Private clinics will be able to write prescriptions online as part of an experiment

From September this year, a number of private medical organizations, including RZD-Medicine, Medsi and Innovative Technologies, will be able to use telemedicine under a simplified protocol under the experimental legal regime (EPR). Their doctors will be able to correct diagnoses and write prescriptions for medicines during a secondary online appointment. However, the IT infrastructure for the circulation of electronic prescriptions is fully operational so far only in three regions of the Russian Federation.

From September this year, the government will launch a pilot project in the field of telemedicine with the participation of private clinics. They will be able to conduct remote consultations under a simplified protocol, follows from the government decree, which was presented yesterday by the Ministry of Economy.

Recall that telemedicine consultations for patients became legal in the Russian Federation in 2018 – doctors are allowed to provide medical care to patients using both telemedicine consultations and consultations, and remote monitoring. But in order to qualify for a correspondence appointment, the patient still needs to come to the initial consultation in person. Only after a face-to-face meeting, diagnosis and treatment appointment, the patient can contact a specialist with additional questions remotely. This significantly limited the potential for using telemedicine in both the private and public segments, even despite the interest in the new service from patients, which has especially increased during the coronavirus pandemic. Nevertheless, the consulting company BusinesStat estimated the number of telemedicine appointments in private clinics in the Russian Federation at the end of 2021 at about 5 million. This is less than 0.5% of the total number of appointments in public clinics in the outpatient segment (according to Rosstat, their number is estimated at 1.2-1.3 billion annually). The number of remote consultations in state clinics is even smaller: according to the All-Russian Union of Insurers, although it has increased dramatically since 2020, the total bill still does not exceed 300 thousand per year.

In an attempt to stimulate the development of telemedicine, the Ministry of Economy has repeatedly proposed to simplify the requirements for remote patient admission using an experimental legal regime – for example, in 2021, the department proposed launching a pilot project, the participants of which would be able to consult patients remotely without an initial face-to-face appointment. Both the Ministry of Health and the State Legal Department under the President were regularly opposed (see Kommersant dated July 22, 2022).

The latest version of the original initiative of the Ministry of Economy suggests that the government will still conduct a three-year experiment and test a number of indulgences for the provision of telemedicine consultations. It will be attended by 15 private medical organizations, both subdivisions of medical clinics (RZD-Medicine, Medsi, and Doctor Nearby) and initially telemedicine startups (Innovative Medicine, Sbera and M-LINE). Some of them have clinics only in Moscow, but a number of organizations are also represented in the regions. As Kommersant was told in the Ministry of Economy, “the EPR mechanism does not imply the creation of monopolistic competition,” therefore, in the future, other market participants will be able to join it.

For telemedicine consultations, pilot participants will still need to arrange a face-to-face appointment for the patient in advance, but they will be able to correct the preliminary diagnosis online and issue an electronic prescription for the necessary drugs to the patient. Any doctor of the clinic can conduct such consultations, but no later than one month after the full-time appointment. As Maxim Chernin, head of the board of directors of the medical company Doctor Nearby, explains, “business understands the desire of the state to develop the telemedicine industry gradually.” “For us, the main task is to build a hybrid treatment process, so during the “pilot” we will focus on qualitative indicators and do not set ourselves quantitative goals in the form of a multiple increase in the number of telemedicine consultations,” he said. According to him, the Ministry of Economy did not set requirements for the prices of online consultations, so each clinic will determine them for itself. “Someone believes that since the amount of work for a doctor does not become less, then the cost should be the same as that of a personal visit. In our organizations, telemedicine consultations will be cheaper than face-to-face consultations, since they do not require additional work on the clinic infrastructure and in practice they often take less time,” he notes.

Partial deregulation of telemedicine services is likely to attract additional users and increase the final number of appointments, says Kirill Khromov, head of the First Electronic Prescription company, and the launch of the project will help popularize electronic prescriptions. It should be noted, however, that although many regions are developing infrastructure for the circulation of electronic prescriptions, it fully functions only in Moscow, the Moscow and Belgorod regions. For most pharmacy chains in the regions, the costs of introducing electronic prescriptions are quite high, and since they are still little known among consumers, the payback period is difficult to calculate. In addition, until the federal register of electronic prescriptions is launched in the Russian Federation, they can only be used within the region where they were issued (for more details, see Kommersant dated April 14, 2022)

Anastasia Manuylova, Venera Petrova