Order of the Ministry of Health of the Russian Federation dated 02.06 290n. On the basis of the established norms, the norms of workload, the norms of the number and other labor norms of doctors are calculated. Personal card N ___ accounting for the issuance of PPE

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

By this order. It's about about district doctors (general practitioners, pediatricians, family doctors) and specialist doctors (neurologist, otorhinolaryngologist, ophthalmologist, obstetrician-gynecologist). Time limits apply when providing primary medical and primary specialized health care on an outpatient basis, as well as when visiting a patient by a specialist doctor at home.

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

« The time spent by a specialist doctor on the preparation of medical documentation, taking into account the rational organization of labor, 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 of these time standards».

Paragraphs 3 and 6 of the document establish absolute indicators norms for the duration of a doctor's appointment for various cases. Accordingly, if we take as a starting point that the workplaces of employees of a medical organization (MO) are equipped with computer technology(which, in theory, should already be achieved by at least 50% on average across the country as a result of "Basic Informatization" in 2011-2012) and that the organization of work in this MO is rational (otherwise, where do the inspection and regulatory authorities look and why the head physician in such a MO still holds his post, and the regional minister of health - his own) - then we get these standards for maintaining medical records, which in the case of proper automation of the MO should be created in the relevant electronic medical record (EMR) system:

So, we have determined the threshold value of the standard time that a user can spend on working with EHR in the case of an initial, repeated examination or inspection with a preventive visit, we have determined. 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(HIS) - because the efficiency of spending this time is determined not only (and frankly, and not even so much) by the quality of the user's work, but by the quality of design, convenience, maturity and performance of the HIS. It is bad when the user does not have fluent typing or is generally at odds with computer technology. But it's even worse when the most requested actions by the user are performed by the EHR system for a long time, difficult or inconvenient.

At the same time, we understand that each such action - whether it is opening a document from an EHR, making an entry, etc. - this is a certain sequence of events, each of which, in turn, also consumes time: the user's command to the EMR system, displaying the results on the screen, creating a screen form of the document for filling it out, entering information by the user through the keyboard, primary format-logical data control 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 only consider 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. Be sure to note that this is not a complete list of those documents, the execution of which must be done in the allotted time. Got poisoned? - we draw up a "Notice of a case of acute poisoning of chemical etiology" (Form No. 58-1 / y), required by order of the Ministry of Health of the Russian Federation No. 460 dated 12/29/2000. Got an infection? - we issue a "Notice of an infectious disease, food, acute occupational poisoning, an unusual reaction to vaccination" (Form No. 058 / y), provided for by order of the Ministry of Health of the USSR No. 1030 dated 04.10.1980. Found an STD or skin disease? - you need to make a “Notice 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 12.08.2003. - etc. We must not forget the dispensary record of diseases, which, in theory, should also be kept. Update of exposure sheet. Vaccination control. In general, a doctor at a regular outpatient appointment has a more than impressive list of documents, journals and other records that also need to be registered in the system - and all this must be done in the allotted time.

At the same time, a very important help from the MIS can be that the system can do a number of mandatory forms for maintenance on its own. For example, if we conduct a full-fledged EHR - then the same "Outpatient Coupon" (TAP) - MIS may well issue itself, because all the necessary data for this is in the medical records. In theory, you don’t even need to print out the TAP at the reception, because. legislation is not explicitly required. Another example is if temporary disability has occurred, that the doctor (or, most often, the nurse at the reception, if any) must print out the completed form of the “Disability Certificate” from the MIS (Order of the Ministry of Health and Social Development of the Russian Federation No. 624n dated 06/29/2011). But the system may well make an entry in the “Book of Registration of Disability Sheets” (Form 036 / y) automatically, why force the medical staff to re-duplicate the data already entered? Thus, if you look at the maintenance of medical records in terms of strict adherence to all available this moment regulatory framework, then the management of EHR really allows you to reduce the number of forms of documents that need to be filled out at a medical appointment.

