Health Information Systems: Background and Trends of
Development Worldwide and in Russia
Elena Vaganova
1,2
, Tatiana Ishchuk
1
, Anatoly Zemtsov
1
and Dmitry Zhdanov
1,2
1
National Research Tomsk State University, 36, Lenin Ave., Tomsk, Russia
2
Diagnostika + LLC ,of.47, 8, Razvitiya Ave., Tomsk, Russia
Keywords: Medical Informatics, 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
Health information systems (HIS) belong to IT-
industry, which contributes to the global economy
providing jobs for IT-specialists and increasing tax
revenues from the activities related. The
development of medical engineering and
technologies in general and HIS in particular is
related to changes in the needs of health care
industry including steady increase of knowledge in
medical field, complexity of the examination,
diagnostic, and treatment methods.
2 BACKGROUND OF THE
DEVELOPMENT OF HEALTH
INFORMATION SYSTEMS
Medical informatics as a discipline is still young, in
particular when compared with other medical
disciplines However approaches to the data
processing in medicine and health care have over 50
years of history.
A historical analysis shows major milestones of
the development of global medical informatics and
HIS:
1959, Robert Ledley and Lee B. Lusted
published a widely read paper on diagnostic
decision-making appeared in Science, in which the
authors expressed hope that by using computers,
much of physicians’ work would become automated
and that many human errors could therefore be
avoided.
1965 – one of the first clinically-oriented health
care Information Systems Technicon Medical
Information System was developed as a
collaborative project between Lockheed and El
Camino Hospital in California.
1967 – Health Evaluation through Logical
Processing (HELP) was the first hospital
information system to integrate clinical data
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
Non Government Organization, and with the
International Federation of Health Information
Management (IFHIMA).
1968 – COmputer STored Ambulatory Record
(COSTAR), an electronic medical record, was
developed by the Laboratory of Computer Science at
Massachusetts General Hospital between for
Harvard Community Health Plan by Octo Barnett
and Jerome Grossman.
1960s – first hospital information systems were
first introduced. The staff used them primarily for
managing billing and hospital inventory.
Major
work on: signal analysis, laboratory applications,
modeling and simulation of some biological
processes, databases; first attempts on decision
support (diagnosis).
424
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
1973 - in the Netherlands at the Free University
in Amsterdam the department of Medical
Informatics started under the chairmanship of Jan
van Bemmel.
1974 - the department of Medical Cybernetics
and Informatics was established in the Soviet Union,
headed by S.A. Gasparyan.
1976 - The Problem-Oriented Medical
Information System, or PROMIS, was designed for
maintaining health care records at the University of
Vermont by Jan Schultz and Dr. Lawrence Weed,
M.D.
1980 - Edward H. Shortliffe founded one of the
earliest formal degree programs in biomedical
informatics at Stanford University, emphasizing a
rigorous and experimentalist approach.
1986 - European Society for Artificial
Intelligence in Medicine (AIME) was established.
1970s - 1980s - a shift from a paper-based to
computer-based records system; founding most
national and international organizations,
conferences; attempts to systematize major areas of
medical informatics; first specialized schools and
courses; principles of clinical and hospital
information systems, security and medical data
protection; advanced decision support systems –
expert systems.
1990s–2000s - medical Informatics consolidates
its position as an independent discipline and is
mandatory in most medical schools; hospital
information systems are implemented in some
hospitals, mainly for management; first e-health and
telemedicine research; notable progress in data
bases, medical imaging; more visible importance
and complexity of electronic health record (HER),
including confidentiality, data protection, standards
etc.
2000 – 2010 - clearer understanding of e-health
potential as a specialized industry and business;
hidden gaps and difficulties in real implementation:
integration and interoperability, modest rate of user
acceptance, quality assessment. Clear contour of
sub disciplines: bioinformatics, neuroinformatics
etc.
