Marta Matyushko: EKOFPHO replaces MSEC: What was the first week like for city hospitals?

On January 1, 2025, the medical-social expert commissions (MSEC) ceased operations and were replaced by expert teams. In accordance with the state reform, we established specialized teams for the expert assessment of daily functioning (ECOF) at two city facilities – the St. Panteleimon Hospital and the St. Luke Hospital. The actual review of patient cases began on January 7. We have had a week of active work, yielding both positive results and some shortcomings in the new system.

I will try to summarize briefly.

Thus, the work of ECOF in the First Medical Association of Lviv effectively began on January 7, 2025. This concerns the direct examination of cases. The preparation and organizational elements were carried out much earlier.

Who now provides services instead of MSEC?

Within the working hours of medical personnel from the separate divisions of the First Medical Association of Lviv, as a cluster hospital, specialized teams for expert assessment of daily functioning are operating.

Based on the two hospitals, 24 ECOF teams have been created – 12 teams at the St. Panteleimon Hospital and 12 teams at the St. Luke Hospital. Physicians of various specialties are involved in the assessment process: cardiologists, neurologists, traumatologists, surgeons, and other specialists. Each team must include a therapist.

There is no permanent head of such a commission. The head is chosen according to the patient's diagnosis. For instance, if it is a surgical pathology, the surgeon will be the chair. If it is neurological, the head of the commission will be a neurologist, and so on. The chair of the commission changes in each case.

It is important to note: ECOF teams in the First Medical Association of Lviv consider diagnoses of diseases, except for specific narrow-profile cases such as oncological, cardiological, phthisiatric, and psychiatric. Such cases are reviewed by the hyper-cluster hospitals in the Lviv urban community (oncology center, cardiology center, phthisio-pulmonology center, psychiatric hospital).

What has changed for the patient?

I will repeat this information, as it is crucial for people to understand the new procedure. Starting January 1, all documents are accepted only in electronic form. The patient must contact their treating physician or family doctor. The doctor determines whether there are signs of loss of working capacity and prepares the documents for the commission. They enter the data into the system and send it via email. An administrator processes the documents. We have 6 administrators working on this. They check for all necessary documents – passport, military registration, medical documentation. They then notify the treating physician and the patient or their representative via email that the case has been accepted for review and that the review is scheduled for a specific date and time.

Next, the administrator enters the patient's nosology into the program. For example, if it is neurological, therapeutic, surgical, or traumatological, the program indicates which doctors should be included in the team – neurologist, cardiologist, therapist, for example. Therefore, the composition of the commission changes with each case. The system randomly selects the names of the commission doctors, so neither the patient nor the doctors know who is on the evaluation committee or what case they will be reviewing. The doctors determine whether there are signs of disability or if the patient requires continued treatment. Everything is recorded in the protocol.

Currently, it takes up to 1 hour for each patient.

Additionally, it's important to specify that the family doctor or therapist can create a referral for the assessment of daily functioning when the patient's case already contains all necessary medical documents and no further examinations are needed. In other cases, the treating physician prepares the referral.

What are the results of the work for the week?

In the first week, TMO No. 1 examined 78 patients: 53 from group 3, 16 from group 2, 1 from group 1b, 3 individuals had their disability removed, 3 were not recognized as disabled, 1 was referred for further examination, and 7 individuals did not show up.

At the St. Panteleimon Hospital, a total of 8 teams were active: three general and surgical, one traumatology, and one ophthalmology. A total of 29 individuals were examined, with 7 individuals not showing up.

At the St. Luke Hospital, there were 7 commissions: 3 general, 2 surgical, and 2 traumatology. A total of 49 cases were reviewed.

All ECOF teams' work is conducted under video surveillance.

What are the advantages and disadvantages of the new system?

Overall, patients are satisfied with the work of our ECOF teams. There have been no complaints; feedback indicates that everything is organized much more professionally and better. Even when patients are referred for further examinations or are denied, the refusals are qualified, and patients do not have additional questions.

However, not everything is functioning perfectly yet. For example, currently, our patients receive paper documents with wet stamps and signatures because the electronic ECOF system is not fully operational. According to the Ministry of Health, a little more time is needed for the complete launch of the electronic ECOF system.

There are no problems with the organization of work in our hospitals – appointments are made, people come, and know their times. There is also no rush, so the corridors are not filled with people.

We are in the process of gaining operational experience, and there are questions among ECOF specialists across Ukraine, but there is a constant communication channel, and everyone receives answers to their questions. Therefore, this work will continue.

I will keep you informed about any changes.

• people with disabilities
• Marta Matyushko

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