Телемедицина в частной клинике

Галина Ксензова — заместитель по маркетингу директора сети клиник репродукции «Эмбрио» (Краснодар), консультант по медицинскому маркетингу — рассказала НаПоправку, что такое телемедицина и нужна ли она клинике. Галина 11 лет занимается продвижением медицинских услуг, начинала работу в федеральной офтальмологической клинике «Три-З» в Краснодаре, позже возглавила департамент маркетинга федеральной сети лабораторий «Ситилаб» в Москве. Галина уже внедрила телемедицинские услуги в нескольких ЛПУ, внедряет в новых и считает, что у направления большое будущее.

Телемедицина

Для меня телемедицина — это информационно защищенная коммуникация по медицинским вопросам через специализированный видеомессенджер. Изначально она разрабатывалась не для пациентов, а для врачебных консилиумов.

Безусловно, о ней сейчас много говорят. Причины понятны. Она сокращает путь от клика на ссылку до очного приема. Удаленные услуги удобны пациенту и экономят его время. Спрос на них растет, клиника получает большую загрузку и снижает издержки на очный прием.

Но многие клиники пока побаиваются и не понимают, как ее внедрять. Нет четкого законодательства, судебной практики, разработанных стандартов, сложившегося рынка. Получается, что интерес и ощущение перспективы есть, а понимания, с чем ее едят, пока нет. Но первые «ласточки» уже предлагают пациентам телемедицинские услуги.

Мой опыт

Я внедрила телемедицину в клинике, где работаю, а также в двух других как консультант. Каждый случай уникален. Например, в нашем центре, учитывая специфику профиля, мы предлагаем пациентам телемедицинскую консультацию при первичном обращении. На ней доктор изучает историю болезни, рассказывает, как подготовиться к очному приему, и, если необходимо, направляет на дополнительные анализы по месту жительства.

Повторная телемедицинская консультация проводится после очного приема. Доктор расшифровывает результаты анализов и контролирует ход лечения. Такие консультации стоят столько же, сколько обычные, и проходят строго по защищенному протоколу соединения с соблюдением всех норм законодательства. Услуги ориентированы на жителей отдаленных регионов.

Кому нужна

Телемедицина нужна не всем. Не всем клиникам и не всем пациентам. Сначала разработайте бизнес-модель проекта и оцените экономическую эффективность. Не воспринимайте телемедицину как источник высокой выручки. Глупо думать, что консультациями, пусть даже онлайн, можно заработать миллионы.

Когда стандартные клиники зарабатывали только на консультациях? Никогда. Даже если она длится двадцать минут (Считать умеем все!), то это три пациента в час со средним чеком тысяча рублей, то есть 36 000 рублей при полной загрузке 12 часов без перерыва на обед. Вычитаем издержки — что получается? Вы сами понимаете. Клиники зарабатывают на манипуляциях разной инвазивности, а их пока удаленно не проведешь.

В «Эмбрио» телемедицина улучшает качество услуг. Мы на ней не зарабатываем, а обеспечиваем сервис, экономим время пациента, увеличиваем эффективность первичного приема (для подготовленного пациента прием проходит эффективнее), охватываем отдаленные регионы, повышаем конверсию первичного контакта.

Потребности клиники

Если вы задумались о телемедицине, оцените потребности. Эффективен ли для вас некий инструмент, который обеспечит пациенту удаленную консультацию? Будет ли он влиять на рост конверсии из клика в очный прием или манипуляцию? Окупятся ли вложения в вашей клинике? Не потеряет ли консультация в качестве, если ее проводить онлайн?

Например, я не понимаю, зачем нужна телемедицина в экстренной хирургии. Это срочные пациенты с острой болью, которым нужна реальная помощь. В психологии, эстетической медицине, репродукции она уже применима.

Клиника «‎Эмбрио»

Потребности пациентов

Следующий шаг — оценить, нужна ли эта услуга пациентам. В сфере репродукции пациенты приходят уже с необходимыми лабораторными исследованиями, часто с диагностированным бесплодием. Женщина приходит в определенный день цикла, с анамнезом, после многомесячных или многолетних попыток забеременеть. Зачем такой пациентке первичная телемедицинская консультация? Чтобы прийти на очный прием с результатами диагностики и не тратить лишнее время на дообследование и поездки, если она из другого города.

Портрет потребителя услуги

Его пока нет. Чтобы определить целевую аудиторию, не хватает статистики. Эта одна из причин, почему телемедицина буксует. В медицине все строится на практике и аналитике. И пока делать выводы рано.

