Electronic Health Records (EMR)

2023: In 2024, everyone will switch to electronic medical records

Russian Health Minister Mikhail Murashko noted that from 2024 the transition to electronic medical records will become mandatory.

From 2024, we will present this (transition to electronic medical records) to the executive authorities as a prerequisite, because otherwise we simply cannot collect data arrays. Paper rejection is a financial, intellectual tool, continuity, including between levels of medical care, and patient escort, the minister said.

At the same time, we are talking about the transition to an electronic medical card "with the formation of fields, requirements for regional medical information systems."

In general, the future of primary health care is, of course, accessibility to the population and the rejection of paper. We do not encroach on anyone's powers, we do not encroach on medical handwriting in any way, sorry, please - he has already proven himself in anecdotes. The question is not to read the medical handwriting, translating all this into a figure. And it is the data resource that allows us to transform healthcare, "Mikhail Murashko explained.

The transfer of paper to digital is the main step in ensuring the full digitalization of public spheres, said Anton Nemkin, a member of the State Duma Committee on Information Policy, Information Technologies and Communications.

One of the opportunities that digitalization offers us is decision-making based on an analytical approach. That is, when performing a preliminary analysis of possible risks and consequences. This is only possible in conditions where all data is stored digitally. It is not so important what they mean: a diagnosis or information about a person's purchasing behavior. All this is valuable capital for making an effective and effective decision, including in the social spheres. Therefore, the introduction of such an obligation is a timely and positive trend, the deputy believes.

2022

Moscow has created an AI system that looks for signs of genetic diseases according to medical records

At the end of December 2022, iPavlov (created by MIPT employees) announced a computer system for screening electronic medical records (EMR) in order to identify rare genetic (orphan) diseases. The solution is designed for children under seven years of age and allows you to identify patients from risk groups. Read more here

CT and MRI images from clinics in Moscow are now available in the electronic medical record of EMIAS

On November 2, 2022, it became known that residents Moscow can now view the results of CT and MRI studies done in private clinics. electronic medical record (EMR) 15 private clinics and 25 federal institutions are already participating in the project. More. here

Moscow allocated 170 million rubles for the digitization of paper medical records and extracts

In September 2022, a tender was announced for updating the Unified Medical Information and Analytical System (EMIAS) to digitize paper medical records and extracts. The winner of the competition will be able to count on the conclusion of a contract worth up to 171.8 million rubles. Read more here.

All children's clinics in Moscow have completely switched to electronic medical records

On August 9, 2022, it became known about the complete transition of all children's clinics in Moscow to electronic medical records. Thanks to this, doctors and patients are exempt from unnecessary paperwork.

Old medical records have already begun to be transferred for storage to the Glavarkhiv robotic cluster, and on the site of cardboard storage facilities in clinics they equip comfortable professional growth rooms and lounges with computers, coffee machines and comfortable sofas. The storage area in the new cluster is almost 70 thousand square meters. Up to 100 million units of paper materials can be placed here.

Children's clinics in Moscow switched to electronic medical records

We have completed an important stage in the transition to a digital clinic of the future. The entire children's outpatient link of the capital refused to conduct medical records on paper. Now the work is carried out exclusively in electronic medical records. This is convenient for parents of young patients - you no longer need to disassemble the medical handwriting, worry about the loss of the card or that it fades or deteriorates. All key medical information about the child is now always at hand - right in the smartphone, - said Anastasia Rakova, Deputy Mayor of Moscow for Social Development.

As explained in the capital's mayor's office, thanks to electronic medical records, all medical data about the patient are stored in a single digital environment in a convenient structured format, this allows you to quickly find the necessary information during admission. At the same time, an electronic medical record gives the patient access to medical information 24 hours a day, and this information can be presented to any attending physician in city, federal or private medical institutions. All documents from the electronic medical record can be downloaded and then sent by e-mail (or using any other messenger) or simply printed.^[1]

A failed IT project in Australia. The system of electronic medical records for $2 billion turned out to be unnecessary

On June 5, 2022, a study was published that shows that more than 10 years after the introduction of the My Health Record electronic medical record system in Australia, less than a quarter of all citizens have medical records in it, and doctors do not see the benefits of using the national online database. data More. here

In the United States launched a new system of electronic medical records for $16 billion

In mid-March 2022, the United States launched a $16 billion electronic medical card system for veterans. The U.S. Department of Health and Human Services plans to introduce a digital health records system at the second Washington hospital in Walla Walla and then accelerate adoption at other hospitals and clinics in the Pacific Northwest and other regions by December 2022. Read more here.

