"We are not reinventing the bicycle here in Russia," said Sergey Morozov. Radiologists anywhere would be familiar with the experience of restructuring imaging services for the nation's healthcare system, he said.
Yet Russian radiologists must also confront a funding crisis, system dysfunctions, self-referring patients, and head hunters chasing highly valued staff, he explains in this interview with Medical Device Daily from his office at the European Medical Center in Moscow where he leads the radiology group.
Thanks to a recent modernization program, today there are new radiology systems installed in even smaller community hospitals across the country, he said.
"The heads of these radiology operations face the same kinds of issues confronting our colleagues across Europe or the United States. The equipment we have is the same, the standards for operating the equipment are the same, the protocols are very similar," said Morozov, who is a member of the Management in Radiology (MIR) Subcommittee of the European Society of Radiology (ESR; Vienna).
Morozov's work with the ESR on the MIR committee is part of a larger effort to introduce a program for retraining Russian doctors as professional managers of healthcare services.
The expanded number of radiology systems, and a rapidly increasing demand on the utilization of that equipment has shown that doctors put in charge of operations need specific skills in order to run these department effectively, and efficiently in terms of logistics, patient through-put and business analysis.
"We have found that a good radiologist can become a manager, but it does not mean this good radiologists is going to suddenly become a good manager," he laughed.
The next level of challenge, he said, is to build an information technology (IT) system on top of these processes in order to better manage hospital departments and networks of hospitals.
Currently there is a widening gap between the level of digitization and IT capabilities between public and private hospitals, which are moving faster to introduce PACS and hospital information systems (HIS).
"[Private hospitals] can make purchasing and installation more straightforward, they are more transparent in their operation, and they can assure financing because they are structured as businesses," said Morozov.
The same processes become complicated at the larger public hospitals, he said.
"It can sometimes be difficult for public hospitals to understand why they need things like PACS or IT or HIS, and to understand why they need to find the funding for these projects," he said.
As with other European countries, the Russian healthcare system is under financial pressure with severe constraints put on radiology operations. While some of these issues will seem familiar to radiologists elsewhere, he said, several key challenges are peculiar to Russia.
Making a tough situation even more difficult, he said, is that financing has collapsed for the national program of healthcare modernization that equipped hospitals and clinics.
"Unfortunately, much of the equipment was often provided without service contracts, only guarantees for one year after installation. And not all equipment was installed according to the proper specifications. This has left many hospitals without equipment service. Clearly the lesson has been learned that we cannot just buy a piece of equipment without thinking about service from the beginning," he said.
Radiology departments in Russia are also learning the importance of looking beyond the initial purchase in order to assure ongoing financing for operations, as well as proper staffing and training.
A huge difference with other countries, he said, is the ability of patients to refer themselves for radiology exams.
"They do not come from a specialist or even a general practitioner," Morozov explained. "They go to Google Doctor and then come to us saying they would like an MRI. I had one patient who, when I asked her what was her health issue, she said she suffered from T2 hyper intense lesions in the brain."
Another issue impacting patient flows and throughput for radiology is a rapidly expanding percentage of patients who pay out of their own pocket for health services, and the resulting competitive environment created by these high-end patients.
"Money has become the major driver of healthcare," he lamented. "Today in Russia, radiology services are perceived as a source of revenue for hospitals. Radiologists have become the stars of the healthcare system. As a result, qualified radiologists are requesting high salaries. There are head hunters after them, making it difficult to find good radiologists and trained technicians."
Morozov also holds a chair in radiology at the Sechenov Moscow Medical University and notes that where five years ago the faculty worked with 15 residents each year, today there are between 50 and 60 residents each year.
Unable to find an appropriate program to advance at the university, he said these future radiologists turn to post-doctoral medical education increasingly offered by private companies that can provide specialized training courses with experienced doctors.
The way forward, he said, depends on efforts to establish national standards combined with an initiative to lead by example with a large-scale center of excellence.
Over the past three years more than 150 CT and 70 MR scanners have been acquired for the healthcare system serving Moscow and Agfa Healthcare has won the tender to install a regional PACS system to connect the different centers. The goal is to create a centralized center that can offer second readings for other medical centers.
"Here we are seeing a concerted effort by the state in a policy of providing better standards for radiology in imaging and interpretation," said Morozov. "The center for excellence in Moscow is proving to be a driver for increasing quality, and it creates an opportunity for enhancing the education and training system. Radiologists learn a second opinion is not a punishment but a systematic review to identify discrepancies. In this way people learn how to avoid any mistakes, whether in use of the equipment or in interpretation."