2.1. BASIC TERMS AND DEFINITIONS

During the period of electronic presentation of information, computer systems become a tool of labor, for which information is the object and result, and collective access to this information becomes the most common way of organizing production. Thus, the purpose of computer systems is gradually shifting from the automation of manual labor of individual workers to the informatization of the activities of all personnel. Information is becoming the main corporate resource.

In medicine, ensuring timely access to information becomes critical when it comes to people's lives. Possession of the necessary information, current or historical, is often the only thing that a doctor lacks in order to provide the patient with the necessary medical care in a timely and qualified manner. Routine document flow, lost copies of documents, geographically dispersed information about the same patient, lack of qualified search methods - all this takes time and energy from medical specialists and significantly reduces the effectiveness of their activities.

In addition, the amount of information that a doctor must constantly keep in mind in order to be able to assess the condition of each patient is certainly enormous. When the volume of processed information exceeds the value of some critical parameter, individual for each person, the ordering and systematization of this information becomes impossible. To keep the ability handlecontinuously increasing volumes of data, a transition to a new method of collecting and processing information is necessary, which can be considered as a kind of individual information revolution, the result of which should be the beginning of the use of a new tool in the professional activity of a specialist - an information system.

Let's try to define what is meant by an information system. The official definition of the concept of "information system" is given in the "Federal Law on Information, Informatization and Protection of Information" (N24-O3, adopted by the State Duma on 25.01.95, signed by the President of the Russian Federation on 20.02.95): “Information system is an organizationally ordered set of documents (arrays of documents) and information technology, including the use of computer technology and communication, implementing information processes. "

In the framework of this manual, we will use the following definition: “ Information system -it is a complex of methodological, software, technical, informational and organizational tools that support the functioning of an informatized organization. "

Depending on whether it functions independently (without human participation) or not, the information system can be automaticor automated.

Automated information the system provides the ability to perform both manual and automated processes. The user (operator), which is a link in such a system, and computer facilities work together to process and further use information.

Since the treatment and diagnostic process cannot proceed without the participation of a person (doctor), in the future we will mean only automated systems.

The introduction into medical practice and the development of computer hardware and software will be called automation of the treatment and diagnostic process.

Hence, the following definition of a medical information system can be given: “ Medical Information System (MIS)Is a set of software and hardware tools, databases and knowledge designed to automate the processes taking place in a medical and preventive institution. "

Open medical information systems.The definition of "open" MIS means that they implement procedures for the exchange of medical and economic documents with other systems that meet generally accepted rules and standards. To implement the openness of medical information systems, it is necessary to first develop rules and standards for their interaction. Ideally, two open medical information systems can interact without any additional effort on the part of their developers.

We emphasize that opennesssystems in this case does not mean the general availability of the information stored in them. The owners of each system decide for themselves which information can and cannot be transferred to other institutions.

2.2. MAIN GOALS OF CREATING IIA

The main goal of informatization of health care in general can be formulated as follows (Concept of informatization of health care): the creation of new information technologies at all levels of health care management and new medical computer technologies that increase the quality of preventive care and contribute to the implementation of the main function of protecting public health - increasing the duration of active life.

In addition to the designated main goal, the IIA faces a number of interrelated and very important tasks, among which the following can be noted:

Creation of a single information space to accelerate access to information and improve the quality of medical documentation;

Monitoring and managing the quality of medical care in order to reduce the likelihood of medical error and eliminate redundant prescriptions;

Increasing the transparency of the medical institution's activities and the effectiveness of management decisions;

Analysis of the economic aspects of the provision of medical care is a very important task for domestic health care, which is moving to a commercial basis;

Reducing the time of examination and treatment.

2.3. FUNCTIONAL CAPABILITIES OF THE IIA

The main features of the IIA include:

Collecting, registering, structuring and documenting data;

Ensuring information exchange and creating an information space;

Information storage and retrieval;

Statistical data analysis;

Monitoring the effectiveness and quality of medical care;

Decision support;

Analysis and control of the institution's work, management of the institution's resources;

Supporting the economic component of the treatment process;

Training.

Similar information.

Systems of this class are designed to provide information support for making both specific medical decisions and organizing work, monitoring and managing the activities of the entire medical institution. These systems, as a rule, require a local area network in a medical institution and are information providers for medical information systems at a territorial level.

Information systems of consulting and diagnostic centers are intended for the organization of consultative and diagnostic examinations of patients, registration, processing, analysis, accumulation and storage of diagnostic information.

Information systems of polyclinic institutions are intended for organizing and analyzing the work of specialists and medical and diagnostic rooms of the polyclinic, storing information about the population attached to this polyclinic and generating this necessary medical and statistical reporting.

Information systems of medical institutions of stationary type are intended for registration of patients' appeals to the admission department of the hospital, their movement through the treatment departments, accumulation of anamnestic, clinical, diagnostic and other information in the database, personalized registration of medicines and the results of the patient's stay in the hospital.

Outpatient and inpatient information systems generate bills - registers for outpatient and inpatient care provided for payment to insurance medical organizations.

Territorial level information systems.

These software systems provide management of specialized and profile medical services, polyclinic (including prophylactic medical examination), stationary and emergency medical care to the population at the level of the territory (city, region, republic).

At this level, medical information systems are represented by the following main groups:

Information systems of the territorial health departmentaccumulating and processing information about the work of all medical institutions in the territory.

Personalized registers (databases and data banks) containing information about certain contingents of patients (occupational diseases, diabetes mellitus, narcology, etc.).

Information systems of offices (centers) for the provision of emergency advice, providing interhospital interaction for remote consultations, departure of specialists and evacuation of patients in order to provide highly qualified and specialized medical care.

Information systems of compulsory health insurance fundsproviding information support for planning and monitoring financing of medical institutions through the CHI system.

