The fate of telemedicine in Russia: what is possible if nothing is impossible

Victoria Pavlova

In the previous material , Novye Izvestia found out that telemedicine is the last hope of domestic healthcare, which cannot recover from optimization. It is remote technologies that should become a substitute for living doctors and save people. The powers that be have been shouting about this recently literally from every iron. The country is falling into a demographic hole, and villages and villages are dying out because people are fleeing to big cities. In such a situation, it would seem that health officials must do everything possible and impossible to save health care and the last pillars on which it is based.

The time is right for experiments - there is not much to lose. Polls even of the state VTsIOM show that people are dissatisfied with the quality of medical care. Only 49% of Russians have a positive experience of treatment in state medical institutions. At the same time, mostly young people aged 18–24 living in Moscow and St. Petersburg are satisfied with the result. That is, those who do not experience serious health problems and live in major cities with a large number of federal medical centers. But you will not envy people of the age in the outback. But can they find salvation in telemedicine today?

The topic of telemedicine is being actively promoted to the masses, and, perhaps, some of the officials have already received impressive bonuses for ticks in reports on the introduction of new technologies. According to the head of the Department of Information and Internet Technologies, Moscow State Medical University. Sechenov Georgy Lebedev, today it is already possible not only remote consultations, but remote diagnosis:

- We have developed mathematical models that allow us to evaluate the completeness of information about the patient. If this completeness is available, then why not make a diagnosis to the doctor? This is the future. And the next direction is remote monitoring of the state of health, the transfer of medical care from the hospital to the home. This is necessary and important for patients with chronic diseases. This topic is close to the concept of the “Internet of Things”, when a person at home can use different devices that allow him to assess his state of health. There are more and more such devices, starting with the simplest ones (thermometer, glucometer, tonometer, blood analyzers). We can already talk about the transfer of medical care from the hospital to the home. And this is already a salvation for bedridden patients when he can be observed at home.

Despite this, it turned out that telemedicine is completely prohibited by law in our country! It is impossible to conduct an examination using technical diagnostic tools and make a diagnosis during an online consultation. Boris Zingerman, Head of Digital Medicine at Invitro, talks about this:

- Large legislative restrictions are currently imposed on the use of telemedicine in the Russian Federation, and Russia is not alone in this. Today, according to the current legislation, it is impossible to make a diagnosis at the primary telemedicine consultation and it is impossible to prescribe treatment. The possibility of telemedicine as primary care is severely limited.

The introduction of innovations in the public sector is carried out according to the principle “he who does nothing makes no mistakes”. The fear of the Ministry of Health is understandable: for a "welfare state" the price of a mistake in the healthcare sector can be very high. But there is also the private health sector, which can afford to experiment much more daringly. The Ministry of Health even made legislative indulgences for commercial clinics, adds Boris Zingerman:

- In 2020, a law was passed on experimental legal regimes, which should make it easier to promote innovation in a reasonable controlled manner, and in 2021, amendments to the law on health protection were adopted, which suggested the possibility of expanding the use of telemedicine, but the law stated - "only in within the private healthcare system.

However, here, too, the matter did not go further than a legislative initiative. Private clinics are ready to introduce telemedicine services, but everything depends on the indecision of the Ministry of Health, says Boris Zingerman:

- Already during the year, at least 4 applications were received, prepared by large commercial medical organizations, for an experimental legal regime that would expand the possibilities of using telemedicine. To date, none of the applications for an experimental legal regime in telemedicine has been approved, and the Ministry of Health has written negative reviews for all of these applications.

With the private practice of doctors, it is even more difficult. The reality is that people trust not only the brand of the clinic, but also the name of a trusted doctor, they come to him on the recommendation. This allows doctors to work independently and contact patients without intermediaries. Only doctors in private practice do not have an abundance of various rooms, there is no way to accept all patients at once. Telemedicine is their salvation. Boris Zingerman explains that it is generally banned in Russia. If you come across such services, then they are entirely in the shadow sector of the economy:

- There is a common fundamental Russian problem: a doctor is not an independent legal entity. That is, he can provide medical care, including telemedicine, only as an employee of a medical organization. The ability to organize in some private way a private telemedicine service is not legally allowed, although many doctors do this - they advise patients through standard instant messengers, by phone.

The position of the Ministry of Health is convenient for officials: when it comes to saving and reducing doctors with medical institutions, they are ready for experiments. When the time comes to transfer projects into reality, initiatives begin to slip. And why strain and take risks, if high-profile PR statements have already been made, checkmarks have been put in the reports ... and the fact that the country is losing its population will be blamed on the machinations of the LGBT. For nothing that so much paper was spent on the next new bans and inventing their justifications.