Telemedicine problems in Russia

Main article: Telemedicine (Russian market)

2022: Low efficiency and huge costs: what doctors and clinic managers fear when introducing new technologies

Telemedicine becomes as familiar a service as a routine doctor's appointment. Insurance companies are starting to include online consultations in programs. insurance VHI Still, some clinics are still wary of the idea of introducing new technologies. The article provides common reasons for abandoning them as of 2022 and the fears of doctors and leaders, as well as arguments for why many fears are not justified.

Телемедицина — не такая сложная в освоении система, чтобы кто-то из врачей не справился с ней
Фото: forbes.ru / Getty Images

What fear rests on

In the understanding of many doctors, communicating with a patient via video link is not very different from a regular call, with which the risk of a "damaged phone" is great. The patient may incorrectly describe, for example, the appearance of the injury, or explain where he has pain, and the doctor, on inaccurate or incorrect data, tries to make a diagnosis. As a result, such an appointment may not bring any benefit to the patient.

In fear of providing ineffective advice, there is only a fraction of the truth: if, for example, to make an accurate diagnosis, the doctor needs to listen to the patient, he will not do this through the screen. Online does not aim to completely replace face-to-face admission, but with the help of telemedicine services, it is possible to effectively route the patient to a narrow specialist based on the collected history, monitor the patient's treatment, advising him on emerging issues, and much more.

On the part of patients, when it is "very bad," every tenth person turns to telemedicine, the rest - only at the first signs of illness, just for answers to questions or when "nothing serious": this is indicated by a survey VCIOM (according to information as of July 2022). At the same time, according to the same VTsIOM, 60% of Russians already know about telemedicine, more than half of whom are ready to turn to the service in the future.

Another fear of doctors is associated with fear of the potential inefficiency of online admission - the patient will not come to a second appointment due to negative experience. For example, he received advice, but counted on the appointment of treatment. The patient can also be frightened by the high cost of online consultations, since, according to many, this format should cost less. But some clinics are not going to reduce the cost of consultation if the doctor spends the same amount of time on the patient. Whereas the patient saves money and time that he would spend on the road to the clinic.

Telemedicine is available on a very narrow set of referrals

Often, the clinic management believes that only a therapist can offer telemedicine services, who, after a conversation with a patient, will give a referral to the right specialist - already for face-to-face admission. And for the sake of one doctor, it makes no sense to introduce a whole system: both difficult and expensive.

In fact, almost any medical specialist can conduct online consultations - up to the chiropractor and cosmetologist. Of course, face-to-face reception with them is mandatory, and, for example, the same dermatologist will not diagnose a neoplasm for malignancy via video link. But he will at least be able to discuss risk factors for the patient, taking into account the symptoms and appearance of the mole, tell what are the options for further actions, taking into account the characteristics of the body, and so on. It happens that the patient is advised to urgently appear to the doctor at a face-to-face appointment, and if the online consultation had not taken place, the time would have been missed.

Online reception is a lot of risks

Technologies in medicine are still only developing, for many clinics even an online appointment with a doctor through Public services, their own portals and applications or through other channels - the process is not fully worked out. Electronic document management is still at the implementation stage, as well as connection to the Unified State Health System (Uniform State Health Information System). Although the state is already striving to make available medical records of patients from municipal polyclinics for private medical organizations.

In this regard, some doctors and clinic leaders are wary of the idea of ​ ​ introducing any new technologies: in particular, telemedicine. Fearing that it equipment will not cope with the load, technical failures will occur at the most inopportune moment - for example, during reception it will freeze. communication

But in reality, the thoughts of doctors and patients are just fears based on past experience. Telemedicine is not an innovation that requires analysis and close attention, but a practical tool that helps doctors stay in touch with their patients and increase the number of consultations thanks to the treatment of people from the regions.

As of 2022, the doctor and clinic no longer depend on Western companies, because there are solutions on the Russian market that close almost all of their issues. Domestic technologies in medicine have room to develop, but they work stably, so the clinic can carry out modernization according to plan.

New technologies are difficult to deal with

Almost any team has employees who are negatively inclined to master new technologies. It doesn't matter what we are talking about - about document management software, unusual equipment or innovative areas of work. Such people want to conduct their previous activities, where everything is perfectly familiar to them. And everything new for them is complex, implying a lot of extra work. These are often old-school doctors who find it difficult to rebuild.

The low level of digital maturity in organizations is one of the serious barriers to the introduction of any innovation, as shown by a study by the Ministry of Industry and Trade and the Zyfra Group of Companies. Every second Russian company has employees who lack certain competencies to work calmly with new technologies. Sometimes they can be in top management.

Telemedicine is not such a difficult system to master that one of the doctors, even mistreating a computer, could not cope with it. Especially if the service is developed in cooperation with the medical community: that is, it is not just created by IT specialists, but understanding the specifics of the industry and people within it, consulting with the end user.

The correct introduction of the IT product into the business processes of the clinic involves training both the registry and the medical staff, as well as accompanying all doctors from the first consultation until the process gets on track.

New technologies are expensive and unprofitable economically

Any digital technology that a business introduces has several expense points: the cost of the product itself, its maintenance - within the company or by third-party specialists, personnel training. Somewhere else, the hardware has to be changed, for example, because the computer is not powerful enough for the correct and effective operation of the program. These are serious costs, and often management is afraid that they will not pay off.

However, the pandemic has shown that digital services are one of the few tools through which clinics can stay afloat. And often those who introduced new technologies won more than expected.