Information systems for the organization and control of drug supply to the population, including - accounting for subsidized medicines.

Federal medical information systems

Systems of this class are intended for information support of the state level of the Russian health care system based on data received from territorial health departments in accordance with approved statistical reporting forms.

IIA functional classification

Information systems (IS) of the level of medical institutions are intended primarily for information support of the main business processes of these institutions and, as a result, the organization of their work at a higher quality level.

These include:

Medical technology IS;

Information and reference systems;

Statistical IS;

Scientific research IS;

Educational IS.

These ICs are used in medical institutions of various levels (from a general practitioner's office to large interregional and federal medical centers), in sanatoriums, diagnostic centers, blood transfusion stations, specialized centers (AIDS, family planning, etc.). Of the greatest interest among them are medical information systems (MIS), which integrate all of the above types of IS, which in this case act as subsystems of the general MIS.

The American Institute of Medical Records identifies 5 distinct levels of medical information systems:

The first level of MIS is automated medical records. This level is characterized by the fact that only about 50% of patient information is entered into the information system and in various forms is issued to its users in the form of reports. This level usually covers patient registration, discharge, hospital transfers, input of diagnostic information, appointments, operations. Information processes here run in parallel with the "paper" document flow and serve, first of all, for the formation of various types of reporting.

The second level of the MIS is the Computerized Medical Record System. At this level, medical documents that were not previously entered into electronic memory (first of all, this is information from diagnostic devices obtained in the form of various types of printouts, scans, topograms, etc.), are indexed, scanned and stored in electronic storage systems (as a rule, on magneto-optical drives).

The third level of the IIA is the application of Electronic Medical Records. At this level, an appropriate infrastructure must be developed for entering, processing and storing information from their workplaces. Users are identified by the system and given access rights corresponding to their status. The structure of electronic medical records is determined by the capabilities of their software processing. At this level of MIS development, an electronic medical record plays an active role in the decision-making process and integration with expert systems, for example, when making a diagnosis, choosing drugs, taking into account the patient's current somatic and allergic status, etc.

At the fourth level of the MIS, which is called Electronic Patient Record Systems or Computer-based Patient Record Systems, patient records have many more sources of information. They contain all the relevant medical information about a particular patient, the sources of which can be one or several medical institutions. This level of development requires a national or international patient identification system, a unified system of terminology, information structure, coding, etc.

The fifth level of the IIA is called Electronic Health Records. It differs from the system of electronic patient records by the existence of almost unlimited sources of information about the patient's health, which allows accumulating information about his behavioral and social activities (smoking, playing sports, using diets, etc.). In fact, in the MIS of the fifth level, electronic health passports (Long Life Personal Health Record) of the population are accumulated.

According to the current standard, medical information systems must ensure the implementation of the following functions:

Maintaining medical records ("electronic medical records");

Formation of structural and economic descriptions (passports) of health care facilities and their transfer to the consolidated databases of passports of health care facilities, which are maintained in the territorial funds of compulsory medical insurance and territorial health departments;

Registration of patients and maintaining a register of medical services performed under compulsory medical insurance;

Planning and recording of vaccinations performed;

Mutual settlements with health insurance organizations and territorial compulsory medical insurance funds for treated patients;

Maintaining regulatory and reference information;

Operational planning and accounting of medical care resources (bed fund, medical personnel, complex medical equipment, reception rooms, stocks of pharmaceutical goods);

Planning and accounting of medical and diagnostic appointments, as well as referrals to other health care facilities;

Submission of state medical statistical reporting to territorial health departments;

Maintaining a database of registered diagnoses for the formation of statistics of diseases;

Formation of information about the availability of medicines available to patients and keeping records of medicines provided to patients under benefits.

MIS should be a tool that ensures and organizes the work of a medical institution. To do this, it must cover the entire set of information about the medical services provided in it and must provide the opportunity to receive various indicators of the performance of a medical institution, in particular:

Indicators characterizing the processes of providing medical care: timely detection of pathology, validity of hospitalization, timely registration of patients with dispensary registration, analysis of discrepancies in diagnoses, the volume of diagnostic and laboratory tests; adherence to the standards of treatment duration, deviation from the drug formulary during drug therapy; the proportion of paraclinical treatment methods, that is, the compliance of the assistance provided to the standards and treatment protocols.

Outcome indicators (final results): reduction in labor losses and incidence of disability; reduction of the duration of treatment, the level of hospitalization, the number of visits to the emergency room; a decrease in mortality rates at working age; a decrease in the incidence and morbidity as a result of timely and effective clinical examination and a high level of immunization; reduction in the number of "neglected" cases of oncopathology, tuberculosis, etc.

Treatment efficacy indicators: no relapses, complications, re-hospitalizations; compliance of the level of costs with the volume of assistance provided; satisfaction of insured patients with the level of care provided; improvement of population health indicators, etc.

It should be noted that in addition to medical ISs, specialized ISs can be operated in medical institutions, for example ISs of accounting, personnel department, group (department) for the repair and maintenance of medical equipment, etc., as well as specialized image storage systems, specialized diagnostic systems, etc. etc. The modern concept of building medical information systems assumes their close interaction based on standard data exchange protocols such as XML, HL7, DICOM, etc.

At the same time, information interaction between MIS and information systems of other medical organizations should be organized, in particular:

with other health care facilities and health resorts;

with territorial health departments and medical departments of ministries and departments;

medical insurance organizations and territorial compulsory medical insurance funds;

bodies of the State Sanitary Epidemiological Surveillance;

medical schools.

This exchange is carried out in accordance with the standards (protocols) of information exchange, known to all participants in such an exchange. The protocols of information exchange in the health care system and the compulsory medical insurance of the Krasnoyarsk Territory are approved by the Conciliation Commission and are part of the Tariff Agreement in the system of compulsory health insurance of the Krasnoyarsk Territory. At the federal level, standards for information exchange are developed and approved by the Ministry of Health and Social Development of the Russian Federation.