2021

Electronic medical records of children became available to health workers in schools and kindergartens in Moscow

From October 5, 2021, information about children's appeals to health workers in schools and kindergartens in Moscow began to be stored electronically. Doctors and paramedics of these institutions were able to fill out a digital protocol in the Unified Medical Information System (EMIAS), according to the website of the mayor of Moscow. Read more here.

The child's digital medical passport began to be used in Moscow

The child's digital medical passport began to be used in Moscow. The city authorities announced this on September 21, 2021.

The new service is available to doctors of children's clinics, as well as health workers in schools and kindergartens as part of the patient's electronic card. In addition to medical data on benefits, chronic diseases, the digital passport also contains information about attaching a child to a specific medical institution, data on the child's representative, information about the school or kindergarten where the child goes.

The child's digital medical passport began to be used in the capital of Russia

According to Anastasia Rakova, deputy mayor of the capital for social development, the service allows doctors to see a collection of the most important information about the child, and not only medical. For example, these are: blood type, the presence of chronic diseases, information about the educational institution visited by the young patient, contacts of its representatives. The information is promptly updated and reflected on a single form. Previously, such information was stored separately, which made it difficult to find them.

It is claimed that the new tool provides healthcare professionals with quick and convenient access to patient health information and improves the quality of care for children. For example, up-to-date information on social status allows you to determine measures of additional social support, as well as plan medical examination of children in difficult life situations.

In August 2021, a digital passport of the site became available for district doctors of polyclinics - another service that helps to more effectively monitor the health of citizens. It contains information on the structure of morbidity, data on patients eligible for social services, statistics on medical examination and other important information. This dataset provides an opportunity to assess the overall picture by site and monitor the health status of each patient individually.^[2]

Support for access to CT and MRI images in online format

On March 12, 2021 Moscow , information appeared on the official website of the mayor that images of instrumental studies, such as computed tomography (), CT magnetic resonance imaging MRI (),, and others, began to be added to the electronic medical records of citizens X-ray. mammography Users can download images so as not to visit the doctor's office.

Citizens will no longer have to apply to the clinic for an image once again, and if, for example, a consultation of several specialists is required, a link to the archive with pictures will be available online, "explained Anastasia Rakova, Deputy Mayor of Moscow for Social Development.

CT and MRI images are now added to the electronic medical records of Muscovites, they are available for download

Muscovites can download files with pictures of research directly in the electronic medical record on the mos.ru portal and in the mobile application "EMIAS.INFO." In addition, users can get pictures of instrumental studies of positron emission tomography combined with X-ray computed tomography (PET/CT).

To get a link to the archive with pictures, you need to go to the "My research" section, select the desired protocol from the list and then click "Request a study image." An alert about the readiness of the download link will appear on the mos.ru portal in the notification section (bell icon), which is located at the top of the start screen. In the mobile version of the medical card, the notification will be reflected in the form of a red signal dot next to the "Research" button.

It is noted that medical examinations are carried out using complex medical equipment, so the result is provided in the form of a high-quality detailed picture in DICOM format. A special program for viewing such images is added to the archive, as well as instructions for its use. Links for downloading files are valid on the page with the study protocol for five days.^[3]

Clinics and hospitals in the Russian Federation have the opportunity to completely abandon paper medical records

On February 1, 2021, an order of the Russian Ministry of Health came into force, according to which clinics and hospitals were able to completely abandon paper medical records and switch to electronic document management.

According to the approved procedure, the decision on the full or partial transition to electronic document management is made by the medical organization at its discretion. This means that medical organizations have the right to independently establish the timing of the transition to legally significant electronic document management and the types of documents to be translated into digital format.

Medical institutions in the Russian Federation may completely abandon paper medical records

At the same time, the patient is assigned the right to choose a convenient format for himself. He can submit a request for duplication of information from an electronic resource, which the medical organization is obliged to satisfy on the same day.

This order is a key document for the industry that will allow medical organizations to move from paper to electronic. Until today, there was a problem. For the second year we have been living in a federal project to create a single digital circuit, and the digitalization process itself has been going on even longer - since the early 2000s. And we were still obliged to keep all medical documentation in paper form, - said Pavel Pugachev, Deputy Minister of Health of Russia.

The electronic medical document must be signed with an enhanced qualified electronic signature (UKEP). Journals created on the basis of electronic medical documents signed by UKEP can be signed by other types of electronic signature.

