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MIL OSI Translation. Region: Russian Federation –

The new system analyzes the patient’s complaints and offers three preliminary diagnoses, a list of tests to confirm them, and a list of specialists whose consultations are required for treatment.

Doctors of adult polyclinics in Moscow now have a digital assistant that allows them to make preliminary diagnoses more accurately, Sergei Sobyanin said during a visit to the city polyclinic number 68 on Malaya Yakimanka (house 22, building 1).

Work on key projects in the digitalization of healthcare does not stop even during a pandemic. For several months now, computer vision and artificial intelligence have been used to detect coronavirus pneumonia on CT scans, and doctors can enter data into an electronic card using their voice.

According to Sergei Sobyanin, Moscow is entering a new stage of informatization of the medical system. Prior to that, the city created a digital base – the Unified Medical Information and Analytical System (UMIAS), which covers the solution of almost all tasks within the medical system: from making an appointment with a doctor to administrative issues.

“At the next stage, an electronic digital patient record was created, and today records of almost 100 percent of patients have become electronic. At the third stage, the results of laboratory tests plus CT and MRI images were digitized and also uploaded to an electronic medical record. In parallel, centers for the analysis of this data were created, in particular, an X-ray data processing center using artificial intelligence. This center, in fact, is a reference center for the entire medical system, ”said the Moscow Mayor.

He added that today Moscow is on the verge of a revolutionary solution, which was prepared by a large team of doctors, consultants and experts. “Sberbank has created an artificial intelligence system, prompting medical decisions. Now we need to combine the huge amounts of knowledge that we have – digital streams, protocols, assignments – and train this machine by combining these technologies. And of course, I am sure this will have a tremendous effect – the quality of diagnostics, the accuracy of the final diagnosis, the level of treatment and further patient follow-up will increase, ”Sergei Sobyanin said. He emphasized that the new system will be based not on someone’s subjective opinions, but on the opinions of the best doctors and experts in the country.

The implementation of the medical decision support system (MDSS) project began on June 1, 2019. And since October 2020, a preliminary diagnosis tool has been introduced in all 45 adult polyclinics in Moscow. The project partner is Sberbank PJSC, whose specialists have vast experience in the field of big data analysis and artificial intelligence.

“New technologies open up fundamentally new opportunities in such an important area as medicine. And Moscow is the absolute leader in digitalization, including healthcare. And what we see today is, of course, the result of the enormous work that has been done before, ”said German Gref, President of Sberbank.

The system is a set of digital tools that help a doctor in making medical decisions at all stages of patient management – collecting complaints, making a preliminary diagnosis, choosing diagnostic procedures, drug therapy, treatment regimen, and others.

The Unified Medical Information Analytical System became the technological basis of the SPPVR, and digital tools were created in accordance with clinical protocols for diseases developed by specialists of the Moscow Department of Healthcare in conjunction with federal experts.

Today 87 protocols have been prepared for the most common diseases. The system helps to make a preliminary diagnosis, offers a list of studies required to confirm it, as well as a list of doctors whose consultation the patient will need. Also, the doctor gets access to the questionnaire filled in by the patient in advance.

“Artificial intelligence technologies are based on a large amount of data. And we often say that artificial intelligence is the icing on the cake. Just to put this cherry, you must first bake the cake. In Moscow, this cake, if not yet baked to the end, is at a very high stage of readiness, “added German Gref.

Making a preliminary diagnosis

After examining the patient, the doctor enters into an electronic medical record information about the existing complaints and symptoms of the disease (for example, pain in the spine, fever, and others). This data is processed by artificial intelligence online; as a result, the system offers the doctor the three most likely preliminary diagnoses out of 265 standard groups. Having received the offer of a digital assistant, the doctor can choose one of the preliminary diagnoses offered to him or make his own.

Testing of a pilot model of the system was completed in mid-2020, and since October it has been implemented on an ongoing basis. Using this tool will improve the accuracy of diagnosis and reduce the number of inaccurate diagnoses. Thanks to the self-learning mechanisms built into the system, the tool for making preliminary diagnoses will be constantly improved.

Approximately in a year, it can be offered to the regions.

According to the president of Sberbank, by the end of 2021, it is planned to enter into the system descriptions of several dozen of the most common diseases that could be treated using new technology that makes a diagnosis with more than 90 percent accuracy. “This is critically important, first of all, not even so much for Moscow, where there is a large number of qualified doctors and specialists. These developments can be used throughout the country. Especially in remote towns, where you can get help in making decisions based on the opinion of the most qualified doctors, “added German Gref.

