Modern technology for the benefit of
Computer systems are already quite firmly entered into our lives. We do not pay attention to the ubiquitous presence of things that have become commonplace, such as machines for the sale of everything and everyone, electronic registration and ordering of any goods and services, payment through the terminals of accounts or making an appointment to see a doctor via the Internet. In this case, few people think about how a process is carried out, who participates in it and how the actions of such automated systems are controlled. But they are created by us - people. And controlled, of course, also by us.
It became interesting to us to trace a similar process from its beginning to the end. And, as an example, one of the most important areas of human activity was chosen - health care, namely, the entire path of a patient admitted for treatment until his discharge from the hospital. In this case, we look at everything that happens from three main positions: the patient, the medical staff and the system administrator. To do this, we visited 62 Moscow City Oncology Hospital and talked with the developers of hospital automated information systems (GAIS) - representatives of the company "Programs and Complexes" . The main activity of the company is the development, implementation and support of the GAIS. The company has been operating in this market since 1991 and has in its portfolio more than 20 successfully implemented projects in departmental health facilities, and the total number of automated workstations served (ARM) has long exceeded 5,000.
So, the patient comes to the hospital and goes to the emergency department. The recorder has an arm on a desk: a 19-inch monitor with a WYSE C10LE thin client attached to it. Here, an electronic medical record is entered on the patient, where the primary data is entered: full name, passport number, compulsory health insurance policy and other related information. The OMS number of the policy is automatically, through a connected software module, checked in the Unified Register of the Insured (ERZ) for relevance. If the treatment is repeated, the data together with the medical history are automatically raised from the archive. Immediately, depending on the requirements of the hospital, forms are printed out for the patient's signature or filling: consent to the processing of data, vaccinations, absence of infectious diseases, etc., and a plastic card with a barcode of the medical history is issued. The doctor on duty, having examined the patient, makes an initial conclusion on his AWP. At the same time, he does not dial the entire A4 sheet manually, but selects from the existing database a ready-made template corresponding to the disease, where he enters the inspection data into the free fields.
')
The main preference for creating an AWP is given to Wyse terminals for several reasons. First, it is an advantage for the administrator in terms of security, monitoring, centralized update, configuration, diagnostics, and management using the Wyse Device Manager software. Secondly, the almost instantaneous speed of replacing a failed device without losing data. For medical staff a big plus is the high download speed and compactness of the device. Finally, full support for the device by the manufacturer during the entire service life.
So, the initial examination has been carried out, the completed template is already in the electronic medical history, and the doctor signs the document. Protection of such a signature is carried out according to the login and password of the doctor’s account. Only he can make changes to his diagnosis by removing his own signature, and only until new documents appear on top of it, signed by another doctor. It also decides which department the patient will be sent to. In the system, the doctor selects the department name in the drop-down menu and, if there is free space in it (otherwise, the line is highlighted in red and will not let you select this department), marks it. At this moment, an alert appears at the post of the selected department, indicating the data of the patient being referred to the hospital and its preliminary diagnosis. The nurse on duty through the automated workplace arm selects a ward and a bed for the patient who has arrived. After this, the alert appears on the AWP of the head of the doctor’s department, in which the patient’s data and his placement in the department are indicated. His workplace is different from the previous ones by an additional widescreen monitor connected to the WYSE thin client — on it you can view research data. The head of the department looks at the primary diagnosis and appoints the attending physician. If the attending physician is currently circumventing, he can receive a notification about his new patient on a tablet computer ( Latitude 10 , for example), tablet or smartphone on any platform supporting the installation of the Citrix mobile client - BYOD (Bring Your Own Device) concept in action ! If the institution does not have a full-scale deployed Wi-Fi network, an alert via SMS is provided. The doctor just needs to go to the nearest Wyse terminal, log in to the system and view all the available data on your new patient. Thus, when the patient is in the department designated for him, he already has a ward and a doctor.
