Articles from rubric: «Informatization of healthcare»
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2023 № 7 The use of artificial intelligence technologies as a way to ensure the quality of chest radiography.
When performing radiographic studies, errors may occur that reduce the diagnostic value of the radiographs and complicate their interpretation by radiologists and diagnostic software based on artificial intelligence technology. The creation of automated quality assessment systems will optimize this process, especially in conditions of increased workload of medical personnel.
Purpose: development of an automated quality control tool for chest radiographs, which allows for quality control of the patient’s positioning and the correctness of filling in meta-information about the study.
Material and methods. To train and test automated quality control models, were used 61505 chest radiographs, obtained from open datasets and the Unified Radiological Information Service of the Unified Medical Information Analysis System of the City of Moscow. To create models we used transfer training of deep neural network architectures VGG19 and ResNet152V2.
Results. 7 models were created: a model for determining the anatomical area of study, a model for determining projection, a model for determining photometric interpretation, models for determining incomplete visualization of the anatomical area on the frontal and lateral projections of the chest radiographs, a model for determining rotation on the lateral projection of the chest radiographs. All created models have diagnostic accuracy metrics above 95%, which allows them to be used in clinical practice. Based on the developed models, a web-based quality control tool of the chest radiographs was created, which allows analyzing the quality of X-ray datasets.
Conclusion. The active use of this quality control tool will optimize the process of assessing the quality of diagnostic studies and facilitate the processes of classification of studies and the formation of datasets. Also, this tool can be used to support the decision-making of an X-ray technician and assess the quality of the study before sending the study for processing to artificial intelligence-based services. -
2023 № 6 Experience in the application of artificial intelligence technologies for the development of preventive health care on the example of the Kirov region.
Healthcare is one of the priority sectors for the practical application of artificial intelligence (AI) systems. In 2018, in the Kirov region, it was decided to launch its own regional project for the implementation of AI technologies in order to gain practical experience and understand the features, advantages and barriers to the use of AI. Improvement of preventive medicine was chosen as a priority direction.
The Russian predictive analytics platform Webiomed was chosen as the base software product. The project implementation included 3 stages: pilot testing in 2019–2020, commercial operation in the “second opinion” mode in 2021–2022. and implementation in the digital assistant mode, launched in 2023. As a result of the implementation of the 1st and 2nd stages of the project, it was possible to prove that the main advantage of AI in the analysis of big medical data is the autonomous and high accuracy of interpretation of the information available in it. An AI system for independently extracting the data necessary for analysis from electronic medical records, comparing them with data from past periods, assessing the dynamics of changes in health indicators, and identifying the emergence of dangerous trends and risk factors. Together, this allows the formation of the so-called “digital profiles” of patients, which in turn are a valuable resource for supporting management and clinical decision-making. -
2023 № 6 Methodology for developing medical expert systems using graph databases and ontological approach.
Expert systems are a complex software system that accumulates the knowledge of specialists in specific subject areas and disseminates this empirical experience for consultations with less qualified users, which reduces the number of medical errors caused, in particular, by a lack of specialist doctors in local areas and the time required for a single consultation.
P u r p o s e of the study is to present a modern methodology for developing expert systems based on knowledge engineering using an ontological approach and graph databases.
M a t e r i a l s a n d m e t h o d s . System analysis methods were applied during the creation of the methodology for developing expert systems, including analytical and descriptive methods, knowledge engineering methods such as structuring methods, knowledge representation, and fuzzy logic. The methodology assumes the use of a graph database as a storage for the knowledge base.
R e s u l t s . The methodology describes the process of developing expert systems based on a graph database using an ontological approach. It includes the following components: a knowledge base, an intelligent editor of the knowledge base, a problem solver, and explanation subsystem. The methodology assumes the participation of a group of experts in the development of the expert system, with whom the development of two artifacts is carried out: a terminological database of the subject area and intermediate information objects describing the logic of solving the problem. Both artifacts should be formed automatically using the intelligent solver of the knowledge base, as well as filling the knowledge base, which will facilitate the subsequent maintenance of the knowledge base and keep it up-todate.
According to the methodology, the solver and explanation subsystem work with a graph database, which is a means of storing the knowledge base, in order to find the optimal path in which nodes are used to solve the problem of the expert system, for example, supporting a specialist doctor in establishing a preliminary/final diagnosis, and the path is used by the explanation subsystem to argue the proposed solution of the expert system.
F i n d i n g s . A methodology for creating expert systems using a graph database and an ontological approach has been developed and presented. The methodology describes the development of two components: a knowledge base and a combined component consisting of a solver and an explanation subsystem. -
2023 № 5 Development of the telemedicine services market in the form of remote consultations during the COVID‑19 pandemic
During the COVID‑19 pandemic, there was an ever-increasing demand for telemedicine services in remote consultation format. This review analyzed 24 scientific publications, literary data in PubMed, eLibrary, «Guarantor», «Consultant» and WHO databases on this issue.