At the same time, the cost of modern services is available for any clinic. And there is often included not only the tool itself, but also training, support, updates. Doctors just need to look at the number of messages in the messenger, most of which could be converted into paid consultations in the app's chat.

"Our internal figures also show a sharp increase in demand for telemedicine in Russian clinics: in 2020, the number of service partners increased 4 times, consultations ― 8 times. And the amount of revenue that clinics earned on telemedicine increased 12 times compared to 2019. The outstripping growth in revenue compared to the number of consultations was due to the fact that patients began to choose more expensive video consultations on average instead of chatting with a doctor, since this format is closest to face-to-face appointments, "said Dmitry Gaponov, operations director and co-founder of iBolit.

All these new technologies are temporary

In 2021, 10% of the Russian population used telemedicine services, and 60% were ready to resort to it if necessary. Almost 90% of health organization leaders expected this trend to continue on digital services.

However, the remaining 10% believe that the surge in popularity of online consultation is associated exclusively with the pandemic. Many were afraid of getting infected or simply could not break through to the doctor in person. And if the pandemic ends, and people stop fearing the virus, everything will return to its previous course: no one will need remote techniques anymore. It turns out that the introduction of such technologies will be in vain in the long term.

In fact, people have developed a new pattern of behavior in two years: they have seen the benefits.

First, online expands the boundaries: a patient from the region can now get an appointment with a doctor in the capital or another large city without spending money and time on tickets. Naturally, according to the legislation, within the framework of the initial consultation, he will not receive an accurate diagnosis, but he can receive doctor's recommendations for the necessary research, a second opinion on the diagnosis already made, instructions on how to properly prepare for surgery, and much more.

Secondly, in a large number of cases, telemedicine has become a more convenient format for receiving medical care. Patients prefer not to waste time on fees, travel and waiting in the clinic and receive medical advice online from any convenient place. Decoding according to the test results, management of the prescribed treatment, most questions to the pediatrician and much more - can be carried out in the format of telemedicine with the same quality as at a face-to-face appointment.

Every fourth Russian believes that online consultations expand the availability of medical services, and every fifth - that they save time and money.

Thirdly, the cost of remote reception is often lower than full-time, on average by 20%. And somewhere and 50%. These are significant figures when the primary face-to-face consultation costs about 2,000 rubles.

Fourth, the doctors themselves are gradually also understanding the value of new technologies. Telemedicine is not only about an online appointment for a patient, but also about interaction with colleagues from other hospitals: including in different cities and countries. In 2020, on Sakhalin, it was the teleconsultations between the regional hospital and the National Medical Research Center for Children's Health that helped save the life of a newborn with a brain tumor.

In general, the market for medical services has been transforming for several years, and the pandemic has accelerated this process. Patients get used to technology - to the opportunity to sign up for a doctor in the application, to get advice anywhere in the world. This is convenient and improves the quality of medical services. Therefore, there will be more and more new technologies in medicine. The sooner the clinic comes to them, the better for her and her patients.

2017: What are the challenges facing telemedicine in Russia

The first problem is the availability of modern technologies to the population.

Not all of Russia has gas and electricity, not to mention high-speed Internet and high-quality audio and video equipment. If you connect a polyclinic to a reliable Internet and reduce telemedicine to a conversation with a doctor from a local regional center or Moscow, then the question of effectiveness will inevitably arise - how will this patient's doctor treat if he is 100 km away from him? And will this doctor simply duplicate the local paramedic, which is unnecessary with the already modest costs of medicine?

There is no certainty that older people will easily be able to master the same Skype - and if the connection breaks down or something breaks down? So far, these risks outweigh the possible benefits of telemedicine, however, an optimal solution may soon be found. Moreover, the patient cannot always buy the necessary equipment.

The second problem is security issues.

Of course, it would be very convenient to create a full-fledged unified medical base throughout Russia with the ability to access any doctor, but how to make sure that this base is well protected and the data in it is reliably encrypted? On a regular video call, a doctor can find out confidential information - how to check that it will not be intercepted? And how to make sure that it is used legitimately and it is impossible for pensioners with mental disorders to be massively approached by "black realtors"? So far, these are isolated risks, but they can become a serious problem if telemedicine is used everywhere.

The third is the readiness of doctors to work with telemedicine.

Doctors reluctantly accepted the computerization of polyclinics. Many specialists had difficulty training in the use of computers, which led to delays in patient care and a deterioration in the quality of appointments. The doctor cannot pay sufficient attention to the patient if half of the appointment is spent on entering passport data into the computer. Telemedicine technologies are more difficult to apply, and the risks of making the wrong decision increase. The social consequences of the introduction of telemedicine for doctors are also important - theoretically, this can lead to a reduction in the already few clinics in remote regions, which means that some doctors may be out of work.

The fourth is the trust of patients in telemedicine.

Everyone is used to classical medicine, it inspires confidence, but what about teleconsultations with a doctor from another region? Especially when you consider that conservative-minded people who are distrustful of new technologies often turn to clinics. The expert believes that patients' trust in telemedicine can be gained by showing by real example that there is value in online consultations, and it is real to remotely get answers to questions about health. The more often people receive high-quality care from high-quality doctors, the faster telemedicine will become a worthy alternative to finding symptoms on the Internet.

But do not forget about alternative medicine and charlatans - the complete legalization of telemedicine without serious control over it can lead to the flowering of alternative specialists. In addition, telemedicine should not be perceived as inferior medical consultations or "medicine for the poor." Otherwise, the queue for face-to-face receptions will only grow, because everyone will think that it is so more reliable.