HISTORIA ROZWOJU STATYSTYKI MEDYCZNEJ I JEJ STAN W CZASIE REFORM SYSTEMU OPIEKI ZDROWOTNEJ NA UKRAINIE

Mykhailo V. Golubchykov1, Nataliia M. Orlova1, Inna V. Bielikova2

1SHUPYK NATIONAL MEDICAL ACADEMY OF POSTGRADUATE EDUCATION, KYIV, UKRAINE

2UKRAINIAN MEDICAL STOMATOLOGICAL ACADEMY, POLTAVA, UKRAINE

ABSTRACT

Introduction: The role of medical and statistical information in health care cannot be overestimated. The main task of medical statistics is to serve health authorities, provide control over the activities of medical institutions and the state of health of the population, and provide managers with timely and reliable information. For practitioners of health care, statistical indicators allows forming an adequate idea of the quality and effectiveness of therapeutic and preventive work.

The aim: To analyze the existing terminology concerning medical statistics and to determine its contemporary aspects. The work analyzes the existing medical information systems, which are proposed for collecting, processing and storing of the data.

Materials and methods: To achieve the aim of this study, the following methods were used: historical; bibliosemantic, comparative analysis.

Review and discussion: Nowadays, the most known term that describes mass phenomena and processes in health care is “Medical statistics”. In the literature of different times, we encounter a number of definitions used to describe medical statistics. In addition, it should be noted the rapid development of evidence-based medicine in Ukraine, which is widespread in all areas of medicine and health care management. At the same time, methods of biostatistics and epidemiology are the main methodological tool of medicine based on evidence. The principle of evidence and cost-effectiveness was identified as one of the main priorities of the development of public health in Ukraine.

Conclusions: The conceptual apparatus of medical statistical science has undergone a great historical path and continues to change depending on the requirements of the present times. The development of medical statistics cannot occur without the introduction of medical information systems. This study confirms the significant role of medical statistics during the reform of the health care sector in Ukraine and the implementation of the public health system.

STRESZCZENIE

Wstęp: Nie można przecenić roli informacji medycznych i statystycznych w opiece zdrowotnej. Główne zadania statystyki medycznej obejmują dostarczanie informacji władzom odpowiedzialnym za opiekę zdrowotną, sprawowanie kontroli nad instytucjami medycznymi i stanem zdrowia populacji oraz zapewnianie osobom zarządzającym aktualnych i wiarygodnych danych. Osobom wykonującym zawody medyczne wskaźniki statystyczne umożliwiają formowanie adekwatnych wniosków dotyczących jakości i skuteczności pracy, zarówno w obszarach prewencji, jak i leczenia.

Cel pracy: Analiza istniejącej terminologii dotyczącej statystyki medycznej i ustalenie jej współczesnych aspektów. Praca analizuje istniejące systemy informacji medycznej, które służą do zbierania, przetwarzania i magazynowania danych.

Materiał i metody: Aby osiągnąć cel badania wykorzystano następujące metody: historyczne, biblio-semantyczne i analizy porównawczej.

Przegląd i dyskusja: Współcześnie najpowszechniej używanym terminem do opisywania zjawisk masowych i procesów w ochronie zdrowia jest „statystyka medyczna”. W piśmiennictwie z różnych czasów spotkaliśmy się z licznymi definicjami wykorzystywanymi do opisania statystyki medycznej. Dodatkowo powinno się podkreślić gwałtowny rozwój medycyny opartej na faktach na Ukrainie, która rozpowszechniła się we wszystkich dziedzinach medycyny i opieki zdrowotnej. Równocześnie metody biostatystyki i epidemiologii są głównym narzędziem metodologicznym wykorzystywanym w medycynie opartej na faktach. Zasada opierania się na faktach i koszt-efektywności została uznana za priorytet rozwoju zdrowia publicznego na Ukrainie.

Wnioski: Koncepcja statystyki medycznej jako nauki przeszła znaczną drogę i nadal zmienia się zależnie od wymagań czasów współczesnych. Rozwój statystyki medycznej jest niemożliwy bez wprowadzania systemów informacji medycznej. Badanie to potwierdza znaczącą rolę statystyki medycznej w czasie reform sektora ochrony zdrowia na Ukrainie i wprowadzania systemu zdrowia publicznego.

