Modern technologies for the benefit of Bashny.Net

Computer systems are already quite firmly established in our lives. We do not pay attention to the ubiquitous presence of these have become commonplace things like vending machines for everything, electronic registration and order any goods and services, pay bills through the terminals or write to the doctor via the Internet. At the same few people think about how to implement a given process, who participates and how to control the actions of these automated systems. And they created us - the people. And controlled, of course, we too.

It became interesting to see a similar process from the beginning to the end. And as an example was chosen, probably one of the most important areas of human activity - health care - namely, all the way to the patient admitted for treatment until his discharge from the hospital. Here we look at what is happening with the three main positions: the patient, the medical personnel and the system administrator. To do this, we visited 62 Moscow City cancer hospital and talked with the developers of automated hospital information systems (GAIS) - representatives of the company «Programs and complexes" < / a>. The main activity of the company is the development, implementation and support of GAIS. In this market, the company operates since 1991 and has a portfolio of more than 20 successfully implemented projects in the departmental health care facilities, and the total number of serviced automated workstations (AWS) has long overstepped the mark in 5000.

So, the patient comes to the hospital and into the emergency room. At the registrar's table is ARM 19-inch monitor attached to it a thin client WYSE C10LE . It is put on the patient electronic medical history, which made the raw data: full name, passport number, a policy of compulsory medical insurance and other related information. Policy number OMS automatically connected through a software module is checked in the database Unified Register of Insured (ERZ) to date. If re-treatment, the data along with the medical history is automatically lifted from the archive. Immediately, depending on the requirements of hospitals, printed forms for the signature of the patient or the filling: consent to the processing of data supplied vaccines, the lack of infectious diseases and so forth., And issued a plastic card with a bar code history. The doctor on duty, after examining the patient, making an initial opinion on his workstation. However, he is not gaining full A4 sheet manually, and select from the available base templates, the corresponding disease, which enter into free field survey data.





The main priority when creating ARM given Wyse terminals for several reasons. Firstly, it is an advantage to the security administrator, monitoring and centralized update, configure, control and diagnostics using software Wyse Device Manager. Secondly, the - almost instantaneous speed replacement of the failed unit without losing data. For medical staff a big plus is the high download speed and compactness of the device. Finally, full support for the device by the manufacturer throughout the service life.

So, the initial examination conducted, completed template is already in electronic medical records, and the doctor signs the document. Protecting such a signature is performed using login and password account of the doctor. Make changes in their diagnosis can only he took off his same signature, and only until such time as new documents appear on top of it, signed by a different doctor. It also adopted a decision in which department will be sent to the patient. The system selects the name of the doctor offices in the pull-down menu, and if it is not full (otherwise the line is highlighted in red and you will never choose this section), it notes. At this point, the selected branch office appears alert, which shows the data is sent to a hospital patient and preliminary diagnosis. Nurse on duty through the guard room and workstation chooses to enroll a patient bed. After this alert appears already on ARM department head doctor, stating the details of the patient and its placement in the department. His workplace is different from the previous ones connected to the thin client WYSE additional widescreen display - it is possible to view the data research. Zavotdeleniem scans and assigns a primary diagnosis of the attending physician. If you are currently attending physician produces round, it can get a notification about the new patient on a tablet computer ( Latitude 10 for instance), tablet or smartphone on any platform that supports the installation of a mobile client Citrix - concept BYOD (Bring Your Own Device) in action! If the institution is not a full-scale network deployed Wi-Fi, provided notification via SMS. The doctor is just go to the nearest terminal Wyse, to log in and view all the available data on their new patient. Thus, when the patient is in the office assigned to him, he already has a chamber and the treating physician.

After examination of the patient with the doctor assigns your AWS necessary in his opinion analyzes drugs and notes patient number prescribed him a diet. If the tests are carried out in another department (X-ray, MRI, ultrasound, etc.), a request comes to them automatically to the post of the office, where the chief of department on the basis of load, puts it in the work plan, allocate time if multiple devices, and signs. All of this information is accumulated at the workstation guard sister. She warns the patient about the time and place of the tests determines how will be delivered to the patient for analysis (if it is not walking), in the dining room electronic application is sent to the patient according to the prescribed diet doctor. As a result, the patient gets to put his treatments without the queues at the appointed time and has on hand only a plastic card with a bar code.

