Medical Data | Do not give out a medical card.

    Least of all your electronic medical data you need (s). There is also good news - today users can already receive medical electronic data in several services, if very necessary. Today we understand how and why to start embedding your medical information system into the medical data ecosystem and whether the patient needs its data.

    Patient and data

    A very clear and simple Use Case “Patient and Medical Data” - getting access to your medical data on demand. Today such access is possible to get in the services:

    • at the federal level EGISZ .
    • through regional IIAs - in St. Petersburg MIAC , in Moscow - EMIAS .

    Information for the patient is available in services in the form of PDF forms approved by the Order of the Ministry of Health of the Russian Federation of 09.01.2018 No. 2n. So, MIAC speaks in open sources and about the possibility of obtaining in the near future 23 forms in the patient's medical record. If we talk about dentistry (our segment and the DentalTap service ), then order No. 2n includes Form No. 043-1 / y “Medical Card for an Orthodontic Patient”. The new form 043 / y “Medical record of a dental patient”, proposed by the Dental Association of Russia, is not included in the order of the Ministry of Health.

    Standards and Regulators

    It is worth making a digression that in Russia a special GOST R 52636-2006 has been developed, describing the management of the patient’s medical electronic data. It contains technical and organizational requirements that must be met in order for the data in the program to replace paper medical documents.

    There is no medical patient's electronic card in the terminology of the standard. The standard operates with EHR terminology - Electronic Health Record or electronic personal medical record with EDS. The medical history in the definitions of the standard is the toolkit for working with the EHR, that is, your service or the IIA (medical information system). From the point of view of the architecture of the entire ecosystem of medical IT solutions, this is a wonderful approach, since, in general, of all the EHRs, it is possible at any time to collect all patient data (case history) from one side of the application.

    The standard defines the procedure for transferring medical data to third parties and obliges the transfer of e-signatures to the patient by the clinic. The standard does not have a simple thing that would simplify the life of all - the architecture of EHR.

    Further, it is important to note that Law N 152-F “On Personal Data” determines that medical data can be processed if it is publicly available and work with this data is regulated by the Federal Law “On the Basics of Citizen Health Protection in the Russian Federation” of 11/21/2011 N 323-ФЗ, the Law on Electronic Signature and the Law on Telemedicine. Got some other medical information, yes.

    Medical data 

    After becoming familiar with the requirements of regulators, it became obvious that medical electronic data is not only documents signed with an electronic signature, but service medical information that is necessary for the operation of services, the exchange of data between them and the transfer to the patient. What's next?

    Not when the paper medical card was not given on the hands and here again. Medical electronic data signed with an electronic signature (visit-form No. 2n) will make up 20% of their total volume, and 80% is official information about patients, which is publicly available. Common sense dictates that developing a branch of communications clinic - the patient according to the data from the EDS does not have any meaning because of their uselessness to the patient and the current regulatory basis is built on contradictions. The value of the patient for the data on the diagnosis, visits, services, money. All this data needs to be included in the Electronic Health Record and the ideological focus in creating an IP is to be done precisely on the elaboration of the architecture and data formats.

    Clinic and patients

    This is the optimal Use Case for the developer of the IIA and medical data clinics. The clinic is well aware of all the values ​​of avoiding paper work, the importance of keeping the patient through the history of the disease and there is an understandable, though outdated, standard. Plus, no one forbids a patient to have several case histories in digital format. In this scenario, the tasks of the IIA are clear - to realize the possibility of using documents, digital signatures, patient’s personal account and to help the clinic with the internal regulations of electronic documents.

    Regional IT systems and others

    The concept of creating a unified state information system in the field of health, approved by order of the Ministry of Health and Social Development of the Russian Federation of April 28, 2011 No. 364. Today, most patients use the services of an appointment to see a doctor. Penetration of electronic hospital in Moscow 3-4%.

    Today, access to your medical data is available on the portal Gosuslug. The implementation of access contradicts the requirements of the standard (according to them the patient must receive an EDS in the clinic), but is regulated by the Law on Telemedicine, which determines access to services through its digital signature.

    The regional systems themselves are developing towards independent sets of services with an emphasis on communication between the medical institution and the patient. Federal IP goes the way of integration and partial development from zero - Rostelecom develops Electronic Registry for 1 ruble and Integrated EHR for 1 ruble, 1C-Parus gave the accounting system to the project, and Softline delivered identification and authentication solutions. In St. Petersburg, we went our own right way and do everything ourselves from scratch and already have api.netrik to interact with the developers of IIAs.

    Perhaps the development of such systems will reshape the market for the automation of medical institutions in general, but this is not certain.

    • Users of the systems of municipal clinics, which in dentistry 30%.
    • Developers leave the possibility of integrating third-party services by API.
    • Systems are under development.
    • Penetration of telemedicine services, digital signatures and electronic hospital is not enough.
    • Some projects in 2018 are not funded.

    In the meantime, somewhere in an ideal world, there should be an Electronic Health Record repository, in which my medical history should lie and my doctor can see it with one click.

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