Focus of problem
  • 2020 № 6 Application of the method of analysis of “oriented trees with assessments” to identify regional features of forming the pathology of dairy teeth in children

    In order to identify regional features of the sequence of lesions of primary teeth in children, the data of the medical in- formation system of a children’s hospital using the method of “oriented trees with estimates” were used. The data of 3,405 children under the age of 6 years who contacted a dentist about diseases of deciduous teeth during 2015–2018 were analyzed. They had 17,462 appeals. It was found that in 516 children the first diseased milk tooth was 51, with an average age of 2.72 years. The second is either 61 (237 patients, with an average age of 2.91 years), or 52 (224 patients, with an average age of 2.58 years). In 113 patients, a sequence of newly diagnosed affected primary teeth 51–52–61 was observed. Only one tooth was observed in 59.9% of patients, in 13.1% of two and in 27% of three or more teeth. It is calculated that if premolar is the first diseased milk tooth, then with a probability of 0.619 the next will be the same as the premolar. Application of the method made it possible to es- tablish regional features of the sequence of lesions of primary teeth in children and to develop approaches to individual prevention.

    Authors: Choloyan S. B. [11] Pavlovskaya O. G. [8] Sheenkova M. V. [7] Ekimov A. K. [10] Baygazina E. N. [6] Tricomenas N. N. [3]

    Tags: baby  teeth1 medical care for children4 medical information system5 regional  features1 the  method  of  “oriented  trees  with  estimates”1

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  • Information management
  • 2022 № 1 About the ability of the Uniform State Health Information System to solve management problems

    The unified state health information system (UHISZ) is becoming a state-significant information system (IS), which is capable of solving any problems of preserving and strengthening the health of citizens.
    Purpose of the study is to substantiate the problems of the construction and functioning of the Unified State Health Information System, the solution of which will multiply the capabilities of the Unified State Health Information System to solve the problems of preserving and strengthening the health of citizens and look for new non-traditional ways to improve their health.
    Results. I n the article, the authors distinguish three levels of problems to be solved. The first level of problems is problems that can be solved at the highest (legislative) level. The second level of problems is the problems that must be solved at the regional level. The third level of problems is the problems faced by ordinary users of the Uniform State Health Information System – doctors and other medical workers.
    The article initially uses the position – “Any information system is a tool for solving management problems.” The authors trace the stages of creating informatization in the Russian Federation from the complex program “Development and implementation of automated consultative systems for diagnosis, prognosis and choice of treatment tactics in emergency conditions”, which substantiated the development of automated systems for the period 1978–1990 until 2018, when Russia was the National Healthcare Project was launched, which includes the Federal project “Creation of a unified digital circuit in health care based on the unified state health information system (Unified State
    Health Information System) ”. The article discusses the problem of the privacy of data on the health of a resident of the region and the privacy of knowledge of the factors that determine both the health of a particular resident of the region and those around him. Preserving the complete privacy of a citizen’s “personal space” will lead to the fact that the Unified State Health Information System will have the most general data on the health of a resident of the region. In this case, it will only be possible to solve those problems that characterize the health of the region’s inhabitants, which were solved without any digitalization. The second level of problems is associated with the work of “Uniform State Health Information System” and support programs operating at the level of the regional health care system. The main
    regional problems associated with “EGISZ” are: problems of licensing of auxiliary programs; problems of accounting for the quantitative parameters of the development of the Uniform State Health Information System and auxiliary programs; problems of control over the work of auxiliary programs; problems of control over the filling of the Uniform State Health Information System; the problem of “user-friendliness of the interface” (especially for departments with cases of “peak work” – emergency departments).
    Separately, it should be noted the issues that are not problems of the functioning of the Uniform State Health Information System, but more characterize the new opportunities that arise in the presence of the Unified State Health Information System, which has a wide range of knowledge about human health. Uniform State Health Information System allows to solve in a different way the traditional tasks of an informational, organizational, medical, economic, scientific and educational nature that exist in the region. The noted fact prompts to look for new problems of assessing the health of residents of the region and ways to solve them, which were previously unavailable due to the lack of systematized data on the treatment and diagnostic process, other aspects of the activities of medical organizations, as well as information on factors affecting the health of residents of the region.
    Conclusions. Any information system is a tool for solving management problems. Without eliminating the problems of replenishing the Uniform State Health Information System with data on the factors influencing the health of the inhabitants of the region, it is impossible to effectively solve the problems of preserving and strengthening the health of the citizens of the region. The data, which, in accordance with the Federal Law “On Personal Data”, are included in the list of closed data, are encrypted in the EGIZS. To oblige the regional health authorities to introduce a licensing mechanism for programs interacting with the regional Unified State Health Information System.
    The development of regional Uniform State Health Information System will lead to a radical change in the view of the traditional tasks of information, organizational, medical, economic, scientific and educational nature, solved in the region.

