The text of the new order is commented on by Alexander Gusev, Deputy Director for Development of the Integrated Medical Information Systems company.

With this order. We are talking about local doctors (general practitioners, pediatricians, family doctors) and medical specialists (neurologist, otorhinolaryngologist, ophthalmologist, obstetrician-gynecologist). Time standards are applied when providing primary medical and primary specialized health care in an outpatient setting, as well as when a specialist visits a patient at home.

This document for those involved in healthcare informatization is primarily interesting for point No. 5, which reads:

« The time spent by a specialist doctor on preparing medical documentation, taking into account the rational organization of work, equipping workplaces with computer and organizational equipment, should be no more than 35% of the time standards associated with a visit by one patient to a specialist doctor in connection with a disease in accordance with paragraphs 3 and 6 real time standards».

Paragraphs 3 and 6 of the document establish absolute indicators of the norm for the duration of a doctor’s appointment for various cases. Accordingly, if we take as the starting point that the workplaces of employees of a medical organization (MO) are equipped with computer equipment (which, in theory, should already be achieved by at least 50% on average in the country as a result of “Basic informatization” in 2011-2012 .) and that the organization of work in a given municipality is carried out rationally (otherwise where are the inspection and control authorities looking and why is the head physician in such a municipality still holding his post, and the regional minister of health - his) - then we get these standards for the conduct of medical documentation, which, if properly automated, should be created in the appropriate electronic medical record (EMR) system:

So, we have determined the threshold value of the standard time that a user can spend working with the EHR in the case of an initial, repeat examination, or examination for the preventive purpose of a visit. Now we need to understand what actions, at least in the most typical cases, our user should have time to do during this time.

More precisely, our user with our medical information system (MIS) - because the efficiency of spending this time is determined not only (and to be honest, not even so much) by the quality of the user’s work, but by the quality of design, convenience, maturity and productivity of the MIS. It’s bad when the user does not have fluent typing or is generally not comfortable with computer technology. But it’s even worse when the EHR system takes a long time, is difficult or inconvenient to perform the most requested actions by the user.

At the same time, we understand that each such action - be it opening a document from the EHR, making an entry, etc. - this is a certain sequence of events, each of which, in turn, also consumes time: a user command to the EHR management system, displaying the results on the screen, creating a document screen form for filling it out, user input of information via the keyboard, primary format-logical control of data by the MIS , saving an electronic record in the MIS database, updating the system interface, etc. But we will not carry out calculations to such a level of detail; we will consider only in general the most typical types of user interaction with the EHR management system, presented in the table below.

This list contains the most typical cases. It should be noted that this is not a complete list of those documents that must be completed within the allotted time. Have you discovered poisoning? - we fill out the “Notification of a case of acute poisoning of chemical etiology” (Form No. 58-1/u), required by order of the Ministry of Health of the Russian Federation No. 460 dated December 29, 2000. Have you identified an infection? - we fill out the “Notification of an infectious disease, food poisoning, acute occupational poisoning, unusual reaction to vaccination” (Form No. 058/u), provided for by order of the USSR Ministry of Health No. 1030 dated 10/04/1980. Found an STD or skin disease? - you need to make a “Notification of a patient with a newly established diagnosis” (Form No. 89/u-kv), this is required by order of the Ministry of Health of the Russian Federation No. 403 dated 08/12/2003. - etc. We must not forget the dispensary records of diseases, which in theory should also be kept. Update the radiation exposure sheet. Vaccination control. In general, at a regular outpatient clinic appointment, a doctor has a more than impressive list of documents, journals and other records that also need to be filled out in the system - and all this needs to be completed in the allotted time.

At the same time, a very important help from the MIS can be the fact that the system can produce a number of mandatory forms on its own. For example, if we maintain a full-fledged EHR - then the same “Outpatient Patient Certificate” (TAP) - the MIS can easily be issued by itself, because all the data necessary for this is in the medical documentation. In theory, you don’t even need to print out the TAP at the appointment, because this is not explicitly required by law. Another example is if a temporary disability occurs, the doctor (or, most often, the nurse at the reception, if there is one) must print out the completed “Certificate of Incapacity for Work” form from the MIS (Order of the Ministry of Health and Social Development of the Russian Federation No. 624n dated June 29, 2011). But the system can easily make an entry in the “Book of registration of certificates of incapacity for work” (Form 036/u), why force the medical staff to duplicate the data already entered? Thus, if we look at maintaining medical records from the point of view of strict compliance with the entire currently available regulatory framework, then maintaining an EHR can actually reduce the number of document forms that need to be filled out at a medical appointment.