An electronic medical record (EMR, Electronic Medical Record, EMR) is an electronic collection of information related to the health of a subject (patient) that is created, stored, maintained and used by certified medical professionals and personnel in one healthcare organization.

Justification of the need to use EMC in the treatment and diagnostic process:

1. Over the past 40-50 years, the amount of information with which a doctor operates has increased several times and continues to grow. On the other hand, the technology for dealing with increased data flows has remained at the level of the middle of the last century. Accordingly, an effective "tool" for processing the ever-growing volume of medical information and a powerful "amplifier" of the doctor's capabilities are needed.

2. With the exception of automation tools for accounting and personnel, most of the information systems implemented in health care facilities are separate programs or their complexes for solving specific specialized tasks. For example, accounting of services and data exchange with insurance companies and compulsory medical insurance funds, registration of mortality, birth registration, registration of the incidence of diabetes mellitus, tuberculosis, etc.

3. For each "accounting", as a rule, a separate special software is supplied, which does not interact in any way or almost in no way with other programs. The more you need to "take into account", the more various programs are being implemented in each health facility and each new program requires entering into its "own" database all or part of the information that has already been entered into the database of another program, unreasonably increasing the workload on staff.

4. The doctor, in addition to maintaining a medical record in paper form, is required to fill out statistical coupons, registration forms for patients with newly diagnosed diseases, etc.

The introduction of EMC removes the need to support the "zoo" of accounting programs and the formation of numerous accounting forms, since any report or accounting form can be obtained from the EKM automatically at any time.

The use of modern computer technologies and the introduction of an Electronic Medical Record in a healthcare facility is the most effective mechanism that provides an opportunity to quickly structure, detail, analyze and use all the information recorded in a medical record.

Independent work "Work in MIS Bars"

Access via Mozilla Firefox browser

http://31.13.128.106/med2/

LOGIN: demouser

PASSWORD: demo2010

Cabinet: advisory cabinet

Exercise 1. Get to know all the features of MIS Bars. Note what functions this MIS performs, and, using table "Functions of medical information systems", draw a conclusion to which class of MIS it belongs. Directions: Make your own notes with a plus sign (+). Your conclusion should be written after the table.

	Information systems functions	IP classes
	Information support for the processes of diagnosis, treatment and rehabilitation of patients
	Information support of physicians' activities (pharmacological databases, guidelines for the use of medicines, patient management protocols)
	Personal registration of patients, maintenance and processing of medical documents
	Accounting for medical care and medical services provided to patients, determining the need for basic types of medical care; assessment, control and quality assurance of medical care
	Calculation of standards and tariffs for payment for medical care provided; organization of mutual settlements between healthcare institutions
	Accounting, planning of financial and material resources and management of health care facilities
	Monitoring the state of the medical, demographic and epidemiological situation
	Collection and processing of medical statistics, monitoring of the health status of the population, preparation and submission of state medical statistical reports, analysis of statistical data
	Decision support, including based on modern knowledge bases, inference methods, expert systems, etc.
	Information exchange between health IP, as well as IP of other departments (social protection, education, etc.) in standard exchange formats
	Support for telemedicine technologies (telemonitoring, telemedicine consultations and consultations, video conferencing, access to remote information resources)
	Access to Internet resources; formation and support of our own information Internet resources.
	Support for the processes of education, training and retraining of specialists
	Maintaining a database of regulatory and reference documentation
	Automation of document flow in the institution

Conclusion: __________________________________________________________________

Task 2. Check out the IP menu. Answer the questions (the answer will look like this: Accounting / accounts registers)

In which section, in which menu item can a new patient be registered?
In which section, in which menu item can you make an appointment with a doctor?
In which section, in which menu item can you see the doctors' schedule?
In which section, in which menu item, can you select and view a list of outpatient cards for a certain period of time (for example, the last month)?
In which section, in which menu item, can you view statistics for departments (number of beds in a department, number of patients in a department, etc.)?
In which section, in which menu item can a sick leave be issued to a patient?
In which section, in which menu item can you add / change the structure of medical facilities?

Task 3.Indicate for which user (registrar, doctor, department head, chief physician, information system administrator) this or that section of the information system is intended and why.

Task 4.

Search the patient database: find your namesakes, or surnames similar to yours, take a screenshot.

Assignment 5... Search for another patient (by an arbitrary surname, except for the surname Ivanov, the patient must be registered, otherwise it will not be possible to make an appointment). Make an appointment (payment - by compulsory medical insurance)... Make a screenshot.

Do not close the window that appears.

Task 6. Generate a itinerary for this patient. To do this, press the "Talon" button

Task 7. Find the patient you recorded earlier in the workplace of the chief physician, make a screenshot.

Task 8. In the ACCOUNTING item, view the journal of payments for the current month for cash. Make a screenshot.

MIS-Ristar is a set of programs, web applications and services working with a single database.

MIS-Ristar is supplied either as part of a hardware and software complex, or pre-installed on workplaces provided by the customer, or in the form of a distribution kit and provides automation of input, processing, storage, search and analysis of ALL information processed by the administration and personnel of medical institutions.

MIS-Ristar includes:

Database is a storage of accumulated information and procedures for processing this information.

- Applications designed to automate the workplaces of the administration of medical and prophylactic institutions, doctors, middle and junior medical personnel, as well as non-medical personnel.