3 KEY CONCEPTS OF HEALTH
INFORMATION SYSTEMS
In recent decades medicine and health care have
changed significantly. Major companies (IBM,
Cisco, Microsoft, AGFA, GE et al.) are involved in
the development of hardware and software solutions
for health care. Special attention is paid to standards
of digital medicine, HIS and their components. For
Russian conditions (a lot of remote parts of the
country) implementation of e-health programs
including telemedicine systems, networks and data
banks is of great current interest.
Intended use and functional options of HIS
depend on the territorial level of health care, as well
as the special features of a particular health care
organization. The main objectives of HIS usage are
enhancement of efficiency of treatment (reducing of
medical errors), and optimization of diagnosis and
treatment expenses including health and clinical
management and patient records. The most urgent
and challenging task is considered to develop
computer-based medical decision-support.
Healthcare information systems, health
information systems and hospital information
systems are often used today to refer to the same
concept. A series of terms such as computerized
patient records, electronic medical records, and
electronic health records, have been have been
mentioned in scientific papers in the evolution of
this phenomenon from its early foundations in the
1960s. They are commonly used almost
interchangeably.
Thus there are two main types of HIS: electronic
medical records (EMR) и clinical decision support
(CDS).
Electronic medical records maintain patient
information and physician notes in a computerized
data base. Electronic records allow the provider to
track the patient's health over time, read the input of
other consulting physicians, or recall his own
clinical assessment from a previous day or hospital
visit. Clinical decision support provides timely
reminders and suggestions to medical practitioners.
Decision support may recommend screening tests
based on a patient's age and medical conditions, and
drug allergy information. Electronic medical records
and clinical decision support systems together form
the backbone of the hospital information system.
The main application fields and functions of HIS
consist of:
Patient management (patient registry, scheduling
of appointments, admittance and bed control;
emergency care; in-patient/out-patient system);
Clinical management (hospital releases; medical
reports, electronic prescriptions; surgery appoint-
ments);
Diagnostics and treatment ( lab exams);
Supplies management (stockroom; ordering of
supplies; pharmacy; current assets);
Health Information Systems: Background and Trends of Development Worldwide and in Russia
425
Financial management (accounts payable and
receivable; banking control);
Support services (hospital infection controls;
assets maintenance; vaccine control);
Research and education (library; convention
center scheduling, recruiting and personnel).
4 SPECIAL ASPECTS OF THE
DEVELOPMENT OF HEALTH
INFORMATION SYSTEMS
HIS is a set of software, hardware, and data for
automation of health care processes in medical
institutions health and recreation resorts. Besides the
above mentioned main application fields and
functions a corporate HIS carries out the following
tasks:
- maintaining of common information space,
intended for immediate access to data;
- improvement of the quality of medical
records;
- control of health care quality and reduction of
medical errors;
- increasing transparency of a medical
institutions;
- constant analysis of economic aspects of health
care;
- reduction of time of examination and
treatment.
The developers of health information systems
have to deal with a constantly changing subject area.
The most important sources of these changes are:
- development of social and economic spheres;
- development of medical science;
- the influence of information technologies on
patients’ behavior (they become more
informed) and health management in general.
Unlike most industries, in medicine there are
three sides of financial and economic relations: the
party that receives services (patient), the party that
provides services (medical organization), and the
party who pays for services (patient, insurance
company, government).
Another special feature of health information
which must be always considered is privacy.
5 OPPORTUNITIES AND
CHALLENGES OF HEALTH
INFORMATION SYSTEMS
5.1 Opportunities
Economic and administrative efficiency of a
hospital:
- cost savings due to reducing of paper work and
errors in billing;
- cost savings on medication due to instant
access to comparison of drugs consumed);
- cost savings on laboratory studies (due to
access to comparison of total annual costs
of laboratories);
- standardization of hospital administration;
- improvement of management decisions due
to an integrated information system;
- access to a more complete, accurate and
structured documentation of clinical data;
- automatic sorting of data;
- direct access to instant updates, including
remote access to a patient's medical history;
- reduction in medical errors due to more
accurate data entry;
- continuous remote monitoring of patients;
- access to analysis and interpretation of data
that can be used for the study of diseases
and preventive measuresin clinical practice.
