Human Resources, Digital and Repair: How Outpatient Care Is Developing in Moscow

The foundation of the entire healthcare system can be called outpatient care - polyclinics. This is the primary link that a citizen encounters most often in life and from which he expects a high-quality and effective solution to his issues. “The average Muscovite visits hospitals every 8-10 years. He visits the polyclinic on average eight times a year, and changes should take place there, ”said Moscow Mayor Sergei Sobyanin. The city authorities are paying special attention to the modernization of outpatient care in several areas at once: this is the renewal of infrastructure, the digitalization of processes, and the introduction of patient-centered principles.

Experts discussed the latest trends in the development of outpatient care and the success of the capital at the My Polyclinic forum, which was held from December 15 to 17 in Gostiny Dvor. The forum participants not only summed up the intermediate results of the development of the capital's outpatient care over the past year, but also outlined a program for the further development of Moscow polyclinics. it includes measures to personalize the medical care provided, further digitalization, as well as the formation of unified approaches among the mayor's office and the medical community. Despite the ambitiousness of the tasks set, they are assessed as feasible for Moscow healthcare.

Face to face

Starting next year, as part of the MHI program in Moscow, proactive dispensary observation of citizens with chronic diseases will take place, said Anastasia Rakova, Moscow Vice Mayor for Social Development. This project was launched back in 2022 and includes the most common diseases that occupy the main share in the structure of mortality: type 2 diabetes mellitus, hypercholesterolemia, arterial hypertension, coronary heart disease and myocardial infarction, atrial fibrillation and flutter, chronic heart failure, acute cerebrovascular accident, chronic obstructive pulmonary disease, peptic ulcer. Their treatment allows to increase the duration and quality of life of patients.

Anastasia Rakova (Photo: press service)press office)

To implement the project, the city has developed a special service in EMIAS, with the help of which the district DOCTOR gets access to the register of people with all designated nosologies. During the examination, the doctor will be able to open the patient’s dispensary observation card, determine the necessary examinations and generate electronic referrals for them and consultations of other specialists, as well as prescribe drug therapy and write out electronic prescriptions for drugs. The doctor will also have the opportunity to evaluate the results of the studies and, if necessary, adjust the monitoring and treatment program. In addition, the specialist will be able to monitor the patient's condition between appointments, for example, if he asked for urgent help, was hospitalized, or received a consultation from a doctor in another institution.

According to Rakova, more than 1 million Muscovites with chronic diseases will receive an individual monitoring and research program. “In order for polyclinics to be interested in these patients, starting next year we will specifically introduce a separate tariff for comprehensive dispensary observation in addition to per capita funding for polyclinics,” the vice mayor said. In addition, about 600 assistants will be in touch both with doctors and directly with patients. They will help form the necessary package for a full-fledged, consistent and continuous dispensary observation, Rakova specified.

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The vice-mayor also announced the creation by doctors of city polyclinics of the rules of mutually respectful relations between specialists and patients, about which all residents of Moscow were notified. “Now you can compare how patients are treated in polyclinics with what standards our doctors have set for themselves. Moreover, we not only provide an opportunity to compare practice with our values, but since this year we have also been conducting regular patient surveys, on the basis of which we form ratings with an assessment of the work of our clinics, ”said Rakova.

According to her, the publication of the first rating of Moscow polyclinics, which took place within the framework of the forum, became one of the stages in the formation of a new culture of communication between a doctor and a patient. According to the totality of such indicators as respect for the patient, professionalism, team cohesion, patient focus and others, the city polyclinic No. 220 became the absolute leader - three of its branches entered the top 5 rating.

Photo: press servicepress office

An example of a new approach to communicating with patients is the emergence of employees of public service centers as administrators of polyclinics. Over the years of operation of the MFC, their employees managed to create a client-oriented environment there and develop their communication skills. By December 2022, 1.5 thousand MFC employees throughout Moscow are already helping the staff of polyclinics. The experiment was recognized as so successful that from 2023, the practice of attracting specialists from the My Documents centers as administrators will also work in the latest emergency hospital complexes (CICs) - modern multifunctional emergency centers.

Personnel issues

Orientation to the patient, in turn, is impossible without proper retraining of those who are in direct contact with the patient - with the staff of polyclinics. On the basis of the personnel center of the capital's department of HEALTH, a number of trainings are now being implemented for specialists from polyclinics renovated according to the new standard. Now 7.8 thousand specialists have already passed them.

Also, on the basis of the personnel center, all general practitioners are trained. These specialists should have a wide range of professional competencies in the diagnosis and treatment of the most common diseases. The program includes 13 areas: urology, endocrinology, rheumatology, cardiology, gastroenterology, pulmonology and other sections. Leading doctors, as well as chief freelance specialists of the Moscow Department of Health, took part in the development of training programs for each specialization.

