FFOMS transfers insurance medical organizations to work in a new IT system, for which 6.4 billion rubles have been allocated
| Customers: Federal Compulsory Medical Insurance Fund (FFOMS, Federal Compulsory Health Insurance Fund) Moscow; Pharmaceuticals, Medicine, Healthcare Contractors: Organizational & Technological Solution Project date: 2020/07
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2024
FFOMS transfers insurance medical organizations to work in a new IT system, for which 6.4 billion rubles have been allocated
The Federal Compulsory Health Insurance Fund (FFOMS) initiated the transfer of the register of insurance medical organizations (SMO) to the new section of the State Information System of the Compulsory Medical Insurance System "GIS OMS." 6.4 billion rubles were allocated for the development and modernization of this system in 2024. As reported in the letter of the FFOMS No. 00-10-92-3-06/8445 dated May 23, 2024, the outdated subsystem "Compulsory medical insurance registers," which previously posted data on medical organizations and insurance companies, ceased to operate. Now, to store and update information about CMO, the Unified Register of GIS OMS "ERSMO" has been created.
According to the FFOMS, large-scale changes will affect all 85 territorial compulsory medical insurance funds, 29 insurance medical organizations and about 170 of their branches. They have to transfer data to a new system and reconfigure territorial registries.
In addition, the federal fund has developed detailed instructions for connecting users to GIS compulsory medical insurance using an electronic signature, as well as for setting up and using EPSMO by insurance companies and terfonds. The latter are responsible for the correctness of the information in the registers and transfer the data to the FFOMS.
In 2022-2023, FFOMS has already carried out large-scale work to modernize GIS compulsory medical insurance, including the introduction of digital policies and changing the structure of storing data on insured citizens. Then at least 1.7 billion rubles were spent on the relevant events, the technical operator of which was Rostelecom.
The FFOMS stressed that the transfer of the register of insurance medical organizations to the new GIS section of the compulsory medical insurance is a continuation of the reform to digitalize the compulsory health insurance system in Russia. It is expected that the updated IT infrastructure will increase the efficiency of the FFOMS, territorial funds and insurance companies, as well as improve the quality of service for insured citizens.[1]
How digitalization expands the possibilities of compulsory medical insurance
The introduction of digital technologies significantly expands the possibilities of compulsory health insurance (compulsory medical insurance) in Russia. This was announced on June 10, 2024 by the chairman of the Federal Compulsory Health Insurance Fund (MHIF) Ilya Balanin.
Since the end of 2022, the MHIF has been actively developing the State Information System of the Compulsory Medical Insurance (GIS Compulsory Medical Insurance), which allows citizens to provide a set of medical services in digital format. This increases the transparency and efficiency of the compulsory medical insurance system as a whole. According to Balanin, the main task is to transfer the functionality of regional information systems to the federal level and accumulate information on all subjects, which will reduce the number of information flows and standardize data exchange protocols.
Balanin noted that the MHIF switched to the formation of digital compulsory medical insurance policies with the introduction of the Federal Unified Register of Insured Persons (ERZ). In 2024, more than 17 million insured have policies exclusively in digital form. Citizens can get their policy through the State Public services portal, where claiming and proactive services are also available, which have already been used by 700 thousand people.
He added that within the framework of the GIS compulsory medical insurance, a prototype of the "Digital Medical Profile of the Patient" (CMP) subsystem was created, including a digital policy and an electronic medical history. CMP provides access to citizen health data for all professional participants in the health care system, which is especially useful in urgent situations.
The introduction of the CMP will increase the number of digital services in the compulsory medical insurance system. The information collected in the new subsystems will expand the list of services on the Public services portal, including personalized recommendations for the prevention and early diagnosis of diseases.
