Chapter 13 national health information system

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  • Korea is strong in IT, at least provisioning its infra structure. As you see here, all most all people who are able ot hold a mobile phone hold subscription.
    Almost of all household connected by broadband.
  • 의원급 EMR 보급은 우리에게는 기회요소, 표준화가 이루어질 경우 파급효과가 상당할 것임
  • In accordance with the objectives, the scope of development before moving into the new hospital includes various integrated modules like HIS, EMR, DW, GW, ERP, SEM and ABC. The relationship among the modules is shown in this slide.
    So, the integrated HIS integrates not only EMR and PACS but also OCS which has been used separately in each hospital. Mobile system users will benefit from this as usability will be enhanced. The current office automation systems will be converted into ERP after undergoing BPR process.
    All the information from integrated HIS and ERP will be channeled into DW to provide care information, management information and ABC cost analysis information and will become a foundation for CRM in the future. New groupware to be introduced will standardize PC user environment in the Hospital along with ERP and will serve as a framework to develop knowledge-based information system in the future.
  • They input patients problems at the patients side at the general ward, intensive care unit and anesthesia side of the patients. It enables also doctors to discuss the patients problem and enables live medical education with various patients results.
  • Chapter 13 national health information system

    1. 1. 1 National Health Information System in Korea Young Moon Chae, Ph.D. Graduate School of Public Health Yonsei University, Korea ymchae@yuhs.ac
    2. 2. Table of Contents BackgroundBackgroundII National Health Information SystemNational Health Information SystemIIII Community Health Information SystemCommunity Health Information SystemIVIV 1. National plan for health information system 2. Standards and law 1. Problems of old community health information systems 2. New community health information systems 3. Telemedicine 1. IT environment 2. e-Health status in Korea Future e-Health /u-Health ModelFuture e-Health /u-Health ModelVV Hospital Information SystemHospital Information SystemIIIIII
    3. 3. 3 Community Health Information System Ⅱ. National Health Information System IV. Future e-Health modelV. Hospital Information SystemⅢ. BackgroundI.
    4. 4. 4 Health Status in Korea 4 Health Indicators OECD Korea Average Life Expectancy 78.6 78.5 Infant Mortality Rate 5.4 5.3 No. of Beds per 1,000 5.6 7.9 No. of MD per 1,000 3.0 1.6 No. of CT per 1 million 20.6 32.2 No. of Outpatient Visits 6.8 11.8 No. of Admissions 9.9 13.5 Alcohol Consumption per Person (l) 9.5 8.1 % of Smokers 24.3 25.3 % of Overweight 47.6 30.5 % of Medical Expenditure for Public Sector 72.8 55.1
    5. 5. 5 International Comparison of Health Status 5.0 7.0 8.0 11.0 13.0 15.0 100 90 80 70 60 50 40 30 % of Medical Expenditure out of GDP Healthcare Performance Score (by the Conference Board of Canada, Feb. 2006) Korea (5th ) (5.6, 82) Japan Italy France Swiss Germany Canada U.S.A.
