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8TEXNOLOGIYA
CREATING A MODERN APPROACH TO THE DEVELOPMENT OF THE NATIONAL ELECTRONIC HEALTH STRATEGY OF UZBEKISTAN
Bekturdeiv Sanjarbek Sharifboyevich Tashkent State Technical University is named after Islam Karimov. sanjarbeksharifboyevich@gmail. com
Abstract. The introduction of information and communication technologies in healthcare is an urgent task that should be addressed at the national level. Overcoming the problems associated with this process requires an integrated strategic approach, covering a set of legislative, institutional, and technological measures. The current e-health strategy of the Republic of Uzbekistan has made it possible to form a solid foundation for further development. At the same time, the transition to a qualitatively new level of introduction of digital technologies requires updating the national strategy, ensuring harmonization with the current priorities of the healthcare system and the accumulated scientific and practical knowledge.
Annotatsiya. Sog'liqni saqlashga axborot-kommunikatsiya texnologiyalarini joriy etish milliy darajada hal etilishi lozim bo'lgan dolzarb vazifadir. Ushbu jarayon bilan bog'liq muammolarni bartaraf etish qonunchilik, institutsional va texnologik chora-tadbirlar majmuini qamrab oluvchi kompleks strategik yondashuvni talab qiladi. O'zbekiston Respublikasining amaldagi elektron sog'liqni saqlash strategiyasi yanada rivojlantirish uchun mustahkam poydevor yaratish imkonini berdi. Shu bilan birga, raqamli texnologiyalarni joriy etishning sifat jihatidan yangi bosqichiga o'tish milliy strategiyani yangilash, sog'liqni saqlash tizimining dolzarb ustuvor yo'nalishlari hamda to'plangan ilmiy-amaliy bilimlar bilan uyg'unlashtirishni ta'minlashni taqozo etmoqda.
Аннотация. Внедрение информационно-коммуникационных технологий в здравоохранении является актуальной задачей, которую необходимо решать на национальном уровне. Преодоление проблем, связанных с этим процессом, требует комплексного стратегического подхода, охватывающего комплекс законодательных, институциональных и технологических мер. Существующая стратегия электронного здравоохранения Республики Узбекистан позволила сформировать прочную основу для дальнейшего развития. В то же время переход на качественно новый уровень внедрения цифровых технологий требует обновления национальной стратегии, обеспечения гармонизации с текущими приоритетами системы здравоохранения и накопленными научными и практическими знаниями.
Kalit so'zlar: elektron sog'liqni saqlash, raqamlashtirish, strategiya, sog'liqni saqlash tizimi, telesog'liqni saqlash, axborot texnologiyalari, kommunikatsiya texnologiyalari, milliy sog'liqni saqlash strategiyasi, axborot tizimlari va ma'lumotlar bazalari
Ключевые слова: электронное здравоохранение, цифровизация, стратегия, система здравоохранения, телездравоохранение, информационные технологии, коммуникационные технологии, национальная стратегия электронного здравоохранения, информационные системы и базы данных.
Keywords: e-health, digitalization, strategy, healthcare system, telehealth, information technology, communication technology, national eHealth strategy, information systems, and databases.
Introduction. The term eHealth is defined by the World Health Organization as the use of information and communication technologies (ICTs) for health purposes. The history of the use of ICT in healthcare goes back more than a decade, but the rapid growth in the introduction of these technologies began after 2000 [1]. At the same time, over the past decades, there has been a rethinking of the role and functions of eHealth based on accumulated knowledge and experience. International reviews demonstrate the understanding that increased use of ICTs, and
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in particular, the Electronic Health Record can help provide a better quality of care, reduce medical errors, and strengthen administration. At the same time, when implementing such projects, states face a significant number of difficulties, including the unpreparedness of legislation and the regulatory framework, insufficient resources and capacity, the need to develop and implement uniform standards, poor data quality, difficulty in linking disparate data from various sources, etc. [2].