The doctor did, for example, X-ray, wrote an opinion on the procedure. The word "writing" re meant to fill preprinted forms. All documents are signed directly with the doctor who performed the study. If the equipment supports the format DICOM (X-ray, CT, MRI, ultrasound, ECG), in addition to electronic story of a doctor will be carried pictures studies. This is especially true during a consultation and preparation of the patient for surgery.

The attending physician determines the kind of analysis on the received treatment. Assigns, still with its workstation products, and the module is connected through a check of compatibility of medicines. If drugs are poorly compliant, the field is highlighted in yellow when the incompatible - red and appoint such treatment is impossible. After the signature of the doctor treatment plan goes to ARM guard sister. It remains to see the resulting report with all patients on medicines and the application form elder sister. The elder sister, respectively, ready for dispensing drugs. In addition, depending on the flow of drugs, the older sister application forms for pharmacies.

The pharmacy after receiving applications from all departments of the hospital takes place taksirovka drugs: specifies the number of items in stock, the request for the near future, after which the corrected list is sent to the department to sign older sisters. Begins the formation of the basket for each department. All medicines after they arrive at the warehouse pharmacy get a room ceilings and are on numbered shelves. In addition, the fixed-based pharmacy suppliers, manufacturers, the dosage, the purchase price and expiration date of each drug. To avoid confusion, all the names of medicines are taken regularly updates of the Russian Unified Directory. For the convenience of the medical staff at the pharmacy workstation connected plug-in "Analytics consumption of drugs." It allows the system to automatically generate purchase for the next quarter, taking into account parameters such as the presence of drugs in stock, flow dynamics, expiration dates. In addition, there is the possibility of reserving the drug for expensive surgeries. In this case, the drug will only be displayed on the workstation at the main doctor, pharmacy and department heads with the reason for the reservation. For paid sick personalization module can be connected to the possibility of exhibiting in future bills for services rendered.

Generally, the company has currently more than 60 developed and implemented modules and their number is increasing according to the requirements of a hospital system. Also, in a pharmacy there such a thing as ekstempora - when mixed preparations of the pharmacy according to a formula. This formula is approved in the hospital itself, signed by the chief doctor of the (amended after that only he can), is written in the module, and the write-off of drugs from the warehouse pharmacy has been going according to this formula. The calculation of dividing drugs (if doctor prescribed, for example, 2 tablets from the package) is as follows: the system trims the first 9 fractions and adds them to the 10th tablet.



If the patient is assigned to an operation by the module zavotdeleniem "plan of operations" determines the surgeon and anesthesiologist assistants, which will automatically come online notification. In this module the surgeon fills the template plan of operations, and formulate a plan of anesthesia anesthesiologist. Automatically checks the availability of operating, there is a reservation on the date and time, and the information goes to the post surgical department to order the necessary materials and medicines. All documents signed by their creators. The medical staff has full information about the proposed transaction and holds the necessary preparatory steps. For example, preparation for surgery, we observe well-coordinated work of different departments within the same task. No need for constant phone approvals, conducting paper magazines and, finally, the human factor.

In some cases, the course of the operation may be recorded on video and stored in the archive hospitals for training young professionals. HD-camera for such purposes is mounted in the center of the lighting in the operating rack. The company's history is an example of this way of open learning as a visiting professor to conduct operations at the hospital, and the image in real-time broadcast in the conference room. This surgeon was DECT-Headset, and he was able to answer questions from the audience at the moment of the transaction. Following the surgery, the surgeon and the anesthesiologist form protocol operation, filling pattern.



