Scientific Justification of the Model for Implementing Telemedicine in the Regions of Siberia

The dissertation is devoted to the scientific justification of the model for implementing telemedicine in the healthcare system of Siberia. The research was conducted on the basis of the Irkutsk Oblast and covers three key directions of high-technology medical care — pediatric cardiac surgery, phthisiology, and pediatric oncohematology. A methodology for the comprehensive economic analysis of the efficiency of telemedical consultations has been developed in the work, the needs of the population for receiving specialized care remotely have been studied, and the medical and economic feasibility of the widespread implementation of telemedicine technologies in conditions of remote and sparsely populated territories has been demonstrated.

Relevance of the Topic.

Today, the possibility of providing qualified medical care at any point on Earth has become a reality thanks to the development of telemedicine technologies. Telemedicine, literally meaning medicine at a distance, has in recent years gained wide popularity both in our country and abroad. This is an applied branch of medical science that ensures the practical application of methods of remote medical care based on the use of modern telecommunications technologies.

The term 'telemedicine' itself has only appeared in recent years, although works on the remote transmission of medical information have been conducted in our country since the 1960s, and medical telemetry was most actively applied in space medicine, as no other means can ensure monitoring of the health status of cosmonauts in orbit.

Worldwide, projects for creating telemedicine networks are among the most important medical programs. The need to develop telemedicine is recognized by leading countries of the world, such as the United States, Great Britain, Germany, France, Norway, and others. Methods of telemedicine are also being actively developed in Eastern Europe.

T.N. Stukolova et al. [123] emphasize that the implementation of telemedicine is a crucial task facing domestic healthcare today. Its relevance is determined by a number of factors that define Russian specifics:

- a large territory and low population density in many regions;

- uneven development of healthcare in the regions;

- the need to raise the level of medical care for the population.

At present, the process of forming a Russian telemedicine network is underway, ensuring access to specialized care for patients at territorially remote healthcare facilities (HCFs). At the federal level, telemedicine centers have been created in the State Medical Center of the Ministry of Health of Russia, the A.V. Vishnevsky Institute of Surgery of the Russian Academy of Medical Sciences, the Scientific Center of Cardiovascular Surgery (SCCS) named after A.N. Bakulev of the Russian Academy of Medical Sciences, the Moscow Research Institute of Pediatrics and Pediatric Surgery (MRIPPS) of the Ministry of Health of Russia, the Russian Scientific Center of Surgery of the Russian Academy of Medical Sciences, the Russian Military Medical Academy, and other federal centers.

Within the telemedicine project 'Moscow — Regions of Russia,' telemedicine centers in the republics of Mordovia, Yakutia (Sakha), and Buryatia, in the Nizhny Novgorod, Smolensk, Rostov, Tyumen, and Orenburg oblasts, and in Stavropol Krai and others, interact with federal institutes.

An important step in the development of domestic telemedicine was the creation in 2000 of the corresponding coordinating council of the Ministry of Health of Russia. The result of the council's activities was the development of the Concept for the Development of Telemedicine Technologies in the Russian Federation, which was subsequently approved by the joint order of the Ministry of Health of Russia and the Russian Academy of Medical Sciences No. 344/76 dated August 27, 2001. For the successful implementation of this Concept, comprehensive and effective scientific support is necessary. The present period is characterized by the accumulation of experience in the use of telemedicine technologies in Russian healthcare. Works by many researchers (B.A. Kobrinsky [59-65], S.P. Mironov [85], A.I. Grigoryev [32-35], O.I. Orlov [90-94], B.A. Stolyar [121-122], V.K. Belyakov [6], and others) contribute to the advancement of various directions of telemedicine in the system of medical care for the population. Interesting data on the implementation of telemedicine in Altai Krai are contained in publications by S.K. Tribunsky et al. [127], A.G. Lesnichev et al. [74-77]. The majority of authors [6,35,65,85,43,102-106,123,173] note that at this stage of telemedicine development, its main component is the conduct of telemedical consultations. Therefore, the main efforts should be directed toward building a unified telemedicine network that will ensure access to specialized medical care from any point in our country.

At the same time, it should be noted that in many works the main attention is devoted to technical aspects of telemedicine, with detailed consideration given to the equipment of telemedicine terminals, requirements for communication channels, and issues of image digitization. However, as S.P. Mironov et al. [85] emphasize, the overwhelming majority of publications do not contain information on the number of consultations actually conducted. This indicates that the success of telemedicine implementation is determined not only by successful technical but also by organizational solutions.

In the literature studied on this question, we have not encountered publications revealing the mechanism for integrating telemedicine into the regional healthcare system, nor a deep analysis of the efficiency of its use across various directions of medical activity. Despite the fact that in many works the costs of telemedical consultations are analyzed and calculations of their optimal cost are provided, unified protocols have not been developed that would allow the result of the implementation of a telemedicine project as a whole or its individual components to be evaluated. A methodology for the economic evaluation of telemedicine and its relationship with clinical outcomes has not been developed. Factors determining the long-term nature and prospects of a telemedicine project have not been established. Questions related to the influence of the human factor on the development of telemedicine have been insufficiently studied. Solving these problems is especially important for the regions of Siberia, which have similar geographic and socio-economic conditions. The widespread implementation of telemedicine in Siberia is not only a medical but also a crucial social task facing healthcare management bodies at all levels. All of the above determined the goal of our research.