This means that in the time allotted by Order 290n, working with documentation may require fewer actions with various forms than if we kept them in the usual paper form. In other words - or we still spend the full time allotted for medical documentation, but at the same time we make a more thorough record, for example, on a more detailed description of the patient's complaints, objective status or recommendations issued. Or we save the total time of the doctor’s work in favor of more attention to the patient and dialogue with him. There really is another problem here, which is that many of the current orders of the Ministry of Health do not provide for maintaining medical records in electronic form, and therefore there is a certain dilemma: how legal is it to maintain an EHR? But that is another topic.

Of course, there are no absolutely identical techniques, because There are no completely similar patients, their specific disease, life history and many other factors that make up each specific situation. However, now, taking into account this order and the specific indicators specified in it, we can understand how much time we have in a given situation to fully maintain an EHR. And based on this, calculate the time standards for each specific user action, a certain type of electronic medical record, etc. In fact, this turns out to be quite a good guideline. Are we developing or improving the function of issuing a certificate of incapacity for work? Great - now we need to not only carefully read the Order of the Ministry of Health No. 624n dated June 29, 2011, but also take into account that all work, including creating a screen form, filling out all the fields provided for by the order, as well as inserting the form into the printer tray and printing - us no more than a certain number of minutes and seconds. This is the criterion for assessing the maturity and quality of MIS. Does the average medical worker have time to do this in a really working MIS? If yes, that's good. If not, now there is a normative reason to think about why this happened and look for ways to solve the problem.

True, the reasons for this problem are sometimes not in the MIS, but, for example, in the rules for creating and submitting registers for compulsory health insurance payments, in communication channels, in hardware for which there is no money to update. And in the same orders of the Ministry of Health, some of which, to be honest, need to be clarified and, perhaps, revised - in order to normatively establish the possibility of maintaining documents in electronic form or to simplify and speed up the preparation of documents, and in some places - and even to abolish those that have no special meaning of form. But that is another story….

Order of the Ministry of Health of the Russian Federation dated June 2, 2015 N 290n “On approval of standard industry standards”

Order of the Ministry of Health of the Russian Federation dated June 2, 2015 N 290n
“On approval of standard industry standards for the time required to perform work related to one patient’s visit to a local pediatrician, a local general practitioner, a general practitioner (family doctor), a neurologist, an otolaryngologist, an ophthalmologist and an obstetrician - gynecologist"

Time standards have been established for a patient to visit a doctor in a clinic. We are talking about local doctors (general practitioners, pediatricians, family doctors) and medical specialists (neurologist, otorhinolaryngologist, ophthalmologist, obstetrician-gynecologist).

Time standards are applied when providing primary medical and primary specialized health care in an outpatient setting (not providing for round-the-clock medical observation and treatment), including when a medical specialist visits a patient at home.

Thus, for one visit by a patient in connection with a disease, a local physician or pediatrician is allocated 15 minutes, a family doctor - 18 minutes, an ophthalmologist - 14 minutes, an otorhinolaryngologist - 16 minutes, a neurologist and obstetrician-gynecologist - 22 minutes. The time limits for return visits due to illness and for preventive visits are somewhat lower.

Preparation of medical documentation should take no more than 35% of the time allocated for the visit.

Adjustment factors are applied to the norms depending on the density of residence and age-sex composition of the population, the level and structure of morbidity.

Based on established standards, workload standards, headcount standards and other work standards for doctors are calculated.

Order of the Ministry of Health of the Russian Federation dated June 2, 2015 N 290n “On approval of standard industry standards of time for performing work related to a visit by one patient to a local pediatrician, a local therapist, a general practitioner (family doctor), a neurologist, otorhinolaryngologist, ophthalmologist and obstetrician-gynecologist"

This order comes into force 10 days after the day of its official publication

Order 290n “Inter-industry rules for providing workers with special clothing, special footwear and other personal protective equipment”

The Rules establish mandatory requirements for the acquisition, issuance, use, storage and care of special clothing, special footwear and other personal protective equipment.
The requirements of these Rules apply to employers - legal entities and individuals, regardless of their legal forms and forms of ownership.

