One of the notable trends of the last timewas the development of networks covering several medical organizations. Moreover, this trend is evident not only in the capital but also in regions. Of course, the history of some of the organizations of this type did not begin yesterday. Since the days of the Soviet Union there are now actively developing departmental group clinics. The economic growth of the last decade has given a powerful impetus to such phenomena as corporate network clinics and are not directly connected to the corporate private health network.
It is necessary to mention that under the phrase"Network of medical organizations" refers to a group of organizations that, regardless of the legal form of certain of its constituent units or the group as a whole, and regardless of the details of the control system, integrated by common organizational, material and technological resources.
In other words, within the network takes placefree enough, although not always strictly formalized, exchange of personnel, resources and information. Commercial networks usually have a common structure owners, although recently appear franchise schemes. In public institutions the elements of the network structure can be presented as an option, in the form of regulatory and procedural and administrative links between the organizational units.
Apparently, there is the medical community,adhering to a conservative approach to clinical practice, should be in line with the overall development of management. As in other industries, the network model to reduce administrative costs, generate standards for the provision of services to obtain economies of scale in the procurement, etc. etc.
It is obvious that after the organizational decisionsthe establishment or expansion of networks should be tightened and technology. We, as the automation specialists are primarily interested in information aspect of interaction within the network structure and its technological implementation. The topic of this article - especially the automation of network structures in health care. It's about what are the requirements for information systems network of health organizations, what these requirements are different from the automation project of separate organizational units, what are the prospects for development of information technologies in this area.
Awareness of the benefits of networking takes placealready at all levels. For example, automation, medical institutions subordinated to the territorial health authorities, gives a fundamentally different effect than a scattered equipment with new, even if it is by the advanced, technology specific clinics and integrated health centers. This effect is somewhat similar to the effect of the occurrence of central nervous system in living organisms. It is caused by a set of new features, which will be discussed in detail below, but for simplicity, can be reduced to three key principles:
- presence-wide network of information resources;
- replication of valid data from a single center;
- data consolidation and data in a single center.
On Requirements network of medical institutions to the information system
What are the requirements to the information systemmakes any network of health care organizations? First of all, it is necessary to provide access to the same customer information. It is necessary that each business unit or each clinic in the network have the opportunity to receive an electronic patient record. The satisfaction of this requirement - the minimum condition in order to be able to start talking about a single information space network.
What is it for? For example, the patient is moved and the new place of residence too, uses the services of the same network clinics, but its another branch - the one closer. Or take another, more typical case where the laboratory is located separately from the clinic. In this case, a technology solution that will ensure the rapid transfer of the electronic directions for research and as operational data acquisition on the results of the attending physician.
In a situation where diagnosticinstrumental studies conducted in other organizations, it is possible to exchange not only text, but also more resource-intensive multimedia information. It can be X-rays, ultrasound diagnostic indications, tomography. Modern technology makes it possible to do not only static images but also videos. All this not only increases the requirements for data channels but also to medical applications.
Another key requirement for informationsystem for health care organizations - is to ensure access from anywhere on the network to the information on resources and modes of operation. The most typical example - the ability to view the schedule of doctors or clinics other separate division. It is desirable that this feature was not available only for physicians and administrative staff. Ideally, the information system should support the ability to remote patient make an appointment at another branch, as well as independent record patients via the Internet. This network gives a more optimum allocation of resources, and for the patient - a quick service that is not more than for many kinds of diseases.
In addition to centralized updating of standardstreatment, medicines handbooks, manuals for discharge of soft drugs, etc. in the network of medical institutions is extremely important to ensure the replication of certain types of information not directly related to the therapeutic process. For example, the base directories, and commercial clinics - the price list of services, with the possibility of modifying the general version in accordance with the terms of remote units (branches, subsidiaries, other related entities).
What is important is the reverse process - Consolidationfinancial data, unit load indicators, consumption of drugs and materials - all that can be useful for further analysis. Consolidated statements are interested in the first place, decision-makers, managers of organizations or public oversight bodies.
Moreover, analysis of the data it is possible to carry outsimple and affordable means. But if the network is large enough, and the management company or the parent network hospital has the appropriate capabilities, you can create a data warehouse, and then to take advantage of the specialized class Business Intelligence applications (BI), which will allow managers to receive not only standard reports, but also to consider the data under a variety of point of view, to find non-obvious relationships and dependencies between the different indicators.
Function replication and consolidation can be claimed and to improve collaboration with the insurance companies.
Of course, there are many differences betweenrequirements of commercial networks and public (state and municipal) health care facilities. So, for the commercial networks important data speed and functionality, providing financial accounting at all levels. For, to combat social diseases of public hospitals more relevant mandatory medical statistics, information exchange with the fund of obligatory medical insurance (and with health insurance organizations) and unification of both at the level of general statements, as well as in the context of special government programs.
Differences in requirements are determined not onlyownership. Another important factor - the geographical location of the network, the mutual distances of its constituent organizational units. private network configuration is varied. Founders can follow the principle of "one city - one clinic." Some are guided by the density of the market, others - to the local co-investors or purchasers of a franchise.
Public health facilities, as a rule, can notafford this flexibility in the placement - which is understandable - they have to provide a solution to their tasks, regardless of the availability of people of the region and the economic situation. Similarly, region or city, when the decision to merge the reporting of health care institutions in the information network, is trying to reach a single solution all institutions, regardless of their performance.
