Institutional and management aspects of telemedicine network

VG Ostashko, GA Light, M. V. Zvyagintsev, A. Kovalenko

Introduction. Development of telemedicine technology to create a legal framework for their implementation, development of relevant documents that regulate the functioning of telemedicine networks providing telemedicine services, conducting distance learning, financial security and so on. International experience shows the introduction of telemedicine, which is true is the organizational structure of telemedicine networks can provide high impact in the provision of medical services in remote areas of the country in emergency situations.

Main results. The first task in the development of telemedicine - a creation of telemedicine network. Telemedicine network (TMM) - a hierarchically organized within a specific territory (district, region, country) system telemedicine centers, points and classrooms are equipped with specialized software and hardware and trained personnel to provide telemedicine services through various types of communication channels 'communications [1]

Tasks to solve TMM:

assist doctors working in remote areas of the country;
accelerate and simplify the management and distribution of documents in the field;
remote training and counseling sessions with employees medychnykamy;
TMM can combine all types of health care facilities - from regional hospitals to the regional offices and the MOH of Ukraine.

TMM must meet requirements for systems that provide telemedicine services:
zabezpechyvaty access to all services kruhlodobovo;
effectively protect private information and to identify users TMM.
provide the necessary geographic and functional expansion of TMM;
provide necessary and sufficient features to meet the challenges of diagnosis, treatment and rehabilitation of patients, teaching and training medical staff and the collection and dissemination of management information;
implement a single medical information space for all participants in the network;
based on informatsiyniyy infrastructure of medical facilities and institutions that are members of the TMM using medical information systems.
Therefore, you can determine the actual direction of institutional arrangements that should accompany the process of creating a telemedicine network in Ukraine. These include:
development and approval of regulatory and legal framework of telemedicine;
development and approval of accounts and reports relating to telemedicine, and their electronic equivalents on the basis of modern information standards;
definition of technical equipment and information and software, ranging from user level (LPZ) to the level of regional telemedicine center, creation of conditions of introduction and storage of medical information;
development of standards for telemedicine services;
definition of domestic and foreign partners TMM Ukraine;
determine the sources of financing telemedicine.
Stop at each of them. First review the development and adoption of legal framework Telemedical. It consists of several levels of legal documents and several units that should regulate the activities of telemedicine in Ukraine:
evidence to conduct telemedicine consultations and «telemedicine care» population;
Voluntary informed consent of the patient (or relative or person who acts on behalf of the patient) on the use of personal medical data in a telemedicine consultation;
consultant responsible for the conclusion made in terms of his whole complex of information on the status of the patient and the doctor performing the right obtained by telemedical consultations recommendations;
autentychnist medical records that are discussed (the same as the confirmation provided / received);
authorization materials obtained using telemedicine consultations;
telekonsultatsiyi confidentiality and protection of personal data following the patients;
protokolizatsiya (documentation) telemedicine consultations, and following arhyvuvannya data telekonsultatsiyi;
authentication consultant and his signature;
technical timely conduct telemedicine consultations, responsibility for the accuracy of information that is published on the Web-servers;
ensuring the copyright and property of the materials used in telekonsultatsiyi;
provide paid telemedicine services [2].
Thus, the priority for the introduction of telemedicine technology is legal acts (first of all, the law) of telemedicine, where rehlamentuyusya basic provisions for telemedicine in the light of the patient and doctor (in the absence of laws on the rights of the patient, medical institution, etc.).

Regulations (the Cabinet of Ministers of Ukraine Ministry of Health orders) should govern the practical implementation of the telemedicine. This includes decisions and orders of the telemedicine network, the rules of its operation, orders approving accounting records for telemedicine consultations, definition of performance indicators of different levels of telemedicine.

Another important development is the introduction of telemedicine accounting records. References such documents was given by us in [3].

