Institutionalization of scientific researches in the field of distant automated diagnostics in the RSFSR (1970-1990s)

Vladzymyrskyy Anton Vyacheslavovich ORCID: 0000-0002-2990-7736 Doctor of Medicine Deputy Director of Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies of the Moscow Health Care Department 127051, Russia, Moscow, ul. Petrovka, 24, p. 1 avv_mobile@mail.ru Other publications by this author

The second half of the 1970s is characterized by intensive processes of institutionalization of scientific research in the field of automation and informatization of healthcare: "In the light of the decisions of the XXV Congress of the CPSU, significant attention is paid to the issues of scientific research aimed at the widespread and effective use of computer technology and electronics in the national economy" ^[1].

The relevant processes and scientific research were of a large-scale and complex nature, relating not only to the problems of the history of science and technology, but also to the history of medicine. At the highest level, the following directions can be distinguished^[1]:

1.      Scientific justification, experimental design development, testing and implementation of information systems for automating the activities of structural divisions of medical organizations, electronic medical document management, database management, automation of accounting and reporting tasks.

2.      Scientific substantiation, experimental design development, testing and implementation of information systems for automation of health system management at the level of the city, region (region), republic.

3.      Improvement of the hardware and technical base of computer equipment.

4.      Scientific justification, experimental design development, testing and implementation of decision support systems (automated, computational diagnostics) ^{[2, 3, 4]}.

In this context, a separate set of research papers was devoted to the so-called "remote automated diagnostics". The essence of this phenomenon was as follows.

The development of computer technology allowed us to start creating software for processing and analyzing biomedical data. One of the tasks of such an analysis was to determine the mathematical probability of the presence of a particular disease in a particular patient. Unified forms were created to enter data from the medical history into an electronic computer (computer). In the 1960s and 1970s, various scientific groups developed algorithms and programs for the diagnosis of a variety of pathological conditions. A separate direction was the machine analysis of electrophysiological data – that is, automated decoding of electrocardiography (ECG) results on a standardized scale. The corresponding scientific activity was carried out in a number of large scientific and clinical centers both in the USSR and abroad ^{[5, 6, 7]}. The practical implementation of developments was hindered by technical difficulties - during the time period under study, computers were the most complex hardware and software complexes that required significant qualified personnel for their maintenance. Of course, computers were technically and economically inaccessible to ordinary hospitals. The solution to this problem was biotelemetry, a scientific direction that studies methods of remote investigation of biological phenomena and indicators, assessment of the functional state of a biological object by exchanging biomedical data through telecommunication technologies ^[8]. By means of telecommunications (teletype, telephone communication), data from the hospital could be transmitted to a large scientific and clinical center, on the basis of which a computer was located. For data entry, as already mentioned above, unified forms were used, as well as special transmitting devices were designed. The biotelemetric approach made it possible to form the concept of "remote automated diagnostics".

Research objective: to study the processes of formal structuring of scientific research in the field of remote automated diagnostics in the USSR (1970-1990s).

Historiography. The history of scientific research and other events in the field of automation and informatization of healthcare in the USSR has been studied and presented in sufficient detail in the works of Gasparyan S.A., Pashkina E.S., Zarubina T.V., Kobrinsky B.A., Hai G.A. and others. ^{[9, 10, 11, 12, 13]}. However, the issues of the development of remote automated diagnostics by the same researchers are covered extremely superficially, sometimes even contradictory. This was the basis for our study of the history of scientific research of biotelemetry in the context of large-scale complex research works on automation and informatization of healthcare.

The source base of the research is formed by a set of published (scientific papers, journalistic materials) and unpublished documents, some of which are introduced into scientific circulation for the first time in this article. The materials deposited in the State Archive of the Russian Federation (GARF) were used.

From 1979 to 1990, a targeted comprehensive program of scientific and practical development of automated advisory systems was carried out in the RSFSR ^{[1, 4]}. Under the auspices of the program, both previously performed and new scientific research were combined.

The concept of "automated advisory systems" was quite broad, it included: machine analysis of the results of electrophysiological and laboratory diagnostic studies, formalized medical histories or medical questionnaires; diagnostic tables created on the basis of formalized medical histories or medical questionnaires and intended for use "manually", on a computer or even a programmable calculator. In some cases, the presence of a biotelemetric component in the form of remote input of the necessary data into a computer for machine analysis was not implied at all. In others, initially remote systems (primarily for ECG diagnostics) were supplemented with automated analysis technologies. Finally, a number of researchers immediately created their systems for two modes of operation: with direct and remote data entry into a computer.

