gehr Project: Nation-wide EHR Implementation in JAPAN
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1 Kyoto Smart city Expo Kyoto University University of Miyazaki gehr Project: Nation-wide EHR Implementation in JAPAN YOSHIHARA Hiroyuki, MD/Ph.D Emeritus professor of Kyoto University and University of Miyazaki 謝 辞 本 研 究 は 国 立 研 究 開 発 法 人 日 本 医 療 研 究 開 発 機 構 (AMED) 臨 床 研 究 等 ICT 基 盤 構 築 研 究 事 業 の 支 援 を 受 けた 大 規 模 健 康 診 療 データ 収 集 利 活 用 に 関 する 研 究 Acknowledgement This research is supported by "Clinical Study Oriented ICT Infrastructure Development Project - Sustainable Massive Health and Clinical Data Repository for Secondary Use" from Japan Agency for Medical Research and Development, AMED (15lk h0001).
2 EHR Research Unit 5 years project, since Original members come from Staff Kyoto University Hospital Naoto KUME (Associate Prof.) Shinji KOBAYASHI (Lecturer) Lab belongs to Graduate School of Informatics Social Informatics Design school unit Graduate School of Medicine Research collaboration with 5 companies Pharmaceutical company Lab test company SIer company Healthcare service company
3 Computerization in medicine (in Japan) 1999 Electric insurance claim submission DPC; Diagnosis Procedure Combination Japanese DRG Inclusive payment, based on primary disease name, per a day 2003 EMR installation in hospitals Electric insurance claim EMR Hospitals ( >600 beds) 96% 70% Clinics (GPs) 96% 30% Kokumin-eisei no doukou, Health, Labour and Welfare Statistics Association, 2012 EMR: Hospital domestic HIS EHR: Regional medical information sharing system
4 Medical Accounting System and EMR HIS Record Charge to patients 30% + 70% Pay by fund EMR Electronic Medical Record since 2003 Orders Prescription, Lab test Accounting Reimbursement $ 275 billion USD 33,000 billion JPY Test order Test result Medical accounting system since 1997 Receipt (Bill) Insurance Payment fund Test Lab Health insurance society
5 What is EHR; Electronic Health Record? EMR Electronic Medical Record Record is secured in an institute Belongs to an institute EHR Electronic Health Record Record is shared in a region Belongs to a patient patient life Risk Multiple prescriptions Overlapped lab test Difficulties on HTA Health technology Assessment Risk Access violation Reference responsibility Social consensus
6 Sustainable EHR-centered Ecosystem Agreement Administration Approval, audit request Web server Authorization server ISO extended Archetypes Disaster Healthcare info Individuals (PC, mobile phones) Named-data register Anonymization Anonymization EHR Cloud Research University, Pharmaceutical, lab test, medical equipments CSV, XML Healthcare domain Company (food, healthcare) Care givers CSV, XML Healthcare organization Pharmacy Medical examination Medical organization Univ. hospital Public hospital Private hospital Clinics, dentist
7 Data center (current state) 4 idolphin 2013
8 Kyoto Maiko-net 3500 users; 5% of patient of two univ. hospitals, Opt-in
9 Document list
10 Lab test result list 拡 大 表 示
11 ipad, iphone viewer for Patients
12 Document lists Progress course Prescription Lab test result Summary Reports
13 Lab test result and graph view
14 (cabinet document) Health/Medical Strategy Head quarter by law 政 策 的 助 言 Health/Medical strategy Head quarter 専 門 的 調 査 Chief : Prime minister 等 に 関 す る 専 的 助 医 健 療 康 分 野 医 の 療 研 分 究 野 開 の 発 成 の 出 戦 略 戦 略 産 業 界 医 療 関 係 機 関 等 の 有 識 者 Advisory board Vice-chief: Chairman: Co-chair: Chief cabinet secretary, Health/Medical strategy minister H/M strategy board members H/M strategy minister H/M strategy office chief 医 療 実 分 施 医 野 の 療 の 推 分 研 進 野 究 に 研 開 関 究 発 す 開 に る 発 関 調 推 す 査 進 る 計 専 検 画 討 の 家 作 で 成 構 及 成 び Strategy expert board Drug design support network Next generation medical equipments Next Generation Medical ICT board Healthcare, medical funding Next generation Healthcare industries International extension of Japanese medical services Advisory board: Cabinet secretariat office
15 Next generation Medical ICT infrastructure project Users Company A Company B Company C PHR? Hospitals Patients
16 National EHR Trials in The World Canada USA UK Finland Estonia Singapore Australia New Zealand Russia (Moscow)
17 How much should EHR investment As running 5 to 10 year 60 USD/person would be required Expectation In 2015, 6 million USD is funded by the Cabinet for EHR establishment for one year project.
