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Rationale for centralized medical data processing as an effective method of information supply in healthcare, based on total cost of ownership estimation


А.А. Konovalov – Ph.D.(Med.), Associate Professor, Department of Preventive Medicine, Nizhny Novgorod State Medical Academy, Head of Nizhny Novgorod Medical Information and Analytics Centre

Informatization of healthcare system is one of the main objectives of public policy in Russian Federation, embodied in the federal legislation. In 2011-2012, the governmental tasks of modernizing healthcare consisted transition to the unified mandatory health insurance policies, including secured electronic application electronic card, the implementation of telemedicine systems, electronic document management systems and introduction of Electronic Health Records. Creating a regional segment of the Unified State Health Information System conducted under the concept, approved by order of the Health Ministry of the Russian Federation in 2011, has required detailed preliminary analysis and scientific approach. It was shown that in urban institutions, much more attention was given to the construction of technical infrastructure, so in municipal institutions level of infrastructure development was very low. These disparities and the accompanying differences in personnel supply provided evidence for the use of a centralized architecture that minimizes the requirements for peripheral components of information systems. To determine the cost-effectiveness ratio for centralized and decentralized architectures the technique of calculating the total cost of ownership (TCO) has been applied. Initial and subsequent investments were estimated, incl. people costs, environment costs, service costs, security costs, hardware costs, network costs and software costs. 71% of total expenditure amounted to three categories of costs - human resources, environment and hardware. Obviously, the most effective method of reducing these costs is centralized software and data processing. Obviously, in addition to the economic benefits centralized architecture has other advantages: the concentration of all the information about the state of one node in the network management, complete picture of network construction, the minimum length of the control cycle, the consistency of decisions, etc. Thus, healthcare management information system of Nizhny Novgorod region was characterized by a pronounced tendency to strengthen material and technical base, variety of software and increasing staffing shortages (especially in rural areas), and the question of optimization of existing resources and the establishment of effective approaches to planning and building a unified information health care system in the region had a high relevance. In recent years, a favorable environment for development and implementation of healthcare information system based on application of modern information technology has been created, due to the strengthening of both the material and technical base, and organizational changes. Comparative analysis of alternative ways of constructing a unified health information system in the region has shown that the main priority for optimize total cost of ownership is to reduce the use of human resources by centralizing the system architecture.

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