STAGES OF DEVELOPMENT, RESEARCH AND PROBLEMS OF MEDICAL INFORMATICS IN THE WORLD. PROBLEMS OF MEDICAL INFORMATICS

ABSTRACT

This article analyzes the achievements in the stages of development in Medical Informatics, as a science, and also identifies the problems that arise at these stages and ways to solve them. The content of the article tries to reveal new important stages in the development of science. The possibilities of development and application of medical informatics in Uzbekistan are also being explored.

АННОТАЦИЯ

В данной статье анализируются достижения на этапах развития медицинской информатики, как науки, а также выявляются проблемы, возникающие на этих этапах, и пути их решения. Содержание статьи пытается выявить новые важные этапы в развитии науки. Также изучаются возможности развития и применения медицинской информатики в Узбекистане.

Keywords: "Medical informatics", telemedicine, information systems, interactivity.

Ключевые слова: «Медицинская информатика», телемедицина, информационные системы, интерактивность.

Prerequisites

The rationale for the science of "Medical Informatics" lies in the very concept of informatics.

Despite the fact that this science is very young when compared with others. It is gaining momentum and becoming a part of the larger scientific world. If we consider its development in stages, the origins of the science of "informatics" lie, with the development of technical progress in the second half of the 20th century, with the advent of personal computers, side branches in informatics began to appear, such as Medical Cybernetics, which later gave the name of the new science such as "Medical Informatics".[7]

The purpose of this review: to show the development of Medical Informatics as a science in the context of different countries of the world medical community. What are the goals of this science and how it solves the problems that arise on its way.

Despite the fact that all the leading countries of the early twentieth century were engaged in the development of computers, the United States can still be considered as associates in the creation of Medical Informatics.

Main part

The pioneer of the use of computing in medicine was the US National Bureau of Standards, led by Robert Ledley for dental projects in the 1950s, while Neil Pappalardo, Curtis Marble, and Robert Greens developed the "Multi-Programming System for Massachusetts Hospital Utilities".

The next step in the development of this direction was the development of such expert systems as MYCIN and INTERNIST-I. In 1965, the National Library of Medicine began using MEDLINE and MEDLARS. In the United States, in 1996, the Health Insurance Portability and Accountability Act (HIPAA) provisions regarding the confidentiality and transfer of medical records prompted a large number of physicians to switch to electronic health record (EMR) software, primarily for the security of medical data.

The countries of the European Union are also creating their national programs for the implementation of Informatics in the health care of their countries. In particular, the United Kingdom experience in moving towards registration and regulation of health informatics began with the establishment of the UK Council for Health Informatics Professions (UKCHIP) can be considered.

Asia, Australia and New Zealand are part of a regional group called the Asia-Pacific Association for Medical Informatics APAMI, which was established in 1994 and currently consists of more than 15 Asia-Pacific member regions.

China has developed a computerized patient registration system called the Clinical Management System (CMS) since 1994, which includes more than 40 hospitals and 120 clinics and employs all 30,000 clinical staff daily, with up to 2 million daily operations. It contains detailed records of 7 million patients available online in an electronic patient record, integrated from all sites. Since 2004, a radiological image viewer has been added to the EPR.

Since 1993, there is IAMI - Indian Association for Medical Informatics in India.

Although there are a number of health informatics organizations in Australia, Informatics Nurses in Australia were the driving force behind the creation of HISA, which is now a registered company, research, and the association's database is used in all areas of Australia's medicine.[2]

The development of this direction on the territory of the CIS countries was pushed by such science as "Medical Cybernetics", which arose in the 1950s of the last century. In particular, in 1966, the Institute of Cybernetics of the Academy of Sciences of the Uzbek SSR was created, headed by Academician V. Kabulov, which served as an impetus for the development of "Medical Informatics in Uzbekistan". The development of this science in Uzbekistan today is a nationwide policy.

As this science developed, new terms were born such as:

- medical computer science, computing medicine, medical-electronic data processing, medical-automatic data processing, medical information processing, medical information science, medicine and engineering equipment and medical computer technology, telemedicine.

