National health systems are experiencing a number of common global challenges: population growth, demographic ageing, the prevalence of chronic noncommunicable diseases, the constant growth of health-care costs, while increasing resource scarcity, including staffing. At the same time, the rapid development of information technologies, including the accumulation of big data, artificial intelligence, telemedicine, remote patient monitoring, and the increasing availability of high-performance mobile devices and a high-speed Internet connection create truly unique prospects for the development of digital healthcare products and services. Growth of investment from tech giants and venture capital funds is one of the main drivers of digital healthcare transformation. More and more innovative products are being offered not to enhance the effectiveness of existing processes within health systems, but to create new alternative ways to receive medical care or reduce problems in its delivery. Thus, a key customer and a user of digital healthcare products is gradually becoming not the heads of medical organizations, public health authorities or doctors, but patients themselves. In this article, we present an analysis of the existing global trends and directions of development of the digital healthcare market, form our image of the future and the most prospective scenarios and technologies for products and services in this area.

The use of telemedicine technologies in the Russian Federation has been allowed legally only since 2018. Such a small experience is objectively insufficient for a development of a serious practice of using telemedicine technologies. Given the global trend of unification of medical and information technologies, it would be illogical to ignore the experience of foreign countries, in many of which the right to use telemedicine technologies was secured earlier than in the Russian Federation and experience has been gained in solving a number of problems arising in this area. Moreover, a detailed analysis allows us to identify the main emerging trends in this area.
A review of foreign practice shows that most countries have followed the path of both legislative regulation of the use of telemedicine technologies, and more detailed regulation in the standards of medical care or similar documents. Moreover, in many cases, this regulation is carried out by medical associations or insurance companies. This is especially true for the United States. The experience of this country is also interesting because each state has its own legislation in the field of telemedicine technologies, reflecting different approaches to solving emerging problems.

Nowadays, the Public Health systemisundergoing a significant digital transformation. Various medical technologies basing on artificial intelligence are being implemented. Such segment of public health as telemedicine is actively developing.
The pandemic of COVID-19 was an important factor, which has initiated the progress of telemedical technologies to rationalize the work of medical staff and change the medical algorithm strategy of patients monitoring. In order to maintain a high level of medical care provided in the conditions of “remote medicine” and to obtain satisfactory treatment outcomes, it is necessary to ensure that patients and medical staff are fully aware of various changes, both legislative and technological in the telemedicine segment.
The paper presents an overview of regulatory documents and measures taken by the Ministry of Health of Russia for the introduction of telemedicine technologies, and also describes the contribution of Sechenov University in the promotion of elemedicine communications using fun learning techniques that help medical professionals to form “digital thinking” and create public confidence in digital healthcare. The new functionality will improve the efficiency of planning and accounting for the training of medical workers in accordance with changes in the digital healthcare ecosystem.

The change in demographic trends observed in most of the subjects of the Russian Federation in recent years has had an impact on the structure of morbidity. The increase in the morbidity of the population for certain classes of diseases required operational accounting and planning of increasing the corresponding health resources, procurement of medicines. National medical research centers are of fundamental importance in the management of the quality of medical care and the assessment of health resources. The lack of an effective control tool at national medical research centers for many years did not allow to increase the effectiveness of quality management of medical care. In 2019, the Ministry of Health of the Russian Federation created a modern mechanism for managing medical care in the main profiles through
the use of vertically integrated medical information systems.
The introduction of such information systems led to a search for a balance of interests of medical professionals who do not have the opportunity to spend a lot of time filling out various electronic documents and forms, as well as the interest of developers of information systems whose rigid algorithms had to be transformed into convenient and familiar business processes for doctors.
The optimal solution proposed by the authors of this article is the use of regional specialized subsystems for disease profiles, which receive primary information about the case of treatment from various sources and automatically generate structured electronic medical documents.

Telemedicine technologies are successfully implemented and will be used in a global perspective to optimize and improve the quality of diagnostic radiology. On the basis of teleradiology, the concept of centralized radiological reporting has been implemented. The centralization of expertise within the Reference Center provides a complete solution to the issues of staff shortage, uninterrupted research, the maximum level of accessibility and quality of diagnostic radiology. At the same time, the quality and effectiveness of the independent performance of X-ray technicians using telemedicine technologies without the direct presence of a radiologist remain unexplored.

The aim of the study. To evaluate the quality and reliability of remote interaction between primary health care X-ray technicians and radiologists of the Reference Center for diagnostic radiology.