- A set of Internet applications and services for patients, staff and administration of medical institutions, as well as for business owners (for private medical institutions)

- A module for analyzing accumulated data and generating reports, which allows you to form arbitrary queries to the Database, receive any reports and analytical information, analyze the accumulated data according to freely formed search criteria

- Special software "tools" that allow you to quickly configure the system as a whole and each workplace, depending on the specifics of the work, including:

- "designer" of programs (courses) of treatment / examination / rehabilitation, designed for the appointment of diagnostic studies, sets of treatment and recovery procedures, in-depth medical examinations and medical commissions "with one button"

- "constructor" of structured documents ("templates") of an electronic medical record (hereinafter EHR), which allows you to customize screen and printed forms of EHR documents, as well as to link the fields filled in the document with the database. At the same time, you can work with each EHR document both as a text document and as a structure optimized for automatic processing

- "editor" of "complex norms", to quickly set up the conditions for checking the reliability of the received data, for example, from diagnostic equipment and automatic assessment of "deviations from the norm" depending on the values \u200b\u200bof other parameters (height, weight, age of the patient, type of equipment, individual characteristics of the patient etc.)

- "designer" of printed and screen forms and forms, which allows you to create new or modify previously created reports and queries to the database (DB) required to select from the database information displayed in these forms

- "subsystem for setting print parameters", which provides setting the order of printing all documents by all users (the number of copies by default, preview, etc.) at the system level as a whole, for a specific organization, department or user

- "constructor" of data structures and registered parameters, which provides unlimited expansion of the list of data stored and processed by the system, including for use in analytics and reports (in fact, it allows you to add new "fields" to the database without making changes to the program code and structure DB)

Individual settings for each user (types of screens, sizes and colors of fonts, etc.)

- Special software "tools" and "constructors" to support the export / import of data for organizing information interaction with third-party information systems (laboratory information systems (LIS, image storage and processing systems (PACS), management automation systems, medical information systems of third-party manufacturers) , information systems of the regional and national / federal levels, etc.)

Configuration and architecture.

In general, MIS-Ristar can be configured to operate:

- at separate workstations (automated workstations)

- within the local area network of the department (division)

- within the institution as a whole

- in a single information space, uniting various medical institutions, including those remote from each other, connected by local information networks or Internet channels.

The software runs under MS Windows 2000, Windows XP, Windows Vista, Windows 7 and older

Oracle DBMS Oracle 10g, 11g and older (for small solutions - up to 20 workplaces, the DBMS is included in the delivered solution and does not require additional costs for licenses

Architecture - Client-Server, or multi-tier architecture.

Special technical solutions allow the implementation of the system to be carried out in various versions, depending on the requirements and capabilities of the customer:

- Option I. Integrated supply of equipment and software, installation of workstations at each workplace.

- Option II. Launching the system and starting work in the minimum version with subsequent expansion (you can start with 2-3 workstations). Expansion work boils down to connecting new workplaces, customizing them depending on specialization, connecting additional functional blocks of software.

Option II is recommended when implementing MIS-Ristar in an already operating institution, because it is impossible to distract all personnel from the main work at the same time to conduct training, as well as during the installation and setup of workplaces.

Expansion and development by "regular" means of MIS

MIS-Ristar can develop in several directions:

- connection of additional workplaces

- connection of additional functional modules

- combining several institutions and organizing their work with a common Database, with the ability to obtain appropriate reporting and analyze the stored information both separately for each institution or group of institutions, and throughout the Database

- promptly making changes to reports already in use or generating and including new arbitrary reporting and analytical forms in the list of available reports

- promptly making changes to already used forms and printed forms or adding new free printed forms and forms

- unlimited expansion of the range of stored data, including the addition of new "fields" without changing the structure of the Database and without the involvement of programming specialists

- by additional agreement, the development and connection of new functionality and / or new applications.

Internet applications and services:

1) Self-recording. It is used for direct self-registration of patients with a doctor using the link on the website.

2) Information kiosks (infomats) installed in the lobby of the medical facility. Used for self-enrollment of patients with a loaded registry or for appointment with specific specialists / for specific examinations (procedures)

3) Subsystem of notifications and e-mail mailings

4) Remote registry. Web-interface to workstations in the registration and patient appointment. It can be used for remote registration, for example, for preventive or prophylactic examinations directly at the exit on the territory of the institution that ordered the examinations. Doctors for recording "from home" upon the patient's call. Registry work from remote branches. Information department (Call-center) for patient registration along with the “fat” client.

5) Remote workplaces of doctors. Web-interface to workstations in the medical staff for maintaining electronic medical records (EHR) of patients. It can be used for organizing remote workstations when leaving "home", when working with remote branches with weak or unreliable Internet connection.

6) On-line Questionnaires. Allows the patient waiting for an appointment to fill out the appropriate questionnaire - frequently asked by the doctor questions from the informant or by self-recording via the Internet. The completed questionnaire is connected to the patient's "medical history" and allows the doctor not to waste time on preliminary questioning of the patient. Questionnaires can be made for each medical specialty, in fact, this is a preliminary collection of complaints and anamnesis - everything that the doctor writes down in the "medical history" "according to the patient's words." Additionally, it is equipped with a module for setting up and processing "scanned" questionnaires (when filling out questionnaires "on paper", for example, during medical examination.

7) Information table. Allows you to display on the TV screen and / or external monitor the current reception schedule with the indication of free / occupied seats.

8) Links to the schedule grid for an external site.Designed for direct links from sites.

9) Published price list. To display the price list on an external site.

10) Published schedule.

11) Print service (converting protocols filled in by doctors into Word and / or PDF) - directly from the DocMainFrom.exe task.

File sharing

1. "Attaching" files to the patient's "medical history" - files are saved in a separate file storage

2. Two-way data exchange with LIS (PACS). VLIS (PACS) napplications for conducting research in files of appropriate formats are sent, research results are returned from the LIS in files of agreed formats and PDF forms for printing and distribution to patients.

3. The same scheme is used to exchange data with functional diagnostics devices, special simulators, third-party systems, etc.

