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56
Section 9. Technical sciences
Abdumanonov Akhrorjon Adxamjonovich, Ferghana branch of the Tashkent Medical Academy Karabaev Muhammadjon Karabaev, Ferghana branch of the Tashkent Medical Academy E-mail: [email protected]
Computerization medical institutions for the organization and optimization of clinical processes
Abstract: Article is devoted introduction of the medical is information — communication technologies in emergency medical aid Uzbekistan. On the basis of practice introduction of complex medical information system is shown, that introduction of such systems in medical institutions, is a basis of effective gathering, storage, processing and use of the medical information.
Keywords: information system, an information stream, medical information system, electronic case record, an automated workplace.
Healthcare reform of the Republic of Uzbekistan brings to the forefront the problem of information support of all levels of the system, as the main problems of practical medicine. The significance of this problem is especially important in a system of emergency medicine.
In connection with it, realizing step — by step transition of paper information technology to electron information — communication technology of the medical — diagnostic process (MDP) organization is becoming emergent task and also the basis for creation information infrastructure of medical prophylactic institution (MPI) on which automation the organizing will be based and managements both MDP and MPI as a whole. Thus, information status becomes as resource especially in emergency medicine institutions as strategic. Next, it demands the presence of operative reception possibility for important information on patients, their illnesses, and appropriate professional knowledge.
In this channel, it is necessary first of all to change MDP organization from intuitive to demonstrative (applied, testimonial) and its management from bureaucratic to information basis which demands attraction for optimization of organization of medical informational technology, special program security and technical collection means, storage, processing and information representation [1; 2; 3], Besides electron-communicational system for their import and export on MDP scale, region and in case of need department [4; 5; 6].
It is known that MDP is a technology of information interaction ofphysician with the patient and on the other hand, all medical personnel having relations to the patient. Automation MDP mustn't change its main point moreover it should develop and improve this point with its handling methods with information.
First of all it is necessary to automate interaction between participants of MDP and documenting process all steps of this interaction.
The basic and obliged carrier of this complex organized exchange traditional is the paper case record (CR).
It serves for storing information accepted by medical decisions, being not only medical, but also legal document.
But absence of possibility to use it simultaneously by several practice paints of MDP is difficult to read, and also arbitrary maintenance of records, absence of formalization medical information makes difficult operative and high grade use in practice of emergency medicine.
It is established that [7], the quantity of readable information in paper CR doesn't exceed 75 %, and beneficial factor of saved information is 82 %. In result, in conditions of a strictly limit of time, that is characteristic for emergency medicine, paper CR takes much working hours (not less than 30 %) for registration, remains only passive information storage, which doesn't meet the requirements of maintenance quality.
Obviously, MDP organization in an urgent condition on the basis of paper documentary circulation becomes serious brake for improving this process. Decision is obvious, it is necessary to introduce electron information — analytical and communication technologies.
In this case, on the other hand, there are possibility of automated formation of medical document, and with another their long — term and safe storage and in need operative processing, transfer and representation by the user i. e. to provide with information and intellectual support of MDP. Besides, realizing complex approach in designing medical informational system (MIS), one can achieve by automation conducting not only CR, but also organization of other main components of MID. Let's note, automation of medical institutions is first of all creation of unique MDP information field, that allows to create automated workplaces of doctors, and databases, to carry electrons case records (ECR), create their electrons archive and to connect in a unique system all medical, diagnostic, administrative, economic and financial processes.
Thus, modern development and improvement of emergency medical aid efficiency demands to carry out its complex automation on the basis of operative authentic (reliable) information in real time (scale).
Mentioned below our first complex information — communication and analytical system "ExterNET" [8], realizing in clinical practice all above mentioned functions and introduced into Fergana branch of Republican scientific emergency medical center.
It presents MIS, consisting of 82 computers united in a unique local network, server stations and specially developed software.
Programed technical complex system "ExterNET" is intended for automation emergency medicine institutions activity, which has versatile hospital, receiving — diagnostic department, clinical laboratories, functional diagnostics, drugstores blood transfusion
Computerization medical institutions for the organization and optimization of clinical processes
department, food block, administration and important engineering technical and other providing divisions.
Let's nite that, in order to generalize full information on patients and medical processes (actions) organize and operate medical processes we need ECR and local network.
According to it our purpose was designing and creating ECR which fUnction is not only automating conducting patients' medical records, but new technology support for intellectual and communication support for making medical decisions, by representing primary processed information in the form of analytical data, and also new effective interaction technology of different subdivisions of the hospital and MDP's participants.
Case record should become as full and structured, as it is necessary to form any secondary documents from its elements: appoint prescription sheet, analyses sheet, recipe for pharmacy, laboratory order, extract from case record and so on.
Nowadays Electrons Case History (ECH) standard hasn't accepted yet in the Republic we were guided by requirements of Russian national standard (GOST-52636) "Electron Case Record General principles regulations" implemented into practice since January 1, 2008 and establishing general requirements for formation, creation, support and use of information systems type "Electrons Case Records" [9].
According to it: as under ECR we are accepting storage on electronic carriers, search and delivery on a query (including electronic communication channels) personal medical records (PMR), patients further named electrons personal medical records (EPMR). Relative to EPMR we provided with the main requirement of the standard that is to provide with the following conditions:
- Invariance and authenticity during the whole storage period;
- Regulation for access rights and confidentiality;
- Persoificty (possibility to define the author and a record origin at any time moment).
By functioning possibilities our ECR belongs to collective class and is an integral element of MDP.