The purpose of the study. The purpose of the review is to assess the current state and possible ways to address problematic issues in the development of the market for telemedicine services.
Materials and methods. The research method was systematic review. As a result of the work carried out, it was revealed that the development of the market of telemedicine services in the form of remote consultations in the Russian Federation is much slower than abroad, due to the presence of certain provisions in the legislative framework, making it difficult to expand the horizons of telemedicine applications.
Results. The most important issues are ensuring the adaptation of the legal framework, technical security of confidentiality of information, insurance of the risk of professional responsibility of medical workers and guarantees of patient rights. It was concluded that the development of the market for telemedicine services in the form of remote consultations was expected in connection with the pilot legal regime submitted for consideration in the Russian Federation.
Findings. This trend will contribute to improving the availability and quality of health care. -
2023 № 5 Soft-technologies in medical rehabilitation after reconstruction of the anterior cruciate ligament of the knee joint.
The use of soft-technologies in medical rehabilitation is a highly relevant and promising direction of the remote method of restoring the health of patients. The authors have developed a program for an electronic computer «Medical rehabilitation (therapeutic gymnastics after reconstruction of the anterior cruciate ligament of the knee joint)». It is designed for patients to independently perform a set of exercises of therapeutic gymnastics at home. Based on the results of the lesson, the patient fills out a report, on the basis of which the attending physician makes adjustments to the individual medical rehabilitation plan. The analysis of the results of the approbation based on an anonymous survey
indicates high patient satisfaction when using a mobile application and an increase in commitment to the implementation of recommendations. -
2023 № 4 Medical datasets for machine learning: fundamental principles of standartization and systematization.
Backgraund: Active implementation of artificial intelligence technologies in the healthcare in recent years promotes increasing amount of medical data for the development of machine learning models, including radiology and instrumental diagnostics data. To solve various problems of digital medical technologies, new datasets are being created through machine learning algorithms, therefore, the problems of their systematization and standardization, storage, access, rational and safe use become actual.
A i m : development of an approach to systematization and standardization of information about datasets to represent, store, apply and optimize the use of datasets and ensure the safety and transparency of the development and testing of medical devices using artificial intelligence.
M a t e r i a l s a n d m e t h o d s : analysis of own and international experience in the creation and use of medical datasets, medical reference books searching and analysis, registry structure development and justification, scientific publications search with the keywords “datasets”, “registry of medical data”, placed in the databases of the RSCI, Scopus, Web of Science.
R e s u l t s . The register of medical instrumental diagnostics datasets structure has been developed in accordance with stages of datasets lifecycle: 7 parameters at the initiation stage, 8 – at the planning stage, 70 – dataset card, 1 – version change, 14 – at the use stage, total – 100 parameters. We propose datasets classification according to the purpose of their creation, a classification of data verification methods, as well as the principles of forming names for standardization and datasets presentation clarity. In addition, the main features of the organization of maintaining this registry are highlighted: management, data quality, confidentiality and security.
C o n c l u s i o n s . For the first time, an original technology of medical datasets for instrumental diagnostics structuring and systematization is proposed. It is based on the developed terminology and principles of information classification. This makes it possible to standardize the structure of information about datasets for machine learning, and ensures the storage centralization. It also allows to get quick access to all information about the dataset, and ensure transparency, reliability and reproducibility of artificial intelligence developments. Creating a registry makes it possible to quickly form visual data libraries. This allows a wide range of researchers, developers and companies to choose data sets for their tasks. This approach ensures their widespread use, resource optimization and contributes to the rapid
development and implementation of artificial intelligence. -
2023 № 4 Determinants of the use of telemedicine in pediatric dentistry.
Currently, favorable conditions are being created in the Russian Federation for the development and effective use of telemedicine in healthcare. Options for the use of information and communication technologies in pediatric dentistry are: telemedicine consultations, consultations, distance education of medical workers, medical education and preventive activities among the child population.
The aim of the research as part of the dissertation work, the research was aimed at studying the attitude of dentists to the use of telemedicine technologies in pediatric dentistry.
Materials and methods. The process of studying the attitude and readiness of pediatric dentists to use telemedicine technologies was aimed at identifying individual (micro) and conceptual (meso- and macro) factors affecting the use of medicine in pediatric dentistry. The study included a semi-formal interview and questionnaire.
Results. As a result of the research on the sections: Telemonitoring – remote monitoring of patients, including outpatient management of patients; storage and transmission of medical data; interactive telemedicine, it was found that doctors in Tver and the Tver region have both positive and negative beliefs and opinions that can promote or hinder their use of telemedicine in their professional practice.
