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2003. 11.72003. 11.7
Hospital Information System in Hospital Information System in KoreaKorea
Kyoo-Seob Ha, MD, PhD
CIODept. of Neuropsychiatry SNU Bundang Hospital
ContentsContents
ⅠⅠ.. Overview of HIS in KoreaOverview of HIS in Korea
II. HIS in SNUBHII. HIS in SNUBH
III. Vision for HIS in KoreaIII. Vision for HIS in Korea
3
Brief History of HIS in Korea
1980 1990
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 Korealate 1990s:
Oct. 15th- POE in SNUHEMR in EMR in Korea-outpatientKorea-outpatient
1999:
PACS in SNUH2001:
2000
Digital Hospital in SNUBH withDigital Hospital in SNUBH with EMR, PACS, POE, etc.EMR, PACS, POE, etc.
2003:
4
Present status of HIS in Korea
System Implementation
POE 72.6% (149 / 205 hospitals)
PACS 38.7% (77 / 199 hospitals)
EMR 2.6% (5 / 190 hospitals)
282 General Hospitals with over 100 inpatient-beds
5
Present status of HIS in Korea
Standardization in HIS
Disease codeSNOMED CTICD-10Modification of ICD-10EDI code
Procedure codeSNOMED CTModified ICD-9-CMEDI codelocal code
Symptom codeSNOMED CTUMLSModification of ICD-10
Transfer format: DICOM, HL7
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
ブンダンソウル大学病院情報システムブンダンソウル大学病院情報システム --Bundang SNUH Electronic System for ToBundang SNUH Electronic System for To
tal Care(BESTcare)-tal Care(BESTcare)-
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
Hospital Information System in Hospital Information System in SNUBHSNUBH
EMR PACS MIS Groupware Visual Information
System KIOSK
Integrated HIS
10
Time Table for development of BESTcare
POE in SNUHPOE in SNUH
EMR Case study
: USA, Japan, Australia etc
EMR TFT in SNUHEMR TFT in SNUH
EMR Workshop
Finish EMR Consulting Finish EMR Consulting
StandardizationStandardization
EMR TFT for SNUBHEMR TFT for SNUBH
Start ProjectStart Project
Open BESTcareOpen BESTcare
19991999 年年 20002000 年年 20012001 年年 20022002 年年 20032003 年年
5.10.2003
11
EMREMREMREMRPACSPACSPACSPACS OCSOCSOCSOCS MISMISMISMIS
Digitalized medical recordDigitalized medical recordStructured Data InputStructured Data InputClinical Decision SupportClinical Decision SupportStandard Medical TerminologyStandard Medical Terminology
Digitalized order CommunicationDigitalized order CommunicationDrug InteractionDrug InteractionDrug side effectDrug side effectDrug InformationDrug Information
Digitalized ImageDICOM
AccountManagementADTAncillary service
BESTBEST carecare : Integrated HIS of SNUBH
Components of Components of BESTcareBESTcare
12
EMR
OCSOCS
PACSPACS
EMR and other HIS
MISMIS EMR
OCSOCSPACSPACS MIS MIS
Integration!!
Structure of BESTcareStructure of BESTcare
13
Hardware System Hardware System StructureStructure
SiSi
Backbone
L4 Switch
L4 Switch
Router
FireWall
...
Web Server
SiSi
EMR Part
Web&Secutrity
Mail Server
DNS Server
Hotline to SNUHSNUnet
PACS Part
Backup
IDS
Image Server
Policy Server
MIS Dev. Server
GW Server
EMR Dev. Server
Client Part
Starage
Acq. Server
EMR Server
MIS/EMRDB Server
Internet
Storage
IDS
SiSi
NMS
IDS
L4 Switch
DB Server
Backup
MIS Part
14
Administration InformationAdministration Information
AccountAccount Management of medical serviceManagement of medical service Ancillary systemsAncillary systems
General ManagementGeneral Management
Personnel Manag. Purchasing/stock Financial affairs
Statistics User's information
POEinformation
patientinformation
test
medication
other resourcesMedical record
Nutrition
Clinical Path
Anatomic Path.
Rehabilitation
Radiology
Blood trasf.
Supply
Special test Pharmacy
Health center
Infection
Reservation
ADT
Billing
Claim
reimbursement
EDI
Statisticsmedical code ICU
Inpatient
Nurse depart.
