Health Information Systems: Background and Trends of Development Worldwide and in Russia

Elena Vaganova1,2, Tatiana Ishchuk1, Anatoly Zemtsov1 and Dmitry Zhdanov1,2 1National Research Tomsk State University, 36, Lenin Ave., Tomsk, Russia 2Diagnostika + LLC ,of.47, 8, Razvitiya Ave., Tomsk, Russia

Keywords: Medical , Health Information Systems (HIS), Special Aspects of Development, Opportunities and Challenges, Trends.

Abstract: The paper is to study the background, opportunities, challenges, and trends of development of health information systems in Russia and worldwide. There are two main types of HIS: electronic medical records and clinical decision support. The key areas of their application include patient management, clinical management, diagnostics and treatment, research and education. The development of economic efficiency of HIS is considered to be one of the future research field in medical informatics.

1 INTRODUCTION much of ’ work would become automated and that many human errors could therefore be Health information systems (HIS) belong to IT- avoided. industry, which contributes to the global economy 1965 – one of the first clinically-oriented health providing jobs for IT-specialists and increasing tax care Information Systems Technicon Medical revenues from the activities related. The was developed as a development of medical and collaborative project between Lockheed and El technologies in general and HIS in particular is Camino Hospital in California. related to changes in the needs of 1967 – Health Evaluation through Logical industry including steady increase of knowledge in Processing (HELP) was the first hospital medical field, complexity of the examination, information system to integrate clinical data diagnostic, and treatment methods. accumulation and clinical decision support. 1967 – International Medical Informatics Association (IMIA) was established. It has close ties with the World Health Organization (WHO) as a 2 BACKGROUND OF THE Non Government Organization, and with the DEVELOPMENT OF HEALTH International Federation of Health Information INFORMATION SYSTEMS Management (IFHIMA). 1968 – STored Ambulatory Record Medical informatics as a discipline is still young, in (COSTAR), an electronic , was particular when compared with other medical developed by the Laboratory of Computer at disciplines However approaches to the data Massachusetts General Hospital between for processing in and health care have over 50 Harvard Community Health Plan by Octo Barnett years of history. and Jerome Grossman. A historical analysis shows major milestones of 1960s – first hospital information systems were the development of global medical informatics and first introduced. The staff used them primarily for HIS: managing billing and hospital inventory. Major 1959, and Lee B. Lusted work on: analysis, laboratory applications, published a widely read paper on diagnostic modeling and simulation of some biological decision-making appeared in Science, in which the processes, ; first attempts on decision authors expressed hope that by using , support (diagnosis).

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Vaganova E., Ishchuk T., Zemtsov A. and Zhdanov D. Health Information Systems: Background and Trends of Development Worldwide and in Russia. DOI: 10.5220/0006244504240428 In Proceedings of the 10th International Joint Conference on Biomedical Engineering Systems and Technologies (BIOSTEC 2017), pages 424-428 ISBN: 978-989-758-213-4 Copyright c 2017 by SCITEPRESS – Science and Technology Publications, Lda. All rights reserved

Health Information Systems: Background and Trends of Development Worldwide and in Russia

1973 - in the Netherlands at the Free University for health care. Special is paid to standards in Amsterdam the department of Medical of digital medicine, HIS and their components. For Informatics started under the chairmanship of Jan Russian conditions (a lot of remote parts of the van Bemmel. country) implementation of e-health programs 1974 - the department of Medical Cybernetics including telemedicine systems, networks and data and Informatics was established in the Soviet Union, banks is of great current interest. headed by S.A. Gasparyan. Intended use and functional options of HIS 1976 - The Problem-Oriented Medical depend on the territorial level of health care, as well Information System, or PROMIS, was designed for as the special features of a particular health care maintaining health care records at the University of organization. The main objectives of HIS usage are Vermont by Jan Schultz and Dr. Lawrence Weed, enhancement of efficiency of treatment (reducing of M.D. medical errors), and optimization of diagnosis and 1980 - Edward H. Shortliffe founded one of the treatment expenses including health and clinical earliest formal degree programs in biomedical management and patient records. The most urgent informatics at Stanford University, emphasizing a and challenging task is considered to develop rigorous and experimentalist approach. computer-based medical decision-support. 1986 - European Society for Artificial Healthcare information systems, health in Medicine (AIME) was established. information systems and hospital information 1970s - 1980s - a shift from a paper-based to systems are often used today to refer to the same computer-based records system; founding most concept. A series of terms such as computerized national and international organizations, patient records, electronic medical records, and conferences; attempts to systematize major areas of electronic health records, have been have been medical informatics; first specialized schools and mentioned in scientific papers in the evolution of courses; principles of clinical and hospital this phenomenon from its early foundations in the information systems, security and medical data 1960s. They are commonly used almost protection; advanced decision support systems – interchangeably. expert systems. Thus there are two main types of HIS: electronic 1990s–2000s - medical Informatics consolidates medical records (EMR) и clinical decision support its position as an independent discipline and is (CDS). mandatory in most medical schools; hospital Electronic medical records maintain patient information systems are implemented in some information and notes in a computerized hospitals, mainly for management; first e-health and data base. Electronic records allow the provider to telemedicine research; notable progress in data track the patient's health over time, read the input of bases, medical imaging; more visible importance other consulting physicians, or recall his own and complexity of (HER), clinical assessment from a previous day or hospital including confidentiality, data protection, standards visit. Clinical decision support provides timely etc. reminders and suggestions to medical practitioners. 2000 – 2010 - clearer understanding of e-health Decision support may recommend screening tests potential as a specialized industry and business; based on a patient's age and medical conditions, and hidden gaps and difficulties in real implementation: drug information. Electronic medical records integration and interoperability, modest rate of user and clinical decision support systems together form acceptance, quality assessment. Clear contour of the backbone of the hospital information system. sub disciplines: , The main application fields and functions of HIS etc. consist of: Patient management (patient registry, scheduling of appointments, admittance and bed control; 3 KEY CONCEPTS OF HEALTH emergency care; in-patient/out-patient system); INFORMATION SYSTEMS Clinical management (hospital releases; medical reports, electronic prescriptions; appoint- In recent decades medicine and health care have ments); changed significantly. Major companies (IBM, Diagnostics and treatment ( lab exams); Cisco, , AGFA, GE et al.) are involved in Supplies management (stockroom; ordering of the development of hardware and software solutions supplies; ; current assets);