Integration with third-party information systems

1. Setting up information interaction in accounting automation systems (1C, Parus)

2. Bidirectional data exchange with imaging and radiological systems (PACS, RIS)

3. Two-way information exchange with laboratory automation systems (LIS)

4. Integration with a pharmacy warehouse management system (pharmacy kiosk)

5. Integration with federal and regional services of the Unified State Health Information System (setting depending on the region)

6. Integration with any third-party information system according to the customer's specifications

24180 0

The development of information technologies and modern communications, the appearance in clinics of a large number of automated medical devices, tracking systems and individual computers led to a new round of interest and to a significant increase in the number of medical information systems (MIS) of clinics, moreover, as in large medical centers with large flows of information, and in medium-sized medical centers and even in small clinics or clinical departments. In the USA alone, the costs of clinics in this area are about $ 8.5 billion a year, and, according to experts, in 2000 costs are expected to rise to $ 12-14 billion due to the planned replacement or modernization of outdated MIS.

Naturally, investing such significant funds in the creation of MIS, the heads of clinics and medical personnel have the right to expect from their implementation a real increase in the efficiency of using medical information. First of all, due to the real advantages of using computers when entering, storing, searching, processing, analyzing and presenting data on patients and a sharp reduction in paperwork. And, secondly, due to the possibility of operational analysis of the activities of individual services of the clinic for quick management decisions, operational accounting of costs for treatment and maintenance of patients, billing, accounting for the real load on each employee, etc. - up to the use of nosocomial e-mail for scheduling examinations and ordering tests. As a rule, with a correctly chosen MIS concept, these expectations are justified, although few doctors have a real idea of \u200b\u200bwhat problems the clinic staff and administration will face in the process of implementing and operating MIS.

According to various estimates, a handwritten case history contains 40 to 70% of information about a patient obtained during the treatment process. The rest is in the services' own archives or is irretrievably lost. About 11% of laboratory tests need to be repeated due to the fact that previous data simply cannot be found. Standard archives of ECG, X-ray images, etc. are rather inconvenient and cumbersome. Conducting any research work in the archives of medical records requires a significant amount of time. All this in a complex and led to the need to transfer to a qualitatively new level of the process of collecting and processing clinical and financial information in a clinic.

The modern concept of information systems involves the integration of electronic patient records with archives of medical images and financial information, monitoring data from medical devices, the results of the work of automated laboratories and tracking systems, the availability of modern means of information exchange (electronic nosocomial mail, Internet, videoconferences etc.).

In general, the set of requirements for the construction of an MIS is as follows:
1. Meet the needs of all clinic staff and be patient-centered.
2. Flexibility, customization and ease of making changes.
3. Integrability into other information systems.
4. Users should see real benefits from the use of IIAs.
5. Providing convenient automatic coding of medical terms for further analysis.
6. Management of the key elements of the system should be in the hands of the medical institution, and not the system designer.
7. The organization must be able to develop and implement solutions gradually, adding new tasks to a single working system.
8. MIS should be developed by medicine for medicine, i.e. clinic specialists should be actively involved in the development of the concept.
9. Direct data entry by medical personnel, easy access to information, real-time alarms and scheduled events.
10. The IIA must grow with the growth of the organization it serves.

We would like to note that, although these requirements are not stringent, most of the successfully functioning MIS clinics in the world were developed by research teams working in large hospitals, university clinics, etc. At the same time, most of the failures in the development and implementation of MIS were due to the lack of experts in the field of medicine in the composition of the development firms, insufficient communication between developers and doctors - end users. This is all the more important because the introduction of MIS often leads to a change in the style of work of medical personnel, even to a change in their mentality.

The problems of terminology and the use of standards for presenting data in electronic patient records, image formats, etc., international classifiers of diseases, diagnoses, etc., deserve a separate discussion. These problems have become especially relevant with the increasing exchange of patient information (between clinics, insurance companies, national registries, etc.). In particular, in the United States, the "inconsistency" of MIS of different clinics led not only to significant costs for the development of converter programs and industry standards, but also was one of the reasons for replacing MIS in clinics with more modern ones that support basic data presentation standards (for example, for data - Health Level 7 and ASTM, for images - DICOM).

Of the important standards, we also note the International Classification of Diseases (ICD-9CM) and two projects on terminology: Systematized Nomenclature of Medicine (SNOMED III), developed by the American College of Pathology, and the Unified Medical Language System (UMLS), developed by the National Library of Medicine. The de facto imaging standard is DICOM, proposed by the American College of Radiology - National Electrical Manufactures Association (ACR-NEMA) and supported by major medical equipment and software manufacturers.

It is not the intent of this brief overview to fully describe the health software and medical information systems market, but it seems appropriate to focus on some of the major proposals.

C-HIS (Hospital Information System) is a product of CITATION Computer Systems Inc., one of the leading providers of client-server information systems in healthcare. This is a clinical information system, consisting of several modules: laboratory information system, patient database, treatment management system, radiological information system, pharmacological information system, payment registration system, general accounting system, medical history with financial tracking, information management system clinic, planning system, interaction mechanism. C-HIS are installed in more than 450 clinics around the world.

ChartMaxx ™ Electronic Patient Record System - developed by MedPlus Inc. ChartMaxx EPR is a software and hardware integration system that creates complete digital medical records that meet all clinical information requirements inside and outside the clinic.

Note that in order to reduce access time and required storage volumes, the data is divided into two logical parts: primary histories and secondary histories. The primary history contains documents that may be of interest after the history is closed (passport, medical history, epicrisis, surgery records, laboratory tests, and other reports). The secondary history contains all other documents that are rarely needed after completion, such as diary, appointments, etc.

When scanning documents, barcoding is used to automatically recognize the document type and patient. The documents are electronically signed.
The system has been installed in more than 500 clinics in the USA.

