The Ministry of Health approved the principles of electronic document management (EDM) in medical organizations. This initiative should make it easier for physicians to work with documentation and improve quality of data collection. What does it take for EDM in medicine to work at full capacity?
What wasn’t enough?
Health market participants were looking forward to the document, which was adopted on January 12. It is not the first year that you can work with EDM inside a medical organization, but as for the external exchange of electronic documents, there are still many unknowns. New order did not clarify all the controversial issues.
For example, a medical organization is obliged to transmit an electronic document – a conclusion signed by the doctor with an enhanced qualified electronic signature — in federal Register of Electronic Medical Documents (REMD). However, it is unclear how you can demand a document from the REMD in case it is required by a patient or other institution, for example during the trial. So we go back to the paper document. Today it is impossible to get a document from the REMD — the service works only for reception of documents.
Nevertheless, the document is not useless. In my opinion, it can be compared with acceleration band. Now the principles of EDM have become clearer for medical institutions, you can expect that many will switch to it. But in order for healthcare to be able to confidently follow industries where EDM has been used for a long time and actively, and to keep up, you need to maintain the speed gained and work out aspects that are not affected in the first version of the document.
There is an excellent rule — “if you criticize — do offer,” so let’s figure out what questions, in my opinion, are waiting for attention in the first place.
Acceptance of documents by other organizations and their employees. For example, a person gets Electronic certificate necessary for the issuance of a driver’s license. It needs to be taken to the traffic police, but very often there it will not be accepted in electronic form. After all, the procedure for the adoption and verification of such documents is not yet adjusted, administrative regulations have not been changed. The same happens with electronic medical books, test results, pool certificates, in school, university, military registration and so on. To resolve the issue, you can refer to the experience of others industries already using EDM. For example, drivers receive fines electronically at public services portal: it is enough to print them and take them to court to challenge if the driver is sure that he did not violate anything. Similar is situation with electronic policy of Obligatory state insurance of motor vehicles (OSAGO): many drivers keep a printout of the document in the car. It is legally valid and accepted by the traffic police, they have tools for checking it. These examples combine the procedure for the adoption of certain documents in electronic form, and that’s what’s missing yet when we talk about EDM in healthcare.
Verifying the legitimacy of electronic documents. Let’s say electronic medical documents will be accepted in other organizations. But their authenticity needs to be verified: documents must be signed by the current enhanced qualified electronic signatures of real employees of medical institutions. The time of their formation and signature must be specified on medical documents.
Here again you can give an example with fines of the traffic police. The inspector draws up a resolution and signs it by electronic signature, a stamp appears on the document with the date and time of formation of the resolution and the fact of an electronic signature, as well as a special numerical sequence. It can be checked in the electronic notary system to verify the authenticity of the resolution.
Similarly, each fine, tax, state duty in the country now has a unique accrual identifier (UAI), and in any banking mobile application we can verify the authenticity of the invoice before payment. If we talk about healthcare, so far no understandable and simple mechanisms exist to verify, for example, the authenticity of electronic permit to visit the pool. And its owner is very likely to be told something like: “We need a real certificate with a seal and a “live” signature.”
In order to resolve the two issues described above, it is necessary, inter alia, to continue work on by-laws of the Federal Law “On the Basics of Health Protection of Citizens in the Russian Federation” dated 21.11.2011 No. 323-FZ, as well as on the Resolution of Government of the Russian Federation dated 05.05.2018 No. 555 “On a unified state information system in health care”. Their finalization will make it possible to clearly spell out the list of organizations that must trust electronic medical documents as well as define principles and procedures for their verification by those who are not participants in the health system.
Revision of archival legislation. At the moment, medical institutions using EDM duplicate all documentation in paper form. Of course, it would be much more profitable to avoid duplication, taking into account the cost of special forms and other factors. But so far this is impossible, since archival law obliges to store information in paper form. For example, the archive of medical histories is led in paper form only — but this is not the area of law regulated by the Ministry of Health.
Where will EDM get us?
When all regulations related to the use of EDM in medicine will be finalized, everybody will receive benefits: medical facilities, patients as well as other organizations that work with the medical documents. The procedure for issuing and exchanging medical documents will become simpler and more transparent. For example, the patient will be able, on the web-site of public services, to get QR-code, by which, the traffic police officer will have the opportunity to get acquainted with the results of his medical commission, and the specialist of the water sports complex will see his certificate from therapist and issue permission to visit the pool.
It is clear that this will become a reality not in a month and even probably not in a year, but the beginning already laid. In the future, the active use of EDM in healthcare will simplify integrating the healthcare industry into a single digital loop. Medical institutions will be able to improve the quality of care provided, and patients will save time. As a result, everybody will win.
By Vladimir Soloviev, Development Director of Netrika Medicine