Experience of informatization of health care of the Kirov region

Uniform State Health Information System of the Kirov region

The state health care system of the region includes 76 medical organizations and 13 pharmaceutical enterprises. All of them are united in a regional Uniform State Health Information System segment. The medical information system is implemented in 98% of the medical organizations. The total quantity of the automated jobs makes about 12.5 thousand. Including work more than 1.6 thousand doctors of hospitals, about 2.5 thousand nurses on point duty is automated. The number of users of polyclinic divisions makes more than 8 thousand.

Accomplishment of "road map" of development reg. a Uniform State Health Information System Kirovskoy segment of the region in 2015 - 2018 on the main actions it is characterized by the following indicators:

• 95% of divisions of the medical organizations and all pharmaceutical organizations are connected via secure channels of communication to a regional information resource
• 70% of doctors and average medical personnel work in a medical information system
• 87% of the divisions providing medical care in out-patient conditions give an opportunity to register in appointment or a research via the Uniform portal of public services and the official site of the Ministry of Health of the Kirov region
• Schedules of acceptance of 57% of doctors are transferred to a subsystem of federal electronic registry of Uniform State Health Information System
• In medical information system MO the electronic medical records (EMR) for 88% of the patients insured in the compulsory health insurance system are kept
• Data transmission, contained in electronic medical records from a medical information system in the regional system of the integrated electronic medical record (IEMR) is provided
• In Uniform dispatching service of ambulance and emergency medical service the automated system accepting calls from the population of all area is implemented.

One of crucial elements of informatization of health care is the electronic medical record. In the Kirov region the electronic medical record is filled out in 310 structural divisions of 64 medical organizations, including 128 offices of general practitioners (only 138 VOP) and in 7 with medical and obstetrical center-ah (only 528 medical and obstetrical centers).

In the electronic medical record of clinic:

• The possibility of formation of the passport of the medical organization and the uniform electronic database of patients is implemented.
• In it all sections are filled out, including at visit, medical examination and medical examinations.
• The statement of recipes, the directions on hospitalization, sick-lists is kept.
• Laboratory, instrumental, radiological researches are appointed, their results are entered.

It is important that for maintaining primary medical documentation in paper form sections of "clinical record" are not filled out again, and are just printed from the electronic medical record. In a system accounting of the patients having the right to preferential provision of medicines including "pilot project" on medicinal insurance is possible.

Recipes for preferential provision of medicines are written out directly in the electronic medical record.

Before the statement of the recipe the doctor has an opportunity to check availability of medicine in pharmaceutical points and the central pharmaceutical warehouse online.

For doctors of primary link an opportunity to obtain necessary information on rendering emergency medical service to patients on assigned section is implemented. In the Kirov region the possibility of receiving on mobile devices is implemented by crews of emergency medical service of calls and routes of hospitalization of patients.

In 60 health facilities maintaining electronic medical records is performed in the round-the-clock hospitals:

• All sections of "clinical record" are filled out.
• In electronic form sheets of appointments which are made out according to basic templates are kept.
• Laboratory, instrumental, radiological researches are appointed, their results are entered.

As the basic software of a regional Uniform State Health Information System Kirovskoy segment of the region software products of K-MIS company are applied, in particular:

• End-to-end medical information system
• Electronic registry of version 2.x
• Regional information resource
• System of operational monitoring of death rate
• System "KIIS. Drugstore" and some other solutions.

The module MIS is Drugstore

The module MIS - Drugstore is actively implemented and is used. In MO all medicines, products of medical appointment and other supplies are entered into a medical information system where further there is their complete accounting, from revenues to "warehouses of the first level", to a mark about accomplishment of medical appointments as average medical personnel in electronic sheets of appointments. Thus, appointment and accounting of the actual expense is carried out is personified using a medical information system.

Since 2017 in all medical organizations in the electronic medical record sheets of appointments are filled out on the basis of "basic templates" which are developed by the chief non-staff specialists of the Ministry of Health of the Kirov region together with the leading doctors of our clinics. The idea of implementation of "basic templates", or regional "medical electronic standards", is clear and simple - it is systematization of approaches to medical diagnostic process.

The regional "medical electronic standard" is developed on the basis of standards of medical care and clinical protocols, contains the minimum list of laboratory, instrumental methods of a research and medicines on MNN, changes the attending physician depending on a clinical situation and specific features of the patient. By specialists of the region it is developed 142 "electronic the standard" in the main nosological forms.

2010-2016: Electronic registry

Development of the Electronic Registry project goes in the Kirov region. This project is created at the initiative of department of health care of the Kirov region and the MIAC in Russia is supported by the Kirov regional public institution of health care Medical Information and Analytical Center (MIAC), one of the best and active regional.

The software Electronic registry is developed based on the IBM Lotus Notes/Domino platform. Among main advantages of this solution there are a cross-platform, the highest reliability and security, high speed of work and compliance to the main IT standards. The server of Electronic registry works under control of Solaris.

For the project will unroll the portal of Electronic registry [1]which is integrated into the website of Department of health care of the Kirov region [2].

Development of the project began in March, 2010. As the "pilot" platform on which primary implementation was performed the running in of the software and organizational and methodical solutions, acted "The Kirov city hospital No. 7". At the end of March the head of department of health care of the Kirov region Dmitry Aleksandrovich Matveev together with the chief physician of hospital Alexander Anatolyevich Sobolev and the director of KOGUZ "Medical information and analytical center" Alexander Viktorovich Kashin directly checked work of local therapists, have a talk with employees of registry and checked a recording capability for acceptance through a new electronic system. Heads of health care of the Kirov region highly appreciated convenience and efficiency of a new form of record of patients to the doctor. Need of its fastest implementation in other treatment and prevention facilities of health care of the city of Kirov, and further and areas was emphasized. MUZ "Northern city clinical hospital" became the next health facilities where system implementation proceeded. Then, in April, 2 central district hospitals (CDH) were connected already and the project began to take new participants actively.

16 central district hospitals and 22 treatment and prevention facilities of health care of the city of Kirov and area participate in the Electronic Registry project of the Kirov region. As it is written in the blog by the head of department of health care D.A. Matveev ([3]), on average in a week about 2500 people, from them directly via the Internet a little more than 40% register in appointment. The management of health care of area expects that the record count in process of development of the project will reach 10,000-20,000 addresses to week. There is an active connection of new district health facilities. The most active participants - Belokholunitsky central district hospital, the Kirov city children's clinical hospital, Suburban TsGB and Northern city clinical hospital. Now also process of connection and regional specialized treatment and prevention facilities develops.

At the press conference devoted to issues of development of regional health care and which took place on July 21, 2010 with the assistance of the governor of the region N.Yu. Belykh, the head of department of health care of the region D.A. Matveev it is perspective estimated work of Electronic registry as its use allows to regulate flows of patients and reduces queues in treatment and prevention facilities. "Creation of a common information space of health care – one of priority tasks of the Concept of upgrade of health care of the region", - the head of department emphasized ([4]).

Forces of companies "Vyatka Information Technologies" (Kirov) and "End-to-end medical information systems" (the Republic of Karelia [5]) develop the new, significantly improved version of a system. Following features will be a part of new Electronic registry:

• The updated improved interface;
• Close integration with the Karelian medical information system, in particular - with electronic calendars of KIIS;
• New features of the notification of patients about making an appointment by e-mail and the SMS;
• New flexible opportunities of setup;
• Possibility of independent registration and authorization of users (patients);
• Detailed help system.