Order of the Ministry of Health and Social Development of the Russian Federation dated June 1, 2009 N 290n

Approval of intersectoral rules for providing workers with special clothing, special footwear and other personal protective equipment

In accordance with clause 5.2.70 of the Regulations on the Ministry of Health and Social Development of the Russian Federation, approved by Decree of the Government of the Russian Federation of June 30, 2004 N 321 (Collection of Legislation of the Russian Federation, 2004, N 28, Art. 2898; 2005, N 2, Art. 162 ; 2006, N 19, article 2080; 2008, N 11, article 1036; N 15, article 1555; N 23, article 2713; N 42, article 4825; N 46, article 5337; N 48, Art. 5618; 2009, N 2, Art. 244; N 3, Art. 378; N 6, Art. 738; N 12, Art. 1427), I order:

1. Approve intersectoral rules for providing workers with special clothing, special footwear and other personal protective equipment in accordance with the appendix.

2. Declare as invalid:

Resolution of the Ministry of Labor of Russia dated December 18, 1998 N51 “On approval of the Rules for providing workers with special clothing, special footwear and other personal protective equipment” (registered with the Ministry of Justice of Russia on February 5, 1999 N 1700);

Resolution of the Ministry of Labor of Russia dated October 29, 1999 N 39 “On amendments and additions to the Rules for providing workers with special clothing, special footwear and other personal protective equipment” (registered with the Ministry of Justice of Russia on November 23, 1999 N 1984);

Resolution of the Ministry of Labor of Russia dated February 3, 2004 N 7 “On introducing amendments and additions to the Rules for providing workers with special clothing, special footwear and other personal protective equipment” (registered with the Ministry of Justice of Russia on February 25, 2004 N 5583).

Minister T.A. Golikova

By order of the Ministry of Health and Social Development of Russia dated January 27, 2010 N28н, changes were made to this application, which come into force 10 days after the official publication of the said order

Cross-industry rules
providing workers with special clothing, special footwear and other personal protective equipment

I. General provisions

1. Intersectoral rules for providing workers with special clothing, special footwear and other personal protective equipment (hereinafter referred to as the Rules) establish mandatory requirements for the acquisition, issuance, use, storage and care of special clothing, special footwear and other personal protective equipment (hereinafter referred to as PPE).

2. The requirements of these Rules apply to employers - legal entities and individuals, regardless of their organizational and legal forms and forms of ownership.

3. For the purposes of this order, PPE refers to personal equipment used to prevent or reduce the impact of harmful and (or) hazardous production factors on workers, as well as to protect against pollution.

4. The employer is obliged to ensure the acquisition and issuance of PPE that has undergone certification or declaration of conformity in the prescribed manner to workers engaged in work with harmful and (or) dangerous working conditions, as well as in work performed in special temperature conditions or associated with pollution.

The purchase of personal protective equipment is carried out at the expense of the employer.

An employer may purchase PPE for temporary use under a lease agreement.

Employees engaged in work with harmful and (or) dangerous working conditions, as well as in work performed in special temperature conditions or associated with pollution, are issued the appropriate PPE free of charge.

5. The provision of personal protective equipment to employees, including those acquired by the employer for temporary use under a lease agreement, is carried out in accordance with the standard standards for the free issuance of special clothing, special footwear and other personal protective equipment (hereinafter referred to as the standard standards), which have undergone certification or declaration of conformity in the prescribed manner, and on based on the results of certification of workplaces for working conditions, carried out in the prescribed manner.

6. The employer has the right, taking into account the opinion of the elected body of the primary trade union organization or other representative body of workers and its financial and economic situation, to establish standards for the free issuance of special clothing, special shoes and other personal protective equipment to employees, which, compared to standard standards, improve the protection of workers from harmful and (or) hazardous factors, as well as special temperature conditions or pollution.

These standards are approved by local regulations of the employer based on the results of certification of workplaces for working conditions and taking into account the opinion of the relevant trade union or other body authorized by employees and can be included in a collective and (or) labor agreement indicating standard standards, in comparison with which the provision of workers with personal protective equipment is improved.

7. The employer has the right, taking into account the opinion of the elected body of the primary trade union organization or another representative body authorized by employees, to replace one type of personal protective equipment provided for by the standard standards with a similar one that provides equivalent protection from dangerous and harmful production factors.

