Medicine of the future. Programmer's Look

Good morning. For various reasons, I often encounter health workers and healthcare facilities. So in the age of high technology, I am very surprised that most of the information is on paper. Moreover, if you are being treated by different doctors in different clinics, this will begin to be even more inconvenient, because every doctor wants to know the full picture of the diseases for which I was treated. So you carry these piles of papers with you. A separate topic here is getting help. Well, I think many were in line.

So today I read the post " Medicine: electronic medical history - a view from the doctor " and decided to share my thoughts as a programmer on a possible implementation of such a system.



In my opinion, such systems should solve several problems:

• translation of workflow related to health care in hospitals and beyond into electronic form;
• collection of medical research data (physician examination data, x-rays, ultrasound, tests, blood tests, etc.);
• analysis and systematization of the data;
• patient access to medical history and appointments via the Internet, mobile apps;
• Reporting research results via sms, email, mobile apps;
• remote communication of the patient with the attending physician (including from another region);
• creating a system for an objective assessment of the effectiveness of a medical worker, healthcare institution or regional unit;
• the exclusion of the possibility of substitution of research data, their subsequent changes, concealment of medical errors - which should increase the level of quality of services provided;
• a single centralized database will allow avoiding a series of problems with obtaining one or another card or certificate, since any doctor even from another city is able to get the whole patient’s medical history, regardless of where the card was opened;
• assistance in making the correct diagnosis on the basis of a statistical analysis of previous experience (the exclusion of obviously incorrect diagnoses, help in predicting the course of the disease under certain conditions);
• doctor’s access to the generalized experience of other doctors;

Let us dwell on some points in more detail. Collection and analysis of medical research data - now a large number of medical devices can give data in electronic form (I see no reason to keep them on paper). These data may in the future become that indispensable statistical basis for research.. Experience in any field is indispensable, especially in medicine. But I consider the past to simply store such data - medical systems must take a step forward: they can help doctors avoid commonplace mistakes in making diagnoses, they can help make the right diagnosis (this is more like systems in airplanes when the pilot forgot to remove the landing gear after take-off the system will remind him of this). Perhaps in the future, the system itself will be able to make simple diagnoses (such as acute respiratory viral infections, acute respiratory infections, VSD, and others).

Items such as informing and accessing medical history via the Internetmake the patient’s life easier. After all, this is not a healthy person, for whom it may not be difficult to walk a couple of kilometers to a medical institution. And so you sitting at home will get all the desired results, as well as the destination. Fast and convenient. A big plus can be the remote communication of the patient with the attending physician.

A single information space throughout the country gives you the opportunity to not worry about the fact that when you arrive in another city and get sick, the new doctor will have to retell what you used to be sick with. I am already silent about emergency cases, accidents, etc., where you need to act and not dig paper in search of contraindications for a particular patient. Perhaps it will save lives.

All data in the system must be stored without the possibility of their deletion and substitution. This is more like a version control system. All changes will be committed, creating only a new version of the document, but not replacing the old one. A medical error will be available and visible immediately. Given a distributed storage system, it will be difficult to “bring” anyone who needs to replace the data. Based on the same data, it is possible to build a system for assessing the quality of services, objective, with numbers.

The biggest problem now is prescription drugs. The system may have affiliated pharmacies. Then the doctor simply informs the pharmacy convenient for the patient that a certain medicine will be necessary, and the patient will only have to come and pick it up (medicine).

What a standard scheme of interaction between a doctor and a patient might look like:

• Patient N went to hospital B;
• M1 doctor issues the patient a document identifying him with the service session; for identification, a QR code containing the user's credentials is used. Moreover, only the session ID remains on the system side, and without a QR code it is not possible to attach a specific person to this ID. This ensures the safety and anonymity of the data.
• The M1 doctor conducts an initial examination, enters the initial examination data into the system, and registers referrals for research.
• the patient picks up a document identifying him with the service session. And he goes to the doctor with a study in which he was prescribed.
• The M2 doctor scans the QR code and receives the patient service session ID. Carries out the research assigned to him and fixes the data in the system.
• Next, the patient returns to the doctor M1. He scans the QR code and looks at the results of the study. It makes an interim diagnosis. The system captures it. And writes out appointments, which are also fixed. The system gives the doctor comprehensive accumulated statistical data on the disease based on the doctor’s assumptions and analysis of the results of the studies.
• Then the patient returns again for a second consultation with the doctor M1. He again scans his QR code and conducts a second examination, fixing the dynamics of the course of the disease. If the prognosis is negative, then an additional intermediate diagnosis may be made if the first was erroneous and new appointments were recorded.
• If the patient is cured, then the maintenance session closes. And the doctor confirms the final diagnosis. Now the system can identify all the experience of the interaction of a given patient with a specific disease and doctor, as well as the experience of treating this disease.

Thus, the system stores the entire complete comprehensive picture of the disease of the person and treatment methods. The availability of the patient's card in electronic form gives a significant increase in the speed of medical decision-making.

A big bet should be placed on mobile applications. So the doctor’s workplace can be mobile, rather than tied to an office. A physician can provide assistance and receive information anywhere where there is access to the Internet.

I would single out four levels in the structure of the system:

1. level of patient interaction - doctor. These include: doctor’s web interfaces, client web interfaces, results distribution systems, mobile applications.
2. institution level. That part of the system that provides communication between institutions in the same region.
3. federal level. At this level, communication is established between regional centers.
4. level. There is only a head center that collects information from all regional centers.

To ensure security, you must adhere to several rules:

• the base should not contain direct links between research data and data capable of identifying a particular citizen;
• storage should be distributed (part of the data of the Tula region lies on the servers in Kaluga);
• data should be duplicated (complicates the substitution - at the same time replacing data in three sources - somehow an unlikely scenario);
• data is exchanged over encrypted channels.

I am sorry that I took a lot of time, I just wanted to express how I would like to see the health care system of the future. I do not pretend to be the ultimate truth :). I will be glad to any criticism and comments.

PS I would be happy to take part in the development of such a system in Russia.