In connection with it EPMR is alienated from their authors and can be taken from electronic archive by other medical person having on this right and can be used as official medical document, accepting medical decisions on its basis, or carry out definite procedural action [10].
EPMR structure includes all necessary elements (patient identifier, identifier given by EPMR, date and time, CR number, identifier of EPMR author, text reflecting its content and e. t.c.), providing with medical and legal status. Under the leadership of Fergana branch of the Republican Scientific Center for Emergency Medical Aid we worked out and introduced regulations for creation and implementation EPMR of patients into the system where determined medical staff has the access right, and also information structure set by standard recommendations.
Such statement of ECR question will serve as the main medical information system (MIS) of multiprofile hospital, which is the scientific center of emergency medicine and its branches.
Let's notice, that ECR instead of "paper" is undoubtedly, the basis for automating medical process. Common CR is primary data carrier in usual work system, ECR is automated.
Creation of ECR has some realization versions among chosen designing and working out CR conducting ECR, integrating all other functional modules (Registry, Laboratory, Pharmacy, Functional diagnostics, Blood transfusion department, Statistics, Administration and others) which is necessary for organization and management MDP. All modules can work independently or in "ExterNET" system.
Such information systems functionality range for medical purposes are determined by solving the following tasks:
- Collection registration and data documenting;
- Providing with information exchange;
- Star age and search of the necessary information;
- Control of illness course;
- Support of accepting decision;
- Organization of patients resource maintenance;
- Static analysis of data.
It is necessary to notice once again, application information technology in clinical medicine should have purposes not to replace experience and ability of the doctor and opposite to raise its role, to supply with information and knowledge in proper time and in convenient format make it possible to concentrate on clinical work, to present him important information in needed moment, place and in demanded volume.
Thus we developed mathematical formalisms, person technology that is computer interaction and necessary computer program toolkit [11], allowing in aggregate to carry out not only collecting, storage and representation medical information, but also intellectual processing massive medical data during the work with patients and solve important problems on information and also intellectual support of medical decisions.
Physicians should have computer programs and electronic technologies suitable for their work purpose. Contact of user with medical informational system "ExterNET" is carried out by means of specially created automated workplaces (AWP) and their interfaces. Thus, we created 25 suitable AWPs for various types of users, representing possibility for realizing all actions which the user do in his work, that is considering functional duties of every category of employees.
Registration of functional duties of employees is the main demand necessary for observing in choosing interface decisions in created software MIS.
Let's notice, that by working out AWPs and the user interface we considered all demands of the standard namely in the interfaces of developed by us intuitively clearly and dose not suppose ambiguous interpretation and is executed taking into account ergonomic require ments, and also have elements allowing unequivocally to define; what patient concern given EPMR data time described in EPMR events; the status, a stage of life cycle EPMR and so on.
For convenience information introduction on survey the special system offers the doctor survey samples which is created by leading experts of the center using the international standards of medical terms SNOMED.
We will note that, in advance prepared text samples, is a perfect way of marking casy doctor's work and simultaneous increase his culture, if only not to give forming these samples to all who want. The problem consists of that by means of highly skilled experts to make a set of the best, fullest and differentiated stereotypic descriptions. The developed samples of the required quantity on clinical medicine of service programs system "ExterNET".
Considering an urgency of intellectual support of acceptance process of medical decisions, we developed special applied program and its database (DB) [12] providing automatic data processing ECR and make their analysis taking into account norms available in clinical practice dynamics, etc, with the subsequent representation to the doctor for their use.
Naturally database, the knowledge base and algorithm calculation and the analysis of medical parameters, of the program are created physician experts for every emergency medicine direction separately. They should be based or on officially confirmed or suggested sources.
As a result, the conducting CR system developed by us became information-analytical and architecture, DB structure projected by us taking into with its given function.
MIS "ExterNET" is based on client-server architecture. For maximum efficiency the system uses objective relational principle DB formation.
It is known that medical diagnostic standard's allow a regulation of the main technological process of emergency medicine — is the suitable diagnostics menacing to the patient's life conditions and qualified elimination at the rendering stages of emergency medical al aid.
In this connection ECR developed by us provides automatic registration of date and time formation of those or other MDP, and its DB keeps the asserted or recommended regulations of the standard were brought which allows to automate, within the limits of ECR, the control over their correct performance.
Our ECR and "ExterNET" technology, passed clinical tests in 2008, in Fergana Branch of Republican Scientific Center for Emergency Medical Aid and was accepted in experimental operation on hospital conditions where today works and develops successfully. For maintenance daily and continuous work of program-technical
part of the system, support its users, was created special department in Republican Scientific Center Emergency Medical Aid structure completed by programmers among the developers and engineering-technical personnel.
Effective operation of information system are provided by training all users in special teaching courses, by confirmed programs, with passing exam on certificate.
The conclusion — Our MIS "ExterNET" in clinical practice of emergency medicine gives the following possibilities: the whole complex of medical documentary, including case records transfers into electronic format, provides their automated formation, transfer, processing's, search and archive's; creating unique information space in MPI provides information, intellectual and communicative organization support of MDP, and acceptance of optimum medical decisions; performance of medical-diagnostic standards and their operative control; automates interrelations among clinical, par clinical and other divisions of MPI in patients interests; providing automated reception of various reports, data, and official static reports and on their basis the analysis activity as MPI as a whole and its structural divisions, increases efficiency of administrative work; provides safety of the medical information in needed level.
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Astanakulov Komil, Institute mechanization of agriculture, PhD of technical sciences, laboratory of harvesting machines
Karimov Makhmud, scientific employee, laboratory of harvesting machines.
E-mail: [email protected]
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