It’s been a year since the Ministry of Healthcare of the Russian Federation legalized telemedicine, a service allowing doctors to provide advice to patients remotely. What opportunities does it offer in the healthcare sector? What do experts think about this law?
Telemedicine is a set of technologies, means, and methods that make healthcare services more accessible, proficient, and prompt.
Telemedicine technology has two areas:
- doctor-to-doctor communication: health workers (doctors and medical staff) contact with each other and solve healthcare issues;
- patient-to-doctor communication: remote exchange of information between doctors and patients.
The second concept is considered newer and more promising. It started rapidly growing when technologies were advanced and society digitalization was accelerated. At the same time, the patient-to-doctor communication can be divided into two types: remote diagnosis using special equipment (for example, measurement and control of heart rhythms) and remote patient advice.
Besides, customers can contact doctors by phone, Skype, or via messengers and special apps. Such a kind of consultations cannot replace an in-person physician visit, but makes medical services more available.
Due to telemedicine, it is easier for patients who live far enough from specialized health facilities to consult doctors. Remote advice also reduces queues in hospitals. For instance, doctors can remotely assign analyses so that patients will be able to come for examination with a package of results.
Advantages of telemedicine:
- immediate aid;
- saving of time and money;
- a wide range of specialists;
- a lower risk of infection prevalence;
- permanent monitoring in case of chronic diseases.
According to specialists, the main disadvantage is the impossibility to examine a patient, which is a crucial stage when determining an accurate diagnosis.
Dr. House puts it, patients always lie. As part of the teleconsultation, it is much harder to realize how honest a patient is. It is not clear yet how to combat this,” says Valery Stolyar, Head of the Department of medical information and telemedicine at Peoples’ Friendship University of Russia.
Along with the question whether patients will provide reliable information or not, there is a problem of confidence between the patient and the doctor. Not all people, even forward-minded ones, are ready to trust in the voice in the phone.
Telemedicine across the globe
Various countries support the development of telemedicine in order to provide their citizens with high-quality and prompt aid. One should primarily focus on legislation and development of a corresponding infrastructure in this matter. This aspect is developed most of all in the USA, Australia, and European countries.
USA. country has been practicing telemedicine since the late 1960s after the establishment of the first specialized clinic in Massachusetts. The USA allows to partially compensate telemedicine services using insurance and has strict patient data protection regulations. Remote psychological therapy and monitoring of health conditions of people living in rural regions are quite popular. Telemedicine regulation is supplemented by new amendments and laws every year, with each state having its own rules.
Germany. Telemedicine is officially approved and supported at the state level there. However, there are some limitations to patient-to-doctor consultations: specialists have the right to appoint and conduct video consultations only after personal examination. Besides, insurance covers telemedicine services. Telemedicine is popular among diabetic patients who have to be followed up by a doctor regularly as well as monitor blood sugar level and weight.
Australia. It has one of the world’s most efficient healthcare systems (according to Bloomberg research). Telemedicine, together with other novelties, is strongly supported by the authorities. The Australian Digital Health Agency is in charge of development strategy and regulation solutions. According to CSIRO, the application of telemedicine in treatment of chronically ill people allows Australian healthcare to save approximately $2.1 billion dollars per year.
Telemedicine in Russia: how does regulation help?
In 2018, Russia’s telemedicine is regulated by the Law No. 242-FZ “On amendments to certain legislative acts of the Russian Federation to clarify the procedure of personal data processing in information and telecommunication networks”.
In fact, Russia has been practicing telemedicine for more than 30 years, but mainly in the doctor-to-doctor mode rather than the patient-to-doctor option, which has been adopted by many countries for dozens of years. Not only does the new law simplify an access to medical services for citizens, but it also allows clinics remotely advising patients to earn money.
What does the telemedicine law permit?
To provide remote consultations using the app, phone, or video communication programs;
- to correct a treatment pattern if a person has already seen a doctor;
- to give advice concerning what highly specialized doctor you should address;
- to tell patients what analyses should be submitted before a face-to-face visit.
A substantial advantage for patients is a possibility to get advice of certain specialists that are far away. For instance, they can listen to the opinion of Moscow professors being dozens of thousands of kilometers away from them. Moreover, telemedicine services are cheaper than a personal visit to private clinics. Grigory Bakunov from Yandex.Health stresses that a remote consultation costs, in average, two or three times cheaper than a conventional one.
Telemedicine regulation challenges
One of the core problems related to the new law is that it imposes a veto on remote diagnosing. This aspect significantly constricts a range of services that clinics can provide to clients interested in the possibility to obtain a doctor's decision remotely.
By the way, there is much concern about diagnosing using telemedicine not only in Russia. It is practiced only in the USA now, but not in all states.
Furthermore, each clinic providing telemedicine services should register its electronic signature. It officially confirms that patients receive a competent service. Such a signature requires annual updates, but one has not yet allocated money to public clinics for this purpose.
To make the law work with maximum performance, one should elaborate the legal framework as well as adopt corresponding acts and standards, e.g. a procedure of writing out remote prescriptions.
Case studies of Russian services
Despite the fact that the healthcare sector is just adapting to new realias and the law is not yet applied practically in a proper way, Russia’s telemedicine market is successfully operating. Telemedicine services are provided by specialized tools, including:
- Doc Plus;
- Online Doctor;
An average cost of services is 500 RUB per each consultation that lasts, in average, about 15–20 minutes.
In late 2018, KHOST Group of Companies introduced its own solution: a telemedicine app called Medved.Telemed designed for public clinics and their patients. It is expected that the service will be used in north regions with poor connection in order to exchange data even via a weak channel of 1 Mb/s. Konstantin Suslov, CEO of KHOST, believes that this solution will help to significantly reduce government expenditures for healthcare.
Sberbank also took an interest in the telemedicine market and acquired 79.6% of the DocDoc project. Specialists’ advice is available twenty-four-seven to owners of Sberbank Premier service packages.
In 2017, LLC Alfa Life Insurance, in liaison with the Online Doctor service, launched the Good Health product. It provides remote advice of primary care physicians around-the-clock as well.
Other companies also add telemedicine to their health insurance programs. It can be referred to such companies as Renaissance Insurance and Doctor Ryadom network of clinics. At the same time, the Ministry of Healthcare of the Russian Federation is going to make a remote consultation on obligatory medical insurance policy available by 2019. Thus, it should be included in the public guarantee program of every region.
According to HIS analytical company, the global telemedicine market will reach almost $44 billion and show the growth of 17.7% by 2019. Telemedicine is a promising area that can fundamentally change the healthcare sector in Russia if the authorities support it legislatively, introducing required changes in the standards of care.