At the end of the 1970s, the necessity of conducting intersectoral scientific research in the field of remote automated diagnostics was stated. It was supposed to develop five types of "medical systems for telemetry data processing": consultative computational diagnostics (SCD), automation of laboratory research (SALI), continuous intensive observation (ASPIN), preventive examinations of the population (ASPON), and finally, automation systems for biomedical research (SAMBI). Conceptually, the development of information support, requirements for information systems was supposed to be carried out in research institutes of medical and biological profile; to develop technical aspects, design and master the hardware - in institutions of the Ministry of Medical Industry; issues of data transmission via communication channels were to be solved by the Ministry of Communications; unification of aggregated medical computing complexes was to be provided by the Ministry of Instrumentation and Automation ^[2].

In 1979, on the initiative of Professor Suren Ashotovich Gasparyan (1932-2005), Head of the Republican Information and Computing Center (RIVC) The Ministry of Health of the RSFSR, the implementation of the Republican target program "Development and implementation of an automated system for remote diagnosis of certain emergency conditions" has begun. 

The first stage of the program was to include the period 1979-1985 . Program research determined the principles of construction, the structure of medical information, mathematical, technical, organizational and legal support of such systems, research and design work on the creation of a standard replicated system based on standard domestic computer equipment. "The creation and implementation of standard automated systems for diagnostics, forecasting and selection of treatment tactics for emergency conditions for territorial health services was carried out; at the same time, a number of clinical, organizational, socio-economic tasks were solved" ^{[1, 13]}.

"The program united 12 research institutes, 3 universities, 3 information and computing centers, it was advised by Academician of the USSR Academy of Medical Sciences, Professor V.S. Saveliev and the head of the section, member of the Coordinating Council, Professor L.G. Erokhina" (Table) ^{[1, 13]}.

To implement the program, a coordinating council was established under the chairmanship of S.A. Gasparyan. "In addition, the members of the coordinating council of the republican targeted comprehensive program were V.A. Alekseev - Ph.D., Associate Professor, Deputy Head of therapeutic and preventive care for children and mothers of the Ministry of Health of the RSFSR and S.M. Kulagin - Ph.D., Head of the Main Department of Therapeutic and Preventive Care of the Ministry of Health of the RSFSR" ^{[1, 13]}.

Within the framework of the program, research and development work was structured initially in four directions, then in 1980 two more were added (Nos. 5 and 6) ^[2]:

1.      Automated advisory systems for emergency conditions in cardiology.

2.      Automated advisory systems for emergency abdominal surgery.

3.      Automated advisory systems for emergency conditions in neurology (brain stroke).

4.      Automated advisory systems for emergency conditions in neurosurgery (traumatic brain injury).

5.      Automated medical care management system for threatening conditions in children.

6. Development of standard design solutions for the creation of an automated advisory system for diagnosis, prognosis and choice of treatment tactics in emergency conditions.

A scientific secretary was appointed for each section of the program.

It is important to note that initially biotelemetry was the main component of the program: "By the end of the 70s, computer technology and developments in the field of mathematical methods of medical diagnostics and forecasting created conditions for the implementation of practical diagnostic systems accumulating the experience of clinical medicine. Technical means made it possible to give such systems a remote character for the possibility of medical institutions seeking advice from remote diagnostic centers" ^[1].

However, a few years later there was a conceptual change.

The first stage of the program was interrupted ahead of schedule. In March 1983, a working meeting of the problem commission on medical cybernetics and computer technology was held in Moscow, at which the scientific objectives of the program were fundamentally revised and expanded, its renaming took place: "Development and implementation of automated advisory systems for diagnosis, prognosis and choice of therapeutic tactics in emergency conditions". The new concept has changed the accents. Biotelemetry has become only one of the components, the issues of machine analysis of various types of biomedical data have come to the fore, regardless of the way they are entered into the computer (direct or remote). The range of tasks to be solved has expanded: in addition to diagnostics, the issues of forecasting and the formation of recommendations for optimal patient management tactics have been added. The period of implementation of the second stage of the program was determined - 1983-1990; problem-thematic plans of scientific research of institutions, coordination plans of work until 1990 were formed. The new version of the program was reviewed and approved by the Presidium of the Scientific Medical Council of the Ministry of Health of the RSFSR in November 1983. Additionally, scientific aspects of the updated program were discussed and clarified in November 1984 at the Republican Scientific andpractical conference on medical cybernetics ^[4].