And this means - that in the time allotted by order 290n for working with documentation, fewer actions may be required with various forms than if we were leading them in the usual paper form. In other words - or we still completely spend the time allotted for medical documentation, but at the same time we make a more thorough record, for example, for more detailed description patient 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, dialogue with him. Here, however, there is another problem, which is that many of the current orders of the Ministry of Health do not provide for the maintenance of medical records in in electronic format and therefore there is a certain dilemma: how legal is the conduct of EHR in general? 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. Nevertheless, now, taking into account this order and the specific indicators indicated in it, we can understand how much time we have in this or that situation for the full maintenance of the EHR. And based on this - already calculate the time norms for each specific user action, a certain type of electronic medical record, etc. Actually, this is a pretty good guideline. Are we developing or improving the function of issuing a sick leave certificate? Great - now we need not only to carefully read the Order of the Ministry of Health No. 624n dated 06/29/2011, but also take into account that for all the work, including creating a screen form, filling in all the fields provided for by the order, as well as inserting the form into the printer tray and printing - we have no more than a certain number of minutes and seconds. This is the criterion for assessing the maturity and quality of the IIA. Does the average medical worker to do it in a real working MIS? If yes, that's good. If not, now there is a normative reason to think about why it happened and look for ways to solve the problem.

True, the causes of this problem are sometimes not in the MIS, but, for example, in the rules for the formation and submission of registries for compulsory medical insurance, in communication channels, in hardware, for which there is no money to update. Yes, 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 legally fix the possibility of maintaining documents in electronic form or to simplify and speed up the execution of documents, and in some places - and generally cancel forms that do not make much sense. But that is another story….

Application. Standard industry norms of time for performing work related to a visit by one patient to a district pediatrician, district general practitioner, general practitioner (family doctor), neurologist, otorhinolaryngologist, ophthalmologist and obstetrician-gynecologist

Order of the Ministry of Health of the Russian Federation of June 2, 2015 N 290n
"On the approval of standard industry norms for the performance of work related to a visit by one patient to a district pediatrician, a district general practitioner, a doctor general practice(family doctor), neurologist, otorhinolaryngologist, ophthalmologist and obstetrician-gynecologist"

In accordance with paragraph 3 of the Rules for the development and approval of model labor standards, approved by a government decree Russian Federation dated November 11, 2002 N 804 (Sobraniye zakonodatelstva Rossiyskoy Federatsii, 2002, N 46, art. 4583), and paragraph 19 of the action plan ("road map") "Changes in industries social sphere aimed at improving 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 consultation with the Ministry of Labor and social protection Russian Federation, the attached standard industry norms of time for performing work related to a visit by one patient to a district pediatrician, district physician, general practitioner (family doctor), neurologist, otorhinolaryngologist, ophthalmologist and obstetrician-gynecologist.

IN AND. Skvortsova

The time limits for a patient to visit a doctor in a polyclinic have been established. We are talking about district doctors (general practitioners, pediatricians, family doctors) and specialist doctors (neurologist, otorhinolaryngologist, ophthalmologist, obstetrician-gynecologist).

Time limits apply when providing primary medical and primary specialized health care on an outpatient basis (not providing for round-the-clock medical supervision and treatment), including when a specialist doctor visits a patient at home.

So, for one visit by a patient due to a disease, a local general practitioner or pediatrician is given 15 minutes, a family doctor - 18 minutes, an ophthalmologist - 14 minutes, an otorhinolaryngologist - 16 minutes, a neurologist and an obstetrician-gynecologist - 22 minutes. The time limits for a return visit due to illness and for a visit for prevention purposes are slightly lower.

Registration of medical documentation should take no more than 35% of the time allotted for a visit.

Corrective coefficients are applied to the norms depending on the density of residence and the sex and age composition of the population, the level and structure of the incidence.

Based established norms calculate workload norms, staffing standards and other labor standards for doctors.

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

This Order shall enter into force 10 days after the date of its official publication.

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

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

So, for one visit by a patient in connection with a disease, a local general practitioner or pediatrician is given 15 minutes, a family doctor - 18 minutes, an ophthalmologist - 14 minutes, an otorhinolaryngologist - 16 minutes, a neurologist and an obstetrician-gynecologist - 22 minutes. The time limits for a return visit due to illness and for a visit for prevention purposes are slightly lower.

Registration of medical documentation should take no more than 35% of the time allotted for a visit.

Corrective coefficients are applied to the norms depending on the density of residence and the sex and age composition of the population, the level and structure of the incidence.

On the basis of the established norms, the norms of workload, the norms of the number and other labor norms of doctors are calculated.

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

This Order shall enter into force 10 days after the date of its official publication.

Order 290n "Intersectoral 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 organizational and legal forms and forms of ownership.