Public Health Forum 2018;IV(XII)3(46):159-163

INTRODUCTION

The role of medical and statistical information in health care cannot be overestimated. The main task of medical statistics is to serve health authorities, provide control over the activities of medical institutions and the state of health of the population, and provide managers with timely and reliable information. For practitioners of health care, statistical indicators allows forming an adequate idea of the quality and effectiveness of therapeutic and preventive work. Medical statistics are the basis for defining strategies for the further development of the health care system, as well as an indicator of the quality of managerial decisions that are taken during work [1].

The implementation of new methods of informational support for making managerial decisions should ensure effective reforming of the health care system and create conditions for improving the quality of operational management, reasonable planning of medical care and increase the efficiency of system resources utilization. The reform of the medical statistics service of Ukraine needs to be considered only in the context of reforming the entire health care system [2].

Aim

The aim of our study is to analyze the existing terminology concerning medical statistics and to determine its contemporary aspects. The work analyzes the existing medical information systems, which are proposed for collecting, processing and storing of the data.

MATERIALS AND METHODS

To achieve the aim of this study, the following methods were used: historical – to study the development of scientific thought about medical statistics in chronological sequence; bibliosemantic – to generalize the analysis of literary and personal data; comparative analysis – to study the transformation of the statistical analysis process.

RESULTS AND DISCUSSION

The theory of probabilities and mathematical statistics arose in the middle of the XVII century as a result of development of society and commodity-money relations. The development of mathematical statistics is associated with the need to process a cluster of information that have been already accumulate in the field of demography, health, trade, etc.

The first one who successfully combined the methods of anthropology and social statistics with achievements in the field of probability theory and mathematical statistics was the Belgian statistician Adolf Kettle. From his works it turned out that the tasks of statistics are not only the collection and classification of data, but also their analysis in order to discover the regularities.

The creation of a mathematical foundation for biometrics belongs to the English school of statisticians of the XIX century, headed by F. Galton and K. Pearson. F. Galton noted that biostatistics is a system of knowledge about the rules of planning and analysis of the results of natural and experimental studies of biological objects [3, 4].

Nowadays, the most known term that describes mass phenomena and processes in health care is “Medical statistics”. In the literature of different times, we encounter a number of definitions used to describe medical statistics. So the term “sanitary statistics” and “variation statistics” is found in the works of G. Dunker; N. Bailey writes about “statistical method in biology”. P. Rokitsky in his work noted that the application of mathematical methods in biology was connected with the transition from the descriptive method of studying of phenomena to the experimental one and used such terms as “biological statistics”. The term “biometric methods” is used in the works of academician V.J. Urbach. Professor A.M. Merkov uses the term “sanitary statistics” in his essays [5−10]

In addition, it should be noted the rapid development of evidence-based medicine in Ukraine, which is widespread in all areas of medicine and health care management. At the same time, methods of biostatistics and epidemiology are the main methodological tool of medicine based on evidence.

The principle of evidence and cost-effectiveness was identified as one of the main priorities of the development of public health in Ukraine [11].

Medical statistics have a significant methodical apparatus, which includes methods and means of their application. Depending on the range of tasks put forward by researchers, they use the terminology of a particular type of medical statistics. The basic terms included in the term “medical statistics” and used in modern science are given in Table 1.

The task of medical statistics is ensured by the availability of a system of special indicators. The system of these indicators is a hierarchical structure, the individual fragments of which are reflected in the accounting, reporting and analytical documents. Timely relevant information on the state of health of the population, the provision of medical care, health care resources and their use is collected by the medical statistics service headed by the Center of Medical Statistics of the Ministry of Health of Ukraine. In all oblasts of Ukraine and in the city of Kyiv there are regional or city information-analytical centers of medical statistics, and medical institutions in their structure have an information and analytical department, where collect and analyze medical-statistical information.

The collection of statistical information from all health care facilities, regardless of the form of ownership, is provided in Ukraine. Processing of information is carried out in an automated mode by using of the specialized software “Medstat”. It is an information system that allows to automate the processing of medical-statistical information. The software is intended for the formation, analysis and storage of reporting and statistical information in accordance with the annual reporting forms of medical statistics.

Also, it should be noted that in recent years in Ukraine, as in most European countries, a system of electronic healthcare is being developed (e-health). An integral part of this system is a variety of electronic registries of patients, which in turn, aims to simplify the processing of medical-statistical information and improve the quality and reliability of medical-statistical information.