We see the reasons for such a significant change in the following.

1. Duplication of research on bio-telemetry of the electrocardiosignal, primarily with a nationwide scientific experiment on the operation of remote ECG transmission systems that took place at the same time. Some key participants of the program (Saratov branch of the Leningrad Research Institute of Cardiology, M.F. Vladimirsky MONIKA) were at the same time responsible performers in the experiment; this obviously created a conflict of interests.

2.      The problem of automated analysis of biomedical data is quite wide and diverse. Ultimately, its successful solution in relation to specific tasks does not depend on how the data gets into the computer: from the keyboard, data carrier or remotely – via teletype or telephone. The emphasis on telemetry objectively created an artificial barrier, limiting research topics and sharply narrowing the possibilities of their practical implementation. In the new concept, the main efforts of scientists were to focus on the mathematical and medico-informational aspects of analysis, and not on data transmission and related (not scientific at all!) problems of telecommunication infrastructure of medical organizations.

3. Some of the solutions were originally created for direct use near the patient (for example, in an ambulance or in an intensive care unit) by using minicomputers or programmable calculators.

Thus, the change in the concept of the target program is due to both scientific and organizational, as well as social (conflict of interests) reasons. Objectively, we consider the change quite reasonable, although it had a somewhat negative impact on the development of biotelemetry.

Next, we will describe the scientific research related to biotelemetry within each direction of the target program.

A distinctive feature of the research carried out within the framework of the target program was the mandatory practical implementation of all developments – mathematical models, algorithms, software and hardware solutions, etc. "The system of remote computational diagnostics of emergency conditions worked on the basis of formalized maps. The centers of consultative diagnostics were deployed at the air ambulance stations of regional, regional and republican hospitals. Their work was carried out around the clock. Over a direct telephone connection, the user dictated the numbers of signs of a clinical standardized card, which were entered into the computer by the on-duty physician of the diagnostic center and then, after about 20-30 seconds, a probable diagnosis was issued. Sometimes signs were suggested that had to be obtained (clinical or laboratory) for a better separation of alternative (probable) diagnoses" ^[1].

Automated Advisory systems for Emergency conditions in cardiology

Saratov branch of the Leningrad Research Institute of Cardiology ^[4]. In 1981-1983, research on the problems of the Republican Program was conducted by the scientific group of Professor E.S. Halfen. They were structured in the form of research "Improvement of remote cardiological service based on automation of ECG decoding and the use of DCC for performing mass examination of persons threatened by myocardial infarction" (Research No. state registration 81063586, responsible executor – Yu.N. Shigin)^[2].  In the interests of the program, experimental development and subsequent pilot operation of automated ECG analysis systems (Saratov-1 and Saratov-2) were carried out. The work was carried out in scientific cooperation with engineers of the p / o "Volna" and TSNIIIIA. Analog telephone channels created a huge number of different interferences and noises during data biotelemetry. Therefore, the tasks of noise and interference filtering, identification and measurement of cardiogram teeth, rhythm analysis, and the formation of a full-fledged medical cardiographic conclusion were solved in the research. New hardware solutions, algorithms and programs have been created to ensure the noise immunity of ECG biotelemetry. The accuracy of machine decryption has reached 90-98%. At the same time, in the SSMI, the studies were formalized in Research No. 118 "Development and research of methods of automatic ECG analysis in the system of a remote cardiology center" (responsible executor - M.F. Khoroshenkova). The main focus of this work is focused on automated ECG analysis based on original author's techniques ("with the use of a contour diagnostic solution"), as well as on the creation of a "memory bank of cardiovascular diseases" (a special set of biomedical data). Clinical trials were conducted, algorithms and programs developed; the accuracy of machine analysis of 448 ECG was 76.8-92%^[3]. In 1981-1982, a set of equipment for synchronous three-channel ECG transmission over a telephone communication channel was developed, which included the original interface unit of the Jaguar receiving radio device with the Electronics 100/25 computer. In subsequent years, a system of automated remote cardiological examination of the population ("SADKO-2") was created on the basis of this kit. The system is implemented in the activities of the remote advisory center (it was indicated that this is the first center for remote automated ECG analysis in the USSR)^[4]. It should be noted that "research on the study of suitable medical signs for the creation of algorithms and programs for automatic diagnostic conclusion" in the SSMI continued until 1986 inclusive^[5]. The scientific research of Professor E.S. Halfen in the field of ECG biotelemetry was studied in detail by us earlier ^[14]