    Authors: Choloyan S. B. [11] Ekimov A. K. [10] Baigazina E. N. [3] Molodtsov N. S. [3] Kalinina E. A. [3] Posnov A. A. [3]

    Tags: health care24 information systems4 management14

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  • 2021 № 8 Evolution of information systems

    In medical organizations, information systems solve the following tasks: the ability to receive and store information, quick access to it and its transmission, the ability to generate various reports, the availability of specialized workplaces of medical workers, etc. Information systems are gradually evolving, turning from a tool capable of solving the simplest management tasks into a tool capable of solving the entire range of management tasks encountered in the practice of a medical organization at all levels of management. The purpose of the study is to describe the four stages of creating information systems, highlight the characteristic features of the functioning of information systems at each stage, as well as highlight the list of the main management tasks that are being developed at the selected stage and ways to solve them. The main attention was paid to the development of information systems of medical organizations working with the children’s population.
    Results. The first stage of the development of information systems began with the use of computer technology in the practice of medical organizations and was reduced to the fact that programmers of both medical and third-party organizations began to develop tasks, the totality of which later became known as “creating an information system” of a medical organization. The goal of the second stage is already the transformation of information systems of medical organizations in order to describe production processes in terms of a process approach and implement them in the form of software modules. The third stage of building information systems is the stage of describing the work of a medical organization based on mathematical models in order to justify the optimal solution of the production tasks available in it. The fourth stage of building information systems is the construction of an “information system that implements the functions of an intelligent management system of a medical organization”. The authors of the article give recommendations on the formalization of information available in a medical organization for the purpose of its
    effective use by artificial intelligence.
    Findings. Thus, an information system is a tool for solving management problems, its development as a tool for solving management problems requires knowledge of management theory, organization theory, process approach in management, methods of multidimensional statistical analysis and modeling methods, languages and modeling methods based on neural networks.

    Authors: Choloyan S. B. [11] Ekimov A. K. [10] Baigazina E. N. [3] Molodtsov N. S. [3] Kalinina E. A. [3] Posnov A. A. [3]

    Tags: artificial intelligence2 information system3 mathematical models2 medical organization49 neural networks1 process approach7

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  • Management in health care
  • 2021 № 10 MODERN APPROACHES TO SOLVING THE TASKS OF MANAGEMENT OF MEDICAL ORGANIZATIONS

