Modern patient services provide assistance but do not have a significant impact on morbidity or mortality rates. However, digital medicine cannot develop without such solutions. This is the opinion of the moderator of the panel discussion AI in Life Science, Deputy Director for Development at K-MIS, member of the Expert Council of the Ministry of Healthcare of the Russian Federation on the use of information and communication technologies in the healthcare system Aleksandr Gusev.
We have run an interview with Aleksandr and found out which software solutions are popular in healthcare, where they are applied, and what results they bring.
Interviewer: M-Health Congress (MHC).
Respondent: Aleksandr Gusev (A.G.).
MHC: Which information and communication technologies are especially popular and useful in the healthcare system today?
A.G.: Today they are medical information systems that are already implemented throughout almost the whole country. Online medical appointment services (the so-called Electronic Registrars) are very popular. Almost all medical facilities use laboratory information systems (LIS), picture archiving and communication systems (PACS) – solutions intended to automate diagnostics and treatment and move from paper to electronic form. This helps to speed up and simplify data processing.
Besides, patient services are widespread. Undoubtedly, they provide assistance, but we cannot say that these technologies have a significant impact on clinical results such as morbidity or mortality rates. They are more like basic platform solutions, without which one cannot develop principles and technologies of digital medicine.
Things that can truly bring tangible benefits are electronic clinical decision support systems (eCDSS) and artificial intelligence. They use the accumulated medical digital data and reveal rather valuable knowledge about the health of every specific person by processing it with complex algorithms and mathematical models. They help doctors to factor in important symptoms, assist in routine tasks, draw attention to emerging pathologic processes and make many other useful things.
Use of such products allows doctors to detect cancer at an early stage, take effective preventive measures, and choose treatment that is more efficient. These things are the future of digital medicine. They are changing it so drastically that we cannot clearly imagine what expects us in the future. However, the development speed of such technologies and constantly appearing examples of their implementation are truly impressive.
MHC: Where are the healthcare automation solutions from K-MIS deployed?
A.G.: These products are used in 30 subjects of the Russian Federation, around 25,000 users work with them at several hundreds of medical facilities. The biggest projects are the complex automation of healthcare in the Kirov Region, integration of Medical Information Systems (MIS) and different regional medical services on the Yamal Peninsula. Many medical institutions of the Federal Biomedical Agency (FMBA) were automated. The company expands both the product range and the geographical reach of projects.
MHC: What results have your projects brought for medical institutions? And for patients?
A.G.: For doctors, primarily the introduction of electronic health records. They allow quickly finding the required data, give access to medical history, results of instrumental and laboratory diagnostics.
For patients, we are developing our Electronic Registrar, which in addition to the online medical appointments allows providing citizens with other convenient services. For example, a possibility to arrange for a home visit using the Internet or order a medical certificate from the comfort of your home.
In the future, the launch of the appointment service for health survey and occupational health exam is expected. The service will also give access to the archive of medical documents and a number of other functions through a personal profile. For this purpose, we are working together with regional healthcare executives and specialists of the Medical Center for Information and Analysis: we generate ideas and implement them, increase convenience, simplicity, and speed of services.
MHC: Solutions of K-MIS include automation of pharmacies and medical provision. What advantages do these projects have?
A.G.: Indeed, one of the important projects of the company is the automation of hospital pharmacies, medical provision systems, and prescribing systems. The most successful collaboration in this field is with our keynote contractor – the Kirov Region, where every in-patient clinic uses fully automated monitoring of drugs and consumables, from procurements to the write-off of drugs, bandage, and other materials.
This comprehensive monitoring of expenditures on medication and consumables allowed making this cost-demanding work fully transparent. Executives can see the whole dynamics, which directions require the most of expenditures. They can control the leftover stock and provide additional procurements not spending money on drugs and consumables that are sufficient. It helps to control expiration dates and check overpricing in the work with suppliers.