According to the MHIF, by 2024, almost 12 thousand insurance representatives of three levels are engaged in protecting the rights of the insured and accompanying them at all stages of medical care. In 2023, 108.5 million people were informed about the right to undergo a preventive medical examination, of which more than 82 million people passed professional measures. At the beginning of May 2024, more than 52 million people were informed, almost 35 million people took place.[2]
Rostelecom appointed sole executor of the GIS OMS modernization project
Prime Minister Mikhail Mishustin signed a decree, which he again appointed Rostelecom as the sole executor of the project to modernize the state information system of compulsory health insurance (GIS compulsory medical insurance). The corresponding document was published in early February 2024.
From the order it follows that Rostelecom is determined by the only counterparty of the purchases carried out in 2024-2025. FFOMS purchases in order to modernize the GIS of the compulsory medical insurance and organize its information interaction with the UIS in the field. health care It is assumed that within the framework of the relevant contract, the creation, development, implementation and operation of state platform services will be carried out.
The document says that in the execution of contracts, Rostelecom has the right to attract subcontractors and co-executors, subject to the fulfillment together with subsidiaries and affiliates of at least 70% of the total value of obligations, of which at least 5% must be fulfilled by a single counterparty personally. The deadline for the execution of the relevant contracts is December 31, 2025.
By February 7, 2024, specific plans for the modernization of GIS compulsory medical insurance, which Rostelecom will deal with, were not disclosed. Most likely, the telecom operator will be engaged in the creation of new services for the platform and its integration with the Uniform State Health Information System - the draft budget of the FFOMS for these purposes laid 3.2 billion rubles annually in 2024-2026.
More detailed information is contained in the report of the Accounts Chamber of the Russian Federation on the draft budget of the FFOMS for 2024, according to which about 3.3 billion rubles annually should have been spent on the creation of the national digital platform "Health." The main "digital" task of the fund is the development of services on the portal of public services, a single register of insured persons, commissioned at the end of 2022, as well as integration with the GosTech platform.
Government of the Russian Federation Order of February 2, 2024 No. 208-r
Mishustin allocated 6.4 billion rubles for the development of GIS compulsory medical insurance
On January 19, 2024, the Russian government ordered to allocate 6.41 billion rubles for the modernization of the state information system in the field of compulsory health insurance (GIS compulsory medical insurance). These funds will go to the Federal Compulsory Medical Insurance Fund (FFOMS) in 2024.
The published order, signed by Prime Minister Mikhail Mishustin, says that the funds will be used to financially support the procurement of works (services) for the creation, development, implementation and operation of GIS CHI services. In addition, the organization of information interaction of this platform with the unified state information system in the field of health care is provided.
The money is provided in accordance with Articles 5 and 6 of the Federal Law "On the budget of the Federal Compulsory Health Insurance Fund for 2024 and for the planning period 2025 and 2026." The funds will come from the normalized insurance stock of the fund itself. The FFOMS is obliged to monitor the targeted and effective spending of money and submit a report on the work performed for budgetary allocations by March 1, 2025.
According to the FFOMS report on activities in 2022 and prospects for 2023, in 2023-2024, the department is implementing various subsystems of GIS compulsory medical insurance in pilot regions. We are talking, in particular, about the decisions "Federal personalized accounting of medical care," "Information support services for insured persons," "Management services," etc. Among the priority areas are the implementation of superservices on the public services "My Health," "Birth of a Child," state automated system "Management," the creation of a single master register of patients based on the register of insured persons, the application of new principles and a unified system of personalized accounting in the compulsory medical insurance system, the creation of a digital medical profile of the patient.[3]
2022
The Accounts Chamber spoke about the problems in the GIS compulsory medical insurance
Numerous shortcomings have been identified in the work of the state information system of compulsory health insurance (GIS compulsory medical insurance). This is stated in the conclusion of the Accounts Chamber of the Russian Federation on the report on the implementation of the budget of the Federal Compulsory Health Insurance Fund (MHIF) for 2022, published on July 3, 2023.
