Electronic health record
Perm Krai was the first to start working with the updated interface of the electronic health record. Currently, 100% of the region's residents have records in the EHR and access to information about their health through the portal of the the Public Services Portal and the Regional Portal of Medical Services "K-vrachu".
- The doctor assigns appointments to the EHR taking into account the workload of other doctors and the patient's time.
- Signaling information: structured history of treatment cases.
- Diagnoses: complete systematization of appointments.
- Formalization of the parameters of medical care.
- Research: quick access to patient documents.
- Automatic selection of the minimum time with the distribution of consultations or research.
- Minimization of visits by a patient to a medical organization.
- Awareness of the doctor about the patient's condition prior to examination.
- Prompt diagnosis based on the patient's medical history.
- Laboratory results and medical images are available in the EHR immediately after submission.
- Patients have access to the history of treatment cases, research results.
Innovations are born not only in Moscow. For example, Perm Krai is actively investing in the digitalization of medicine. Now we are unique in that we have 100% implemented electronic health records. Not only in cities and large settlements, but also in villages.
In EHR, when filling out patient cases, doctors use batch appointments - ready-made templates that you just need to add to the case. Batch appointments are created from custom templates, templates created by colleagues, or based on clinical guidelines and treatment standards. Thus, the time for entering information is halved and the effective time of the doctor's work increases:
27% fewer clicks when admitting a patient with acute illnesses; 31% fewer clicks when admitting a patient with chronic diseases; 53% fewer clicks when admitting a "difficult" diagnostic patient.
“This is the first region that invented and implemented a system of clinical decisions in terms of batch assignment of analyzes for certain nosologies. And we will definitely do this in the near future."
The project was piloted in 2 medical organizations in the region. The pilot group included patients from 25 to 45 years old (30% adherence). Patients remotely transmitted their heart rate and blood pressure readings. The doctor observed and adjusted the treatment.
The therapist informs about the monitoring program durhing the medical checkup, routine and preventive examinations. A dedicated specialist oversees remote monitoring. The patient is included in the program. He signs an agreement and undergoes training. The section "Health Diary" appears in the patient's personal account. The doctor sets individual monitoring criteria for the patient. According to the doctor's prescription, the patient measures blood pressure the required number of times a day. It independently enters data into the Personal Account, or automatically transmits it from devices with Bluetooth function. The doctor receives data from patients. The data is reflected in a special section of the EHR in the workstation of the doctor of the polyclinic. In case of deviation from the standard values, the doctor contacts the patient and gives the necessary recommendations.
The doctor timely adjusted the treatment and gave the necessary recommendations. During the 2 months of the pilot project, patients' blood pressure did not rise more than 160 mm, they did not need emergency or urgent medical care.
Paperless document flow
The introduction of paperless document flow into the practice of medical organizations of Perm Krai began in 2019 and continues this year. In March 2019, there were 4 pilot polyclinics, by the end of the year 100% of polyclinics in the region used paperless document flow, in 2020 regional hospitals are switching to paperless document flow.
Paperless document flow - complex transition to electronic documents:
- Electronic document flow within and between medical organizations.
- Interdepartmental electronic interaction.
- Remote examination by medical insurance organizations.
- Electronic sick leave certificate.
- Medical certificates in the "Personal account" of the patient.
- Electronic recipes.
- Electronic queue, patient flow management.
The introduction of paperless workflow ensures the work of medical organizations in accordance with the principles of "lean" production:
Reducing the time for working with paper documents, increasing the time for working with a patient; Reducing non-core labor costs and costs; Patient loyalty by reducing the number of "paper sheets".
You have already solved the problem of reducing paperwork, you are at a low start, and these results really deserve respect and application of the practices you have developed in other regions.
Medical assistance in medical and obstetrical centres
Improving the quality and availability of medical care in hard-to-reach medical and obstetrical centres is provided by a number of subsystems and modules: telemedicine, electronic sick leave certificates and electronic prescriptions. In 2019, all medical and obstetrical centres of Perm Krai were connected to the Unified State Information System in the Healthcare Sector of Perm Krai, as a result of:
- 55893 electronic prescriptions were issued by medical and obstetrical centres;
- 282 electronic sick leave;
- 382 telemedicine consultations requested.
Online we transfer all the necessary data of the child, test results, anamnesis, symptoms, examination results, so that each participant sees an objective picture. For patients, this is an unique opportunity to receive specialized medical care without leaving the regional center, saving time and money.
The automation of the full cycle of preferential medication supply began in 2013. Currently, the system has 124 pharmacies and 101 medical institutions of various forms of ownership: 97 state medical organizations, 2 non-state, federal and private medical organizations.
- All medical organizations issue prescriptions exclusively in electronic form, but with confirmation on paper. Since 2013, 7 million e-prescriptions have been issued.
- A unified republican database of patients in need of preferential medication supply has been created.
- All processes of registration and provision of preferential prescriptions have been automated.
