Digit helps all the way: from making a diagnosis to routing the flow of patients
IT innovation
Moreover, digital solutions concern not onlypatient care - business processes related to the administration and admission of patients can also be automated. In such medical centers, patients will not endure pain in a crowded emergency room while waiting for a doctor. Hospitals are already using machine learning solutions to streamline their queuing process.
Algorithms not only help to deal withflow of patients, but are engaged in more complex tasks - developing pharmaceuticals, analyzing and storing patient records, or can alert the doctor that a particular patient may have an underlying disease that is easy to miss. AI is already reducing the number of errors in cancer diagnosis, and cancer patients are much more likely to survive.
This is not a utopia and not a description of the fantasticfuture. In 2017, the Mayo Clinic partnered with Temptus to begin using algorithms to identify signs of cancer. Researchers at the Lineberger Comprehensive Cancer Center used the IBM product to identify specific treatments for people with tumors who were found to have genetic abnormalities.
Moreover, algorithms are needed not only for treatmentcomplex diseases, but rather to get rid of routine - according to a study by Sage Growth Partners, 90% of medical institutions in the United States have already implemented algorithms or have written down a plan for their implementation in the future. For example, patients at The Ohio State University Wexner Medical Center can see a doctor without a single call and review their medical records at any time. In Moscow, patients received the opportunity to independently register remotely, not within one hospital, but throughout the city, back in 2011, and access to an electronic medical record in 2020.
It doesn't matter if new tools are used toregulating the flow of patients or developing drugs for cancer, they are reinventing modern healthcare. An area in which smart solutions can predict, understand, learn and act for the health of the patient.
Digitization is not just electronic services
How algorithms are being introduced into Moscow medicine
In Moscow ten years ago they began working oncreation of a unified digital healthcare platform. Its basis is EMIAS (Unified Medical Information and Analytical System), Moscow clinics and then hospitals began to connect to it. The first service within the system was basic, but the most popular was remote booking of an appointment with a doctor. Despite the fact that in Russia they are wary of digital systems, according to official statistics, 80% of Muscovites took advantage of making an appointment with a doctor via the Internet this year.
The system was created from scratch, so initiallyit was necessary to digitize and upload all paper documents to the cloud, organize them and create a system that allows you to instantly access the necessary information. Over time, the platform has become more advanced - services have appeared for collecting the medical history of citizens, issuing electronic prescriptions. The result was an electronic health record, a “digital twin” of a paper patient record. It stores all the health information that both the doctor and the patient can see.
“The system is primarily convenient for the Muscovite himself.When an ambulance goes to a call, it still gets access to the patient's data along the way - the team has 5-7 minutes to check the anamnesis, see chronic diseases, - Vladimir Makarov, Deputy Head of the Information Technology Department of the Moscow Government, noted in an interview with CNews , Head of Digitalization at the Moscow Social Development Complex. - It is convenient that a person does not need to carry papers between the outpatient and inpatient link, for example, when he is hospitalized. Now it's all happening automatically."
Moreover, digitalization is not just electronicservices that are launched without real infrastructure. To implement EMIAS, it had to be created from scratch: laying communication and engineering networks, installing modern sockets and computer equipment for doctors, improving the medical devices on which specialists work - X-ray machines, CT and MRI machines, mammographs, fluorographs and angiographs and much more. Digital structured data in a unified form is also important for the system; specialists are already rapidly digitizing the data, which is then used in the EMIAS system.
Digitalization should not be total - it will only lead to the opposite effect
“If the majority is engaged in the creationdocument-oriented systems, then the main thing for us is the clinical essence: body temperature, pulse, blood pressure indicators,” explains Vladimir Makarov. “Wherever the blood sampling takes place, the result is put into the system, it doesn’t matter if it was taken in an ambulance, a hospital, as part of a medical examination, these documents break down into clinically significant entities. This is a product that works on the scale of a huge metropolis.”