The new system will be in demand and will ensure continuity between different levels of medical care. “In addition, it will also include training functionality for people who have just graduated from universities, for people who are really in remote places and it is difficult for them to turn to their older comrades for help,” says Maryana Lysenko, chief physician of the city clinical Hospital No. 52, chairman of the working group for the development and implementation of a medical decision support system.

Diagnostics to confirm the diagnosis

After a preliminary diagnosis has been made, the SPPVR offers the doctor batch appointments – a standard list of instrumental and laboratory tests, as well as consultations of specialized specialists required by the patient. The functionality of additional appointments includes criteria that are visible to the doctor during work – they will show in which case it is recommended to conduct additional research.

Along with the appointments, the patient receives a memo on the rules for preparing for research. And in the future, the system will control that the studies were carried out on time.

As in the case of the preliminary diagnosis, the use of the batch prescription tool does not limit the doctor’s rights – at his discretion, the doctor can either expand the list or remove from it, in his opinion, studies that are unnecessary.

Since September 2020, the system has been offering doctors 54 packaged appointments for the initial diagnosis of diseases, which cover up to 90 percent of the reasons for visits to the clinic. The introduction of the batch prescribing tool made it possible to reduce the average time of prescribing diagnostic examinations by 10 times – from two minutes 37 seconds to 15 seconds. The instrument is in demand by doctors: in September over 37 thousand appointments were made with its help. Most of them related to the diagnosis of ARVI, which is similar in symptoms to the coronavirus.

According to Sergei Sobyanin, artificial intelligence is very important, but it only gives recommendations to doctors and no one will relieve them of responsibility for decisions – the patient and the doctor remain at the center of the system, as before.

Patient life history questionnaire

A number of additional tools are currently being developed. Among them is a patient questionnaire, which is already being applied in practice. It is proposed to fill it out in advance in the electronic medical record so that the doctor can use this data at the appointment.

What else can the system do

Several more instruments are planned to be introduced by the end of the year. For example, the smart examination system will tell the doctor what to look for depending on the patient’s complaints. The directory of complaints is structured by characteristics (up to eight for each of them), which are divided by diseases into general, main and additional. It contains over 600 values ​​verified by leading medical professionals.

The digital drug compatibility guide will offer the doctor a drug compatibility analysis after the necessary tests have been carried out, and will also form a reminder for the patient. As in the case with other tools of the SPPVR, the digital guide does not limit the doctor’s rights in prescribing drug therapy.

The medical decision support system is an active tool that is actively used in the daily work of doctors in city polyclinics. It will continue to develop and improve. The protocols, reference books and algorithms used in the system will be constantly updated with the names of new drugs and treatment methods.

Artificial intelligence in Moscow healthcare

Modern equipment for performing radiation diagnostics allows the use of artificial intelligence tools. More than 1.2 thousand devices are connected to the Unified Radiological Information Service (ERIS). About 13.5 thousand radiation studies are carried out in Moscow every day.

An experiment on using artificial intelligence technologies to analyze medical images began in the capital in February this year. Using artificial intelligence, more than 800 thousand studies have been analyzed in four areas – identifying signs of COVID-19, identifying lung cancer, studying lung pathologies and detecting breast cancer.

In the departments of radiological diagnostics of Moscow polyclinics, the technology of voice input of conclusions was introduced. Since October 2019, more than 25 thousand protocols of X-ray examinations have been prepared with its help. The pilot project was recognized as successful – it is being actively implemented in the city’s polyclinics. The use of modern equipment and artificial intelligence technologies is becoming the standard of work for Moscow polyclinics.

“In a year, these technologies have changed from experimental to operating in almost all clinics in Moscow,” said German Gref. “A huge amount of work has been done with the doctors, with the staff of the City Hall in order to turn the experiment into a working technology”.

He thanked the doctors who created the program outside of working hours, despite the fatigue and workload due to the pandemic. “I think that Moscow has a good chance to become one of the most advanced cities in the world in terms of using artificial intelligence technologies in healthcare,” added the President of Sberbank.