HNA - Health Network Architecture - Clinical Automated System from Cerner Corp. It includes the following components: patient registration system, treatment planning, processing automation in clinical laboratories, patient registration system, information support in the operating room, pharmacology databank, general medical databank of the entire institution, patient record management process automation system (transcription , coding, tracking the completeness of records), an interface between various systems (including storage and image processing systems), a database to support clinic management and decision-making, a set of software tools for a doctor, a knowledge base. Installed in more than 200 clinics in the United States.

Of course, the above developments are a very small part of the products available on the market (about 450 companies are successfully working in this area in the USA and Europe alone). In principle, it is possible to adapt Western developments (translation of messages, customization of program modules, etc. to the tasks and specifics of Russian clinics, but this is a very complicated and expensive procedure. At the same time, it is quite logical to use already debugged and tested in US blades and Europe of solutions and concepts of MIS. It is important to note that there are also domestic developments in the field of MIS. The most famous MIS in the Scientific Center for Cardiovascular Surgery named after A. N. Vakulsva RAMS, IRTC "Eye Microsurgery", in a number of leading clinics in Kazan, Moscow, St. -Petersburg, Chelyabinsk, etc. In Russia, about 20 companies are successfully working in the field of MIS, however, information on developments and implementation experience is rather stingy and scattered.

According to the staff of the American Medical Records Institute (USA), in fact, it is possible to distinguish 5 different levels of computerization for MIS.

First level IIA are automated medical records. This level is characterized by the fact that only about 50% of patient information is entered into the computer system and issued to its users in the form of reports of various forms. In other words, such a computer system is a kind of automated environment around the "paper" technology of patient management. Such automated systems usually cover patient registration, discharge, hospital transfers, input of diagnostic information, appointments, operations, financial issues, they run parallel to the "paperwork" and primarily serve various types of reporting.

Second level IIA is a Computerized Medical Record System. At this level of MIS development, those medical documents that were not previously entered into the electronic memory (first of all, we are talking about information from diagnostic devices obtained in the form of various types of printouts, scans, topograms, etc.) are indexed, scanned and stored in electronic systems. storage of images (as a rule, on magneto-optical drives). The successful introduction of such MIS began almost only in 1993.

The third level of IIA development is the introduction of electronic medical records (Electronic Medical Records). In this case, a medical institution must develop an appropriate infrastructure for inputting, processing and storing information from their workplaces. Users must be identified by the system and given access rights appropriate to their status. The structure of electronic medical records is determined by the capabilities of computer processing. At the third level of MIS development, an electronic medical record can already play an active role in the decision-making process and integration with expert systems, for example, when making a diagnosis, choosing medicines taking into account the patient's current somatic and allergic status, etc.

At the fourth level of IIA developmentwhich the authors call Electronic Patient Record Systems (or Computer-based Patient Record Systems), patient records have many more sources of information. They contain all the relevant medical information about a particular patient, the sources of which may be one or several medical institutions. This level of development requires a national or international patient identification system, a unified system of terminology, information structures, coding, etc.

The FIFTH level of development of the IIA is called the Electronic Health Record. It differs from the system of electronic patient records in the existence of almost unlimited sources of information about the patient's health. Information is emerging from the fields of alternative medicine, behavioral activity (smoking, playing sports, using diets, etc.).

Today we can talk about the achievement of the first and second levels of computerization of health care. In recent years, according to researchers from the Medical Records Institute, the development of electronic medical record systems (the third level of MIS) has been going on. The next level could be achieved in small regions by 2002, but in general it is not likely to be implemented in the health system until 2005.

Currently, the number of implemented and successfully functioning medical information systems continues to grow steadily around the world. Almost all of them, in accordance with the above classification, belong to either the first or the second level of development. However, due to the fact that the overwhelming majority of them were developed at different times, by independent development teams and on various platforms, the need to use standard terminology, standard classifiers and standard coding of medical information comes to the fore for the electronic exchange of medical documents.

Most often, medical information systems in large hospitals develop gradually, starting with the computerization of several departments. Often, local information tasks of departments are solved using heterogeneous equipment, and MIS developers face serious problems when trying to integrate these systems, including systems for processing and storing graphic information, into a single whole. As you know, clinical medicine includes various types of information. In addition to textual and numerical information, there are clinical inventions, audio (Doppler studies) and videograms (sonograms, angiograms). The computerized medical history should also provide integration with multimedia information.

The increasing specialization of medical institutions often leads to the fact that the patient needs consultations in other geographically remote clinics. Most often, we are talking about the need for qualified advice when studying the obtained clinical images. The solution to the problem is the use of modern telecommunications for high-quality image transmission and the organization of video conferencing (Fig. 1). However, as it was figuratively said by French telemedicine experts, sending out clinical images to the whole world for a diagnosis that may save a patient's life is, without a doubt, a great technical achievement, but in fact it is only the tip of the iceberg.

Figure: 1 Leading laboratory specialists VL Stolyar and DK Vinokurov during a videoconference demonstration at the exhibition.

Telemedicine is not just about transferring digital images across borders; it is a new way of medical practice. The use of telemedicine implies certain obligations of each doctor who takes part in the diagnosis. Ethical considerations and the preservation of medical confidentiality must also be mandatory. Thus, the doctor making a diagnosis does not need to know the name of the patient whose data was obtained through telemedicine channels. The largest computer companies also pay much attention to the issues of medical videoconferencing. For example, Intel announced the creation of a special ProShare system that allows doctors to simultaneously see each other, hear, present clinical images to each other, etc. At the same time, doctors only need to use ordinary personal computers. The experience of using this system is in the N.N. A.N.Bakuleva RAMP.

