Hospital Information System in Korea

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1 Hospital Information System in Korea Kyoo-Seob Ha, MD, PhD CIO Dept. of Neuropsychiatry SNU Bundang Hospital

2 Contents Ⅰ.Overview of HIS in Korea II. HIS in SNUBH III. Vision for HIS in Korea

3 Brief History of HIS in Korea late 1970s: Account (ex: FACOM M160) 1980s: Ancillary systems (ex: clinical pathology) mid 1990s: The first POE and PACS - win32, C/S late 1990s: PACS expansion in Korea 1999: Oct. 15th- POE in SNUH EMR in Korea-outpatient 2001: 2003: PACS in SNUH Digital Hospital in SNUBH with EMR, PACS, POE, etc.

4 Present status of HIS in Korea General Hospitals with over 100 inpatient-beds System Implementation POE PACS EMR 72.6% (149 / 205 hospitals) 38.7% (77 / 199 hospitals) 2.6% (5 / 190 hospitals)

5 Present status of HIS in Korea 5 Standardization in HIS Transfer format: DICOM, HL7 Disease code SNOMED CT ICD-10 Modification of ICD-10 EDI code Procedure code SNOMED CT Modified ICD-9-CM EDI code local code Symptom code SNOMED CT UMLS Modification of ICD-10

6 Present status of HIS in Korea 6 National wide electronic data interoperability No Standard in data content No Standard in data format No Standard in medical terminology except ICD-10 and EDI code Try to adopt international standards in these fields

7 ブンダンソウル 大 学 病 院 情 報 システム- Bundang SNUH Electronic System for Total Care(BESTcare)-

8 Introduction to Bundang SNUH 8 Overall Facilities - 3 Underground and 14 Ground Facilities - 23 medical departments and 6 specialized centers beds for inpatient care (550 at present) - 66 clinics for outpatient care - 16 Operating rooms with day surgery rooms - Administrative offices and Support services

9 Hospital Information System in SNUBH 9 Integrated HIS EMR PACS MIS Groupware Visual Information System KIOSK

10 Time Table for development of BESTcare 年 2000 年 2001 年 2002 年 2003 年 POE in SNUH EMR TFT in SNUH EMR Case study : USA, Japan, Australia etc EMR Workshop Finish EMR Consulting EMR TFT for SNUBH Standardization Start Project Open BESTcare

11 Components of BESTcare 11 BEST care : Integrated HIS of SNUBH PACS EMR OCS MIS Digitalized Image DICOM Digitalized medical record Structured Data Input Clinical Decision Support Standard Medical Terminology Digitalized order Communication Drug Interaction Drug side effect Drug Information Account Management ADT Ancillary service

12 Structure of BESTcare 12 EMR and other HIS MIS EMR EMR PACS OCS MIS OCS PACS

13 Hardware System Structure 13 SNUnet Internet Hotline to SNUH Client Part... Web& Secutrity L4 Switch Router IDS GW Server Si FireWall DNS Server PACS Part L4 Switch IDS IDS L4 Switch Mail Server NMS Web Server Acq. Server DB Server Backbone Si Si EMR Part MIS Part MIS Dev. Server Starage Backup Image Server EMR Server MIS/EMR DB Server Policy Server EMR Dev. Server Storage Backup

14 Components of MIS in BEST care 14 Account Management of medical service Ancillary systems Reservation ADT Billing medical code Claim reimbursement EDI Statistics patient information POE information Outpatient Inpatient Emergency room Nurse depart. OP room ICU test medication other resources Clinical Path Anatomic Path. Rehabilitation Special test Infection Medical record Radiology Blood trasf. Supply Pharmacy Nutrition Health center Statistics User's information General Management Personnel Manag. Purchasing/stock Financial affairs Administration Information