According to him, the order enshrines the legal status of electronic document management, allowing medical organizations to report to control and supervisory authorities in digital format.^[4]

2020

Muscovites opened access to medical records through a mobile application

On June 26, 2020, access to electronic medical records was opened in Moscow through the EMIAS.INFO mobile application. Patients will be able to independently enter health data into it using smartphones.

The mobile version of the electronic medical record provides full access to your health information. All medical documents can be downloaded and sent via email or instant messengers.

Access to electronic medical records through a mobile application is open in Moscow

In addition, in the application you can make an appointment with a doctor, set up notifications about upcoming visits to the doctor or alerts about opening an appointment with him. There is no need to print a coupon.

With the help of a medical card, you can monitor key health indicators. Users will be able to download data on body temperature and oxygen levels, heart rate, blood sugar levels and blood pressure. To do this, the section "Health Diary" has been created.

For users accustomed to keeping health diaries in other services, it will be enough to install a special application "EMIAS Connect" and agree to send information to an electronic card, according to the official portal of the mayor of Moscow.

To access the "Medical card" section in the mobile application, the user needs to be over 15 years old and have a Moscow compulsory medical insurance policy. It is also important to issue access to the EMR on the portal mos.ru.

Muscovites will be able to independently upload such medical data, such as a doctor's examination protocol, results of laboratory and instrumental studies, discharge epicrisis, the conclusion of a medical commission, to an electronic card on the website mos.ru. Later, this function will appear in the mobile application.^[5]

It is impossible to provide a complete picture of medical information without the patient's participation in this process. And now we give the opportunity to enter data into the medical record on our own, - explained Anastasia Rakova, Deputy Mayor of Moscow for Social Development.

Test results for COVID-19 are now posted in electronic medical records of Muscovites

From May 20, 2020, the results of tests for the presence of coronavirus COVID-19 and for immunity to it began to be added to the electronic medical records of residents. Moscow This was announced by the official portal of the capital's mayor with reference to the deputy mayor of Moscow. Anastasia Rakova

The results of PCR and ELISA testing for COVID-19 have become available to Muscovites in an electronic medical record. Residents also receive a detailed transcript of all indicators and a clear explanation of what needs to be done next. Thanks to the electronic medical record, it has now become more convenient to receive information about the results of testing, "she said.

The results of tests for coronavirus can be viewed in the electronic medical record

The deputy mayor added that the test results will appear in the map within 2-4 days after the test. We are talking about the results of PCR and ELISA tests carried out after April 20, 2020.

By May 20, in Moscow, tests for a new type of coronavirus are required from patients with signs of SARS, pneumonia and everyone who lives with people who have confirmed COVID-19. In addition, screening of employees who often contact the townspeople is organized. These are medical and social workers, employees of transport, utilities, police. Patients of non-infectious hospitals are also tested for coronavirus.

On May 15, mass testing for the presence of population immunity to coronavirus began in Moscow. Every three days, about 70 thousand residents of the capital are invited to a free test. Test participants are determined by random sampling. Tests are carried out on the basis of 30 city polyclinics in all districts of the capital.

In 2-3 weeks, any resident of Moscow will be able to undergo free testing for antibodies to coronavirus, capital mayor Sergei Sobyanin said on May 17, 2020.^[6]

Vaccination cards for children in Moscow have become available electronically

In mid-February 2020, vaccination cards for children in Moscow became available online. The corresponding section called "Vaccination" appeared children's electronic medical records.

According to Anastasia Rakova, Deputy Mayor of Moscow for Social Development, now Muscovites will be able to see information about all vaccinations and tuberculosis samples performed, new vaccinations will also be stored in the child's electronic medical record.

Vaccination cards for children in Moscow have become available online

These data opened the possibility for analyzing the situation with children's vaccination throughout the city. We can quickly online monitor the work on vaccination of children and respond to cases of refusals from vaccinations, predict in advance the epidemiological situation in the city as a whole, as well as in certain groups of children - in schools and kindergartens. We have two systems connected - EMIAS and MES, and we can predict the risk of developing a particular disease in each class, - said Anastasia Rakova, whose words are quoted on the official website of the mayor of Moscow.

A list of 150 names of vaccines registered in Russia was added to the system. Also on the website of the Moscow Department of Health you can get acquainted with the regional calendar of vaccinations and vaccines that need to be done in the near future.

The Moscow government is conducting a lot of information work on vaccination, and with the advent of the vaccination register, it became possible to notify people not with general mailings, but targeted to each parent, taking into account the individual situation for each child.