One of the most important services providingsuccession and continuity of medical care, as well as the collection and storage of clinical data - this is an electronic medical record. The service is constantly being improved - at first, in the medical record, users could see the protocols of examinations of doctors, the results of laboratory and instrumental studies, as well as extracts from hospitals. Then information about the vaccination of children and adults was added to the map. Currently, valid e-prescriptions with a QR code are available to citizens in their electronic medical records — patients do not have to go to the pharmacy with a written prescription form, it is enough to show the QR code of the prescription to the pharmacist on the phone. Moreover, some of these functions are not even in foreign systems.
In addition to convenience for the doctor and patient, the arraymedical data in an anonymized format makes it possible to develop digital services, including AI. “Automation of the process of collecting medical information makes it possible to accumulate an array of big data on the health of the population and opens up huge potential for training artificial intelligence in solving practical healthcare problems,” says Alexey Loleit, Deputy General Director for Strategy and Product Development, Data MATRIX. “Starting from improving the accuracy of early diagnosis and predicting the development of diseases, ending with the analysis of pharmacoeconomics and the ability to reduce costs in the healthcare system.”
Moreover, digitalization, as conceived by the creatorsservices should not be total - this will only lead to the opposite effect: a decrease in labor productivity and a decrease in the number of medical staff. The doctor is not excluded from the process, but remains the key link that makes the final decision. But digitalization gives him the opportunity to make better decisions, free himself from routine and double-check himself.
Digital assistance during the pandemic
Especially digital systems have shown theirefficiency in Moscow during the pandemic. All medical institutions around the world are facing the same challenges - a huge number of patients, a lack of resources, and routine operations that must be performed manually at the moment when patients need help. Scientists and doctors began to use technology in order to win the race against time for the lives of patients.
Moscow was ready for such a challenge thanks todigital maturity of metropolitan healthcare. This helped in a very short time to create a digital system that helps each patient in a personalized way at all stages of treatment for coronavirus.
The basis of the digital platform is a laboratory serviceCOVID-19 diagnostic tool created in less than a month, including 600 institutions - both city, private and federal institutions. This made it possible to have a single up-to-date database of all residents of Moscow with a confirmed diagnosis. Another important information service is the unified digital register of patients with coronavirus infection, which includes about 250 healthcare organizations. It provides personalized accounting, routing and management of patients from the moment the virus is detected. The register is available in real time to all parts of the healthcare system.
Here's how it works:immediately after confirming the patient's diagnosis, data on the severity of his condition are entered into the register. Contact them and check the status. An ambulance goes to seriously ill patients, and the treatment of patients with symptoms of acute respiratory viral infections or pneumonia that does not require hospitalization is carried out by a telemedicine center.
Artificial medicine also came to the aid of doctors.intelligence (AI) — using new technologies, radiologists have the opportunity not to miss pathologies in a large stream of studies and to quickly determine the stages of development of pneumonia on CT scans of the lungs.
Artificial intelligence (AI) has also come to the aid of doctors
Algorithms managed to be trained thanks to digitalizationand anonymized data accumulated over the past few years. An AI-based neural network for determining the degree of lung damage in case of COVID-19 was introduced into the Unified Radiological Information Service (ERIS) of EMIAS. It was trained on data from half a million patients - algorithms can now help doctors and millions of people who seek help with the same problem.
“We noticed that even those doctors who initiallywere skeptical of AI systems and quickly embraced their value in use. In general, the time factor, getting used to and improving the products themselves will contribute to building confidence in AI,” says Anna Meshcheryakova, CEO of Third Opinion. “Although the developers of AI services for some narrow tasks already today show the accuracy of detecting pathologies that exceeds the human one.”
In addition, through the introduction of voice input andcomputer vision technology, as well as the integration of beam equipment into a single digital network, the time for decoding CT images was reduced to several minutes. At the same time, the results of all studies are automatically entered into the electronic medical records of patients.