In a small lecture, it is not possible to talk in detail about the systems for processing and storing images in the MIS, although without a full linking of patient records to all video and graphic information available in the clinic, the patient's history is at least incomplete. Among the available integrated systems for archiving and transferring images, the authors distinguish as the most complete systems PACS (Pictuture Archiving and Communications Systems) offered by IBM and Siemens. Note that, according to Austrian radiologists, the cost per unit of image storage in an automated PACS system and a conventional archive differs by a factor of 50 (not to mention the possibility of fast search, processing and computer analysis of images, obtaining any number of copies, etc.).

The rapid development of the international information network Internet has provided users with access from any remote clinic to the servers of the World Wide Web (WWW), incl. to international medical servers, updated databases and knowledge. Many healthcare software firms have created their own medical servers with information about their MIS developments. On medical information servers WWW there are databases on cancers (National Cancer Institute, USA), MEDNEWS medicine news, databases on the available poisons and toxic substances, a large collection of histological sections, a database on biotechnology, etc.

The enormous opportunities offered to doctors on the Internet have led to the emergence of "gateways" in MIS for doctors and researchers to access the Internet.

The main goal of any IIA is to provide the right information to the right people at the right time and in the right place. One of the promising and interesting directions in the field of MIS is the appearance in many technically developed countries of individual electronic medical cards (smart card, 1C card, microprocessor health card, optical memory card), which are constantly in the hands of the patient. Projects for their development and implementation in clinical practice are available in Japan, Germany, Canada, France, Taiwan, Holland and in a number of other countries. Such medical electronic records are replenishing and contain basic information about the patient's health and, ideally, should be organically included in the MIS. However, the implementation of such projects is extremely difficult further within the same country. In this case, a single data format should be applied in all hospitals and a single information network for healthcare should be built. Nevertheless, individual regional projects are successfully developing and functioning, and they should be noted, since such a project is extremely promising for Russia and we plan to actively develop it.

In our Center from September 1983 to the present day, that is, for the fourteenth year, an automated medical history has been successfully operating, first on the basis of the MICRON multiprocessor micro-computers, and later on the basis of a network that combines Mikrons with displays and personal computers, now - based on the local network of personal computers. At the beginning of the 80s, it was the first in our country and one of the few in Europe, a really functioning automated medical history of a cardiac surgery center. It was developed by specialists of the Center on the instructions of the State Committee on Science and Technology of the USSR and the Ministry of Health of the USSR in the framework of the Agreement on Scientific and Technical Cooperation with the Norwegian company Mikron, which produced modern computers (the supplies of American technology were frozen at that time).

Almost all archives of the automated medical history for 12 years from the Mikron computer (about 47,000 patients) have been transferred to personal computers and are an integral part of the existing automated medical history performed on a network of personal computers. Over the years, the qualifications of the Center's employees in working with computers and various programs have significantly increased. Nowadays many young employees create their own thematic databases for scientific research practically independently and carry out their statistical processing. Subject scientific archives are actually an integral part of the automated archive of the Center.

The concept of the automated medical history of the new building of the Center is based on a modern approach to the construction of complex information systems in the client-server architecture with high operational reliability. The idea of \u200b\u200bbuilding this network assumes:

• operational reliability in case of all kinds of technical failures;
• the possibility of developing the system up to 200-250 computers;
• the ability to store text information, monitoring data, graphical information, medical images;
• multiple data duplication and multilevel protection against unauthorized access.

In terms of the software concept, the approach is similar to the new case history of this building, but with the implementation of the “client-server” concept, when a convenient and relatively simple database functions at the doctors' workplaces or on a group server, and all requests to the central computer server are automatically transformed through SQL drivers to queries against a very powerful fast Sybase superbase running on a central computer. This is the standard modern approach that exists throughout the world.

Literature

1. Burakovsky V. I., Bockeria L. A., Lishchuk V. A., Joiner V. L. Computerized case history of a cardiac surgery clinic // Vestn. Academy of Medical Sciences of the USSR. - 1985. - S. 17-23.
2. Emelin IV On the standards of electronic exchange of medical documents // Computer. technol. in medical - 1996.-№ 1.-S. 44-47.
3. Moodj. Dose of Reality // PC WEEK / RE. - 1996 .-- S. 52-55.
4. Joiner VL Conference HIMMS // Computer. technol. in honey. - 1996. - Part 2. - S. 23-27.
5. Dargahi R., Fowler J., Moreau D. R., Buffone G. J. A server architecture for ambulatory patient record systems / MEDINFO 95 Proc. // IMIA. - 1995. "- P. 219.
6. Do Amaral Marcio B., Satomura Y. Associating semantic Grammars with the SNOMED: Processing medical language and representing clinical facts into a language-independent frame / MEDINFO 95 Proc. // Ibid.
-P. 19-22.
7. Dusserre P., Allaert F. A., Dussere L. The emergence of international telemedicine: No ready-made solutions
exist / MEDINFO 95 Proc. // Ibid. - P. 1475.
8. Emelinl. V., Leverison R., Perov Y. L, Rykou V. V. A russian version of SNOMED-International / MEDINFO 95 Proc. //Ibid.-P. 173.
9. Engelbrccht R., Hildebrand C, Jung E. The smart card: An ideal tool for a computer-based patient record /
MEDINFO 95 Proc. // Ibid. - P. 344.
10. Flier F. J., Hirs W. M. The challenge of an International Classification of Procedures in medicine / MEDINFO
95 Proc. //Ibid.-P. 121.
11. Ilahn C. H., Handels H., Rinast E. et al. ISDN based telcradiology and image analysis with the software system KAMEDIN / MEDINFO 95 Proc.//Ibid. - P. 1511.
12. Jonassen K., Saboe R. The use of text encoding in the development of a terminology and knoledge system associated with the norwegian version of the ICD-10 / MEDINFO 95 Proc. // Ibid. - P. 51-55.
13. Kaudewilz G „Schulte A. Avoiding pitfalls when implementing local area networks in hospital environments /
MEDINFO 95 Proc. // Ibid. - P. 445.
14. Medical Records Institute. What is An Electronic Patient Record? / INTERNET May 27 1996. - [email protected]
15. Michel A., DieJ Jenbacli M., Riesaclier A. et al. Moving a hospital information system towards a client server
architecture / MEDINFO 95 Proc. // IMIA. - 1995. - P. 450.
16. Oguslii V., Misawa T., Hayashi Y. et al. Regional medical information network using optical memory cards and integrated services for digital network / MEDINFO 95 Proc. // Ibid. - P. 1535.
17. Paradinas P. C Dufresnes E., Vandewalle J-J. CQL: A database in smart card for health care applications /
MEDINFO 95 Proc. // Ibid. - P. 354.
18. Pouliqaen B., Riou C, Denier P. et al. Using World Wide Web Multimedia in medicine / MEDINFO 95 Proc. // Ibid.-P. 1519.
19. Van den Droek L. Introducing smart cards in healthcare in the Netherlands / MEDINFO 95 Proc. // Ibid. - P. 359.
20. Wagner J. C, Solomon W. D., Michel P.-A. et al. Multilingual natural language generation as paet of a medical terminology server / MEDINFO 95 Proc. // Ibid. - P. 100-104.

