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104 East European Scientific Journal #7(71), 2021 ...av,...,..
ПОЛИТИЧЕСКИЕ НАУКИ
Makarenko M. V.
Candidate of Medical Sciences, Director of MM-Dental Clinic, candidate for the degree of Doctor of Science, Taras Shevchenko National University of Kyiv ORCID: 0000-0001-8677-8670
ORGANIZATIONAL MECHANISMS FOR IMPROVING THE ELECTRONIC HEALTH SYSTEM IN UKRAINE
Abstract. The article analyzes the organizational mechanisms for improving eHealth in Ukraine. It has been proven that the digitalization of the medical industry must be effectively coordinated and have a reliable source of funding, and for this it is necessary to reform the financial support system with the introduction of compulsory health insurance. It has been substantiated that the success of eHealth, in particular, depends on the internal and external interoperability of medical information systems and registries and the use of modern digital technologies in technological processes. It was found that despite the active position of the government of Ukraine on the development of the digital economy and society and the introduction of the electronic health care system in the context of reforming the financing of the medical industry, there is an unsatisfactory use of modern digital technologies both in clinical medicine and in management technologies. There is a lack of sufficient digital literacy of health professionals. There is a technical and moral obsolescence of equipment, incompatibility of information and communication operating systems.
Keywords: health care, public administration, organizational mechanisms, electronic health system, interoperability of medical information systems.
Formulation of the problem. Proper collection, management and use of information within the health care system determines the effectiveness of the system in identifying health problems, setting priorities, inventing innovative solutions and allocating resources to improve health care.
According to experts of the joint project of the World Bank and the Ministry of Health of Ukraine "Improving health care at the service of people" [1], one of the important factors of unsatisfactory management in the field of health care in Ukraine is the low efficiency of information management in the health care system. primarily in terms of poor availability, reliability and timeliness of data.
Another problem is the imperfection or lack of proper information protection in most existing information systems and information transmission networks. But given the strong IT potential of Ukrainian society, we have the potential to introduce the latest digital technologies in health information management and adequate health care administration. An important condition for the success of the digitalization of Ukrainian health care is the movement of government towards business, which has been confirmed in the activation of the market of medical information systems. On the other hand, the Ministry of Health of Ukraine, as a state regulator, needs to pursue a policy aimed at monitoring compliance with the interoperability of commercial digital products for the medical industry. No less attention should be paid to the practical training of medical personnel for the use of modern digital technologies, especially medical managers, as they depend on making effective decisions on the digitalization of health care. The implementation of medical information systems and the use of such modules as analytical-statistical or
management accounting and real-time quality management should improve the efficiency of management decisions at all levels of the medical industry, but this requires setting managers to work with new digital products through practical training.
Analysis of recent research and publications. Problems of digitalization of public administration were studied by: O. Karpenko, P. Klimushin, V. Namestnik, D. Spasibov and others. D. Borkovsky, V. Zhuravel, T. Tkachuk and T. Hryadil studied the use of digital technologies in the field of healthcare. However, despite the large number of scientific publications, further research is needed on the priorities for the transformation of public health management.
The main material. The main reasons for the unsatisfactory state of health care in Ukraine include inefficient management of information about the health sector (lack and isolation of data registers and outdated filling of statistical forms) and insufficient and uncoordinated use of modern information and communication technologies. These include: data management in health facilities and statistical systems is in some cases unmanageable and in others excessively managed, resulting in unbalanced management of medical data, which results in results that are not comparable to the efforts made; The information space of the health care system is fragmented, it is difficult to obtain the values of many indicators at the national level, there is no operational and reliable data on most health care parameters.
Among these shortcomings, the most significant
are:
— the type, volume and quality characteristics of medical care provided to the patient;
— the type, volume and conditions of the
L»
patient's discharge and receipt of drugs and medical devices;
— analytical data on planning the need for medicines, medical devices for certain prescribed categories of patients (patients with hypertension, acute coronary syndrome, etc.);
— resource provision of health care institutions (staff, balances of medicines, fixed assets for activities, etc.);
— there is no full scope of necessary sectoral regulations on the development, implementation, operation and development of information technology;
— there is no regulation of health care informatization.
Even despite the examples of successful use of information technology in medical institutions, there is no widespread use of modern information and communication technologies directly in medical practice. There are also no formalized criteria for determining the economic efficiency of the introduction and operation of information technology. There are not enough qualified specialists in medical informatics in medical institutions. We observe the technical and moral obsolescence of equipment, incompatibility of information and communication systems that function or its absence at all. A serious legal problem is the imperfection or lack of proper protection of information in most existing information systems and information transmission networks. A significant gap is the lack of possibility to exchange data with electronic resources of external agencies (for example, databases of the Fund of Compulsory State Social Insurance) [2].
The main approach to reforming the medical sector in Ukraine is to create a single, integrated information and analytical system of public health based on electronic identification of patients in health care facilities, data collection of preventive examinations for further use in analytical, expert and statistical systems, which corresponds to the establishment of a national eHealth system that has the safe and cost-effective use of information and communication technologies in the field of health care, including the provision of health care, the organization of public health surveillance, medical education, research results [3].
Organizational, legal, financial, managerial, economic, structural, personnel, informational and other fundamental mistakes prevent Ukraine from benefiting from its own human capital and hinder a set of economic and social measures that directly or indirectly contribute to the highest level of health of Ukrainians and increase duration of their quality of life.
