1. Scope of Medical Information Management at the Regional Level in Russia Alexander Shoshmin, Yanina Besstrashnova Department of Information Technologies for Disability Problems, Federal State Institute “Saint Petersburg Scientific and Practical Center of Medical and Social Expertise, Prosthetics and Rehabilitation of the Disabled named after G.A. Albrecht of Federal Medical-Biological Agency”

2. Contents Need for Medical Information Management System (MIMS) Need for Medical Information Management System (MIMS) Difficulties in MIMS development and implementation Difficulties in MIMS development and implementation Solutions Solutions Capabilities of MIMS Capabilities of MIMS Perspectives for MIMS Perspectives for MIMS

3. Need for MIMS People are lost, sometimes by reason of medical errors. People are lost, sometimes by reason of medical errors. Expensive treatment is not always justified. Expensive treatment is not always justified. Evaluation of treatment effectiveness is complicated. Evaluation of treatment effectiveness is complicated. There is lack of data about citizens needs for medical care (and so about resources). There is lack of data about citizens needs for medical care (and so about resources). There are no certain data for health care management. There are no certain data for health care management.

4. Difficulties in MIMS development and implementation Information technologies evolve quickly. It seems they can fulfill almost all things. How to use them? Information technologies evolve quickly. It seems they can fulfill almost all things. How to use them? Low effectiveness of MIMS implementation is the result of rare using of integrated solutions which coordinate citizens health, modern technologies and knowledge, economics and management. Low effectiveness of MIMS implementation is the result of rare using of integrated solutions which coordinate citizens health, modern technologies and knowledge, economics and management.

5. Main reasons for decreasing MIMS effectiveness No measurable target indicators (both during MIMS development as a whole and during implementation at a working place) ; No measurable target indicators (both during MIMS development as a whole and during implementation at a working place) ; Low administrative competence of persons responsible for implementation; Low administrative competence of persons responsible for implementation;

6. Implementation period Implementation period MIMS modules depend on each other as usual. In the long implementation period they irritate users because of limited (unavailable) functionalities; MIMS modules depend on each other as usual. In the long implementation period they irritate users because of limited (unavailable) functionalities; MIMS itself, IT and medicine are in progress. The latest subsystems may be incompatible to ones in use; MIMS itself, IT and medicine are in progress. The latest subsystems may be incompatible to ones in use; Main reasons for decreasing MIMS effectiveness

7. Fear to lose one’s work (not to meet new requirements, changed processes may result in decreasing number of employees) ; Fear to lose one’s work (not to meet new requirements, changed processes may result in decreasing number of employees) ; Unwillingness by managers to change business processes (statistics is close to managers’ point of view) ; Unwillingness by managers to change business processes (statistics is close to managers’ point of view) ; Underestimation of required investments… Underestimation of required investments… Main reasons for decreasing MIMS effectiveness

8. How do these reasons act at the regional level in Russia? Disadvantages Low automation level as a whole and in hospitals as usual; Low automation level as a whole and in hospitals as usual; No integrated programmes for health care IT implementation; No integrated programmes for health care IT implementation; Misunderstanding the fact: Misunderstanding the fact: IT implementation means changes in ALL processes rather than automation of some functions!

9. Enthusiasts attain spontaneous financing and start implementation of whatever software (without experience in implementation it is difficult to estimate differences in suggested solutions); Enthusiasts attain spontaneous financing and start implementation of whatever software (without experience in implementation it is difficult to estimate differences in suggested solutions); Integrated automation programmes for health care are approved rarely in the regions of Russia. Integrated automation programmes for health care are approved rarely in the regions of Russia. How do these reasons act at the regional level in Russia? Disadvantages

10. There are no old information systems with patients data almost at all; There are no old information systems with patients data almost at all; An opportunity to implement MIMS which meets certain requirements exists (to implement a standard) ; An opportunity to implement MIMS which meets certain requirements exists (to implement a standard) ; It is possible to develop a common electronic health record; It is possible to develop a common electronic health record; Those who started implementation and failed (80% according to statistics) know how need not to do ; Those who started implementation and failed (80% according to statistics) know how need not to do ; How do these reasons act at the regional level in Russia? Advantages

11. Solutions To integrate existing information systems: To integrate existing information systems: Difficult from the manager’s point of view; Difficult from the manager’s point of view; Difficult technically; Difficult technically; To install a common MIMS at once if possible; To install a common MIMS at once if possible; To do nothing (we’ll have spontaneous MIMS elements in 1-3 years and start to integrate them). To do nothing (we’ll have spontaneous MIMS elements in 1-3 years and start to integrate them).