CT center in polyclinic number 68

Outpatient CT centers for the rapid diagnosis of coronavirus pneumonia were opened in April 2020. The patient can get to the CT center in the direction of the doctor of the polyclinic or telemedicine center of the Moscow Department of Health. Also, the patient can be delivered to the CT center by an ambulance team. Based on the results of the lung tomography and other studies, the doctors of the CT centers decide whether to hospitalize the patient or to treat him at home, with the delivery of the necessary medications.

In the spring – at the beginning of summer, 48 CT centers operated in the city, then – due to a decrease in morbidity – their number was reduced to 11. During the work in outpatient CT centers, about 270 thousand studies were carried out.

Currently, due to the worsening epidemiological situation, the number of CT centers has increased – now there are 22 such centers in the city. At the same time, in contrast to the spring period, after the resumption of their work, most polyclinics continue to work as usual. Reception of planned patients has become possible due to the organization in polyclinics with several entrances and lift groups, separate routing of patients in “clean” and “dirty” areas.

The CT center in the head building of the city polyclinic No. 68 on Malaya Yakimanka Street was open from April 11 to June 29. During this time, specialists have conducted 2864 studies of the chest organs. Signs of coronavirus pneumonia were detected in 62.1 percent of the patients who underwent the study – in 1778 people.

The CT center in polyclinic No. 68 resumed its work on October 20. To separate patient flows, a filter box was created in the building and additional doors were installed. Passing to the polyclinic, patients with suspected pneumonia take a separate elevator to the sixth floor, where the CT center is located, without crossing over with other people.

On the remaining floors of the polyclinic, a scheduled appointment is underway, an MRI room and an endoscopic unit continue to work.

In addition to the CT center, the COVID-19 vaccine research center operates in the city polyclinic No. 68. Doctors have already vaccinated over a thousand volunteers. All of them are under medical supervision.

Sergei Sobyanin added that some of the clinics are now switching to work with patients with COVID-19. He thanked the doctors who remain at the forefront in the fight against coronavirus infection, as well as everyone who works in conventional clinics. “By sending a large number of doctors to fight the pandemic, we are increasing the burden on those doctors who continue to provide planned and emergency care. And they are also at risk, ”the Moscow Mayor emphasized.

EDITOR’S NOTE: This article is a translation. Apologies should the grammar and or sentence structure not be perfect.

MIL OSI Translation. Region: Russian Federation –

The new system analyzes the patient’s complaints and offers three preliminary diagnoses, a list of tests to confirm them, and a list of specialists whose consultations are required for treatment.

Doctors of adult polyclinics in Moscow now have a digital assistant that allows them to make preliminary diagnoses more accurately, Sergei Sobyanin said during a visit to the city polyclinic number 68 on Malaya Yakimanka (house 22, building 1).

Work on key projects in the digitalization of healthcare does not stop even during a pandemic. For several months now, computer vision and artificial intelligence have been used to detect coronavirus pneumonia on CT scans, and doctors can enter data into an electronic card using their voice.

According to Sergei Sobyanin, Moscow is entering a new stage of informatization of the medical system. Prior to that, the city created a digital base – the Unified Medical Information and Analytical System (UMIAS), which covers the solution of almost all tasks within the medical system: from making an appointment with a doctor to administrative issues.

“At the next stage, an electronic digital patient record was created, and today records of almost 100 percent of patients have become electronic. At the third stage, the results of laboratory tests plus CT and MRI images were digitized and also uploaded to an electronic medical record. In parallel, centers for the analysis of this data were created, in particular, an X-ray data processing center using artificial intelligence. This center, in fact, is a reference center for the entire medical system, ”said the Moscow Mayor.

He added that today Moscow is on the verge of a revolutionary solution, which was prepared by a large team of doctors, consultants and experts. “Sberbank has created an artificial intelligence system, prompting medical decisions. Now we need to combine the huge amounts of knowledge that we have – digital streams, protocols, assignments – and train this machine by combining these technologies. And of course, I am sure this will have a tremendous effect – the quality of diagnostics, the accuracy of the final diagnosis, the level of treatment and further patient follow-up will increase, ”Sergei Sobyanin said. He emphasized that the new system will be based not on someone’s subjective opinions, but on the opinions of the best doctors and experts in the country.

The implementation of the medical decision support system (MDSS) project began on June 1, 2019. And since October 2020, a preliminary diagnosis tool has been introduced in all 45 adult polyclinics in Moscow. The project partner is Sberbank PJSC, whose specialists have vast experience in the field of big data analysis and artificial intelligence.