After examining the patient, the attending physician prescribes tests, medications necessary for his view, and indicates the number of the diet prescribed to the patient. If analyzes are carried out in another department (X-ray, MRI, ultrasound, etc.), the request for them automatically comes to the post of this department, where the department, based on the load, puts it in the work plan, distributes the time if there are several devices, and is signing. All this information is accumulated in the workplace of the sister's guard. She warns the patient about the time and place of testing, determines how the patient will be taken for tests (if he is not walking), an electronic application for the patient is sent to the dining room according to the diet prescribed by the doctor. As a result, the patient enters the procedures prescribed for him already without a queue at the appointed time and has only his plastic card with a bar code on hand.
The doctor, who made, for example, x-rays, writes a conclusion on the procedure. The word "writes" again means filling out the forms. All documents are signed directly by the doctor who conducts this study. If the equipment supports the DICOM format (X-ray, CT scan, MRI, ultrasound, ECG), in the electronic history, in addition to the doctor's opinion, there will be pictures of the studies performed. This is especially true when conducting consultations and preparing the patient for surgery.
The attending physician determines the type of treatment according to the received analyzes. He assigns all the same, from his AWP drugs, while through the connected module is checking the compatibility of medicines. If the drugs are poorly compatible, the field is highlighted in yellow, if incompatible, red, and it will be impossible to prescribe such treatment. After being signed by the doctor, the treatment plan goes to the workstations nurse sister. She has only to look at the resulting report from all patients on drugs and form an application to her elder sister. The older sister prepares the drugs accordingly. In addition, depending on the consumption of drugs, the elder sister forms an application for a pharmacy.
At the pharmacy after receiving the application from all departments of the hospital, the medicines are taxed: the quantity in the warehouse is specified, a request for the near future, after which the adjusted list is sent to the departments for signature to the older sisters. The formation of the basket for each compartment begins. All drugs after they arrive at the warehouse of the pharmacy get a rack number and are on the numbered shelves. In addition, the database of the pharmacy records suppliers, manufacturers, dosage, purchase price and shelf life of each drug. In order to avoid confusion, all the names of medicines are taken from the regularly updated Unified Russian Directory. For the convenience of the medical staff, an additional software module “Drug consumption analytics” is connected to the automated workplace of the pharmacy. It allows the system to automatically generate purchases for the next quarter, taking into account such parameters as the availability of drugs in stock, the dynamics of consumption, expiration dates. In addition, there is the possibility of reserving the drug for expensive operations. In this case, the drug will be displayed on an automated workplace only at the head physician, heads of departments and a pharmacy with an indication of the reason for reservation. For paid patients it is possible to connect a personification module for the possibility of further invoicing for services rendered.
In general, the company’s assets currently include more than 60 modules developed and implemented, and their number is increasing in accordance with the requirements of the health facilities for the system. Also in the pharmacy there is such a thing as extremum - when drugs are mixed in the pharmacy itself according to a specific formula. This formula is approved at the hospital itself, signed by the head physician (only he can make changes after that), is written into the module, and the medicines are written off from the pharmacy warehouse according to this formula.
If a patient is scheduled for surgery, the head of department, using the “planning operations” module, determines the surgeon, assistants and anesthesiologist, who are automatically notified online. In the same module, the surgeon completes the surgery plan, and the anesthesiologist draws up the anesthesia plan. The availability of the operating room is automatically checked, a reservation is made on the date and time, and the information goes to the post of the surgical department to order the necessary materials and medicines. All documents are signed by their creators. The medical staff receives complete information about the planned operation and carries out the necessary preparatory actions. On the example of preparation for the operation, we observe the coordinated work of different departments within the same task. There is no need for permanent telephone approvals, keeping paper journals and, finally, the human factor.
In some cases, the course of the operation can be recorded on video and stored in the archives of the hospital for training young professionals. HD camera for such purposes is mounted in the center of the lighting stand in the operating room. In the history of the company there is an example of conducting this kind of open training when a visiting professor performed an operation in a hospital, and the image was broadcast in real time in a conference room. In this case, the surgeon was a DECT-headset and he could answer questions from the audience directly at the time of the operation. After the operation, the surgeon and the anesthesiologist form an operation protocol, filling out the template.