Standard software for processing of statistical data containing of most certified software for personal computers is used for analytical work with medical statistics information. In addition, various general and special-purpose software tools are widely used.

The use of statistical methods at the present stage was marked by the use of various software packages: Statistica, SAS, SPSS, STATA, Medcalc, in particular with free access — EZR (Easy R), which allow to implement both routine statistical methods and the most complex statistical techniques.

Medical information systems are designed to greatly facilitate the work of doctors, medical staff and healthcare managers with medical documentation and statistical information.

Under the notion of medical information systems, the program complex for automation of certain aspects of the activity of medical institutions is usually considered.

The medical establishments in Europe use special software that called Hospital Information System [12].

Nowadays, there are a large number of software products at the market that provide automation of the basic processes of medical establishments. In addition, this software provides an opportunity to work with eHealth of Ukraine.

The list of medical information systems present in the medical services market is presented in Table 2.

CONCLUSIONS

The conceptual apparatus of medical statistical science has undergone a great historical path and continues to change depending on the requirements of the present times.

The development of medical statistics cannot occur without the introduction of medical information systems.

There is a sufficient number of medical information systems in the medical software market, but there is no unified system that would be approved at the state level.

This study confirms the significant role of medical statistics during the reform of the health care sector in Ukraine and the implementation of the public health system.

References

1. Belikova IV. Optimizaciya informacionno-analiticheskogo obespecheniya sistemy zdravoohraneniya Ukrainy. Publ Health For. 2015; 1:39–42.

2. Golubchikov MV, Orlova NM, Belikova I.V.. Osnovnye napravleniya reformirovaniya sluzhby medicinskoj statistiki v Ukraine. Wiad Lek. 2018;1(2):207-210.

3. Morra Imas LDzh, Rist RK. Biostatistika. K., 2009;. Shlyah do rezultativ: planuvannya ta provedennya efektivnih ocinyuvan rozvitku. Per. z angl. K., 2015. M. V. Golubchikov, N. M. Orlova

4. Stolyarov GS. Statistika ohoroni zdorov’ya: Pidruchnik. Stolyarov G. S., Voronenko Yu. V., Golubchikov M. V. K., 2002.

5. Lakin GF. Biometriya. M.: Vysshaya shkola, 1973, 343.

6. Bejli N. Statisticheskie metody v biologii. M.: Mir, 1964.

7. Yul Dzh E, Kendel MDzh. Teoriya statistiki. Per. s angl.. M.: Gosstatizdat, 1960, 779.

8. Rokickij PF. Biologicheskaya statistika. Izd. 3-e, ispr. Minsk, «Vyshejsh. shkola», 1973, 320.

9. Urbah VYu. Biometricheskie metody. M., Nauka, 1964, 415 str. Biometricheskie metody. Iz-vo «Nauka», Moskva. 1964 .

10. Ocherki istorii otechestvennoj sanitarnoj statistiki, Merkova AM(edn), M, 1966. 286 s.

11. Rozporyadzhennya KMU «Pro shvalennya Koncepciyi rozvitku sistemi gromadskogo zdorov’ya» vid 30 listopada 2016 r. № 1002-r
– Elektronnij rezhim dostupu – z ekranu: www.kmu.gov.ua/ua/npas/249618799/

12. Nguyen L, Bellucci E, Thuy Nguyen L. Electronic health records implementation: An evaluation of information system impact and contingency factors. International Journal of Medical Informatics. 2014;83(11):779-796.

Conflict of interest:

The Authors declare no conflict of interest.

CORRESPONDING AUTHOR

Inna Bielikova

Ukrainian Medical Stomatological Academy

23 Shevchenka Str, 36011, Poltava , Ukraine

tel: +380983621293

e-mail. byelikova.inna@gmail.com

Received: 10.08.2018

Accepted: 15.10.2018

Table 1. Key terms included in the concept of “Medical Statistics”.

Terminology

Definition

Medical statistics

(synonym: sanitary statistics, medical sanitary statistics, statistical method in medicine and health care)

studies the quantitative and qualitative characteristics of population health, development of the health care system of the state, determines the impact on them of socioeconomic, medical and biological and other factors, and also justifies the use of various statistical methods for processing and analysis of the results of medical research (clinical, experimental, epidemiological, hygienic, medical and social)

Public health statistics

studies quantitative and qualitative characteristics of the health status of the population as a whole and its individual contingents (children, adults, pregnant women, etc.), as well as various factors affecting it (socio-economic, medical and biological, etc.).