18 EHR-centered Medical Information Circulation Model Secondary Use Companies Research University, Lab, Pharmaceutical company, Medical Equipments Information request Approval USE3 Step2:Anonymous data management Anonymous data management company Anonymous secondary use ü Preservation of anonymous information ü Statistic processing Named data management company Named secondary use USE4 Information request Approval, audit Healthcare industries Step3:Named data management EHR cloud NPO Step1:EHR 閲 覧 診 療 情 報 閲 覧 EHR DB Contract delegation company 診 療 情 報 ü Medical information standardization and anonymisation 閲 覧 ü ü 個 人 同 意 契 約 管 理 閲 覧 者 の 認 証 健 康 情 報 依 頼 ( 同 意 ) Hospital USE1 Clinics Patients USE2
19 Load map; Working groups, management company setups EHR Secondary use EHR implementation NPO setup Secondary use company setup EHR 運 営 データソース 拡 充 Secondary use To Nationwide EHR EHR working groups EHR management company preparatio n Definition of standards Management company setup 初 期 ソース 宮 崎 京 都 Data sources 宮 崎 別 府 京 都 市 町 村 EHR Operation Operating management company Data sources 宮 崎 別 府 京 都 琉 球 市 町 村 等 Data sources 市 町 村 全 国 Secondary use board members Secondary use management company preparati on Company setup Requirement survey 京 都 GSK 宮 崎 BAYER 等 Running company Secondary use DB setup 京 都 GSK 宮 崎 BAYER 東 九 州 メディカルバレー 京 都 GSK Self sustainable management Secondary use DB Operation 二 次 利 用 者 確 保 BAYER 東 九 州 メディカルバレー 医 療 関 連 産 業 ( ) 記 名 データの 本 格 運 用 及 びそれに 向 けた 機 関 システム 整 備 については 匿 名 化 データの 本 格 運 用 以 降 将 来 的 に 検 討 整 備 する 等 宮 崎 等 京 都 GSK User propagation 二 次 利 用 者 確 保 宮 崎 BAYER 東 九 州 メディカルバレー 医 療 関 連 産 業 等
20 ISO13606/MML endorsement plan ISO13606 (OpenEHR) International standard ISO13606 Localized ISO13606 archetypes MML MML Domestic standard Few extension ISO13606 original + Localized archetypes MML = Medical Markup Language
21 2015 plan EHR-centered Medical Information Circulation Model Secondary Use EHR cloud Research University, Lab, Pharmaceutical company, Medical Equipments Information request Approval USE3 Step2:Anonymous data management 閲 覧 Anonymous data management company Anonymous secondary use Step1:EHR 診 療 情 報 ü Preservation of anonymous information ü Statistic processing 閲 覧 EHR DB Named data management company 診 療 情 報 Named secondary use Contract delegation company ü USE4 Medical information standardization and anonymisation 閲 覧 ü ü 個 人 同 意 契 約 管 理 閲 覧 者 の 認 証 健 康 情 報 Information request Approval, audit 依 頼 ( 同 意 ) Healthcare industries Step3:Named data management Hospital Clinics Patients USE1 USE2 <Participant organizations> Connected: 12 hospitals, Scheduled: 48 hospitals, Total Beds: 31,036
22 Conclusion Without a viewpoint of cost and efficiency, Healthcare cannot be sustained Data source, EHR, Secondary Use Insurance claim information Clinical information Genome information Lifestyle healthcare information EHR ecosystem: financially sustainable system Enforcement of secondary use EHR is an infrastructure, so that strong governance is required Budget Specialized Organization National unique ID Legislation of personal information handling policy
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