“New technologies open up fundamentally new opportunities in such an important area as medicine. And Moscow is the absolute leader in digitalization, including healthcare. And what we see today is, of course, the result of the enormous work that has been done before, ”said German Gref, President of Sberbank.

The system is a set of digital tools that help a doctor in making medical decisions at all stages of patient management – collecting complaints, making a preliminary diagnosis, choosing diagnostic procedures, drug therapy, treatment regimen, and others.

The Unified Medical Information Analytical System became the technological basis of the SPPVR, and digital tools were created in accordance with clinical protocols for diseases developed by specialists of the Moscow Department of Healthcare in conjunction with federal experts.

Today 87 protocols have been prepared for the most common diseases. The system helps to make a preliminary diagnosis, offers a list of studies required to confirm it, as well as a list of doctors whose consultation the patient will need. Also, the doctor gets access to the questionnaire filled in by the patient in advance.

“Artificial intelligence technologies are based on a large amount of data. And we often say that artificial intelligence is the icing on the cake. Just to put this cherry, you must first bake the cake. In Moscow, this cake, if not yet baked to the end, is at a very high stage of readiness, “added German Gref.

Making a preliminary diagnosis

After examining the patient, the doctor enters into an electronic medical record information about the existing complaints and symptoms of the disease (for example, pain in the spine, fever, and others). This data is processed by artificial intelligence online; as a result, the system offers the doctor the three most likely preliminary diagnoses out of 265 standard groups. Having received the offer of a digital assistant, the doctor can choose one of the preliminary diagnoses offered to him or make his own.

Testing of a pilot model of the system was completed in mid-2020, and since October it has been implemented on an ongoing basis. Using this tool will improve the accuracy of diagnosis and reduce the number of inaccurate diagnoses. Thanks to the self-learning mechanisms built into the system, the tool for making preliminary diagnoses will be constantly improved.

Approximately in a year, it can be offered to the regions.

According to the president of Sberbank, by the end of 2021, it is planned to enter into the system descriptions of several dozen of the most common diseases that could be treated using new technology that makes a diagnosis with more than 90 percent accuracy. “This is critically important, first of all, not even so much for Moscow, where there is a large number of qualified doctors and specialists. These developments can be used throughout the country. Especially in remote towns, where you can get help in making decisions based on the opinion of the most qualified doctors, “added German Gref.

The new system will be in demand and will ensure continuity between different levels of medical care. “In addition, it will also include training functionality for people who have just graduated from universities, for people who are really in remote places and it is difficult for them to turn to their older comrades for help,” says Maryana Lysenko, chief physician of the city clinical Hospital No. 52, chairman of the working group for the development and implementation of a medical decision support system.

Diagnostics to confirm the diagnosis

After a preliminary diagnosis has been made, the SPPVR offers the doctor batch appointments – a standard list of instrumental and laboratory tests, as well as consultations of specialized specialists required by the patient. The functionality of additional appointments includes criteria that are visible to the doctor during work – they will show in which case it is recommended to conduct additional research.

Along with the appointments, the patient receives a memo on the rules for preparing for research. And in the future, the system will control that the studies were carried out on time.

As in the case of the preliminary diagnosis, the use of the batch prescription tool does not limit the doctor’s rights – at his discretion, the doctor can either expand the list or remove from it, in his opinion, studies that are unnecessary.

Since September 2020, the system has been offering doctors 54 packaged appointments for the initial diagnosis of diseases, which cover up to 90 percent of the reasons for visits to the clinic. The introduction of the batch prescribing tool made it possible to reduce the average time of prescribing diagnostic examinations by 10 times – from two minutes 37 seconds to 15 seconds. The instrument is in demand by doctors: in September over 37 thousand appointments were made with its help. Most of them related to the diagnosis of ARVI, which is similar in symptoms to the coronavirus.

According to Sergei Sobyanin, artificial intelligence is very important, but it only gives recommendations to doctors and no one will relieve them of responsibility for decisions – the patient and the doctor remain at the center of the system, as before.

Patient life history questionnaire

A number of additional tools are currently being developed. Among them is a patient questionnaire, which is already being applied in practice. It is proposed to fill it out in advance in the electronic medical record so that the doctor can use this data at the appointment.

