Features of the current state of mis. What is a medical information system (MIS) and its assistance in the work of the clinic. Flexible configuration of the database structure and input interface

The medical information system MEDWORK was developed by the MASTER LAB company to solve a complex of medical and management problems facing a modern clinic and hospital. Today, thanks to twenty years of experience in operating and developing the system, we can offer a fully functional, scalable and open product - a working tool for the manager, doctor and all clinic employees. MIS Medwork meets the requirements of GOST R 52636-2006 “Electronic medical history”, follows the recommendations for ensuring the functionality of MIS MO of the Ministry of Health of the Russian Federation. As part of open source software support, integration with and is provided.

Computer program MedWork © is designed for automation of medical institutions of any profile and provides:

• Maintaining medical history and outpatient records
• Coverage of all main stages of the treatment process
• Receiving and processing medical and financial statistics
• Preparation and printing of statements
• Planning appointments and treatment work
• Generating patient invoices and accounting for services provided
• Automation of printing sick leave certificates
• Interaction with organizations and insurance companies on compulsory medical insurance and voluntary medical insurance
• Design and generation of output reporting forms
• Applicable in all types of medical institutions thanks to:

1. Fully customizable by the user of all input forms and statements
2. Ease of administration and training
3. Scalability of the system from use in a medical center to a large clinic, diagnostic center, hospital of several buildings
4. Flexibility and convenience of the system in setting up user profiles, integrating with existing programs, exporting and importing data from existing programs
5. Openness of the system for modification and maintenance by both clinic staff and third-party developers

Disease history

In Medwork, the Patient's Illness History is presented in the form of a patient's chart, which is familiar to doctors, consisting of a set of documents (forms). Documents can contain various types of data: text, images, tables, charts, etc.

This allows you to store electronically any information about the patient and the progress of treatment, including:

• survey results;
• descriptions of the patient's functional state, diagnoses;
• information about operations, procedures;
• laboratory test data;
• medical bills;
• images obtained from medical devices, scanner or digital camera.

Filling out the card is significantly accelerated through the use of formalized treatment regimens and updated and customizable reference books.

A convenient interface with the ability to group and sort documents allows the doctor to quickly find the necessary information in the patient’s record.

Data from devices (ultrasound, cardiograms, tests, etc.) can be directly transferred to the patient’s card using a special interface.

Extract from medical history with one keystroke

Data from the patient's record can be presented in a customizable form using a powerful and customizable statement engine. The creation of statements occurs automatically and frees users from the lengthy work of collecting information - a few seconds, and you receive a ready-made statement in the form of a Microsoft Word document.

The most convenient work with certificates of incapacity for work

Working with sick leave certificates of the new sample (approved by order No. 347n dated January 26, 2011) in MedWork is as simple and intuitive as possible. The document “Certificate of Incapacity for Work” is inserted into the patient’s card; MedWork itself fills in most of the fields of the certificate with data from the database or templates. Verified data from MedWork is imprinted on the temporary disability certificate form. Data on all issued certificates of incapacity for work are stored in MedWork.

Statistical reports on all areas of activity

Medwork allows you to receive any statistical reports for any period: on medical work, admission statistics, morbidity, various financial reports, etc. Creating a new report does not require additional programming and is performed using a special wizard included in Medwork. The open data format makes it possible to access the system from any well-known report generators.

Convenient scheduling of patient appointments

Users can interactively create a variety of queues and lists of patients for referral to other workplaces. A simple and convenient interface for working with groups of patients makes it possible to plan appointments at any workplace, from the treatment room to planning and recording operating lists

Setting up and developing the system during the work process by specialists from the medical institution

Medwork is highly customizable and can work in any healthcare setting. Concepts such as departments, queue lists, user groups allow you to flexibly describe the structure of the clinic and the technology for passing the patient through the various stages of the treatment process.

Editing and expanding the library of introductory forms, statements and reports using a convenient and powerful editor, as well as changes in the database structure, can be done in the process and does not require special qualifications. The open architecture of the system makes it possible to connect software modules developed by users to it, which allows the system to be functionally expanded as the clinic expands or new treatment regimens are introduced.

MIS architecture

The MEDWORK medical information system is a comprehensive solution.

The key concept of the system is the profile. For example, profile: receptionist, reception department, guard nurse, procedural nurse,…. and so on. In total, within the framework of the Standard Configuration (full delivery of the system), more than 60 profiles have been developed for different types of medical institutions. All profiles are available for use. A set of profiles forms a Configuration. Examples of configurations – Standard (full), Hospital, Clinic, Private clinic, Dialysis, IVF clinic, etc. Clients can easily modify and develop profiles and configurations to suit their needs without losing data integrity.

Selecting a MIS profile

Key functionality

"Electronic medical record"

An “electronic medical record” (EMR) is a convenient automated outpatient patient record or (for hospitals) an electronic medical history. The EHR meets the requirements of the state standard “Electronic Medical History” (GOST R 52636-2006).

It is installed at the workplace of medical specialists of various profiles: doctor, nurse, laboratory assistant, managers at various levels of a medical institution, as well as wherever there is a need to enter information into the patient’s record.