“AI tools, in particular computer vision,in medicine began to be widely implemented with the beginning of the COVID-19 pandemic, when the flow of patient requests increased fivefold or more in a short period of time. Doctors needed tireless digital assistants, notes Anna Meshcheryakova. — As part of the Moscow experiment on the implementation of innovative technologies in the field of computer vision for the analysis of medical images, it was confirmed that thanks to AI processing, the time for describing one medical study is reduced by 30%. Ultimately, the radiology department is able to process a larger flow of studies.”
Experts around the world recognize the high accuracyalgorithms - they can determine the results of tests in 99.3% of cases (sometimes traditional analyzes are not even needed for this, the sound of a cough is enough), they select individual treatment for patients in a few minutes and can change it if necessary. If doctors were doing this, they would not have enough time to pay attention to patients who need it, and the workload would be many times greater.
Citizen experience
To check how algorithms and digital services help the patient, the Hi-Tech correspondent wrote her child to the doctor through an application with an electronic medical record.
Previously, in order to get an appointment, she had toearly in the morning to come to the clinic and take a coupon. On the day of the appointment, stand in line at the reception to get a paper medical record, and then wait in line to see the doctor. After acceptance, wait again to return the card to the registry. If the specialist wrote out referrals for additional examinations or tests, it became even more difficult, the documents are easy to lose.
With the introduction of digital technology, the recording processtakes several minutes - for this you need to enter the access code, go to the application and select the child on the start page. Finding a doctor is easy - you can choose him by specialty or by last name. At the same time, in order to get an appointment, you do not need to call anywhere. The application opens his schedule, and not for the near future, but for two weeks in advance. The correspondent without any problems signed up for an appointment and delivery of tests in the direction of the next day.
With the introduction of digital technologies, the process of making an appointment with a doctor takes a few minutes
Thanks to EMIAS, polyclinics cope with the flowpatients - I had to wait about 10 minutes for an appointment only because the previous patient was late for a short time and his appointment took a little longer. There was no queue.
Booking an appointment for a doctor's referraltook a minute. For the procedure, I also had to wait 5-10 minutes, here patients enter the office a little more slowly, but only because some children need to be given a little more attention. The results of the procedure the next day came to the electronic medical record in the mobile application. You can also view the inspection protocol and test results there.
The results are also stored in the electronic medical recordinstrumental studies, examination protocols, vaccination data, doctor's prescriptions and much more. It is no longer necessary to go with a paper prescription, and a paper medical record and registry become unnecessary and archaic.
The future of digitalization
It seems that medicine is one of the mostinnovative areas where digital technologies are most actively introduced, but world data refute this. According to a study by Danish scientists, they are more commonly used for security, entertainment, and even employee management.
At the same time, the digitalization process is underway in Moscow10 years already. Dynamic development continues now, but technology still has great potential to help doctors, keep people healthy, relieve specialists from routine and focus on cases where a living doctor is needed.
"Health care system and pharmaceuticalindustry needs large data sets containing data from real clinical practice and methods of treating patients, - reports Alexey Loleit, Deputy General Director for Strategy and Product Development at Data MATRIX. - Having learned from such data, artificial intelligence is able to build predictive model and become a valuable assistant to the physician, and contribute to the assessment of standards of care to optimize and improve clinical and cost-effectiveness.”
Physicians can focus on cases where they are most needed
As doctors share in the study, the majorityof them remain satisfied not with the technology itself, but with "a combination of algorithm and human intuition." For example, Daniel A. Orringer, a neurosurgeon at Langone Health, performs surgery to remove brain tumors and uses the system to determine if he has removed as much of the tumor as possible or if the operation should continue.
Despite patients' fears that AI will rob them of personal care, while the opposite effect occurs, doctors can focus on cases where they are most needed.
“If during the operation I have sixquestions, I can get answers without waiting 30 or 40 minutes. And this reduces the time of the operation, the patient is less under anesthesia, which is always good, he notes. “From this example, it is obvious that technology will not change brain surgery and medicine in general, we are talking about small details. The patient will feel more comfortable, and doctors will get a quick assistant.”
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