration certificate, and the average period for obtaining it is from 2 to 3 years. But, for example, Moscow came out of this problem and uses an experimental mode, which simplifies the use of AI in the activities of clinics, since new technologies and their update in this area appear quite quickly. There are regulatory requirements that need to be met, such as the organization of infrastructure for storing and processing personal data of patients, and it is clear that data is not sent to any servers abroad. Moreover, even in relation to anonymized data, clinics adhere to very strict standards regarding storage and processing. So the existing regulatory rules quite allow you to stay at the tip of technology.

Alexey Ostroushko: Yes, when the problems began at the well-known largest air carrier in the country and two networks of private clinics, and quite well-known, the first thing we did was to complicate the work of users, removed the last crumbs of access that the user had. Now it is more difficult to connect to us, but this is due to the need to strengthen security. Of course, we did not reach the conditional level of state secrets - that is, in 100% of cases we do not need to come to the office, insert keys and work only from the office, but we connected two-factor authentication, strengthened encrypted communication channels, changed all users passwords. Within two weeks, we actively worked, however, without stopping at this: now we are once again ordering pentests for us - tests for penetration into our infrastructure.

With all this, we have a centralized SOC (Security Operations Center) from our "parent" company, which protects us as part of Ingosstrakh. But the management of subsidiaries also bears personal responsibility for information security, so we additionally double-check our own perimeter.

It is important to understand that this is an endless story. No matter what we do now, after some time it will be necessary to strengthen ourselves again from the point of view of information security. You can never assume that data is 100% protected. And if desired, a sufficient budget and perseverance can be "unearthed" any security system in any company. The same air carrier mentioned above is an example: not the last specialists in the field of information security are clearly working there. They, of course, recovered from this attack quite quickly, but their experience demonstrated that no one is safe from such incidents.

Alexey Ostroushko: Compared to what happened earlier - about 5 years ago, now, for example, there are much fewer attacks using ransomware. Most likely, standard defenses have adapted to such attacks, and now there are practically no ransomware. Now, perhaps, they use this approach more often: they penetrate the infrastructure and stay in it for months to pump out some unique information from the organization. That is, we are talking about not just breaking and destroying, but getting the maximum benefit from being inside the infrastructure. I believe that in the coming few years this approach will remain relevant.

Alexey Ostroushko: The dynamics is positive - about 25-30%, if we talk about IT infrastructure, software, etc. And in terms of the number of IT specialists, we have an increase of 30% year-on-year. Here, of course, there is also a low base effect. We are opening new clinics, and this entails an increase in development and the need for more IT specialists. Growth here also stimulates the active development of individual areas, such as, for example, mobile development and AI. In this, mainly funds are invested.

Alexey Ostroushko: In Moscow, the penetration rate of mobile use is higher than in other regions - 70-80%. And in general, about 60% of our clients use a mobile application to make appointments to clinics. According to our data, this is the highest rate among medical organizations. We consider it important that all communications go to the mobile application, because it is more convenient for the consumer. And there have been studies that the last one where people turn off push notifications is banking and medical apps.

Alexey Ostroushko: There is no obvious form. But this affected the plans to open its own clinics, taking into account their construction, therefore, against the background of the high rate of the Central Bank, the direction of franchisees began to actively develop.