These differences give rise to network topologyDifferent approaches to the architecture solutions. Well secured commercial network clinics create their own telecommunications infrastructure, which is in the center of a powerful data center (data center). In this model, even medical applications are physically located in a single center. This approach is justified, provided that each node of the network, each unit has a guaranteed high-speed access to centralized data and applications.
Networks do not have great potential orscattered in different regions, selected model data replication. This model makes more modest demands on communication channels, but it requires a fairly reliable software and designed mechanisms of information exchange.
Project work on the automation of medicalNetworks also has its own characteristics. Automate single medical organization or an entire network of clinics - tasks of different complexity classes. The transition from the single structure to the network raises the bar not only for communications and software, but also for the team, is working to implement software and technology solutions.
It is desirable that at the head of a teamIt turned out to be either the head of the network, or his closest deputy - otherwise the automation project can face great difficulties and, in the end, will not reach the planned figures.
Next, it is important to emphasize that we are talking aboutteam within the network organization, not just the experts supplier information system. To reduce the risks and costs of health care organizations must have their own IT-specialists who will be able to master the technology and purchased on the market, and key procedures for project implementation, and maintenance procedures. Experience in the preparation and training of professionals clearly indicates that even a small information service in the state medical organizations can significantly improve the quality of implementation and reduce total cost of ownership.
Experience in other sectors of automation allowsIt argues that the best is such a model of the interaction group companies or with external agencies, in which technology providers ensure the development of their solutions, and IT-division of the customer at every stage of development gradually takes their routine functions and procedures that do not require specialization performers or permanent work - for example, such as the duplication of applications for new branches or user training.
Automation of the network in the normal caseIt is divided into several stages. At the same time on one of the early stages of the work is done only in favorites, "pilot" unit and only then, when all the main technologies will be tested and run-transferred to the other structural units of the network. In some cases, the work on the pilot clinic may take a long time. But such delays are usually fully justified, given the fact that the errors identified in the earlier stages, is much easier to correct than errors propagated in the network scale.
Fashion networking is a logical question: Do we come to the fact that all Russian medical institutions will be included in a single network, and will be covered by a single information system. In fact, it is, of course, two or even three different issues: belonging to a certain network, access to the information resources and the possibility of a unified software and technological solutions.
For example, a clinic with Internet access,It can be considered covered by this network. But they certainly do not "belong" to the network. Most of them thus has different information systems. Apparently, this situation will continue in the future. There are other obstacles to the creation of very large information systems. For example, different decision-makers, or different levels of responsibility in the public administration hierarchy, different interests and capabilities - these factors will work to maintain the diversity of technical solutions.
There are, of course, technological, and seriouslegal restrictions, which should be discussed separately. At the current stage of development of information and, most importantly, organizational technologies, attempts to build an information "vertical" in a thin region as medicine and public health hardly succeed. At the same time, the tendency to unite into larger medical facilities network, the trend to integration and alignment is likely to be maintained. In the public sector this trend, as a rule, due to the need for more operational control over the work of subordinate agencies, the commercial sector - the desire for savings based on economies of scale ..
The current variety of software and hardwaresolutions meets the objective needs of various medical institutions, different systems of priorities, finally, various financial and personnel capabilities. The competition between these solutions - an important factor in increasing the availability of information technology to medicine.
Even in the largest cities of the level ofpenetration of medical applications in everyday practice is measured in units per cent of the total number of health care organizations. Obviously, in such circumstances, unification is possible and useful only at the legislative level, at the level of common industry standards of electronic documents and public mechanisms for information exchange. For example, in a single all-Russian and regional medical centers for certifying digital signature technology.
If we try to evaluate the different perspectivesTechnology based on the current situation and the fundamental assumptions about the diversity of technical solutions, the most serious chances are the decisions where provided replication mechanisms. Decisive advantages given to those developers of network applications, which, firstly, offer a reliable means of installation and commissioning of hardware and software across the distributed network, and, secondly, to create a replication tools useful settings.
The first problem - the installation and commissioning of reliability -easier. Precedents its solutions can be observed in a variety of industries where information technologies are used. However, it is not surprising exclusion technology software product (that is, the transfer of real control over technical decision) have not yet become a mandatory requirement for suppliers of medical applications. But without these technologies is difficult to speak about any successful information system development within the network organization.
The second task will mean realbreakthrough in technologizing medical networks. Take, for example, headache clinic in a network, which creates a new to this network specialized department or even just adds to the professional staff of the existing subdivisions additional specialty, which was previously not there represented. The mechanism of setting replication allowed to transfer all the standards and tested in one place clinical practice to all other organizations of the network.
Thus, the coverage of health care organizationsinfrastructure network communication has a great future. One of the number of market operators of medical services, who would rather implement information systems in its activities, has a chance to make it cost-effective and more efficient in comparison with the others. Breakthrough in technologizing medical networks, and therefore - and the effectiveness of medical activities in the economic turnover will provide replication useful settings, so that any institutional innovations immediately get ready information provision. Thus, organizational problems and challenges both to medical organizations, and to the health authorities, as well as to health care financing institutions, in many respects can find a solution in the field of information technology, network organization of microeconomics industry.