    6. 6. 6 보건 의료 사업 방향 변화 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 1970 1980 1992 2002 2017 2030 2050 2100 64세 이상 15~64세 0~14세 3.1% 3.8% 5,1% 7.9% 45.0% 37.6% 23.9% 13.6% Over 64 15-64 0-14 Population Composition Increasing elderly population Decreasing children
    7. 7. 7 Healthcare Systems in Korea U.K. Singapore France Germany Japan U.S.A Korea 91% 80% 75% 62% 36% 18% 11% Percentage of Public Sector Private sector dominance • Share of private hospitals: >90% of all hospitals • Clinics: all private • Public health center: provision of public health services and basic ambulatory services
    8. 8. 8 95 94 94 93 90 89 87 86 79 77 74 74 73 70 67 36 34 7 2 1 South Korea Argentina Australia Belgium Switzerland United States Canada Spain Japan Sweden Germany Netherlands France Italy nited Kingdom Brazil Mexico India China Russia Power in Broadband Reach,1 Percentage of Total Households Reach,1 Millions of Total Households 93.5 37.3 28.2 17.3 16.9 16.9 15.4 14.8 14.4 10.8 10.4 8 7.3 7.3 5.2 4.4 3.9 3.2 3.1 0.3 United States Japan Germany France Brazil United Kingdom South Korea Italy India Spain Canada Mexico China Australia Netherlands Argentina Belgium Switzerland Sweden Russia 319 million house- holds within reach of broadband networks 1 Households within reach of broadband networks in top 20 economies (ranked by GDP) as of 2002. Source: McKinsey Proprietary Broadband Research Broadband in Korea
    9. 9. 9 Subscribers of High-speed Internet in Korea 731 1,634 3,103 10,860 19,040 24,380 26,270 28,610 0 5000 10000 15000 20000 25000 30000 ' 96.12 ' 97.12 ' 98.12 ' 99.12 ' 00.12 ' 01.12 ' 02.12 ' 03.6 (1,000 people) Internet Users of Korea –28,610,000 Number of High-Speed Internet Service Subscriber in Korea 11,427,998 [Source : MIC (Ministry of Information and Communication) 2004]
    10. 10. 10 0 500 1,000 1,500 2,000 2,500 3,000 3,500 4,000 4,500 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 Wired Phone Wireless Phone Broadband Internet IT-strong Korea : Subscribers No. 1 in the Digitalization Index in 2005
    11. 11. 11 Korean IT market has grown at about 25% annually since 2000 Growth of Korean Hospital IT market 2,500 4,095 0 1,000 2,000 3,000 4,000 5,000 6,000 2001 2002 2003 2004 year1000 million Won 5,119 3,150 26% 30% 25% • Separation of prescription from dispensing drug (2000) • MOHW “Information sharing between hospitals” • Legalization of EMR and telemedicine (2003.3) G E • Increasing competition between hospitals • Opening of hospital market to foreign countries according to WTP agreement • Web technology, ASP application in hospitals • PACS/OCS/EMR, E-CRM, ERP, E-Procurement T • Increasing number of malpractice suite • Increasing demand for quality care • Increasing need for productivity improvementt S Environmental factors for Hospital IT market Trends in Korean IT Market
    12. 12. Applications Status of e-Health (%) Specialty tertiary Hospitals (n=41) General Hospitals Hospitals Total 1999 2005 1999 2005 1999 2005 1999 2005 Outpatient CPOE 81.8 97.6 46.9 84.2 22.7 66.9 50.5 75.6 Inpatient CPOE 81.8 97.6 43.6 84.2 18.2 58.4 47.9 70.6 Pharmacy 83.3 100 78.1 88.2 42.9 53.4 68.1 69.1 Laboratory 83.3 97.6 50 86.7 23.8 54.1 52.4 68.5 Radiology 83.3 97.6 51.6 88.2 23.8 53.4 52.9 68.7 Specialized tests 83.3 97.6 46.9 82.2 15.0 43.1 48.4 60.9 ADT 100 100 96.9 98.7 96.0 95.4 97.6 96.8 Administration 91.7 100 93.8 63.1 87.5 62.6 91.0 73.0 Insurance claim 100 100 96.9 100 87.5 89.4 94.8 93.5 Referral 75.0 97.6 41.4 69.1 9.5 36.4 42.0 53.8 PACS 16.7 90.5 6.5 78.6 5.0 22.6 9.4 47.1 Inpatient EMR - 21.4 - 14.5 - 21.0 - 19.6 Outpatient EMR 16.7 19.1 0.0 14.8 9.5 23.4 8.7 20.7 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)Status of e-Health in Korean Hospitals (Comparison of 1999 and 2005)
    13. 13. 13 History and Plan for the e-Health in Korea 1980 1990 2000 2010 Medical insurance for teachers and government workers Nationwide Medical Insurance Separation of ordering and dispensing Programs for insurance claims Information system for health center 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 * CPOE: Computerized physician order entry system
    14. 14. 14 Current Status of e-health in Korea • Information systems for hospitals (as of 2005.10) - Insurance billing, admission and discharge: 100% - Computerized Order Entry System for tertiary hospital: 100% - Electronic medical record (EMR): 15% • Information systems for clinics (as of 2005.1) - EMR: over 70% - Insurance billing: over 90% • Insurance claims by EDI (Electronic data interchange) as of 2004.12 - Tertiary hospitals: 100% - Secondary hospitals: 67.5% - Clinics: 92.7% - Pharmacies: 92.9%
    15. 15. 15 Community Health Information System Ⅱ. National Health Information System IV. Future e-Health modelV. Hospital Information SystemⅢ. BackgroundI.
