Health Information Systems: Background and Trends of

Development Worldwide and in Russia

Elena Vaganova

1,2

, Tatiana Ishchuk

, Anatoly Zemtsov

and Dmitry Zhdanov

1,2

National Research Tomsk State University, 36, Lenin Ave., Tomsk, Russia

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

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.

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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.

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