8. The issuance of PPE to employees, including foreign-made ones, as well as special clothing that is temporarily used by the employer under a lease agreement, is allowed only if they have a certificate or certificate of conformity or have a declaration of conformity and (or) a certificate of conformity that has expired, not allowed.

9. The employer is obliged to ensure that employees are informed about the PPE they are entitled to. When concluding an employment contract, the employer must familiarize employees with these Rules, as well as with the standard standards for issuing PPE corresponding to his profession and position.

10. The employee is obliged to correctly use the PPE issued to him in the prescribed manner.

11. In case of failure to provide an employee engaged in work with harmful and (or) dangerous working conditions, as well as with special temperature conditions or associated with pollution, PPE in accordance with the legislation of the Russian Federation, he has the right to refuse to perform labor duties, and the employer has no right to demand that the employee their execution and is obliged to pay the downtime arising for this reason

II. The procedure for issuing and using PPE

12. PPE issued to employees must correspond to their gender, height, size, as well as the nature and conditions of the work they perform.

13. The employer is obliged to organize proper accounting and control over the issuance of PPE to employees within the established time frame.

The period for using personal protective equipment is calculated from the date of actual issue to employees.

The issuance of PPE to employees and their issuance of PPE is recorded by an entry in the personal record card for the issuance of PPE, the form of which is given in the appendix to these Rules.

The employer has the right to keep records of the issuance of personal protective equipment to employees using software (information and analytical databases). The electronic form of the registration card must correspond to the established form of the personal registration card for the issuance of personal protective equipment. Moreover, in the electronic form of the personal card for recording the issuance of PPE, instead of the employee’s personal signature, the number and date of the accounting document on the receipt of PPE, on which the employee’s personal signature is indicated, are indicated.

14. Workers in cross-cutting professions and positions in all sectors of the economy are issued PPE in accordance with standard standards, regardless of the organizational and legal forms and forms of ownership of the employer, as well as the presence of these professions and positions in accordance with standard standards.

15. Foremen, foremen performing the duties of foremen, assistants and assistant workers, whose professions are specified in the relevant standard standards, are issued the same PPE as employees of the corresponding professions.

16. The PPE for workers, specialists and other employees provided for in the standard standards is issued to the specified workers even if they are senior in their profession and position and directly perform the work that gives them the right to receive these personal protective equipment.

17. Workers who combine professions or constantly perform combined jobs, including as part of complex teams, in addition to the PPE issued to them for their main profession, are additionally issued, depending on the work performed, other types of PPE provided for by the relevant standard standards for the combined profession (combined type of work).

18. Employees temporarily transferred to another job, employees and other persons undergoing vocational training (retraining) in accordance with an apprenticeship contract, pupils and students of educational institutions of primary, secondary and higher vocational education while undergoing practical training (industrial training), masters of industrial training, as well as other persons participating in the production activities of the employer or carrying out control (supervision) measures in the established field of activity in accordance with current legislation, PPE is issued in accordance with standard standards and Rules for the duration of this work (professional training, retraining, industrial practice, industrial training) or implementation control (supervision) measures.

19. In cases where such PPE as a signal vest, a safety harness, a retaining harness (safety belt), dielectric overshoes and gloves, a dielectric mat, safety glasses and shields, filtering PPE for the respiratory organs with anti-aerosol and anti-gas filters, insulating PPE for the respiratory organs, protective helmet, balaclava, mosquito net, hard hat, shoulder pads, elbow pads, self-rescuers, headphones, anti-noise inserts, light filters, vibration-proof mittens or gloves, etc. are not specified in the relevant standard standards, they can be issued to employees with a wear period “until wear” based on the results of certification of workplaces for working conditions, as well as taking into account the conditions and characteristics of the work performed.

The above PPE is also issued based on the results of certification of workplaces for working conditions for periodic use when performing certain types of work (hereinafter referred to as duty PPE). At the same time, anti-noise liners, balaclavas, as well as PPE for respiratory organs, which do not allow multiple use and are issued as “duty” ones, are issued in the form of a disposable kit before the work shift in an amount corresponding to the number of employees at a given workplace.

20. General use PPE on duty is issued to employees only for the duration of the work for which they are intended.

The specified PPE, taking into account the requirements of personal hygiene and individual characteristics of workers, is assigned to certain workplaces and transferred from one shift to another.

In such cases, PPE is issued under the responsibility of the heads of structural units authorized by the employer to carry out these works.