15 100Mbps Fast Ethernet Back bone of PACS 15 DS3000 Rapidia DLT jukebox Storagetek L40 1.6TB MDCT data storage server Compaq ML GB HIS Broker Compaq ML370 TEST modules Web1000 server Compaq ML GB Cache Acquisition server Clarix FC4700 SUN V880 6TB CS5000 DB server SUN V880 Backup server SUN V880 DLT jukebox Storagetek L700 13TB Giga bit Firewall ExWeb server Compaq W6000

16 Characteristics of PACS 16 No. of Clients Terminals DS3000 (11 clients)-3 dimensional minipacs CS5000 (226 clients)-c/s PACS Web1000 (320 clients)-web PACS No. of Modalities: 57 different sources Radiology (including OR, ER, HPC, OBGY US, URO US) (31) Direct DR (2) CR (6) Digital mammography BMD (2) US (10) 16-MDCT (1) MR (1) Angiography (2) Digital fluoroscopy (4) C-arm (2) Intraoral digital readiography (1) NM (4) Gamma camera (1) SPECT (2) PET (1) Endoscope (15) Colonoscope (2) GFS (2) EUS (1) Bronchoscope (1) ENT (3) OR (3) Arthroscope (2) Cystoscope (1) Cardiac Cath (3) Echocardiography (2) Cardiac angiography (1) OT (4) US (1) FAG (1) Specular microscope (1) Photo slit lamp (1)

17 Integration of EMR-PACS 17 PACS Management EMR PACS MODALITIES Interface machine Client PC

18 Characteristics of PACS 18 Single LOG-ON for PACS and EMR

19 Characteristics of PACS 19 Interface between PACS and EMR bestcare button

20 Characteristics of PACS 20 Web PACS-remote access from outside Extra-hospital Intra-hospital internet switch Image Routing from Main server Fire Wall Other services ex) internet reservation Access using VDSL, ADSL users Image Routing External WEB 1000 Server Internal WEB1000 Server users

21 EMR in BEST care EMR development EMR design Characteristics of EMR Estimated economic benefit of EMR

22 EMR Development: step by step 22 User friendly Environment Integration Stage 3 Networking Nationwide DB Expansion Stage 2 EMR for special section Clinical research Data Warehouse EMR Infrastructure Stage 1 primary forms Lab Scan support Job flow without chart delivery

23 EMR Design 23 Structure of EMR frame Web-based UI with 2 monitors Patient information retrieval input POE Structured data input; flexible and adjustable Common record frame; universal

24 Characteristics of EMR in BEST care Structured data input in medical record Based on analysis of paper medical record in SNUH 108 secondary records Test reports 73 primary records 171 ancillary records adm. note 4 short term adm. note 33 progression note 5 operation note 6 pre-anesthesia note 1 anesthetist note 1 discharge note 17 outpatient note 6 test report 103 consulting note for test 5 consulting note 6 consent form 7 medical certificate 3 doctor's opinion1 protocol 22 questionnaire 14 others 108

25 Characteristics of EMR in BESTcare Structured data input in medical record :User defined structured data input module : over 1300 forms :Input forms associated with specific clinical situations Functional test report forms Present illness form in nephrology

26 Characteristics of EMR in BEST care Structured data input in medical record :User defined template module: text-template, image-template Text template for any text field in EMR Image template for image input field which is defined by users

27 Characteristics of EMR in BEST care Medical terminology mapped to Standard Vocabulary Chief complaint Diagnosis Operative procedure Drug Nursing terms Domain SNOMED CT ICD-10 ATC from WHO ICNP Number of term Chief complaint concept 6746 Synonym Diagnosis Operative procedure 9609 Nursing terms about 7000

28 Characteristics of EMR in BEST care Medical terminology mapped to Standard Vocabulary Mapping chief complaint to SNOMED CT % ,800 admissions in SNUH for 7 years 0.5% 63,400 chief complaints Broad in SNOMED 6.7% Normalization partially mapped Broad in SNUH 1 0.2% 2.5% exactly mapped 6317 CCs 90.1 % 429 :user defined CCs