The document says that as part of the implementation of state contracts with PJSC Rostelecom, three GIS CHIs have been created: a service for informing insured persons about compulsory medical insurance rights, a proactive notification service for directions and appointments to insured persons, as well as a service for routing insured persons at all stages of medical care, including using digital assistants. In addition, work was carried out on six subsystems: "Analytical database," "Risk-oriented selection of cases of medical care for control and expert measures," "Risk profile assessment," "Analysis and forecasting of medical care," "Forecasting of drug consumption," "Data visualization."
However, as the audit of the Accounts Chamber showed, in 2022, instead of the actual creation of subsystems (services), layouts were developed, and not completed software products. It is said that these layouts do not interact with real data, and therefore there are risks of their flaw or refusal to implement.
The report also emphasizes that the analysis of the Departmental Digital Transformation Program (WPTP) for 2022-2024 showed that the reflected result in 2022 cannot be considered achieved. We are talking about the creation of algorithms for the selection of personalized recommendations for the prevention and early diagnosis of diseases and the development of algorithms for the management of chronic patients in terms of oncology and diseases of the circulatory system. The fact is that the work is carried out in two stages. The first was accepted and paid by the MHIF in the amount of 230 million rubles, while the second was not closed at the time of the inspection.[4]
Rostelecom has been selected as the only integrator of GIS OMS and Uniform State Health Information System
In September 2022, Prime Minister Mikhail Mishustin signed a decree that approved the sole executor of the contract for the integration of GIS compulsory medical insurance and Uniform State Health Information System.
 | Determine PJSC Rostelecom as the only supplier of purchases of goods, works, services carried out by the Federal Compulsory Medical Insurance Fund in order to modernize the state information system of compulsory medical insurance and organize its information interaction with the unified state information system in the field of healthcare, the document says, published on the official portal of legal information. |  |
In addition, a government order established the procedure for attracting subcontractors by Rostelecom. The state corporation will have to fulfill at least 5% of the total joint volume of obligations under contracts, and subsidiaries and affiliates - at least 70%. The same order determined the deadline for which state contracts are concluded with the company - until December 31, 2023.
Rostelecom, one of the largest players in the digitalization market for medicine, is the founder of Tsifromed, which in 2021-2022 became the sole executor of the Ministry of Health's contracts for the development of Uniform State Health Information System subsystems. The same organization in 2022 became a key operator for the creation, implementation and development of centralized subsystems of a single departmental medical information and analytical system in FMBA.
The modernization of GIS OMS involves, in particular, its integration into Uniform State Health Information System. Within the framework of GIS compulsory medical insurance, unified registers of insurance medical organizations, medical organizations and experts of the quality of medical care will be maintained.
The modernization of GIS compulsory medical insurance was planned to be carried out before the end of 2021, however, the Accounts Chamber established the risks of failure by the Compulsory Health Insurance Fund (MHIF) of the specified terms.
Order of the Government of the Russian Federation No. 2779-r dated 26.09.2022
2021
Mishustin allocated 1.8 billion rubles for the modernization of GIS compulsory medical insurance
In December 2021, Prime Minister Mikhail Mishustin signed an order of the Government of the Russian Federation on the allocation of 1.8 billion rubles for the modernization of the state information system of compulsory health insurance (GIS OMS), designed to take into account information about medical care, monitor the efficiency and quality of its provision, as well as for conducting departmental reporting.
The allocated funds will be used to organize the interaction of GIS compulsory medical insurance with a unified state information system in the field of health care. This will help to quickly resolve issues related to the provision of free medical care to citizens, simplify the interaction of participants in the compulsory medical insurance system, which means it will increase the availability of medical care for citizens, the cambin said.
In addition, within the framework of GIS, they plan to launch a single Internet portal of compulsory health insurance. Its purpose is to increase the openness and accessibility of information about compulsory medical insurance.
Funds through the Ministry of Finance will go to the budget of the GIS CHI operator - the Federal CHI Fund (FFOMS). The Ministry of Health of the Russian Federation is entrusted with control over the targeted and effective use of the allocated allocations. The department must submit a report to the government by July 1, 2022.