After completing all the necessary medical procedures and preparing the patient for discharge, the system automatically generates a discharge statement, the necessary summaries and reports for subsequent sending to specialized and higher organizations. After the patient is discharged, his electronic medical record is sent to the hospital archives, from where, if necessary, can always be retrieved, for example, in the case of a second patient's treatment.
Since the introduction of such a complex takes time and certain financial investments, the whole process is carried out in stages. At the first stage, the automated workplace of the emergency department, the automated workplace at the wards, senior nurses and pharmacies are connected to the hospital automated information system. These are about 50 jobs that are served by 1 Dell PowerEdge R620 server with 128 GB of RAM installed. It installs VMware ESX Server using four virtual machines: a domain controller, an infrastructure one, an Oracle server, and a terminal server for publishing applications. With further development, when laboratories and instrumental studies are connected, a second PowerEdge R620 and a disk rack are added, for example from the Dell PowerVault series. In the future, server growth is calculated from the ratio of 50-60 clients per server, and the number of disk chassis is predicted taking into account the video archive and the approximate storage period of data in the hospital. The convenience of just such an approach — the modularity of the GAIS and the possibility of a phased connection of additional servers — is the ability to plan the budget for the current needs of the hospital. There is, however, one tough requirement - full hardware compatibility, which is exactly what Dell provides. The company has extensive experience in working with various servers: from self-assembled to vendor. However, with the transition to Dell hardware, the problems of correct operation and the subsequent support of hardware have faded into the background. This is not some kind of marketing collusion or linkage to equipment, no. These are the words of the employees of the integrator company.
A similar approach, using the example of the 62nd hospital, allowed us to increase the capacity of a medical institution by more than 3 (!) Times. Through the use of terminal technology, virtualization, coupled with a unified hardware and real technical support, it is possible to achieve high reliability of the entire complex and minimize the risks of system failure. And this is for all participants of our today's review is the main indicator.
What do we get in the end?
For the patient, this is, above all, the absence of painful queues. All necessary tests, studies, procedures are assigned directly “for each” patient. The possibility of loss or accidental substitution of test results or conducted studies and procedures, and hence the risk of incorrect treatment, is excluded.
For medical staff this is a huge time saving. There is no need to fill dozens of conclusions, forms, referrals, applications and recommendations. All doctors through whom the patient passes, have full information about the patient's condition. For example, a surgeon can view not only the conclusion of the radiologist, but also examine the images in preparation for the operation, and the anesthesiologist - a list of all medications taken, their dosage and frequency when preparing the anesthesia plan. The attending physician at any time can check at what stage the implementation of the procedures prescribed by him, the results of the research, the conclusions of specialists, and correct the treatment of the patient. And thanks to the alert system, the entire medical staff receives timely information on current changes.
The system administrator, using terminal technologies and Wyse, receives the whole package of benefits: maximum data security, simple and quick installation, start-up, replacement of employees' workplaces. Using Wyse Device Manager allows you to centrally monitor all parameters of work and system updates. In addition to this, virtualization and migration technologies on the server side of the complex reduce the risk of system failure to the minimum values. The use of proprietary Dell OpenManage solutions greatly simplifies system administration functions in hardware, and technical support for devices significantly protects the investment.
Instead of conclusion
Not so long ago, together with the Japanese company AnD, a test sample of a health monitoring system was made when it was admitted to the mine for gold miners. The main requirements of the customer were the exclusion of the human factor and the reduction of the time of medical examination to 5 minutes. The assembled complex included: an automatic apparatus for measuring pressure (tonometer), a breathalyzer, a card reader, a 7-inch screen for displaying the results of express inspection and a thin Dell Wyse D90 client (without a keyboard and mouse). And the D90 was chosen precisely due to its reliability. At the entrance to the checkpoint, the miner is authorized with a card, extends his hand into the automatic tonometer and breathes into the breathalyzer. The results are displayed on the monitor of the doctor on duty and are automatically recorded in the archive. In case of exceeding the permissible standards for any indicator, the system blocks the turnstile to enter the territory of the enterprise. As a result, the time of passage through the checkpoint by the personnel of the mine was reduced to 50 seconds per employee. At the moment, 2 such automated gearboxes are being tested and, judging by the customer's feedback, in the near future they will begin to work on an ongoing basis. And the scope of such systems are quite extensive.
