The age of technology. Doctors on new standards in Moscow healthcare

Moscow’s healthcare is constantly evolving and getting better; hospitals with well-thought-out layouts, new healthcare standards, high-precision equipment, digital technology and artificial intelligence — what was hard to imagine a decade ago has become reality and even commonplace today.

Medical Worker’s Day is celebrated in Russia on the third Sunday of June. In celebration of their professional holiday, doctors told the mos.ru team about key changes in healthcare in Moscow.

More new cutting-edge healthcare institutions

Moscow gets new medical institutions every year, running intensive construction of the flagship centers at the Buyanov City Clinic Hospital, City Clinical Hospital named after S.P. Botkin and O.M. Filatov City Clinical Hospital No.15 in addition to a major overhaul of the building to host the flagship center at City Clinical Hospital No.1 named after N.I. Pirogov, to be fully equipped clinics with admission departments, ORs, intensive care units and thousands of state-of-the-art devices.

“They have everything for the fastest top-notch medical care in situations where every minute counts. Up-to-date diagnostics and treatment methods, high-tech equipment, professional teams and common healthcare algorithms — all this enables as quick and efficient assistance as possible with an emergency,” says Anastasia Rakova, Deputy Moscow Mayor for Social Development.

Patients will spend no more than 24 hours in the flagship centers, which will be needed for diagnosis, and then they will be transferred to a special department for treatment or will be discharged if no further hospitalization is required. In total, Moscow will have six flagship centers, two of them, at the Veresaev State Clinical Hospital and N.V. Sklifosofsky Research Institute for Emergency Medicine, are already admitting patients.

In addition, this year builders will complete a medical and diagnostic facility at Infectious Disease Clinical Hospital No.1, while construction of the new medical and diagnostic facility of the Loginov Moscow Clinical Scientific Center (MCSC) has finished to date. They are running modernization of existing hospitals and overhauling outpatient units with more than 80 buildings having been renovated.

They have also built and overhauled the perinatal center in L.A. Vorohobov City Clinical Hospital No. 67, Pediatric Building No. 1 in Morozov Hospital, nine Botkin Hospital buildings (for renal surgery, palliative care, eye surgery and hematological diseases in addition to the Outpatient Cancer Care Center (OCCC), etc.), the cancer surgery block and OCCC in Oncology Hospital No. 1, and buildings of the Multidisciplinary Palliative Care Center.

The Kommunarka Multidisciplinary Clinical Center, which opened in 2020, is more than just a hospital as it has a perinatal center, children’s infectious diseases/new children’s blocks and a regional vascular center; it is also one of the five anchor oncology inpatient hospitals in Moscow. As soon as the radiation therapy building is ready, Kommunarka will turn into the largest multidisciplinary medical center in the city. Modern hospitals have well-thought layouts, said Kommunarka Director Denis Protsenko.

“Those that were built in the Soviet years had conventional admission departments with visitors waiting near the rooms. We also have such an area, but it is intended for the so-called green patients who do not need urgent medical care. In Kommunarka, we have introduced a triage system (from French triage ‘sorting’): there are green, yellow and red zones. People with serious illnesses and injuries are yellow patients. This implies that “not the patient goes to the doctor, but the doctor goes to the patient” The patient receives doctors and has ultrasound testing, while in bed. And the red zone is a shock hall for critical patients,” Denis Protsenko explained.

In the integrated red-zone operating rooms, interventions are performed using various methods and equipment, including orthopedic and neurosurgical. If a patient has multiple injuries, they forge a so-called trauma team, consisting of a surgeon, neurosurgeon, traumatologist, anesthesiologist and resuscitator.

Also, Kommunarka has a smart navigation system to make it easier for patients to move around the hospital. Diagnostic and exercise therapy rooms are available in those departments where they are especially needed, for example, in those providing post-stroke rehabilitation.

“The grounds of healthcare institutions have become seamless. All Kommunarka buildings are interconnected by underground and surface passages. We are not afraid of snowfall or rain. You do not need to put on a warm coat, go to the next building and show your pass again. It is easier for doctors to interact with colleagues from other departments, conduct research, and transport patients,” Denis Protsenko emphasized.

Gamma knife and Da Vinci surgical robot

Innovative equipment for Moscow hospitals is not a luxury, but everyday stuff. Tens of thousands of different medical devices, including CT/MRI scanners, robotic systems, etc., are used in healthcare institutions. The gamma knife employed at N.V. Sklifosofsky Research Institute for Emergency Medicine is intended for treating tumors and vascular malformations in the cranial cavity (radiation enters the body without incisions and prevents the neoplasm from growing further). The angiography machine visualizes the lumen of blood vessels and heart cavities. The Da Vinci robot operates on patients following the surgeon’s commands, its ‘hands’ being capable of performing complicated manipulations as they rotate 540 degrees.