Health care statistics

investigates the quantitative and qualitative characteristics of the resources of the health care system of the state (the number of health care facilities and their capacity, the number of doctors in each specialty, etc.) and analysis of efficiency (social, economic, medical) of the health care system.

Clinical statistics

studies the quantitative and qualitative characteristics of the species activity of the human body (the content of various macro- and microelements in blood, urine or other biological fluids, blood cell count, etc.) during various physiological (pregnancy) and pathological (coma, illness, hypothermia, etc.) states of the organism

Biometrics (or biometric statistics)

a scientific branch that combines biology and variation statistics, is associated with the development and use of statistical methods in scientific research (both in the planning of quantitative experiments, and in the processing of experimental data and observations) in biology, medicine, health care and epidemiology.

Table 2. Medical information systems

Medical information system (МІS)

Features of МІS

Dr. Eleks

The system provides automation of all key processes of the medical institution. It includes all the necessary modules for work: register, finance, hospital, laboratory, and others.

IRIS (Radiological Information System)

It makes it possible to sort patients by status, sites and types of examination.

Contains the patient’s anthropometric data necessary for the proper conduct of radiological examination. Creates a patient information archive for use in subsequent surveys.

Allows customizing of reporting and tracking of the results.

Organizes the work for a productive workflow.

Improves the logistics of patient ingestion

Simplifies the work of an intuitive role-based interface.

Allows making of statistical analysis.

Reduces the time of the registrar’s health facility with the patient.

Reduces the contact time of an X-ray laboratory with a doctor and other middle medical personnel.

Increases the number of patients surveyed for a certain period of time.

МІS ЕМСіМЕD

The system contains the following modules: the electronic medical card of the patient, medical documents (medical forms of the Ministry of Health), medical staff, clinic and registry, hospital, laboratory (integration of laboratory equipment), compilation and personalized registration of drugs, statistical records and reports of the Ministry of Health, Contact Center, PACS, Partners, Online Doctor Reception, Mobile Patient Application.

MEDSTAR

Contains an electronic medical card, a patient registration module, an electronic prescription and a medical reference book, an ICD-10 classifier, protocols of treatment, approved printed forms, and more.

Meditex

Monitoring and management of a complete cycle of infertility treatment;

Clear structure of stimulation cycle;

Automated reporting interfaces for different registries;

Sperm quality analysis and test laboratory;

Daily observation of each oocyte;

Control of cryopreservation and contact management;

Flexible reports with using of statistical analysis;

Instant and easy access to performance metrics;

Integration and exchange of data with medical equipment.

Clinic without queues

Monitoring and managing of the patient flow and the physicians’ workload; integrates with systems and modules for working with a patient’s electronic card, electronic recipe and accounting systems.

MedEyr (Ukraine)

Protection of information and compliance with national and international standards.

MedCard Plus

The feature of the MIS is the use of a process approach to automating the work of a medical institution in medical and administrative activities.

Askep.net

Work with eHealth system, patient card, polyclinic (record for doctor’s appointment), in-patient department (form No. 066 and others), laboratory (analytical results), electronic recipe, statistics (internal and official form), specialized modules (dentistry, lying-in hospitals, oncology, dermatology, ultrasound diagnostics, psychiatry, etc.), integration with third-party services and equipment. It is also possible to upgrade any functionality to the needs of the institution.

Health24

Intended for automation of clinical work of doctors, implementation of electronic medical card of the patient and organization of effective interaction between all participants of the medical-diagnostic process.

nHealth

Includes work with patient databases, comfort of communication, informational support of physicians about diseases, complaints and further treatment of patients. The workflow meets the requirements of the Ministry of Health of Ukraine.

UASMART

Modules available in the system: electronic registry, doctor’s office, patient’s cabinet, medical portal, electronic patient medical card, laboratory, statistics, management.

MIS „Chestnut” («Каштан»)

Comprehensively covers all medical, economic, analytical and managerial processes of the health care system from the ambulatory of family medicine to the Ministry of Health.

Med info service

Consists of a workplace of a staffing officer and a program complex for outpatient clinics and in-patient departments. Statistical reporting, analytical reports on the activities of the institution, generalization and analysis of information are available. Patient management program, information about morbidity and treatment, keeping records of doctors’ work.

* Information is provided by eHealth electronic system.