By mid-February 2020, electronic cards were opened by about 190 thousand Muscovites, of which more than 30 thousand are children's cards. Data on all vaccinations made in city polyclinics or educational institutions are automatically loaded into an electronic card.^[7]

Muscovites opened access to their electronic medical records

On January 14, 2020, Muscovites were opened access to their electronic medical records. This was reported in the personal blog of the capital's mayor Sergei Sobyanin.

Patients over 15 years old can get access to electronic medical records on the official portal of the mayor and the government of Moscow (Mos.ru) in the "Services" section, as well as in any of the centers of public services "My Documents." After the appeal, access will be open within five working days.

Moscow polyclinics opened access to electronic medical records

To use the service through your personal account on the portal of the mayor of Moscow, you need to indicate passport data, a series and number of the compulsory medical insurance policy, a mobile phone number and attach your color photo with a passport in your hand. 

By January 14, 2020, in the electronic map, you can see the protocols for examining doctors from 2017, the results of tests and studies and epicrises from hospitals from 2019. All studies that will be carried out from 2020 will be automatically entered into the electronic map.^[8] 

In the future, information will be opened on an appointment with a doctor, medical examination, vaccination of children, etc. It is planned that in the future patients will have the opportunity to enter data into their card, for example, about a visit to a doctor in a private clinic.

Sergei Sobyanin stressed that such cards cannot be lost. By mid-January, the service will work in test mode.

We will gradually develop it, make it more convenient and informative, "said Anastasia Rakova, Deputy Mayor of Moscow for Social Development.

She said that so far the personal electronic card is available only on stationary computers, but within a year and a half it is planned to create a mobile version of the electronic card.

Parents and legal representatives of the child can access the children's electronic medical record in Moscow from January 14, 2020.

The Constitutional Court of the Russian Federation decided to issue electronic medical records of deceased patients to relatives

On January 13, 2020, the Constitutional Court (CC) of Russia  issued a resolution that obliges medical institutions to provide the relatives of the deceased with data (including electronic) on the progress of his treatment.

The Constitutional Court recognized the need to amend the law "On the Basics of Health Protection of Citizens in the Russian Federation" in order to exclude the possibility of such an interpretation of its norms, which allows doctors to deny close relatives of the deceased patient access to information about his treatment.

The Constitutional Court ordered doctors to provide data on the dead to their relatives

In accordance with the resolution of the Constitutional Court, if the widow or widower of the deceased patient (as well as his close relatives and persons indicated in the consent signed by the patient himself), then the medical institution will have to

provide medical documents of the deceased patient to familiarize themselves with the possibility of taking copies; if there are documents in electronic form , provide access to them.

The hospital can issue a refusal only in one case - if before his death the patient himself "expressed a ban on the disclosure of information about himself, constituting a medical secret."

In its resolution , the Constitutional Court noted that medical information, which concerns not the citizen himself, but his deceased loved ones, may be "no less important to him than information about himself." Therefore, the refusal to receive such information can "significantly affect" human rights.

The court decision was made after the complaint of Rimma Svechnikova, who, after the death of her husband, could not obtain information about the treatment of her husband from the Kirov Research Institute of Hematology and Blood Transfusion of the Federal Medical and Biological Agency. After the man died, doctors in Israel considered that the cause of death was improper treatment in Russia.

The courts of general jurisdiction, to which Svechnikova appealed, did not oblige the research institute to disclose the information, and the Supreme Court of the Russian Federation did not accept the cassation appeal. At the same time, the woman turned to the Constitutional Court.^[9]

2019: Only 4% of medical institutions in Russia switched to electronic medical records

By the end of October 2019, only 4% of medical institutions in Russia switched to electronic medical records, abandoning paper documentation. This is stated in a study that the company "Medical Information Solutions" conducted in conjunction with the Association for the Development of Medical Information Technologies (ARMIT). 4398 doctors and nurses from 82 regions of Russia were interviewed.

Electronic medical records allow you to significantly reduce queues in clinics, and also open access to the recommendations of the doctor in the personal account of the public services portal. However, 31% of medical institutions by the end of October 2019 were not ready to abandon paper medical records, and 27% of respondents do not see an opportunity for such technological migration.

Russia switched to electronic medical records, abandoning paper documentation

When talking about the reasons for the inhibition of informatization, health care respondents most often chose the following answer options:

• impossibility of refusing to maintain paper documentation, despite the introduction of electronic "(66%);
• lack of funds from medical institutions (49%), the prospect of increasing the amount of work when using digital technologies instead of saving time (49%);
• functionality that does not meet the needs of a medical institution (48%).

