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Hospital Information System in Korea

Hospital Information System in Korea. 2003. 11.7. Kyoo-Seob Ha, MD, PhD CIO Dept. of Neuropsychiatry SNU Bundang Hospital. Contents. Ⅰ ． Overview of HIS in Korea II. HIS in SNUBH III. Vision for HIS in Korea. Brief History of HIS in Korea. 1980. 1990. 2000. Account (ex: FACOM M160).

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Hospital Information System in Korea

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

  4. Present status of HIS in Korea 282 General Hospitals with over 100 inpatient-beds

  5. Present status of HIS in Korea 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 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 • 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

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

  10. Time Table for development of BESTcare 1999年 2000年 2001年 2002年 2003年 POE in SNUH 5.10.2003 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. BESTcare : Integrated HIS of SNUBH Components of BESTcare OCS MIS EMR PACS 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. EMR EMR PACS PACS MIS MIS OCS OCS Structure of BESTcare EMR and other HIS Integration!!

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

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

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

  16. No. of Clients Terminals Characteristics of PACS • 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. Client PC Integration of EMR-PACS PACS Management EMR Interface machine PACS MODALITIES

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

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

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

  21. EMR in BESTcare EMR development EMR design Characteristics of EMR Estimated economic benefit of EMR

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

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

  24. 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 Characteristics of EMR in BESTcare 1. Structured data input in medical record Based on analysis of paper medical record in SNUH 73 primary records 108 secondary records Test reports 171 ancillary records

  25. Characteristics of EMR in BESTcare 1. 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 BESTcare 1. 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. SNOMED CT ICD-10 ATC from WHO ICNP Characteristics of EMR in BESTcare 2. Medical terminology mapped to Standard Vocabulary Chief complaint Diagnosis Operative procedure Drug Nursing terms

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

  29. Characteristics of EMR in BESTcare 3. Clinical Decision Support Systems

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

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

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

  33. ? No. of AP: 7 教授すっぱい 教授すっぱい AP?7 AP?6 ザンゴンウィれる ザンゴンウィれる 看護婦 更衣室 配線室 配線室 会議室 倉庫(ストアハウス) 風呂場 風呂場 AP?4 AP?3 AP?2 治療室 トイレ (余(女, 与)) トイレ (男) 相談室 相談室 耳鼻咽喉科 治療室 耳鼻咽喉科 治療室 意思(医者)すっぱい 意思(医者)すっぱい 2燐(仁, 印)室 2燐(仁, 印)室 5燐(仁, 印)室 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 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 5燐(仁, 印)室 1燐(仁, 印)室 AP?5 1燐(仁, 印)室 AP?1 5燐(仁, 印)室 5燐(仁, 印)室 5燐(仁, 印)室 5燐(仁, 印)室 2燐(仁, 印)室 2燐(仁, 印)室 2燐(仁, 印)室 2燐(仁, 印)室 1燐(仁, 印)室 1燐(仁, 印)室 2燐(仁, 印)室 2燐(仁, 印)室 7 階坪面度 Characteristics of EMR in BESTcare 6. Mobile solution Wireless noｔebooks Wireless PDA

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

  35. Estimated economic benefit of EMR (COST BENEFIT/YEAR, UNIT: million won-MW)

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

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

  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. 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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