 Keywords: the MANAGEMENT INFORMATION SYSTEM, a hospital, the automated control system, medical computer science, the abstract, a computer, use of a computer in medicineTHE AUTOMATED CONTROL SYSTEM OF THE HOSPITALDevelopment of clinical functions of the MANAGEMENT INFORMATION SYSTEM of a hospitalThere are two basic ways of addition of clinical functions to an available MANAGEMENT INFORMATION SYSTEM of a hospital:
The first way is typical for the German hospitals in which administrative - financial functions are realized on the basis of a universal control system of manufacture R/3 of firm SAP. This expensive enough system has the general integrating nucleus to which "branch" modules are added, for example the module of public health services IS-H providing the account koechnogo of fund and movement of patients, and also the medical aid rendered to him. Therefore rather natural the decision according to which on the basis of the general nucleus for realization of clinical functions the new "clinical" module is developed is represented, and such attempts are really undertaken. However thus the certain style of the dialogue which typical for registration functions of system R/3 and has been not adapted to convenient and technological performance of the clinical data is imposed to the user. The second way - development or adaptation concerning independent clinical information system (PUSSYCATS) - allows to develop or get the information system specially intended for performance to doctors of data on a state of health of the patient and about his treatment, and also for input of the clinical information. Lack of this approach is necessity of additional expenses for integration of clinical information system with already existing systems. Modern clinical information systems are developed for simplification of the decision of a problem of integration with use of standards of an electronic exchange by medical documents. The choice of this or that approach essentially depends on architecture of a working complex of information systems. If he is executed on the centralized architecture at which practically all functions or the basic databank are realized on a powerful central computer, and workstations carry out a role of intellectual terminals the first way can appear preferable. If the complex is formed by several systems, each of which has own database development of PUSSYCATS, as a rule, appears more favourable. the Purposes of creation of the MANAGEMENT INFORMATION SYSTEMThe basic purposes of creation of the MANAGEMENT INFORMATION SYSTEM can differ depending on a structure and character of medical establishment. For example, for the university medical centers the accent for research work and maintenance of educational process is characteristic. However in all cases to number of the basic purposes operative management of medicinal and diagnostic purposes (input of recipes, input of orders for laboratory analyses and diagnostic researches, a conclusion of results) concerns. Stages and terms of creation of the MANAGEMENT INFORMATION SYSTEMStages and terms of creation of the MANAGEMENT INFORMATION SYSTEM essentially depend on financial opportunities of medical establishment and a degree of his readiness for introduction of clinical information system. For example, realization of the MANAGEMENT INFORMATION SYSTEM can be designed for four years and, accordingly, to have the following three overlapped stages: A stage 1 (1-2 years):
A stage 2 (1-2 years):
A stage 3 (1-2 years):
Preconditions to creation of the MANAGEMENT INFORMATION SYSTEM.Creation of the MANAGEMENT INFORMATION SYSTEM probably and expediently at performance of some preliminary conditions. the Level of equipment means of computer facilities.The basic users of PUSSYCATS are the doctors directly responsible for treatment of the patient. Therefore their workplaces (studies of reception, ordinatorskie) should be equipped with corresponding stationary and mobile means of computer facilities (workstations). As PUSSYCATS should give doctors of data on the patients, information acting from various automated sources on the average on each workstation of PUSSYCATS 1-3 workstations established in auxiliary divisions of medical establishment (in the rank of nurses, in administrative - financial divisions, in a drugstore, in laboratories and diagnostic branches, in service of a feed, service of logistics, etc.) have as a minimum. This factor appears higher in a hospital (2,5 and more). In polyclinics and polyclinic branches of hospitals he can be closer to 1. For a possibility of introduction of PUSSYCATS in each clinical branch of a hospital it is necessary to have as a minimum 3 workstations (one at managing branch and two in ordinatorskoj). From here follows, that at an average koek in one branch about 40 and factor 2,5 minimal equipment of hospital should make about 1 workstation on 4 kojki. At such proportion in a hospital designed on 1300 koek, for example in the Central clinical hospital, it is necessary to have about 325 workstations. At 150 studies of medical reception in a polyclinic designed for 3-4 thousand of visitings in day, the minimal equipment workstations will make about 300. the Communication infrastructure.Requirements to communication structure essentially depend on computer architecture and necessity of transfer of medical images. If workstations are the terminals connected to a powerful central computer (mainframe), and transfer of medical images on these stations does not practise, as physical liaison channels it is