Telemedicine in Russia: more questions than answers so far

Is doctor real or fake?

The law on telemedicine, which envisages the possibility of medical help at a distance, came into force in our country on 1 January 2019, that’s to say, over 1,5 years ago. But despite the presence of legislation, a patient can get a consultation at a distance and not always has a chance of making sure if it is a doctor in front of him on the screen or simply a person in a white coat.

I have had to hear stories in which students of medical universities didn’t get a licence but already consulted as doctors. Yes, they are familiar with the terminology and probably know more information about medicine than an ordinary citizen of our country, but this isn’t what gives them the right to cheat a patient and break the law.

Three tips to start with

• First of all, I will note that telemedicine in itself isn’t licensed as a separate service. It is a “social service” and can be provided in those areas of a medical organisation it has a licence for. In other words, if a clinic has a licence for ophthalmology or neurology, it has the right to provide telemedicine services only in these areas, but not in therapy.
  
  Consequently, before consulting a doctor, a patient should find out exactly in what clinic he works, examine the licence of the medical establishment and the type of service that is provided. It is the basics to at least not to harm your health. As a health worker, I recommend having the first visit to the doctor face to face in any case.
• Secondly, after a person chose the health establishment and doctor, he should understand the way the communication will be established and make sure of the safety of personal data, that it is protected from a leak. For instance, it can be a programme certified by Russia’s state health watchdog. Communication with a patient can also be maintained via audio messages, emails or messengers. Here it is very important to understand which type of communication is convenient for the person.
  
  By the way, the legitimacy of medical consultations via messengers is still open for discussion. At least I haven’t seen a clear answer or recommendations in this respect in related documents.
• Thirdly, it is very important to register the fact of consultation, that’s to say, a patient must have a document after a talk with the doctor. This can be a note in the medical record, prescription or the protocol of prescription the doctor wrote. If a person dislikes something in the online consultation, he has the right to make a complaint about the poor quality of medical services.

It is three basic components I think one should pay special attention to.

What else needs to improve

Telemedicine is anyway a novel area for Russia (and the whole world as well). This is why there are a lot of sore points that require being improved.

For instance, it is the issues of medical privacy, communication security and development of quality criteria. I think the last point is one of the priorities: Russia has quality criteria and regulations for medical services, and similar requirements must be created for telemedicine as well. Both doctors and patients must know what such consultation must be like, that’s to say, what’s the norm and what’s not.

Yes, telemedicine increases the availability of medical advice: a resident of a remote town can be consulted by a capital’s medical luminary at home. But what will be the result, what will medical statistics of use of such a type of service be like especially not in individual cases but on average? I haven’t seen detailed research on it yet. It probably happens because of a lack of time to do it: the pandemic, in fact, became the first big “test drive” of telemedicine in our country, moreover, this trial turned out to be forced.

Health workers’ wage is an interesting aspect that needs to be addressed separately. Opinions about this are different. So some experts think a patient must pay for an online consultation less because there is no direct contact with the doctor. Others, in contrast, say that given the cost of technology and equipment, telemedicine must be more expensive than a traditional appointment. I think it is necessary to create clear criteria to calculate the cost of such services for the transparency of the process. Moreover, they can be different in every area of medicine.

It is also important to determine the cases when telemedicine won’t be good but evil: medical cases and diseases when a doctor must see a patient personally and do a complete examination (for instance, with palpation) to be able to make a diagnosis correctly and choose the protocol of treatment. And vice versa, in many situations it is really simpler and more effective for a patient to be consulted at a distance or continue treatment than go to a face-to-face appointment (for instance, in case of diabetes control).

After all, there are a lot of questions. In any case, the future lies with telemedicine and consultations at a distance. Most importantly, it is necessary to consider this activity smartly and do good for the patient’s health.