- Improvement of patient care quality:
- access to patient data from other hospitals;
- simplification of administrative procedures;
- processing of medical records and quick
results.
Remote data processing and transmission -
cloud technologies.
5.2 Challenges
The development of HIS is a complex socio-
technical process, characterized by a high level of
uncertainty.
Different needs of practical health care
representatives (regional authorities, chief
physicians, doctors, nurses etc.).
State medical institutions which purchase
devices and equipment have to adhere to very
serious limitations.
Long-term implementation of HIS in the context
of constantly changing healthcare conditions and
obligations of staff.
HEALTHINF 2017 - 10th International Conference on Health Informatics
426
My baby syndrome: most of the innovation
products in the field of healthcare are promoted by
developers who are too confident in their project.
They may not be able to abandon their project,
ignoring its economic efficiency.
Implementation of information technologies is
time-consuming. It is impossible to immediately
estimate the efficiency of a freshly introduced HIS.
Users need to get used to new tools and new
opportunities provided by software or hardware
modifications. The value and applicability a
particular HIS are constantly changing due to
different economic and management reasons.
Each HIS is to some extend unique. Some
information technologies may be similar in various
aspects, but the functionality may be different.
The success / failure of a HIS depends on
compatibility between the developed device and
existing realities of current medical institutions.
Two key stakeholders of HIS development,
developers and users, may have different versions of
a reality. Developers see HIS exclusively from its
technical feasibility.
Hospitals are concerned about the costs, payback
period, and even the interests of external
stakeholders, e.g. the government.
Creation of large regional and national health
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
such projects is they often do not involve actual
participants of the process. Obtaining and sharing
medical data stored in isolated systems require a
carefully specified product developed by
professionals. At the same time, different regions
and countries apply very different requirements to
such complex systems. The product must have easily
and quickly adaptable to these demands and provide
additional developmental options.
6 FACTORS OF THE
DEVELOPMENT OF HEALTH
INFORMATION SYSTEMS
The main aspects of the development of medical
informatics in general are progress in information
and communication technologies (including data
processing methods), improvement of public
healthcare, and constant changes in the needs,
requirements and expectations of the society.
In Russia and worldwide there are factors which
are more likely to influence the development and
implementation of health information systems at
local and regional levels.
The state policy in the field of IT-based
management is one of them. In this regard attention
must be paid to the problem of different levels of
knowledge in the field of information technologies.
Computer literacy of medical professionals, software
and hardware, unification and standardization of
primary data, methods of processing and
transmission, the possibility of treatment in remote
data centers (cloud architecture), data availability for
physicians and patients are required.
The worldwide popularization of cloud
computing and gradual integration of health
information systems in web-applications and mobile
devices, requiring support of international standards,
must be noted as another impact factor.
Financial capacity of healthcare institutions
directly affects the future of HIS. No matter what
potentially interesting and attractive ideas and
opportunities are offered in the industry, available
financing of each health facility in particular and a
region in general must be properly assessed. The
costs of the proposed solutions and possible
financial support must be considered. Thus, another
important factor of the development of HIS is the
cost - efficiency ratio of information technologies.
7 CONCLUSIONS: TRENDS OF
THE DEVELOPMENT OF HIS
The globalization of IT business is one of the main
tendencies. At present, any person (or company) is a
potential data consumer. Therefore, even
considering tough competition of major
manufacturers, the possibilities of IT market are still
boundless. The main market players include
producers form the US, Japan, France, Britain and
Germany, South Korea, Taiwan, Singapore and
others.