enough to have the allocated telephone lines with the corresponding terminal equipment (modems, terminal adapters ISDN, etc.) . In this case all data processing is carried out on the central computer, and the terminal provides visual performance of results of processing to the user of information system. However now with occurrence of so-called structured cable systems (SKS) for all new installations of hospital and polyclinic information systems local or corporate computer networks are used. They have universal character and provide an opportunity of functioning of computing systems practically irrespective of their architecture. Maintained information systems.Introduction of PUSSYCATS in medical establishment is possible only in that case when in this establishment a number of information systems which will provide PUSSYCATS with the necessary information is already maintained. The minimal structure of working information systems necessary for maintenance of functioning of PUSSYCATS, depends on a structure and specific features of treatment-and-prophylactic establishment in which PUSSYCATS it should be used, and also from the purposes of use of PUSSYCATS in the given establishment. Clinical information system and the electronic case record.Clinical information system and the electronic case record essence different, though and the connected concepts: the clinical information system represents a way of realization of clinical functions of medical information system in the form concerning an independent complex of program modules, and the way of the organization and storage of the clinical data refers to as the electronic case record. The clinical information system can be realized (and frequently realizes sja) without the full-scale electronic case record; on the other hand, the electronic case record can be realized without allocation of clinical functions of hospital or polyclinic information system in independent enough complex of program modules. Clinical information systems of the Medical center.For successful realization of PUSSYCATS conditions in the Central clinical hospital and the Polyclinic of the Medical center are most prepared: in both establishments the advanced infrastructure of computer networks, a level of equipment is created by modern computers will correspond in the near future to the mentioned above criteria, for a long time and successfully administrative - financial information systems function, a number of clinical functions is already realized. So, in information system " Hospital " of the Central clinical hospital administrative - financial functions of the account koechnogo fund and movements of patients are successfully combined with such clinical functions, as input of chemist's orders and orders of laboratory analyses, reception of results of laboratory analyses, performance of these results to attending physicians. Despite of various conditions of rendering of medical aid in a polyclinic and a hospital, it is represented expedient in both establishments named above to realize the general nucleus of clinical information system to which the functions typical only for a hospital or only for a polyclinic can be added. Presence of the general nucleus allows to provide also an electronic exchange not only directions on hospitalization and vypisnymi epikrizami, but also and detailed results of laboratory analyses and diagnostic researches. The prototype of clinical information system is supposed to introduce in the Central clinical hospital in the current year. Integration of the MANAGEMENT INFORMATION SYSTEM and systems of processing of medical images.In most cases the MANAGEMENT INFORMATION SYSTEM is focused on reception, storage and processing of text medical documents. Functions of processing of medical images which are carried out with participation of doctors and also can be qualified as clinical, are usually realized by the separate specialized programmno-technical complexes cooperating from the MANAGEMENT INFORMATION SYSTEM (by an exchange of orders for diagnostic researches and the conclusions of doctors - diagnosticians) and an administrative - financial system (by an exchange of the demographic data of patients and data on the services rendered to him). Medical images share on two basic classes: linear images (for example, cardiograms), typical for functional diagnostics, and raster images (for example, roentgenograms), characteristic for beam diagnostics. Linear images are quite often transferred from the corresponding specialized system in the general databank of medical establishment or in clinical information system. Transfer of raster images to clinical information system does not practise more often. For viewing and processings of such images clinical physicians usually receive an opportunity of direct connection on a computer network with the specialized system. Now complex processing of raster medical images is carried out by systems of integration of the beam diagnostics, being integral components of modern medical information system of large hospital or a polyclinic. The following section is devoted to the brief description of purpose and features of realization of these systems. Systems of integration of beam diagnostics.Computer systems of integration of beam diagnostics (Computer Integrated Radiology) unite technical problems of processing of raster medical images and organizational methods of carrying out of beam researches in a single whole. The term used earlier - systems arhivirovanija and transfers of medical images PACS (Picture