Information society development on the example of health care
This article is a summary of my experience in a public health institution that deals with information services for all medical institutions in the region (including the Ministry of Health). No names and assessments of the activities of individuals in this article will not sound, describes the phenomenon, not deeds.
Health care institutions (like all public institutions) are divided into three types: municipal, regional and federal. Accordingly, a similar chain is built in financing / management: institutions first report to the main municipal institution (for example, the city health committee), then together with the regional institutions report to the regional committee / ministry, then the level of the Russian Federation.
For many years, the entire communication system was built on a system of reports: first paper and then electronic: reports on the clinical examination of citizens, on the health status of people exposed to radiation at the Chernobyl NPP, a large report on the status and operation of health facilities once a year (aka Annual Report) and so on. These reports provide an opportunity to see the dynamics of the development of the industry, but the resulting assessment is often obtained in “parrots” and allows for different interpretations of its importance and significance.
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An example of parrots can serve as a “simple bed”, which is considered as a
Be that as it may, such a system existed and quite successfully solved its tasks, while possessing such minuses as great inertia and low informativeness.
In recent years, health care is moving along the path of increasing controllability: the number of reports is increasing, their processing and verification is being automated. As a result, this led to a kind of collapse of an existing system:
As it is not difficult to see - the situation is complicated and requiring solution. Then I will talk about how they tried to solve this situation.
Surely everyone has heard about the program of modernization of health care, which is now underway, many people remember the public procurement scandal with the active participation of Mr. Navalny. I will try to tell you what filling was invested in projects on informatization of the Ministry of Health and Social Development.
As we see from the point above, the main problems that these projects should have been solved by these projects are:
The result was such a project:
If we add to the above a declaration that the data exchange in the system is based on xml (via secure channels), medical and economic standards (with automatic verification) are prepared for mass implementation, and the passport of the health care facility is broken so that everything can be tracked each bed in each compartment and adequately analyze the information in case of changes in the institution (merging with the other, etc.) (see figure), then it turns out just a fairy tale.
Explanations to the picture: All reports are now attached to the offices in separate buildings, as well as licenses for activities, i.e. It is automatically checked that the doctor who has the necessary qualifications works in the case with the necessary equipment (and does not make operations in the back room or works at a different rate.
And now let's see what came out of it and how, since I worked with all aspects of this system.
I participated in the implementation of the EHR based on the IIA "Typical IIA". It is written in python + qt, a fat client to the database, which can work both on Windows and on * nix systems. As a result, a more budget version was tried with Mandriva as an operating system. It was expected that the main problem would be training of doctors and it really took a lot of time, but other problems were unexpectedly more important and unpleasant:
Here the problem is at the same time an advantage:
As a result, the official position is as follows: the Ministry of Health and Social Development provides standard solutions for its money and approves all the standards, while the regions are free to use those solutions that implement these standards. Typical solutions in the form of source codes are available at the Algorithms and Programs Fund.
You say, “So this is beautiful! Open source solutions are advanced and a new market is opened. ”- and you will be absolutely right, but that’s not all. The other half of the picture will be that many regions simply do not have the necessary money and will work on standard solutions without add-ons that do not represent a user-friendly interface and the like - they only provide basic functionality and often require manual checking of all database fields from a person. How can this affect quality - imagine for yourself.
Will we build an information society? Yes, we build. Most likely it will not be perfect at first, and sometimes an army joke about “digging from here to dinner” will be remembered, but conceptually it will be correct and will gradually come to a human condition. Whether we, like ordinary citizens, will feel a kind of profit - at first definitely not, rather, on the contrary, because We pay more money, and we will only be served more slowly at first. In the future, medical and statistical standards, a common base with all research and automatic analysis are a definite plus.
PS The article used a fragment of the presentation of G. Lebedev. (Central Research Institute for Organization and Informatization of Health)
A bit of history:
Health care institutions (like all public institutions) are divided into three types: municipal, regional and federal. Accordingly, a similar chain is built in financing / management: institutions first report to the main municipal institution (for example, the city health committee), then together with the regional institutions report to the regional committee / ministry, then the level of the Russian Federation.
For many years, the entire communication system was built on a system of reports: first paper and then electronic: reports on the clinical examination of citizens, on the health status of people exposed to radiation at the Chernobyl NPP, a large report on the status and operation of health facilities once a year (aka Annual Report) and so on. These reports provide an opportunity to see the dynamics of the development of the industry, but the resulting assessment is often obtained in “parrots” and allows for different interpretations of its importance and significance.
')
An example of parrots can serve as a “simple bed”, which is considered as a
= (365- )/ , where the = / = / , which, as it is not difficult to see, has the dimension of * / (but oddly enough gives an idea of ​​the loading of beds).Be that as it may, such a system existed and quite successfully solved its tasks, while possessing such minuses as great inertia and low informativeness.