Brief list of features:

• Provides users with the ability to quickly and conveniently enter patient information.
• Ensures the security of access to the EHR, taking into account the access rights of users to medical information approved by the medical institution.
• Allows you to view the patient’s EHR and quickly find the necessary information in large volumes of medical documentation.
• Makes it possible to generate various extracts, certificates, epicrises based on the EHR, print them and store a copy of these documents.
• Provides the opportunity to visually view medical data on the patient: diagnoses, prescription list, build various graphs, etc.
• Allows you to set up convenient protocols for doctors of any specialty.
• Makes it possible to attach various documents, for example, voice messages, to the EHR.
• Allows you to electronically transfer to the patient his EHR on various media in a format that can be viewed on any computer.
• Closely integrates with almost all modules of the MEDWORK system: service accounting, pharmacy, bed capacity, image processing and others.

Features and Benefits

Quickly fill out an outpatient card and medical history

Entering examinations, test results and other medical information is done by creating records of various profiles, specially designed for doctors of different specialties: therapists, ophthalmologists, surgeons, cardiologists, pulmonologists, etc.

The EHR/electronic medical record comes with ready-made input forms, developed jointly with doctors and fine-tuned over many years of using the system in medical institutions.

The system provides tools designed to speed up typing text information:

• Context references are attached to input fields and contain frequently used terms and phrases. The hierarchical structure of directories allows you to automatically construct long phrases. The standard delivery of an EHR includes many ready-made reference books that can be expanded independently.
• Mode search allows you to quickly find the necessary terms in the reference book.
• Tool templates allows you to copy data from previous records of the medical history, and also facilitates the entry of the same type of information (protocols of operations, medical examinations, etc.).

Entering various information

The MEDWORK EHR/electronic medical record offers the physician a powerful arsenal of data entry tools tailored to a variety of types of information.

The program provides the possibility of typed input, that is, filling out fields of text, numeric, logical types, lists and dates, which in turn provide additional opportunities for collecting statistics and constructing graphs. The diagram editor allows you to make graphic notes and drawings, for example, on an image of the cornea of ​​the eye. Images in any of the most common formats can be placed in the EHR.

Data entry tools are varied. They can be universal, highly specialized, with elementary or complex logic of behavior. The open architecture of the program allows you to constantly expand and improve the set of such objects.

Flexible configuration of the database structure and input interface

Data can be entered not only quickly, but also in full accordance with the professional needs of the specialist.

The standard set of screen forms included in the MEDWORK medical information system can be easily modified and expanded using built-in form editor. Using this convenient tool, the user creates new forms and input fields, changes the appearance of the desktop and the relative position of the main interface objects. Thus, you can reflect new types of research in the system at any time or optimize the maintenance of an electronic medical record without resorting to the help of developers.

Switching between data entry mode and input form editing mode is instantaneous, but can be locked to protect against unauthorized use.

It is also possible to change the database structure. You can add fields of different types to tables, change storage formats and

Convenient and quick search for patient information

The EHR/electronic medical history of the MEDWORK medical information system was designed in such a way that not only the entry, but also the subsequent viewing and analysis of data was convenient, visual and informative, and any information stored in the MEDWORK database was easily accessible to the user.

An important tool for viewing a medical record is the object "extract", reflecting the main indicators of the patient’s health status, the progression of the disease, prescribed courses of treatment and allowing you to quickly go to any screen in the dossier.

An object "Assignment sheet" shows when and what medications were prescribed to the patient, for how long and which medications were discontinued ahead of schedule.
Another interesting feature of the system is the ability to analyze using graphs change of any numerical parameters over time.

ICD-10 Handbook

The EHR/electronic medical record contains the reference book “International Classification of Diseases, 10th revision,” which is used to enter diagnoses in a standardized form.

It is possible to formulate your own diagnosis and link it with the “official” ICD diagnosis, as well as many other useful functions.

For example, a doctor can find a certain diagnosis in the ICD using a keyword, MEDWORK will translate it into English using the English version of the ICD and execute a query in the medical database MEDLINE on the Internet to search for articles on this topic.

VIDAL® Directory

The prescription tool is implemented based on the interaction of the MEDWORK system and the built-in database of the VIDAL® electronic drug reference book

Generating documents for printing

Creating documents of various types (reports, letters, extracts, conclusions) is the daily work of a doctor. The EHR/electronic medical record of the MEDWORK system provides tools that significantly facilitate this process, and also ensure reliable archiving of all documentation in electronic form.

Each patient's record contains a set of documents sorted into categories and provided with special descriptors. The simplicity of classification allows doctors to quickly find the necessary documents in the archive.

Working with texts can be done either through built-in text editor, or using Microsoft Word ® .

Data can be copied from the patient record directly into the document.
Letters and other standard documents can be created automatically based on pre-prepared templates. You can add fields from the electronic medical record to the templates, which are filled in with real data during the letter generation process. Documents created using templates are automatically attached to the map and can be edited manually.

Additional automation options

Integration with laboratory and other systems

Integration with laboratory systems significantly increases laboratory productivity and increases its throughput. The presence of a laboratory module in the system reduces the costs of automation for a medical institution, providing the opportunity to use a unified information system in both medical and diagnostic departments without the need to integrate disparate software products.

The call center will automate the work of reception desks, reception areas, doctors and other departments for incoming calls, as well as systematize the information received. Based on the indicators obtained as a result of the work of the Call Center, the CC administration will be able to:

• evaluate various aspects of their activities, for example, the effectiveness of advertising campaigns and the dynamics of demand for medical services provided,
• optimize the work of various departments,
• determine the profitability of existing areas,
• determine promising directions for further development of the CC.

Integration of MIS with other application systems can be ensured, for example: accounting system, personnel, warehouse, etc.

Personal plastic cards

Personal plastic cards can be used in various processes, both by patients and employees. For example, using universal plastic cards, users can be identified in the System, preventing unauthorized access, patient identification at the registry, or the ability to use a plastic card as an “electronic wallet.”