Carpenter V.L.

Humanity, in the course of its existence, comes up with various possibilities to facilitate its existence and simplify life. One such tool that frees you from routine is the Medical Information System (MIS), which helps coordinate the work of the health system.

Information system

What is generally understood by them? An information system is defined as an information processing system that works with people and the financial resources on which the provision and distribution of information depends.

Automated system

An automated system is called a complex that consists of human labor automation and personnel who serve it. The speaker performs functions pre-programmed for it. In the case of the presence of several automated systems (from two pieces), provided that the functioning of one directly depends on the other (others), then they are called integrated.

Medical information systems

Luminaries of science give different definitions of MIS. But the most popular option sounds like this: a set of software, information, technical and organizational tools that aim to automate medical processes / organizations. But for completeness, you should read one more. It sounds like this: MIS is a form of organization of medical processes that enable medical personnel, with the necessary technical support, to use a set of tools that ensure the collection, processing, analysis, storage and output of information for medical purposes, which relates to health and its state for specific person. In addition to conventional MIS, diagnostic and related ISs are additionally distinguished. It was not possible to designate them into clearly defined groups due to the fact that there is no clear state standard that would be processed with high quality, therefore there is no generally accepted division into various medical information systems. The classification, however, is carried out by individuals or groups of specialists.

Classification of medical information systems

Due to the novelty of the technology, there are no state approved standards yet, so I bring to your attention the following classification:

1. Information services. Information service for patients. It aims to provide the widest coverage of work and service for the maximum number of people in the shortest time intervals.
2. Information technology medical systems. The object of work is a patient, the user is a medical worker.
3. Information and statistical medical systems. Creates the population of the served region. The division is carried out according to objects and on a territorial basis.
4. Research medical information systems. The main subjects of work are documents and objects of science. They are additionally divided into subsystems depending on the differences in the description objects.
5. Information-training and educational medical systems. Trainers provide support to those who go through the training and learning process. Educational systems are used to assess the level of knowledge.

But besides this, MIS are also divided into subsystems and have a number of additions. So, medical information systems, the classification and purpose of which is difficult, were brought into diagnostic and related types. Additionally, a determination is made as to whether the system is complex or not.

Complex systems

The medical information system (MIS), which deals with both administrative and clinical functions, and for which an electronic medical record is chosen as the core, is called an integrated automated medical information system. It includes:

1. Taking care of the automation of accounting, personnel and economic services, office work, engineering support, material and technical supply - everything that allows you to automate administrative and economic activities.
2. System of personal accounting of medical care. Maintaining support subsystems of procedural and diagnostic departments with a hospital pharmacy.
3. Reference information. This can be a complex description of various problems, methods of their treatment, symptoms, as well as the work schedule of doctors, laboratories, their level of employment and a short dossier.

Diagnostic medical information systems

The task of this type is to receive, transmit and analyze data that was obtained as a result of certain diagnostic or laboratory studies using special external devices. Due to the frequency of cases when DIMS or MIS is installed and the differences in their functionality, they are considered as separate systems. But if there are medical information systems, then DIMS is considered its subsystem. Its purpose is to supplement the main one.

Related medical information systems

Modules for special use (usually medical or household). SIMS can include personnel or accounting systems, full-fledged pharmacy systems (which can provide planning, procurement, and distribution of medicines and medical inventory), systems for automating processes in specific departments. Despite the introduction of this topic in the article, in practice it is considered exclusively as an addition, the purpose of which is to increase the functionality.

Modern systems and their use

And finally, about some of the medical information systems in Russia, which are used (although not very common) in medical institutions.

Medical information system built on a modular basis. It is designed to automate the processes of activities of hospitals and clinics. The number of modules for them is 11 for each institution. Allows for data exchange and centralized collection of necessary indicators. Supports interaction between staff, collects data to inform the management of the institution in which BARS is installed. The medical information system makes it possible to ensure work not only with staff, but also with patients and facilitate their interaction with a medical institution in matters of making an appointment, writing prescriptions, sick leaves, and calling for emergency help. Based on the data received, it can generate reports on the status of individual patients, doctors and medical institutions.

It is an integrated information and functional environment that has united various classes of medical information systems (MIS). Support for hospital services, from financial reports and documentation to individual patient records. Integration with and support of decision making systems is important.

An information system of a medical institution that automates activities, planning and optimizes patient treatment processes. It allows you to reduce the time spent on documentation, coordinates the work of doctors' offices and laboratories, optimizes the use of labor resources, and organizes the prompt exchange of information.