“CONCEPTION OF REFORM OF MEDICAL INFORMATICS IN THE FIELD OF OCCUPATIONAL AND ENVIRONMENTAL MEDICINE IN RUSSIA”
Dr. Nikolay V. Matveev, Nizhny Novgorod, Russia
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.