Working remotely with the work schedule of a medical institution through the medihost.ru portal.

The ability to work remotely with the work schedule of doctors and offices through the portal www.medihost.ru allows you to:

• an employee can work remotely with the System, including with a patient’s electronic medical record or in consultation mode;
• the patient can remotely make an appointment with a specialist, find out the results of their tests, etc.

Additional information services also make it possible to increase the efficiency of the healthcare network and patient satisfaction. Among such services, the following possibilities can be considered:

Deployment of an information portal that allows:

• Inform patients about news
• Patients can remotely receive the necessary information (for example, find out the results of their tests)
• Allow patients to interact remotely with the healthcare network (for example, make an appointment with a doctor or cancel an appointment, contact the receptionist using the instant messaging service)

A medical information system is an electronic database that helps to effectively organize work with patients, maintain operational records of the warehouse and employees, and control administrative and financial issues. At its core, the MIS system is software for automated document flow in medical institutions and medical centers of general and specialized specialization (for example, dentistry, ophthalmology centers, etc.).

MIS is a necessity in modern healthcare

In modern society, automation of medicine is an inevitable process. Huge volumes of medical information, strict reporting and its standardization, high requirements for the quality of services - all this leads to the need for automatic processing and electronic storage of data. To make all this information convenient to process, store and use, many hospitals and health centers have already switched to electronic document management, while others are preparing for its implementation.

The main advantage of an integrated medical information system is the increase in the efficiency of healthcare facilities. Starting from the work of the registry and ending with making management decisions.

Problems of managing a modern clinic

Medical automated information systems allow solving many management problems in a modern medical center.

First of all, the informatization of medicine creates optimal conditions for maintaining a client database, storing their personal information, data on services provided, diagnoses and diseases, results of examinations and analyzes (electronic card). Having this information in electronic format here and now without searching through archival records, it is much easier for the doctor to navigate the data, make diagnoses and plan further treatment and observation. The doctor reduces the amount of paperwork, since the information at the appointment is also entered into the computer and, if necessary, printed based on a standard text template. Eliminates the risk of losing important data and the need for repeated examinations due to lost information. For example, according to statistics, 11% of laboratory tests performed have to be re-ordered precisely because of the inability to find the results in the institution’s paperwork. These are additional costs and time costs that reduce the efficiency of health care facilities as a whole.

Also, through the medical information system, appointments with specialists are made, clients are distributed among branches, taking into account the workload and work schedule of employees. The work of call centers is being organized.

At the same time, it is easy to assess the demand for specific services, doctors, branches, convenient visiting hours, etc. Regarding commercial clinics, MIS keeps records of each client according to the loyalty system, with automatic calculation of discounts, bonuses, certificates, VHI policies and other programs. Payments for services are made (it is possible to connect cash register equipment). The medical information system allows for reporting and interaction with insurance organizations.

It makes it possible to quickly monitor the condition of the warehouse and receive always up-to-date information on inventories and consumption of items, deliveries and payments, movement of drugs and consumables by type of service, specializations, branches, etc.

With the help of MIS, pricing of medical centers is carried out. Price lists are generated for individual types of services or complex programs. Changes are made to the price, discounts and other bonuses are automatically taken into account individually for clients or as part of promotions, etc. The entire price history is also stored.

On the basis of the medical information system, employees are recorded, their activities are analyzed, the work schedule of specialists is filled out, on the basis of which salaries are calculated and financial relations with the employee are recorded.

Thus, a medical information system is a huge electronic archive of institutional data that is easy and quick to navigate.

Service capabilities allow you to create access to different groups of information for employees and managers.

MIS from First BIT will simplify work with medical information

The First BIT company has developed a unique medical information system for healthcare institutions. It is suitable for public and commercial organizations. Can be used in multidisciplinary and highly specialized clinics.

BIT program. Medical center management was created taking into account the real needs of medical institutions. It implements the ability to automate accounting for clients, warehouses, employees, equipment, pricing, financial settlements with suppliers and other counterparties. There is also a service for calculating wages, maintaining mutual settlements with employees, and analyzing their effectiveness.

BIT program. Managing a medical center creates a convenient workplace for an administrator who can quickly register clients, issue examination results, enter into contracts, and make payments (with the connection of commercial equipment).

Based on the system, it is possible to conduct analysis, collect statistical data on the enterprise and keep patient records. With our system, work will become easier and more transparent.

The program is open source, which makes it possible to independently modify the system for specific requests. Regular updates are carried out.

MIS is compatible with any professional versions of 1C products.

We offer favorable prices for modules for clinics with licenses for a different number of workplaces (up to 100 or more).

The program from First Bit has already been successfully implemented and works in multidisciplinary medical institutions in Moscow and the region. and other cities of Russia.

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

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

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

Information systems of inpatient medical institutions are designed to register patients' requests to the hospital's emergency department, their movement through medical departments, accumulation of anamnestic, clinical, diagnostic and other information in the database, personalized accounting of medications and the results of the patient's stay in the hospital.

Polyclinic and inpatient information systems generate invoices - registers for outpatient and inpatient care provided, submitted for payment to medical insurance organizations.

Information systems at the territorial level.

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

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

Information systems of the territorial health department, carrying out the accumulation and processing of information about the work of all medical institutions in the territory.

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

Information systems of departments (centers) for providing emergency advisory assistance, providing interhospital interaction for conducting remote consultations, visiting specialists and evacuating patients in order to provide highly qualified and specialized medical care.