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Financial management (accounts payable and 5 OPPORTUNITIES AND receivable; banking control); CHALLENGES OF HEALTH Support services (hospital infection controls; assets maintenance; vaccine control); INFORMATION SYSTEMS Research and education (library; convention center scheduling, recruiting and personnel). 5.1 Opportunities

Economic and administrative efficiency of a 4 SPECIAL ASPECTS OF THE hospital: DEVELOPMENT OF HEALTH - cost savings due to reducing of paper work and errors in billing; INFORMATION SYSTEMS - cost savings on medication due to instant access to comparison of drugs consumed); HIS is a set of software, hardware, and data for - cost savings on laboratory studies (due to automation of health care processes in medical access to comparison of total annual costs institutions health and recreation resorts. Besides the of laboratories); above mentioned main application fields and - standardization of hospital administration; functions a corporate HIS carries out the following - improvement of management decisions due tasks: to an integrated information system; - maintaining of common information space, - access to a more complete, accurate and intended for immediate access to data; structured documentation of clinical data; - automatic sorting of data; - improvement of the quality of medical - direct access to instant updates, including records; remote access to a patient's medical history; - control of health care quality and reduction of - reduction in medical errors due to more medical errors; accurate data entry; - continuous remote of patients; - increasing transparency of a medical - access to analysis and interpretation of data institutions; that can be used for the study of diseases - constant analysis of economic aspects of health and preventive measuresin clinical practice.

care; - Improvement of patient care quality:

- reduction of time of examination and - access to patient data from other hospitals; treatment. - simplification of administrative procedures; - processing of medical records and quick The developers of health information systems results. have to deal with a constantly changing subject area. The most important sources of these changes are: Remote and transmission - cloud technologies. - development of social and economic spheres; - development of medical science; 5.2 Challenges

- the influence of information technologies on The development of HIS is a complex socio- patients’ behavior (they become more technical process, characterized by a high level of informed) and health management in general. uncertainty. Different needs of practical health care Unlike most industries, in medicine there are representatives (regional authorities, chief three sides of financial and economic relations: the physicians, doctors, nurses etc.). party that receives services (patient), the party that State medical institutions which purchase provides services (medical organization), and the devices and equipment have to adhere to very party who pays for services (patient, insurance serious limitations. company, government). Long-term implementation of HIS in the context Another special feature of health information of constantly changing healthcare conditions and which must be always considered is privacy. obligations of staff.

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Health Information Systems: Background and Trends of Development Worldwide and in Russia

