=Paper=
{{Paper
|id=Vol-2104/paper_197
|storemode=property
|title=Application of Medical Information Systems for the Implementation of Lean
Technologies in the Management of Medical Institution
|pdfUrl=https://ceur-ws.org/Vol-2104/paper_197.pdf
|volume=Vol-2104
|authors=Tatyana Avacheva,Sergey Yablochnikov
|dblpUrl=https://dblp.org/rec/conf/icteri/AvachevaY18
}}
==Application of Medical Information Systems for the Implementation of Lean
Technologies in the Management of Medical Institution==
https://ceur-ws.org/Vol-2104/paper_197.pdf
Application of Medical Information Systems for the
Implementation of Lean Technologies in the Management
of Medical Institution
Tatyana Avacheva1 and Sergey Yablochnikov 1
1
Ryazan State Medical University, Vysokovoltnaya str. 9, 390026, Ryazan, Russia
t.avacheva@rzgmu.ru, vvkfek@mail.ru
Abstract. The article considers the principles of application of lean technolo-
gies for management of medical organization. It is shown that the introduction
of medical information systems can improve the business processes of the clin-
ic, increase patient satisfaction, availability of services, increase efficiency and
eliminate temporary, financial and other losses.
Specialized software for organization of logistic flows during medical examina-
tions is presented. The article describes the experience of implementing the au-
tomation system of the medical institution within the framework of the target
program "Digital economics of the Russian Federation".
Among the results that can be achieved in the implementation of the approach,
it is possible to identify a reduction in the waiting time for the patient to receive
services, increasing patient satisfaction with the quality and timing of services,
ensuring a balanced distribution of functional responsibilities between doctors
and the average medical staff, as well as the restriction of staff functions within
individual structural units (registry, clinical laboratory, etc.), optimization of in-
formation flows, including improving the efficiency of the medical information
system, elimination of duplication and excessive manual labor when entering
medical information into an electronic medical record.
The necessity of formation of doctors competences in the field of information
technologies within the system of continuous medical education is also shown,
the program of professional development on the basis of effective interaction of
higher educational institution and practical health care is offered.
Keywords: lean manufacturing technologies, medical information systems, au-
tomated control system of medical examinations
1 Principles of Lean Production for Health Care
In recent years, great attention has been paid to the development of one of the most
socially important sectors of the economy – healthcare. However, despite the emerg-
ing positive trends in the growth of life expectancy, reduction of mortality, including
infant mortality, yet health care reforms in Russia have not yet yielded the expected
result.
A possible solution - a set of approaches and methods to improve production effi-
ciency and product quality, which received the definition of Lean production (LP) is a
management concept based on a steady desire to eliminate all types of losses. Lean
production involves the involvement of each employee in the process of business
optimization and maximum focus on the consumer. RyazGMU participates in the
implementation of this approach in the leading institutions of the Ryazan region in the
framework of a joint project of the Ministry of health of the Russian Federation and
the state corporation "Rosatom". The project "Lean hospital" are implemented to im-
prove processes in medical organizations aimed at increasing patient satisfaction and
availability of services, increase efficiency and eliminate the existing time, financial
and other losses, improving the workplace, ensuring the safety and comfort of em-
ployees ' work (see Fig.1).
Fig. 1. Scheme of possible losses detected in healthcare institutions
So, in short, the project "Lean clinic" is designed to optimize the work of the regis-
try, health workers, laboratories and remove unnecessary walking around the offices
so. In the framework of the joint project of the Ryazan state medical university in
Ryazan and "Ryazan-stroy" is carried out on the development and implementation of
specialized software for the implementation of lean production concepts, in particular
engaged in the logistics of patient flows in the institution. With its help, it is possible
to create a itinerary for visiting doctors with a minimum waiting time, which signifi-
cantly reduces the presence of the patient in a medical institution and as a result, re-
ducing queues [1].
2 Digital Transformation of Medicine
Great hopes in the modernization of the management system in medicine are placed
on the transition to digital health care, the widespread introduction of telemedicine
technologies. The approaches that they provide, you can solve the problems of effi-
ciency at all stages of rendering of medical aid.