Conclusions. Research with the participation of pediatric dentists will help both developers and managers of medical institutions to understand the limitations and advantages of technologies from the point of view of practicing pediatric dentists, will allow predicting its development.
The results of this study will contribute to solving the problems of implementing telemedicine services, contribute to the rational development of telemedicine platforms in pediatric dentistry in Tver and the Tver region. -
2023 № 4 Evaluation of the effectiveness of using remote monitoring of blood pressure in the dispensary observation of patients with arterial hypertension
Arterial hypertension (AH) is by far the most important risk factor for cardiovascular disease. An effective method of dealing with high blood pressure (BP) is dispensary observation. Of particular relevance is the search for new tools to improve the dispensary observation of patients with hypertension, one of which may be remote monitoring of blood pressure, as an option for providing medical care using telemedicine technologies.
Purpose of study – Analysis of the effectiveness of using remote monitoring of blood pressure in the dispensary observation of patients with hypertension.
Methods. A non-randomised, open-label, generalized, single-centre, retrospective, longitudinal, parallel, applied study included 78 patients who completed a remote blood pressure monitoring program who were subsequently divided into 2 groups depending on the degree of achievement of target values of blood pressure (<135/85 mm Hg).
Results. During the observation period, all patients (n=78) experienced a decrease in SBP by 8.2 mmHg, DBP at 3.8 mmHg. Group 1 consisted of 35 patients who reached target levels of blood pressure, group 2 included 43 patients who did not reach target levels of blood pressure. Initially, the groups did not differ in sex and age, while in the second group, the initial values of SBP and DBP were higher. The study found that the degree of achievement of target levels of blood pressure is influenced by the following factors: the level of SBP and DBP at the beginning of observation, the proportion of extraordinary measurements with blood pressure levels above 135/85 mmHg during the observation period, the proportion of missed blood pressure measurements during the observation period, as well as the duration of remote monitoring.
Conclusions. Remote monitoring of blood pressure is an effective tool for improving the dispensary observation of patients with arterial hypertension and can improve the availability and quality of medical care. -
2023 № 4 The possibilities of redistributing the functions of the city clinic at the opening of the Distant consultation center unit.
Goal. To evaluate the interim results of a pilot project on the organization of an independent unit of a city clinic that provides remote support to citizens – the Distant Consultation Center of the Government Autonomous Organization Healthcare “City Clinic No. 8” (hereinafter referred to as the DCC).
M e t h o d s o f w o r k . To assess the effectiveness of the pilot project, a number of indicators of the work of the medical organization were analyzed before the start of the project and 12 months after the start of its implementation. The analysis was carried out in two way of work of the Distant Consultation Center: 1. the process of providing medical care to patients with acute respiratory viral infections / Influenza / COVID‑19; 2. the process of providing medicines to the Subsidized category of citizens. The volumes of work that can be transferred to the Distant Consultation Center
from the department of primary care physicians care and from the emergency medical care are analyzed.
The source of the data was the medical information system of the medical organization “URMO TO” (modules Registry, Control of realization, doctor’s ARM, Disability sheets, Additional processing). The period of work of the medical organization from 01.01.2022 to 31.12.2022 is analyzed.
Statistical processing of the results was carried out using the Statistica 6.0 application software package.
Distance consultation was carried out via IP telephony, as well as using specialized Telemedicine software.
R e s u l t s o f t h e w o r k . Before the organization of the DCC, the median indicator of the actual workload per hour of the covid team was 2,5 [2,3–2,7] patients, p<0,07. While the doctor of DCC carried out an average of 56,9 [44–68] remote consultations, which is an average of 8,8 patients per hour, p< 0,07.
The median value of patients for prescriptions for Subsidized medicines before the start of the project was 4 [3–6] patients per day (p<0,07), on average 22.2% time of the initial consultation falls on patients requiring a Subsidized medicine. The median value of applications for the purpose of providing Subsidized categories of citizens with medicines when discharged by a medical assistant at the DCC was 1 [0–3] (p<0,08). Thus, this section began to occupy 0,06% in the structure of reasons for the initial appointment to the primary care physician.
C o n c l u s i o n s . The organization of the work of the DCC allowed us to develop approaches, approve and adapt them to the processes of filling out the schedule of primary care doctors in order to increase accessibility to the primary consultations of the primary care physician’s department.
Scaling up the organizational model and processes of the Distance consultation center of the Municipal Polyclinic No. 8 can serve as an effective tool in achieving the goals announced within the framework of the pilot project of the Ministry of Health of the Russian Federation “Incident 38” launched in 2022.