Scientific, educational and medical organizations of Gorky. Since 1968, research works on medical cybernetics have been conducted at 7 departments of the Gorky Medical Institute named after S.M. Kirov. Of these, two had a biotelemetric component: the Department of Faculty Therapy of the Faculty of Pediatrics (Head A.P. Matusova) and the therapy of advanced training of Doctors and the Faculty of Hygiene (Head E.P. Kamysheva). The corresponding research was conducted in cooperation with the Research Institute of Applied Mathematics and Cybernetics of Gorky State University. Lobachevsky Research Institute, Research Institute of Applied Physics of the USSR Academy of Sciences, Computing Center of the Gorky Railway ^{[15, 16, 17]}. The works of scientists from Gorky were included in the Republican target program.

Professor Evgeniya Pavlovna Kamysheva of the Gorky Medical Institute scientifically substantiated and implemented a model of screening and medical examination of persons with cardiovascular pathology, which included programs for automated selection of a contingent of persons for in-depth examination, telemetric transmission of ECG and its automated analysis. At the so-called "second pre-medical" level, the model assumed the registration of an ECG with its transmission by phone "to the clinic's computer via the Salyut cardiophone system." The conclusion was transmitted by a doctor or the ECG was encoded by the operator of the direct computing center, followed by its automated analysis and the issuance of a conclusion. The proposed concept of "computational telediagnostics" was successfully used in almost 1,700 examined patients with a diagnostic accuracy of 70-85%. The corresponding network of automated remote diagnostics functioned in Gorky and Saransk, covering 60 medical organizations ^[16]. The use of biotelemetry in combination with machine data analysis provided optimization of mass preventive (screening) studies, increased detection of cardiovascular diseases and financial savings ^[4].

Doctor of Technical Sciences, Professor Yuri Isaakovich Neymark actively collaborated with the Department of Internal Diseases No. 2 of the Medical Faculty of the Gorky State Medical Institute, which was headed by Doctor of Medical Sciences, Professor Alexandra Petrovna Matusova. However, this scientific cooperation has been going on for quite a long time. Since 1962, a group of doctors and engineers led by these scientists conducted research on automation problems in cardiology ^[17]. The scientific group developed and implemented methods of automated diagnostics of various diseases of the cardiovascular system based on the author's algorithms for recognition and analysis of medical information, methods of mathematical prediction of outcomes, methods of automated pre-medical screening, etc. As a result of enormous theoretical and experimental work, it was possible to create new methods for processing initial data and complementary approaches to solving the issues of feature selection and constructing decisive classification rules, to design algorithms for recognition, selection and formation of features, as well as to specify complete systems of machine signs of medical curves, in particular, cardiograms. With the help of the developed methods, a number of specific tasks of medical diagnosis, prediction and choice of treatment method were successfully solved. The results obtained in this field are published in the monograph "Pattern recognition and medical diagnostics", which was published in 1972 under the editorship of Yu.I. Neymark. In the mid-1970s, on the initiative of A.P. Matusova, on the basis of the Department of Internal Diseases of the Gorky State Medical Institute and the city Hospital No. 38, a cardiological remote diagnostic center was opened with the reception of information from medical institutions of the city. For about 10 years of active work, this center has conducted about 31,000 remote consultations. Based on the accumulated experience, a special model for the use of remote ECG diagnostics at the outpatient stage was developed, the methodology and features of the deployment of remote diagnostic centers on the basis of polyclinic institutions were determined. By 1986, two centers were receiving ECG and clinical data from 15 polyclinics and medical-sanitary units in Gorky. It is noteworthy that a scientific analysis of diagnostic errors was carried out, the leading role of tele-ECG for their prevention was determined. To unify data transmission, special coding schemes have been developed to formalize the description of a clinical case according to 29-33 encoded signs, further "three linear formulas have been developed, with the help of which, based on the encoded clinical information in the DC [diagnostic center – author's note.] mathematical diagnostics of the main forms of coronary heart disease is carried out." In the period 1977-1987, 13950 remote consultations were conducted using this method of automated diagnostics. However, the described scheme of work was not effective enough due to the mandatory medical examination of a remotely consulted patient. That is, paramedics and nurses could not send patients to remote consultations, and the need for such services was very high. Therefore, after a few years, the schemes were replaced by a scientifically based "unified program for the diagnosis of thoracic pain syndrome", which was based on the patient's questionnaire (a total of 19-27 signs). Thanks to this innovation, "clinical remote consultations ... become available to any paramedic medical center. The time spent on remote consultation is shortened" (the average time "does not exceed 15 minutes"). Interesting fact: the authors carry out the simplest economic calculation and claim that the cost of one remote ECG consultation is "1 ruble 70 kopecks". For 15 years, the scientific topic of remote ECG diagnostics has been actively developed by the students of Prof. Matusova – N.N. Borovkov, L.M. Velikovskaya and M.S. Bubel. Their scientific and practical work was awarded with awards of VDNH. The accumulated work experience was summarized in a number of articles and methodological recommendations ^{[17, 18]}.