In early December 2021, the Ministry of Health and the Ministry of Digital Development of the Russian Federation announced the integration of part of the document flow on the public services portal for the patient to receive medical care in federal medical organizations. Now the compulsory medical insurance insured will be able to track online whether he will be admitted to hospitalization, and will also receive a report on the costs of the compulsory medical insurance system for his treatment. Proactive notification of medical services provided has already been implemented on the portal for residents of a number of regions. The GIS compulsory medical insurance in 2021 immersed the work of federal medical centers, the financing of which has become centralized, from the budget of the FFOMS.[5]
The Ministry of Health approved the exchange of data between the IT systems of compulsory medical insurance and Goznak for the issuance of medical policies
The Ministry of Health of the Russian Federation approved the exchange of data between the state information system of the compulsory medical insurance and the Goznak IT system for issuing medical policies. The corresponding document in November 2021 was published on the federal portal of draft regulatory legal acts.
The document is supplemented by paragraph 27 of the Rules for the Functioning of the CHI GIS by sub-clause "and," according to which information interaction with the Goznak information system will be provided. This is a joint stock company, the only shareholder of which the state issues and delivers to the population paper and electronic compulsory medical insurance policies.
Goznak manufactures and delivers compulsory health insurance policies in the form of a paper document, as well as using microelectronic products. In accordance with the order of the Government of the Russian Federation No. 1530-r of 05.09.2011, Goznak is the sole executor of the state order placed by the Compulsory Medical Insurance Fund for the manufacture, personalization and delivery of compulsory medical insurance policies. Since 2017, Goznak has been producing electronic compulsory medical insurance policies with Russian chips.
In October 2021, the Cabinet of Ministers submitted to the State Duma a bill on a new concept of a compulsory health insurance policy. According to the proposed amendments, the compulsory medical insurance policy, in fact, will not be a document, not a plastic card or other medium of information, but an entry in a single register of insured persons in the GIS compulsory medical insurance. This entry will be formed by TFCMI and appear in the register "on the fact of the right (birth, citizenship)" (the insured, of course, will have the right to change/choose the insurance company, before the exercise of this right, the choice of CMO for the insured, as now, will be at TFCMI).
Information about the insured will be submitted at interdepartmental requests not only to various government agencies (as now), but also to medical organizations in the field of compulsory medical insurance - to identify the patient.[6]
Accounts Chamber: GIS OMS budget is mastered only by 34.2%
On October 18, 2021, the Accounts Chamber (JV) announced the conclusion on the draft federal law "On Amendments to the Federal Law" On the Budget of the MHIF for the Period 2022-2024. " It follows from this document that the budget of the state information system of compulsory health insurance (compulsory medical insurance) is being mastered by only a third.
According to the joint venture, by September 23, 2021, contracts concluded for this whole year were executed 34.2%, the amount of accepted and paid expenses is 289 million rubles. The total amount of expenditure obligations contracted for 2021 is 846.23 million rubles against 393.5 million rubles a year earlier.
It is reported that even with the full fulfillment of obligations in accordance with the concluded state contracts, the expenses of the MHIF for GIS compulsory medical insurance will not exceed 846.2 million rubles in 2021, despite the fact that the fund pledged 2.4 billion rubles for these purposes. Thus, the fund's forecast for the level of expected budget execution in 2021 is overestimated in the total amount of 1.56 billion rubles, the auditors concluded.
According to the report of the Accounts Chamber, one of the GIS contractors, which is part of the Merlion holding company Organizational and Technological Solutions 2000, does not perform work on the development of the system's application software in 2021, for which it has already received a fine of 1.4 million rubles. Instead of December 2021, the company is expected to hand over work only in February 2022, although according to the government's National Action Plan, GIS compulsory medical insurance should be built by the end of 2021.
