MOSCOW, April 10. /TASS/. Development of telemedicine is affected not that much by a lack of technologies but by a vacuum of legal regulations, experts told TASS.
In an address to the Russian legislators, President Vladimir Putin called the wide implementation of telemedicine a healthcare priority for 2017. Most experts say modern technologies are extremely important, especially in development of the Arctic. They stress, the current system of healthcare in the Russian North is specific and does not comply smoothly with the standards and rules fixed by the current Russian legislation.
Law without borders
The main problem for development of telemedicine in Russia is that formally remote consultations are not legal. Healthcare Minister of the Arkhangelsk region Anton Karpunov explained - under the current legislation "telemedicine consultations are only in the doctor-to-doctor mode." "This means, further treatment is discussed between two specialists, for example a doctor at a regional hospital and a specialist in a big clinic," he told TASS.
Doctors’ remote consultations to patients are related to the aspect of responsibility for the decision and further treatment. Medical expert of the Northern State Medical University Larisa Menshikova says it is necessary to approach accurately the legal aspect of remote medical services, as it is related to doctor’s responsibilities for the patient. "There is a bill, which may legalize the "patient-doctor" consultations, but there are very many legal questions here. The doctor will become responsible for the patient, whom the doctor has never seen," she said.
In fact, we are facing a legal vacuum, which would not allow remote medical services using telemedicine technologies; and the solution should come from a law, which now is with the State Duma since last May. The bill’s authors say use of modern telemedicine technologies "raises quality of diagnostics and health monitoring," and thus raises the life quality. "However, for wider use of telemedicine, it is necessary to provide regulations for using modern technologies in medicine," the bill’s authors said.
The bill reads that with use of telemedicine, a patient is granted a choice: to agree or refuse from assistance and diagnostics with use of telemedicine.
The immense region
At the recent forum Arctic: Territory of Dialogue in Arkhangelsk experts stressed it necessary to mind peculiarities of living in the Extreme North. "The Arctic has the peculiarities, which may make ineffective the standards or provisions for healthcare services, which are used in the Russian Federation, and scientists should adjust them accordingly to the local conditions," head of the Research Institute of the Human Ecology and Environment Igor Bobrovnitsky told the forum participants.
It is not a rare situation, when a doctor has to cover dozens or even hundreds of kilometers to see a patient. "The most outstanding issue, in our opinion, is the problem of qualified medical assistance, not only in villages, at meteorology stations, gas and oil fields, to the indigenous peoples, including the nomadic population, but also at the Arctic cities and towns," Georgy Lebedev of the Sechenov Fist Medical University said.
In the Nenets Autonomous District, the only clinic is the local hospital. "This peculiarity is typical also for other Arctic regions, and the great deficit of labor and the high share of specialists doing several jobs makes it next to impossible offering fully qualified medical services to the local people," he added. The most complicated situation remains in the settlements, getting to which is highly problematic.
"The only existing communication is by air, but expenses for sanitary aviation - in terms of local budgets - are very high," he said.
This opinion is shared by Larisa Menshikova of the Northern State Medical University. The sizes of the territories, the lack of medical assistants - those are the main problems with medical services in the Arctic. For example, in the Arkhangelsk region there are more than 4,000 settlements where fewer than 100 people live. "According to all the existing norms, we cannot organize for them even medical offices with assistants, as for that the required number of people living in a settlement should be 100," she said.
Telemedicine conquers the North
In reality, when the bill passes the Duma, telemedicine will be legalized, Russia’s presidential advisor on the Internet German Klimenko said. "We all are involved in telemedicine," he told TASS earlier. "What it (the law) will do first of all - it will legalize the very process."
The expert from the Northern State Medical University confirms it. Remote medical services develop in the Arkhangelsk region since 1995, she said. Nowadays, they are available in all the districts there. "Besides, recently appeared a tele-medical center on the basis of the First Municipal Hospital for consultations of patients with stoke," she said.
In the country’s less-numbered populated area - the Nenets Autonomous District - where about 44,000 people live, every year more than 1,000 tele-medical consultations are made. Every third person lives in distanced settlements. In January, the region launched a three-year Russia-Norway project "Innovative technologies for improvement of life in the Extreme North." Press service of the local administration said the task for the Russian side is to develop the medics’ skills in remote work, prevention of diseases typical for the people in the north, as well as establishment of tele-medical communication with eight most distanced stations of initial medical assistance. Tele-medical complexes are working now at regional hospitals and clinics.
In the Krasnoyarsk Territory, which has distanced districts and settlements, continue several projects related to telemedicine and remote consultations. The first project was implemented in the territorial hospital, which organized a center for remote ECG-based consultations. Within one day, the center receives about 200 recordings. "The territory also implements X-ray consultations, where, like with ECG, specialists not only analyze the recordings and films, but also give consultations regarding further treatment tactics," the local healthcare ministry told TASS.
Telemedicine is impossible without high-speed Internet connection at hospitals and clinics in the country. President Vladimir Putin ordered to settle this problem within two years.
This problem is vital for the Arctic zones in Yakutia, which have all preconditions for development of modern communication technologies. "The communication channels would not let us use fully telemedicine in distanced areas," the republic’s First Deputy Minister of Healthcare Oleg Pripuzov told TASS. "They are available only in central districts and big cities: Nerungri, Mirnyi, and Yakutsk, thus we are launching satellite equipment to transmit data to distanced areas."
Yakutia’s Ministry of Communications reports 72 settlements (59% of the republic’s population) are connected to fiber-optic lines. By 2019, the communication will be available to 75.3% of the population (720,000 people), while the technical progress costs much higher here than in the rest of the country: in the north, where access to the Internet is provided by satellites, the price for unlimited access may be 10-15 thousand rubles ($175-263) a month, depending on the tariff. In Yakutsk, the tariffs are between 850 ($15) and 2,400 rubles ($42).
Both doctors and cell communication operators are ready to participate in development of telemedicine technologies. MTS and the Medsi clinics plan a new online service, where users would be able to receive remote consultations from more than 2,000 doctors. The companies do not name the release date, but promise it would be the biggest-ever complex project in telemedicine.
Meanwhile, until the bill passes the legislators, the project remains pending. "Before the bill comes into force, all consultations will be exclusively recommendations: a doctor may offer additional tests or may discuss earlier prescriptions," head of MTS’ press service Dmitry Solodovnikov told TASS.
A bill on telemedicine was presented to the State Duma (parliament’s lower house) in spring of 2016. The document is based on suggestions from the Healthcare Ministry on legal regulations for telemedicine.