Over the past ten years, the Russian Federation has accumulated considerable ex-
perience in the development and implementation of information systems used in the
work of health care institutions and health management at various levels [2]. As part
of the construction of "Digital health" at the state level, the task is to create conditions
for the construction of a common information space in the field of medicine, the
widespread introduction of information technologies for the real improvement of the
quality of medical care.
The introduction of information systems of different levels for the effective man-
agement of the medical institution is associated with the solution of several tasks of
modernization of the health system:
• creating the necessary economic conditions;
• development and updating of computer and communication tools;
• operational improvement of information systems in connection with the introduc-
tion of new requirements;
• improvement of the user's intellectual environment through various forms of train-
ing and retraining.
Thus, the process of informatization in health care has several components: eco-
nomic (investment), technical (computing and communications), information (medi-
cal information system, specialized software), the intellectual (trained personnel and
patients).
If the technical and economic components are completely dependent on financial
investments, then the rest is also determined by the human factor, and the elimination
of difficulties here is the most laborious task.
Therefore, one of the most significant problems of informatization of medical and
technological processes and management of health care is the creation of the neces-
sary software and intellectual level among physicians, starting with managers and
ending with average medical workers.
3 Specialized Software for Implementation of lean
Manufacturing Approaches in Polyclinics
The project "Lean hospital" aims to optimize the registry, health care workers, labora-
tories and deleting the unnecessary walking from office to office patients. In the
framework of the Ryazan state medical University jointly with "KIVTS Ryazan'stroy"
on the basis of 1C program was written which optimizes the logistics flow of patients
in a medical facility. With its help, it is possible to create a route list of visits to doc-
tors during medical examination with a minimum waiting time, which significantly
reduces the presence of the patient in a medical institution and as a consequence re-
duces queues, reduces the economic costs of the organization.
To get started in the program you need to fill in the directories. Reference
"EXPERTS" designed to maintain a database of the specialties of the doctors of the
medical institution.
Directory "EMPLOYEE" is designed to maintain a database of hundreds of medi-
cal organizations in accordance with their specializations. Templates for preventive
examinations are created for each age group, in which doctors and their time of ad-
mission are entered.
Reference books "PATIENTS" and "INSURANCE COMPANIES" are used to
maintain a database of patients and their details, if the medical institution in the
course of work need to store data on patients. Help is created for each section of the
program to facilitate the use of all functionality.
After filling of reference books it is necessary to fill in the section "SCHEDULES
of WORK" in which the schedule of doctors according to types of examinations con-
tains (see Fig.2).
Fig. 2. The formation of a single card for medical examination
On the basis of the schedule of doctors, a single coupon per day is created in the
SINGLE COUPON section to visit several doctors.
When creating a single pass selects the type of inspection, date of visit, change of
doctor and pressed to FORM a UNIFIED CARD ACCORDING to the SCHEDULE.
A list of doctor's visit vouchers per day is created.
Thus, the passage of medical examinations is carried out for one visit, the patient
passes the maximum possible number of doctors, which significantly reduces his time
in the clinic and reduces the size of queues, optimizes economic and labor costs.
This program has been successfully installed and is already used in children's poly-
clinic №7, as well as installed and is being tested in children's polyclinic №1. With its
help, it was possible to reduce the time spent on the examination of the patient in the
clinic for 1 month old children to 35 minutes (need to be examined by 3 doctors), and
for 12 months – up to 1 hour 15 minutes (need to be examined by 5 doctors). At the
moment, additional modules of the program are being developed, thanks to which it
will be possible to collect statistics of medical examinations.
4 Modernization of Medical Education in the Field of
Information Technology
4.1. Advanced Training of Doctors and Interaction of the University with
Practical Health Care
As our experience shows, the introduction of any automated systems should be ac-
companied by training of users and their material stimulation, since the use of com-
puter technology entails not only organizational and technological restructuring, but
also requires intensification of labor.
Without the creation of a system of total training and retraining of medical person-
nel and the field of Informatics, it is impossible to solve the problems of informatiza-
tion of the industry. At the moment, among the heads of health care bodies and insti-
tutions and practitioners, the percentage of retraining is very low.
In this regard, Ryazan state medical University, on the basis of the Department of
mathematics, physics and medical Informatics, organizes advanced training courses
for doctors using distance learning technologies to teach them the basics of work in
medical information systems [3].