Information systems of compulsory health insurance funds, providing information support for planning and monitoring the financing of medical institutions through the compulsory medical insurance system.

Information systems for organizing and monitoring drug supply to the population, including accounting for preferential medicines.

Federal-level medical information systems

Systems of this class are intended for information support at the state level of the Russian healthcare system based on data received from territorial healthcare departments using approved statistical reporting forms.

Functional classification of MIS

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

These include:

Medical and technological IP;

Information and reference systems;

Statistical IS;

Research IP;

Educational IS.

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

The American Institute of Medical Records identifies 5 different levels of health information systems:

The first level of MIS is automated medical records. This level is characterized by the fact that only about 50% of the patient’s information is entered into the information system and presented to its users in various forms in the form of reports. At this level, patient registration, discharge, intra-hospital transfers, entering diagnostic information, appointments, and operations are usually covered. Information processes here run in parallel with “paper” document flow and serve, first of all, to generate various types of reporting.

The second level of MIS is the Computerized Medical Record System. At this level, medical documents that have not previously been entered into electronic memory (primarily information from diagnostic devices received in the form of various types of printouts, scanograms, topograms, etc.) are indexed, scanned and stored in electronic storage systems (usually on magneto-optical storage devices).

The third level of MIS is the use of electronic medical records (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, electronic medical records play an active role in the decision-making process and integration with expert systems, for example, when making a diagnosis, choosing medications taking into account the patient’s current somatic and allergic status, etc.

At the fourth level of MIS, which is called electronic medical record systems (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 either one or several medical institutions. For this level of development, a national or international system for identifying patients, a unified system of terminology, information structure, coding, etc. are necessary.

The fifth level of MIS is called Electronic Health Records. It differs from the system of electronic patient records in the existence of practically unlimited sources of information about the patient’s health, which allows one to accumulate information about his behavioral and social activities (smoking, playing sports, using diets, etc.). In fact, the fifth level MIS accumulates electronic health passports (Long Life Personal Health Record) of the population.

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 consolidated databases of passports of health care facilities, which are maintained in territorial compulsory medical insurance funds and territorial health departments;

Registering patients and maintaining a register of completed medical services under compulsory medical insurance;

Planning and recording of completed vaccinations;

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 (beds, medical personnel, complex medical equipment, reception rooms, stocks of pharmaceutical goods);

Planning and recording of treatment 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 to generate disease statistics;

Generating information about the availability of medications available to patients and maintaining records of medications 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 obtain various indicators of the performance of a medical institution, in particular:

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

Result indicators (final results): reduction in labor losses and cases of disability; reduction in treatment duration, hospitalization rate, and use of emergency medical services; reducing mortality rates in working age; reducing the level of morbidity and morbidity as a result of timely and effective medical examination and a high level of immunization; reduction in the number of “neglected” cases of cancer, tuberculosis, etc.

Indicators of treatment effectiveness: absence of relapses, complications, cases of re-hospitalization; correspondence of the level of costs to the volume of assistance provided; satisfaction of insured patients with the level of care provided; improving public health indicators, etc.

It should be noted that in addition to medical information systems, specialized information systems can be used in medical institutions, for example, information systems of the accounting department, human resources department, group (department) for repair and maintenance of medical equipment, etc., as well as specialized image storage systems, specialized diagnostic systems, etc. d. 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 the MIS and the information systems of other medical organizations should be organized, in particular:

with other health care facilities and sanatorium-resort institutions;

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

insurance medical organizations and territorial compulsory health insurance funds;

bodies of the State Sanitary Epidemiological Surveillance;

medical educational institutions.

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

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

Rationale for the need to use EHR in the diagnostic and treatment 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 working with increased data flows has remained at the level of the middle of the last century. Accordingly, we need an effective “tool” for processing the ever-growing volume of medical information and a powerful “amplifier” of a doctor’s capabilities.

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

3. For each “accounting”, as a rule, 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 diverse programs are being implemented in each health care facility and each new program requires entering into “its” database all or part of the information that has already been entered into the database of another program, unjustifiably increasing the burden on staff.

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

The introduction of an EHR eliminates the need to support a “zoo” of accounting programs and the creation of numerous accounting forms, because any report or accounting form can be obtained from the ECM automatically at any time.

The use of modern computer technologies and the introduction of an Electronic Medical Record into health care facilities is the most effective mechanism that provides the ability to quickly structure, detail, analyze and use all the information recorded in the medical record.

Independent work “Working at MIS Bars”

Access via Mozilla Firefox browser

http://31.13.128.106/med2/

LOGIN: demouser

PASSWORD: demo2010

Office: consultation office

Exercise 1. Get to know all the possibilities 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: Use a plus sign (+) to mark your notes. Your conclusion should be written after the table.

	Functions of information systems	IP classes
	Information support for the processes of diagnosis, treatment and rehabilitation of patients
	Information support for the activities of doctors (pharmacological databases, guidelines for the use of medicines, patient management protocols)
	Personal patient registration, 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 payment tariffs for medical care provided; organization of mutual settlements between healthcare institutions
	Accounting, planning of financial and material resources and management of healthcare institutions
	Monitoring the state of the medical, demographic and epidemiological situation
	Collection and processing of medical statistical data, monitoring the health status of the population, preparation and presentation of state medical statistical reporting, analysis of statistical data
	Decision support, including based on modern knowledge bases, logical inference methods, expert systems, etc.
	Information exchange between health information systems, as well as information systems 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 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 an institution

Conclusion: __________________________________________________________________

Task 2. Get acquainted with the IS menu. Answer the questions (the answer will look like this: Accounting/account registers)

In which section, in which menu item can I register a new patient?
In which section, in which menu item can you make an appointment for a patient with a doctor?
In which section, in which menu item can I 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 see statistics on departments (number of beds in the department, number of patients in the department, etc.)?
In which section, in which menu item can you issue a sick leave note to a patient?
In which section, in which menu item can you add / change the structure of health care facilities?