T h e s c o p e o f t h e r e s u l t s . The presented experience shows the possibility of managing patients with respiratory viral diseases in outpatient polyclinic conditions on an ongoing basis, as well as the telemedicine format of care can be extended and adapted to non-infectious nosologies. -
2023 № 4 The use of information technologies in assessing the quality of medical care
The currently relevant value-based healthcare model (Value-Based Healthcare) is more focused on ensuring long-term effectiveness and patient satisfaction, which is directly related to the implementation of the principles of patient-oriented and patient-centered activities [1].
In accordance with the Proposals (practical recommendations) on the organization of internal quality control and safety of medical activities in a medical organization (hospital) of the Federal State Budgetary Institution “National Institute of Quality” of Roszdravnadzor, compliance with the principles of patient-centered medical care provides for the development and implementation at the level of a medical organization of a patient safety strategy, including compliance with ethical standards and rules in the implementation of medical care activities. This also includes the procedure for organizing feedback with patients [15].
The use of information technologies in patient questionnaires and analysis of results allows for operational monitoring of patient satisfaction indicators and to create a basis for assessing most aspects of hospital activities from the perspective of patients: the quality of medical services and their results, interaction with staff, infrastructure and service components.
The purpose of the study is to provide the results of the implementation of the author’s information and analytical system for collecting and processing information about patient satisfaction through an electronic web questionnaire and providing the calculation of satisfaction indicators in a multidisciplinary hospital.
M a t e r i a l s a n d m e t h o d s . The basis of the study was a multidisciplinary hospital of the state budgetary healthcare institution “Regional Clinical Hospital No. 2” in Vladivostok. Within the framework of the study, the inpatient patients were surveyed using questionnaires in electronic form prepared by a medical organization, an information and analytical system was developed to conduct a mathematical analysis of the results of the survey according to five criteria for assessing the quality of medical care conditions.
The study used a questionnaire including 20 questions, the answers to which express the opinion of patients about the quality of work of doctors and nursing staff, the comfort of the conditions of stay in the emergency department, as well as in the hospital during hospitalization.
The questionnaire was developed in 2015, and for many years the survey was conducted using paper and manual calculations. But since 2021, patient questionnaires and analysis of the collected data have been transferred to an electronic format.
In this article we present the results obtained with the help of an information system for collecting and analyzing questionnaires, in which adult patients of a round-the-clock hospital participated.
R e s u l t s . The use of information technologies in patient questionnaires and analysis of results allows for operational monitoring of patient satisfaction indicators and to create a basis for assessing a number of aspects of hospital activity from the perspective of patients: the quality of medical services and their results, interaction with staff, infrastructure and service components make it possible to evaluate the effectiveness of measures to ensure comfortable conditions for the patient’s stay and can be used in practical healthcare to organize measures to eliminate defects and make decisions on the management of a medical organization.
C o n c l u s i o n s . The introduction of additional methods for studying patient satisfaction using electronic forms, taking into account the specifics of the work of a medical organization to the requirements established by the Ministry of Health of the Russian Federation, makes it possible to increase the effectiveness of interaction with patients and can be one of the tools for assessing the social effectiveness of a medical organization (hospital). -
2018 № 2 Financing of Informatization of Public Health in Russia in 2013–2016
The analysis of state purchases of software and services for the informatization of health care for the period 2013-2016 was carried out. As the study materials, public data from the public procurement portal on procurement of software and health information services, which were conducted under Federal Law No. 44-FZ of 5.04.2013, were used. Data on procurement of hardware, activities to ensure information security or provision of communication channels in this study have not been studied. The work analyzes the main statistical indicators of competitive procedures, data on the winners of tenders and auctions, data on the main areas of financing, the distribution of funding by region, types of costs and types of software. In general, for informatization of health care, at least in terms of software and related services, Russia spent about 4-5 billion rubles over the past 4 years. in year. In 2015, the volume of financing decreased significantly - by 44.4% to the level of 3.6 billion rubles, in 2016 showed an increase of 10%. Financing of health informatization is carried out mainly through regional budgets, extrabudgetary funds and MHI. Over the past time, the situation with developers and applied solutions has generally stabilized. The main funding is allocated to regional systems with a 61% share of costs, as well as medical information systems of an institutional level with a 27% share of costs
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2014 № 11 Personalized record-keeping of persons involved in the health care (Military medical academy of S.M. Kirov, Saint-Petersburg, Russia).
It was carried out an analysis of the current state of the procedure of personal record-keeping in the process of medical care conduction of persons involved in the health care and its impact on the public health system. There were substantiated and formulated some proposals to improve it as well as prospects of application in medical information systems.
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2013 № 4 Assessing the economic efficiency in healthcare information systems (Ailamazyan Program system institute of RAS, Pereslavl-Zalessky, Russia)
This article describes methods of assessing the economic efficiency of informatization project in medical institution. The described methods take into consideration costs and benefits of a medical institution. The results of assessing the investment projects in some clinics of different type are considered in this article.