Moscow Regional Research Clinical Institute named after M. F. Vladimirsky (MONICA). During the time period under study, MONICA is the head institution for scientific and practical issues of healthcare informatization in the Moscow region, which "coordinates the organization and operation of information retrieval, telemetry, semi–automated and automated systems implemented in medical science and healthcare in the Moscow region" ^[30]. Scientific and practical activities for the development of remote, including automated, ECG diagnostics have been conducted since the early 1970s under the leadership of Professor Tamara Sergeevna Vinogradova, the organizer and head of the functional diagnostics service of the Institute^[6]. Initially, the creation of a regional network of remote ECG diagnostics was carried out, which assumed only human-to-human interaction. Then, on the basis of 5 years of practical experience in telemetric ECG diagnostics, taking into account "the experience of communication between doctors and engineers during the start-up, commissioning and operation of systems", the basic principles of the structure for semi-automated and automated biomedical systems are scientifically substantiated. The next step was to scientifically substantiate and implement a rather original concept of a hierarchical telemetry network, including the main and a set of intermediate remote diagnostic centers. This approach made it possible to redistribute requests for remote consultations, use resources more efficiently, nevertheless ensuring a high level of accessibility of medical care. At the same time, the man-to-man format was supplemented by automated analysis of biotelemetric data. The computer was located in the main center, as well as in some intermediate "for which the economic and technical conditions of operation of complex equipment are acceptable" ^{[19, 20, 21, 22]}.

In the context of the Republican Target Program, MONIKI carried out a scientific search for a methodology for comparing various automated ECG analysis systems, assessed the medical, social and economic efficiency of automation, unified the language of machine conclusions, developed a model of mass preventive examinations and medical examinations using biotelemetry and automated analysis. By 1982, the network of remote and automated diagnostics in the Moscow Region covered 19 remote diagnostic centers and 203 data transmission points; three types of equipment were used. In this activity, the Department of Functional Diagnostics^[7] interacted with the MONICA Automation Laboratory, which was headed by L.V. Koryakov during the study period ^{[4, 19, 20, 21, 22]}.

Actually, the introduction of automated analysis of biotelemetric data began with complex tests of the Soviet-Hungarian system "SAS-1" ^[23]; at the same time, MONICA's scientific group developed medical information and organizational support for such tests, as well as advanced scientific developments for its time on standardization of ECG databases and on the creation of medical and organizational methods.technical and clinical trials of automated diagnostic systems.

We will briefly mention: the Soviet-Hungarian development of "SAS-1" is an automated multichannel system for transmitting and analyzing ECG based on the EU 1010 small computer, which appeared in the early 1980s. Developers: Institute of Problems of Information Transmission (USSR), Communication Research Institute (Hungary). There is information about the testing of this system on 400 patients and its use in 16 hospitals in Hungary ^{[24, 25]}.