The Accounts Chamber also stated that the budget of the MHIF for 2022-2024 does not plan measures to organize research work on compulsory health insurance, which makes it possible to conclude that the fund does not fulfill the powers to carry out such work. [7]
Mishustin approved the rules for the work of GIS in the field of compulsory medical insurance
Prime Minister Mikhail Mishustin approved the rules for the operation of the state information system of compulsory health insurance (GISOMS). The press service of the Cabinet of Ministers announced this on June 15, 2021.
She also called one of the main tasks of the new GIS - optimization of the exchange of information between those who participate in the provision of health insurance services. For this, the rules spell out the peculiarities of the interaction of the system with other GIS, including Uniform State Health Information System (Unified State Information System in the Field of Health), the Electronic Budget system, and a single portal of public services. At the same time, in case of failures in the operation of electronic services, it is possible to temporarily switch to paper document circulation.
The rules also touch upon issues related to the legal regime of GIS, the protection of information, the organization of access to GIS and the procedure for its use.
The government says that GIS is designed to take into account information about medical care, monitor the efficiency and quality of its provision, as well as to maintain departmental reporting. The systems will include a single register of insured persons, which will become the basis for the transition to a digital compulsory medical insurance policy. In addition, within the framework of GIS compulsory medical insurance, a single Internet portal of compulsory medical insurance will be launched. Its purpose is to increase the openness and accessibility of information about compulsory medical insurance.
It is assumed that the state information system in the field of compulsory medical insurance will be put into operation in stages - all its functionality will be available in 2022. According to the authorities, the launch of GIS will quickly solve issues and problems related to the provision of medical care for compulsory medical insurance, as well as simplify the interaction of system participants.
It is assumed that thanks to the launch of the GIS and the electronic register of insured persons, Russians will not need to present a paper compulsory medical insurance policy.[8]
The Ministry of Health of the Russian Federation approved the main functions and requirements for GIS in the field of compulsory medical insurance
In March 2021, the Ministry of Health of the Russian Federation approved the main functions and requirements for the state information system in the field of compulsory health insurance. Among other things, the document determines the creation of a "single compulsory medical insurance portal," where the budgets of territorial funds (TFCMI) will be disclosed in the public domain.
The unified information state system of compulsory medical insurance will include information about insured persons, about insurance medical organizations and about experts in the quality of medical care. In fact, the GIS compulsory medical insurance system will become a platform for the formation of three registers - a register of experts in the quality of medical care, a register of insurance medical organizations, a register of insured citizens.
The new GIS will store all reports in the field of compulsory medical insurance and monitor its reliability, completeness and relevance.
It is assumed that GIS will interact with other systems, with its help it will be possible to form various certificates, since the register will reflect complete personalized information on the received medical care by each insured person. Certificates will be formed in electronic form. In the event of a system failure, the information must be documented in a paper version. The procedure for the technical failure was also prescribed in the draft resolution.
The main functions of GIS in the field of compulsory medical insurance in the Ministry of Health included the following:
- accounting of information on insured and provided medical care;
- electronic document management;
- formation and maintenance of unified registers of medical organizations, insurance medical organizations (SMO), quality experts of medical care;
- formation of reports in the field of compulsory medical insurance.
Total expenses for the development of GIS compulsory medical insurance are estimated at 2.8 billion rubles. Most of this amount (1.8 billion rubles) was allocated in 2021, and in 2020 the costs amounted to 1 billion rubles.[9]
2020: The Compulsory Medical Insurance Fund was allocated 1 billion rubles for the creation of GIS
In October 2020, Prime Minister Mikhail Mishustin signed an order to allocate 1 billion rubles to the Federal Compulsory Health Insurance Fund (FFOMS) for the creation of a state information system.
As reported in the document posted on the official Internet portal of legal information, budget allocations from the reserve fund of the Government of the Russian Federation were allocated for "financial support of measures to modernize the state integrated information system in the field of compulsory health insurance and organize its information interaction with the unified state information system in the field of health care."
