Екатерина Добрикова
На данный момент разработанный ведомством проект закона1 находится на рассмотрении Правительства РФ. Однако, по словам заместителя директора Департамента информационных технологий и связи Минздрава России Олии Артёмовой, он может быть одобрен и, возможно, внесен в Госдуму уже на следующей неделе.
Напомним, что сейчас на рассмотрении депутатов уже находится другой законопроект2 о телемедицине. Он содержит понятие телемедицинской технологии, под которой понимает комплекс организационных, технических и иных мер, применяемых в процессе оказания медицинских услуг пациенту с использованием способов передачи данных по каналам связи, обеспечивающих достоверную идентификацию медицинского работника и пациента. Однако пока этот документ не был рассмотрен даже в первом чтении.
Проект закона, разработанный Минздравом России, схожим образом подходит к определению телемедицинской системы, но охватывает более широкий круг вопросов, включая ведение электронного документооборота, выписку электронных рецептов, дистанционное проведение медицинских консультаций и др.
Как только законопроект Минздрава России будет внесен в Госдуму, добавила Олия Артёмова, ведомство планирует уделить особое внимание реализации пилотного проекта «врач-пациент» и пилотным проектам по дистанционному мониторингу показателей состояния здоровья пациентов, страдающих хроническими заболеваниями.
Какие действия необходимо совершить пациенту, если врач отказывает в выписке рецепта на обезболивающий препарат? Ответ на этот и другие практические вопросы – в «Базе знаний службы Правового консалтинга» интернет-версии системы ГАРАНТ. Получите бесплатный доступ на 3 дня! Получить доступ
Экспертное медицинское сообщество относится к обоим законопроектам скорее позитивно. Заведующий кафедрой информационных и интернет-технологий ПМГМУ им. И.М. Сеченова Георгий Лебедев отметил, что какой бы из двух документов ни был принят, основные нюансы все равно будут решены только в подзаконных нормативных правовых актах.
При этом, по словам заведующего отделом информационных технологий Гематологического научного центра Бориса Зингермана, нет никаких препятствий для того, чтобы начать применять принципы телемедицины на практике уже сейчас. «Большинство считают, что телемедицина у нас запрещена. На самом деле это не так, просто в законе ничего об этом не сказано. Это привело к тому, что весь рынок сидит и ждет закона. Но что мы этим законом определим? В том виде, в котором представлены оба законопроекта сейчас, они просто введут термин «телемедицина» и ничего не добавят в текущую ситуацию. Телемедицину можно реализовывать уже сегодня. Конечно, есть определенные технические трудности, но никакого законодательного запрета нет», – пояснил он.
Дистанционное взаимодействие с пациентом, по мнению Зингермана, можно условно разделить на первичное (электронная запись на прием, дистанционное проведение консультации до очного визита) и последующее (электронная доставка результатов анализов и обследований, направление рекомендаций и напоминаний, дистанционный мониторинг пациента и контроль проводимого лечения, удаленные консультации с лечащим врачом после очного визита и др.).
А научный руководитель НИКИ педиатрии имени академика Ю.Е. Вельтищева Мария Школьникова в свою очередь подчеркнула важность применения основ телемедицины для удаленного мониторинга больных с имплантированными устройствами (в частности, кардиостимуляторами). Такой мониторинг, по ее словам, необходим для своевременного получение информации о пациенте, сокращения времени принятия решений и повышения качества ведения пациентов за пределами специализированного центра. Кроме того, это существенно снизит нагрузку на клиники и сократит расходы пациентов на дорогу до медицинского учреждения.
Вместе с тем, заключил Георгий Лебедев, для того чтобы телемедицина в России применялась успешно, необходимо урегулировать ряд важных вопросов, например:
упорядочить рабочее время врача. «Когда мы говорим о телемедицине, мы должны понимать, что количество врачей не безгранично. И если врач целый день работает на очном приеме, откуда у него возьмется время на то, чтобы консультировать заочных пациентов? Решить эту проблему не сложно – например, запись на прием к врачу может предусматривать, какой способ общения с врачом выбирает пациент. И у врача в списке приема будет перечень пациентов, записанных на телемедицинскую консультацию», – указал эксперт;определить перечень медицинских услуг, которые могут выполняться с применением телемедицинских технологий;сформировать реестр медицинских изделий, позволяющих дистанционно измерять показатели состояния здоровья пациентов;четко определить правила оказания медицинских слуг, выполняемых с применением телемедицинских технологий;продумать механизм идентификации пациентов и медицинских работников (например, создать федеральный реестр лиц, которые участвуют в оказании медицинских услуг);регламентировать порядок ведения бумажного и электронного документооборота;рассчитать тарифы оказания медицинских услуг, выполняемых с применением телемедицинских технологий;разработать методологию оценки эффективности оказания медицинских услуг, выполняемых с применением телемедицинских технологий.
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