Digital Polyclinic: how high technologies help doctors and patients
Moscow polyclinics keep on switching to the digital services. Doctors are assisted by AI at examinations and when making a diagnosis, and patients can look at their medical records at any time and see results of the examinations. The success of the capital's healthcare has been repeatedly noted by international experts, the latest achievement being the nomination of the Unified Medical Information and Analytical System (UMIAS) to the WSIS Prizes 2021 international award final round.
The article on mos.ru explains what one can tell the chatbot about and how artificial intelligence helps doctors and patients.
Online appointment and chatbot
Digital technologies are used at the stage of making appointment with a doctor. Muscovites assigned to one of the city's polyclinics can schedule a visit to a therapist, general practitioner, surgeon, ophthalmologist and other specialists. To visit specialized doctors one needs a referral from the therapist or general practitioner.
“You can not only make appointment but also change the appointment time or cancel your appointment. Another patient will take the vacant time slot. As a result the number of patients who previously visited the polyclinic only to make appointment significantly decreased,” said Olga Kolesnikova, Polyclinic No. 218 Deputy Chief Physician for Medical Treatment.
A total of 72 percent of patients make their appointments via online services. This saves Muscovites’ time and allows medical organizations to manage resources and plan the schedule of specialists. One can make appointment with a doctor via mobile apps “UMIAS.INFO”, “State Services of Moscow”, “My Moscow”, on mos.ru and UMIAS.INFO platforms, as well as via call center at +7 (495) 539-30-00.
The doctor learns the patient’s complaints at the very beginning of the appointment, even before talking to him. Doctors are assisted by the chatbot created on the basis of artificial intelligence. The patient receives a text message and push notification with an URL to the survey form before visiting the clinic. One can describe his/her complaints in a free form and then answer the questions from the bot. The collected complaints are automatically transmitted to the UMIAS, and the doctor will see them in the examination report and will be able to correct them during the examination if necessary. Thanks to the preliminary survey, the doctor has more time to examine the patient.
“The doctor sees two windows in the application during the examination. One contains complaints collected by the chatbot, and the other is intended for the doctor's notes. While speaking with the the patient, the doctor will either confirm the information or correct it”, said Olga Kolesnikova. “Collecting correct anamnesis is rather a laborious process; it can take up to half the examination time when a complicated diagnoses is to be made. The chatbot's questions encourage the patient to think, recall, and analyze the symptoms that thereafter are reported to the doctor.”
Help in decision-making
New technologies help in the examination itself. Doctors are assisted by a decision support system. The AI-based tool selects the three most likely diagnoses taking into account the patient's complaints. The doctor can either agree with it or make another one. Then the system offers a set of studies and additional consultations of specialized doctors to confirm the diagnosis. Appointments are made in batches which significantly saves the examination time.
“If the patient came for the first time or was not at a check-up for a long time it is practically a matter of one click to assign all the examinations for making complete diagnosis. This eliminates the influence of human factor because it is totally the system’s advice. For example, a number of examinations for certain diagnoses should be carried out annually,” explained Natalia Shindryaeva, Polyclinic No. 2 Chief Physician.
Only the doctor decides whether to agree with the proposed diagnoses or not. Six months of using the service saw more than a million preliminary diagnoses made.
“Technologies are used to provide the doctor with maximum time for working with the patient. It is communication with the patient that is crucial for the correct diagnosis and treatment”, added Natalia Shindryaeva. “We made such a great progress in using information technologies that we actually can’t imagine our work without the UMIAS. Such services minimize errors in diagnosis and help young doctors”.
Hints from computer
Images from 1,300 digital diagnostic devices in Moscow’s medical institutions are uploaded every day to the Unified Radiological Information service (URIS), the city's cloud storage of medical images.
Radiologists can describe the stored images remotely, and if one needs advice of an experienced specialist experts of the Moscow Reference Center for Radiation Diagnostics can be contacted. This is the first teleradiology center in the city. Leading radiologists, candidates and doctors of medical sciences, and members of international associations work for it.
