2003. 11.7 hospital information system in korea kyoo-seob ha, md, phd cio dept. of neuropsychiatry...

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


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


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


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


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


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


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


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


31

4. Integration with other systems1) Interface with test machines: HL7, DICOM, XML2) Integration with OCS, MIS, and PACS


32


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


34

Primary DatabaseStandby Database

Archive LogArchive Log

Switch Over

Disaster Server Working Server

User User

OP8/Disk Mirroring


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!

2003. 11.7 hospital information system in korea kyoo-seob ha, md, phd cio dept. of neuropsychiatry...

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