Medical Informatics. Учебное пособие

Scientists. These users have the highest requirements for EHR because they want to be able to create a personal database for research and analysis of the collected material. The EHR technology allows you to do it, significantly reducing a great deal of work for entering the collected data into a computer for analysis, which involves all researchers: much of the data about the patient is entered into the computer by different employees in the course of treatment and may be used for scientific work.

Nursing staff. The work of nurses can also be significantly facilitated by the elimination of repetitive data entry (for example, while preparing various requests) or the need for writing out prescriptions from the health record. These users often have low computer literacy.

Doctors of other medical facilities. In some cases, the logic of the diagnostic and treatment process requires co-treatment of patients by physicians of different, particularly specialized, clinics. Basing EHR on the Internet technology allows to maintain a unified health record, filled by clinical doctors participating in the treatment process. In this case all the data entered into the computer will be immediately available to the doctors of other hospitals which may contribute to the intensity of the treatment process.

6. Management as an information process. Information space of medicine

At present technological advances in means of communications resulted in opportunities for the users to transmit, in principle, any amount of information in any form anywhere in the world in real time. This circumstance opens up previously unknown possibilities for professionals to improve management systems that are starting to be used extensively in science and medicine. The prospects related to these opportunities, attract attention of specialists in health management, as well as other health professionals. The whole complex of the problems on the use of information and telecommunication technology for the medical and health care is very extensive: some of them are now joined together by the term "telemedicine".

The variety of conditions under which a person may found him/herself, in some cases does not allow to realize to full extent his/her right to receive appropriate

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medical care in the right place at the right time, despite the presence of the health care system. There is a need to bring together the natural, engineering and social sciences to provide an acceptable form of this human right. To some extent, telemedicine – a new interdisciplinary direction, becomes information and technological basis of such association.

The concept of telemedicine is the concept of active use of scientific and technological progress in the most science-intensive sectors of the economy - science, cybernetics, computer science, telecommunications for the diagnosis, treatment and prevention of human diseases by providing high quality medical care in the point where it is needed this very moment, regardless of the degree of remoteness of the place from the specialized medical facility.

Telemedicine is collection of fundamentally new means and methods of data processing implemented, "embedded" in the medical information systems, to ensure the creation, transmission, storage and display of information product (data and knowledge) at the lowest cost to carry out all necessary and adequate diagnostic and remedial actions, as well as training for all who need them in the right place at the right time.

7. Medical (health) information systems and electronic health record

The term medical (health) information systems (MIS) is used in reference to software designed for automation of inpatient, outpatient, auxiliary (laboratory, diagnostic, etc.) and other departments activities of medical organizations, including personalized record keeping of medical service delivery to the patient based on EHR or outpatient medical record.

MIS solves the following tasks:

•collection and storage of information on medical care provided to the patient;

•information support of therapeutic and diagnostic, administrative, financial and economic departments functioning.

MIS computerizes the following processes:

1. Registration and accounting of the population served:

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•record keeping covering personal and demographic data of patients;

•search patients by identification codes.

2. Medical appointment scheduling (the entry of patients on the service), the management of employment resources (human resources management) and the distribution of patients flow in health care institutions:

•scheduling of employees, and structural units;

•medical appointment scheduling for examination, procedure or surgery;

•scheduling of actually held events and working hours;

•receiving operational reports on the planned employment of resources; 3. The activities of inpatient hospital admissions office:

•registration of patients hospitalization, registration of admission to hospital or refusal of admission;

•registration of the diagnosis, examination in the hospital admission office;

•registration the patient's consent to medical intervention, processing the of personal data, providing information to relatives, denial of hospitalization;

•maintaining the queue of scheduled hospitalization.

4. Keeping electronic health records:

•keeping records of medical examinations;

•registration of medical services;

•keeping records of specialized medical consultations, laboratory, instrumental, x-ray examinations, outpatient surgery, procedures, prescription of medicines and other things;

•making medication orders;

•registration of patients visits, including the registration of opening/closing the case and treatment outcome, services rendered;

•formation of printable forms meeting the requirements of the Russian Federation Ministry of Health.

5. Maintaining electronic health records:

•keeping records of medical examinations, including primary examination, progress notes;

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•recording of documents concerning laboratory tests, instrumental methods of examination, x-ray examinations, procedures, medication and other things;

•planning and registration of surgery results, including preparations of preoperative and operative report;

•formation of medication administration records and cheсklists in accordance with medical administrations, measurement and recording of patient performance status;

•automatic generation of hospital discharge lists with;

•formation of printable forms, meeting the requirements of the Russian Federation Ministry of Health.