    16. 16. 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 Professional Information services • Improve quality of services • Improve health status • Reduce medical expenses
    17. 17. 17 Electronic Health Record (EHR) • Individual patient's medical record in digital format for lifetime • Contains complete history for health maintenance - Full listing of illness - Laboratory tests and treatment ,etc • Need interoperabilty
    18. 18. 18 NHIS Plan 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~ ) - Implementation of information system (‘08.7 ~) • 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 (~’08.12)
    19. 19. 19 Health Information StandardsHealth Information Standards Terminology for health services Terminology for health services Nursing terminologyNursing terminology Terminology for health statistics Terminology for health statistics Medical terminologyMedical terminology Terminology for drug and traditional medicine Terminology for drug and traditional medicine Terminology for diagnosis and laboratory Terminology for diagnosis and laboratory Health LawHealth Law PrivacyPrivacy National health information center National health information center Health information sharing among health institutes Health information sharing among health institutes Health Information Standards and Law
    20. 20. 20 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 • Insurance reimbursement
    21. 21. 21 Obstacles to National Health Information System • Asymmetry of Cost and Benefit of EHR -Cost is high -Benefit goes to Insurers and patients -Increased workload to physician -Cost to hospital -Difficult to obtain patient consent • Absence of standard and consensus of interoperability • Concern about security and privacy
    22. 22. 22 Overview of Hospital Information System ERP • Healthcare Portal • Telemedicine • CRM(Customer Relationship Mgmt) • e-Procurement • e-Marketplace Supply Customer Sister Hospital Pharmacy E- Prescription B2B (Biz to Biz) B2C (Biz to Customer) ASP Health Ministry Academic Ass. Health Insurance Co Knowledge Management System ERP HIS SEM Data Warehouse Group Ware ERP Administration, /Research Bank • HIS : Hospital Information System • OCS : Order Communications System • PACS : Picture Archiving and Communications System • EMR : Electronic Medical Record • ERP : Enterprise Resource Planning • ASP : Application Service Provider • EDI : Electronic Data Interchange • EDMS : Electronic Document Management System CDSS OCS EMR PACD(s,d) PoC • PoC : Point of Care • CDSS : Clinical decision Support System • SEM : Strategic Enterprise Management • DW : Data Warehouse EDI Customer Integrated Medical Information System u-Severance
    23. 23. 23 Community Health Information System Ⅱ. National Health Information System IV. Future e-Health modelV. Hospital Information SystemⅢ. BackgroundI.