According to estimates, altogether this allowed the region to reduce budget expenditures on medical provision significantly. Last year, together with the government of the Kirov Region, we launched a large-scale project to modernize this system, and currently the project undergoes a follow-up and approbation period. We expect a complete shift to electronic prescriptions, centralized system for the control over procurement of subsidized medicines, single record of the leftover stock in pharmaceutical organizations, and integration with the federal medication labeling system.
MHC: Will you tell us about K-MIS 4.0 cloud system, please?
A.G.: In 2014, the company set a course for import phase-out of its product line. We started with our Electronic Registrar and rewrote it from scratch. Instead of the old decentralized system on the thick client, IBM Notes, and Domino, we released a new solution based on a java platform, free software, and high-load architecture. In 2016, we started to develop the new version of our regional services and finished it last year by launching the replacement program to replace the old systems with the new one called K-MIS.Region. We joined ARPP “Otechestvennyi Soft” (Association of software developers “National Software”) to strengthen our positions in this direction.
The most difficult thing for us was the development of the cloud-based medical information system in 2017 and 2018. The thing is that the currently existing K-MIS 3 includes dozens of subsystems, thousands of different functions, hundreds of medical electronic documents, records, journals, reports, and other tools. It is merely impossible to provide fast technological modernization and fully maintain the functional services. For this reason, we had to choose and our choice was the technological development as a guarantee that the new system would not get outdated in the nearest 5-7 years. We can see this exact cycle of functional depreciation and complete replacement in the market today.
We called the new system K-MIS 4, although it is a completely different product with parameters that differ from the K-MIS 3 used by medical institutions. The main technological distinctive feature is the engine that was developed from scratch: the system is designed as a centralized web app and does not require commercial system-wide software. It is compatible with national operating systems (for example, ALT Linux) and the Russian version of PostgreSQL Pro. We are planning to provide support to national hardware solutions, among other things.
The second distinctive feature is the shift from the conception “one big system for all tasks” to the introduction of electronic health records and schedule. All other functions will be provided through the integration with standalone services and products such as specialized LIS, PACS, and regional systems of the Digital framework.
We are currently analyzing the market and selecting potential partners for such an integration and collaboration. We can see this approach in the West: there are almost no so-called hospital information systems. These products have matured into electronic health / medical record systems (EHR/EMR), which are gradually moving in the direction of Patient Relationship Management systems (PMR). We believe that this is quite a logical development and will be promoting this trend in our new product.
Last year, we tested the system and collected feedbacks, ran trials using focus groups, and arranged test demonstrations. Now we are finishing the basic follow-up stage and getting ready to launch the first pilot projects. With the advancement of the system, we are planning to move our old products to the new solution and by doing so to close the program of the total import phase-out for all our products and to refuse from old technologies.
MHC: What projects is K-MIS working on now and what solutions is the company planning to implement in the future?
A.G.: The company primarily bets on the artificial intelligence technologies and development of decision support services. For this purpose, we established a standalone research lab called K-Lab several years ago, where we produced all our new products. Its staff members have studying artificial intelligence and machine learning methods since 2018.
Our new product is the clinical decision support system called Webiomed, which we teach to analyze electronic medical records, retrieve data about risk factors from EMR, and make forecasts about the development of diseases. In the nearest future, the system will learn to look for suspicions of latent or nonregistered diagnoses. We believe that preventive measures and prognostics are the key directions for the efficient future healthcare, the main task of which should be the prevention rather than treatment of illnesses.
This product was supported by the Association of Developers and Users of Artificial Intelligence Systems in Medicine “National database of medical knowledge”, in the collaboration with which we are testing the product in healthcare on the Yamal Peninsula. Last November, we signed an agreement with the government of the Kirov Region, with which we study the efficiency of artificial intelligence in the primary care and get ready to spread the technology for the whole region. Besides, several projects are in progress now, including with our partners and colleagues working in the field of artificial intelligence, for example, developers of the medical image analysis system called Botkin.AI.