What else can the system do

Several more instruments are planned to be introduced by the end of the year. For example, the smart examination system will tell the doctor what to look for depending on the patient’s complaints. The directory of complaints is structured by characteristics (up to eight for each of them), which are divided by diseases into general, main and additional. It contains over 600 values ​​verified by leading medical professionals.

The digital drug compatibility guide will offer the doctor a drug compatibility analysis after the necessary tests have been carried out, and will also form a reminder for the patient. As in the case with other tools of the SPPVR, the digital guide does not limit the doctor’s rights in prescribing drug therapy.

The medical decision support system is an active tool that is actively used in the daily work of doctors in city polyclinics. It will continue to develop and improve. The protocols, reference books and algorithms used in the system will be constantly updated with the names of new drugs and treatment methods.

Artificial intelligence in Moscow healthcare

Modern equipment for performing radiation diagnostics allows the use of artificial intelligence tools. More than 1.2 thousand devices are connected to the Unified Radiological Information Service (ERIS). About 13.5 thousand radiation studies are carried out in Moscow every day.

An experiment on using artificial intelligence technologies to analyze medical images began in the capital in February this year. Using artificial intelligence, more than 800 thousand studies have been analyzed in four areas – identifying signs of COVID-19, identifying lung cancer, studying lung pathologies and detecting breast cancer.

In the departments of radiological diagnostics of Moscow polyclinics, the technology of voice input of conclusions was introduced. Since October 2019, more than 25 thousand protocols of X-ray examinations have been prepared with its help. The pilot project was recognized as successful – it is being actively implemented in the city’s polyclinics. The use of modern equipment and artificial intelligence technologies is becoming the standard of work for Moscow polyclinics.

“In a year, these technologies have changed from experimental to operating in almost all clinics in Moscow,” said German Gref. “A huge amount of work has been done with the doctors, with the staff of the City Hall in order to turn the experiment into a working technology”.

He thanked the doctors who created the program outside of working hours, despite the fatigue and workload due to the pandemic. “I think that Moscow has a good chance to become one of the most advanced cities in the world in terms of using artificial intelligence technologies in healthcare,” added the President of Sberbank.

CT center in polyclinic number 68

Outpatient CT centers for the rapid diagnosis of coronavirus pneumonia were opened in April 2020. The patient can get to the CT center in the direction of the doctor of the polyclinic or telemedicine center of the Moscow Department of Health. Also, the patient can be delivered to the CT center by an ambulance team. Based on the results of the lung tomography and other studies, the doctors of the CT centers decide whether to hospitalize the patient or to treat him at home, with the delivery of the necessary medications.

In the spring – at the beginning of summer, 48 CT centers operated in the city, then – due to a decrease in morbidity – their number was reduced to 11. During the work in outpatient CT centers, about 270 thousand studies were carried out.

Currently, due to the worsening epidemiological situation, the number of CT centers has increased – now there are 22 such centers in the city. At the same time, in contrast to the spring period, after the resumption of their work, most polyclinics continue to work as usual. Reception of planned patients has become possible due to the organization in polyclinics with several entrances and lift groups, separate routing of patients in “clean” and “dirty” areas.

The CT center in the head building of the city polyclinic No. 68 on Malaya Yakimanka Street was open from April 11 to June 29. During this time, specialists have conducted 2864 studies of the chest organs. Signs of coronavirus pneumonia were detected in 62.1 percent of the patients who underwent the study – in 1778 people.

The CT center in polyclinic No. 68 resumed its work on October 20. To separate patient flows, a filter box was created in the building and additional doors were installed. Passing to the polyclinic, patients with suspected pneumonia take a separate elevator to the sixth floor, where the CT center is located, without crossing over with other people.

On the remaining floors of the polyclinic, a scheduled appointment is underway, an MRI room and an endoscopic unit continue to work.

In addition to the CT center, the COVID-19 vaccine research center operates in the city polyclinic No. 68. Doctors have already vaccinated over a thousand volunteers. All of them are under medical supervision.

Sergei Sobyanin added that some of the clinics are now switching to work with patients with COVID-19. He thanked the doctors who remain at the forefront in the fight against coronavirus infection, as well as everyone who works in conventional clinics. “By sending a large number of doctors to fight the pandemic, we are increasing the burden on those doctors who continue to provide planned and emergency care. And they are also at risk, ”the Moscow Mayor emphasized.

EDITOR’S NOTE: This article is a translation. Apologies should the grammar and or sentence structure not be perfect.

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