The government has approved a “second package” of assistance to the digital industry. In addition to the introduction of a digital tax, an important place in the plan is occupied by the support of domestic developments, including services for the healthcare system of the Russian Federation. “MK” decided to find out how the market of medical information systems (MIS) works, what specific benefits they have already brought to citizens and will bring in the future.
In three steps
Russian hospitals began to implement solutions to automate the reception and service of patients at the end of the last century. But the boom began in 2011, when the project for the creation of the Unified State Health Information System (EHISZ) was launched. At its first stage, which is listed in the documents as “Basic Informatization”, 30 billion rubles were allocated from the state budget.
At the second stage, which took place in 2013–2018, the regions received and utilized 28 billion rubles. The government added another 2 billion to them in the form of federal subsidies. We managed to do a lot for this money. The Ministry of Health of the Russian Federation has created vertically integrated medical information systems (VIMIS) for individual profiles: oncology, cardiovascular diseases, obstetrics and neonatology, and prevention. In a short time, electronic medical records became popular. Municipal and departmental hospitals have introduced paperless circulation of electronic documents. The pioneer was the FSS project for the transition to an electronic certificate of incapacity for work. Nowadays, many clinics issue electronic prescriptions, electronic birth certificates. In 2021, developers need to support about 50 new types of medical documents. They are actively moving to digital models for the provision of results and laboratories.
At the third stage of the project, during 2019–2924, it is planned to create a single digital health care circuit based on the UGHI. For this strategic task, 151 billion rubles have been allocated from the federal and regional budgets. Of these, about 19 billion rubles. it is required to master from the consolidated state budget for the introduction of MIS in the current year.
Kinks in the field
It is clear that such a “sweet” budget “pie” worth 151 billion rubles. attracted increased attention of law enforcement agencies. For example, the scandalous arrest of ex-minister of informatization of the Tula region Artur Kontrabayev and businessman Alexei Chernousov, accused of fraud in the creation and implementation of a regional health information system, caused a great public outcry. According to the SK, all allocated for these purposes over several years 68 million rubles. was kidnapped, and “the cost of actually performed work was zero rubles zero kopecks.”
At the same time, the victim in the high-profile case – the government of the Tula region – did not agree with the conclusions of the prosecution, or with the amount of damage. Since the regional system, created on the basis of the MIS “Infoklinika”, has been successfully operating for a long time and has even been recognized by the Ministry of Health of the Russian Federation as one of the best in the country. Directly Griboyedov’s comedy “Woe from Wit” performed by Tula investigators.
For comparison: according to the State Services portal, St. Petersburg signed 107 contracts for 123.3 million rubles. for the supply of MIS “Infoklinika”, Rostov region – 12 contracts for 16.3 million rubles, Volgograd region – 7 contracts for 4.4 million rubles. Moscow generally allocated in 2013–2017. for the purchase of software and services for informatization of health care 8.9 billion rubles. And the regulatory authorities did not find a single violation.
The alignment of forces
According to Alexander Gusev, a member of the supervisory board of the National Medical Knowledge Base Association, Webiomed Development Director, the market of software products for medicine and healthcare is clearly divided into two segments. Almost 90% of the turnover is formed by the state order, therefore, all manufacturers support in their solutions integration with the Unified State Information System, ECDC. “There are no data on the sector of private clinics, but we estimate its volume at 300-500 million rubles. annually, ”added the expert.
10 years ago, about 100 companies were involved in the development of MIS. Now, according to ARMIT, there are 47 players left. In the segment of government orders in terms of turnover and customer base, the leaders are RT Medical Informsystems from Perm (JV RT Labs and GC SVAN), Bars Group (Kazan) and GC Netrika (St. Petersburg). On the private market, the top 3 include the capital’s Smart Delta Systems (MIS Infoklinika), Post Modern Technology (MIS Medialog) and the St. Petersburg-based Renovazio Soft (MIS Renovatio).
According to the marketing research of the K-MIS company (Petrozavodsk), a private clinic is ready to pay, on average, a one-time payment for the implementation of a medical information system of about 20-40 thousand rubles. (the maximum amount was 120 thousand). A comfortable level of payment for technical support services is in the range of 10-15 thousand rubles. in year.
Interestingly, some large private clinics have abandoned third-party customers and developed software products on their own. For example, the network of clinics “European Medical Center” (EMC) has invested more than 50 million rubles in digitalization in a year and a half. But now EMC has a proprietary MIS “Element”, which has increased the performance of the network and made it possible to automate original business processes.
Note that private clinics, despite a small share in the medical software market, make higher demands on developers. Sergei Mityanin, deputy general director for information technology at SM-Clinic, told MK: “Previously, we used a“ monolithic ”MIS, with a single architectural and software code for all functionality, and a single data warehouse. Now we are in the process of moving to a microservice architecture, in which there are many autonomous modules, where each is responsible for his own range of tasks. This approach allows maintaining the overall functionality in the event of a failure of an individual module. “
“More and more clinics understand that the client’s experience depends on the work of MIS, and there is very strong competition for the client,” noted Philip Mironovich, general director of the Bud Zdorov clinic network (owned by Ingosstrakh). “Therefore, a number of major players“ wrote ”their systems to better manage the experience of their clients. A large number of ideas arise on how to apply AI in this process. But I do not yet know examples where this would give any tangible financial results, except for PR. On the other hand, the state allocates a lot of money for the digitalization of healthcare in the regions, and many companies are trying to please the state customer, where the priority is not at all on the client’s experience, but on the control over the write-off of consumables and the fulfillment of the compulsory medical insurance requirements. Here are two oppositely directed trends that are now shaping the market for such solutions.
The pandemic has become a test of strength for the developers of the IIA. In late 2020 – early 2021, they needed to develop and include new services in the digital healthcare circuit within a few days – recording for vaccinations, registries of COVID-19 patients, analytical reporting on the incidence of COVID-19, etc. They coped with stress better. those companies that, at the architecture level, have foreseen the possibility of including new functional blocks. “The pandemic has shown the practical value of digitalization. If earlier experts for several years discussed the possibility of carrying out some types of telemedicine consultations in accordance with the current legislation, now the questions have been removed, and regulations are being promptly revised to provide an opportunity to consult with a doctor remotely in an extreme situation, “said the head of the department sales and development of Netrika Medicine Andrey Dyukov.
According to Alexander Gusev’s forecast, the consolidation of the market of software products for medicine and healthcare will continue in the coming years. Some of the players will be forced to leave him. Some leaders will not be able to hold their ground. Their places will be taken by young and ambitious teams that will offer fashionable cloud technology systems. In addition, the trend towards import substitution will increase. More and more MIS developers will use Russian software.
It is already known that new VIMIS will appear next year. For example, on infectious diseases. “Digital health is moving towards specialization. Increasingly, there will be demand for integration services that will be able to ensure data exchange and continuity between systems. When visiting a doctor, the patient does not have to bring paper documents and medical history with them. All information will be available in electronic form, including to the patient himself, ”concluded Andrey Dyukov.