The general practitioner training project was launched at the end of December 2021 and will end in February 2023. After completing the training, about 3,000 doctors will improve their professional level in all these disciplines - these are all general practitioners working in the Moscow healthcare system.

Each educational module consists of theoretical and practical parts and takes 18 hours of study. Doctors study the theoretical part online. At lectures, they consider algorithms for diagnosing and treating the most common diseases using modern methods and drugs, which helps to reduce the time of diagnosis and increase the effectiveness of the prescribed therapy. The practical part takes place directly in the personnel center and includes the development of skills on modern simulation and medical equipment, as well as solving situational problems.

Photo: press servicepress office

However, any organizational changes, Vice Mayor Rakova is sure, require maximum transparency in the dialogue with the team itself: employees must be aware of upcoming changes, they must understand and accept their goals and objectives. In her opinion, it is necessary to create a system within which all links will receive feedback on any situation. “Openness and honesty with each other will help, if necessary, to make adjustments to plans and move in a given direction,” the Vice Mayor emphasized.

“If we create a system where we are honest with each other and have a desire to move in the same direction, then we are in the same row, shoulder to shoulder, we can achieve success. And share with you all the responsibility and complexity of these decisions that lie ahead of us. If all this is summarized in a simple understandable word, then it sounds very simple - this is trust, ”she said.

Digitization of outpatient care

To achieve maximum efficiency in the work of polyclinics, a strong motivated team is not enough - these people should not be slowed down by paperwork. And if since the summer of 2022 all children's polyclinics of the capital have switched to a digital format of work, adult outpatient facilities will follow them in the near future, said Natalya Kataeva, HEAD of the Moscow Mayor's department in the Moscow government for social development.

Photo: press servicepress office

In 2023, Moscow will include the analysis of X-ray images by artificial intelligence (AI) in the MHI tariff. According to Anastasia Rakova, this will complete the first stage of introducing digital vision services into practical healthcare and routine medical practice. The first, in particular, the analysis of mammographic images will be included in the compulsory medical insurance system, and such studies will remain free for Muscovites.

Now such services are working as part of an experiment to introduce computer vision into Moscow medicine. So, about 40 AI services help radiologists in 17 areas of research. Neural networks apply markup to ray studies and make the necessary measurements. Doctors can access both original images and images processed by AI. Neural networks are already helping to find signs of lung cancer, covid-19 , osteoporosis of the spine, thoracic aortic aneurysm, coronary heart disease, stroke, pulmonary hypertension, hydrothorax on computed tomography, and also look for breast cancer, lung pathologies and many other diseases.

Moscow has been working on the digitalization of the healthcare system for more than a decade. An experiment on the introduction of computer vision technologies into medicine was launched by the Moscow Social Development Complex on the basis of the Moscow Center for Diagnostics and Telemedicine, as well as the city department of information technology. The center has become a platform for the development of artificial intelligence technologies in RUSSIA. Artificial intelligence services were integrated into URIS EMIAS, as a result of which about 150 medical organizations of the capital, including children, received the opportunity to use innovative technologies.

Photo: press servicepress office

Among other experimental services launched in pilot mode in the outgoing year is the project of a digital passport for a polyclinic, which now involves nine metropolitan outpatient clinics. It is conceived as an online control center to help the chief physicians and their deputies: all relevant statistics are displayed there for each of the branches of the clinic and the patients attached to them with an electronic medical record (EMR).

In turn, the functionality of the EHR itself has expanded in 2022. Now they have a personalized calendar of children's vaccinations and the ability for parents to fill out a questionnaire with data about the child. EHR also plays an increasingly important role as a database of human health, regardless of where he was examined: in a city, federal or private outpatient clinic. So, since this year, it has become possible both to upload archives with CT and MRI images from private and federal clinics to the service, and to share the latest selected data from EHR with specialists.

The presence of an electronic medical record in a patient contributes to the development of a remote consultation of a doctor - telemedicine. Since February 2022, telemedicine services have been operating at all polyclinics in the capital. According to the Moscow Social Development Complex, by the end of 2022, specialists have already conducted more than 1 million telemedicine consultations for Muscovites.

Old new clinics

New processes and approaches require changing the space around them. It is hard to imagine the work of a highly qualified team with digital tools in obsolete and obsolete Soviet clinics. To this end, a large-scale program for the overhaul of city polyclinics was launched, covering almost half of the outpatient fund of the capital. It included 201 polyclinics, and by the end of December 2022, 72 of them had already been repaired. In addition, 32 brand new buildings are under construction, five of which have already opened their doors to patients in 2022.

Photo: press servicepress office

The renovation of the old and the construction of the new fund follows the unified Moscow standard for polyclinics. It combines all the above-mentioned areas for the development of outpatient care - focus on the patient, caring for the team, and the introduction of new technologies. Thus, the floors are planned as conveniently and ergonomically as possible for both visitors and employees. Each polyclinic is supplied with a unified set of equipment, and recruitment is carried out according to uniform rules throughout the city.