Task 3. Indicate for which user (registrar, doctor, head of department, 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.

Task 5. Search for another patient (by any last name, except for the last name Ivanov, the patient must be registered, otherwise it will not be possible to make an appointment for him). Make an appointment for him (payment - according to compulsory medical insurance). Take a screenshot.

Do not close the window that appears.

Task 6. Generate a route ticket for this patient. To do this, press the “Talon” button

Task 7. In the chief physician’s workplace, find the patient you previously registered and take a screenshot.

Task 8. In the ACCOUNTING section, look at the journal of payments for the current month in cash. Take a screenshot.

2019 has arrived and all medical organizations will be required to implement medical information systems, or MIS for short.

The advantages of such a system for all employees are obvious:

• For the director of the clinic - a convenient display of statistics on the work of the clinic and a report constructor.
• For the clinic administrator - a convenient system for displaying the schedule of each specialist, maintaining accounting and printing the necessary documents with a mouse click.
• For doctors - appointment reminders, complete medical history, various treatment plans and price lists for services.

Now the market for these products in Russia includes more than a hundred solutions. In this article we publish the most popular solutions in the Russian Federation.

Before you start choosing which information system to implement, contact MIS integration specialists. The main criterion for selecting a future contractor should be implementation experience and knowledge of the specifics of business processes in the clinic.

If suddenly, your MIS does not meet the stated requirements of the Russian Ministry of Health and you suddenly decide to replace it, then it is worth noting that if you purchased a medical information system as part of the “Basic Informatization” program, which took place in 2011-2012, you may be charged inefficient use of budget funds.

What to do correctly in this case:

• Conduct an independent examination of your MIS
• Send a letter to your regional health authority to replace the MIS

Or there is an option to negotiate with the developers to replace the information system, and spend the implementation costs as a service, and not as the purchase of new software.

The composition of medical information systems for each medical organization may differ in the composition of the included modules.

For example: MIS for hospitals requires modules - admission department, maintaining electronic inpatient patient records, bed management.

You can read which modules your organization needs in the “Methodological recommendations for ensuring the functionality of medical information systems of medical organizations” approved by the Ministry of Health of the Russian Federation.

We also recommend that you familiarize yourself with the “Unified Register of Russian Programs for Electronic Computers and Databases,” which is located on the website of the Ministry of Communications. You have the right to buy MIS only from those included in this register.

IMPORTANT! Since January 1, 2016, there has been a legislative ban on foreign goods and work in the public procurement system!

Let me finish with the regulatory part and move on directly to the review of the most common medical information systems.

MEDODS

Cost: from 3900 rubles

MEDODS is a new generation medical system. It is used both in private clinics and in government institutions.

Does not require lengthy training to operate the system due to its friendly and simple interface.

It has both basic common functions such as making appointments and invoicing, as well as powerful marketing modules.

The main advantage for which it is most often chosen is the cost of MEDODS, it is very affordable and quickly pays for itself.

MEDODS includes:

• Cloud solution
• SMS and email notification of patients
• Online booking of an appointment with a doctor
• Templates for various protocols
• Patient electronic medical record
• Ability to maintain warehouse records
• Generating reports
• Integration with online cash registers
• Integration with laboratories
• Integration with booking portals
• Integration with telephony

Medesk

Cost: on request

Managing a private clinic using the Medesk medical system is a combination of modern technology and medicine.

The system is distinguished by a simple and intuitive interface, which allows your specialists to master working with the system without much effort.

Medesk includes:

• Cloud solution
• SMS notification to patients
• Online appointment with a doctor
• Templates for various protocols
• Integration with online cash registers
• Remote work consulting patients

MedElement

The main goal of MedElement developers is to improve the quality of medical services for the population.

The main advantages of the system are:

• Cloud data storage
• Electronic doctor's office system
• Large database of medical reference books
• The mobile application can be downloaded for free
• Separate module for automation of the clinic's catering unit
• Frequent updates to the medical system

Clinic365

Cost: from 25,000 rubles.

This medical information system has a user-friendly interface for all the main functions of the medical information system

This solution includes such modules as:

• patient file
• schedule
• medical document management
• finance to control payments.

The main feature of MIS Clinic365 is the ability to build an algorithm for working with a patient. The card includes information such as client preferences, history of contacts with the patient, and of course medical information.

There is strong technical support for the product.

Infoclinic

Cost: from 25,000 rubles.

The medical information system "INFOCLINIC" will help build a structured information space for a medical clinic. This solution will be convenient for both patients and clinic staff.

MIS “Informatics” has all the necessary tools, which allows you to easily set up integration with other systems of your clinic, and also allows you to set up flexible communication with patients.

The system includes many prepared templates for reports, protocols, and case histories.

IDENT

Cost: from 4900 rubles per month

IDENT is a medical information system for dentists that will allow you to get away from paperwork with patients. A distinctive feature is that it was created under the guidance of dentists and for dentists.

There are several versions of MIS, the difference is in the number of modules included.

Even with basic functionality, the information system will allow you to:

• Quickly manage scheduling and appointments
• Keep accounting
• Quickly print patient documents
• Conduct statistical reports

ClinicIQ

Cost: from 2400 rubles per month

This product is an online service for dentists and medical centers.