21. PPE intended for use in special temperature conditions caused by annual seasonal temperature changes are issued to employees at the beginning of the corresponding period of the year, and at its end are handed over to the employer for organized storage until the next season.

The time for using these types of PPE is set by the employer, taking into account the opinion of the elected body of the primary trade union organization or other representative body of workers and local climatic conditions.

The time period for wearing PPE used in special temperature conditions includes the time of their organized storage.

22. PPE returned by employees after the wear period has expired, but suitable for further use, is used for its intended purpose after taking measures to care for it (washing, cleaning, disinfection, degassing, decontamination, dust removal, neutralization and repair). The suitability of the specified PPE for further use, the need to carry out and the composition of measures to care for it, as well as the percentage of wear of the PPE are established by an official authorized by the employer or the labor protection commission of the organization (if any) and are recorded in a personal record card for the issuance of PPE.

23. Rented PPE is issued in accordance with standard standards. When an employee is issued with special clothing rented by the employer, the employee is assigned an individual set of PPE, for which the appropriate marking is applied to it. Information about the issuance of this kit is entered into the employee’s personal PPE registration and issuance card.

24. When issuing PPE, the use of which requires practical skills from workers (respirators, gas masks, self-rescuers, safety belts, mosquito nets, helmets, etc.), the employer ensures that workers are instructed on the rules for using the said PPE, the simplest ways to check their performance and serviceability, as well as organizes training on their use.

25. In the event of loss or damage to PPE in designated storage areas for reasons beyond the control of employees, the employer issues them other serviceable PPE. The employer provides replacement or repair of personal protective equipment that has become unusable before the end of the wearing period due to reasons beyond the employee’s control.

26. The employer ensures that employees use PPE.

Workers are not allowed to perform work without PPE issued to them in the prescribed manner, as well as with faulty, unrepaired or contaminated PPE.

27. Employees are prohibited from taking PPE outside the employer’s territory or the territory where work is carried out by the employer as an individual entrepreneur at the end of the working day. In some cases, when, due to working conditions, the specified procedure cannot be followed (for example, in logging, geological work, etc.), PPE remains with employees during non-working hours.

28. Employees must notify the employer (or his representative) about the failure (malfunction) of PPE.

29. In accordance with the deadlines established in national standards, the employer ensures testing and checking the serviceability of PPE, as well as timely replacement of parts of PPE with reduced protective properties. After checking the serviceability, a mark (stamp, stamp) is placed on the PPE indicating the timing of the next test.

III. The procedure for organizing the storage and care of PPE

30. The employer, at his own expense, is obliged to provide care for PPE and its storage, promptly carry out dry cleaning, washing, degassing, decontamination, disinfection, neutralization, dust removal, drying of PPE, as well as repair and replacement of PPE.

For these purposes, the employer has the right to issue employees with 2 sets of appropriate PPE with double the wearing period.

31. For the storage of PPE issued to employees, the employer provides specially equipped premises (dressing rooms) in accordance with the requirements of building codes and regulations.

32. If the employer does not have the technical capabilities for dry cleaning, washing, repair, degassing, decontamination, neutralization and dust removal of PPE, these works are carried out by an organization engaged by the employer under a civil law contract.

33. Depending on the working conditions, the employer (in its structural divisions) sets up dryers, chambers and installations for drying, dust removal, degassing, decontamination and neutralization of personal protective equipment.

IV. Final provisions

34. Responsibility for the timely and full issuance to employees of PPE that has undergone certification or declaration of conformity in accordance with standard standards, for organizing control over the correct use of them by employees, as well as for the storage and care of PPE rests with the employer (his representative).

35. State supervision and control over the employer’s compliance with these Rules is carried out by the federal executive body exercising the functions of supervision and control over compliance with labor legislation and other regulatory legal acts containing labor law norms, and its territorial bodies (state labor inspectorates in the constituent entities of the Russian Federation).

36. Control over compliance by employers (legal entities and individuals) with these Rules in subordinate organizations is carried out in accordance with Articles 353 and 370 of the Labor Code of the Russian Federation** by federal executive authorities, executive authorities of constituent entities of the Russian Federation and local governments, as well as professional unions, their associations and under their supervision by technical labor inspectors and authorized (trusted) persons for labor protection.