Order of the Ministry of Health and social development RF dated June 1, 2009 N 290n

Approval of the Intersectoral Rules for Providing Workers with Special Clothing, Special Footwear and Other Personal Protective Equipment

In accordance with paragraph 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 (Collected Legislation of the Russian Federation, 2004, N 28, Art. 2898; 2005, N 2, Art. 162; 2006, N 19, Art. 2080; 200 8, N 11, item 1036; N 15, item 1555; N 23, item 2713; N 42, item 4825; N 46, item 5337; N 48, item 5618; 2009, N 2, item 244; N 3, item 378; N 6, item 738; N 12, item 1427), I order:

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

2. Recognize as invalid:

Decree of the Ministry of Labor of Russia of 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);

Decree 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);

Decree of the Ministry of Labor of Russia of February 3, 2004 N 7 "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 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 N28n, this appendix has been amended to come into force 10 days after the official publication of the said order

Cross-industry rules
providing employees 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 means personal use means used to prevent or reduce exposure of workers to harmful and (or) dangerous production factors and also to protect against contamination.

4. The employer is obliged to ensure the acquisition and issuance of PPE that have passed certification or declaration of conformity in accordance with the established procedure for workers employed in work with harmful and (or) hazardous conditions work, as well as in work performed in special temperature conditions or associated with pollution.

The purchase of PPE is carried out at the expense of the employer.

It is allowed for the employer to 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 given the appropriate PPE free of charge.

5. The provision of PPE to employees, including those purchased by the employer for temporary use under a lease agreement, is carried out in accordance with the standard norms for the free issuance of special clothing, special footwear and other personal protective equipment (hereinafter referred to as standard norms), which have passed certification or declaration of conformity in the prescribed manner, and based on the results of attestation 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 employees and its financial and economic situation, to establish norms for the free issue of special clothing, special footwear and other personal protective equipment to employees, which improve, compared with standard norms, the protection of workers from harmful and (or) dangerous factors, as well as special temperature conditions or pollution.

These norms are approved by the employer's local regulations based on the results of attestation of workplaces in terms of 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 improves.

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 model standards with a similar one that provides equivalent protection against hazardous and harmful production factors.

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

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

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 does not have the right to demand from the employee their performance and is obliged to pay for the resulting downtime

II. The procedure for issuing and applying PPE

12. PPE issued to workers should be appropriate for their gender, height, size, and 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 in a timely manner.

The terms of use of PPE are calculated from the date of their actual issuance to employees.

The issuance of PPE to employees 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 PPE to employees using software tools (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 PPE. At the same time, in electronic form personal card for the issuance of PPE instead of the personal signature of the employee, the number and date of the document are indicated accounting on receipt of PPE, on which there is a personal signature of the employee.

14. Workers of cross-cutting professions and positions in all sectors of the economy are issued with PPE in accordance with standard norms, 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 norms.

15. Brigadiers, foremen performing the duties of foremen, assistants and assistant workers, whose professions are indicated in the relevant standard norms, are issued the same personal protective equipment as employees of the relevant professions.

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

17. Employees combining professions, or constantly performing combined work, including as part of integrated brigades, in addition to the PPE issued to them for the main profession, depending on the work performed, other types of PPE are additionally issued, provided for by the relevant model standards for a combined profession (combined type of work).

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

19. In cases where such PPE as a signal vest, safety harness, holding harness (safety belt), dielectric galoshes and gloves, a dielectric mat, goggles and shields that filter respiratory PPE with antiaerosol and gas filters, insulating respiratory PPE, a protective helmet, balaclava, mosquito net, helmet, shoulder pads, elbow pads, self-rescuers, earmuffs, earmuffs, filters, anti-vibration gloves or gloves, etc. are not specified in the relevant standard norms, they can be issued to employees with a wear period “to wear out” 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 PPE mentioned above is also issued on the basis of the results of certification of workplaces in terms of working conditions for periodic use when performing certain types works (hereinafter referred to as on-duty PPE). At the same time, anti-noise liners, balaclavas, as well as PPE of the respiratory organs, which do not allow multiple use and are issued as "on duty", are issued in the form of a one-time set before working shift in an amount corresponding to the number of people employed in this workplace.

20. On-duty PPE for general use are 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 workers are assigned to certain jobs 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 due to annual seasonal temperature changes are issued to employees with the onset of the corresponding period of the year, and at the end of it are handed over to the employer for organized storage until 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 period for wearing PPE used in special temperature conditions includes the time of their organized storage.

22. PPE returned by employees after the expiration of the socks, but suitable for further use, are used for their intended purpose after taking measures to care for them (washing, cleaning, disinfection, degassing, decontamination, dust removal, decontamination and repair). The suitability of the specified PPE for further use, the need for and composition of measures to take care of them, as well as the percentage of wear and tear of PPE are established by an authorized employer or by the organization’s labor protection commission (if any) and are recorded in the personal PPE issuance card.