    A large amount of data is currently appearing in the information systems of medical organizations, which requires a revision of those industrial relations that exist in the practice of health care institutions.
    T h e p u r p o s e o f t h e s t u d y is to study the possibilities of mathematical methods using the concept of “an object with estimates in a certain state” to solve management problems that are in the practice of medical organizations.
    R e s u l t s . The authors use the term “production process”, which is not typical for the classical description of the activities of a medical organization. This is due to the fact that the approaches to solving management problems available in a medical organization are valid not only for medical and diagnostic work, but also for other household work. New approaches to solving the existing management problems of a medical organization consist in the fact that the description of the solution to the control problem is made in the form of some algorithm, which can then be implemented in some programming language. The digitization of production processes leads to the need for their formalized description in the language of mathematics, as well as the widespread use of mathematical methods, on the basis of which algorithms for solving control problems are built. Markov chains make it possible to find general patterns in the behavior of control objects within the framework of the problem being solved, which can be used to construct a tree giving a detailed description of the behavior of each control object. Further, the method of oriented
    trees with estimates is applied, which provides information for writing job descriptions for employees of the Ministry of Defense, on the basis of which the management problem will be more optimally solved. It is necessary to highlight four features of the method of oriented trees with estimates: it allows to give a detailed analysis of the sequence of transitions of each object for the selected states; in the presence of a large number of analyzed objects, the resulting tree is difficult to analyze; you can rebuild the branches of the tree; in the course of building a tree, it is possible to change a set of states without changing the obtained chronological sequences of states of each control object in the initial data. Oriented trees with estimates can be used to simulate the production process, which is based on the possibility of simultaneously changing both quantitative and qualitative characteristics of the tree.
    The article presents two options for modeling using changes in the qualitative characteristics of the tree.
    F i n d i n g s . The introduction of digitalization in healthcare requires a different approach to solving management problems, which should be carried out with extensive use of mathematical methods at the stages of analysis and modeling. The work on the use of mathematical methods in solving management problems should be organized by regional medical information and analytical centers.
    It is necessary to carry out work on the formalization of production processes, the creation and storage of algorithms for solving control problems. Promising methods that allow solving most of the management problems available in the practice of medical organizations are the methods of Markov chains with estimates, branching processes with estimates and oriented trees with estimates.

    Authors: Choloyan S. B. [11] Ekimov A. K. [10] Baigazina E. N. [3] Molodtsov N. S. [3] Kalinina E. A. [3] Posnov A. A. [3]

    Tags: digitalization of healthcare2 management of a medical organization1 mathematical methods1 production process1

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  • 2020 № 7 Modern approaches to the construction of an effective model of preventive work with children

    The approaches to the analysis of the information of the medical information system about the child population
    attached to the medical organization (22,950 children) are described to identify homogeneous groups in order to build a
    preventive work plan with each. The team of experts of the medical organization has developed an electronic work plan for
    4,745 options for monitoring a child, which is implemented as a computer program that allows you to automatically rearrange
    the plan. It is considered as a sequence of standard operating procedures. The program automatically “restructures”
    the calendar plan of work with the child, allowing you to complete the missed work in an acceptable time for the child
    and the performer. The use of such planning is especially necessary for work in the conditions of prevention of COVID‑19.

    Authors: Choloyan S. B. [11] Pavlovskaya O. G. [8] Sheenkova M. V. [7] Ekimov A. K. [10] Baygazina E. N. [6] Tricomenas N. N. [3]

    Tags: medical care for children4 medical information system5 medical planning1 prevention17 process approach7

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  • Management in healthcare
  • 2019 № 9 Modern approaches to the analysis of emergency medical care for children

    112 936 cases of 24-hour emergency medical care in a children’s clinic for 2018 were analyzed. The meth¬ods of multivariate statistical analysis and theory of time series are used. It has been established that about 30% of the challenges occur in children of the first year of life. From January to March and from June to October, there is an increase in the number of calls. The days with the most calls are the 12th, 19th and 26th of the month. Almost a quarter of weekly calls fall on Monday. The resulting model of the call service duration structure allows you to evaluate changes in the work of the emergency service in different periods and proves the need for round-the-clock work.

    Authors: Choloyan S. B. [11] Pavlovskaya O. G. [8] Sheenkova M. V. [7] Ekimov A. K. [10] Baygazina E. N. [6] Dmitrieva I. V. [3] Tricomenas N. N. [3]

    Tags: emergency medical care2 factor analysis1 markov chains with estimates1 medical care for children4 time series1

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  • 2019 № 8 Modern management of medical organization based on the process approach in russian scientific publications

    The intensity and direction of development of the process approach in the management of medical organizations from the time of the first publications in the Russian literature to the present has been evaluated. 282 literary sources were studied, of which 235 were for managing a medical organization and 47 were papers that analyzed the construction of business processes in non-medical enterprises. It was found that to accelerate the pace of building business processes in medical organizations, it is necessary to use computer programs for building processes.