It became interesting to us to trace a similar process from its beginning to the end. And, as an example, one of the most important areas of human activity was chosen - health care, namely, the entire path of a patient admitted for treatment until his discharge from the hospital. In this case, we look at everything that happens from three main positions: the patient, the medical staff and the system administrator. To do this, we visited 62 Moscow City Oncology Hospital and talked with the developers of hospital automated information systems (GAIS) - representatives of the company "Programs and Complexes" . The main activity of the company is the development, implementation and support of the GAIS. The company has been operating in this market since 1991 and has in its portfolio more than 20 successfully implemented projects in departmental health facilities, and the total number of automated workstations served (ARM) has long exceeded 5,000.
So, the patient comes to the hospital and goes to the emergency department. The recorder has an arm on a desk: a 19-inch monitor with a WYSE C10LE thin client attached to it. Here, an electronic medical record is entered on the patient, where the primary data is entered: full name, passport number, compulsory health insurance policy and other related information. The OMS number of the policy is automatically, through a connected software module, checked in the Unified Register of the Insured (ERZ) for relevance. If the treatment is repeated, the data together with the medical history are automatically raised from the archive. Immediately, depending on the requirements of the hospital, forms are printed out for the patient's signature or filling: consent to the processing of data, vaccinations, absence of infectious diseases, etc., and a plastic card with a barcode of the medical history is issued. The doctor on duty, having examined the patient, makes an initial conclusion on his AWP. At the same time, he does not dial the entire A4 sheet manually, but selects from the existing database a ready-made template corresponding to the disease, where he enters the inspection data into the free fields.
')
The main preference for creating an AWP is given to Wyse terminals for several reasons. First, it is an advantage for the administrator in terms of security, monitoring, centralized update, configuration, diagnostics, and management using the Wyse Device Manager software. Secondly, the almost instantaneous speed of replacing a failed device without losing data. For medical staff a big plus is the high download speed and compactness of the device. Finally, full support for the device by the manufacturer during the entire service life.
So, the initial examination has been carried out, the completed template is already in the electronic medical history, and the doctor signs the document. Protection of such a signature is carried out according to the login and password of the doctor’s account. Only he can make changes to his diagnosis by removing his own signature, and only until new documents appear on top of it, signed by another doctor. It also decides which department the patient will be sent to. In the system, the doctor selects the department name in the drop-down menu and, if there is free space in it (otherwise, the line is highlighted in red and will not let you select this department), marks it. At this moment, an alert appears at the post of the selected department, indicating the data of the patient being referred to the hospital and its preliminary diagnosis. The nurse on duty through the automated workplace arm selects a ward and a bed for the patient who has arrived. After this, the alert appears on the AWP of the head of the doctor’s department, in which the patient’s data and his placement in the department are indicated. His workplace is different from the previous ones by an additional widescreen monitor connected to the WYSE thin client — on it you can view research data. The head of the department looks at the primary diagnosis and appoints the attending physician. If the attending physician is currently circumventing, he can receive a notification about his new patient on a tablet computer ( Latitude 10 , for example), tablet or smartphone on any platform supporting the installation of the Citrix mobile client - BYOD (Bring Your Own Device) concept in action ! If the institution does not have a full-scale deployed Wi-Fi network, an alert via SMS is provided. The doctor just needs to go to the nearest Wyse terminal, log in to the system and view all the available data on your new patient. Thus, when the patient is in the department designated for him, he already has a ward and a doctor.
After examining the patient, the attending physician prescribes tests, medications necessary for his view, and indicates the number of the diet prescribed to the patient. If analyzes are carried out in another department (X-ray, MRI, ultrasound, etc.), the request for them automatically comes to the post of this department, where the department, based on the load, puts it in the work plan, distributes the time if there are several devices, and is signing. All this information is accumulated in the workplace of the sister's guard. She warns the patient about the time and place of testing, determines how the patient will be taken for tests (if he is not walking), an electronic application for the patient is sent to the dining room according to the diet prescribed by the doctor. As a result, the patient enters the procedures prescribed for him already without a queue at the appointed time and has only his plastic card with a bar code on hand.