23. PPE taken by the vardu is issued in accordance with standard norms. When an employee is issued with special clothing rented by the employer, an individual set of PPE is assigned to the employee, for which the appropriate marking is applied to it. Information about the issuance of this kit is entered in the personal card for recording and issuing PPE of the employee.

24. When issuing PPE, the use of which requires practical skills from employees (respirators, gas masks, self-rescuers, safety belts, mosquito nets, helmets, etc.), the employer provides employees with instructions on the rules for using these PPE, the simplest ways to check their performance and serviceability, and also organizes training on their use.

25. In case of loss or damage to PPE in the designated places of their storage for reasons beyond the control of employees, the employer issues them other serviceable PPE. The employer provides replacement or repair of PPE that has become unusable before the expiration date for reasons beyond the control of the employee.

26. The employer ensures the mandatory use of PPE by employees.

Employees are not allowed to perform work without PPE issued to them in accordance with the established procedure, as well as with faulty, unrepaired and contaminated PPE.

27. At the end of the working day, employees are prohibited from taking PPE outside the territory of the employer or the territory where work is performed by the employer - an individual entrepreneur. In some cases, when it is impossible to comply with the specified procedure due to working conditions (for example, at logging, geological works, etc.), PPE remains with employees after hours.

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

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

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

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

For this purpose, the employer has the right to issue to employees 2 sets of appropriate PPE with a double wear period.

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

32. If the employer does not have technical capabilities for dry cleaning, washing, repair, decontamination, decontamination, neutralization and dedusting 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 of the employer (in his structural divisions) dryers, chambers and installations for drying, dust removal, degassing, decontamination and disposal of PPE are being installed.

IV. Final provisions

34. Responsibility for the timely and full issuance to employees who have passed certification or declaration of conformity to PPE in accordance with standard norms, for organizing control over the correct use of them by employees, as well as for storing and caring for PPE rests with the employer (his representative).

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

36. Monitoring compliance by employers (legal and individuals) of 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 the constituent entities of the Russian Federation and bodies local government, as well as trade unions, their associations and technical labor inspectors and authorized (trusted) persons for labor protection that are under their jurisdiction.

* Dermatological personal protective equipment for the skin against exposure to harmful factors for use in the workplace is subject to state registration Rospotrebnadzor in accordance with the Decrees of the Government of the Russian Federation of December 21, 2000 N 988 "On State Registration of New Food Products, Materials and Products" (Collected Legislation of the Russian Federation 2001, N 1 (part 2), Art. 124; 2007, N 10, Art. 1244) and of April 4, 2001 N 262 "On State Registration certain types of products that pose a potential danger to humans, as well as certain types of products imported into the territory of the Russian Federation for the first time ”(Sobranie Zakonodatelstva Rossiyskoy Federatsii 2001, No. 17, Art. 1711).

** Collection of Legislation of the Russian Federation, 2002, N 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, this appendix has been amended to come into force 10 days after the official publication of the said order

Application

to the Interindustry Security Rules
workers with special clothing, special
shoes and other personal items
protection

Front side of personal card

Personal card N ___
accounting for the issuance of PPE

Order of the Ministry of Health of the Russian Federation No. 290n on the norms of time for outpatient admission

MINISTRY OF HEALTH OF THE RUSSIAN FEDERATION

ON APPROVAL OF TYPICAL INDUSTRY NORMS
TIME TO COMPLETE WORK RELATED TO THE VISIT
ONE PATIENT OF A PEDIATRIC DOCTOR, THERAPIST
DOCTOR, GENERAL PRACTITIONER (FAMILY PHYSICIAN),
NEUROLOGIST, OTORHINOLARYNGOLOGIST,
Ophthalmologist and obstetrician-gynecologist

In accordance with paragraph 3 of the Rules for the development and approval of model labor standards, approved by Decree of the Government of the Russian Federation of November 11, 2002 N 804 (Collected Legislation of the Russian Federation, 2002, N 46, Art. 4583), and paragraph 19 of the action plan ("road map") "Changes in social sectors aimed at improving the efficiency of healthcare", approved by order of the Government of the Russian Federation of December 28, 2012 N I order:
Approve, in agreement with the Ministry of Labor and Social Protection of the Russian Federation, the attached standard industry norms for the performance of work related to a visit by one patient to a district pediatrician, a district general practitioner, a general practitioner (family doctor), a neurologist, an otorhinolaryngologist, an ophthalmologist and an obstetrician-gynecologist.