It has a wide range of functionality, from the patient database to billing and accounting.

There is integration with the DocDoc portal and Viber messenger. The main advantage of this service is a very well-thought-out system for making appointments and recording patients.

MedWork

Cost: 69,900 rubles

The flexibility of system customization is MedWork's trump card up its sleeve.

Each clinic, be it a small clinic or a large one, has its own nuances. The MedWork system is designed in such a way that the architecture initially includes a variety of settings for any task.

There is a convenient editor based on the WYSIWYG principle, which allows you to edit any form of service to suit the tasks of the clinic

MedOffice

Cost: 16990 rubles

One of the oldest medical systems. Development dates back to the mid-90s.

The system is designed to maximally optimize and automate the work of both outpatient clinics and hospitals. There is a medication accounting system.

It is also worth noting the built-in Call center and API. Pre-registration for an appointment is possible, there is a call center and API for integration. In order to learn how to operate this system, there are many video lessons.

Renovatio

Cost: from 24,000 rubles

This medical information system has an intuitive interface, which makes it easy to master at the start.

It is possible to automatically import into the system, for example, you can quickly create a price list for your services and upload it to Renovatio.

There is a convenient built-in editor for printed forms.

1C-Rarus: Attending physician

Cost: from 10,000 rubles

This system was developed with the participation of leading specialists involved in medical practice. 1C-Rarus: The attending physician aims to reduce the time of patient appointments and stores the entire history of visits to the doctor.

The system also includes such functions as a disease classifier, templates for basic documents, an appointment scheduler, SMS messaging with a reminder to make an appointment, Email reports on examination results.

It is convenient to work with the system both from a computer and from a smartphone or tablet.

BARS.Med

BARS.Med allows you to quickly transfer all the work of a medical clinic from paper to electronic form. Easy to customize to suit the clinic's needs.

Among the main functions, it is worth noting the availability of remote appointments and the creation of an electronic patient card.

Also, using this system, you can easily build the business processes of your clinic.

MedusaPRO

Cost: from 2800 rubles per month

MedusaPro is a cloud service for automating the work of a medical clinic.

In addition to maintaining outpatient cards, the system also allows you to create mailings in the form of SMS messages to patients (advertising, congratulatory, informational).

It is possible to make an online appointment with a doctor. This function has a database in which doctors’ work schedules are recorded, which allows the patient to always see free hours and days of appointment.

A patient’s personal account has been implemented, where the entire history of visits is stored, as well as tests and examinations. All documents can be downloaded.

There is the possibility of integration with a touchscreen, where patients in the lobby of clinics can automatically make an appointment.

Medialogue

Cost: from 82,500 rubles

The interface of the MEDIALOG system is quite easy to learn for the user. A system of prompts about the operation of the system has been set up, and the work with filling out forms has been simplified by automatically filling out standard information.

MEDIALOG is a modular system; you can buy each module separately, which allows you to avoid overpaying for unnecessary functionality.

The second advantage of the modular system is its easy scalability.

MGERM

Cost: from 27,900 rubles per month, installments for 12 months.

The system allows you to work with a large database without loss of performance.

Clinic management has a tool for flexible control.

The medical record management system was created by doctors and for doctors.

The system design has a minimalistic design, which allows you to work with the system without being distracted by unnecessary interface elements.

The system is open source and allows you to work with the system without the involvement of third-party developers.

BIT:Medical center management

Cost: from 3600 rubles

BIT.Medical center management is a system that is aimed at reducing operating costs in a medical center.

Three advantages of this system

• Simple and convenient work for staff.
• Flexible control over all areas of the clinic’s activities: finances, personnel, patients.
• Customer focus. Informing patients via SMS, thorough medical history, clinic promotions, certificates for patients.

IntraMed

Cost: on request

The Intramed system became the best in 2010 in a competition held by the Ministry of Health of the Russian Federation.

Advantages of MIS Intramed:

• powerful reporting system for the medical clinic;
• system for monitoring the quality of services and comparing them with standards;
• the patient knowledge base collects data over a long period about all changes in health;
• built-in online recording and contact center system;
• all personal data about patients is stored in a separate module of the system

Medix CRM

Cost: from 29,900 rubles

Medix CRM is a modular medical system made in a minimalist design.

Key Features:

• Clear distribution of roles (everyone sees only what they are responsible for)
• Flexible configuration allows you to easily create both departments and personnel
• Fight against routine, all templates for basic documents are included in the system and are automatically filled out
• Planning system, separately for doctors, separately for departments of a medical clinic
• A powerful analytical center, it is easy to get statistics on finances and employee working hours.

MIS Medical Examination

Cost: on request

The system was created to simplify and speed up the process of medical examination. This system implements only the best solutions in this area.

Thanks to the Medical Examination system you will be able to:

• build a system of control over your personnel
• Reduce appointment time by up to 90%
• possibility of individual modification of functionality
• automatic generation of frequently filled out documents
• patient examination results are available without getting up from your desk chair
• flexible queue management system

ArchiMed+

Cost: on request

Clinics choose the ArchiMed+ medical information system due to the modules it includes:

• Reports module - allows you to create more than 15 reports in two clicks
• Doctor module - allows you to fill out a medical history in the shortest possible time, thereby reducing the time of one appointment
• Info-plasma module - this module will show the real employment of doctors and reduce queues at the clinic
• Self-Recording Terminal - we all know that sometimes the reception desk can’t cope, the patient self-recording module will come to the rescue

And also you get:

• Built-in IP telephony
• Working with online cash registers
• Notifying patients via SMS
• Laboratory module, thanks to which all tests are automatically included in the medical history

Cost: from 1900 rubles per month

The Medmis medical information system has both a boxed version and a cloud version.

