Healthcare informatics in Russia
For most of us living at the western extremity of the huge Eurasian
landmass, the physical size of the Russian Federation is difficult, almost
impossible, to comprehend. Stretching from the Baltic to the Bering Strait,
it covers over 6.5m square miles (twice the size of the United States) and
no fewer than nine time zones. There is a population of some 143m and vast
areas of very low population density.
The immensity of the landmass is matched, if not surpassed, by the
magnitude of the challenges that face the Russian Federation. In healthcare,
the challenges are equally great. Life expectancy at birth in Russia is more
than 12 years less than in western Europe.1,2 The three leading causes of
death remain as they were before the transition to democracy —
cardiovascular disease, cancer, and accidents — but the numbers in each
category have increased dramatically, as have deaths from tuberculosis. And,
as in so many other countries, HIV/AIDS presents a formidable problem.2 At
the same time as grappling with these major health issues, the healthcare
system itself has faced the difficulties inherent in a move from a centrally
controlled economy to one where the economics of the free market reign. The
breakdown of earlier administrative systems, crises in finance, inadequate
staffing and low pay, have all contributed to the need for reform. Earlier
this year, President Putin announced plans to tackle the problem, which in a
number of respects echo some of the recent strands in English healthcare:
more money, more emphasis on quality, greater emphasis on primary care and
more attention to public health.3 As always, when healthcare reform is
proposed, there are differing views about how it might be achieved; and some
argue strongly that the Soviet healthcare structure — but not
necessarily its operation — had much to commend it.4 But, however the
argument is eventually resolved, there is no doubt that, just as in this
country, computing has a vital role to play.
In this issue, the Journal publishes four articles illustrating
some of the approaches being taken by informaticians in the Russian
Federation’s evolving healthcare services. That we are able to do so has
been made possible by the invaluable help of Dr Michael Shifrin, of the NN
Burdenko Neurosurgical Institute Moscow, who also represents the Russian
Association of Medical Informatics in the European Federation for Medical
Informatics.
Our first article — by Professor Boris Kobrinskiy, Chairman of the
Medical Centre for New Information Technology of the Moscow Research
Institute for Paediatrics and Children’s Surgery — describes how in the last
decade telemedicine has become a reality. With the distances and population
density involved, the scope for the myriad facets of telemedicine to be
deployed is not only considerable but vital. The Federation’s experience
with multiple users and uses shows just how great the synergetic power of
telemedicine can be.
In the second article, Dr Yadulla Guliev, Head of the Medical Informatics
Research Centre at the Program Systems Institute of the Russian Academy of
Sciences, explains how the Interin toolkit for developing hospital
information systems came into being. Its range of abilities is comparable to
those available in this country for a hospital with an advanced HISS, but
the similarities do not stop there: Dr Guliev comments wryly that the system
was developed at a time of radical changes in the country’s social and
political life, which "on the one hand complicated the development process,
but on the other encouraged medical institutions towards the use of IT . . .
for reorganising their activities" — a hope that applies here with equal or
greater force.
The development of a second-generation HIS, DOCA+, is the subject of our
third article, in which Drs Shulman and Rot, of the Medsanchast-168 Fund,
based in Novosibirsk, focus on the improvements made in its human–computer
interface. Not only has browsing been made considerably less time-consuming
for users but, because the system is on an open-systems platform, clinicians
can tailor data collection and reports to their own requirements. There are
substantial lessons to be learnt here that merit very serious consideration.
On a different aspect, the fourth article — from Dr Alexander Gusev —
tells how he and his team developed a scalable solution for providing
computing power for the primary care service of the city of Kondopoga, close
to the Finnish border. Its geographically dispersed multidisciplinary
services and mobile workforce are being connected to the community-wide
intranet that gives clinicians, managers and accountants ‘anytime, anywhere’
access to the databases they work with. The overall flexibility of the
system is one that both healthcare and socialcare workers across the world
would welcome.
For those of us in this country, preoccupied with the challenges of our
own healthcare revolution, it is salutary to look at developments elsewhere,
in a country where healthcare has in some respects much greater problems,
and to see that its directions, hurdles and solutions have much in common
with our own.
Michael Fairey
References
These are available on request from bjhc&im’s Editorial Secretary.
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