How content is our country to develop telecommunications in medicine and how can these technologies be useful for Russian health care? These issues were discussed at the conference "Affordable Medicine. Change time, organized by RBC.

Fashion or need?

Information technologies today are widely used in medicine. With their help, the remnants of drugs, the maximum efficiency of the use of pharmaceuticals, is calculated to calculate the bike, equipment loading. And their use will only increase. The law adopted this summer is even more expanding the areas of use of the Internet in the medical process.

Of course, it is primarily awaited from him that it will increase the availability of medical care. Where is such assistance in the first place? Naturally, in the removed corners of endless Russia, in areas with low density of the population, where people do not have the opportunity to get to the doctor to get a second consultation, where there are not enough narrow specialists, such as cardiologists, neurologists, children's oncologists.

Indeed, despite all the efforts of the federal and regional authorities, the program for the modernization of FAPs, the program "Zemsky Doctor", which from 2012 could attract 25 thousand doctors to rural medicine, many residents of remote areas can not get a full-fledged medical care. The problem of inequalities with metropolitan residents, with residents federal centers, big and relatively small cities are obvious.

"Of the 36 thousand outpatient and stationary buildings in our country, 1730 do not have cold water, 2110 do not have working sewers, in 4105 buildings there are no central heating, and in 9167 there are no hot water, "such sad statistics voiced director of the Institute of Economics of Health Economy HSE Larisa Popovich. "It is unlikely that they need accessibility in these" huts on the whims of their legs "- continues Larisa Popovich. - Telemedicine there, probably, could be a much more useful option. "

Scope of application

As the member of the Expert Council under the Government of the Russian Federation, a member of the Public Council under the Ministry of Health of Russia, Vladimir Gurdus, with the help of telecommunications, the following tasks can be solved.

1. Health management. Monitoring health status using remote instruments.

2. Help the patient in the speedy recovery at the expense of a closer relationship between the doctor and the patient.

"According to the highest school of the economy, the level of self-treatment in Russian Federation is above 70%. People appeal to the Internet, in the pharmacy, to the neighbor ... This does not lead to the long term to improve the health of health, says Vladimir Gurdus. - As a result, the Ministry of Health is now forced to develop a program to combat antibiotic-resistant. Telemedicine technologies can be a s-ereous "backup" for the health care system. "

3. Informing the population, how faster getting a medical service.

4. Storage, processing, and then the use of medical information (the so-called Big Data). True, to apply these technologies in health care, it is necessary to solve many more legal issues. For example, who will make complaints if the use of Big Data led to a negative result in treatment. "There is no answer to this question, it will come in a few years," says the expert.

5. Help the patient and his relatives at the moment they expect the arrival arrival. "The one who caused" ambulance "knows that the waiting for the arrival of the doctor's brigade is the most difficulty time. If telecommunication with the patient and his relatives is established in these painful minutes, it can reduce mortality and improve the quality of medical care. "

Doctor is always near

"When a patient from the regions returns home from a medical institution after a complex operation, it often does not find a doctor on the venister of the necessary qualifications, the desired levelwhich could continue watching him. With the help of telecommunication technologies, the doctor who operated on or led the patient after high-technological intervention will be able to lead it further, remotely, - clarifies head of the Internet + Medicine Committee of the Institute of Internet Development Georgy Lebedev. - It will help save the life to a large number of patients. Opuzh K. good doctor, the patient can continue to be observed. Moreover, new technologies with medical care using mobile medical devices will allow you to organize a hospital at home. With the help of these devices, the doctor will be able to monitor the patient's health status, adjust the appointment, to understand that he has any problems, and this is to extend the life to the patient, extend its active activity. "

In addition, according to him, remote technologies will allow to organize a telemedicine consultation between the doctor and the health worker, and this will make it possible to fully establish work in the Fayas.

"The adopted law is a step forward not only for postoperative, but also for chronic patients," says director of Legal Affairs and Initiatives of the Development Fund of the Internet Initiatives Odender Nurbekov.