    Authors: Choloyan S. B. [11] Pavlovskaya O. G. [8] Sheenkova M. V. [7] Danilova L. V. [4] Ekimov A. K. [10] Baygazina E. N. [6] Dmitrieva I. V. [3]

    Tags: medical organization49 process approach7 quality management system8

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  • 2019 № 3 The formation of a new model of medical organization providing primary health care. Treatment of patients in the clinic: analysis and modeling

    As part of the formation of a new model of medical organization providing primary health care to children promising mathematical apparatus for management decision-making are Markov chain with estimates. The generation of models with different scenarios in the treatment of children in the clinic revealed that the activation of dispensary work leads to a decrease in both the number of visits for diagnostic and treatment purposes, as well as the total number of visits to the clinic. The experience of dispensary work will be replicated in other regions from 2019.

    Authors: Choloyan S. B. [11] Pavlovskaya O. G. [8] Sheenkova M. V. [7] Danilova L. V. [4] Ekimov A. K. [10] Baygazina E. N. [6] Dmitrieva I. V. [3]

    Tags: markov chains2 markov chains with assessments1 modeling of management decisions1 primary health care for children1 seeking medical care1

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  • 2019 № 2 Management of a medical organization based on Markov chains with grades

    Different aspects of management decision-making based on mathematical models have been actively examined in scientific papers over recent years. The mathematical apparatus of Markov chains with estimations is a perspective mathematical apparatus of management decision-making. The advantage of Markov chains with estimations is that the method adequately works with quantitative, as well as with qualitative data. The modelling based on Markov chains is a variation of imitational modelling using random number generators. Generating models with different scenarios allows to find a management decision that has the best characteristics of the required state of a medical organisation.

    Authors: Choloyan S. B. [11] Pavlovskaya O. G. [8] Sheenkova M. V. [7] Danilova L. V. [4] Ekimov A. K. [10] Baygazina E. N. [6]

    Tags: markov chains2 markov chains with estimations1 medical organisation management1 modelling management decisions1

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  • 2018 № 9 Influence of activity of the medical organization, providing medical assistance to children, on the economy of the region

    The analysis of 46 7122 entries in the medical information system of the organization for 2016 characterizing the treatment of children for the purpose of medical care, 9533 cases when the sheet can not work (SNW) was issued. The costs of territorial funds of compulsory medical insurance (CMI) and social insurance fund, an internal regional product for the treatment of a child, are estimated. It is established that the budget of the region loses 8,9 times more than the amount of CMI funds that was spent for the treatment of the child, if issued by the SNW. This requires active prophylactic measures for children.

    Authors: Choloyan S. B. [11] AEkimov. K. [1] Pavlovskaya O. G. [8] Sheenkova M. V. [7] Danilova L. V. [4]

    Tags: compulsory medical insurance14 compulsory social insurance1 gross domestic product1 payment of a disability certificate1 preventive measures for children1

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  • Population and healthcare
  • 2021 № 4 REMOTE EFFECT OF IMMUNOPROPHYLATICS OF INFECTIOUS DISEASES ON THE APPEALS OF CHILDREN TO THE POLYCLINIC

    The structure of complaints about diseases of 28,432 children aged 0 to 14 years was studied, for the period from 2006 to 2019 to a medical organization against the background of vaccination. The data of the medical information system were used. To compare the distributions of values in vaccinated and unvaccinated children, the “copy-pairs” method and the nonparametric Mann-Whitney test were used. It was found that the analysis of data over a long period of time, allows you to identify special effects. Thus, the vaccinations given to children do not lead to a decrease in the number of visits for diseases, but lead to changes in the structure of visits by children in ICD‑10 classes. In unvaccinated children, the proportion of requests for diseases of the genitourinary system, infectious and parasitic diseases is significantly higher than in vaccinated children. Starting from the age of 4 years, the proportion of vaccinated children with diseases of the digestive system is higher than that of unvaccinated children.

    Authors: Choloyan S. B. [11] Pavlovskaya O. G. [8] Ekimov A. K. [10] Setko N. P. [1]

    Tags: immunization of infectious diseases1 medical information systems10 the calendar of vaccinations for epidemic indications1 the incidence of children1 the national calendar of preventive vaccinations1 the organization of medical care for children1

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