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2003. 11.7 Hospital Information System in Korea Kyoo-Seob Ha, MD, PhD CIO Dept. of Neuropsychiatry SNU Bundang Hospital.

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Presentation on theme: "2003. 11.7 Hospital Information System in Korea Kyoo-Seob Ha, MD, PhD CIO Dept. of Neuropsychiatry SNU Bundang Hospital."— Presentation transcript:

1 2003. 11.7 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 3 Brief History of HIS in Korea 19801990 Account (ex: FACOM M160) late 1970s: Ancillary systems (ex: clinical pathology) 1980s: The first POE and PACS - win32, C/S mid 1990s: PACS expansion in Korea late 1990s: Oct. 15th- POE in SNUH EMR in Korea-outpatient 1999: PACS in SNUH 2001: 2000 Digital Hospital in SNUBH with EMR, PACS, POE, etc. EMR, PACS, POE, etc. 2003:

4 4 Present status of HIS in Korea SystemImplementation POE72.6% (149 / 205 hospitals) PACS38.7% (77 / 199 hospitals) EMR2.6% (5 / 190 hospitals) 282 General Hospitals with over 100 inpatient- beds

5 5 Present status of HIS in Korea Standardization in HIS 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 Transfer format: DICOM, HL7

6 6 Present status of HIS in Korea 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 8 Overall Facilities - 3 Underground and 14 Ground Facilities - 23 medical departments and 6 specialized centers - 812 beds for inpatient care (550 at present) - 66 clinics for outpatient care - 16 Operating rooms with day surgery rooms - Administrative offices and Support services Introduction to Bundang SNUH

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

10 10 Time Table for development of BESTcare POE in SNUH EMR Case study : USA, Japan, Australia etc EMR TFT in SNUH EMR Workshop Finish EMR Consulting Standardization EMR TFT for SNUBH Start Project Open BESTcare 1999 年 2000 年 2001 年 2002 年 2003 年 5.10.2003

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

12 12 EM R OCS OCS PACS EMR and other HIS MIS MIS EM R OCS OCS PACS MIS MIS I n t e g r a t i o n ! ! Structure of BESTcare

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

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

15 15 DLT jukebox Storagetek L40 1.6TB MDCT data storage server Compaq ML370 300GB Web1000 server Compaq ML570 800GB DB server SUN V880 Cache Clarix FC4700 6TB DLT jukebox Storagetek L700 13TB Firewall HIS Broker Compaq ML370 Backup server SUN V880 Acquisition server SUN V880 ExWeb server Compaq W6000 TEST modules DS3000 CS5000 Rapidia Giga bit 100Mbps Fast Ethernet Back bone of PACS

16 16  DS3000 (11 clients)-3 dimensional miniPACS  CS5000 (226 clients)-C/S PACS  Web1000 (320 clients)-WEB PACS No. of Clients Terminals Characteristics of PACS  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) No. of Modalities: 57 different sources

17 17 PACS MODALITIES EMR Client PC Interfacemachine PACS Management Integration of EMR- PACS

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

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

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

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

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

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

24 24 Characteristics of EMR in BEST care 1. Structured data input in medical record Based on analysis of paper medical record in SNUH Test reports 171 ancillary records 73 primary records 108 secondary records adm. note4 short term adm. note33 progression note5 operation note6 pre-anesthesia note1 anesthetist note1 discharge note17 outpatient note6 test report103 consulting note for test5 consulting note6 consent form7 medical certificate3 doctor's opinion1 protocol22 questionnaire14 others108

25 25 1. Structured data input in medical record :User defined structured data input module : over 1300 forms :Input forms associated with specific clinical situations Characteristics of EMR in BESTcare Functional test report forms Present illness form in nephrology

26 26 1. Structured data input in medical record :User defined template module: text-template, image-template Characteristics of EMR in BEST care Text template for any text field in EMR Image template for image input field which is defined by users

27 27 2. Medical terminology mapped to Standard Vocabulary Chief complaint Diagnosis Operative procedure Drug Nursing terms Characteristics of EMR in BEST care SNOMED CT ICD-10 ATC from WHO ICNP Domain Number of term Chief complaint concept6746 Synonym11455 Diagnosis12187 Operative procedure9609 Nursing termsabout 7000

28 28 2. Medical terminology mapped to Standard Vocabulary Mapping chief complaint to SNOMED CT Characteristics of EMR in BEST care 63,400chiefcomplaints 220,800admissions in SNUH for 7 years 6317CCs Normalization 429:userdefinedCCs 0.5% 6.7% 0.2% 2.5% 90.1 % % partially mapped Broad in SNUH Broad in SNOMED exactly mapped

29 29 3. Clinical Decision Support Systems Characteristics of EMR in BESTcare ContentsInstalled Alertdrug overdose drug interaction pregnancy and lactation-related drug alerting allergy 2003.5-6 Critiqueantibiotics ordering system transfusion ordering system chemotherapy ordering system 2003.8 Reminderuser's scheduling for patients2003.8 Help/ Link MICROMEDX drug information Other online medical site 2003.9 2003.5

30 30 OVERDOSE-tenormin 500mg/day DRUG INTERACTION- azathioprin+allopurinol 3. Clinical Decision Support Systems Characteristics of EMR in BEST care

31 31 4. Integration with other systems 1) Interface with test machines: HL7, DICOM, XML 2) Integration with OCS, MIS, and PACS Characteristics of EMR in BEST care

32 32 Characteristics of EMR in BEST care 5. Security and privacy -PKI based -Role based -Follow HIPPA Acts in security and privacy Smart Card USB Port User Hospital DataBase Password managing Cheching Password Data Input Applying Authentication Hospital DataBase Data + Authentication + Authenticated Data

33 33 6. Mobile solution Wireless no t ebooks Wireless PDA Characteristics of EMR in BEST care

34 34 Primary Database Standby Database Archive Log Switch Over Disaster ServerWorking Server User OP8/Disk Mirroring Characteristics of EMR in BEST care 7. Disaster Plan

35 35 Estimated economic benefit of EMR EffectCount(/800 beds) Net (MW) 非(比)高非(比)高 Medical record manage- ment medical coder (8→4)4 persons ×35MW 140 Technician job7 persons ×23MW×3.5/8hours 74 Part time job4 persons ×9.3MW×3.5/8hours 16 Aid nurse's cost Ward AN job100 persons ×23MW×10% 230 OPD AN job45 persons ×23MW×50% 518 Doctor's cost Residency job260 persons ×25MW×3% 195 Intern job100 persons ×22MW×50%1,100 Others Area for medical record200 pyeong ×5MW1,000 Paper cost for medical record New patient 30 thousand persons/year ×800won 24 Printing cost for medical record 60 MW/year 60 Total reduction cost2,2574.2 /BED (COST BENEFIT/YEAR, UNIT: million won-MW)

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

37 37 Short term vision 1. 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 38 Long term vision 1. Shared EHR * Standardization Syntactic standardization Semantic standardization * Networking ? ubiquitous healthcare 2. Patient centered EHR

39 39 Obstacles to be resolved in institutions 1. 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 40 Obstacles to be resolved in national base 1. Security, Privacy, Confidentiality 2. Standardization 3. Regulation by law 4. Financial support

41 Thank you for your attention!

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