The goal of the work: scientific justification of the model for implementing and evaluating the medical and economic efficiency of telemedical consultations in Siberia when providing high-technology and expensive types of medical care.

Tasks:

1. To study the needs of the population of the Irkutsk Oblast in teleconsultations when providing high-technology and expensive types of medical care (in pediatric cardiac surgery, phthisiology, and pediatric oncohematology).

2. To analyze the medical and economic efficiency of telemedical consultations in pediatric cardiac surgery.

3. To analyze the medical and economic efficiency of telemedical consultations in phthisiology.

4. To analyze the medical and economic efficiency of telemedical consultations in oncological and hematological diseases in children.

5. To determine the stages and conditions for implementing telemedicine in the regions of Siberia.

6. To determine the main directions of teleconsultation when providing high-technology and expensive types of medical care.

7. To develop a methodology for the economic evaluation of the efficiency of telemedical consultations when providing high-technology types of medical care to patients from Siberian regions.

8. To develop a model for implementing telemedicine in the healthcare system of Siberia.

Scientific Novelty.

For the first time, the needs of the population of Siberian regions (the Irkutsk Oblast) for high-technology types of medical care in the presence of congenital heart defects, tuberculosis, and in pediatric oncohematology have been studied, taking into account the possibilities of using telemedicine.

The influence of telemedicine on the quality of medical care in pediatric cardiac surgery, in oncological and hematological diseases in children, and in phthisiology has been analyzed.

For the first time, a comprehensive economic analysis of the efficiency of telemedical consultations when providing high-technology types of medical care in the specified directions has been conducted.

Stages of implementation have been formed and conditions for integrating telemedicine into the system of practical healthcare have been determined.

The role of telemedicine in the system of ensuring the quality of medical care has been determined.

A methodology for the economic evaluation of the efficiency of telemedical consultations when providing high-technology types of medical care to patients from Siberian regions has been developed.

A model for implementing telemedicine in the regions of Siberia has been developed, ensuring its effective use in the system of medical care delivery.

Practical Significance of the Research.

The developed model for implementing telemedicine in the healthcare system has been implemented in the Irkutsk Oblast in the creation of a telemedicine network and has also been used in other regions of Siberia (Omsk Oblast).

The necessity of widespread implementation of telemedicine when providing high-technology and expensive types of care to the population of Siberian regions has been justified from medical and economic perspectives.

A methodology for the economic evaluation of the efficiency of telemedical consultations when providing high-technology and expensive types of care has been developed and implemented.

The results of the research have been used in the development of the Concept for the Development of Telemedicine in the Irkutsk Oblast for 2002-2005 (Appendix 1), as well as in the preparation of Order No. 181 of the healthcare committee of the oblast administration dated April 2, 2002, 'On the Organization of Teleconsultations' (Appendix 2).

The implementation in the Irkutsk Oblast of scientifically justified recommendations for the use of telemedicine when providing high-technology types of medical care has made it possible to:

- increase the accessibility of medical care and improve its quality;

- use more rationally the resources available in healthcare;

- ensure the improvement of professional knowledge of medical personnel in the region.

Stages of implementation and conditions for integrating telemedicine into the healthcare system have been developed, which are currently applied in the Irkutsk and Omsk Oblasts and can be used in other regions.

Factors ensuring the stable and prospective nature of telemedicine projects have been determined and scientifically justified; these must be taken into account in their further development.

It has been shown that telemedicine is one of the technologies for ensuring the quality of medical care.

The results of the work are used in pedagogical and clinical activities at the departments of the Irkutsk State Institute for Advanced Training of Physicians.

Proposals for working with personnel in the organization of telemedical consultations have been developed and justified.

The research materials were reported and discussed at: a regional meeting on issues of telemedicine development (Irkutsk, 2002); the II Baikal Economic Forum (Irkutsk, 2002); the I All-Russian Congress 'Profession and Health' (Moscow, 2002); the scientific-practical conference 'Health of the Population of the Irkutsk Oblast: Problems and Ways to Resolve Them' (Irkutsk, 2003); the scientific-practical conference dedicated to the 80th anniversary of the phthisiological service of the Irkutsk Oblast; the II All-Russian Congress 'Profession and Health' (Irkutsk, 2003); the All-Russian conference 'Healthy Child' (Ulan-Ude, 2003); the II Russian Congress 'Pediatric Anesthesiology and Intensive Care' (Moscow, 2003).

Main Propositions to be Defended:

1. Significant needs for high-technology and expensive types of medical care among the population of Siberian regions, associated with low population density, remoteness, and unevenly developed healthcare, necessitate the widespread use of telemedicine.

2. The efficiency of telemedicine use is determined by the degree of its integration into a complex of measures aimed at improving the delivery of high-technology and expensive types of medical care.

3. Economic analysis methods make it possible to evaluate the efficiency of the application of telemedical consultations across various directions of medical activity.

4. The proposed model for implementing telemedicine in the healthcare system of Siberia provides for the sequential implementation of stages of telemedicine projects and ensures their high efficiency.

5. Telemedical consultations improve the quality of medical care by affecting all its components (quality of resources, processes, results) and also ensure the principle of its continuous improvement.

6. The proposed methodology for the economic evaluation of the efficiency of telemedical consultations when providing high-technology and expensive types of medical care promotes the integration of telemedicine into the healthcare system of Siberian regions.

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