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National Information System Plan for Health and Welfare by 2010 Young Moon Chae, Ph.D. Dean, Graduate School of Public Health Yonsei University

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Presentation on theme: "National Information System Plan for Health and Welfare by 2010 Young Moon Chae, Ph.D. Dean, Graduate School of Public Health Yonsei University"— Presentation transcript:

1 National Information System Plan for Health and Welfare by 2010 Young Moon Chae, Ph.D. Dean, Graduate School of Public Health Yonsei University (

2 1 Table of Contents I. IT Environment II. National Health Information Systems (NHIS) in Korea III. National Standards IV. Telemedicine V. Hospital Information System VI. District Health Information System VII. Policy Implication for NHIS

3 Applications Status of e-Health (%) Specialty tertiary Hospitals General HospitalsHospitalsTotal 19992005199920051999200519992005 Outpatient CPOE81.897.646.984.222.766.950.575.6 Inpatient CPOE81.897.643.684.218.258.447.970.6 Pharmacy83.310078.188.242.953.468.169.1 Laboratory83.397.65086.723.854.152.468.5 Radiology83.397.651.688.223.853.452.968.7 Specialized tests83.397.646.982. ADT100 96.998.796.095.497.696.8 Administration91.710093.863.187.562.691.073.0 Insurance claim100 96.910087.589.494.893.5 Referral75.097.641.469.19.536.442.053.8 PACS16.790.56.578. Inpatient EMR-21.4-14.5-21.0-19.6 Outpatient EMR16.719. Insurance claims by EDI 100 90.5 92.4 94.8 (Source: Chae et al. National survey on e-health status. Health Insurance Review Agency. 2005.12 Status of e-Health in Korean Hospitals (Comparison of 1999 and 2005)

4 3 Categories Health Center (N=74)Health Subcenter (N=136) ComputerizedResponse(%)ComputerizedResponse(%) Health promotion19(52.8)36(48.6)16(45.7)35(25.7) Health education22(59.5)37(50.0)13(40.6)32(23.5) Oral health43(82.7)52(70.3)26(66.7)39(28.7) Nutrition15(38.5)39(52.7)5(19.2)26(19.1) Infectious disease management32(72.7)44(59.5)18(51.4)35(25.7) AIDS22(55.0)40(54.1)2(9.1)22(16.2) TB Control64(100.0)64(86.5)37(77.1)48(35.3) Maternal and Child health59(96.7)61(82.4)67(95.7)70(51.5) Elderly health16(42.1)38(51.4)26(60.5)43(31.6) Primary health care63(98.4)64(86.5)97(99.0)98(72.1) Laboratory, Radiology64(100.0)64(86.5)38(76.0)50(36.8) Telemedicine5(15.6)32(43.2)2(9.5)21(15.4) Electronic Medical Record16(42.1)38(51.4)13(43.3)30(22.1) PACS1(3.3)30(41.1)0(0.0)20(14.7) Status of Computerization in Health centers and Health subcenters in 2005

5 4 Upbringing e-Health Industry Manage Health Structure Applying e- Health to Health Insurance Launch and Development e- Health Industry World Best e- Health Products Construction of e- Health Net u-Health Mobile Service U-Korea/u-city To do for e-Health Korea e-Health Strategy Apply e-Health to Military Military e-Health Devices Research e-Health technology Launch e-Health infrastructure Ministry of Health and Welfare Ministry of Information and communication Ministry of National Defense Ministry of Science & Technology Ministry of Industry, commerce and energy

6 5 History and Plan for the e-Health in Korea 1980 1990 20002010 Medical insurance for teachers and government workers Medical insurance for non-government workers Nationwide Medical Insurance Separation of ordering and dispensing Programs for insurance claims EMR for clinics Insurance claims by EDI Hospital CPOE* e-prescription EHR EMR for hospitals Legalization of EMR, e- prescription, and telemedicine e-health environment e-health business * CPOES: Computerized physician order entry system

7 6 NHIS Activities in Korea National Standards Phase 1 (04.12~05. 5): Development of standards for the public health center and secondary hospitals Phase 2 (05. 6~06. 5): Development of standards for the tertiary hospitals Phase 3 (06. 5~): Legalize standards and implementation of the pilot projects Information systems for the Public Health Center Development of the Information Strategy Plan (~05.7) Development of the information systems for the public health center (~05.12) Implementation of pilot project (06.1~ ) Electronic Health Record (EHR) Establishment of the Center for Intelligent Medical Support and Information Sharing Establishment of the Center for the EHR Establishment of the Center for Medical Knowledge and Ontology Establishment of the Center for Biomedical Information Law and regulation for e-health Revision of the medical law (~06.12)

8 7 Framework for the NHIS in Korea Information infrastructure Information services Standards Privacy and confidentiality Architecture Network Driving forces Organization Finance Information specialist Law EHR e-prescription Consumer health Profession Information services Improve quality of services Improve health status Reduce medical expenses

