Increased difficulty level: how high-tech medical care works in Moscow
High-tech medical care plays a key role in the development strategy of Russian healthcare. And if earlier it was associated with individual federal centers, today the task is to integrate it into regional medical institutions and the compulsory health insurance system. Moscow, as the country's largest medical cluster, demonstrates the implementation of this strategy in practice. The increase in the number of operations, modernization of infrastructure and staff training allow the capital's healthcare system to provide complex types of medical care in the face of ever-growing volumes and demand for this assistance.
From the exclusive to the system
At its core, high—tech medical care is a complex of treatment methods that require unique resources and complex, often high-tech technologies. The key criterion is not the cost, but the high complexity of the intervention. These include, for example, minimally invasive surgery that minimizes injury and rehabilitation time; therapy using genetically engineered and cellular drugs to combat cancer and orphan diseases; organ and tissue transplantation; robotic surgery; the most complex interventions in cardio and neurosurgery, as well as high-precision diagnostics using PET-CT, expert-grade MRI, and DNA sequencing methods.
The main transformation of recent years has been the decentralization of the VMP. These methods have ceased to be exclusive to a narrow range of institutions and are being systematically implemented in the work of all city hospitals. For example, even 15 years ago, urban hospitals accounted for about 5-6% of all cases of high-tech care in Moscow, today this figure is almost 65%.
— This did not happen by itself, — emphasizes the mayor of the capital, Sergei Sobyanin. — It took a lot of work to repair and equip city hospitals with the latest equipment, train doctors, introduce new standards of treatment and solve many other problems.
Today, 32 city hospitals have successfully mastered 20 profiles of high-tech medical care.
Moscow has taken the path of improving and increasing the availability of military medical equipment. Over the past five years, the number of high-tech vascular and heart surgeries has increased by 26%. The main thing is that patients recover faster and return to their usual lifestyle.
The dynamics in the field of traumatology and orthopedics is even more impressive, with an increase of about 40%. There are also very young areas for urban hospitals.
"A couple of years ago, it would have been impossible to imagine such a complex operation as a heart transplant in an urban multidisciplinary hospital," said Alexey Shabunin, Director of the Botkin Moscow Medical Center. — Today, the Moscow Multidisciplinary Scientific and Clinical Center named after S.P. Botkin has almost 30 patients who have successfully performed this complex intervention. In total, the transplantation clinic has performed more than 2,000 organ and tissue transplants, as well as about 900 corneal transplants in seven years.
Foundation — infrastructure, technology and personnel
The growth in the volume of high-tech assistance in the capital is ensured by the deep modernization of the entire industry. First of all, it concerns the creation of new capacities. The construction of facilities such as the hospital in Kommunarka, flagship centers or the new St. Vladimir State Clinical Hospital is initially being carried out with the expectation of providing the most complex types of care. In parallel, continuous technical re—equipment is underway, since regular updating of the diagnostic and surgical equipment fleet is a necessary condition for performing high-tech operations. Last year, seven new robotic systems for operations were purchased for the city's leading cancer clinics, which means that more than 2,000 cancer patients will receive high-tech treatment.
The prospects for further expansion of VMP volumes are associated with a large-scale program for the construction of new medical facilities. Currently, a project is being implemented in Moscow to create several modern hospitals, including a new complex of the N.V. Sklifosovsky Research Institute of Emergency Medicine, MKNITS, MGOB No. 62 in Skolkovo, a children's multidisciplinary hospital and a new complex for the Demikhov City Clinical Hospital. Each of these institutions is designed as a powerful medical cluster equipped with the latest technology. They will include consulting and diagnostic centers, inpatient units, and specialized departments, such as cardiology, neurosurgery, and others.
Special attention is paid to creating a comfortable environment for patients, from easy navigation to modern wards. The commissioning of these hospitals of the future will not only significantly increase the number of high-tech operations performed, but will also create an integrated medical care system where diagnosis, treatment and rehabilitation will be concentrated in one place. This will reduce the waiting time for patients and relieve existing hospitals, creating a significant reserve of capacities for emergency and planned care.
However, technology does not work without specialists. The implementation of complex techniques requires constant training of doctors and close integration with science.
— Digital technologies are actively used, integrated or smart operating rooms that combine innovation, functionality and increased comfort for patients. It has become customary for a doctor right at the operating table to display CT scans, MRI scans, data from the patient's medical history and other information from EMIAS that he may need during surgery," said Valery Vechorko, Chief physician of Filatov State Clinical Hospital No. 15. — 3D modeling and augmented reality technologies are actively involved in the work of surgeons. The creation of specialized hybrid operating rooms has given a powerful impetus to the development of another important area — simultaneous and hybrid operations, when a patient undergoes several surgical procedures simultaneously, sometimes up to five at a time.
Thanks to high-tech equipment, doctors today perform a wide range of operations on the brain, spinal cord, and peripheral nerves. And in most cases, these operations are performed in the most minimally traumatic way possible, as a result of which the patient can be discharged in a few days.
All this makes the VMP system more efficient and accessible to the patient.
Patient routing: from diagnosis to surgery
A key element of the availability of VMP is a well-established mechanism for obtaining such care for the patient. The so-called seamless routing of patients between polyclinics and hospitals has been introduced in Moscow. It has reduced the waiting time for scheduled medical care and doubled the proportion of scheduled hospitalizations.
When indications for hospitalization are identified, the polyclinic doctor forms an application, which can be viewed by all specialized hospitals in the city, in order to offer their terms and conditions for the provision of planned medical care.
According to Anastasia Rakova, Deputy Mayor of Moscow for Social Development, digitalization and the accumulated data allow us to review many processes and create a more understandable, convenient and effective way for both doctors and patients.
— For example, since the beginning of this year, we have been working on creating a new ecosystem of interaction between polyclinics and hospitals in order to make receiving planned medical care as simple and fast as possible, — says the deputy mayor.
Previously, the path to planned hospitalization required a lot of face-to-face visits from the patient, but now most of the processes are automated and do not require the patient's participation, which saves his time, which ultimately will allow him to receive treatment, including high-tech, faster.
What methods of VMP will become routine tomorrow
The field of medicine, and especially high-tech care, is not static. Methods that may become a new standard of treatment in the near future are already being actively implemented. We are talking about the wider use of gene therapy to correct hereditary diseases that were previously considered practically incurable.
Personalized medicine based on genome-wide sequencing will make it possible to select therapy based on the individual genetic characteristics of the tumor or the patient's body. In addition, areas of regenerative medicine are developing, such as tissue engineering to repair damaged organs and tissues. These innovations will require not only new technologies, but also the adaptation of the regulatory framework, as well as the training of highly specialized specialists, which determines the following challenges for the healthcare system.
The development of high-tech medical care in Moscow demonstrates the transition from the stage of point improvements to systemic transformation. The main trend is the integration of complex treatments into the routine practice of urban hospitals, which objectively increases their accessibility to patients.
Of course, the system also faces challenges. Among them is the need to further increase human resources, ensure uniform implementation of standards in all institutions, maintain expensive infrastructure in working order and update it regularly. And Moscow is successfully doing it. By increasing the volume of care provided and introducing new high—tech treatment methods, Moscow medicine is responding to the key demand of modern healthcare - increasing the duration of an active and healthy life for residents of the metropolis.
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