6. Registration of temporary disability (Sickness record):

•registration of temporary disability case, extension and closing of the case;

•registration of medical sick leave certificates;

•registration of medical commission conclusions on occasion of temporary disability;

•registration of appointments to bureau of medico-social expertise on the occasion of temporary disability and registration of its conclusions, including medico-social expertise bureau conclusions into medical sick leave certificates.

7. Clinical and expert work:

•registration the results of medical commissions;

•formation of appointments to external agencies (bureau of medical and social expertise and other specialized organizations), registration of their conclusions.

8. Management of bed capacity:

•planning the number of beds (bed capacity) and its monitoring;

•analysis of hospital beds utilization.

9.Management of reciprocal payments for medical care.

10.Analysis of the activities and making reports.

Among the many classifications of MIS the closest to the patient is the 5-level classification of the American Medical Records Institute (MRI).

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The first level includes automatic medical records. This level is characterized by the fact that only about 50% of the patient information is entered into the information system and in various forms and it is given to the users in the form of reports. This level usually covers patient registration, discharge, in hospital transfers, entering diagnostic information, medical prescriptions and surgeries. Information processes are going in parallel with the paper document flow and are primarily used to generate different types of reports.

The second level of MIS system is a system of computerized medical record. At this level medical records that had not previously been entered into the electronic memory (first of all the information from the diagnostic devices obtained in the form of various kinds of prints, scans, etc.) are indexed, scanned and stored in electronic storage systems.

The third level of MIS is the use of electronic medical records. At this level, the appropriate infrastructure should be developed for entering, processing, and storage of information from their workspace. The users are identified by the system, they are 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 the electronic health record plays an active role in decision making and integration with expert systems, for example, in the diagnosis, choice of drugs, taking into account physical and allergic status of the patient, etc.

At the fourth level of MIS patient records have farm sources of information about a particular patient from one or more medical institutions. For this level of development national or international identification system for patients identification, unified terminology, information and encoding systems are required.

The fifth level of MIS is called electronic health record. It differs from the system of patients’ electronic health records by the existence of practically unlimited source of information about patient’s health, which allows to accumulate information about his behavioral and social activities (smoking, doing sport, using diets, etc). In fact, MIS of the fifth level accumulate electronic passports of public health.

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Today such an ordinary and familiar in modern practice health record has become a major initial document, containing data about each patient admitted to hospital, regardless of the purpose of admission, the diagnosis and period of hospital stay.

Health record is a medical document, and any medical document is primarily a legal document and may be the subject of the investigative and court proceedings. As a rule, health records must to be stored in medical archives of the hospital for 25 years and must not contain any information irrelevant to the diagnosis, health assessment and treatment of patient.

The records in the health history should provide an opportunity to assess the quality and timeliness of patient’s examination. It is a guide to estimate terms of clinical diagnosis, concomitant diseases, patient's condition during the period of treatment in hospital and the treatment results - positive or negative.

The most common method of case recording, which is applied today in many hospitals is the use of templates. This method can significantly reduce the time to execute a number of records in the health history, but its use may result in the loss of useful information about the patient and non-standard situations, that may potentially occur at any stage of medical examination and treatment. More advanced method of case recording involves formalized registration of information, including computerized information.

8. Health management as an information process

Management is the process of distribution and movement of resources in health organizations with a predetermined purpose, according to a previously developed plan and with continuous monitoring of performance results.

The art of management is the ability to make non-trivial solutions under the shortage of information and time.

Management process can be divided into several stages:

1.Data collection and information processing.

2.Analysis, systematization, synthesis.

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3.Setting goals on this basis. The choice of management method, prognosis.

4.Implementation of the chosen management method.

5.Efficacy evaluation of the chosen management method (feedback).

The process of management consists of management operations. Management operation is completed and appropriate action focused on specific task of medical, organizational and social nature.

Each operation is performed according to some certain operations of the technological cycle. The passage of operations in time and space makes the process of management. The order of operations may be sequential, parallel and parallelsequential. With sequential combination of operations, each subsequent operation begins after the end of the previous one; with parallel combination individual procedures are carried out simultaneously, which speeds up the process and creates conditions for group (batch – пакетная) processing of information.

The subject of management is a manager (the chief of doctor’s office, the chief of department, head physician, head of the department or ministry) who has four basic functions in management process: planning, organizing, directing and monitoring.