Archiving and Communication System) - concerns to technical realization and, hence, represents a part of the concept of systems of integration of beam diagnostics. Systems of integration of beam diagnostics allow to reduce in a single whole both intermediate, and final results of the researches spent on complex devices of medical visualization: x-ray devices, scales - chambers, computer and magnitnorezonansnyh tomographs, devices of ultrasonic diagnostics (sonografah) and other similar devices, allowing to reconstruct bidimentional and even the three-dimensional image of internal organs of the person. Usually these researches are carried out by branches rentgenologii, a computer tomography, radiology, and also branches of ultrasonic diagnostics. Now it is accepted to name collectively these divisions branches of beam diagnostics in spite of the fact that ultrasonic researches not quite respond this name. Integration of the images received with the help of different devices of medical visualization, allows to solve very thin and challenges of diagnostics and treatment of heavy diseases. At the same time of fruits of integration the highly skilled doctors - diagnosticians having wide experience of use of several kinds of devices of medical visualization can take advantage only. Introduction of systems of integration of beam diagnostics pursues is a little bit more whole: - maintenance of more effective organization of carrying out of beam researches; - economy of expensive spent materials (x-ray films, developer, etc.); - improvement of quality of diagnostics; - acceleration of a revolution of images; - improvement of interaction of medical institutions (telediagnostics). At creation of systems of integration of beam diagnostics the most modern means of computer facilities and telecommunication are used, switching: - high-speed local and global computer networks on the basis of technologies Fast Ethernet, FDDI and ATM; - large-format scanners of x-ray high resolution films and the big range of transfer of optical density; - libraries magnitoopticheskih disks (including WORM, CD ROM); - computer monitors with the increased brightness and resolution; - magnitoopticheskie cards of patients; - multiprocessing computer complexes. Usually in a basis of development the principle of the open system using the most widespread standards of data exchange lays. For example, in last development of corporations IBM and Siemens standards of an exchange by medical text documents Health Level Seven and medical images DICOM 3.0. are usedApplication of system of integration of beam diagnostics.In this section the simplified script of application of system of integration of beam diagnostics and its interaction from PUSSYCATS at each stage of carrying out of research is resulted. the Direction of the patient on research.For preparation of information system of branch of beam diagnostics for carrying out of research in it the electronic direction of the patient is transferred to carrying out of research. This function is usually realized in PUSSYCATS, but is vital for operation actually systems of integration of beam diagnostics. Arrival of the patient in branch.Arrival of the patient in branch of beam diagnostics is usually provided with administrative personnel (in procedure of reception of the patient can participate also rentgenolaboranty and on occassion - doctors - radiologi and rentgenodiagnosty). This function is usually realized in PUSSYCATS. As soon as arrival of the patient in branch is registered, the system of integration of beam diagnostics creates an electronic folder with data on the patient, including the given directions on research and the anamnesis. All images of the patient received during carrying out of the given research will be included in this folder. After end of research these images should be transferred to archive of images. The patient can bring with itself x-ray pictures, a VCR cassette or an optical card. If necessary pictures can be transferred by the scanner in the digital form, recording on a VCR cassette also can be otsifrovana. The part of this information can be included in a folder of the patient. On an optical card of the patient can be written down already otsifrovannye images or the data, allowing to identify the researches which have been lead earlier in other establishments. The part otsifrovannyh images can be included in a folder of the patient; if on a card images, and electronic addresses of a wide-area network on which these images can be received to these addresses searches about transfer of images can be made are stored not. After reception these images will be included in a folder of the patient. the Selection of archival images.After end of procedure of registration of arrival of the patient arhivirovanija and transfers of images the search about transfer of previous results of researches of the given patient is sent a subsystem. He is formed on the basis of the data contained in a direction on researches and entered at registration of receipt of the patient. At production of the diagnosis all these images will be in operative (short-term) archive and can be received for some seconds. Carrying out of research.The data of previous researches can be necessary for installation of modes of reception of new images during the current research. After end of research all again received images (or series of images) are included in a folder of the patient and appear accessible to production of the diagnosis alongside with archival images, and also the images brought