It is critical to recognize that successful investment in eHealth projects requires much more than just the development of technological tools. It is not enough to develop or acquire an information system, a holistic view of the intended benefits and required changes in organizational processes, structures, functions, standards, and legislation is needed, as well as taking into account the specifics of human resources, training issues, cost recovery and cultural traditions of people who will use eHealth technologies. Ignoring any of these factors can become a brake on the development of initiatives [3]. Thus, the experience gained in international practice demonstrates that a strategic approach at the national level is needed to solve the problem of introducing ICT in health care. To this end, the World Health Organization, together with the International Telecommunication Union, has developed the National eHealth Strategy Development Toolkit as a basis for developing a national strategic vision, action plan, and eHealth monitoring and evaluation mechanisms [4].
Having a national eHealth strategy aligned with global health system goals is seen as key to strengthening people-centered health systems and building public health capacity. According to an assessment conducted in 2019, 40 Member States of the WHO European Region (75% of the total number of responding countries) have a national eHealth policy or strategy [3].
Materials and methods. Assessment of the compliance of the existing strategy for the development of e-health of the Republic of Uzbekistan with the needs of the domestic healthcare system and the scientific and practical experience accumulated in the international community.
Using the information-analytical method, an analysis was made of foreign and domestic literature on the development of e-health, as well as strategic and regulatory legal documents of the Republic of Uzbekistan affecting the informatization of the industry and reports of bodies and organizations operating in the field of healthcare.
Results. The Ministry of Health of the Republic of Uzbekistan, within the framework of the World Bank Project, developed and approved the Concept for the Development of e-Health in the Republic of Uzbekistan for 2020-2025 (Concept of the EHRU). This document is a long-term national strategy and is based on international experience and priorities for the development of the healthcare system in Uzbekistan, relevant as of 2016.
As part of the EHRU Concept, the following vision was proposed: "By 2025, the implementation of e-health of the Republic of Uzbekistan should provide the possibility of automated receipt of timely, relevant, reliable, and sufficient information that provides a safe, fair, high-quality and sustainable healthcare system focused on the needs of the patient" [5,6 ]. Based on the proposed vision, in addition to activities aimed at institutional development, the implementation part of the EHRU Concept mainly involves the creation and implementation of tools that ensure the collection, processing, and provision of data, such as:
• centrally implemented information systems of the Ministry of Health, providing the collection of statistical, analytical, and financial data for the management of the industry;
• locally implemented medical information systems that provide automation of internal business processes of healthcare organizations, support for clinical decision-making, and a phased transition to paperless healthcare;
• national-level electronic health passport system, which ensures the integration of all
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Over the years of implementation of the EHRU Concept, significant progress has been made in the creation of a legislative and regulatory framework, and institutional structures have been created to ensure policy, management, and coordination of e-health development. Approaches to standardization of e-health have been formed, ensuring the adaptation of international and the development of Uzbek interoperability standards as a conceptual basis for the target architecture. Reengineering of information systems of the Ministry of Health has been carried out. As a result of the de-monopoly and decentralization policy, the IT industry and regional health departments actively participated in the development of e-health, which made it possible to start testing paperless medical data management in the regions of the country in 2022. Thus, a solid foundation has been formed for the further gradual expansion of the introduction of ICT [1,2,7,8].
At the same time, the current version of the EHRU Concept and the conceptual architecture described in it do not provide for solving several issues that are critical for the healthcare system of Uzbekistan. Thus, within the framework of the Health Development Program for 2019-2025, the implementation of two institutional reforms on a national scale is envisaged: the creation of a public health service and the introduction of a system of compulsory social health insurance [6]. This means the emergence of new institutional structures and new functions, which in turn implies an increase in information needs, to which existing or new ICT tools (information systems and databases) must be adapted, appropriate data collection processes, and regulatory legal acts developed. The concept for the development of the healthcare system of the Republic of Uzbekistan for 2019-2025 was developed by the regulatory legal acts of the Republic of Uzbekistan regulating activities in the healthcare sector, as well as international treaties in the field of public health within the framework of the regional policy Health 2020 and the Sustainable Development Goals 2030.
The concept contains approaches based on the recommendations of the World Health Organization, as well as the experience of leading countries that have achieved great success in reforming the healthcare system.
