The Department for International Trade (DIT) is a specialised government body with the responsibility for promoting UK trade across the world and attracting inward investment. DIT initiated the 1st International Digital Health Conference in Moscow, April 2017.
A strong UK delegation of medical experts made their way to Moscow to attend a digital health conference, organised jointly by DIT Russia office and Moscow State University on 20-21 April.
What proved to be a great success started two years ago from an idea to bring UK digital technologies to Russian medicine. The idea was taken forward and developed into a niche industry event which attracted more than 200 healthcare professionals. This was also the flagship event of the UK-Russia Year of Science and Education 2017. “Health science is an area where the UK and Russia are working closely together despite political disagreements”, said Jonathan Brenton, Minister-Counsellor Prosperity at the British Embassy in Moscow, during the opening ceremony.
At the conference experts described how a digital approach can make medicine more effective. Dr. Ilan Lieberman, Clinical Director for Integration at the University Hospital of South Manchester (UHSM), shared his plans for the launch of high-tech medical devices. For example, a glucometer that measures glucose levels through the skin, without injections, and a mini-DNA sequencer integrated in a smartphone. These and other devices, according to Dr. Lieberman, will go into production in the UK in about three months. There are also developments in Russia: for example, electrocardiograms (ECG) using a smartphone and an app.
Data from such personal devices, along with other information about the patient, should be stored digitally. Ideally, the data storage system should be standardised throughout the country, but, as Gary Leeming, Director of Health Informatics at Greater Manchester Academic Health Science Network (GM AHSN), mentioned in his presentation, in Britain such a system is far from being standardised. “Five years ago, we started to create an integrated remote patient monitoring system. In the process it became clear that data on the treatment of patients is often disconnected, stored in different systems, while patients themselves are trying to remember what medical services they should receive in different situations. As a result, a project of a self-learning health system was born, involving the use of Datawell, a system of sharing information for use by clinicians, an innovative smart cities programme CityVerve and ground-breaking test beds such as the Salford Lung Studies.
In Russia, until recently, no unified system existed until the program for the implementation of the Unified Medical Information and Analytical System (UMIAS) was launched in 2011-2012. Despite the fact that the new system is not yet perfect, this is a big step forward.
If digital technologies are really capable of transforming health care in the same way as other spheres of our life, then what is needed for their full integration into medicine? Dr. Ilan Lieberman cited two different examples – Israel and the United States, where people participate in the financing of innovative projects through taxes and are generally ready to accept the risk for this. In Russia, there are a number of challenges, one of the biggest is that according to current legislation any medical assistance must be provided to the patient exclusively in person. To change the situation, a new law “on telemedicine” is being discussed in the State Duma (the lower House of Parliament), said Alexandra Orekhovych, lawyer at the Internet Initiatives Development Fund, who is also involved in the legislative process.
The problem of shortage of healthcare workers can also be solved by means of digital technologies, according to Brendan O’Brien, Consultant in Clinical Informatics of the Board of Health and Social Care of Northern Ireland. Historically, this part of the United Kingdom has a large number of hospitals but only 70,000 healthcare employees for a population of a 1.9 million. “Thanks to the introduction of the e-medicine strategy, we managed to provide the lion’s share of medical services remotely. There are already about 20 thousand online receptions per month, 90,000 prescriptions are being written out”, said Dr. O’Brien.
Liz Mear, Chief Executive of the Innovation Agency at Academic Health Science Network for the North West Coast, also reported that the work of the 15 branches of the Network was aimed at reducing health care costs through digital technologies. At the moment there are already 345 different software solutions to serve the purpose. However, according to Liz, the digital maturity of medical institutions in the UK is not high.
The second day of the conference was fully devoted to m-health technologies. Conference participants noted several major problems that impede development of the market. 2016 was a tough year for the sector. Developers have continued to produce new medical applications so that the total number of applications in the world reached almost 260,000. In the meantime, users were not in a hurry to install them on their smartphones. In 2016, the number of downloads of medical applications increased by 7 percent, although in 2014 and 2015 the growth was more than 35 percent annually. The reason is that consumers have begun to lose interest in medical applications.
About one third of mobile medical applications are now not designed for patients at all. Young and healthy users of technical innovations use mobile applications to count steps, calories, kilograms or pulse during training. But this information is not critical for them. “Of those who start using trackers – to count the number of steps – in two years only half continue to do this. For various reasons, they do not see any further benefits from this, “said Oleg Medvedev, Chair of Department of Pharmacology at the Faculty of Fundamental Medicine at the Moscow State University.
Experts are confident that m-health needs to be integrated into the healthcare system in Russia, provided that applications are of a high standard of quality, reliability and effectiveness and focused on solving the patient’s problems, said Pavel Vorobyov, Director of the Higher School of Therapists. Of course, payment for mobile applications via general medical insurance would mean a revolution in the Russian healthcare. Without the criteria of quality, reliability and effectiveness of m-health with reference to the evidence base, this simply cannot be done.
“A fast integration of medical and IT technologies sometimes leads to the emergence of products on the market which are not adapted to specific clinical problems, while the regulation mechanisms of this market are still not mature enough. There has to be a sufficient evidence base for the safety and effectiveness of digital health technologies to be used in both prevention and treatment of various diseases”, said Sergei Boytsov, Chief Specialist of the Russian Ministry of Health in the field of medical prophylaxis, director of the State Research Centre for Preventive Medicine.
Another question: If a patient decides to download a medical application, what shall he or she focus on? Experts are unanimous: in this case, the rating of medical applications with recommendations for patients will help. “One of the problems in Russia is that we do not have a common list of medical mobile applications. We do not have their ranking from the point of view of the doctor and from the patient’s point of view, “said Oleg Medvedev. Now, if a patient goes online and tries to find something, he can make a lot of mistakes. There should be an independent system for comparing and selecting such applications.”
One more problem. “Nowadays the Russian developers of mobile applications and devices first create a new technology, and then ask doctors to find where it can be applied,” said Oleg Medvedev. The results of such implementation are mixed. Is not this the source of a large number of “junk” developments? “For example, for several decades, a large number of Russian engineers have endlessly developed stimulants for biologically active points, which had no scientific basis,” said Medvedev. They have made a lot of such devices. The result of this activity was zero – a huge loss of time and deceived patients.” “A few years ago I was invited to the contest in Skolkovo, Russia’s largest science park, where I could not approve any development at all, e.g. devices for electronic acupuncture,” recalled Pavel Vorobyov. “We need to start, at the development stage, from what medical problem should be solved with the help of a mobile application or device,” according to Medvedev. We need to include all stakeholders in the process of planning – doctors, patient representatives, psychologists, service providers. And immediately we need to think about the quantitative measurement of the results of the introduction of our technologies.” The criteria for evaluating m-health, based on the evidence base, would serve as benchmarks for developers and would help cut off “garbage” applications even during planning. “It is possible to clarify the requirements for m-health through running several pilot projects,” said Boris Zingerman, Head of the Information Technology Department at the Haematology Research Centre of the Russian Ministry of Health. “For example, you can conduct pilots for such chronic diseases as arterial hypertension, diabetes, asthma and evaluate the result.”
The launch of the conference was marked by a reception at the British Ambassador’s residence in Moscow, where DIT Director John Lindfield said that he believed that the event was the start of a long and fruitful collaboration between the UK and Russia and eventually become a key event in the industry.
Written by Ekaterina Zhuravleva, Trade Adviser, Healthcare & Life Sciences, DiT.
The One Nucleus blog is written by individuals and is not necessarily a reflection of the views held by One Nucleus.