OP room
Outpatient
Emergency room
Components of MIS in BESTComponents of MIS in BEST carecare
15
DLT jukebox Storagetek L40
1.6TB
MDCT data storage serverCompaq ML370
300GB
Web1000 serverCompaq ML570
800GB
DB serverSUN V880
CacheClarix FC4700
6TB
DLT jukeboxStoragetek L700
13TB
Firewall
HIS BrokerCompaq ML370
Backup serverSUN V880
Acquisition serverSUN V880
ExWeb serverCompaq W6000
TESTTEST modules modules
DS3000
CS5000
Rapidia
Giga bit
100Mbps Fast Ethernet
100Mbps Fast Ethernet
Back bone of PACSBack bone of PACS
16
DS3000 (11 clients)-3 dimensional miniPACS CS5000 (226 clients)-C/S PACS Web1000 (320 clients)-WEB PACS
No. of Clients No. of Clients TerminalsTerminals
CharacteristicsCharacteristics of of PACSPACS
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 No. of Modalities: 57 different sources sources
17
PACS MODALITIES
EMR
Client PC
InterfaceInterfacemachinemachine
PACS Management
Integration of EMR-Integration of EMR-PACSPACS
18
Single LOG-ON for PACS and EMR
Characteristics of Characteristics of PACSPACS
19
bestcare button
Interface between PACS and EMR
Characteristics of Characteristics of PACSPACS
20
Web PACS-remote access from outsideWeb PACS-remote access from outside
usersusers
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-hospitalExtra-hospital Intra-hospitalIntra-hospital
internet
Characteristics of Characteristics of PACSPACS
EMR in BESTEMR in BEST carecare
EMR developmentEMR development
EMR designEMR design
Characteristics of EMRCharacteristics of EMR
Estimated economic benefit of EMREstimated economic benefit of EMR
22
EMR Development: step by stepEMR Development: step by step
User friendly Environment
IntegrationIntegration
Stage 3 NetworkingNationwide DB
Stage 2
ExpansionExpansionEMR for special sectionClinical researchData Warehouse
primary forms Lab Scan support Job flow without chart delivery
Stage 1
EMR InfrastructureEMR Infrastructure
23
Structure of EMR frame
inputinputretrievalretrieval
Patient informationPatient information
POEPOE
• Structured data input; flexible and adjustable
• Common record frame; universal
• Web-based UI with 2 monitors
EMR DesignEMR Design
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. note 4short term adm. note 33progression note 5operation note 6
pre-anesthesia note 1anesthetist note 1discharge note 17outpatient note 6test report 103consulting note for test 5consulting note 6consent form 7
medical certificate 3doctor's opinion1protocol 22questionnaire 14others 108
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
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 fieldwhich is defined by users
27
2. Medical terminology mapped to Standard Vocabulary
Chief complaintDiagnosisOperative procedureDrugNursing terms
Characteristics of EMR in BEST care
SNOMED CTICD-10ATC from WHOICNP
DomainDomain Number of termNumber of term
Chief complaint
concept 6746
Synonym 11455
Diagnosis 12187
Operative procedure 9609
Nursing terms about 7000
28
2. Medical terminology mapped to Standard Vocabulary Mapping chief complaint to SNOMED CT
Characteristics of EMR in BEST care
63,40063,400chief chief
complaintscomplaints
220,800220,800admissionsadmissionsin SNUHin SNUH
for 7 yearsfor 7 years
63176317CCsCCsNormalization
429429:user:userdefineddefinedCCsCCs
0
10
20
30
40
50
60
70
80
90
100
1
0.5%6.7%
0.2% 2.5%
90.1 %
%%
partially mapped
Broad in SNUH
Broad in SNOMED
exactly mapped
29
3. Clinical Decision Support Systems
Characteristics of EMR in BESTcare