9 8 Phased approach Phased approach (Building Infrastructure, 04 – 05 ) (Building Public information Systems, 06 – 08) (Applying to Public Sector, 08 – 10) Phase 1 Phase 2 Phase 3 Creating specialist working groups and committees Initiating R & D projects for IT and EHR Developing ISP Revising laws and regulations Applying and testing standards to public health information systems Building infrastructure for consumer health informatics Implementing demonstration project for telemedicine Disseminating standards and EHR to the private sector Building nationwide EHR Strategy for building NHIS

10 9 Stepwise development of healthcare information standards Stage I (Dec. 2004~May 2005) 10 subcommittees Vocabulary standards for health centers and acute hospitals with less than 300 beds Simple collection of concepts Stage II (June 2005~May 2006) 10 + 3subcommittees (clinical documents, security & privacy, and vocabulary in radiology) Vocabulary standards for acute hospitals with more than 300 beds and university hospitals Integration of standards through mapping into UMLS Stage III (June 2006~ ) Implementation of standards into health center information system, public hospitals and cooperative private hospitals Validation, maintenance and dissemination of standards Building vocabulary structure (Ontology)

11 10 Legal Issues for Telemedicine in Korea Definition of Telemedicine and Telehealth Forms of Telemedicine Authorization to Practice Telemedicine Privacy and Confidentiality Quality of Care and Safety in Telemedicine Accountability and Responsibilities of the Physician Reimbursement

12 11 Scope of Telemedicine Type I (doctor – doctor) - Medical services specified under the current medical law (medical knowledge. Diagnosis, prescription, and consultation) Type II (doctor-nurse) - Consulting physician: medical knowledge and consultation - Referring health professionals: services specified under the current medical law Type III (doctor – patient) - Routine visits with the chronic diseases - Same disease as diagnosed at the first visit - Limited to diagnosis and prescription (not surgery) - Both doctor and patient have quality facility and equipment for tele- homecare Type IV (web doctor) - Consultation on health promotion and health education - Not allowed to provide prescription and diagnostic information

13 Direct Benefit Traditional benefit items (e.g. saving of personnel costs) Value Acceleration Benefits from improved information flow (e.g. saving of travel costs) Value Restructuring Benefits from restructuring of organization (e.g. increased no. of patients due to new services or new hospital policy) Value Linkage Benefits from the combined effects (e.g. saving of medical costs due to early detection of disease) Benefit (value) items of Telemedicine by information economics

14 Cost Items Treatment Costs Depreciation and Interests of Equipment and Facilities Operating Costs Maintenance costs for equipment Electricity costs Communication costs Personnel Costs (doctor, nurse, resident, technician) Cost items of Telemedicine

15 Patient Health Center Univ. Hosp. Net Benefit (B/C ratio) Cost and Benefit Cost Direct Benefit Value Linkage (Unit : US$/month) (B/C ratio = Benefit / Cost ratio) 56.5 9587.3 11452.4 14762.4 4723.9 7980.8 561.8 -19517.5 (0.14) -9930.4(0.56) 4748.3(1.24) Value Restructuring 191755322.51123.8 - 6857.0 (0.90) * No of Patients were increased by two times due to reorganization Value Acceleration Economic Analysis of Telemedicine

16 B/C Ratio 0.0 1.0 2.0 (Decrease of the Costs for Equipment and Communication) Sensitivity Analysis on Equipment and Communication Costs

17 16 SliplessFilmless ChartlessPaperless Integration Customer Drug Reservation Treatment Medical supporting Others CPOE Clinical research Reseource management Purchasing inventory Human resources AccountingOthers OA EMR Data entryScanning Digitalize Security Total Integration D/W & ERP PACS 4-less Approach to u-Hospital

18 17 Card reader LAN Mouse Monitor CPU Hard disk Identification EMR and e-prescription Bank card, traffic card, PKI (authentification) Use of Smart card at U-Hospital Memory LAN card Keyboard

19 18 Patient Supplier Hospital Pharmacy Public Medical Offices Efficient management EMR, PACS, HMIS ERP, CRM.. eIP, eMP.. Internet reservation Health Portal Telemedicine Physician order entry EDI Insurance claims EDI Drug B2B ERP CRM SCM Health Care Portal B2G B2B B2C B2B B2G Efficient management Medical DB e-Government G2C B2C EMR : Electronic Medical Record * PACS : Picture Archiving & Communication System. * HMIS : Hospital Management Information System e-Health Model in the hospital setting

20 19 Policy Implication of EHR-based Health Promotion Programs Development of a nationwide EHR Reorganization of community-based health promotion programs using EHR at health centers Initiation of the worksite health promotion programs using EHR at worksites Initiation of the government actions (e.g. legal action, pilot projects, budgets, etc.) to allow exchange of EHR among health centers, worksites, and other health institutions Implementation of pilot projects for health promotion using a personal EHR card in order to experiment its technical feasibility and usefulness

21 20 Dissemination of Telemedicine Initiation of tele-homecare for chronic patients who need refill of previous prescription Initiation of the government pilot projects on tele-homecare for the elderly in order to determine whether it should be covered by the new health insurance for the elderly which is scheduled to be started in 2008 Development of policies and guidelines for telemedicine with foreign countries Development of insurance fee schedule for telemedicine Development of a model for health delivery (or referral) system using telemedicine and implement a pilot project to test its feasibility

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