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 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: PACS in SNUH 2003: Digital Hospital in SNUBH with EMR, PACS, POE, etc. 3 Present status of HIS in Korea 282 General Hospitals with over 100 inpatient-beds System Implementation POE 72.6% (149 / 205 hospitals) PACS 38.7% (77 / 199 hospitals) EMR 2.6% (5 / 190 hospitals) 4 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 5 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 6 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)- 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 8 9 Hospital Information System in SNUBH Integrated HIS EMR PACS MIS Groupware Visual Information System KIOSK 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 Components of BESTcare BEST care : Integrated HIS of SNUBH PACS Digitalized Image DICOM EMR Digitalized medical record Structured Data Input Clinical Decision Support Standard Medical Terminology OCS Digitalized order Communication Drug Interaction Drug side effect Drug Information MIS Account Management ADT Ancillary service 12 Structure of BESTcare EMR and other HIS MIS EMR EMR PACS OCS PACS MIS OCS 13 Hardware System Structure Internet SNUnet Client Part Hotline to SNUH Web& Secutrity ... GW Server Router IDS L4 Switch Si DNS Server FireWall L4 Switch L4 Switch IDS PACS Part Mail Server IDS NMS Web Server Backbone Acq. Server Si DB Server Si MIS Part EMR Part MIS Dev. Server EMR Server Image Server Starage MIS/EMR DB Server Backup Policy Server Storage EMR Dev. Server Backup 14 Components of MIS in BEST care Account Reservation ADT Management of medical service Claim Ancillary systems test patient information Outpatient Inpatient reimbursement medication Emergency room Nurse depart. Billing medical code EDI POE information Statistics Statistics OP room ICU other resources Clinical Path Radiology Anatomic Path. Blood trasf. Rehabilitation Supply Special test Pharmacy Infection Nutrition Medical record Health center User's information General Management Personnel Manag. Purchasing/stock Administration Information Financial affairs 15 Back bone of PACS DLT jukebox Storagetek L40 1.6TB HIS Broker Compaq ML370 Rapidia CS5000 100Mbps Fast Ethernet DS3000 MDCT data storage server Compaq ML370 300GB TEST modules Web1000 server Compaq ML570 800GB DB server SUN V880 Cache Acquisition server Clarix FC4700 SUN V880 6TB DLT jukebox Backup server Storagetek L700 SUN V880 13TB Giga bit Firewall ExWeb server Compaq W6000 16 Characteristics of PACS 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 PACS Management PACS MODALITIES EMR Interface machine Client PC 18 Characteristics of PACS Single LOG-ON for PACS and EMR 19 Characteristics of PACS Interface between PACS and EMR bestcare button 20 Characteristics of PACS Web PACS-remote access from outside Extra-hospital Intra-hospital switch Image Routing from internet Main server Other services ex) internet reservation Fire Wall Access using VDSL, ADSL Internal WEB1000 Server Image Routing External WEB 1000 Server users users EMR in BEST care EMR development EMR design Characteristics of EMR Estimated economic benefit of EMR 22 EMR Development: step by step User friendly Environment Integration Stage 3 Networking Nationwide DB Expansion Stage 2 EMR Infrastructure Stage 1 EMR for special section Clinical research Data Warehouse 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 retrieval input • Structured data input; flexible and adjustable • Common record frame; universal POE 24 Characteristics of EMR in BEST care 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 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 consulting note 6 consent form 7 medical certificate 3 doctor's opinion1 protocol 22 questionnaire 14 others 108 5 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 BEST care 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 Characteristics of EMR in BEST care 2. Medical terminology mapped to Standard Vocabulary Chief complaint Diagnosis Operative procedure Drug Nursing terms Domain Chief complaint SNOMED CT ICD-10 ATC from WHO ICNP Number of term concept 6746 Synonym 11455 Diagnosis 12187 Operative procedure 9609 Nursing terms about 7000 28 Characteristics of EMR in BEST care 2. Medical terminology mapped to Standard Vocabulary Mapping chief complaint to SNOMED CT % 100 90 exactly mapped 80 70 220,800 Normalization 60 admissions 63,400 in SNUH chief partially mapped 50 for 7 years complaints 40 Broad in SNOMED 20 0 90.1 % Broad in SNUH 30 10 6317 CCs 0.5% 6.7% 0.2% 1 2.5% 429 :user defined CCs 29 Characteristics of EMR in BESTcare 3. Clinical Decision Support Systems Contents Installed Alert drug overdose drug interaction pregnancy and lactation-related drug alerting allergy 2003.5-6 Critique antibiotics ordering system transfusion ordering system chemotherapy ordering system 2003.8 Reminder user's scheduling for patients 2003.8 Help/ Link MICROMEDX drug information Other online medical site 2003.9 2003.5 30 Characteristics of EMR in BEST care 3. Clinical Decision Support Systems OVERDOSE-tenormin 500mg/day DRUG INTERACTION- azathioprin+allopurinol 31 Characteristics of EMR in BEST care 4. 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 5. 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 6. Mobile solution Wireless noｔebooks Wireless PDA ? AP?7 AP?6 AP?4 AP?3 AP?2 No. of AP: 7 トイレ 耳鼻咽喉科 (男) 意思(医者)すっぱい 治療室 2燐(仁, 印)室 5燐(仁, 印)室 2燐(仁, 印)室 5燐(仁, 印)室 5燐(仁, 印)室 1燐(仁, 印)室 5燐(仁, 印)室 1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 7 階坪面度 トイレ (余(女, 与)) AP?5 34 Characteristics of EMR in BEST care 7. Disaster Plan User Disaster Server User Working Server Switch Over OP8/Disk Mirroring Archive Log Standby Database Archive Log Primary Database 35 Estimated economic benefit of EMR (COST BENEFIT/YEAR, UNIT: million won-MW) Effect Medical record manage-ment Aid nurse's cost Count(/800 beds) Net (MW) medical coder (8→4) 4 persons ×35MW 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 Paper cost for medical record New patient 30 thousand persons/year ×800won 24 Printing cost for medical record 60 MW/year 60 非(比)高 140 Doctor's cost Others Total reduction cost 2,257 4.2 /BED 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 Thank you for your attention!
© Copyright 2024 ExpyDoc