In addition, based on the vision set out in the EHRU Concept, the result of its implementation should be a comprehensive integrated information infrastructure that provides all participants in the process of organizing and providing medical care, including the patient himself, with the necessary medical and administrative information. It follows from this that, despite the understanding of the significant role of information and communication technologies in modern healthcare, they are assigned a passive, supportive role within the framework of the EZRU Concept.
In contrast to this paradigm, the concept of «digitalization» is now increasingly used, which implies the use of digital technologies to change the business model and provide new opportunities for generating income and values [9,10]. As part of digitalization, ICT is considered a proactive tool, a driver of the qualitative transformation of traditional processes, and methods for their implementation.
Concerning health systems, the international community is exploring some fundamental changes that digitalization can bring.
First, it strengthens the role of the patient concerning the protection of their health. The long overdue shift from a paternalistic model of doctor-patient relationships to a shared decision-making model has been accelerated by the global adoption of the Internet, and as a result, easier access to information. The situation is exacerbated by the constant increase in the need for medical care, due to global trends of increasing population and lengthening life expectancy, accompanied by an increase in the number of chronic diseases. Modern approaches to the organization of care for patients with chronic diseases, such as disease management programs,
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involve a doctor-patient partnership leading to self-management. The role of ICT in this regard includes not just access to data, but also tools for fixing one's condition and individual physiological indicators, remote monitoring of the patient's condition, and personalized notifications. An important direction, from the point of view of national policy, is the use of ICT, social media, and mobile technologies to improve health literacy, support patient decisionmaking regarding a healthy lifestyle, and influence behavioral factors [11,12].
Secondly, changing the traditional methods of providing medical services, aimed at improving the accessibility of care. Various tools and forms of telehealth are finding increasing practical applications, reducing transport costs, ensuring the availability of medical services for remote areas, and increasing the efficiency of using healthcare resources [13, 14]. Based on the results of the integration of healthcare information flows around a particular patient, a conceptual methodology has been developed for developing the continuity of medical care and the transition to "seamless" medical care, in which the patient's route is automatically managed, based on clinical programs and guidelines [16,18].
Third, changing traditional approaches to making a diagnosis, prescribing treatment, and performing procedures and manipulations through the introduction of artificial intelligence and augmented reality technologies [15,14, 19].
The widespread introduction of the described digitalization tools can have a multiplicative effect on the national health care system, which implies the need for reverse adaptation concerning:
• requirements for the skills and knowledge of medical personnel, including the possible emergence of new professions, such for example, a telemedicine doctor, medical informatician, etc.;
• the functions performed by health care providers at various levels of care and the corresponding revision of the norms for the formation of a network and medical personnel;
• strategies and approaches to the implementation of public health functions.
Discussion. Despite the existence of many examples of successful implementation of individual technologies, the comprehensive digitalization of the healthcare industry is a challenge that has not yet been solved by any country in the world [15,19]. The updated strategy must take into account multiple factors related to the priorities and needs of the national health system, the readiness of ICT infrastructure, legislation and capacity, the alignment of innovations with funding mechanisms, and the design of the delivery system.
Against the backdrop of increasing expectations and costs for ICT, the World Health Organization draws special attention from Member States to the almost complete lack of a systematic approach to monitoring and evaluating national programs. Given the available conflicting data resulting from the lack of generally accepted methods for assessing the results of digitalization, the assessment of both the clinical and economic effectiveness of ICT should also become one of the priorities of the national strategy [17,18].
Conclusions. The EHRU concept gave a significant impetus to systemic integrated development, ensuring the creation of the necessary institutional structures, the emergence and consolidation of new functions, capacity building, the development of many standards and regulatory legal acts, and the technological requirements of the information infrastructure of the healthcare system in Uzbekistan.
At the same time, based on the results already achieved, in the light of the changing priorities of the national health system and the emergence of new information tools and technologies, the national strategy for the development of ICT in health should be updated, providing a strategic approach to the digitalization of health for the long term.
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As part of the revision of the EHRU Concept, an integrated approach to the introduction of the proactive role of ICT, including the appropriate adaptation of the healthcare system, should be provided.
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