    24. 24. 24 u-Hospital u-Hospital systems at Severance Hospital ⓝ-Zone Wireless LAN
    25. 25. 25copy right; u-SMART, July, 2006 U-Severance Diagram Integrated HIS CDR Mobile PACS EMR ERP DW OA Cardiovascular cine PACS Youngdong PACS Dental PACS(Infinit) SEM ABC Severance PACS(GE) DentalOCS KM PI Integrated Homepage HP EIP CRM 2nd Project GW 1st Project SeveranceOCS YongdongOCS Sister Hosp
    26. 26. 26 Data Warehouse ERP (SAP R/3) • FI • CO • MM • HR Provide BW – CEO -Recognize status of business information -Provide information for decision making + SEM ( Balance Score Card) SAP BWBW HIS (OCS + EMR) • PM • PS • Medicine • Med. support • administration • Medical EMR • Nursing EMR • Integrat. MI EMR Establish Datawarehouse and SEM  EUC for end-user -Use can access data warehouse to analyze (reduce dependency to the IT) BW: business warehouse, EUC: end user computing
    27. 27. 27copy right; u-SMART, July, 2006 U-Severance Point of Care
    28. 28. 28 EHR – PACS image EHR – PACS image EHR – PACS image PDA Monitor (240 X 320 pixel) POC - EHR Point-of-Care (Pocket PC)
    29. 29. 29 Benefits of Hospital Information Systems • Reduced Medical Costs • Improved Medical Care/service • Increased Patient Access to personal health information • Enables integration of fragmented health data of a patient -Share data with new doctor • Improved productivity of hospital workers • Reduced operating costs • Increased hospital revenues (due to reduced waiting time and length of stay)
    30. 30. 30 Community Health Information System Ⅱ. National Health Information System IV. Future e-Health modelV. Hospital Information SystemⅢ. BackgroundI.
    31. 31. 31 Overview of Community Health Information System Registration CPOE Lab. Pharmacy MCH TB Infectious disease Clinic Health Promotion Mental health Residents Provincial / city government Hospital Mental Hospital VHS Telemedicine ARS EDI Expert System Home National registration Network Insurance Network Telemedicine Demographic data Physical exam & utilization data
    32. 32. 32 Health instituteHealth institute Provincial government Provincial government MOHWMOHW Planning/ and Performance evaluation Paper-based reporting Paper-baed reporting Residents Health statistics Health AdministrationHealth Administration Medical ServiceMedical Service Health ServiceHealth Service Percentage of information support 60% Manual reporting takes more than a month to evaluate program performance 73%43% 62% Inadequate information support to health center activity Inadequately account for community needs Health Service Management under Old System Difficult to develop regional health plan and to evaluate quality of service
    33. 33. 33 Health Center Health Center MOHWMOHWManual processing of health statistics Partial integration ProvinceProvince Duplication Individual insurance claim No integration Other Health center Other Health center Partial integration City District City District KCDCKCDC NCI NTBI NCI NTBI Paper-based sharing Paper-based sharing Information Flow for the Old Health Center System Inefficient information flow results in under-utilization of health information HIRAHIRA NCI: National Cancer Institute, HIRA: Health Insurance Review Agency NTBI: National TB Institute. KCDC: Korea Center for Disease Control
    34. 34. 34 National Health Information Center NHIS NMICNMIC Physical exam KCDC Disease surveillance HIRAHIRA NCI NTBI TB surveillance Cancer registration City, district City, district National registration information Insurance claim Integration with the related systems Information Sharing by New Web-based ASP System Improve information sharing by integration with the related systems NMIC: National Medical Insurance Corporation
    35. 35. 35 Number of TB Patients by Detection Modes Year Detection Modes Follow-up Total Health center Physical exam by NMIC Mobile exam Family exam HIV exam Sub-total 2001 500,421 1,895,057 539,792 23,639 81 2,958,990 72,296 3,031,286 2002 460,779 2,161,037 452,662 22,225 601 3,097,304 50,457 3,147,761 2003 435,491 2,264,063 440,034 19,779 337 3,159,704 43,037 3,202,741 2004 447,468 2,483,314 412,802 17,107 319 3,361,010 38,481 3,399,491 2005 384,012 2,466,281 484,492 16,292 255 3,351,332 33,171 3,384,503
    36. 36. 36 Central Reading Center Tele-radiology system for TB control Web PACS Server Image Storage PACS PACS Health center PACS PACS PACS Local Storage Local Storage PACS Local Storage Local Storage Local Storage Regional hospital B PACS Local Storage Local StoragePACS Local Storage Local Storage Local Storage Regional hospital A PACS 복십자PACS Web_PACS Client Health center PACS PACS PACS PACS Web PACS Viewer Internet A city NationwideB city Images Images Patient Other health center Public TB doctor Request for reading Internet Reading results Sending image Internet Internet Results Web PACS for TB Control TB Specialty hospital