Implementation of software products in medical
institutions for clinical examination and treatment
includes mobile networks, virtualization
technologies, and telemedicine systems which
provide medical professionals with a fast and secure
access to necessary data.
The main trends of the decade 2010 – 2020
include: big data approach; cloud computing; social
networks on health; certification of educational
programs in medical informatics; full
interoperability - communication, devices, semantic
interoperability; integration of molecular & genetic
Health Information Systems: Background and Trends of Development Worldwide and in Russia
427
data; patient empowerment, involvement of Personal
medical record; further steps towards personalized
medicine, increase of patient safety, reduction of
medical accidents and errors; improvement of
preventive medicine and reduction of curative
medicine; use of portable/wearable devices for
monitoring, prediction & prevention; deployment of
home monitoring systems and tele-assistance; deeper
penetration of IT tools in medical research
(modeling & simulation, digital patient etc);
advanced decision support systems.
At present in Russia Medical Cybernetics is a
full-blown health care specialty. Education is
provided by the Siberian State Medical University,
Penza State University and the Voyno-Yasenetsky
Krasnoyarsk State Medical University, in addition to
the education provided by the Pirogov Russian
National Research Medical University. In 2000 the
Russian Ministry of Health approved a program for
this discipline, prepared by the Second Pirogov
Moscow Medical Institute.
In Russia, one of the key trends is creation of a
united national electronic information system
including telemedicine, providing a hot link between
medical organizations of various levels aimed at
remote consultations of physicians.
Distance
learning courses and continuous educational
programs for health care workers are to be
developed.
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.
REFERENCES
Reinhold Haux, 2010. International Journal of Medical
Informatics 79, p. 599–610
Morris F. Collen, 2015. Chapter The History of Medical
Informatics in the United States Part of the series
Health Informatics p. 123-206
Nazarenko G. I., Guliev Ja. I., Ermakov D. E. 2005. Book.
MedicalInformation systems: theory and practice
(Medicinskie informacionnye sistemy: teorija i
praktika), 320p.
M. Ngafeeson, 2014. Chapter. Healthcare Information
Systems: Opportunities and Challenges (IGI Global,
Hershey)
Sonia Valle W. et al., 2011. Journal of Information
Systems and Technology Management Vol. 8, No. 1,
p. 155-178
Jorgen P. Banslera et al., 2010. International Journal of
Medical Informatics 7 9, p. 637–648
Kossova E. V., Muhin Ju. Ju. 2010-2011 Information
systems in healthcare (Informacionnye tehnologii v
medicine), p. 124-148.
Peter Littlejohns et al., 2003. British Medical Journal
326, p. 860–863
Elske Ammenwerth et al., 2003. International Journal of
Medical Informatics 71, p. 125—135
Lebedev G.S. 2011-2012. Information systems in
healthcare (Informacionnye tehnologii v medicine) p.
4262.
Gesev A. V. 2012. Radiotechnics (Radiotehnika)
Zarubina T. V. 2013. Data-measuring and operating
systems (Informacionno-izmeritel'nye i
upravljajushhie sistemy) vol. 11, 10. P. 48.
Gusev A.V. 2006. Doctor and information technologies
(Vrach i informacionnye tehnologii) 5. p. 3243.
International Medical Informatics Association. URL:
http://imia-medinfo.org/wp/welcome-to-imia-2/
World Health Organization. URL: www.who.int
Agha L. 2014. Journal of Health Economics. 34. P.
19–30.
N. S. Fleming et.al. 2011. Health Affairs. Vol. 30, 3.
P.481489.
S. V. W. de Oliveira et.al. // Journal of Information
Systems and Technology Management. 2011. Vol.
8, 1. P. 155178.
George I. Mihalas, 2014. Acta Informatica Medica 22(1):
37–43.
Hasman A., Mantas J., and Zarubina T. 2014. Acta
Informatica Medica. 22(1) p. 25–36.
HEALTHINF 2017 - 10th International Conference on Health Informatics
428