* Dermatological means of personal protection of the skin from exposure to harmful factors for use in production are subject to state registration by Rospotrebnadzor in accordance with the resolutions of the Government of the Russian Federation of December 21, 2000 N 988 “On state registration of new food products, materials and products” (Collection of Legislation of the Russian Federation 2001, N 1 ( Part 2), Article 124; 2007, No. 10, Article 1244) and dated April 4, 2001 No. 262 “On state registration of certain types of products that pose a potential danger to humans, as well as certain types of products imported for the first time into the territory of the Russian Federation” (Collection of Legislation of the Russian Federation 2001, No. 17, Art. 1711).

** Collection of Legislation of the Russian Federation, 2002, No. 1 (Part 1), Art. 3; 2004, N35, art. 3607; 2006, N 27, art. 2878.

By Order of the Ministry of Health and Social Development of Russia dated January 27, 2010 N 28n, changes were made to this appendix, which come into force 10 days after the official publication of the said order

Application

to Intersectoral rules for ensuring
workers with special clothing, special
shoes and other personal equipment
protection

Front side of the personal card

Personal card N ___
accounting for the issuance of personal protective equipment

Order of the Ministry of Health of the Russian Federation No. 290n on the time standards for outpatient appointments

MINISTRY OF HEALTH OF THE RUSSIAN FEDERATION

ON APPROVAL OF STANDARD INDUSTRY STANDARDS
TIME TO PERFORM WORK RELATED TO THE VISIT
ONE PATIENT OF A DISTRICT PEDIATRIC, A THERAPIST
DISTRICT, GENERAL PRACTITIONER (FAMILY DOCTOR),
NEUROLOGIST, OTORINOLARYNGOLOGIST,
OPHTHALMOLOGIST AND OBSTETRIC-GYNECOLOGIST

In accordance with paragraph 3 of the Rules for the development and approval of standard labor standards, approved by Decree of the Government of the Russian Federation of November 11, 2002 N 804 (Collection of Legislation of the Russian Federation, 2002, N 46, Art. 4583), and paragraph 19 of the action plan (“road maps") “Changes in sectors of the social sphere aimed at increasing the efficiency of healthcare”, approved by order of the Government of the Russian Federation of December 28, 2012 N 2599-r (Collected Legislation of the Russian Federation, 2013, N 2, Art. 130; N 45, Art. 5863; 2014, N 19, Art. 2468), I order:
Approve, in agreement with the Ministry of Labor and Social Protection of the Russian Federation, the attached standard industry standards of time for performing work related to a visit by one patient to a local pediatrician, a local physician, a general practitioner (family doctor), a neurologist, an otolaryngologist , ophthalmologist and obstetrician-gynecologist.

Approved
by order of the Ministry of Health
Russian Federation
dated June 2, 2015 N 290n

STANDARD INDUSTRY STANDARDS
TIME TO PERFORM WORK RELATED TO THE VISIT
ONE PATIENT OF A DISTRICT PEDIATRIC, A THERAPIST
DISTRICT, GENERAL PRACTITIONER (FAMILY DOCTOR),
NEUROLOGIST, OTORINOLARYNGOLOGIST,
OPHTHALMOLOGIST AND OBSTETRIC-GYNECOLOGIST

1. Standard industry time standards (hereinafter referred to as time standards) for performing work related to one patient’s visit to a local pediatrician, a local general practitioner, a general practitioner (family doctor), a neurologist, an otolaryngologist, an ophthalmologist and an obstetrician-gynecologist (hereinafter referred to as a medical specialist), are used in the provision of primary medical and primary specialized health care in an outpatient setting (not providing for round-the-clock medical observation and treatment), including when a medical specialist visits one patient per home.
———————————
Clause 2 of part 3 of Article 32 of the Federal Law of November 21, 2011 N 323-FZ “On the fundamentals of protecting the health of citizens in the Russian Federation” (Collected Legislation of the Russian Federation, 2011, N 48, Art. 6724; 2012, N 26, Art. 3442, 3446; 2013, N 27, art. 3459, 3477; N 30, art. 4038; N 39, art. 4883; N 48, art. 6165; N 52, art. 6951; 2014, N 23, art. 2930; N 30, Art. 4106, 4244, 4247, 4257; N 43, Art. 5798; N 49, Art. 6927, 6928; 2015, N 1, Art. 72, 85; N 10, Art. 1425; N 14, Art. 2018).