    37. 37. 37 Infectious Disease Surveillance System Early warning Decision Support Disease Prediction Prevention of epidemics Infectious Disease Surveillance and Reporting System • Web Robot for data collection • Data push for information distribution • News group for announcement • Website for infectious disease - Disease prevention - Disease outbreak - Disease information • Provision of survey statistics • Support early prevention of epidemics • Support prevention program development for region
    38. 38. 38 Improve access to health center Improve vaccination services Improve civil services Improve quality of follow-up care Residents Benefits to Community Residents Residents can receive services from any health center because their electronic health records can be accessed from any health center TB patients and chronic disease patients can receive continuous follow-up care because their electronic health records can be accessed from any health institutes Residents can receive automatic vaccination notice from health center by SMS or e-mail Various certificates including vaccination and birth certificates can be obtained by internet
    39. 39. 39 Improve home visiting services Improve quality of community health plan Improve inventory management Health worker Benefits to Health Workers Home visiting nurse can enter patient information directly to EHR by PDA or internet at patient’s home and this reduces duplicate data entry Health manager can develop better health plan by using information from various health institutes including National Medical Insurance Corporation Health centers can share inventory information and therefore they can share vaccine or other medicine in case of their shortage
    40. 40. 40 Reduce time for collecting policy information Improve effectiveness of program evaluation Improve information sharing between NMIC and health institutes Central government officials Benefits to Central Government Officials Time for collecting policy information at MOHW can be reduced because information on health programs for every public health institutes are stored at the central data warehouse Effectiveness of program evaluation of public health institutes can be greatly improved because various program information can be easily accessed from central data warehouse NMIC used to receive paper-based claims data for the physical exam from health institutes, but this will be replaced by electronic form
    41. 41. 41 Community Health Information System Ⅱ. National Health Information System IV. Future e-Health modelV. Hospital Information SystemⅢ. BackgroundI.
    42. 42. 42 Future e-Health Model for Public Sector HealthHealth centercenter HealthHealth subcentersubcenter HealthHealth postpost MOHWMOHW RegionalRegional hospitalshospitals NationalNational MedicalMedical CenterCenter NationalNational hospitalshospitals Reduction in duplicate tests and Waiting time by improving referring system Reduction in health expenditure by integrating medical services with public health services for discharge patients ResidentsResidents Development of lifetime healthcare system byDevelopment of lifetime healthcare system by information sharing among public health institutesinformation sharing among public health institutes Medical Services Public Health Services
    43. 43. 43 u-Health Components Measured Data SensingSensing MonitoringMonitoring FeedbackFeedbackAnalyzingAnalyzing Data Tx Long-term Analysis Results Bioinformatics Feedback / Value-Added Service Measuring biological signals Filtered & Analyzed Data Display Long-term Data storage Trend analysis  Behavior modification  Emergency Alert  Feedback-Action (Prescription, exercise, etc) U-Health Solution Medical Devices
    44. 44. 44 Ubiquitous-Health SystemUbiquitous-Health System u-Health Service Portal Emergency Medical System Monitoring System Home Server Multimedia Wellbeing Chair Home Platform Office Platform EMR sharing/Cooperation Fitness Center Wellbeing Toilet Wellbeing Bath Wellbeing Bed Well-being House Wellbeing Cars Well-being Mobile Applications Wearable Portable various e-Health tools Registration Mobile Platform GPS EMR Achieves Medical Records Sharing Dev. Home monitoring Ships Kiosk Terminal Cell Phone EMR Card Kiosk Terminal

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