For the implementation of lean manufacturing methods the medical staff should
have skills in the field of IT:
• maintenance of medical records in electronic form,
• registration of sick-lists in electronic form,
• create medical documentation of statistical reports,
• development of templates for electronic maps;
• organization of referral to another institution or appointment with a specialist and
laboratory tests.
The peculiarities of training of existing specialists-doctors are revealed [4]:
1. different level of computer literacy of medical workers, often complete rejection of
computer technologies (applied individual approach to training, the use of a multi-
media projector to demonstrate all operations);
2. the presence of features of the input medical data in the field of e-forms (used to
work with filters and templates);
3. the presence of features of documentation for different types of reception (tech-
nical specialists need to advise specialists on the organization of health care);
4. the need for step-by-step instructions for students (detailed developed clear step-
by-step instructions for laboratory work).
During the training, students increasingly noted the advantages of using infor-
mation technologies in medicine in General, in the design of copper-zinc documenta-
tion and organization of polyclinic.
The use of information technology as a tool for safe production in medicine has al-
ready yielded excellent results. The time of direct work of the doctor with patients
increased by 2 times, queues decreased by 8 times, and the waiting time of the doctor
at the office – by 12 times.
4.2. Training of Students and Residents
One of the goals of modern medical education is the formation of the necessary pro-
fessional information competencies, so RyazGMU is modernizing the course "Medi-
cal Informatics" for students in the direction of "Medical care" [5]. The purpose of
mastering the discipline is to form students ' systemic knowledge in the field of com-
puter technology, informatization of medical activities, automation of clinical and
laboratory research, computerization of management in the field of health care and the
ability to receive and process information from various sources, work with infor-
mation on the Internet, use the capabilities of modern telemedicine technologies to
solve professional problems.
The possible strategy of teaching medical Informatics is proposed by the chief free-
lance specialist of the Ministry of health of the Russian Federation on informatization,
doctor of medical Sciences, prof. Teaching medical Informatics for students in the
direction "medicine" on 1 course helps to build competence related to the simple pro-
cessing of information with the use of application software, but not having the re-
quired specialized knowledge, a student is unable to learn and apply in practice these
sections of the course, systems of support of decision-making, computer modeling of
pharmacokinetic processes, automated medical-technological system of monitoring
and control functions of the body, the use of an automated workplace doctor in clini-
cal practice, the use of information medical systems in the management of medical
institutions.
It is advisable to divide the discipline "Medical Informatics" into three relevant
modules, one of which is designed to form the basic skills of the use of medical in-
formation systems (MIS) of different classes in the professional activity of the doctor.
For training, training versions of MIS are used to fill in electronic medical records,
automated workplaces of medical personnel, systems for supporting medical decision-
making, etc. Of course, training in the second and third modules should be conducted
at senior courses, as students should have a significant amount of knowledge about
the main medical technological processes.
In clinical departments it is also necessary to develop the use of information tech-
nologies, for example, the treatment of patients can be based entirely on the technolo-
gy of electronic medical records instead of traditional medical histories. For methodo-
logical support of disciplines it is necessary to introduce widespread use of remote
educational resources and distance courses [7].
To improve the level of ownership of medical information systems (MIS) of prima-
ry health care workers in RyazGMU organized courses PC "Basics of work in MIS",
as well as developed and implemented in the educational process course "Medical
information systems" for all special functions of the residency.
Higher education should train specialists ahead of the demands of the economy,
which is why it is also necessary to note the importance of improving the skills of
teachers in the field of it.
5 Conclusions
Thus, the proposed approach to the introduction of information technologies in the
organization of medical institutions allows to achieve the goal of improving the avail-
ability and quality of medical care to the population by optimizing the processes,
improving the skills of health workers, and is also a means of developing health in-
formation.
The aim of the project "Lean polyclinic" is to improve the processes aimed at in-
creasing patient satisfaction, availability of services, increase efficiency and elimina-
tion of existing temporary, financial and other losses, as well as the organization of
jobs, ensuring the safety and comfort of employees. Within the framework of the
project, a specialized software was developed to manage the logistic flows of patients
in the polyclinic during medical examinations.
The described modifications of medical education, the integration of the University
with practical health care and the widespread introduction of it in the framework of
continuous medical education will ensure the formation of information competencies
of future doctors and their readiness to work with new information technologies in
digital health.
References
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