The doctor, who made, for example, x-rays, writes a conclusion on the procedure. The word "writes" again means filling out the forms. All documents are signed directly by the doctor who conducts this study. If the equipment supports the DICOM format (X-ray, CT scan, MRI, ultrasound, ECG), in the electronic history, in addition to the doctor's opinion, there will be pictures of the studies performed. This is especially true when conducting consultations and preparing the patient for surgery.
The attending physician determines the type of treatment according to the received analyzes. He assigns all the same, from his AWP drugs, while through the connected module is checking the compatibility of medicines. If the drugs are poorly compatible, the field is highlighted in yellow, if incompatible, red, and it will be impossible to prescribe such treatment. After being signed by the doctor, the treatment plan goes to the workstations nurse sister. She has only to look at the resulting report from all patients on drugs and form an application to her elder sister. The older sister prepares the drugs accordingly. In addition, depending on the consumption of drugs, the elder sister forms an application for a pharmacy.
At the pharmacy after receiving the application from all departments of the hospital, the medicines are taxed: the quantity in the warehouse is specified, a request for the near future, after which the adjusted list is sent to the departments for signature to the older sisters. The formation of the basket for each compartment begins. All drugs after they arrive at the warehouse of the pharmacy get a rack number and are on the numbered shelves. In addition, the database of the pharmacy records suppliers, manufacturers, dosage, purchase price and shelf life of each drug. In order to avoid confusion, all the names of medicines are taken from the regularly updated Unified Russian Directory. For the convenience of the medical staff, an additional software module “Drug consumption analytics” is connected to the automated workplace of the pharmacy. It allows the system to automatically generate purchases for the next quarter, taking into account such parameters as the availability of drugs in stock, the dynamics of consumption, expiration dates. In addition, there is the possibility of reserving the drug for expensive operations. In this case, the drug will be displayed on an automated workplace only at the head physician, heads of departments and a pharmacy with an indication of the reason for reservation. For paid patients it is possible to connect a personification module for the possibility of further invoicing for services rendered.
In general, the company’s assets currently include more than 60 modules developed and implemented, and their number is increasing in accordance with the requirements of the health facilities for the system. Also in the pharmacy there is such a thing as extremum - when drugs are mixed in the pharmacy itself according to a specific formula. This formula is approved at the hospital itself, signed by the head physician (only he can make changes after that), is written into the module, and the medicines are written off from the pharmacy warehouse according to this formula.
If a patient is scheduled for surgery, the head of department, using the “planning operations” module, determines the surgeon, assistants and anesthesiologist, who are automatically notified online. In the same module, the surgeon completes the surgery plan, and the anesthesiologist draws up the anesthesia plan. The availability of the operating room is automatically checked, a reservation is made on the date and time, and the information goes to the post of the surgical department to order the necessary materials and medicines. All documents are signed by their creators. The medical staff receives complete information about the planned operation and carries out the necessary preparatory actions. On the example of preparation for the operation, we observe the coordinated work of different departments within the same task. There is no need for permanent telephone approvals, keeping paper journals and, finally, the human factor.
In some cases, the course of the operation can be recorded on video and stored in the archives of the hospital for training young professionals. HD camera for such purposes is mounted in the center of the lighting stand in the operating room. In the history of the company there is an example of conducting this kind of open training when a visiting professor performed an operation in a hospital, and the image was broadcast in real time in a conference room. In this case, the surgeon was a DECT-headset and he could answer questions from the audience directly at the time of the operation. After the operation, the surgeon and the anesthesiologist form an operation protocol, filling out the template.
After completing all the necessary medical procedures and preparing the patient for discharge, the system automatically generates a discharge statement, the necessary summaries and reports for subsequent sending to specialized and higher organizations. After the patient is discharged, his electronic medical record is sent to the hospital archives, from where, if necessary, can always be retrieved, for example, in the case of a second patient's treatment.