Законодательство

Если вы решили внедрить телемедицину, изучите законодательство. Нужно урегулировать два важных правовых вопроса: защита персональных данных пациента и качество медицинских услуг. Помните: судебной практики нет.

Основные законодательные акты:

  • Письмо Министерства здравоохранения РФ от 9 апреля 2018 г. № 18-2/0579 «О порядке организации оказания медицинской помощи с применением телемедицинских технологий»;
  • Приказ Министерства здравоохранения Российской Федерации от 30.11.2017 г. № 965н «Об утверждении порядка организации и оказания медицинской помощи с применением телемедицинских технологий»;
  • Федеральный закон N 152-ФЗ «О персональных данных»;
  • Стандарты качества оказания медицинской услуги.

Если следовать нормам буквально, то пациент должен общаться с врачом не из дома, а прийти в клинику в своем городе, сесть в отдельный кабинет и подключиться к вам через защищенный протокол, лицензированный ФСБ. Проект дорогой. Насколько мне известно, система реализована в нескольких федеральных центрах для врачебных консилиумов, но не общения с пациентами.

Разница между телемедициной и онлайн-консультацией

Не путайте онлайн-консультации и телемедицину. Онлайн-консультация – это консультация пациента через любой доступный мессенджер, причем не только видео, но и смс. Телемедицинская услуга – это врачебный прием, регламентированный Приказом МЗ РФ и ФЗ №152, использующий аккредитованный видеомессенджер. Но даже при соблюдении этих норм доктор не может поставить диагноз, если по стандартам качества оказания медицинских услуг требуется очный осмотр пациента.

В последнее время часто слышу, что законы в России мешают работать честным людям и компаниям. Но закон не мешает, а защищает пациента и клинику. Не дает клинике ошибиться. Если разрешить ставить диагнозы онлайн, появятся злоупотребления. Вырастет число врачебных ошибок и судебных исков. В результате телемедицину запретят. Поэтому внедряйте ее постепенно и осознанно.

Программное обеспечение

Я долго искала законные способы внедрить телемедицину. Некоторые проводят консультации в скайпе через защищенный протокол httpS//. Мы же хотели гарантировать пациенту информационную безопасность. Я примерно год ездила на выставки, общалась с разными компаниями, мониторила предложения и практики, в том числе зарубежные. В итоге нашла компанию «Энвижн Груп», которая создала телемедицинскую информационную систему (ТИС) «МедАссистент».

Они получили на свой продукт сертификат безопасности ФСБ. Но главное — прописывают в договоре, что несут ответственность за безопасную передачу всех данных через свои каналы связи. Они предоставляют защищенное соединение, программное обеспечение, интегрируются с МИС, хранят данные на своем сервере, если нужно. Для себя мы выбрали это решение.

Клиника может гарантировать качество оказания медицинских услуг и адекватность выбранного лечения. Безопасность передачи данных она гарантировать не может. Каждый должен отвечать за свой участок. Важно найти подрядчика, который несет юридическую ответственность. И в этом случае клиника отвечает перед пациентом, а подрядчик — перед клиникой.

Найти подрядчика сложно. Многие рисуют красивый интерфейс на каком-нибудь внешнем домене и проводят вебинары. Предоставляют ссылку к доступам по защищенному протоколу httpS//. От онлайн-школы или мастер-класса по кулинарии для домохозяек ничем не отличается. В договоре никто ничего не прописывает. Ссылка стоит пятьсот тысяч. Такой продукт можно сделать в любом редакторе самостоятельно.

Ресурсы

После законодательства и ПО оцените свои ресурсы. Посчитайте, сколько вы потратите на телемедицину и когда проект окупится.  Как клиника будет зарабатывать? Например, услуги «Энвижн Груп», насколько мне известно, стоят сейчас от 100 до 500 тысяч рублей, в зависимости от функционала и условий хранения данных.

В нашей сфере, где средний чек высокий, эти деньги можно вернуть за пару месяцев, если качественно выполнить внедрение. У вас может быть по-другому. Ищите свои инструменты и конкурентные преимущества. Для нас мерило эффективности — это конверсия из онлайн-консультации в первичный прием, а также конверсия из приема — в услугу для пациентов из удаленных регионов.

Врачи

Сформируйте список докторов, которые будут работать с телемедициной, с учетом специализации. Это должны быть врачи, которые могут конвертировать поток заявок в услуги. Например, гастроэнтеролог это сделать не может. Его манипуляции в условиях клиники без стационара — это УЗИ ЖКТ или гастроскопия. Эти затраты не окупятся.

Учитывайте и личность доктора: не каждый готов освоить новую технологию. На доктора нельзя давить, даже в угоду интересам маркетинга. Помните: врач лечит пациентов, все остальное вторично. Когда маркетолог ищет способы увеличить выручку, его главная задача — это не навредить.