My baby syndrome: most of the innovation implementation of health information systems at products in the field of healthcare are promoted by local and regional levels. developers who are too confident in their project. The state policy in the field of IT-based They may not be able to abandon their project, management is one of them. In this regard attention ignoring its economic efficiency. must be paid to the problem of different levels of Implementation of information technologies is knowledge in the field of information technologies. time-consuming. It is impossible to immediately Computer literacy of medical professionals, software estimate the efficiency of a freshly introduced HIS. and hardware, unification and standardization of Users need to get used to new tools and new primary data, methods of processing and opportunities provided by software or hardware transmission, the possibility of treatment in remote modifications. The value and applicability a data centers (cloud architecture), data availability for particular HIS are constantly changing due to physicians and patients are required. different economic and management . The worldwide popularization of cloud Each HIS is to some extend unique. Some and gradual integration of health information technologies may be similar in various information systems in web-applications and mobile aspects, but the functionality may be different. devices, requiring support of international standards, The success / failure of a HIS depends on must be noted as another . compatibility between the developed device and Financial capacity of healthcare institutions existing realities of current medical institutions. directly affects the future of HIS. No matter what Two key stakeholders of HIS development, potentially interesting and attractive ideas and developers and users, may have different versions of opportunities are offered in the industry, available a reality. Developers see HIS exclusively from its financing of each health facility in particular and a technical feasibility. region in general must be properly assessed. The Hospitals are concerned about the costs, payback costs of the proposed solutions and possible period, and even the interests of external financial support must be considered. Thus, another stakeholders, e.g. the government. important factor of the development of HIS is the Creation of large regional and national health cost - efficiency ratio of information technologies. information systems for the exchange of data regarding patients and specialized medical centers is one of the key direction in health IT. The problem of 7 CONCLUSIONS: TRENDS OF such projects is they often do not involve actual participants of the process. Obtaining and sharing THE DEVELOPMENT OF HIS medical data stored in isolated systems require a carefully specified product developed by The globalization of IT business is one of the main professionals. At the same time, different regions tendencies. At present, any person (or company) is a and countries apply very different requirements to potential data consumer. Therefore, even such complex systems. The product must have easily considering tough competition of major and quickly adaptable to these demands and provide manufacturers, the possibilities of IT market are still additional developmental options. boundless. The main market players include producers form the US, Japan, France, Britain and Germany, South Korea, Taiwan, Singapore and others. 6 FACTORS OF THE Implementation of software products in medical DEVELOPMENT OF HEALTH institutions for clinical examination and treatment INFORMATION SYSTEMS includes mobile networks, virtualization technologies, and telemedicine systems which The main aspects of the development of medical provide medical professionals with a fast and secure informatics in general are progress in information access to necessary data. and technologies (including data The main trends of the decade 2010 – 2020 processing methods), improvement of public include: approach; cloud computing; social healthcare, and constant changes in the needs, networks on health; certification of educational requirements and expectations of the society. programs in medical informatics; full In Russia and worldwide there are factors which interoperability - communication, devices, semantic are more likely to influence the development and interoperability; integration of molecular & genetic

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data; patient empowerment, involvement of Personal Jorgen P. Banslera et al., 2010. International Journal of medical record; further steps towards personalized Medical Informatics № 7 9, p. 637–648 medicine, increase of , reduction of Kossova E. V., Muhin Ju. Ju. 2010-2011 Information medical accidents and errors; improvement of systems in healthcare (Informacionnye tehnologii v medicine), p. 124-148. preventive medicine and reduction of curative Peter Littlejohns et al., 2003. British Medical Journal № medicine; use of portable/wearable devices for 326, p. 860–863 monitoring, prediction & prevention; deployment of Elske Ammenwerth et al., 2003. International Journal of home monitoring systems and tele-assistance; deeper Medical Informatics № 71, p. 125—135 penetration of IT tools in Lebedev G.S. 2011-2012. Information systems in (modeling & simulation, digital patient etc); healthcare (Informacionnye tehnologii v medicine) p. advanced decision support systems. 42‒62. At present in Russia Medical Cybernetics is a Gesev A. V. 2012. Radiotechnics (Radiotehnika) full-blown health care specialty. Education is Zarubina T. V. 2013. Data-measuring and operating systems (Informacionno-izmeritel'nye i provided by the Siberian State Medical University, upravljajushhie sistemy) vol. 11, № 10. P. 4‒8. Penza State University and the Voyno-Yasenetsky Gusev A.V. 2006. Doctor and information technologies Krasnoyarsk State Medical University, in addition to (Vrach i informacionnye tehnologii) № 5. p. 32‒43. the education provided by the Pirogov Russian International Medical Informatics Association. URL: National Research Medical University. In 2000 the http://imia-medinfo.org/wp/welcome-to-imia-2/ Russian Ministry of Health approved a program for World Health Organization. URL: www.who.int this discipline, prepared by the Second Pirogov Agha L. 2014. Journal of Health Economics. № 34. ‒ P. Medical Institute. 19–30. In Russia, one of the key trends is creation of a N. S. Fleming et.al. 2011. Health Affairs. ‒ Vol. 30, № 3. ‒ P.481‒489. united national electronic information system S. V. W. de Oliveira et.al. // Journal of Information including telemedicine, providing a hot link between Systems and Technology Management. ‒ 2011. ‒ Vol. medical organizations of various levels aimed at 8, № 1. ‒ P. 155‒178. remote consultations of physicians. Distance George I. Mihalas, 2014. Acta Informatica Medica 22(1): courses and continuous educational 37–43. programs for health care workers are to be Hasman A., Mantas J., and Zarubina T. 2014. Acta developed. Informatica Medica. 22(1) p. 25–36. In recent years, in Russia a growing number of health information systems for automation of health care institutions have been developed and imple- mented. Russia is a comparatively young participant in the market discovering the achievements of heath informatics, reproduction and restoration of human resources on the basis of new technologies.

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