"Telemedicine could provide a patient with a quick contact with the doctor, - argues advisor to the Head of Voluntary Medical Insurance Department Alexey Vigdornchik. He said that companies engaged in voluntary insurance have already become included in the portfolio of services remote consultations. - For the insurance company it is beneficial, since telemedicine services are cheaper. We include insurance for individuals Unlimited number of video intertons. The patient talked to the Dr. on Skype - and he no longer need re-visits. In severe cases, remote counseling allows you to get a second opinion to solve the question whether the patient needs to be prescribed, for example, any expensive diagnostic study. In addition, at the request of the patient over the Internet, the doctor may write to him electronic recipes, and then the attendance of our clinic will decrease by a third. "

The law is accepted. What's next?

"For most patients, telemedicine services are some kind of incomprehensible novelty," says director of Development Clinics "Doctor Near" Denis Shvetsov. "Many believe that this is something like a Kashpirovsky television sessions, and here the role of the Ministry of Health and the remaining regulatory authorities are correctly positioned, to determine their legitimacy and the possibility of application."

The law is not all that is necessary for the introduction of telecommunications to the medical sphere. It is prescribed by the main guidelines that will continue to develop, reported director of the Information Technology and Communications Department of the Ministry of Health of Russia Elena Boyko. The main orders will be spelled out in subtitle acts, which are now being developed and will be formulated in the orders of the department. For example, it is necessary to develop algorithms and procedures for the provision of medical assistance using medical technologies, it is necessary to introduce changes to the current orders medical documentation. According to her, the development of registered acts is planned until the end of this year.

The introduction of telemedicine technologies is being prepared for a long time. Already created a unified state information system in the field of health care (EMIS), medical organizations Connect to the Internet, doctors are massively equipped with computers. However, there is still a very large amount of work, a representative of the Ministry of Health is divided: "Since the law introduces a completely different quality of responsibility for holding telemedicine consultations, the basic requirements for equipping telemedicine offices are to be determined. Telemedicine technologies are not limited to visualization on the other side. They imply the identification of participants, and when contacting the doctor is a doctor, and when contacting the doctor is a patient. We must determine under what consultations it is necessary to conduct full documentation of the consultation, with some sufficient to document only the results. "

Questions of control

"When we have new technologies, new types of medical care, there is a very large temptation to remotely render the medical assistance from those people who cannot provide it," George L-Ebedyev expresses his fears.

"How to check the quality of medical care provided in the sphere of telemedicine is still difficult to say. In the near future, we will work with the Ministry of Health to work on it to make a scheme, easy to use, which will work on our citizens - enters into a discussion deputy Head of the Federal Officer Supervision Service Irina Seregin. - But now we can say that in the order of medical care with the use of IT technologies, two things will be required: medical products ( meaning medical appliances, devices for monitoring various parameters of the organism - glucometer, tonometer, etc. - Ed.), which will be used during the provision of telemedicine assistance, should be registered in the territory of the Russian Federation. And the second - medical consultation can be carried out by the species and for those profiles that are in the license of a medical organization. "

Stumbling stone

However, without a personal meeting with a doctor, the patient could not do anyway, since the law is spelled out that the doctor does not have the right to establish a diagnosis of a patient to the patient's full-time visit, "since if it is impossible for a detailed physical examination, when the doctor basics its conclusion only on complaints Patient and diagnostic studies, the probability of incorrect
Verification of data, "Elena Boyko explains.

What are the interactions with the patient going on? Until in full-time patient meeting with a doctor, it will be possible to collect anamnesis, ask the patient, to which he complains, to appoint him some types of analyzes. Decide on the appointment of expensive research, such as CT, MRI, is also possible only after a full-time doctor meeting with the patient. The law introduces the concept of remote observation of the patient's body parameters with the use of medical products. The law is also spelled out that when consulting with the use of telemedicine technologies, the attending physician can carry out the correction of previously appointed treatment, subject to the formulation of the diagnosis and appointment of treatment in full-time, inspection and consultation. The doctor may also adjust the treatment, doses of drugs assigned to a full-time meeting.

The ban on the remote diagnosis installation caused quite a few objections to the discussion participants. According to Larisa Popovich, this rate will not allow to increase the availability of honey care. The law is unnecessary conservative, she believes.