Computers are not installed on workplaces in 16% of medical institutions. At the same time, only 6% of survey participants cope without them. 29% of doctors with a computer do not have access to, and Internet 40% do not have a connection to the medical information system (MIS) of the medical organization. Most of those who work with MIES rate its quality as good, but not without complaints.

The majority of respondents (80%) are confident that it is necessary to improve the qualifications of health workers in the IT field, but only 18% confirmed that the relevant work is being carried out in their medical institutions^[10]

2017: Plans to move cards to blockchain

In September 2017, it became known about the plans of the Ministry of Health of the Russian Federation to transfer electronic patient cards in Russian medical institutions to a blockchain-based system. Citizens will be able to independently choose with whom they will share personal information. The head of the department Veronika Skvortsova spoke about this at the Eastern Economic Forum (Vladivostok, September 6-7).

It will be depersonalized, which will allow this data to be kept completely safe. The key will be individualized, - said Skvortsova.

Medical records of Russians will be transferred to blockchain

According to her, people will have a choice with whom to share their medical information, which will be associated with the choice of the medical organization and the attending physician.^[11]

In the blockchain system of electronic medical records, each patient will receive his own digital key to access personal information that will not be in the public domain. The Ministry of Health believes that this approach will help preserve medical secrecy.

At the end of July 2017, the president Russia Vladimir Putin signed a law on development information technology in health care. Its essence is the formation of a single state information system based on the implementation of an electronic integrated medical record. The same law spelled out norms for telemedicine and cross-document management. The decision, which has been worked out over the past two years together with the presidential administration, boils down to the fact that the system will be arranged on the principle of blockchain.

2014: Minister of Moscow Region M.Shadayev: Electronic medical records cannot be monetized

The Ministry of Public Administration, IT and Communications of the Moscow Region seeks to move away from the classic scheme of creating IT systems at the expense of budget funds. Instead, it tries to attract investors who would invest in the project and then "beat off" their investments at the expense of paid services tied to the created system. There are already several similar projects in the ministry's portfolio, however, with one of the most important - the introduction of an electronic medical card - this scheme could not be implemented: the department could not come up with mechanisms for its commercialization. Read more about the project here.

2010: Plan to allocate 24 billion rubles for 4 stages of health informatization

Director of the Informatization Department of the Ministry of Health and Social Development of the RFUimakov Oleg Vladimirovich, speaking in October 2010, said that the Government of the Russian Federation allocates about 24 billion rubles for informatization of health care, which will go to the constituent entities of the Russian Federation in the next two years.

The informatization project consists of 4 stages:

• 2009-2010 - The zero stage at which the development of a system project and the concept of the development of informatization in health care takes place.

• 2011-2012 - Implementation of an electronic medical record, remote appointment with a doctor and a number of other solutions.

• 2012-2015 - Electronic medical record filling. Full knowledge of the technology of collecting information from the workplaces of each medical institution, passports of medical institutions, their maintenance, operation of the register of medical personnel.

• 2015-2020 - Full-fledged work of all medical institutions in an automated mode.

The cost of switching to an electronic medical card is within 3-3.5 million rubles per standard system. The main requirements are the use of a single electronic medical record and uniform classifiers.

For the first time, a register of medical equipment is being made, which should provide a clear classification of all equipment so that it can be understood that there is already something to buy. The passport will reflect the percentage of depreciation, intensity of use, etc. Plus a register of medical personnel. Today, more than one and a half million industry employees are already reflected in this register of medical personnel. It remains to contribute less than 20 percent. The companies 1C"" and Parus"" have already prepared mechanisms for unloading information from personnel subsystems.

According to statistics, Russians visit medical institutions more than a billion times a year. For each visit, operations are performed related to fixing, displaying this visit. I.e. routine operations on paper, which is then difficult to process. The average head of the department spends 5 to 15% of his time on issuing various kinds of documentation, breaking away from medical time. Health informatization will fulfill a number of tasks at various levels - for the state, medical institutions and ordinary people.

591 Decree of the Government of the Russian Federation, signed on August 2, 2010, opened the opportunity to implement a pilot project. In October 2010, pilot projects for informatization in federal medical institutions will start. The testing of projects will last until July next year.

In order for there to be a full-fledged experiment, there will be two models of SaaS and SOA in architecture. Together with Rostelecom and the Ministry of Telecom and Mass Communications, software technology will be implemented as a service provided from a single subject center using SaaS technology. Moving to a thin client will reduce hardware costs, reduce data protection costs, and a number of other system parameters.

Notes