Contents Installed
Alert drug overdosedrug interactionpregnancy and lactation-related drug alertingallergy
2003.5-6
Critique antibiotics ordering systemtransfusion ordering systemchemotherapy ordering system
2003.8
Reminder user's scheduling for patients 2003.8
Help/Link
MICROMEDXdrug informationOther online medical site
2003.92003.5
30
OVERDOSE-tenormin 500mg/dayDRUG INTERACTION- azathioprin+allopurinol
3. Clinical Decision Support Systems
Characteristics of EMR in BEST care
31
4. Integration with other systems1) Interface with test machines: HL7, DICOM, XML2) Integration with OCS, MIS, and PACS
Characteristics of EMR in BEST care
32
Characteristics of EMR in BEST care
5. Security and privacy
-PKI based -Role based-Follow HIPPA Acts in security and privacy
Smart CardUSB Port
User
Hospital DataBasePassword managing
Cheching Password
Data Input
ApplyingAuthentication
Hospital DataBase
Data + Authentication
+
Authenticated Data
33
7 階坪面度2 燐 ( 仁 , 印 ) 室1 燐 ( 仁 , 印 ) 室2 燐 ( 仁 , 印 ) 室2 燐 ( 仁 , 印 ) 室
1 燐 ( 仁 , 印 ) 室1 燐 ( 仁 , 印 ) 室
意思 (医者 )すっぱい
2 燐 ( 仁 , 印 ) 室
5 燐 ( 仁 , 印 ) 室5 燐 ( 仁 , 印 ) 室
5 燐 ( 仁 , 印 ) 室
2 燐 ( 仁 , 印 ) 室5 燐 ( 仁 , 印 ) 室5 燐 ( 仁 , 印 ) 室
5 燐 ( 仁 , 印 ) 室
耳鼻咽喉科治療室
2 燐 ( 仁 , 印 ) 室1 燐 ( 仁 , 印 ) 室
2 燐 ( 仁 , 印 ) 室2 燐 ( 仁 , 印 ) 室
1 燐 ( 仁 , 印 ) 室1 燐 ( 仁 , 印 ) 室
意思 (医者 )すっぱい
2 燐 ( 仁 , 印 ) 室
5 燐 ( 仁 , 印 ) 室5 燐 ( 仁 , 印 ) 室
5 燐 ( 仁 , 印 ) 室
2 燐 ( 仁 , 印 ) 室5 燐 ( 仁 , 印 ) 室5 燐 ( 仁 , 印 ) 室
5 燐 ( 仁 , 印 ) 室
耳鼻咽喉科治療室
倉庫 (ストアハウス )
看護婦更衣室
ザンゴンウィれる
AP?2 AP?3 AP?4
AP?6 AP?7
AP?5AP?1
ザンゴンウィれる
配線室会議室風呂場
相談室トイレ ( 男 )
トイレ ( 余 ( 女 , 与 ))相談室
治療室
風呂場配線室
? No. of AP: 7
教授すっぱい 教授すっぱい
6. Mobile solutionWireless no t ebooksWireless PDA
Characteristics of EMR in BEST care
34
Primary DatabaseStandby Database
Archive LogArchive Log
Switch Over
Disaster Server Working Server
User User
OP8/Disk Mirroring
Characteristics of EMR in BEST care
7. Disaster Plan
35
Estimated economic benefit of EMR
Effect Count(/800 beds)Net
(MW)非 ( 比 ) 高
Medical record manage-m
ent
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 job 100 persons ×23MW×10% 230
OPD AN job 45 persons ×23MW×50% 518
Doctor's cost
Residency job 260 persons ×25MW×3% 195
Intern job 100 persons ×22MW×50% 1,100
Others
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
Total reduction cost 2,257 4.2 /BED
(COST BENEFIT/YEAR, UNIT: million won-MW)
Vision for HIS in KoreaVision for HIS in Korea
Short term visionShort term vision
Long term visionLong term vision
Obstacles to be resolvedObstacles to be resolved
37
Short term visionShort term vision
1. More convenient than paper recordData retrieval in many aspects on point of careConvenient management of medical record formUser defined data abstractionFlow sheetUser friendly interface
2. Clinical Data RepositoryExtend standardization to structured medical recordUser operated data retrieval for research
3. More sophisticated Clinical Decision Support System4. Computerized Critical Pathway, Guideline, and Protocol5. Evaluation module for quality assurance
38
Long term visionLong term vision
1. Shared EHR* Standardization
Syntactic standardizationSemantic standardization
* Networking? ubiquitous healthcare
2. Patient centered EHR
39
Obstacles Obstacles toto be resolved in institutions 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 baseObstacles to be resolved in national base
1. Security, Privacy, Confidentiality
2. Standardization
3. Regulation by law
4. Financial support
Thank you for your attention!Thank you for your attention!