12. MIMS structure multilevel system that integrates information resources including distributed network of health institutions, regional health care authorities, territorial fund of obligatory medical insurance and insurance companies; multilevel system that integrates information resources including distributed network of health institutions, regional health care authorities, territorial fund of obligatory medical insurance and insurance companies; integration of information from these institutions in a data base. integration of information from these institutions in a data base.

13. Диспансеры Родильные дома Поликлиники Больницы (многопрофильные, специализированные ) Госпитали для ветеранов Медсанчасти Development and support of actual integrated register of insurants in a region; Creating an integrated regional register of obligatory medical insurance agreements and policies; Holding certification of regional health care institutions and their licenses; Forming a common resources register of regional health care; Creating a regional programme of state guarantees. Patients registration and monitoring of: provided medical services; costs for medical care; medicaments and costs for them ; sickness rate. ЦБР MIMS structure

14. Capabilities of MIMS ; Holding a detailed register of regional and territorial health care institutions including data about service districts; Creating a ; Creating a register of health care institutions with their lists of licenced services;

15. (providing consolidation of detailed information about every institution into an integrated data base) ; Certification of health care institutions (providing consolidation of detailed information about every institution into an integrated data base) ; Collection of identifiers, bank and tax essential information about ; Collection of identifiers, bank and tax essential information about health care institutions; Determining indicators of institutions network (till the level of department) and resources; Determining indicators of institutions network (till the level of department) and resources; Capabilities of MIMS

16. Statistics gathering and analyzing: Statistics gathering and analyzing: Organizational structures, Organizational structures, staff members lists, staff members lists, personnel information, personnel information, data about material resources and equipment, data about material resources and equipment, location of departments, location of departments, number of beds; number of beds; Capabilities of MIMS

17. Listing provided medical services (health care institutions, citizens) ; Listing provided medical services (health care institutions, citizens) ; Determining indicators of sickness rate, volumes of medical care (type, profile, financing, place and time of a service, groups of patients…). Determining indicators of sickness rate, volumes of medical care (type, profile, financing, place and time of a service, groups of patients…). Capabilities of MIMS

18. Determining indicators of additional medicaments provision system: Determining indicators of additional medicaments provision system: personal prescriptions; personal prescriptions; personal lists of distributed medicaments ; personal lists of distributed medicaments ; totals and personal statistics of: totals and personal statistics of: quality quality costs costs Capabilities of MIMS

19. Reports and references about insurants; Reports and references about insurants; Monitoring of plans-tasks; Monitoring of plans-tasks; Analytics about programmes of regional state guarantees and municipal tasks; Analytics about programmes of regional state guarantees and municipal tasks; Capabilities of MIMS

20. State medical statistical reports, obligatory medical insurance reports at the institutional, municipal and regional level; State medical statistical reports, obligatory medical insurance reports at the institutional, municipal and regional level; Budgeting of health care institutions according to a regional programme of state guarantees (providing state guarantees in health care for citizens) ; Budgeting of health care institutions according to a regional programme of state guarantees (providing state guarantees in health care for citizens) ; Capabilities of MIMS

21. Citizens needs in health care in the context of institutions; Citizens needs in health care in the context of institutions; Data about provided medical services (health care institutions, groups of citizens) ; Data about provided medical services (health care institutions, groups of citizens) ; Data for prices calculations for medical services… Data for prices calculations for medical services… Capabilities of MIMS

22. Perspectives for MIMS Integration of existing resources for more effective health care! Integration of existing resources for more effective health care!

23. Thank you for your attention! E-mail: shoshminav@mail.ru; besstjan@mail.ru shoshminav@mail.ru besstjan@mail.rushoshminav@mail.ru besstjan@mail.ru