In recent years, the question of restoring a unified system of medical support for maritime and river fleet workers in Russia has been discussed at various governmental levels [1]. Although existing previously, this system has disintegrated into individual companies and organizations as a result of adverse social and economic changes in the country.

These requirements are outlined in the International Labour Organization (ILO) convention adopted in 2006 and were ratified in the Russian Federation in 2012. Currently, the Russian Federation lacks a unified approach to the organization of information support for medical surveillance of marine specialists [2]. Medical organizations of Federal Medical and Biological Agency (FMBA) of Russia involved in medical examination of seafaring personnel apply the Unified Departmental Medical Information and Analytical System of FMBA of Russia (hereinafter referred to as UDMIAS), as well as medical information systems integrated with UDMIAS (hereinafter referred to as MIS) [3].

In the above systems, accounting of performed periodic and preliminary medical examinations was implemented in accordance with the order of the Ministry of Health of Russia as of 28.01.2021 No. 29n “On Approval of the Procedure for mandatory preliminary and periodic medical examinations of employees, provided for in part four of Article 213 of the Labor Code of the Russian Federation, the list of medical contraindications to work with harmful and (or) hazardous production factors, as well as work in the performance of which mandatory preliminary and periodic medical examinations are carried out” [4].

However, the mentioned guiding document lacks a procedure for preliminary and periodic medical examinations of persons working on ships. It should be noted that other regulatory acts of the Russian Federation did not fully present the procedure for medical examinations of shipboard personnel. The only current document establishing medical contraindications to work on a ship was the Decree of the Russian Federation Government as of 24.06.2017 No. 742 “On approval of the list of diseases that prevent work on marine vessels, inland navigation vessels, as well as on mixed (river-sea) navigation vessels” [5].

In order to meet the requirements of the time, at the end of 2022, the Ministry of Health of Russia issued the order No. 714n dated 01.11.2022 “On Approval of the Procedure for medical examination for medical contraindications to work on a ship, including chemical and toxicological studies of the presence of narcotic drugs, psychotropic substances, and their metabolites in the human body, and the form of a medical report on the absence of medical contraindications to work on a ship.” This order defined a procedure for medical examination of seafaring personnel and created prerequisites for optimal organization of accounting of the results of medical examinations of shipboard personnel in information systems, based on reliable statistical data [6]. The timeliness of this activity agrees with the opinion of a number of authors who have carried out a comprehensive legal monitoring of national normative and methodological documents regulating the activities of seafarers’ health care centers, assessed the normative regulation of the issue of medical support of crewmembers and stressed the need to regulate the principles of organization of medical care and sanitary and hygienic support of ships during voyages, taking into account the modern achievements of medicine and informational technologies, including distant ones [7][8].

Thus, the accounting of preliminary and periodic medical examinations of seafaring personnel in the UDMIAS information systems and medical information systems integrated with UDMIAS used by medical organizations of FMBA has become particularly relevant.

In this study, we aim to develop and implement an information system to ensure continuity in the provision of all types of medical support to seafaring personnel with the creation of a digital Register of their medical examinations based on a system analysis of the activities of FMBA medical organizations.

For the period from 2014 to 2023, specific aspects, shortcomings, and prospects of information support of medical care for seafaring personnel were studied. Data on the morbidity of swimming and diving personnel for the year of 2023 were systematized.

An analysis of the data set reflecting the activity of FMBA medical organizations (MOs) on medical care of seafaring personnel in 2023 showed the presence of 35 health posts (HP), 70 shipboard doctors, and 14 doctors of diving medicine. A questionnaire survey of information systems of all MOs integrated in the study was conducted. In order to ensure effective medical support to seafaring personnel, to coordinate interaction between the profile FMBA departments and subordinate institutions, as well as to create an information resource reflecting the results of implemented activities, the Head Center for Health Protection of Seafarers (hereinafter referred to as the Head Center) was established in 2021 on the basis of Sokolov Northwestern District Scientific and Clinical Center by the order of the Head of the FMBA of Russia.

One of the main tasks of the Head Center is to provide information and analytical support for the health protection of shipboard personnel, in particular, to create and maintain a register of medical organizations and a digital Register of medical examinations of seafaring personnel, as well as to create, improve, and provide data and technological support for the information system.

In 2022, the Head Center set a task for FMBA medical organizations to organize personalized registration of medical examinations of seafaring personnel and to supply this information for compiling a Register. Due to the varying degrees of technical readiness of MOs in terms of running personalized registration of medical examinations for seafaring personnel using a medical information system (MIS), the Head Center provided them with the necessary information tools, as well as with a prototype module based on the MIS used in Sokolov Northwestern District Scientific and Clinical Center.

The conducted research established that creation of a unified health monitoring circuit for seafaring personnel and divers in the system of FMBA of Russia requires analysis of aggregate information reflecting the results of MO activities in all Federal districts.

The primary data received from FMBA medical organizations revealed the impossibility of separating exclusive information on the seafaring personnel from the total amount of data on preliminary and periodic medical examinations. This was certainly a precondition for obtaining unreliable demographic data and results on the morbidity of seafaring personnel. Interaction with the MOs also showed that personalized records of medical examinations of seafaring personnel were not carried out; sometimes, only paper records were kept.

At the first stage, a conceptual approach to the implementation and exploitation of an information and analytical system of maritime medicine was outlined, including the introduction of standard protocols for data exchange with MO medical information systems, installation and configuration of licensed software, creation of information resources and measures to ensure information security.