Planning involves the collection, storage, processing, analysis of information (the first part of the management cycle), the development of alternative solutions, the choice and adoption of the optimal solution (the second part of the management cycle).

Organizing is the creation of conditions to implement management decisions, perform plans and programs, ensuring the necessary financial, material and technical, information and other resources.

Organizing is the next management function. Its task is to form the structure of medical organization, as well as providing all the things needed for the normal operation of its medical staff and equipment, buildings, finances, etc.

To organize is to divide into parts and delegate the overall management problems through the distribution of responsibilities and authority, as well as

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establishing relationships between different kinds of diagnostics and treatment of patients.

Coordination is the function of management process to ensure its continuity. The main task of coordination is to achieve consistency in performance of all parts of medical organization by establishing rational relations (communications) between them.

Directing is the creation in medical staff, performing managerial decisions, motives for their implementation. At this point, organizational and administrative methods (orders, recommendations, instructions, resolutions etc.), economic methods (bonus payment, material incentives, etc.), social and psychological methods (encouragement, punishment, formation of public opinion, etc.) are used monitoring is a managerial activity. Its task is the quantitative and qualitative assessment as well

as the analysis of performance results of medical organization.

Two main areas of activities are emphasized:

-monitoring the implementation of the work plan;

-measures to correct deviations from the plan.

The main instruments to perform this function is observation, checking all aspects of the activity, consideration and analysis. Monitoring allows to perform the feedback. It completes the management cycle. The current control allows to correct the decisions and their implementation in accordance with the situation.

Basic functions are associated with 3 levels of health care management.

The strategic level is the basic function of management: prognosis and planning. Strategic level is the head physician of the health care facility. The function of this level includes the development and strategic decision-making with due consideration of health facility capacity to improve its activities. Thus, the strategic level includes the responsibility for the consequences of decisions. The future success of medical facility in Russian health care will depend on the right choice of the decision. Health protection is sues are the joint jurisdiction of the Russian Federation and its territorial entities. It can be assumed that the strategic level of management

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corresponds to the Health Administration of the Russian Federation and territorial entities of the Russian Federation.

The tactical level is the design and organization implemented by Deputy Chief Doctors. The tactical level is responsible for the optimal distribution of resources in accordance with the selected solution at the strategic level. This level is responsible for the organization of work in certain areas of activity of medical institutions and its control, tactically-territorial and municipal levels.

The operational level is the regulation, accounting, control and analysis. The operational level provides the effective implementation of the above made decisions in their divisions. The operational level is responsible for the practical implementation of development strategies adopted by medical organizations. It corresponds to the level of health institutions and enterprises of health care and their departments, individual professionals. Operational level are the head of departments who do not have other subordinate managers. The operational level has two sublevels:

-heads of the structural divisions;

-principal chief and senior nurses.

In general, you must specify an algorithm (sequence) of administrative decisions:

-setting goals and objectives;

-gathering all necessary information;

-modeling and preliminary expertise of possible solutions;

-making administrative decisions;

-follow-up management;

-execution control;

-assessment of efficiency and adjustment of the results.

I would like to stress that health management is extremely complicated. The main features of health care management are:

- the special responsibility of decision-making that affects the life and health of people;

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-the difficulty and sometimes impossibility to predict the long-term consequences of decisions;

-the difficulty and sometimes impossibility to correct wrong decisions.

9. Databases and Database Management System

A database is an organized structure for storing information. The concept of database management system (DBMS) is closely related to the concept of databases. DBMS is set of software tools designed to create a new database structure, filling it with information content, content editing and visualization of information. Visualization of database is used in reference to the selection of the displayed data in accordance with a specified criterion, their sorting, formatting and subsequent delivery to the output device or transmission via the communication channels.

It should be clarified that if there is no data in the base (empty database), it is all the same a complete database. This fact is of methodological importance. Although there is no data in the database, but the information is still - it is the structure of the database. It defines methods for entering data and data storage in the database. The simplest (non-computer) version of the database is a business diary in which one page is allocated for each calendar day. Even if there is not a single line in it, it does not cease to be a diary, since it has a structure that clearly distinguishes it from notebooks, workbooks and so on.

Databases can contain a variety of objects, but, looking ahead, we say that the main objects of any database are its tables. The simplest database has at least one table. Accordingly, the structure of the simplest database is identically equal to its table.

It is known that the structure of the two-dimensional table is formed by columns and rows. Their counterparts (analogues) in the structure of the simplest database are records and fields (margins). By changing the composition of the base table fields (or their properties), we change the structure of the database and, accordingly, we get a new database.

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