The republic has provided comprehensive automation of preferential medication supply - unified registers have been formed, the process of issuing electronic prescriptions has been automated, information exchange between medical organizations, pharmacies, an authorized pharmaceutical organization, the Ministry of Health of the Republic of Bashkortostan has been ensured, control of information processes has been established for the implementation of drug provision for preferential categories of citizens.
Migration to UDP
The Republic of Adygea is a pilot region for migration to the UDP. 100% of medical organizations of the Republic of Adygea - 2800 users who previously worked in RMIS, from August 1, 2020, are fully working in the UDP. Before the start of work on migration, a detailed analysis of the regional specifics was carried out, a schedule was developed and a team was formed for the region.
Migration of data to the UDP
- capacities are provided, the environment is prepared, the system itself is installed;
- scripts were developed to ensure data inheritance, data were loaded into the UDP test environment;
- preparatory work was carried out to develop the functionality of the account registers.
- UDP productive environment is deployed and filled with data;
- user training was carried out;
- On August 1, 2020, the Republic of Adygea was switched to the UDP; pilot operation began.
THE FINAL STAGE
- loading of EHR, historical data;
- debugging implemented integrations;
- the period of experimental-industrial operation has been completed.
Organizational and technical features
WORK IN THE PANDEMIC PERIOD
Most of the medical staff were in self-isolation or worked in closed wards. Distance learning was organized. As soon as possible, we went to the region to conduct full-time training.
With the use of the API, integration with LIS Alfalab, with the systems of preferential Medicinal Provision (Asulon) and Emergency Medical Aid (LLC "KAB") is implemented.
About 100 regional reporting forms have been developed. Added state reporting, improved printing of accounting documents for regional specifics.
Accounts for August have already been deposited from the UDP. To ensure the delivery of account registers:
- the adjustment of the UDP mechanisms for the delivery of account registers was carried out;
- the ability to download and maintain up-to-date tariffs is provided;
- implemented the ability to download the results of checking the account;
- regression testing was carried out;
- delivery of registers has been worked out at pilot medical organizations before the start of the main register period.
As a result of migration, more than 70% of medical organizations gave a positive feedback on the system, and the operational monitoring carried out by The Ministry of Healthcare of the Republic of Adygea revealed a positive trend in the use of the UDP as a full-fledged tool for doctors' work.
Register of diseases of the circulatory system. Digital ECG
The register was put into operation in 2015.
The goal is to record patients at risk, with subsequent routing and monitoring of medical care.
It is based on "Screening of a healthy population" in order to identify patients with risk factors for the development of cardiovascular diseases in the early stages. As part of screening, primary care specialists in the provision of outpatient medical care carry out a questionnaire survey of patients (partner solution).
After filling out the questionnaire, the system automatically determines the risk group, calculates the date of the next questionnaire, generates recommendations for the doctor on treatment tactics and for the patient to change the lifestyle.
Functional capabilities of the system: automatic notification of the therapist about the inclusion in the register of a patient attached to his site; automatic deletion from the register upon expiration of the observation period; monitoring the dynamics of the development of the CSD; registration of electronic referrals; notification of events in the "Signal information" of the patient's EHR.
Automatic interpretation of digital ECGs makes it possible to transfer information to the CSD registers, which significantly increases the efficiency and accuracy of diagnosis, and also promotes proactive work to exclude exacerbations or complications of diseases.
An ECG appointment is created in the UDP.MIS, a direction is formed. In the diagnostic workstation, a command is given to the cardiograph, a cardiogram is taken. The cardiogram is transferred to the interpreter (partner software), an automatic ECG analysis is carried out: a medical opinion, a list of established syndromes, an image file are formed. The cardiogram and the description from the interpreter are available for the doctor to work in the diagnostic workstation. After processing and signing the case, the data goes to the EHR.
From 2015 to 2020. more than 200 thousand people passed the screening examination. By correcting the identified risk factors, it was possible to increase the proportion of people belonging to health group 1 by 29%, and to reduce the proportion of people in health group 3 with pre-existing cardiovascular diseases by 45%.
Voice assistant Svetlana appeared in the Moscow Oblast in October 2020 to unload the COVID 122 service. The system was deployed within a month, as a result:
- integration is configured: records of doctor's calls are reflected in the region's MIS;
- a script for calling a doctor at home was introduced and improved;
- launched 240 lines;
- organized round-the-clock reception of calls;
- the waiting time for an answer on the line has been reduced
On the 35th day, the voice assistant Svetlana received more than 25 thousand calls, of which 8 thousand were successfully processed: she created house calls and answered clarifying questions from patients. Now the voice assistant relieves the contact center of the Moscow Oblast by 30%. She studies, and in the future will close up to 50% of calls.
We see how, due to the unfavorable epidemiological situation, the number of calls to the Governor's call center has sharply increased to call a doctor at home. For the convenience of residents, in order to reduce the waiting time for an operator's response, we launched a voice service based on artificial intelligence, which will automatically accept an application and issue a doctor's home call.