"Our survey shows that 60% of doctors are ready to advise an unfamiliar patient and make a diagnosis if they believe that they have enough information," says Larisa Popovich. - Telemedicine is an additional option, not a compulsory duty. And if the doctor believes that he does not have enough information for establishing primary diagnosis, he will not install it. That is why it seems to be redundant ban on the establishment of a diagnosis. Neither the doctor nor the patient want no harm or another. I believe that we are reinsured here. " In her opinion, the regulators are too complicated by the situation: "It is impossible to work and develop when on each of the chasters their regulations, its protocol. Then we will deal with this for a long time. We have developed standards for so long, as a result they do not match anything, they must already be changed, and technological development is incredibly quickly. Two or three years - and other technologies appear. "

Such conservatism in the development of technology can lead to the fact that the Russian patient, not finding contact with the Russian doctor, will turn to foreign doctors, will begin to use their services and go to treatment abroad, warns Larisa Popovich. "This means that huge efforts made to develop medical care infrastructure, spent on this enormous amounts will be spent in vain. Because only those who really have nowhere to go to Russia in Russia. And people who could make the country's economic bones will begin to be treated abroad and replenish the budgets of other countries. "

Russia and CIS countries inhabit more than 250 million people. Not always, a person has the opportunity to take the right decision, to deal with their doubts about the disease. Ride or not to go to Moscow for advice or hospitalization? With the development of digital technologies, it was possible to answer and resolve some of the problems associated with the need to obtain a qualified help of a doctor from pulmonology. Of course, this is not a full-fledged consultation, but by experience I want to say that in certain cases, such communication with the doctor can bring much benefit.

Video consultation of the pulmonologist's doctor is effective:

• If you are away from a specialist;
• If there is no needed specialist at the place of residence;
• If you want to be hospitalized in the hospital - pulmonological, cardiological;
• You have planned a survey in our, but want to clarify important moments According to the upcoming examination, the preliminary survey plan;
• You want to pre-assess the level of the specialist of our clinic before contacting us
• You are in a foreign business trip, vacation and do not have the opportunity to contact your doctor
• You have long been a patient of our clinic and want to ask questions about the correction of the treatment prescribed by us, or exacerbation of the disease.
• You purchased an annual permissions program for monitoring
• You have a desire to get an independent expert opinion

ATTENTION! Video Consultation on Skype cannot be a full medical examination and our specialists do not appoint basic medicinal products Outdoor consultation.

During consultation, the doctor will appreciate:

• Prepared medical documentation, CT snapshots in digital format, analyzes and research protocols
• Will determine the degree of risk at the time of consultation and identify your further actions, agree on the plan of necessary research
• He will discuss together with your doctor watching you at the place of residence, tactics of treatment and examination
• Answer the questions you are interested in and your loved ones.

Total 3 steps for advice: take advantage of the spell monogram on Skype very simple:

1. Choose a doctor with whom you want to hold a consultation, as well as the date of advice

2. Pay consultation. At your service various payment methods. Our administrators will help you pay. Dial +7 495 662 9924.

3. Send to our email address Medical documentation: extracts, survey protocols. CT studies be sure to provide electronically. After receiving the payment and medical records, you confirm the date and time of consultation.

The cost of consulting a specialist doctor incl. Ph.D.
Skype - 30 minutes: 2 650 rub.

At all stages of the design of online consultation with our doctors, our administrators will help you by phone:
+7 495 662 9924

Russia and CIS countries inhabit more than 250 million people. Not always, a person has the opportunity to take the right decision, to deal with their doubts about the disease. Ride or not to go to Moscow for advice or hospitalization? With the development of digital technologies, it was possible to answer and resolve some of the problems associated with the need to obtain a qualified help of a doctor from pulmonology. Of course, this is not a full-fledged consultation, but by experience I want to say that in certain cases, such communication with the doctor can bring much benefit.