29 Characteristics of EMR in BESTcare Clinical Decision Support Systems Alert Critique Contents drug overdose drug interaction pregnancy and lactation-related drug alerting allergy antibiotics ordering system transfusion ordering system chemotherapy ordering system Installed Reminder user's scheduling for patients Help/ Link MICROMEDX drug information Other online medical site

30 Characteristics of EMR in BEST care Clinical Decision Support Systems OVERDOSE-tenormin 500mg/day DRUG INTERACTION- azathioprin+allopurinol

31 Characteristics of EMR in BEST care Integration with other systems 1) Interface with test machines: HL7, DICOM, XML 2) Integration with OCS, MIS, and PACS

32 Characteristics of EMR in BEST care Security and privacy -PKI based -Role based -Follow HIPPA Acts in security and privacy Hospital DataBase Smart Card USB Port User Cheching Password Data Input Hospital DataBase + Applying Authentication Data + Authentication Authenticated Data

33 Characteristics of EMR in BEST care Mobile solution Wireless notebooks Wireless PDA? No. of AP: 7 AP?6 AP?7 トイレ 耳 鼻 咽 喉 科 ( 男 ) 治 療 室 意 思 ( 医 者 )すっぱい 5 燐 ( 仁, 印 ) 室 2 燐 ( 仁, 印 ) 室 2 燐 ( 仁, 印 ) 室 5 燐 ( 仁, 印 ) 室 5 燐 ( 仁, 印 ) 室 1 燐 ( 仁, 印 ) 室 1 燐 ( 仁, 印 ) 室 5 燐 ( 仁, 印 ) 室 AP?1 5 燐 ( 仁, 印 ) 室 5 燐 ( 仁, 印 ) 室 2 燐 ( 仁, 印 ) 室 2 燐 ( 仁, 印 ) 室 1 燐 ( 仁, 印 ) 室 2 燐 ( 仁, 印 ) 室 AP?2 AP?3 AP?4 7 階 坪 面 度 トイレ ( 余 ( 女, 与 )) AP?5

34 Characteristics of EMR in BEST care Disaster Plan User User Disaster Server Working Server Switch Over Standby Database Archive Log Archive Log Primary Database OP8/Disk Mirroring

35 Estimated economic benefit of EMR 35 (COST BENEFIT/YEAR, UNIT: million won-mw) Effect Count(/800 beds) Net (MW) 非 ( 比 ) 高 Medical record manage-ment Aid nurse's cost Doctor's cost medical coder (8 4) 4 persons 35MW 140 Technician job 7 persons 23MW 3.5/8hours 74 Part time job 4 persons 9.3MW 3.5/8hours 16 Ward AN job 100 persons 23MW 10% 230 OPD AN job 45 persons 23MW 50% 518 Residency job 260 persons 25MW 3% 195 Intern job 100 persons 22MW 50% 1,100 Area for medical record 200 pyeong 5MW 1,000 Others Paper cost for medical record New patient 30 thousand persons/year 800won 24 Printing cost for medical record 60 MW/year 60 Total reduction cost 2, /BED

36 Vision for HIS in Korea Short term vision Long term vision Obstacles to be resolved

37 Short term vision More convenient than paper record Data retrieval in many aspects on point of care Convenient management of medical record form User defined data abstraction Flow sheet User friendly interface 2. Clinical Data Repository Extend standardization to structured medical record User operated data retrieval for research 3. More sophisticated Clinical Decision Support System 4. Computerized Critical Pathway, Guideline, and Protocol 5. Evaluation module for quality assurance

38 Long term vision Shared EHR * Standardization Syntactic standardization Semantic standardization * Networking? ubiquitous healthcare 2. Patient centered EHR

39 Obstacles to be resolved in institutions Leadership 2. Strategic investment : effect vs cost 3. Define and modify business process 4. Integration legacy systems 5. Encourage participation of users in development process 6. Handle the paper medical record 7. Prepare to share medical data

40 Obstacles to be resolved in national base Security, Privacy, Confidentiality 2. Standardization 3. Regulation by law 4. Financial support

41 Thank you for your attention!

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