Прибыль

Конверсия из первичного контакта в услуги у нас выросла. Мы ее считаем для каждого региона в отдельности и сравниваем два показателя: клик-услуга с телемедициной и клик-услуга без нее. В регионе, где расположена клиника, конверсия не увеличится, потому что тут пациенту проще зайти сразу на очный прием.

Раньше в Краснодар к нам обращались условные десять пациентов из отдаленного региона, и в лучшем случае один доходил до услуги. Теперь из десяти 7 приходят на первичный прием, а 4 остаются на услугу. Это большая разница. В общем картина тоже меняется, но не столь глобально.

Реклама

Мы не рекламируем телемедицинские услуги. Включили их в прайс, разместили в разделе «Для пациентов». Еще можно добавить анонс на главной странице.

Ошибки

Ключевая ошибка, которую сейчас совершают многие клиники, — внедрение телемедицины владелец спускает на маркетолога. От нее идут и остальные: непонимание цели, непонимание задач, ожидание гигантской прибыли и пр. Директор или владелец где-то услышал, решил, что надо, вызвал маркетолога и приказал внедрять. Большинство маркетологов не знают медицинское законодательство и стандарты оказания услуг. Они «продавливают» доктора, заставляют его консультировать и даже ставить диагнозы. Если доктор сопротивляется, маркетолог идет к директору и жалуется. Услуга оказывается некачественно. Возможный итог — суд и потеря репутации.

Отдавать все на откуп маркетологу, а еще хуже менеджеру по рекламе (чаще всего в клиниках работают именно они), нельзя. В проекте должны участвовать: топ-менеджмент, главный врач, IT-специалист, разработчик МИС, если планируется интеграция, и потом только маркетолог. Если все же вопросом занимается специалист по рекламе, то главврач должен удерживать его от безумных поступков, напоминать о стандартах и критиковать непродуманные решения, ссылаясь на законодательство. Программист должен грамотно оценить безопасность.

Скрипты

Скрипты телемедицинских консультаций мы не прописываем. Я принципиально против скриптов для врачей. Доктор принимает так, как требуют стандарты качества медицинских услуг, утвержденные МЗ РФ. Если вы уверены, что врач качественно оказывает услугу, то не надо ему диктовать правила. Компетентность доктора оценивает главврач, а не маркетолог. У маркетолога нет нужных знаний. Я могу сделать замечание администратору контактного центра, который неправильно консультирует, но не доктору.

Непонимание между врачами и маркетологами — распространенная ситуация. Маркетологи претендуют на перемены в медицинских услугах, но при этом не пускают врачей в стратегию продвижения. Я не понимаю высказываний: «Уберите доктора от маркетинга». Может, его еще из клиники убрать? Работа маркетолога вращается вокруг услуги доктор-пациент. За любую оплошность недовольство выслушивает врач. Кейсов на эту тему миллион. Маркетолог должен помнить, что, если он ошибется, негатив выльется на доктора, а значит — доктор имеет право на свое мнение.

Прогноз

Сфера будет развиваться. Все больше клиник будет подключать онлайн-сервис. Сначала поиграемся, посмотрим, померяем, а потом за пару лет все вольются и будут активно применять при необходимости.  

Фрагмент презентации «МедАссистента»

План внедрения телемедицины

  1. Определить цели и задачи.
  2. Изучить законодательство.
  3. Оценить ресурсы.
  4. Прописать дорожную карту: этапы, сроки исполнения, ответственных.
  5. Получить заключение юристов, что в рамках этой клиники мы можем оказывать эту услугу.
  6. Изучить подрядчиков и определить ПО, на котором будем работать.
  7. Исходя из задач и ресурсов, определить докторов, которые будут оказывать услугу.
  8. Проанализировать услуги на рынке России: кто предлагает, как проводит. Возможно, стоит попросить у коллег консультацию или совет.
  9. Прописать весь бизнес-процесс от начала и до конца.
  10. Определить критерии эффективности: по каким критериям измеряем и принимаем решение об эффективности.
  11. Внести услугу в прайс.
  12. Определить, как рекламируем и рекламируем ли.
  13. Прописать документооборот: как оформляем пациента, как проводим, как ведем запись.
  14. Обучить персонал.
  15. Внедрить телемедицину.
  16. Оценить эффективность и провести аудит.
  17. Внести изменения, если нужно.

Приветствую! Опубликуйте материал о своём опыте в медицинском маркетинге в нашем Блоге. Для этого напишите мне на k.magomedshafieva@napopravku.ru

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