2. Time standards are the basis for calculating workload standards, headcount standards and other labor standards for doctors of medical organizations providing primary medical care and primary specialized health care in an outpatient setting.
3. Standards of time for one visit by a patient to a medical specialist in connection with a disease, necessary to perform labor actions in the provision of medical care in an outpatient setting (including the time spent on preparing medical documentation):
a) local pediatrician – 15 minutes;
b) local therapist - 15 minutes;
c) general practitioner (family doctor) - 18 minutes;
d) neurologist - 22 minutes;
e) otorhinolaryngologist - 16 minutes;
f) ophthalmologist - 14 minutes;
g) obstetrician-gynecologist - 22 minutes.
4. Time standards for a repeat visit to a medical specialist by one patient in connection with a disease are set at 70 - 80% of the time standards associated with the initial visit to a medical specialist by one patient in connection with a disease.
5. The time spent by a specialist doctor on preparing medical documentation, taking into account the rational organization of work, equipping workplaces with computer and organizational equipment, should be no more than 35% of the time norms associated with a visit by one patient to a specialist doctor in connection with a disease in accordance with paragraphs 3 and 6 of these time standards.
6. Time standards for one patient to visit a specialist doctor for preventive purposes are set at 60 - 70% of the time standards associated with one patient visiting a specialist doctor in connection with a disease, established in a medical organization or other organization carrying out medical activities ( hereinafter referred to as a medical organization), in accordance with paragraphs 3 and 6 of these time standards.
7. In medical organizations providing primary medical and primary specialized health care in an outpatient setting, the time standards specified in paragraphs 3 and 6 are established taking into account the density of residence and the age and gender composition of the population, as well as taking into account the level and structure of morbidity of the population by summation of correction factors of time norms.
The following correction factors are applied:
a) the residential density of the attached population is above 8 people per square meter. km: -0.05;
b) the residential density of the attached population is below 8 people per square meter. km (except for the regions of the Far North and equivalent areas): +0.05;
c) the morbidity rate of the population is 20% higher than the average value for the constituent entity of the Russian Federation: +0.05;
d) the morbidity rate of the population is 20% lower than the average value for the constituent entity of the Russian Federation: -0.05;
e) the proportion of people over working age among the attached population is above 30%: +0.05 (for a local pediatrician - the proportion of children under the age of 1 year among children under the age of 14 is above 8%: +0.05);
f) the proportion of people over working age among the attached population is below 30%: -0.05 (for a local pediatrician - the proportion of children under the age of 1 year among children under the age of 14 is below 8%: -0.05).

ON APPROVAL OF STANDARD INDUSTRY STANDARDS OF TIME FOR PERFORMING WORK RELATED TO A VISIT BY ONE PATIENT TO A DISTRICT PEDIATRIST, A DISTRICT THERAPIST, A GENERAL PRACTITIONER (FAMILY DOCTOR), A NEURO DOCTOR LOGIST, ENTERHINOLARYNGOLOGIST, OPHTHALMOLOGIST AND OBSTETRIC-GYNECOLOGIST

Approve, in agreement with the Ministry of Labor and Social Protection of the Russian Federation, the attached standard industry standards of time for performing work related to a visit by one patient to a local pediatrician, a local physician, a general practitioner (family doctor), a neurologist, an otolaryngologist , ophthalmologist and obstetrician-gynecologist.

Minister
IN AND. SKVORTSOVA

APPROVED
by order of the Ministry of Health
Russian Federation
dated June 2, 2015 N 290n

STANDARD INDUSTRY TIME STANDARDS FOR PERFORMING WORK RELATED TO A VISIT BY ONE PATIENT TO A DISTRICT PEDIATOR, A DISTRICT DOCTOR, A GENERAL PRACTITIONER (FAMILY DOCTOR), A NEUROLOGIST, A DOCTOR THORINOLARINGOLOGIST, OPHTHALMOLOGIST AND OBSTETRIC-GYNECOLOGIST

3. Standards of time for one visit by a patient to a medical specialist in connection with a disease, necessary to perform labor actions in the provision of medical care in an outpatient setting (including the time spent on preparing medical documentation):

a) local pediatrician - 15 minutes;

b) local therapist - 15 minutes;

c) general practitioner (family doctor) - 18 minutes;

d) neurologist - 22 minutes;

e) otorhinolaryngologist - 16 minutes;

f) ophthalmologist - 14 minutes;

g) obstetrician-gynecologist - 22 minutes.