Materials and methods. The study includes data on the performance of the Reference Center and pilot Moscow city medical facilities providing primary health care (city clinics, n = 12) from January 01, 2019 to March 31, 2021. The number and structure of X-ray technician requests to doctors of the Reference Center for consultations during conducting examinations, as well as a proportion and structure of defects in the performance of X-ray technicians have been relatively studied; satisfaction assessment has been conducted. The following methods were used: analytical, sociological, statistical.

Results and discussion. In the conditions of remote performance, the proportion of studies which require communication between X-ray technicians and radiologists is only 0.38 % on average. The share of requests for assistance is decreasing by 35.0 %, while a total number of radiological studies reporting remotely is increasing by 10.0 % monthly. Leading reasons for requests are organizational issues – 45.0 %, admission of an unscheduled patient – 26.0 %. Critical questions on the study methodology are only 11.0 %. Under the working conditions of the Reference Center, the need of X-ray technicians for a doctor’s assistance during the study performance has decreased (p < 0.0001), the pace of getting a consultation if it is required, increased significantly, and time delays have been completely eliminated (p < 0.0001). A satisfaction rate of X-ray technicians with their professional activities has increased (p < 0.0001). In the conditions of remote interaction, the number of technological defects during radiological studies significantly decreased (p < 0.05).

Conclusions. A concept of the Reference Center for diagnostic radiology based on the systemic application of telemedicine technologies has been successfully implemented in practice and proven its positive impact on the quality and safety of the performance of primary health care X-ray technicians.

Digital transformation of healthcare is a factor accelerating the change in the healthcare system in response to the challenges introduced by global demographic, technological and socio-economic trends. There are no technological barriers for digital transformation; however, there are organizational, legal and social limitations that need to be dealt with. In this article, digital technologies are presented as the main driver for the change development, ensuring the availability, speed and continuity of medical care provision, automation of routine processes and the processing of objective data for making management decisions. From the viewpoint of the established change management practice the article presents the current state of healthcare informatization and digital transformation experience of Moscow inpatient care by implementing the Unified Medical Information and Analytical System (EMIAS). Authors also present the general approach to change management developed by the Moscow Healthcare Department for all types of medical organizations, which is stipulated in regulatory documents. The article determines the main mechanisms of change management, certain limitations and ways to overcome them. Authors also describe the levels of digital transformation of Moscow’s medical organizations and propose the guiding principles for developing introduction measures for digital technology.

The article discusses several problems of health and quality of life management, such as motivating people to healthy lifestyle using gamification and monetization methods, the validity of recommendations and their personalization, monitoring results and supporting the use of health-saving programs, correct orientation in the face of a huge amount of unreliable information about methods of improving health from the Internet, etc. The tool for solving these problems is an intelligent digital platform created by the authors, which, based on big data about the human body, its lifestyle and habitat, automatically generates personal recommendations for healthy lifestyle aimed at improving health and quality of life. The complex of scientific and methodological, technological, regulatory, legal, motivational, commercial, and other approaches and solutions developed within the framework of this project is considered. A comparative analysis of several analogues of the platform is carried out.

Justification and purpose of the study. The high social significance of diabetic retinopathy (DR), the complexity of early diagnosis and monitoring of the disease determine the urgency of developing a system for diagnosing diabetic changes in the fundus using artificial intelligence (AI) methods. The aim of the work is to build a demo prototype of a WEB service for recognizing signs of DR from fundus images using machine learning methods using the Python language and the Django framework.

Materials and methods. The study used the Messidor dataset (1200 eyes), which is publicly available on the Internet and includes photos of healthy fundus (546 eyes) and fundus with pathology (654 eyes). With the help of the augmentation method, this set for the study is increased several times. The fundus image recognition system is based on the trained neural network ResNet50. The web service with a connected neural network model was developed on the Django framework.

Results. The main result of the research is the development of a test prototype of a service for the diagnosis of diabetic fundus changes based on photos using machine learning tools, demonstrating the great potential of using AI to improve the effectiveness of decisions. The sensitivity of the neural network model during the diagnosis of DR, even on a small test sample and limited training time, was 85 %.

Conclusion. The high efficiency and potential of AI methods in the construction of a system for automatic detection of fundus pathology in the framework of the developed in the Helmholtz National Medical Research Center of Eye Diseases automated medical decision-making system. In the future, this service can be used to improve the effectiveness of early diagnosis and monitoring of diabetic changes in the fundus in conditions of reduced availability of primary ophthalmological care in parts of the Russian Federation, including at the pre-medical stage.