From the point of view of the formal structuring of scientific activity, it should be noted that the work at MONIKI was carried out not only within the framework of the Targeted Republican Program, but also coordinated with the executors of the topic 2.2.9. "Development and improvement of methods for automatic analysis of electrocardiosignals based on computers" of the plan of scientific and technical cooperation of the CMEA member countries". Perhaps this explains such a comprehensive and thorough approach to the study, quality assessment and application of the "SAS-1" system ^[25]. The scientific research of automated diagnostics in MONICA is characterized by complexity, innovation and an emphasis on the biotelemetric method of data entry into a computer.

Automated advisory systems for Emergency abdominal surgeryCity Hospital No. 3 of Leningrad ^[4].

Within the framework of the target program, since 1980, the scientific development of expert systems "DIANA" for consultative remote differential diagnosis of acute surgical diseases of the abdominal cavity (based on the Iskra-226 computer) has been carried out. The implementation of the results was carried out by creating a round-the-clock automated remote consultation center for prehospital doctors on the basis of one of the city substations of emergency medical care. The Center functioned in the period 1982-1985 . Scientific evaluation of the quality by the system developers themselves based on about 200 clinical cases: the accuracy of machine diagnostics ranged from 76 (the main diagnosis) to 92% (determining the class of the disease), recommendations on management tactics are always "recognized as optimal".

Yaroslavl Medical Institute (YARMI). In the 1970s, YARMI conducted active scientific cooperation with the A.V. Vishnevsky Institute of Surgery of the USSR Academy of Medical Sciences, as a result of which a system of remote automated diagnostics of acute diseases of the abdominal cavity was designed and implemented ^[5].  At the turn of decades, independent scientific research in the field of automated, including remote, analysis of biomedical data was already continuing at the Department of General Surgery of this university.

The general scientific and scientific-organizational management of this work was carried out by the head of the department M.P. Vilyansky; A.A. Chumakov investigated automated support for medical decision-making in surgery ^[26].  Then the postgraduate student Alexander Nikolaevich Khorev (b. 1948) joined this work. He conducted a long-term scientific work "Acute gastrointestinal bleeding", the results of which were reflected in the candidate's and then in the doctoral dissertations under the scientific supervision of M.P. Vilyansky (in 1980 and 1992, respectively). A separate component of this research work was the creation of a cybernetic system of consulting support for the attending physician at all stages of providing care to patients with acute gastrointestinal bleeding, carried out in the late 1970s - early 1980s. It was a complex information system created on the basis of "various cybernetic principles" and included both the analysis of biomedical data and the functionality of accounting, documentation, etc. In the context of our study, it is important to note that the system consisted of five algorithms, the first of which "is designed to diagnose, including remotely, the causes of OGDC, the severity of blood loss and to determine the approximate tactics of treatment. This algorithm was supposed to be used in situations where access to adequate diagnostic services was limited (for example, in rural health conditions, when providing emergency medical care). The system was successfully tested during the treatment of 470 patients; the accuracy of automated, including remote diagnostics was 91.8 - 98.8%. After that, a round-the-clock "center for consultative remote diagnostics" was organized on the basis of the YARMI surgical clinic. The center used a computer "Nairi-K" with author's programs. According to the results of machine diagnostics, indications were determined for the departure of a specialized team directly at the patient's location to perform a surgical operation. Remote automated diagnostics of acute abdominal diseases, bleeding, postoperative intra-abdominal complications in adults and children was carried out ^{[4, 26]}.

It is noteworthy that the system was easy to operate and was serviced by an average medical staff.  The network of remote "computational diagnostics" included medical organizations in urban and rural areas, united by telephone (teletype) lines. The total number of successful remote automated consultations was 874, of which 122 were performed for patients from rural hospitals. The developers planned to additionally equip the network with teletypes, and also proposed to introduce similar networks in remote areas of the country (including along the BAM construction route) ^{[41, 42, 43]}. As follows from the documentation of the doctoral dissertation of A.N. Khorev, the module of the cybernetic system - the automated workplace "Remote diagnostics of OZHKK" - was implemented in the Altai Territory, Kemerovo, Omsk, Novosibirsk, Sakhalin regions, in the Primorsky Territory. "The operation of the system in a number of regions of the country has shown its usefulness and prospects, a significant economic effect" ^{[4, 26]}. Further use of the system developed by Vilyansky, Chumakov and Khorev was already purely practical in nature, there was no continuation of scientific research on this topic.