4. Time standards for a repeated visit to a medical specialist by one patient in connection with a disease are set at 70 - 80% of the time standards associated with the initial visit to a medical specialist by one patient in connection with a disease.

5. The time spent by a specialist doctor on preparing medical documentation, taking into account the rational organization of work, equipping workplaces with computer and organizational equipment, should be no more than 35% of the time norms associated with a visit by one patient to a specialist doctor in connection with a disease in accordance with paragraphs 3 and 6 of these time standards.

6. Time standards for one patient to visit a specialist doctor for preventive purposes are set at 60 - 70% of the time standards associated with one patient visiting a specialist doctor in connection with a disease, established in a medical organization or other organization engaged in medical activities ( hereinafter referred to as a medical organization), in accordance with paragraphs 3 and 6 of these time standards.

7. In medical organizations providing primary medical and primary specialized health care in an outpatient setting, the time standards specified in paragraphs 3 and 6 are established taking into account the density of residence and the age and gender composition of the population, as well as taking into account the level and structure of morbidity of the population by summation of correction factors of time norms.

The following correction factors are applied:

a) the residential density of the attached population is above 8 people per square meter. km: -0.05;

b) the residential density of the attached population is below 8 people per square meter. km (except for the regions of the Far North and equivalent areas): +0.05;

c) the morbidity rate of the population is 20% higher than the average value for the constituent entity of the Russian Federation: +0.05;

d) the morbidity rate of the population is 20% lower than the average value for the constituent entity of the Russian Federation: -0.05;

e) the proportion of people over working age among the attached population is above 30%: +0.05 (for a local pediatrician - the proportion of children under the age of 1 year among children under the age of 14 is above 8%: +0.05);

f) the share of people over working age among the attached population is below 30%: -0.05 (for a local pediatrician - the share of children under the age of 1 year among children under the age of 14 is below 8%: -0.05).

Application. Standard industry standards of time for performing work related to one patient visiting a local pediatrician, a local general practitioner, a general practitioner (family doctor), a neurologist, an otolaryngologist, an ophthalmologist and an obstetrician-gynecologist

Order of the Ministry of Health of the Russian Federation dated June 2, 2015 N 290n
"On approval of standard industry standards for the time required to perform work related to one patient visiting a local pediatrician, a local general practitioner, a general practitioner (family doctor), a neurologist, an otolaryngologist, an ophthalmologist and an obstetrician - gynecologist"

IN AND. Skvortsova

Preparation of medical documentation should take no more than 35% of the time allocated for the visit.

Adjustment factors are applied to the norms depending on the density of residence and age-sex composition of the population, the level and structure of morbidity.

Based on established standards, workload standards, headcount standards and other work standards for doctors are calculated.

This order comes into force 10 days after the day of its official publication

Panov Alexey

Standards for the time it takes for doctors providing outpatient care to see patients have finally appeared.
They are enshrined in the order of the Ministry of Health of the Russian Federation dated 06/02/2015 No. 290n, which comes into force from September 5, 2015.

The time standards have not changed at all compared to the draft of this order, published at the beginning of 2015.

Does this mean that the approved time standards become mandatory for compliance by the employee (doctor) and the employer (medical organization).

As a medical lawyer, I say: “No”! They are for now of an advisory nature, a kind of guideline for the parties to labor relations.

Because they become mandatory if they are included in the terms of the doctor’s employment contract, his job description, collective agreement and other local regulations governing labor relations, including labor standards. Moreover, the doctor must be notified of changes in labor standards no later than in less than two months. This is what the Labor Code of the Russian Federation established in Article 162.

Also noteworthy is the requirement of the order to spend only 35% of the time of a medical appointment on medical documentation, the rest on the patient. And to ensure exactly this standard of time for the so-called “writing” - employer's duty.

As a medical lawyer, I definitely welcome the appearance of this order. Finally, for the first time in the post-Soviet period of domestic healthcare, a regulatory act of the Russian Ministry of Health has appeared, establishing standards for the time doctors can see patients.

This is the Minister of Health! and in August 2015, standard industry time standards appeared.

It's only been a while a little over a year and a half from the moment the initiative was announced.

What do you think about this? In the comment box, share your opinion: what benefits will it give doctors to set the length of time they see patients?