Current situation:
In recent years, health care is moving along the path of increasing controllability: the number of reports is increasing, their processing and verification is being automated. As a result, this led to a kind of collapse of an existing system:
- The amount of data in reports grows exponentially and people often do not have time to process the data to obtain correct information.
- In most institutions, medical workers simply do not have the qualifications for collecting and processing all data, and especially for their subsequent interpretation. Traditionally, the position in small medical institutions was considered to be dust-free and people without special training worked - pregnant nurses, retired employees
- In the course of health development, many software products were created for data collection and follow-up, and as a result, reports are collected by different programs in incompatible formats, and the data collected is often overlapped. In addition, the programs themselves are far from perfect and support for some of them has long ceased
As it is not difficult to see - the situation is complicated and requiring solution. Then I will talk about how they tried to solve this situation.
Ministry of Health and Social Development projects:
Surely everyone has heard about the program of modernization of health care, which is now underway, many people remember the public procurement scandal with the active participation of Mr. Navalny. I will try to tell you what filling was invested in projects on informatization of the Ministry of Health and Social Development.
As we see from the point above, the main problems that these projects should have been solved by these projects are:
- Automated data processing
- Minimizing human factors in the field
- Standardization of received information and ensuring their correctness
The result was such a project:
- All medical data, such as examinations, appointments and treatment are stored in an electronic medical file, which can be viewed from any institution in the system.
- EHR (electronic medical record) is directly related to the registries of medical workers and equipment, which allows to evaluate the work of doctors and the effectiveness of the use of equipment
- The information obtained closes on the passport of health facilities, on the basis of which it is possible to conduct a more detailed analysis of the work of the institution than it was before (and with less participation of the lower echelon)
If we add to the above a declaration that the data exchange in the system is based on xml (via secure channels), medical and economic standards (with automatic verification) are prepared for mass implementation, and the passport of the health care facility is broken so that everything can be tracked each bed in each compartment and adequately analyze the information in case of changes in the institution (merging with the other, etc.) (see figure), then it turns out just a fairy tale.
Explanations to the picture: All reports are now attached to the offices in separate buildings, as well as licenses for activities, i.e. It is automatically checked that the doctor who has the necessary qualifications works in the case with the necessary equipment (and does not make operations in the back room or works at a different rate.
What happened:
And now let's see what came out of it and how, since I worked with all aspects of this system.
Electronic Medical Record
I participated in the implementation of the EHR based on the IIA "Typical IIA". It is written in python + qt, a fat client to the database, which can work both on Windows and on * nix systems. As a result, a more budget version was tried with Mandriva as an operating system. It was expected that the main problem would be training of doctors and it really took a lot of time, but other problems were unexpectedly more important and unpleasant:
- There is a shortage of specialists in * nix systems, of course, there are specialists, but they are already working with a fairly good salary in other places, and the implementation and support of a fleet of a hundred cars is a rather difficult task
- Unpreparedness of Linux "with a human face" to work "out of the box" in the institution. They let you shoot yourself in the leg, incorrectly report problems, contain buggy components (for example, very unpleasant bugs were caught with data loss in OO Calc)
- Strangely enough, but the problem of compatibility with the equipment, which cannot be avoided even with a competent purchase of this equipment, is this: On the one hand, we have to use rather old versions of operating systems, since they have the FSTEC certificate (and we really need to protect the diagnoses), but on the other hand, it is impossible to purchase old equipment, because it does not remain in stores
Registers of medical equipment and medical workers, passport of health facilities
Here the problem is at the same time an advantage:
- Many regions have already implemented some systems of medical accounting and document management for the money of the region and it would be foolish to destroy the existing system.
- The money for the modernization program was not as big as it seemed.
- You should not give a monopoly on the software of one organization, it is fraught
As a result, the official position is as follows: the Ministry of Health and Social Development provides standard solutions for its money and approves all the standards, while the regions are free to use those solutions that implement these standards. Typical solutions in the form of source codes are available at the Algorithms and Programs Fund.
You say, “So this is beautiful! Open source solutions are advanced and a new market is opened. ”- and you will be absolutely right, but that’s not all. The other half of the picture will be that many regions simply do not have the necessary money and will work on standard solutions without add-ons that do not represent a user-friendly interface and the like - they only provide basic functionality and often require manual checking of all database fields from a person. How can this affect quality - imagine for yourself.
Conclusion
Will we build an information society? Yes, we build. Most likely it will not be perfect at first, and sometimes an army joke about “digging from here to dinner” will be remembered, but conceptually it will be correct and will gradually come to a human condition. Whether we, like ordinary citizens, will feel a kind of profit - at first definitely not, rather, on the contrary, because We pay more money, and we will only be served more slowly at first. In the future, medical and statistical standards, a common base with all research and automatic analysis are a definite plus.
PS The article used a fragment of the presentation of G. Lebedev. (Central Research Institute for Organization and Informatization of Health)
Source: https://habr.com/ru/post/123137/
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