From the point of view of the development of scientific problems and formal structuring, the direction No. 6 "Development of standard design solutions for the creation of an automated advisory system for diagnosis, prognosis and choice of therapeutic tactics in emergency conditions" is of particular interest. The main institution for this section of the target program – the Primorsky Krai Health Department's IVC – has been developing in the field of diagnostic automation since the mid-1970s ^[4]. Since 1977, the implementation of research and development work on the tasks of the target program began. Their practical result was the appearance of an active and stable remote diagnostic center, which conducted remote consultations of patients from rural, central district, city hospitals of the region, from ship infirmaries, as well as from medical and preventive institutions of the Khabarovsk Territory and Sakhalin (in particular, 1800 teleconsultations were performed in 1982). By 1981, technical specifications for 1-4 directions of the program were created. Based on them, the IVC of the Primorsky Krai Department of Health started designing standard techno-working projects for an automated system (primarily for advisory support in acute surgical diseases of the abdominal cavity). At the same time, the research and development of a "medical terminal designed to collect, accumulate, display and transmit medical, physiological and clinical information in digital form over a telephone communication channel" was carried out at the IVC. A prototype was created in laboratory conditions, a medical and technical requirement was drawn up ^[4].       

The remaining directions of creating automated advisory systems for emergency conditions in neurology (brain stroke), neurosurgery (traumatic brain injury), and for managing medical care for threatening conditions in children practically did not include a biotelemetric component. They were mainly based on tabular methods or locally operated information systems ^{[4, 27, 28]}.

The generalized results of the targeted scientific program were quite impressive. To quote its initiator and head, Professor S.A. Gasparyan ^[1]: "The analysis of the results of 39 thousand consultations during the 2-year work of three advisory centers showed that the overall quality of diagnostics of doctors in rural and district hospitals is 63%. When applying for advice to the center for computational advisory diagnostics, the accuracy rises to 86%, when re-applying with the issuance of additional computer data - up to 96%. Thus, the quality of early diagnosis for threatening conditions at the prehospital stage and in hospitals was improved without increasing emergency resources. This contributed to a decrease of more than 15% in mortality in children's hospitals in Leningrad for the period from 1976 to 1982. and some reduction in mortality of children under one year. The reliability of statistical information on threatening conditions and their outcomes has also increased, and it has also been possible to obtain data on defects in the work of medical services that led to the occurrence of threatening conditions. The developed system of remote computational diagnostics of emergency conditions has been implemented in more than 40 territories of the RSFSR, including used by the Far Eastern Fishing Fleet. The system solved an important national economic problem of improving the quality of diagnostics for emergency conditions in rural areas, in remote areas and on ships that are on the voyage."

The ways of further development, primarily practical, were outlined: in the future, "to link the automated remote diagnostics system with the automated control system at the territorial level, providing in the future a multi-level diagnostic technological system with access to hospitals and polyclinics everywhere" ^[4].

At the same time, the scaling of scientific achievements has not actually taken place. Basically, the use of automated advisory systems (both with and without a biotelemetric component) remained limited to the walls of development institutions. The reasons for this were partially noted by contemporaries ^[15], partially revealed by us during systematization in terms of historical perspective:

1.                  Conceptual, psychological, informational "distance" between specialists in the field of healthcare automation and specialists in practical medicine. The development of informatization in medicine usually went unevenly. Individual enthusiasts – the heads of the same individual medical organizations – achieved significant, but discrete successes. The main part of practical healthcare workers remained indifferent to them. In fact, this "distance" began to disappear only after 2000, and in the studied period of time it was very pronounced. The majority of practicing doctors and, most sadly, healthcare managers, did not understand and did not perceive automation.

2.                  The following reason followed from the above – the equipment of medical organizations with the required means of telecommunications and computer equipment was low. On the one hand, the operation of the relevant technologies was, in the time period described, quite complex and required additional significant resources. On the other hand, even with sufficient material, technical and personnel support, not all health care managers understood the importance of automation in general, and diagnostics in particular.