Pursuant to the order of the Ministry of Health of Russia from 01.11.2022 No. 714n [6], a pilot project to create a Register in the Northwestern Federal District (NWFD) was launched in 2022 and implemented in March 2023. The structure of the information support system for maintaining the Register of maritime medicine center was developed, see Fig. 1.

A methodology for forming a seafaring personnel identification number in the register consisting of 12 digits was developed. In the format of “12ХХХХ-ХХХХХХ-ХХХХХХХХХ”, the first two numbers denote the subject of the Russian Federation, in which the seafarer underwent a physical examination, “ХХ34-5ХХХХХХХХ-ХХХХХХ” the third-fifth numbers — the MO registration number in the MO register, “ХХХХХ-Х678-9ABХ” the sixth to eleventh numbers — the seafarer serial number, “ХХХХХ-ХХХХХ-ХХХХХХС” the twelfth number — the control sum of the previous numbers (Fig. 2).

At first, the results of compiling a Register in the NWFD were obtained (Fig. 3). As shown in Fig. 3, at the first stage, 26,125 records of information on persons who underwent preliminary and periodic medical examinations were collected by the MOs in the Northwestern Federal District and forwarded to the Head Center.

An analysis of the data presented in Fig. 3 shows that the data contain generalized information on both members of the seafaring personnel and employees of shore-based services working for JSC Atomflot and FSUE Rosmorport. After excluding the shore service employees from the database, 8,259 records were included in the Register based on the attribute of attachment to a watercraft, which amounted to 32% of the previously submitted data. Unique codes of information on seafaring personnel from 7800-0000-0016 to 7800-0001-2277 in accordance with the above-mentioned methodology were inserted in the respective records (Fig. 2). The results of the pilot project were presented at a meeting of the Maritime Medicine Section of the Scientific and Expert Council of the Maritime Board of the Government of the Russian Federation in May 2023 in Vladivostok.

At the next stage, a Register of medical organizations of FMBA of Russia, engaged in medical support of seafaring personnel, including preliminary and periodic medical examinations of this contingent, was created. The Register included 35 FMBA medical organizations located in 8 Federal Districts. The map of their location is shown in Fig. 4.

Based on the results of the pilot project, regulations on the provision of information by medical organizations concerning the results of medical examinations of shipboard personnel to the Head Center for Health Protection of Seafarers, FMBA (hereinafter referred to as the Regulations) were finalized.

The methodological documents developed in the course of the project, as well as a prototype module based on the MIS used by Northwestern District Scientific and Clinical Center named after L.G. Sokolov, were implemented in 2023 in the work of all the FMBA medical organizations included in the register. Since December 2023, these measures have made it possible to provide a complete personalized record of data on periodic and preliminary medical examinations of seafaring personnel, medical reports on the absence of contraindications to work on a watercraft, collection, reconciliation, and analysis of statistical data on the morbidity of seafaring personnel, which fully meets the modern requirements of the health care system [9].

The scope of data storage in the register of medical examinations of seafarers was developed and justified: a seafarer’s passport data (32 fields) and medical data on the medical examination performed in accordance with the order of the Ministry of Health of Russia No. 714n dated 01.11.2022 (60 fields), including data on the medical care provided, therapeutic and preventive measures, results of laboratory and instrumental tests. The included information was rather extensive and formed not only in the MOs conducting seafaring personnel medical examinations. Therefore, it was decided to obtain complete medical data upon request in Uniform State Health Information System (USHIS) and UDMIAS, without storing it in the Register. The composition of the Register of medical data is shown in Fig. 5.

The results obtained were used to compile a general Register for all 35 FMBA medical organizations that provide medical support to seafarers, including data on preliminary and periodic medical examinations (Table 1).

In the 2022–2023 period, 38,993 records on medical examinations of seafarers were processed (Table 1). The work is underway: at the end of the first quarter of 2024, 9504 more medical examinations were conducted by all MOs, with the total number of the seafaring personnel in the Register having reached 39,333 persons. It should be noted that the data on the number of seafaring personnel is preliminary, changing dynamically and requiring additional verification with information from medical organizations due to technical errors in the dates of birth, insurance numbers, personal account numbers, and a number of other documents.

The need to restore a unified system of medical services for seafaring personnel is determined by the fundamental document in the field of national maritime policy, i.e., the Maritime Doctrine of the Russian Federation [10]. In the context of changing geopolitical landscapes, the development of maritime medicine becomes the state’s priority, with the main role entrusted to the FMBA of Russia.

Systematization of the personal data of seafaring personnel for all 35 medical organizations, providing medical support to this contingent, the use of standard effective tools within a single information contour of the FMBA of Russia, the development of a single information resource will form the basis for further improvement of scientific approaches to the organization and development of maritime and diving medicine in the Russian Federation.

Therefore, the introduction of a unified information system in the structure of FMBA medical institutions is an important step towards the implementation of the Maritime Doctrine of the Russian Federation. The issues of medical care for seafaring personnel fully comply with the requirements of the Convention of the International Labor Organization.

Authors’ contributions. All the authors confirm that they meet the ICMJE criteria for authorship. The most significant contributions were as follows. Tatyana V. Yakovleva — the concept and design of the study, general guidance; Olga Yu. Turenko — the concept and design of the study, editing and text writing; Valeriy M. Kolabutin — the concept of the study; Vyacheslav A. Ratnikov — information collection, data processing, text writing; Gennadiy M. Orlov — information collection, data processing; Svetlana S. Moskaleva — information collection, data processing; Victor P. Gorelov — text writing.