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02.03.2012



Is it really happening in Russia: chronicles of healthcare IT development 2010-2012

Konstantin Chebotaev Konstantin Chebotaev

Von Konstantin Chebotaev, International Projects Manager,  Medical Center for Information and Analysis of the Russian Academy of Medical Sciences, Moscow, Russia.

National IT is the youngest child in the Russian healthcare family. Born in 2008, when the Ministry of Health finally established its very own IT Department, it took its first steps in 2010, when we heard that the national informatization was coming.

By the summer of 2010, the politics bought in – healthcare IT made it into the list of priorities, speeches of the President and the Prime-Minister.  Resolution documents of the governmental meetings then said that by the end of 2012 most medical organizations in the nation should have their own electronic information systems. In the city of Tver in 2010, the President said talking the talk was over and ordered the walking.
In July of 2010, our Healthcare Ministry published the Program for the Regional Healthcare Modernization, which was mostly declarative and more often than not, unclear. Still, on the background of literally NOTHING, it was the first outline of what was coming. 
By the fall of 2010, all Regions were ordered to prepare and submit their own regional healthcare informatization programs, in the absence of the proper technological normative base that regulated their efforts, none of the conceptual documents had official status or had enough level of detail.
No wonder Russia was not on fire to get moving. Regions spent their time waiting for a "national state-provided HIS” that was recommended  by the Ministry, which insisted on establishing a "Fund of Algorithms and Software”  that would provide free-of-charge "template” HIS’s to the needy.
By October 2010, budgetary allocation inefficiencies drove the then Head of IT Department out of the Ministry.  The discussions on priorities in HC IT continued. In December, 2010, the Ministry passed law 1240 which regulated reporting on the progress with the regional healthcare modernization projects. Reports were to be submitted quarterly.

Implementation: Phase I – 2011

Mr. Dubinin was appointed to head the Ministry’s IT Department.
He inherited stagnant initiatives, Regions were still in the fog as to what they were to do where it came to concrete steps. They did not know what systems they were supposed to create, neither was the level of interoperability clear.
Most regional authorities treated healthcare modernization as a bomb that could sink any ship. Mr. Putin commented in the end of 2010 that most of the financing toward HC IT was allocated on residual basis (whatever was left, went to IT – as in 4,2% for North-West, that’s 6% less than the average 10% on HC IT within the budget toward overall healthcare modernization).
The regional programs list was still far from complete; the new deadline was shifted to April 1, 2011.  By March 25, only 5 out of 83 territorial subjects of the Federation submitted the required documentation.
The final HC IT Concept was approved April 12, 2011. Mr. Simakov’s "quilt-like Concept for Creation of a Common Information Environment in Healthcare” was out. His successor’s cloud solution was in. The Fund of Template HIS’s was scrapped as a bad idea; the pilot projects in the regions were not launched.
It became painfully clear that the financing vault had been opened to aid a concept that was not yet in place. The financing was called off (May 17 as announced by the Minister Mrs. Golikova), Mr. Dubinin said that " … all the regions should align their programs with the Federal Concept by July…”, after which they went for approval, and therefore, got funds.
June 29, 2011, the Ministry finally published their draft version of the "Technical Requirements” for the Regional HC IT. That is, 2 days before the Regions were ordered to submit their documents, "aligned” with this very document. Nothing new to Russians, but one cannot help wishing things changed.
July was a busy month, the Ministry created a Task Force to make the TC shine. By the end of the month, 3 of the 5 documents were changed. Worth it to note here – each new iteration demanded a thorough re-write of then already prepared Regional Concepts. No wonder Regions preferred to spend their energy elsewhere, no one was in a hurry to charge forward with the "alignment”.
After the publication of the 3rd iteration of TC by the Ministry, the document finally got its official status from the Federal Antimonopoly Service September 26, 2011.
By October 12, 2011, 50 regional informatization Concepts were approved, followed September 14 by a yet another iteration of TC from the Ministry. Oh, and no, that one did not have an official status, either.

Come 2012, what do we have?

One and a half years ensued between the first Informatization financing decision and the approval of the regional HC IT programs. Regulative base constantly lagged behind the real demand throughout the period. It was not until the summer of 2011 that the community actually saw the documents that painted a more or less clear picture of how the Federals envisioned HC informatization on the whole, what information systems were to be used and what functions were considered priorities.
It is clear – to launch a gargantuan National project like this, is an extremely complex task. Anyone who knows healthcare, understands – concepts should be allowed time to "mature”, billions of factors have to align, legions of stakeholders should be pleased for this baby to take its first steps. It will not happen, though, without 1) the Federal elements fully worked-through before demanding the regions to comply, 2) maximizing the experts’ input into the work as opposed to encapsulated Ministry efforts, and 3) better planning.

The materials used in the blogs are:

Gusev A.V., Elyanov M.M. Regional Program of Informatization of Health: chronicle of events 2010-2011.

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