Particular attention in the drafting of documentation for telemedicine consultations should give them electronically. Today, electronic medical records (EHR) is dedicated to many studies in different countries. Created hundreds of variations of such documents. However, the international community regulates the creation of such documents based on specific information standards. First of all, this is standard transmission, storage, archiving of medical data and presentation of electronic medical records. These include standards such as Health Level 7, which is aimed at standardization of formats of medical data between medical institutions, open EHR, which regulates the way to create electronic medical records, DICOM, which regulates the storage formats and transmission of medical images and a number of International Organization for Standardization (ISO), governing the format of electronic health cards, etc.. In the development of information support is also necessary to apply a series of classifiers and directories to be departmental standards of health. These include a classifier, as ICD-10 Classification of health services, surgeries and other procedures.

Health Level 7 - standard for health information exchange application-level communications between information systems in health care. Exchange information (version 2) is usually between information systems in the same hospital, between hospitals and clinical laboratories that are outside hospitals. Today, this standard has the version 3, which specifies the architecture of electronic medical records and their transfer. Used in the U.S., Australia, most European countries.

Standard CEN \ ISO 13606, in other words open EHR, offers a way to standardize electronic medical records based on the so-called archetypes and templates. Today, he is only beginning to apply in countries such as Australia, Britain, Sweden.

For transmission and storage of medical images currently widely used standard DICOM, through which the transmission of medical images with digital diagnostic devices (x-ray machine, ultrasound, scanner, CT, MRI, etc.). Today, on the basis of this information, most standard operating systems such as PACS (Picture Archiving and Communication System), which function in almost every medical institution developed countries where the introduction of telemedicine systems [4-8].

Software and hardware platform telemedicine facilities should be established based on typical automated workplaces (AWP TM) specialist doctors, leaders of other centers using the channel not less than 512 Kbps.

ARM TM should include the following information and tools:
Electronic patient card for remote consultation;
E-book accounting telemedychyh consultations;
Specialized software for telemedicine consultations;
Information system for archiving and storage of medical information and images (PACS);
Module connection of medical diagnostic equipment from the workstation user.
In the telemedicine network storage and data processing must be divided into three main modules:

- Medical service (MS) - responsible for the accumulation and storage of all medical information.

- Workstation (PC) - responsible for processing and diagnosis in the accumulated MS images.

- Remote work station (VRS) - responsible for processing and diagnosis in the accumulated MS medical images in institutions beyond the telemedicine center.

The three main modules to be integrated using the DICOM-protocol with existing devices, digital input image, quality control and other digital equipment.

Thus, a telemedicine network in Ukraine is necessary and the real project. To create the necessary development, availability and combination of the following components:
Planning the network structure;
necessary computer equipment;
availability of DICOM-compatible software.
strategy development of the network.
Solving this problem can not be outside the general field of informatization strategy for telemedicine network will only be effective if the project will be integrated into network sharing medical data.

[center] Literature [/ center]

Vladzymyrskyy AV The basic concept of telemedicine in health care / / Ukr.zh.telemed.med.telemat.-Vol.5, № 3.-2007.-S.244-251.
Naumov VB, Savelyeva DA Legal aspects телемедицины. Under scientific editors, Professor RM Yusupova and Professor Robert I. Polonnykova - St. Petersburg.: SPIIRAS, 2002.-106 pp.
Organization of telemedicine in the health institutions ozorony (guidelines) / / MV Zvyagintsev, AV Vladzymyrskyy, VG Klymovytskyy, GA Light, L. S. Godlewski, V. Ostashko .- MH of Ukraine .- 2008 .- 70 pp.
ISO / TS 18308: Health Informatics - Requirements for an Electronic Health Record Architecture, 2003;
ISO TC 215/WG 1: Health Informatics - Electronic Health Record-Definition, Scope and Context, Draft Technical Report, 16.3.2004;
The openEHR EHR Reference Model - Revision 4.3.2, The openEHR Foundation, 2003 (www.openEHR.org);
Dolin RH, Alschuler L, Beebe C et al.: The HL7 Clinical Document Architecture. JAMIA 8 (6) :552-69, 2001;
Hussein R, Engelmann U, Schroeter A, Meinzer HP.: DICOM Structured Reporting: Part 1. Overview and Characteristics. Radiographics 24 (3) :891-6, 2004.

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