The Medis system has a simple control panel for information system functions. Among the obvious features of such simplicity are the ability to display all doctors’ schedules on one page and the ability to reserve appointments.

There is also a great form builder for medical records.

According to Federal Law 54, everyone is required to have online cash registers. So Medmis fully supports the integration of work with online cash registers.

Ident24

Cost: from 3315 rubles per month

The IDENT24 medical information system for dental clinics is good for both clinic directors and staff specialists.

"Healthcare" (LLC "COMTEK")

Cost: from 99,000 rubles.

The software package/Medical Information System (PC/MIS) "Healthcare" is intended for the full maintenance of an electronic medical record (EMR), automation of the diagnostic and treatment process and accounting activities of large medical institutions of various profiles. MIS "Healthcare" has been successfully operating for 13 years in large medical institutions of the Russian Federation. The system is built taking into account the specifics of domestic medicine and best forms the business model of a medical organization.

The main list of solutions of MIS "Healthcare":

• Clinic
• Hospital
• Dentistry
• Highly specialized assistance
• Automation of individual services
• Paid services
• Data upload and reporting
• Patient communication system

Finally

Any medical information system is aimed at optimizing processes in the clinic. Reducing paperwork and increasing the time provided to patients by your specialists.

Your patients and doctors will be happy and grateful for the implementation of a medical information system only after it has been fully mastered. Having problems at the implementation stage is normal practice.

Do you need to implement MIS in your clinic? for a free consultation. And we will create an action plan for you!.

24180 0

The development of information technology and modern communications, the appearance in clinics of a large number of automated medical devices, tracking systems and individual computers have led to a new round of interest and to a significant increase in the number of medical information systems (MIS) of clinics, both in large medical centers with large flows of information, as well as in medium-sized medical centers and even in small clinics or clinical departments. In the USA alone, clinic costs in this area amount to about $8.5 billion per 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, having invested such significant funds in the creation of MIS, clinic managers 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 a computer 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 clinic services for quick management decisions, prompt accounting of the costs of treatment and care of patients, issuing invoices, accounting for the real workload on each employee, etc. - up to the use of in-hospital e-mail for scheduling studies and placing orders for tests. As a rule, with a correctly chosen MIS concept, these expectations are met, although few doctors really imagine what problems clinic staff and administration will face in the process of implementing and operating MIS.

According to various estimates, the handwritten medical history contains from 40 to 70% of the information about the 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 because previous data simply cannot be found. Standard archives of ECGs, X-rays, etc. are quite inconvenient and cumbersome. Carrying out any research work in archives of medical records requires significant time. All this together led to the need to transfer to a qualitatively new level the process of collecting and processing clinical and financial information in a clinical setting.

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 automated laboratories and tracking systems, the availability of modern means of information exchange (electronic hospital mail, Internet, video conferencing etc.).

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

We would like to note that, although these requirements are not strict, most of the MIS successfully operating in clinics around the world were developed by research teams working as part of large hospitals, university clinics, etc. At the same time, most of the failures in the development and implementation of MIS were due to the absence of experts in the field of medicine among development companies, 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 working style 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 USA, the “inconsistency” of MIS of different clinics led not only to significant costs for the development of converter programs and industrial standards, but was also 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).

Among the important standards, we also note the International Classification of Diseases (ICD-9CM) and two terminology projects: 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. DICOM, proposed by the American College of Radiology - National Electrical Manufactures Association (ACR-NEMA) and supported by major medical device and software manufacturers, is becoming the de facto standard for imaging.

It is beyond the scope of this brief overview to fully describe the healthcare software and medical information systems market, but it seems appropriate to highlight some of the major offerings.

C-HIS (Hospital Information System) is a product of CITATION Computer Systems Inc., one of the leading suppliers 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, management information 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 an integrated software and hardware system that creates complete digital health 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, anamnesis, epicrisis, surgery notes, laboratory tests and other reports). The secondary history contains all other documents that are rarely required after its completion, such as a diary, assignments, etc.

When scanning documents, barcoding is used to automatically recognize document type and patient. Documents have electronic signatures.
The system is installed in more than 500 clinics in the United States.

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

Of course, these 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 (translating messages, setting up program modules, etc. to the tasks and specifics of Russian clinics, but this is a very complex and expensive procedure. At the same time, it is quite logical to use already debugged and tested in US clinics and Europe of MIS solutions and concepts. It is important to note that there are also domestic developments in the field of MIS. The most famous are the A. N. Vakulsva Research Center of the Russian Academy of Medical Sciences, the Eye Microsurgery Institute, and a number of leading clinics in Kazan, Moscow, St. - St. Petersburg, Chelyabinsk, etc. In Russia, about 20 companies are successfully working in the field of MIS, however, information about developments and implementation experience is quite scanty and scattered.

According to employees of the American Institute of Medical Records (Medical Records Institute, USA), in fact, 5 different levels of computerization for MIS can be distinguished.

The first level of MIS are automated medical records. This level is characterized by the fact that only about 50% of the patient’s 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 for patient management. Such automated systems usually cover patient registration, discharge, intra-hospital transfers, entering diagnostic information, appointments, operations, financial issues, they run parallel to “paperwork” and serve primarily for various types of reporting.