Doctors are assisted by AI-based computer vision technologies in the analysis of images. The algorithms mark the areas of probable pathologies with color hints and sort the images. The first studies to be received by radiologists are of those patients who need urgent medical care. Every day the services process thousands of mammograms, CTs and LDCTs and X-rays. The technology increases the accuracy of research and speeds up the doctors’ work. The share of early-stage disease diagnoses is also increasing. But the doctor still has the last word no matter how smart the technology is.
“AI services using computer vision technologies have sufficient sensitivity and are able to detect a pathology at a stage when it is not yet available to human eye. The service is useful when there is a large flow of patients, for example, during periodic health examinations or screening programs, as well as during the pandemic. This increases the number of early diseases detected which in turn affects the effectiveness and positive result of treatment. Nevertheless, the technology gives only the first opinion, while the second and most important one belongs to the doctor” said Olga Omelyanskaya, head of Department of scientific activities coordination of the Center for Diagnostics and Telemedicine.
Doctors can describe images and enter data into the system using speech recognition technology. One only needs a traditional headset (headphones and a microphone) or special talk keys. The voice input system recognizes normal speech and medical terms, adapts to the pronunciation of each doctor and can add phrases to the vocabulary. Such method of describing images is 20 percent faster than the manual one. Immediately after filling out the form, the patient and the attending physician receive a conclusion on the study in the electronic medical record.
Medical history at hand
The entire medical history can be viewed in the electronic medical record on mos.ru platform and in UMIAS.INFO mobile app. Almost two million people have already signed up for the service. One can view the reports of doctors' examinations, results of laboratory tests and investigations, clinical reports from the hospital, sick leave certificates, prescriptions written, data on vaccinations and ambulance calls. Previously, medical institutions needed to be applied to for such data. Citizens referred to the electronic medical records more than 24 million times for one year of the system operation.
In addition Muscovites can upload documents to their medical records, enter information about their personal and family history or keep a health diary. This information is available to the attending physician, which improves the quality of medical care. On top of that the electronic record can be used if the patient decides to apply to medical institutions that are not subordinate to Moscow’s Healthcare Department.
Now clinics are switching to maintaining medical documents only in electronic form without hard copies. The electronic documents test run is planned in April for two clinics for children and others will start it in October. Test results will help make a decision on implementation of the project in polyclinics for adults.
“So far doctors simultaneously keep documents both on paper and in electronic form. In polyclinics, they continue to print out electronic versions and attach them to patients’ medical records. There are also logs that need to be kept in paper. But Moscow is steadily moving to saving the doctor from a large amount of paperwork that could be done automatically”, said Pavel Gulyaev, MD, Chief Physician of the Diagnostic Center No. 5.
In addition, since February one can buy medicines in the capital without a paper prescription form just using an electronic prescription. It is now enough to show the pharmacist an electronic prescription with a QR code on the screen of a mobile device, or a compulsory medical insurance policy if the prescription is preferential. The electronic prescription cannot be lost, forged, or reused.
Electronic prescriptions with QR code are served in all pharmacies under the jurisdiction of Moscow’s Healthcare Department, as well as in a number of commercial pharmacy networks. Plus the list of current and serviced electronic prescriptions and their QR codes are available to citizens in the electronic medical record on mos.ru platform and in UMIAS.INFO mobile app.
Moscow doctors have been writing electronic prescriptions since 2014. Still, each recipe was created in UMIAS and printed out until this February. Now the paper form is not required, and pharmacists can get detailed information about the prescribed drugs from the UMIAS database after reading the QR code of the electronic prescription from the phone screen. This is much faster than writing out prescription by hand, and repeated prescriptions are made in one click. The paper prescriptions are still available though. This is important for those who are not yet ready to use electronic prescriptions or want to buy medicines in pharmacies that are not connected to the system.
“There is a certain wariness in relation to everything new, but it is logical. Some patients prefer to hold a paper prescription in their hands, but people are beginning to understand the benefits, so they try to switch to the digital version. We need to trust e-health more, because it is our future”, Pavel Gulyaev is sure.