Video consultation of the pulmonologist's doctor is effective:

• If you are away from a specialist;
• If there is no needed specialist at the place of residence;
• If you want to be hospitalized in the hospital - pulmonological, cardiological;
• You have planned a survey in our, but you want to clarify important points on the upcoming survey, a preliminary survey plan;
• You want to pre-assess the level of the specialist of our clinic before contacting us
• You are in a foreign business trip, vacation and do not have the opportunity to contact your doctor
• You have long been a patient of our clinic and want to ask questions about the correction of the treatment prescribed by us, or exacerbation of the disease.
• You purchased an annual permissions program for monitoring
• You have a desire to get an independent expert opinion

ATTENTION! Video Consultation on Skype cannot be a full-fledged medical examination and our specialists do not prescribe basic drugs out of full-time consultation.

During consultation, the doctor will appreciate:

• Prepared medical documentation, CT snapshots in digital format, analyzes and research protocols
• Will determine the degree of risk at the time of consultation and identify your further actions, agree on the plan of necessary research
• He will discuss together with your doctor watching you at the place of residence, tactics of treatment and examination
• Answer the questions you are interested in and your loved ones.

Total 3 steps for advice: take advantage of the spell monogram on Skype very simple:

1. Choose a doctor with whom you want to hold a consultation, as well as the date of advice

2. Pay consultation. At your service various payment methods. Our administrators will help you pay. Dial +7 495 662 9924.

3. Send to our email address Medical documentation: extracts, survey protocols. CT studies be sure to provide electronically. After receiving the payment and medical records, you confirm the date and time of consultation.

The cost of consulting a specialist doctor incl. Ph.D.
Skype - 30 minutes: 2 650 rub.

At all stages of the design of online consultation with our doctors, our administrators will help you by phone:
+7 495 662 9924

In our medical center Each patient receives services exclusively professional and experienced doctors and nurses. In our clinic, the reception is carried out by professors and associate professors, doctors and candidates of medical sciences, doctors of the highest or first qualifying category. This is the best guarantee that each patient will be able to get high-quality and effective consultation, based on the results of which an in-depth examination will be recommended and, of course, appointed the most modern, efficient and comprehensive treatment.

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D.L. Sulima

Currently, the reception in Skype leads the following specialists:

And when you already recorded, simply set the link with the Skype address: (press for communication) at the right time.

Consultation doctors in Viber, WhatsApp We are planning in the near future. We currently stretch only Skype.

Paid Consultation of the doctor on Skype It is convenient:

if you are departure and your "personal doctor" is far;

if you are outside the city, at the cottage and visiting the doctor is difficult;

if you are permanently residing in the European Union or US and you have no medical insurance;

if you want to get an alternative opinion of another doctor without leaving home;

if you do not want or can not come to consult personally;

if you have no relevant specialist in the settlement.

Paid Consultation of the doctor in the clinic "Personal Doctor" is safe since:

You contact the Network of the Clinic "Personal Doctor", which has been working in St. Petersburg (Russia) since 2010;

The quality of medical services is confirmed by a medical license issued by the Health Committee of the Government of St. Petersburg;

You will pay after the consultation of the doctor;

Payment for services is made through the site of the world leader of secure Internet payments Paypal.com or Sberbank of Russia.

To obtain a paid video intelligence, you need a doctor:

Provide a computer access to the Internet.

Get a confirmation from the clinic by e-mail that your application for writing to the doctor is accepted.

Connect to a webcam and microphone to computer

Set the Skype to the computer (if the program is already installed on the computer skip this item). You can download it here:http://www.skype.com/intl/en/get-shkype/

Install communication with Skype address: (Click to communicate) to the corresponding time to your consultation.

Get a doctor's advice.

Pay the cost of Skype- consultation(1800 rubles / 27 $ / 24 €):

• Method No. 1 Online through Sberbank of the Russian Federation (we recommend):

on our site any bank card through Sberbank of Russia, go just to click on the link .

Method number 2 PayPal: Through the Safe Paypal payment system. To pay, click on the "Pay Now" button (see below). After pressing the button, you will be redirected to the PAYPAL.COM secure Internet leader's leader page. You will need to pay advice from the available PayPal account or through a bank card (Maestro, Visa, Mastercard, Discover, American Express). At the request of Russian legislation, with this payment method, you will be asked to specify your home address.