Hundreds of operating rooms have been refurbished in Moscow hospitals for doctors to perform organ and tissue transplantations, arthroplasty, blood vessel prosthetics, and other operations. Vitaly Doroshkin, Head of the Department of Emergency Traumatology in L.A. Vorohobov City Clinical Hospital No. 67, gives some examples from his practice why high-tech devices are irreplaceable.

“Thanks to computed tomography, we can improve our actions during surgery. For example, CT scanners are needed in pelvic surgeries. Previously, we used to employ only an electron-optical converter (intensifying an image to be visible to the eye), although it did not provide us with an overall picture. And a CT scanner gives a 3D image; we use it to check the quality of reposition, that is, we compare bone fragments after a fracture and after screw insertion. Without arthroscopic towers, we did not have access to intra-articular fractures,” he said.

Usual instruments have also changed. A patient can be laid on the orthopedic table so that it is convenient for both the patient and the doctors, whereas in the case of old-day tables they had to come up with a holder. There are new-gen electric coagulators; previously they used to be separate wheeled devices and doctors had to move them and remove the cords, while now there are 360-degree rotating coagulator consoles.

“Surgery times have decreased significantly. Minimally invasive surgery minimizes the area of intervention and tissue injury. As a result, the risk of infectious complications is lower and the recovery period is shorter,” said Vitaly Doroshkin.

Farewell to paper medical records

Digitalization has transformed Moscow’s healthcare. Electronic medical records, online appointment with a doctor, centralized laboratory services, computer vision technologies for analyzing radiation images, or an AI-based chatbot for collecting patient complaints about well-being before seeing a doctor — today, applications of new technologies are quite diverse.

Andrey Tyazhelnikov, Chief Freelance Specialist in Primary Health Care for the Adult Population under the Moscow Healthcare Department, recalled which difficulties doctors used to face and what changed with the Unified Medical Information and Analysis System (EMIAS).

“Healthcare in Moscow is developing very rapidly, systematically and progressively. And residents feel this very well. Until recently, patients have waited in queues, registered in journals or even on pieces of paper in order to see a doctor. Now Muscovites can make an appointment without leaving home, either by phone or via the Internet. Also, with the introduction of electronic medical records, patients can view all their records, appointment data, and tests. This is convenient not only for patients, but also for doctors as the latter no longer need to spend time, for example, searching through multi-volume paper medical records for the patient’s test results. E-records are also available to ambulance crews as, when attending a professional call, they can read the medical history on the way,” the doctor said.

We should also mention the Medical Decision Support System (MDSS), which prompts possible diagnoses and suggests prescriptions, depending on the patient’s symptoms.

“Of course, it is the doctor who makes the final decision, but the system facilitates the work of a doctor. In general, continuous introduction and improvement of e-tools make things much easier both for patients and doctors. So, this spring the system got a section called My Self-Monitoring Questionnaire, which is intended for patients with chronic diseases who are under proactive long-term follow-up observation. It allows us to remotely monitor the patient’s health and, if necessary, adjust the treatment, make unscheduled appointments or prescribe necessary tests. This kind of constant health monitoring is a real breakthrough in healthcare,” says Andrey Tyazhelnikov.

Implementation of such solutions was made possible thanks to a one-stop-shop digital healthcare platform, which is being developed jointly by the Moscow Social Development Complex and the Department of Information Technologies.

“Playing out different scenarios helps pull oneself together at once, while on duty”

No matter how unique the devices and technologies are, efficacious treatment would not be possible without professionals as it is they who control equipment, prescribe treatment and save lives in operating rooms. To keep up with modern medicine, they are improving their skills non-stop.

For this purpose, the Moscow Healthcare Department has created its Personnel Center for doctors to learn new medical care standards in flagship centers and get to know how to avoid professional burnout. It also offers medical internships and provide simulators for doctors to hone their skills.

“A mannequin can simulate pulse, blood pressure, pupil response and other parameters that are so important for doctors in emergency situations. Using such devices, we can play out our actions when providing assistance to seriously ill patients, for example, those with heart attack or stroke, after a severe traumatic brain injury or an accident,” explained Maria Tikhomirova, a resuscitator of the flagship center at the Veresaev State Clinical Hospital.

The doctor should quickly understand what has exactly happened and why and then provide assistance, she says.

“We must make fast decisions. When every minute counts, the doctor feels uneasy and is afraid of not finishing it in time. Playing out similar scenarios helps pull oneself together at once, while on duty. If you fail, the teachers of the center will analyze your mistakes and explain what you should have done. And no one says that you are a bad doctor; on the contrary, they are very supportive,” the resuscitator emphasized.