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Video: Telemedicine For Patients
Telemedicine for patients
Modern medicine has gone far ahead, but its achievements are not available to everyone. Getting timely treatment is hampered by the sluggishness of the healthcare system, overload and lack of doctors, and the very geography of the country. The development of telemedicine can provide an opportunity to at least partially remove the problems with routing, maintenance and monitoring of patients' condition.
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Modern medicine has gone far ahead, but its achievements are still not available to every Russian patient. And the reason for this is not always a deficit in health financing. Often, getting timely treatment is hampered by the sluggishness of the system, congestion, or even the complete absence of doctors, and the very geography of the country. The development of telemedicine can provide an opportunity to at least partially remove the problems with routing, maintenance and monitoring of patients' condition.
Even before the adoption of the telemedicine law, de facto non-legal technologies were practiced in many regions of the country. Today, such projects are becoming more and more - telemedicine services are being mastered by private medicine, federal and regional centers, patient organizations. The possibilities of new technologies, problems and the first successful solutions were discussed at the International Forum on Digital Medicine, held in mid-April at Sechenov University.
The International Forum on Digital Medicine is aimed at accelerating the development of innovative methods and technologies, as well as creating conditions for their widespread implementation.
The average Russian patient loses precious time at all stages of diagnosis and treatment. And even early detection of the disease does not guarantee the timely start of treatment. In oncology, this period, instead of the 14 days established by the Ministry of Health, can take up to six months., said Boris Zingerman, director of the Association for Artificial Intelligence in Medicine, scientific director of TelePat - Telemedicine for Patients LLC. “And all this time no one is responsible for the person,” the expert believes. - Therefore, the main thing is to optimize patient routing. And we involve insurance representatives at this difficult stage. " By order of the Territorial Fund of the CHI of the Yaroslavl Region, the specialists of TelePat LLC have developed the information system “Service for the management of insured persons under CHI with suspected malignant neoplasm” (ONKOcontrol).
As soon as a person receives a referral to an oncologist, his data is entered into the information system and sent to the insurance company, where an insurance representative is assigned to him. A personal account and the possibility of correspondence are created for the patient himself. The examination plan, which is assigned by the oncologist, is also seen by the insurance representative, who will monitor the progress of this examination. And if a problem arises, for example, with an MRI recording, it solves it manually. If a person comes to the oncologist without a referral, his data is entered into the system after this appointment. And for those patients who do not use the Internet, the ability to communicate with the insurer by phone has been added.
The next time the patient is "lost" from the field of vision of the attending physician after being discharged from the federal or regional center. At the same time, among patients with chronic diseases, remote post-hospital monitoring and support during long-term treatment are in demand. Thus, chemotherapy is given to cancer patients at their place of residence, where they often remain without professional support. Many doctors continue to communicate with patients on the phone, but such communication falls into the so-called “gray zone” of health care, which does not require any documentation. There is no way to pay for such consultations.
A year and a half ago, the OncoNet platform was launched for remote monitoring and support of cancer patients at home. For the implementation of the project, the Association of Oncological Patients "Hello" received money from a presidential grant. The OncoNet platform is a cloud service that does not require integration into the medical information systems of clinics. The principle is simple: the doctor appoints the patient an individual questionnaire and a schedule for filling it out. The patient periodically receives a link to fill out the questionnaire by e-mail. The responses are summarized in a "heat map" showing the dynamics of the patient's condition.
The OncoNet platform, which also includes an integrated medical decision support system, is provided for free use by Russian cancer centers. The pilot project was tested in several Russian regions. Including, in the Lipetsk regional oncologic dispensary. As the head physician of the dispensary, Sergei Shinkarev, said, such accompaniment made it possible to effectively correct the toxic symptoms of chemotherapy and increase the survival rate of patients.
“The doctor and the patient understand different things differently,” the oncologist explains. - For example, if a person has vomiting or diarrhea, he may subjectively assess their intensity. And in the questionnaire, he specifically notes how many times a day a particular symptom occurred, and as the symptoms grow, his "heat map" is painted in different colors. And if the situation becomes life-threatening, we try to get this information to the ambulance."
In addition, according to Shinkarev, using a "heat map", the system helps to convey to the patient the information necessary for him on the issues of regimen, nutrition, and rehabilitation. This is all that the doctor does not have time to do during a 12-minute appointment. “The number of patients is growing exponentially, while the number of doctors remains unchanged. In addition, in order to receive advice on symptoms, the patient must take a ticket, come to the appointment, often from afar. Therefore, we can talk about economic efficiency here, and our local format of real telemedicine is yielding results,”Shinkarev said.
But there is another side to the coin. Thus, according to the chief physician, over the past year 61 doctors and 155 patients took part in the project, who filled out 777 questionnaires. The number of views of these questionnaires by doctors has exceeded one thousand. But the question of payment for this work remains open. “We have calculated how much this service costs and have brought the issue to our tariff commission. But in order to conduct this as a consultation, the OMS requires an entry in the card. But on the contrary, we want to relieve the doctor. Can take a screenshot? In general, we haven’t agreed yet,”Shinkarev admitted.
Meanwhile, ahead on the path of development of domestic telemedicine is the creation of similar platforms for patients with other diagnoses, says Irina Kargalskaya, head of the Patient-Oriented Medicine Committee at the All-Russian Union of Patients. Thus, a project has already been prepared for a similar platform for remote monitoring and support of patients after organ transplantation. According to her, people return home after expensive operations and do not know how to behave at all, and doctors do not have the opportunity to monitor them.
This spring, OncoREHAB, an online supervised rehabilitation program for cancer patients, also funded by a presidential grant, is starting to operate. According to Irina Kargalskaya, patients discharged from federal cancer centers leave for distant regions and have no chance of receiving physical rehabilitation. Thanks to the new service, they will study remotely in groups of 20 with an exercise therapy specialist from one of the four federal centers participating in the program. The doctor will see both the patient and his questionnaire, where data on side effects, physical activity are entered, and will be able to adjust the load.
Now the experts involved in the formation of OncoREHAB, together with rehabilitation doctors, are developing questionnaires for controlling pain syndrome, wounds, and assessing the motor ability of injured limbs. The issue of tariffication for such work also remains open, it is only known that patients will connect to the OncoREHAB system for free.
The medical neural network "Third Opinion", which solves the problems of diagnosing diseases using artificial intelligence, presented at the Forum a service for monitoring bedridden patients "Care 24/7" developed in cooperation with Sechenov University. The system allows you to monitor the patient's pulse and pressure, his position, and signals if he fell out of bed. And also assesses the state of the environment - lighting, noise, air pollution.
In addition, the system calculates the risk of pressure ulcers and signals the need to change the patient's posture when the maximum allowed time is exceeded. “Every month, 120 thousand patients are discharged from Russian hospitals in need of constant outside care,” Anna Meshcheryakova explained the urgency of the problem to the CEO of the company “Third Opinion”. - Mortality in patients with a risk of pressure ulcers is 35-88%. With professional care, this risk is reduced by 2-3 times."
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