Medical informatics is a powerful tool in healthcare systems of the leading Western countries, it provides all the levels of healthcare system with necessary data needed for proper clinical, managerial and political decisions.
    On clinical level the data flow consists mainly of personal medical data to provide correct diagnosis and proper treatment. A partial case is telemedicine, which can be described as “remote communication of information to facilitate clinical care” (E. Coiera, 1997).
    Next level of medical informatics is healthcare managerial level, where the data from medical institutions are collected, the data are needed for most effective management of medical resourses within local, regional, or national healthcare systems.
    The higher level of medical information exchange is society (or political) level. At this level population, mass media and political circles are supplied with data on most sensitive (most important for society) healthcare problems.
    It can be seen that the healthcare systems that function improperly (like most medical systems in ex-USSR countries nowadays) evidently lack integrity of their medical information systems. Not only lack of financial resources causes slow implementation of modern informational technologies in this group of countries, but also vice versa, unreliable data appearing at different levels of medical system may cause really wrong decisions in sphere of public health.
    Low development of medical informatics in ex-USSR countries (including Russia) can be easily demonstrated by relatively low numbers of publications from these countries on this topic, according to MedLine, in comparison with higher number of such publications from East European countries, not saying about developed countries of Western Europe and the USA.
    For example, there are only 587 publications on medical informatics in Russia, according to MedLine data by July 2001, but there are 175 publications on the same topic from Poland (the number of physicians is 8 times less than in Russia) and 146 – from Hungary (number of physicians is 15 times less than in Russia). The contribution of Sweden was 815 publications, Germany - 2164 articles, the USA – 42457 publications.
    One of the most underdeveloped fields of medical informatics in Russia and other ex-USSR countries is informatics in occupational and environmental medicine. The social and political importance of this sphere and the need of its proper informational supply cannot be overestimated. It is often a temptation for medical and political leaders of new independent countries to “correct” the figures of occupational and environment-related morbidity. Creation of reliable system of medical information transfer in sphere of occupational and environmental health is a must to prevent such politically related “corrections” of socially important data.
    Nowadays a system of so-called «Social and Hygienic Monitoring» (SHM) is implemented in Russian regions, according to the order of Healthcare Ministry of Russian Federation. Unfortunately, the primary data used for SHM are obtained from paper reports of sanitary service institutions (where intentional “corrections” can easily be made), not directly from computerized medical databases that are extremely rare in Russia now. The total list of indexes used for SHM is very short, so the date collected cannot provide really valuable information on relations between environment pollution and morbidity of population.
    The similar situation can be found in sphere of occupational medicine, where registers of patients with occupational diseases are not fully created yet. It results in significantly lower official rates of occupational diseases in Russia than the rates in European countries – Russian rates are up to 100 times lower, that just cannot be true! The only implementation of telemedicine in occupational and environmental medicine in Russia is made in Nizhny Novgorod Research Institute of Hygiene and Occupational Pathology (NV Matveev, 1998-2001).
    To change the situation with medical information in such socially important spheres of medicine as occupational and environmental medicine, a reform in this field must be performed, and the conception of such reform must be elaborated basing on strictly scientific analysis of the needs and possibilities of healthcare system of contemporary Russia, and also on experience of the other countries.

The aim of the proposed research is the scientific substantiation of conception of reform of medical informatics in sphere of occupational and environmental medicine in Russia.

The main tasks of the research are the following:

1) To elaborate criteria for evaluation of various systems of medical informatics in sphere of occupational and environmental medicine.

2) Basing on elaborated criteria, to evaluate systems of medical informatics, with especial attention toward occupational and environmental medicine, in several regions of Russia (e.g. Nizhny Novgorod region, Mordovian Republic, Arkhangelsk region).

3) To evaluate systems of medical informatics, also with main attention toward occupational and environmental medicine, in 1-2 ex-USSR republics (e.g. in Ukraine, in Estonia).

4) To evaluate medical informatics systems in several European countries with advanced occupational and environmental medicine (e.g. Hungary, Sweden).

5) Basing on collected data, to choose several directions of medical informatics, development of which in Russia can be most effective.

6) To create a general conception and detailed plan of implementation of reform of medical informatics in sphere of occupational and industrial medicine in Russia.

    To accomplish task 1, the access to resources of Western electronic journals on medical informatics will be needed.
    Tasks 2 and 3 can be accomplished after 4-5 business trips for 5-7 days to various regions of Russia or ex-USSR.
    To communicate with colleagues from European countries (task 4), 1-2 travels abroad can be made (7-10 days for each travel), later ISDN videoconferences might be used for such communication to save travel expenses (Nizhny Novgorod Research Institute of Hygiene and Occupational Pathology possesses the necessary equipment for such videoconferences).
    The final document, describing conception of the reform, might be affirmed on the regional level or by Russian Healthcare Ministry.
    The document should be published to make it available for medical circles in all countries of ex-USSR. Certain work should be done to make the document known for society and political circles; this can help the most effective implementation of the reform. The attention of mass media and population should also be drawn to the project, to provide public support for it.
    The implementation of the conception of reforms would enable creation of reliable data management system for occupational and environmental medicine in Russia. It will make this sphere of medicine more transparent for the society, and allow making more substantiated managerial and political decisions.