Since the introduction of such a complex takes time and certain financial investments, the whole process is carried out in stages. At the first stage, the automated workplace of the emergency department, the automated workplace at the wards, senior nurses and pharmacies are connected to the hospital automated information system. These are about 50 jobs that are served by 1 Dell PowerEdge R620 server with 128 GB of RAM installed. It installs VMware ESX Server using four virtual machines: a domain controller, an infrastructure one, an Oracle server, and a terminal server for publishing applications. With further development, when laboratories and instrumental studies are connected, a second PowerEdge R620 and a disk rack are added, for example from the Dell PowerVault series. In the future, server growth is calculated from the ratio of 50-60 clients per server, and the number of disk chassis is predicted taking into account the video archive and the approximate storage period of data in the hospital. The convenience of just such an approach — the modularity of the GAIS and the possibility of a phased connection of additional servers — is the ability to plan the budget for the current needs of the hospital. There is, however, one tough requirement - full hardware compatibility, which is exactly what Dell provides. The company has extensive experience in working with various servers: from self-assembled to vendor. However, with the transition to Dell hardware, the problems of correct operation and the subsequent support of hardware have faded into the background. This is not some kind of marketing collusion or linkage to equipment, no. These are the words of the employees of the integrator company.
A similar approach, using the example of the 62nd hospital, allowed us to increase the capacity of a medical institution by more than 3 (!) Times. Through the use of terminal technology, virtualization, coupled with a unified hardware and real technical support, it is possible to achieve high reliability of the entire complex and minimize the risks of system failure. And this is for all participants of our today's review is the main indicator.
What do we get in the end?
For the patient, this is, above all, the absence of painful queues. All necessary tests, studies, procedures are assigned directly “for each” patient. The possibility of loss or accidental substitution of test results or conducted studies and procedures, and hence the risk of incorrect treatment, is excluded.
For medical staff this is a huge time saving. There is no need to fill dozens of conclusions, forms, referrals, applications and recommendations. All doctors through whom the patient passes, have full information about the patient's condition. For example, a surgeon can view not only the conclusion of the radiologist, but also examine the images in preparation for the operation, and the anesthesiologist - a list of all medications taken, their dosage and frequency when preparing the anesthesia plan. The attending physician at any time can check at what stage the implementation of the procedures prescribed by him, the results of the research, the conclusions of specialists, and correct the treatment of the patient. And thanks to the alert system, the entire medical staff receives timely information on current changes.
The system administrator, using terminal technologies and Wyse, receives the whole package of benefits: maximum data security, simple and quick installation, start-up, replacement of employees' workplaces. Using Wyse Device Manager allows you to centrally monitor all parameters of work and system updates. In addition to this, virtualization and migration technologies on the server side of the complex reduce the risk of system failure to the minimum values. The use of proprietary Dell OpenManage solutions greatly simplifies system administration functions in hardware, and technical support for devices significantly protects the investment.
Instead of conclusion
Not so long ago, together with the Japanese company AnD, a test sample of a health monitoring system was made when it was admitted to the mine for gold miners. The main requirements of the customer were the exclusion of the human factor and the reduction of the time of medical examination to 5 minutes. The assembled complex included: an automatic apparatus for measuring pressure (tonometer), a breathalyzer, a card reader, a 7-inch screen for displaying the results of express inspection and a thin Dell Wyse D90 client (without a keyboard and mouse). And the D90 was chosen precisely due to its reliability. At the entrance to the checkpoint, the miner is authorized with a card, extends his hand into the automatic tonometer and breathes into the breathalyzer. The results are displayed on the monitor of the doctor on duty and are automatically recorded in the archive. In case of exceeding the permissible standards for any indicator, the system blocks the turnstile to enter the territory of the enterprise. As a result, the time of passage through the checkpoint by the personnel of the mine was reduced to 50 seconds per employee. At the moment, 2 such automated gearboxes are being tested and, judging by the customer's feedback, in the near future they will begin to work on an ongoing basis. And the scope of such systems are quite extensive.
Source: https://habr.com/ru/post/210448/
All Articles