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

MODEL INDUSTRY REGULATIONS
TIME TO COMPLETE WORK RELATED TO THE VISIT
ONE PATIENT OF A PEDIATRIC DOCTOR, THERAPIST
DOCTOR, GENERAL PRACTITIONER (FAMILY PHYSICIAN),
NEUROLOGIST, OTORHINOLARYNGOLOGIST,
Ophthalmologist and obstetrician-gynecologist

1. Standard industry time standards (hereinafter referred to as the time standards) for the performance of work related to a visit by one patient to a district pediatrician, a district general practitioner, a general practitioner (family doctor), a neurologist, an otorhinolaryngologist, an ophthalmologist and an obstetrician-gynecologist (hereinafter referred to as the specialist doctor), are used when providing primary medical and primary specialized health care to an outpatient clinic conditions (not providing for round-the-clock medical supervision and treatment), including when a specialist doctor visits one patient at home.
———————————
Paragraph 2 of part 3 of Article 32 federal law dated November 21, 2011 N 323-FZ "On the basics of protecting the health of citizens in the Russian Federation" (Collected Legislation of the Russian Federation, 2011, N 48, item 6724; 2012, N 26, item 3442, 3446; 2013, N 27, item 3459, 3477; N 30, item 4 038; N 39, item 4883; N 48, item 6165; N 52, item 6951; 2014, N 23, item 2930; N 30, item 4106, 4244, 4247, 4257; N 43, item 5798; N 49, item 69 27, 6928; 2015, N 1, items 72, 85; N 10, item 1425; N 14, item 2018).

2. Norms of time are the basis for calculating the norms of workload, norms of the number and other labor norms of doctors of medical organizations providing primary medical and primary specialized health care on an outpatient basis.
3. Norms of time for one visit by a patient to a specialist doctor in connection with a disease, necessary to perform on an outpatient basis labor actions to provide medical care(including the time spent on the preparation of medical documentation):
a) district pediatrician - 15 minutes;
b) district general practitioner - 15 minutes;
c) general practitioner (family doctor) - 18 minutes;
d) neurologist - 22 minutes;
e) an otorhinolaryngologist - 16 minutes;
f) an ophthalmologist - 14 minutes;
g) obstetrician-gynecologist - 22 minutes.
4. The norms of time for a second visit to a specialist doctor by one patient in connection with a disease are set at 70-80% of the norms of time associated with the primary visit to a specialist doctor by one patient in connection with a disease.
5. The time spent by a specialist doctor on the preparation of medical documentation, taking into account the rational organization of labor, 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 of these time standards.
6. The norms of time for a visit by one patient to a specialist doctor for preventive purposes are set at 60 - 70% of the norms of time associated with a visit by one patient to a specialist doctor in connection with a disease established in a medical organization or other organization that carries out medical activity(hereinafter referred to as the 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 on an outpatient basis, the time norms specified in paragraphs 3 and 6 are established taking into account the density of residence and the age and sex composition of the population, as well as taking into account the level and structure of the population's morbidity by summing up the corrective coefficients of the time norms.
In this case, the following correction factors are applied:
a) the density of residence of the attached population is higher than 8 people per sq. km: -0.05;
b) the density of residence of the attached population is below 8 people per sq. km (excluding areas Far North and areas equated to them): +0.05;
c) the incidence rate of the population is 20% higher than the average value for the constituent entity of the Russian Federation: +0.05;
d) the incidence rate of the population is 20% lower than the average value for the subject of the Russian Federation: -0.05;
e) the proportion of people older than working age among the attached population is above 30%: +0.05 (for a district 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 older than working age among the attached population is below 30%: -0.05 (for a district pediatrician - the proportion of children under the age of 1 year among children under the age of 14 is below 8%: -0.05).

Panov Alexey

Standards for the time of admission of patients by doctors providing outpatient care have finally appeared.
They are enshrined in the order of the Ministry of Health of the Russian Federation dated June 2, 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 in early 2015.

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

As a medical lawyer I say: "No"! They are still advisory in 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 a change in labor standards no later than than two months. So established the Labor Code of the Russian Federation in Article 162.

The requirement of the order to spend only 35% of the time of a doctor's appointment on medical documentation draws attention to itself, the rest on the patient. And to provide precisely this standard of time for the so-called "scribble" - 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, national healthcare appeared normative act The Ministry of Health of Russia, which establishes the norms for the time of admission by doctors of patients.

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

It's all gone a little over a year and a half since the announcement of the initiative.

What do you think about this? In the comments box, share your opinion: what will doctors gain by setting the length of time for patients?