3.                  Scientists who created automated diagnostic systems clearly pointed out another problem - the lack of standardization made the widespread implementation of developments almost impossible or extremely time-consuming and costly. This is how this problem was formulated in 1978: "the development of telemetry systems for healthcare should provide for their docking with other systems and subsystems created within the framework of the automated control system of the appropriate level. The transition nodes for such a docking are not standardized. For each docking, they must be designed and manufactured according to separate projects. These tasks present the greatest difficulties <...>" ^[25].

4.                  Medical problem – despite the enthusiasm and self-confidence of its creators, the diagnostic value of many automated diagnostic systems remained questionable. There were no uniform principles for assessing accuracy yet (they were just beginning to be formed in individual scientific papers both in the USSR and abroad). Consequently, for the absolute majority of doctors, automated systems were a "black box", which for some reason was entrusted with making a diagnosis. The lack of high-quality scientific evidence sharply restrained the spread of developments, including a negative impact on health care managers who made decisions about infrastructure development. Moreover, in the mid-1980s and in the global perspective, the so-called "winter of artificial intelligence" began - a total decline in scientific interest and investment in automated data analysis systems, including in the field of biomedicine. The reason for this decline was a strong disappointment: the accuracy and quality of machine solutions turned out to be minimal, often unsatisfactory to the needs of a particular user (and not the system developer, namely the average user) ^[29].

5.                  Nevertheless, we see the key reason in the lack of state support for the release of new samples of medical and computer equipment. S.A. Gasparyan argued: "In the coming years, it is necessary to create remote information collection devices designed to dock with automated information processing systems on the basis of mass-produced equipment, or through their own developments." ^[5]. However, this thesis was realized only with regard to equipment for remote ECG diagnostics and appropriate consultations in the "person-to-person" format. Equipment and systems for automated analysis have not been systematically put into mass production. The main reason for this is the political and socio-economic processes of the second half of the 1980s, which ended with the collapse of the USSR in 1991.

Thus, in the 1970s and the first half of the 1980s, computational (automated) remote diagnostics, which is a combination of biotelemetric translation of biomedical data and their computer analysis for interpretation, diagnosis and prediction, became a special area of scientific research.

Research in this area was conducted by numerous scientific groups and collectives. Original mathematical models, methods of unified data collection and analysis algorithms, hardware and software complexes were created. The implementation of the results of scientific research took place mainly through the creation of advisory centers for automated remote diagnostics that solved the problems of practical healthcare. Based on the materials of practical work, in turn, scientific research was conducted on the quality and reliability of hardware-software and software solutions.

The institutionalization of relevant scientific research has reached a high level. At the expense of state and administrative resources, systematic research was provided – since 1979, the Republican target program "Development and implementation of an automated system for remote diagnostics of certain emergency conditions" began in the RSFSR. However, by the mid-1980s, due to a number of reasons (infrastructural, informational, psychological and socio-economic), the biotelemetric component had lost its relevance and almost completely disappeared from scientific topics. Research in the field of automated data analysis and biotelemetry itself has been divided into two separate areas.

We do not focus on the history of scientific research in the field of automated data analysis, however, regarding the development of biotelemetry, we argue that the Republican target program should be considered unsuccessful. Individual scientific groups showed tremendous enthusiasm, but there were no qualitative transitions and systemic changes. A large nationwide scientific project in the field of biotelemetry, which was carried out almost in parallel, is strikingly different in its effectiveness and significance – the "Experiment on the operation of remote ECG transmission systems" ^[14]. Based on the scientific results of this study, a new model of medical care organization was officially introduced, which led to significant social changes. The experiment and its consequences will be studied in detail in the future.

Table. Participants of the Republican Target Program of the RSFSR for the development and implementation of automated advisory systems (1979-1990)

^[1] GARF F.A482. Op.59. d.63. L. 46.

^[2] GARF F. A482. Op. 56. d.5056. l.22-23, 123-126.

^[3] GARF F.A482. Op.56. d.4740. L. 5-6, 13-16.

^[4] GARF F.A482. Op.56. d.4740. l.7, l.18-24.

^[5] GARF F. A482. Op. 56. d.4783. L.11.

^[6] GARF F. R-9506. Op.77. D. 327. L.1, 2, 7-8, 12-23, 44.

^[7] Department of Clinical functional Diagnostics of MONICA.-http://www.monikiweb.ru/node/122.