Development of a medical methodology for telemedicine screening of adult health in outpatient settings for population monitoring of chronic noncommunicable diseases

Today, in many countries of the world, there is a steady increase in public spending related to health. One of the promising options for optimizing these costs is the widespread use of telemedicine as a method of remote medical care. It is known that the main contribution to the health of an individual and the population as a whole is made by lifestyle. Effective screening, timely detection of risk factors and diseases at the early stages of their development, medical examinations, universal opening of health centers, prevention offices, health schools – all these measures are aimed at increasing the duration and quality of life of the nation. Despite the availability and relatively low cost of well-known programs for remote screening, it is impossible not to mention their significant disadvantages: the lack of final analytical documents, the coverage of one or more systems, the need for a face-to-face visit to the doctor to calculate risks and determine further patient management tactics. The article proposes a methodology for telemedicine screening of adult health in outpatient settings using a system for analyzing unstructured data for population monitoring of chronic non-communicable diseases. The development is based on risk calculation using the method of “decision rules” as a means of description used in the theory of fuzzy sets. The result of the method developed by the authors is a variant of telemedicine questionnaire screening, which allows determining health risks by specific profiles, forming a final conclusion with recommendations for a healthy lifestyle, further examination, treatment and prevention of chronic diseases. The development can be used in public and private medical institutions. Of particular interest is the possibility of integrating software into medical practice in the current conditions of the pandemic, as well as in the state projects “Lean polyclinic”, “Arctic doctor” and “Zemsky doctor”.

1. Kim J., Alanazi H., Daim Т. Prospects for Telemedicine Adoption: Prognostic Modeling as Exemplified by Rural Areas of USA. Foresight and STI Governance. 2015;9(4):32–41. Available at: https://foresight-journal.hse.ru/en/2015-9-4/168518790.html.

2. Nelson R. Telemedicine and Telehealth: The Potential to Improve Rural Access to Care. Am J Nurs. 2017;117(6):17–18. doi: 10.1097/01.NAJ.0000520244.60138.1c.

3. Hurst E.J. Evolutions in telemedicine: from smoke signals to mobile health solutions. J Hosp Librariansh. 2016;16(2):174–185. doi: 10.1080/15323269.2016.1150750.

4. Drake T.M., Ritchie J.E. The Surgeon Will Skype You Now: Advancements in E-clinic. Ann of Surgery. 2016;263(4):636–637. doi: 10.1097/sla.0000000000001505.

5. Rao B., Lombardi A. 2nd. Telemedicine: current status in developed and developing countries. J Drugs Dermatol. 2009;8(4):371–375. Available at: https://www.ncbi.nlm.nih.gov/pubmed/19363855.

6. Weinstein R.S., Krupinski E.A., Doarn C.R. Clinical examination component of telemedicine, telehealth, mhealth, and connected health medical practices. Med Clin North Am. 2018;102(3):533–544. doi: 10.1016/j.mcna.2018.01.002.

7. Bongiovanni-Delarozière I., Le Goff-Pronost M. Economic evaluation methods applied to telemedicine: From a literature review to a standardized framework. European Research in Telemedicine. 2017;6(3–4):117–135. doi: 10.1016/j.eurtel.2017.08.002.

8. de la Torre-Díez I., López-Coronado M., Vaca C., Aguado J.S., de Castro C. Cost-utility and cost-effectiveness studies of telemedicine, electronic, and mobile health systems in the literature: a systematic review. Telemed J E Health. 2015;21(2):81–85. doi: 10.1089/tmj.2014.0053.

9. Dowie R., Mistry H., Rigby M., Young T.A., Weather-burn G., Rowlinson G., Franklin R.C.G. A pediatric telecardiology service for district hospitals in south-east England: an observational study. Arch Dis Child. 2009;94(4):273–277. doi: 10.1136/adc.2008.138495.

10. Zaytseva N.A., Shiryaeva A.S. Telemedicine in the modern healthcare system. Byulleten’ meditsinskikh internet-konferentsiy = Bulletin of Medical Internet Conferences. 2016;6(1):58. (In Russ.) Available at: https://medconfer.com/node/5613

11. Smith W.R., Atala A.J., Terlecki R.P., Kelly E.E., Matthews C.A. Implementation Guide for Rapid Integration of an Outpatient Telemedicine Program during the COVID-19 Pandemic. J Am Coll Surg. 2020;231(2):216–222.e2. doi: 10.1016/j.jamcollsurg.2020.04.030.

12. Vladzimirskiy A.V., Shaderkin I.A. Telemedicine in the compulsory health insurance system: perspective or reality. Zdravookhranenie = Public Health Service. 2015;(11):64–73. (In Russ.) Available at: https://elibrary.ru/item.asp?id=24502358

13. Boldyrev B.M. Telemedicine in insurance. Strakhovoe delo = Insurance Business. 2017;6(291):35–45. (In Russ.) Available at: http://ankil.info/lib/1/205/1819/

14. Baranov A.A., Vishneva E.A., Namazova-Baranova L.S. Telemedicine – prospects and difficulties before a new development stage. Pediatricheskaya farmakologiya = Pediatric Pharmacology. 2013;10(3):6–11. (In Russ.) doi: 10.15690/pf.v10i3.691.

15. Arutyunov G.P., Bilichenko T.N., Bubnova M.G., Ipatov P.V., Kalinina A.M., Kaprin A.D. et al. Prevention of chronic non-communicable diseases. Recommendations. Мoscow; 2013. 128 p. (In Russ.) Available at: http://webmed.irkutsk.ru/doc/pdf/prevent.pdf

16. Denisova T.P., Shuldyakov V.A., Tyultyaeva L.A., Chernenkov Yu.V., Alipova L.N., Sadzhaya L.A. Monitoring of internal diseases dissemination (digestive disorders). Saratovskiy nauchno‐meditsinskiy zhurnal = Saratov Journal of Medical Scientific Research. 2011;7(4):772–776. (In Russ.) Available at: http://ssmj.ru/system/files/201104_772-776.pdf.

17. Siddiqui J., Herchline T., Kahlon S., Moyer K.J., Scott J.D., Wood B.R., Young J. Infectious Diseases Society of America Position Statement on Telehealth and Telemedicine as Applied to the Practice of Infectious Diseases. Clinical Infectious Diseases. 2017;64(3):237–242. doi: 10.1093/cid/ciw773.