At a conference on the history of Medical Informatics held in Prague in April 2013, George Michalas highlighted the following development stages:

a) Medical information at an early stage before 1975:

pioneering work of scientists, extensive work on analog information signals, laboratory applications, first attempt at solution support, databases, modeling and simulation of biological processes, biostatistics;

b) Development of MI (1975-1990): the creation of international and national organizations, allows to systematize the main areas of MI, first specializing in the development of techniques, medical history, health information systems (HIS), support for advanced solutions of the port-Expert system;

c) Consolidation of MI (1990-2000): Allocation of this science as an independent discipline. It becomes clear that the object of research is medicine and technical information; the introduction of hospital information systems (HIS) and new technologies such as telemedicine.

d) Formation of MI (2000-2010): a clearer definition of e-health, the ability to solve the main problems of modern health care, the impact of the Internet on medicine; involvement of politicians, expansion of regional, national projects, e-health as a business, MI patient center, the emergence of a sub-discipline: bioinformatics, neuroinformatics, Virtual Physiological Human.

e) Full integration of MI in Medicine and healthcare (2010-2020) continuous empowerment, visible steps towards “personalized medicine”, increased patient safety, preventive medicine, use of tabletop devices, home monitoring system.

These stages of development are inherent in Western countries and the United States, but the countries of the post-Soviet space followed a different stage of development. After gaining independence, Uzbekistan began to work rapidly in this direction. Currently developed electronic textbooks: Tashkent Pediatric Medical Institute - electronic textbook on "Pharmacology"; The Ministry of Health of Uzbekistan is working on the production of multi-information electronic textbooks for both teaching staff and students.

Joint scientific projects are being implemented with scientists from the universities of Bonn, Cambridge, Paris, Seoul, Santiago de Compastela and other scientific centers. The Academy of Sciences of the Republic of Uzbekistan, the Ministry of Innovative Development and the Ministry of Finance of the Republic of Uzbekistan, from January 1, 2020, participates directly in the formation of the Institute of Research Trainees in postgraduate education.[6]

The program of research works of the Institute of Mathematics named after V.I. Romanovsky Academy of Sciences of the Republic of Uzbekistan for 2020 - 2024. It includes such studies as:

1. Development of generative statistical models on deep learning neural networks on an extensive training set; retraining the generative model using the separating model as one reinforcement learning system.
2. Development of predictive models on deep learning neural networks with an initial sample in the SMILES format.
3. Training of generating and predictive models of neural networks based on a controlled learning algorithm with the connection of a codec system.
4. Optimization of neural networks with extended stack memory with high predictive ability with small training samples.
5. Test computational experiments of the developed computational strategy: representation of a molecule in the form of a graph and transformation on convolutional layers into a fixed number of data.
6. Construction of a neural network with activation function ReLu, tanh.

Problems and Research

Availability, equity, quality and cost-effectiveness are key issues facing health care in both developed and developing countries. Modern information and communication technologies, such as computers, the Internet and mobile phones, have revolutionized the way people communicate, search and share information, making people's lives richer. These technologies have enormous potential in solving today's global health problems.

What problems is currently being solved by medical informatics in healthcare in the world?

The key link in health informatization is an information system that allows solving emerging problems at a distance quickly, easily and reliably breaking all geographical barriers to obtain the necessary information.

The classification of medical information systems is based on a hierarchical principle and corresponds to the multilevel structure of health care. Distinguish:

1) medical information systems of the basic level, the main purpose of which is computer support for the work of doctors of different specialties;they make it possible to improve the quality of preventive and laboratory diagnostic work, especially in conditions of mass service with a lack of time for qualified specialists. According to the tasks to be solved, there are:

a) information and reference systems,

b) consultative and diagnostic systems,

c) instrument-computer systems,

d) automated workstations for specialists;

2) medical information systems at the level of medical and preventive institutions. Represented by the following main groups:

a) information systems of advisory centers,

b) information banks of medical services,

c) personalized registers,

d) screening systems,

e) information systems of treatment-and-prophylactic,

f) information systems of research institutes and medical universities;

3) medical information systems at the territorial level. Presented by:

a) IS of the territorial health authority;

b) IS for solving medical and technological problems, providing information support for the activities of medical workers in specialized medical services;

c) computer telecommunication medical networks, ensuring the creation of a single information space at the regional level;

4) federal level, intended for information support of the state level of the health care system.[3][5]

But when using these systems, problems can also arise.

If the Medical information systems of the 1980s could be relevant for 15 years, then modern systems cannot have such time periods, which means that the training of medical personnel in the field of IT must constantly evolve, keeping pace with information and technological progress.

The second, such an important direction in medical informatics is telemedicine.

