Hospital Information System in...

2003. 11.7

Hospital Information System in Korea

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

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 Korea late 1990s:

Oct. 15th- POE in SNUH

EMR in Korea-outpatient 1999:

PACS in SNUH 2001:

2000

Digital Hospital in SNUBH with

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 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

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-Bundang SNUH Electronic System for

Total 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 SNUBH

EMR

PACS

MIS

Groupware

Visual Information System

KIOSK

Integrated HIS

10

Time Table for development of BESTcare

POE in SNUH

EMR Case study

: USA, Japan, Australia etc

EMR TFT in SNUH

EMR Workshop

Finish EMR Consulting

Standardization

EMR TFT for SNUBH

Start Project

Open BESTcare

1999年 2000年 2001年 2002年 2003年

5.10.2003

11

EMR PACS OCS MIS

Digitalized medical record Structured Data Input Clinical Decision Support Standard Medical Terminology

Digitalized order Communication Drug Interaction Drug side effect Drug Information

Digitalized Image DICOM

Account Management ADT Ancillary service

BEST care : Integrated HIS of SNUBH

Components of BESTcare

12

EMR

OCS

PACS

EMR and other HIS

MIS EMR

OCS

PACS MIS

Structure of BESTcare

13

Hardware System Structure

SiSi

Backbone

L4 Switch

L4 Switch

Router

FireWall

...

Web Server

SiSi

EMR Part

Web& Secutrity

Mail Server

DNS Server

Hotline to SNUH SNUnet

PACS Part

Backup

IDS

Image Server

Policy Server

MIS Dev. Server

GW Server

EMR Dev. Server

Client Part

Starage

Acq. Server

EMR Server

MIS/EMR DB Server

Internet

Storage

IDS

SiSi

NMS

IDS

L4 Switch

DB Server

Backup

MIS Part

http://www.ibm.com/kr/pseries/hardware/p690.html

http://www.ibm.com/kr/pseries/hardware/p690.html

14

Administration Information

Account Management of medical service Ancillary systems

General Management

Personnel Manag. Purchasing/stock Financial affairs

Statistics User's information

POE information

patient

information

test

medication

other resources

Medical record

Nutrition

Clinical Path

Anatomic Path.

Rehabilitation

Radiology

Blood trasf.

Supply

Special test Pharmacy

Health center

Infection

Reservation

ADT

Billing

Claim

reimbursement

EDI

Statistics medical code ICU

Inpatient

Nurse depart.

OP room

Outpatient

Emergency room

Components of MIS in BEST care

15

DLT jukebox Storagetek L40

1.6TB

MDCT data storage server Compaq ML370

300GB

Web1000 server Compaq ML570

800GB

DB server SUN V880

Cache Clarix FC4700

6TB

DLT jukebox Storagetek L700

13TB

Firewall

HIS Broker Compaq ML370

Backup server SUN V880

Acquisition server SUN V880

ExWeb server Compaq W6000

TEST modules

DS3000

CS5000

Rapidia

Giga bit

100Mbps Fast Ethernet

Back bone of PACS

16

DS3000 (11 clients)-3 dimensional miniPACS

CS5000 (226 clients)-C/S PACS

Web1000 (320 clients)-WEB PACS

No. of Clients Terminals

Characteristics of PACS

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 sources

17

PACS MODALITIES

EMR

Client PC

Interface machine

PACS Management

Integration of EMR-PACS

18

Single LOG-ON for PACS and EMR


19

bestcare button

Interface between PACS and EMR


20

Web PACS-remote access from outside

users users

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-hospital Intra-hospital

internet


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

Stage 2

Expansion EMR for special section

Clinical research

Data Warehouse

primary forms

Lab

Scan support

Job flow without chart delivery

Stage 1

EMR Infrastructure

23

Structure of EMR frame

input retrieval

Patient information

POE

• Structured data input; flexible and adjustable • Common record frame; universal

• Web-based UI with 2 monitors

EMR 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 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

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 field which is defined by users

27

2. Medical terminology mapped to Standard Vocabulary Chief complaint Diagnosis Operative procedure Drug Nursing terms


SNOMED CT ICD-10 ATC from WHO ICNP

Domain Number 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


63,400 chief

complaints

220,800 admissions in SNUH

for 7 years

6317 CCs

Normalization

429 :user

defined CCs

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 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

OVERDOSE-tenormin 500mg/day DRUG INTERACTION- azathioprin+allopurinol

3. Clinical Decision Support Systems


31

4. Integration with other systems 1) Interface with test machines: HL7, DICOM, XML 2) Integration with OCS, MIS, and PACS


32


5. Security and privacy

-PKI based -Role based -Follow HIPPA Acts in security and privacy

Smart Card USB Port

User

Hospital DataBase

Cheching Password

Data Input

Applying Authentication

Hospital DataBase

Data + Authentication

+

Authenticated Data

33

7 階坪面度

2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


5燐(仁, 印)室

5燐(仁, 印)室

耳鼻咽喉科治療室

AP?2 AP?3 AP?4

AP?6 AP?7

AP?5 AP?1

トイレ (男)

トイレ (余(女, 与))

? No. of AP: 7 6. Mobile solution Wireless noｔebooks Wireless PDA


34

Primary Database Standby Database

Archive Log Archive 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-ment

medical coder (8→4) 4 persons ×35MW 140

Technician job 7 persons ×23MW×3.5/8hours 74

Part time job 4 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 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!

Hospital Information System in...

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