After the completion of all necessary medical procedures and prepare the patient for discharge system automatically generates a discharge summary, the necessary reports and reports for delivery to a specialized and higher organizations. After the patient's discharge of its electronic case record is sent to the archive of the hospital, where, if necessary, can always be removed, for example, in the case of re-treatment of the patient.

Since the introduction of this complex takes time and certain financial investments, the whole process is carried out in stages. At the first stage in the hospital information system connected automated workstation front desk, workstation at the posts offices, senior nurses and pharmacies. That's about 50 jobs, which serves 1 server Dell PowerEdge R620 defined 128 GB memory. It means VMware ESX Server virtual machines installed 4: the domain controller, the infrastructure, the Oracle server and the terminal server for publishing applications. With further development, when connected laboratory and instrumental studies, added the second PowerEdge R620 and disk rack, such as a series of Dell PowerVault . In the future, the growth of servers is calculated from the ratio of 50-60 clients per server and the number of disk chassis is projected considering conducting video archive and the indicative term storage in the hospital. Ease of such an approach - GAIS modularity and the possibility of gradually adding additional servers - is the ability to budget planning for the current needs of the hospital. There is, however, a strict requirement - fully compatible hardware, which just provides Dell. The company has vast experience in working with different servers from Self-assembling to-vendor. However, with the transition to the equipment Dell issues the correct operation and follow-up support "iron" on the backburner. This is not some marketing agreement or binding to the equipment, do not. These are the words of employees integrator.

Such an approach, on the example of 62 th hospital, will increase the capacity of medical institutions in more than three (!) Times. Through the use of terminal technology, virtualization, coupled with standardized hardware and manages the real technical support to achieve high levels of reliability of the complex and to minimize the risk of system failure. And this is for all the participants of today's review is a key indicator.

What do we get in the end?
For the patient, it is, above all, the lack of wearisome queues. All the necessary analyzes, investigations, procedures are directly appointed "under each" patient. The possibility of loss or accidental substitution of the results of analyzes or studies and procedures, and hence the risk of improper treatment.

For medical personnel is a tremendous time savings. There is no need to fill dozens of opinions, forms, directions, orders and recommendations. All doctors, through which the patient have full information about the status of the patient. For example, the surgeon can see not only the conclusion of a radiologist, but also explore the pictures in preparation for the operation and anesthesiologist - a list of all medications, their dosage and frequency when planning anesthesia. Your doctor may at any time check at what stage is the implementation of procedures assigned to them, the results of research, conclusions of experts, and correct treatment of the patient. And thanks to the system alerts the medical staff gets all the operational information about current changes.

The system administrator using the terminal technology and Wyse, gets the whole package of benefits: maximum data security, fast and easy installation, start-up, replace the jobs of employees. Using Wyse Device Manager allows you to centrally keep track of all operating parameters and system upgrade. In addition to this virtualization technology, and migration on the server side of the complex reduces the risk of system failure to the minimum values. Using proprietary solutions Dell OpenManage greatly simplifies system administration functions in hardware, and technical support device essentially protecting your investment.

As a conclusion
Not so long ago, together with the Japanese company AnD test sample was made of health control at admission to mine for gold miners. The main requirements of the customer were to eliminate the human factor and the reduction of time of medical examination up to 5 minutes. Assembled complex included the following: an automatic device for measurement of pressure (tonometer), breathalyzer, card reader, a 7-inch screen to display the results of passing express inspection and thin client Dell Wyse D90 (without keyboard and mouse). And the D90 was chosen due to its reliability. At the entrance to the miner CPT is authorized by the card, holding out his hand in an automatic blood pressure cuff and breathes in the breathalyzer. The results are displayed on the monitor and the doctor on duty is automatically written to the archive. In case of exceeding the permissible norms of any indicator system locks the turnstile to enter the territory of the enterprise. As a result, the passage through the checkpoint personnel mines was reduced to 50 seconds per employee. Currently tests are 2 of the automated CPR and, judging by the reviews of the customer, in the near future they will begin work on a permanent basis. A field of application of such systems is quite extensive.

Source: habrahabr.ru/company/dell/blog/210448/