Second level of MIS is a Computerized Medical Record System. At this level of MIS development, those medical documents that were not previously entered into electronic memory (primarily we are talking about information from diagnostic devices received in the form of various types of printouts, scanograms, topograms, etc.) are indexed, scanned and stored in electronic systems. image storage (usually on magnetic-optical storage devices). The successful implementation of such MIS began almost only in 1993.

The third level of MIS development is the implementation of electronic medical records (Electronic Medical Records). In this case, the medical institution must develop an appropriate infrastructure for entering, processing and storing information from its 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 computer processing capabilities. 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 medications taking into account the patient’s current somatic and allergic status, etc.

At the fourth level of MIS development, which the authors called electronic medical record systems (Electronic Patient Record Systems, or, according to other sources, 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 either one or several medical institutions. For this level of development, a national or international system for identifying patients, a unified system of terminology, information structure, coding, etc. are necessary.

The FIFTH level of MIS development is called the Electronic Health Record. It differs from an electronic patient record system in that there are virtually unlimited sources of information about a patient's health. Information appears from the areas of alternative medicine, behavioral activities (smoking, playing sports, using diets, etc.).

Today we can talk about achieving the first and second levels of computerization of healthcare. In recent years, according to researchers from the Medical Records Institute, electronic medical record systems (third level of MIS) have been developing. The next level may be achieved in small areas by 2002, but in general it will probably not be introduced into the health system until 2005.

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

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 is known, 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 computer 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 distant 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 video conferencing (Fig. 1). However, as the French telemedicine experts so vividly put it, sending clinical images around the world to make a diagnosis that may save the patient's life is undoubtedly a great technical achievement, but in fact it is only the tip of the iceberg.

Rice. 1 Leading laboratory specialists V. L. Stolyar and D. K. Vinokurov during a video conference demonstration at the exhibition.

Telemedicine is not just the transfer of digital images across borders, it is a new way of practicing medicine. The use of telemedicine implies certain obligations of each doctor who takes part in making a diagnosis. Ethical considerations and maintaining medical confidentiality must also be mandatory. Thus, the doctor making the diagnosis does not necessarily need to know the name of the patient whose data was received via telemedicine channels. The largest computer companies also pay considerable attention to the issue of medical video conferencing. Thus, Intel announced the creation of a special ProShare system, which allows doctors to simultaneously see each other, hear, present each other with clinical images, etc. In this case, doctors only need to use ordinary personal computers. There is experience in using this system at the Scientific Center for Agricultural Surgery named after. A. N. Bakuleva RAMP.

In a small lecture, it is not possible to talk in detail about image processing and storage systems in the MIS, although without a full link between the patient’s records and all the video and graphic information available in the clinic, the patient’s medical history is at least incomplete. Of the available complex systems for archiving and transmitting images, the authors highlight PACS (Pictuture Archiving and Communications Systems), offered by IBM and Siemens, as the most complete systems. Note that, according to Austrian radiologists, the cost per unit of image storage in an automated PACS system and a conventional archive differs by 50 times (not to mention the possibility of quick 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 companies producing software in the field of healthcare have created their own medical servers with information about their developments in the field of MIS. WWW medical information servers contain databases on cancer (National Cancer Institute, USA), medical news MEDNEWS, databases on available poisons and toxic substances, a large collection of histological sections, a biotechnology database, etc.

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

The main objective of any MIS 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 trends in the field of MIS is the emergence 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. There are projects for their development and implementation in clinical practice in Japan, Germany, Canada, France, Taiwan, Holland and a number of other countries. Such electronic medical records are replenished 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 one country. In this case, a single data format should be used in all hospitals and a unified health information network should be built. Nevertheless, individual regional projects are successfully developing and operating, 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, i.e. for the fourteenth year, an automated medical history has been successfully operating, first on the basis of multiprocessor microcomputers “MICRON”, and later on the basis of a network connecting “Microns” with displays and personal computers, now - on the basis of a local network of personal computers. In the early 80s, it was the first in our country and one of the few in Europe to actually operate an automated medical history of a cardiac surgery center. It was developed by the Center’s specialists on the instructions of the State Committee for Science and Technology of the USSR and the USSR Ministry of Health within the framework of the Agreement on Scientific and Technical Cooperation with the Norwegian company Mikron, which produced modern computers (supplies of American equipment were frozen at that time).

Almost all archives of the automated medical history for 12 years with the Mikron computer (this is about 47,000 patients) were transferred to personal computers and are an integral part of the currently 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 increased significantly. Nowadays, many young employees almost independently create their own thematic databases for scientific research and carry out statistical processing of them. Thematic scientific archives are actually an integral part of the Center's automated archive.

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

• reliability of operation in case of all kinds of technical failures;
• possibility of system development up to 200-250 computers;
• ability to store text information, monitoring data, graphic information, medical images;
• multiple duplication of data and multi-level protection against unauthorized access.

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

Literature

1. Burakovsky V.I., Bockeria L.A., Lishchuk V.A., Stolyar V.L. Computerized medical history of a cardiac surgery clinic // Vestn. USSR Academy of Medical Sciences. - 1985. - P. 17-23.
2. Emelin I.V. On standards for electronic exchange of medical documents // Computer. technol. in medical - 1996.-No. 1.-S. 44-47.
3. MoudJ. Dose of reality // PC WEEK/RE. - 1996. - P. 52-55.
4. Stolyar V. L. HIMMS Conference // Computer. technol. in honey - 1996. - Part 2. - pp. 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 V., 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. Engelbrüccht 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 telradiology 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 knowledge 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., DieJenbacli 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.

Stolyar V.L.