The only way to solve systemic problems in the field of health care is a strategically oriented state policy, the main task of which is to define human health as one of the main priorities of the state, to create, develop and ensure the functioning of the new national health care system. The new national health care system should be based on fundamental principles, which are fundamental and should be applied in all sectors of
East European Scientific Journal # 7(71), 2021 5 health care and should be reflected at each subsequent stage of construction and development of the health care system, namely: systemic integrated development and integration, decentralization, security, accessibility, publicity, quality, prevention.
The formation and implementation of the National Strategy for Health Development (Transformation) of Ukraine on these principles should be carried out in accordance with the six components identified by the WHO: the provision of medical services, health care resources, health information systems, funding, access to basic medicines and medical devices, leadership management. All of these components are somehow related to digital tools and technologies.
The new health care system must be human-oriented and economically sustainable, and will work effectively in Ukraine at the stage of humanity's entry into the digital economy, which is a new technological device. It is a mistake to believe that advanced technologies in the digital economy will automatically increase the efficiency of medicine and improve health care delivery, and that eHealth aims to "fit in" with the digital economy.
In fact, the introduction of new technologies does not mean that medicine will automatically become more accessible. The use of modern digital technologies, such as the Internet of Things, Big Data or Artificial Intelligence, with the wrong model of health care can only exacerbate inequalities in the provision of health care - by population, territory, nosological units.
The purpose of health care as a system - the same as in any other social system - is to reproduce one's own, preferably expanded. For this, the system will be ready for anything. The task of society should be to ensure that health care provides the highest quality and affordable medical care - at the same time, in a given resource.
In this discourse, the digital economy and digital medicine must have no subordinate or causal links, but coexist. However, their maximum interaction should be aimed at the benefit of each system, and hence the whole society - both directly and indirectly. These are humanitarian and social aspects, but there is also an economic and technological aspect [4].
The digital economy and digital medicine are the state of the art. An electronic health care system is a tool. To implement this ambitious plan, a holistic comprehensive concept, strategy and roadmap are needed, followed by functional systems and projects. WHO, monitoring the construction of elements of the world's health care systems, identifies the existence of a formal national health policy and strategy in the country that meets national needs and priorities, as a key indicator in assessing the public health management system.
Although technology today allows for the most complex projects, they must have the appropriate resources. Solutions, even successful ones, cannot be mechanically transferred to healthcare from other industries. Trying to create an environment of exceptional commercial financing in health care, the
6 East European Scientific Journal # 7(71), 2021 struggle for resources leads to any kind of competition, but not to competition for quality.
Today in Ukraine there is no program-based, scientifically based document legalized at the national level, which would define the national policy and strategy in the field of health care and reflect the national needs and priorities. This document should contain a realistic assessment of available resources, determine the vision of the future of the health care system, goals and objectives, regardless of factional, political and financial interests.
The lack of these crucial documents can result in unsystematic management decisions that carry quite serious risks today and in the future and create distrust in the reform of medical staff and citizens.
Conclusions. Thus, pilot implementation of changes in the mechanism of medical care in four institutions of the National Academy of Medical Sciences of Ukraine (National Institute of Cardiovascular Surgery named after M. Amosov, Institute of Cardiology named after Academician M. Strazhesko, Institute of Neurosurgery named after A. Romodanov, National Institute of surgery and transplantation named after O. Shalimov), implemented in pursuance of the Resolution of the Cabinet of Ministers of Ukraine of June 14, 2017 № 425 "Some issues of the pilot project to change the mechanism of financial support for medical care in some research institutions of the National Academy of Sciences of Ukraine" [5], can be a very useful experience and prevent managerial mistakes at the stages of modernization of secondary and tertiary care in all regions of Ukraine.
The introduction of new mechanisms for financing institutions in a pilot mode demonstrates, in particular, the need to use modern digital technologies of accounting, analysis and communication in the organization of the statutory activities of medical institutions operating on an enterprise basis [6].
However, the health regulator (Ministry of Health) does not make informed management decisions about the introduction of an electronic health care system: it is worrying that in the context of free choice of health information systems by health care institutions to work with eHealth, urgent unification to ensure their
integration with each other, as currently the use of data between different systems is impossible even within the hospital district, not to mention the institutions of the National Academy of Medical Sciences of Ukraine.
In addition, the electronic health care system (eHealth) was launched without creating a system of information protection of the central database, as provided by the Resolution of the Cabinet of Ministers of 25.04.2018 № 411 "Some issues of the electronic health care system", which approved the Procedure electronic health care system. The new regulations of the Cabinet of Ministers provide for full responsibility for ensuring the protection of patients' personal data on service providers. This situation creates significant risks today and in the future and creates distrust of the reform among medical staff and citizens.
References:
1. About the joint project of the World Bank and the Ministry of Health of Ukraine "Improving health care at the service of people". URL : https://wb.moz.gov.ua/pro-proekt.html
2. Tech Trends 2018: 5G, Killer Robots, Cryptocurrency Regulation. URL : https://www.youtube.com/watch?v=h8EHAaqTy4M
3. Health sector national minimum data sets. URL : https://meteor.aihw.gov.au/content/index.phtml/itemId /344850
4. Personalized medicine: everything the digital economy has to offer. URL : https://chameleoncollective.com/blog/medical-technology-digital-economy/
5. Health Care. Stanford Medicine delivers unparalleled care for each patient's unique needs. Our multidisciplinary approach to health care coordinates expertise with the most advanced technology for the best possible outcomes. URL: https://med.stanford.edu/health-care.html
6. National Telecommunications and Information Administration United States Department of Commerce. URL : https://www.ntia.doc.gov/page/chapter-5-technology-and-privacy-policy