by the patient. Production of the diagnosis.After end of research the information necessary for drawing up of the description, the conclusion (diagnosis) and recommendations, is in an electronic folder of the patient. It includes: - the images received during the given research; - the images received at previous researches in the given branch and taken from his long-term archive; - the images received at previous researches in other branches (establishments) and generated with the help of scanning of pictures or numbering of videos, transferred from own archives of these branches (establishments) or read out from a personal optical card of the patient. To last two categories of images texts of descriptions, the conclusions and recommendations are applied also. At system engineering integration of beam diagnostics the big attention is given the form of performance of images. Developers aspire to make this form as more as possible similar to traditional technology of viewing of pictures on negatoskopah. Dear browsing systems of pictures allow to mount automatically a part of the big series of pictures and enable the doctor - diagnostician to carry out scrolling of series forward or back. To keep this habitual technology, systems of integration of beam diagnostics use the so-called diagnostic stations having from 2 up to 4 monitors with the big screen (from 17 " up to 21 " on a diagonal), high resolution (up to 1600х1200) and the big range of gradation of brightness. These monitors can be established in a number across or form a square. Feature of diagnostic station will be, that with the help of one manipulator (the keyboard, the mouse, dzhojstika or light to a feather) it is possible to change images simultaneously for all its monitors, that is to receive about the same mode, that for traditional browsing systems of pictures. However the computer system as against traditional offers additional functions of viewing, including linear and nonlinear kill of gradation of brightness, transformation of a scale of brightness to a color scale, imposing of images against each other, etc., let alone complex functions of definition of the sizes and the area of objects, and also functions of three-dimensional reconstruction of images. Cost of one diagnostic station can reach 100-150 thousand US dollars. Analyzing images at diagnostic station, the doctor - diagnostician dictates the description, the conclusion (diagnosis) and recommendations (basically he could type these texts on the keyboard, but this way of input is not popular in doctors of branches of beam diagnostics of foreign hospitals). These texts can be entered by the operator into PUSSYCATS or in the specialized information system of branch of beam diagnostics; recently special systems of automatic recognition of speech are applied to these purposes. The entered texts are transferred from PUSSYCATS in system of integration of beam diagnostics. Verification of the diagnosis.At verification of the diagnosis all that information that is represented at production of the diagnosis, and besides texts of the dictated description, the conclusions and recommendations is accessible to the doctor - diagnostician. End of research.After production of the diagnosis and his verification the electronic folder of the patient, including again received images and texts, is sent in archive. This folder can be lifted from archive and is investigated at so-called viewing stations which are established in operational, studies of reception of doctors - experts, educational audiences and the premises intended for carrying out of consultations. Viewing stations usually differ smaller computing capacity and, as a rule, are supplied only with one monitor. Data recording on personal optical cards of patients and other replaceable carriers of given The part of the images received during the given research, can be written down on a personal optical card of the patient or other replaceable carrier of the data together with texts of the description, the conclusion and recommendations. Usually even before interpretation of images on a card of the patient the information identifying lead research (registration number, a kind of research, number of the received images, the characteristic of projections, etc.) will be worn out. Results of researches can be written down on a card at the following visit of the patient or at his extract from a hospital. Reception of images.Reception of images includes sem the data from diagnostic devices and their preservation in a digital kind. Many manufacturers of diagnostic devices use own formats of storage of such images (for example, SIENET firms Siemens, PMS-Net firms Philips). Transformation of these data to the standard format intended for transfer of images and the data on conditions of their reception in external information systems is if necessary provided. The most widespread standard of transfer of images of beam diagnostics is DICOM 3.0. Transfer of images.The memory size, necessary for storage otsifrovannogo images in own format of the manufacturer of the equipment or in a standard format, essentially depends on a kind of research and can make from tens and hundreds kilobyte up to 10 and more megabytes on one image. Therefore for transfer of images high-speed data links, as minimum ISDN (64 kbps, 128 kbps, T1, E1), and also 10 and 100 Mbps Ethernet, 100 Mbps FDDI, 155 Mbps ATM and his subchannels up to 25 Mbps. are usually usedEXAMPLES OF PROGRAMS WIDELY USED IN HOSPITALS
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