The project involves the completion of the design and development of at least three digital GIS services in the field of compulsory medical insurance and the connection of at least 5 thousand users to them.
The Ministry of Finance of the Russian Federation is instructed to control the targeted and effective use of the allocated money. The department will have to prepare a corresponding report by April 1, 2021.
In June 2020, the head of the FFOMS Elena Chernyakova spoke about plans to create a unified information system for compulsory medical insurance in order to unite all "participants and subjects of compulsory medical insurance," "and not in the way that is happening now, when the federal fund has its own information resource, the terfonds have their own, the SMO has its own." According to her, the creation of a new IT system will take two to three years.
On October 28, 2020, the State Duma adopted in the first reading the draft budget of the Federal Compulsory Health Insurance Fund (MHIF) for 2021-2023, submitted by the government.
According to the document, the budget revenues of the fund for 2021 are planned in the amount of 2.53 trillion rubles, expenses - 2.55 trillion rubles, for 2022 - 2.66 trillion rubles each. The fund's budget was formed with a deficit in 2021 in the amount of 11.6 billion rubles, in 2022 - 1.5 billion rubles, in 2023 - 473.9 thousand rubles.[10]
2019: "Organizational and Technological Solutions 2000" won a tender for the development of an IT system for compulsory medical insurance
At the end of July 2020, it became known that the company Organizational and Technological Solutions 2000 (OTR), which is part of the Merlion group, won a tender for the development of an IT system for the Federal Compulsory Health Insurance Fund (Compulsory Medical Insurance). The contract value is 405 million rubles.
According to the terms of the agreement, OTR will have to create new subsystems of GIS "Documents of compulsory medical insurance," "Unified access point" and "Fund of algorithms and programs" by October 2021, and deploy already developed systems for centralized analysis of TFCMI data and electronic document management.
In addition, the company must prepare a target functional and technical architecture and develop technical requirements for promising changes in the GIS of the compulsory medical insurance, as well as increase the efficiency of the current system, indicated in the technical assignment to the order holder from the MHIF on the public procurement website.
It assumes that the Compulsory Medical Insurance Documents system will allow participants in the compulsory medical insurance program, including CMO, to form and conclude agreements on the provision of funds from the budgets of the FFOMS, TFCMI, and it will also be possible to upload data on the state task, which is distributed between medical organizations by the federal fund. Information will be accessed by users who are registered on the new platform. The latter will also launch a chat and a section with methodological materials.
As Vademec writes with reference to Kartoteka data, Organizational and Technological Solutions 2000 is a traditional executor of state contracts of the Department, information technology Moscow the Federal Treasury and other government agencies.
In addition to OTR, the National Center for Informatization (NCI) also claimed to develop the compulsory medical insurance IT system.
Notes
- ↑ Insurers in the field of compulsory medical insurance began to be transferred to work in the Unified Register of Insurance Medical Organizations (ERSMO) GIS OMS
- ↑ How digitalization expands the possibilities of compulsory medical insurance
- ↑ Order of the Government of the Russian Federation No. 25-r dated 16.01.2024
- ↑ Conclusion on the results of the external audit of the report on the implementation of the budget of the Federal Compulsory Health Insurance Fund for 2022
- ↑ Order of the Government of the Russian Federation No. 3706-r dated 18.12.2021
- ↑ On amending paragraph 27 of the Rules for the Functioning of the State Information System of Compulsory Health Insurance
- ↑ [https://ach.gov.ru/upload/iblock/0e4/0e4adcc9e24bd789afc191160db88c0f.pdf CONCLUSION for the draft federal law "On the budget of the Federal Compulsory Health Insurance Fund for 2021 and for the planning period 2022 and 2023"]
- ↑ The government approved the rules for the operation of the state information system of compulsory medical insurance
- ↑ On the procedure for functioning of the state information system of compulsory health insurance
- ↑ Order of the Government of the Russian Federation No. 2750-r dated 24.10.2020
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