In 2005, following the formulation of WHO's eHealth strategy, the Organization undertook a global eHealth study to provide an overview of the status of this issue in Member States. Based on the data obtained from the survey, in 2009 she conducted a second global survey.[8]

The 2009 study looked at the current level of development in four areas of telemedicine: teleradiology, teledermatology, telepathology and telepsychiatry, and four mechanisms that promote and develop telemedicine solutions in the short and long term: national agencies, national policy or strategy , research and evaluation. The section “Telemedicine - Capacity and Development in Member States” discusses the results of telemedicine research conducted in 114 countries (59% of Member States). Survey results show that currently the highest the level of service availability on a global scale is typical for teleradiology (33%). About 30% of countries have national agencies for the promotion and development of telemedicine, and the likelihood of having such agencies in developing and developed countries is about the same. In many countries where there are no national telemedicine agencies or strategies, scientific institutions are involved in the development of telemedicine. About 50% of countries reported that scientific institutions are currently involved in the development of telemedicine, and 20% of countries reported that they have published publications since 2006,dedicated to the assessment and analysis of the situation in the field of telemedicine. The importance of assessment in telemedicine cannot be overemphasized: the industry is still in its infancy, and although its potential is great, it is the assessment that contributes to its early development. ICTs can be quite expensive, and so can the programs that use these technologies in health care.

Indeed, the most frequently cited obstacle to the implementation of solutions in the field of medical information systems and telemedicine is the financial side.

The next problem that arises in the development of the science of "Medical Informatics" is the low level of exposure of medical personnel in the field of information technology. The lack of teaching aids that meet the specifics of this region, as well as competent teaching literature and qualified teaching staff, does not allow this science to be fully revealed.[8]

In an article in the journal of the American Association for Medical Informatics, the authors: M. Kim, Enrico Coyuera, Fara Magrabi cite data that are errors of use, as well as the inability to use the interface of the IT environment by medical personnel, which led to the death of patients, since they were not provided medical assistance.

Although if we consider countries such as the United States and highly developed countries of Europe, there are special servers containing huge resources in the field of medicine: Anatomical multimedia atlases, electronic versions of medical journals, materials of numerous conferences and symposia, the results of various scientific research and achievements of practical medicine, extensive databases on drugs, telemedicine - this is not a complete list of areas that are presented on the Internet.

There are a large number of medical bibliographic and library systems. The most powerful of these are Medline, Search MedWeb, Medscape, and the US National Library of Medicine.

Medline is a searchable medical scientific information database and is the main abstracts of biomedical literature in the world.

The most powerful medical library is the US National Library of Medicine. In addition to the Medline system, it has created a system of on-line access to information using such a powerful tool as HyperDoc.

Having identified the priority problems of the whole world, we can highlight the main problems of our state:

Lack of research in medical informatics and work experience in this area, as well as scientific literature is the most significant problem today.[1]

Conclusion

Having considered the world experience in the development of this science, we can conclude that the purpose of the action plan in the field of e-health is to study and eliminate the factors that prevent the full benefit from using an interoperable e-health system.

In fact, competently provided medical care depends on the speed of a competently made diagnosis, and this can no longer be done without the use of knowledge of medical informatics. Life is the most important value in the modern world, and a well-saved life is doubly valuable.

The importance of striving to keep up with the times gives the science of our state a great stimulus in the knowledge of medical informatics.

References:

1. Bukharbaeva L.Ya., Egorova Yu.V. Automated decision support system for a doctor in diagnosing a patient's condition // Health Economics. - 2005. - No. 2.
2. Daniel Castro. The Role of Information Technology in Medical Research. IEEE 2009 Atlanta Conference on Science, Technology and Innovation Policy, October 2009.
3. Dolzhkova, E. Yu. On the integration of a unified accounting system for preferential drug provision with medical information systems / E.Yu. Dolzhkova, A.A. Koshkarov A.N. Oskin // Abstracts of the International Congress "Information Technologies for Medicine 2016" [Electronic resource]. - M .: "Consef", 2016.
4. Gasparyan S.A. and others. Technology of information support for automated workstations of doctors in medical departments, development of hospitals Methodical recommendations. - M., 2000.
5. 5.Gerasimov A.N. Medical Informatics: Textbook. M .: LLC "Medical Information Agency", 2008. - 324 p.
6. Decree of the President of the Republic of Uzbekistan, dated July 9, 2019 No. PP-4387. On measures of state support for the further development of mathematical education and science, as well as further improvement of the activity of the institute of mathematics named after V.I. Romanovsky Academy of sciences of the Republic of Uzbekistan. Creation of computer technology for the synthesis of new chemical compounds in the development of new drugs. (https://lex.uz/docs/4409505#4410175)
7. Korolyuk I.P. Fundamentals of Medical Informatics: Textbook / I.P. Korolyuk. - Samara: OOO "Etching", GOUVPO "SamSMU", 2012. - 244 p.
8. The report is accompanied by an online interactive attachment with options for detailed data presentation and analysis of the results of the 2015 WHO global eHealth survey for countries in the European Region. The application is available on the website: (http://portal.euro.who.int/ru/data-sources/ehealth-survey-2015).