To-be Process

Document Sample
To-be Process Powered By Docstoc
					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
                                                                                      3

       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.
                                                     4

   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)
                                                   5

        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
                                                                      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-
Bundang SNUH Electronic System for
      Total Care(BESTcare)-
                                                         8

             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
                                                   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                     EMR                  OCS                        MIS




Digitalized Image    Digitalized medical record       Digitalized order Communication         Account
  DICOM                Structured Data Input            Drug Interaction                      Management
                       Clinical Decision Support        Drug side effect                      ADT
                       Standard Medical Terminology     Drug Information                      Ancillary
                                                                                                service
                                             12

            Structure of BESTcare

EMR and other HIS




             MIS
                                       EMR
                           EMR
                    PACS

      OCS           MIS             PACS
                            OCS
                                                                                                                                                  13

                        Hardware System Structure
                                                     SNUnet                  Internet     Hotline to SNUH

          Client Part                                    Web&                                                                  GW Server


       ...                                             Secutrity                                         Router

                                                                                                                  IDS
                                                                 L4 Switch
                                             Si



                                                                  FireWall                                                       DNS Server

                                                                                                         L4 Switch
                                                                 L4 Switch
                                                                                                                                Mail Server
                                                              IDS                             IDS
              PACS Part
                                                                                        NMS
                                                                                                                                 Web Server

                                                                 Backbone
                                                                                  Si                Si
Acq. Server             DB Server


                                                        EMR Part                                                            MIS Part


                                                                                                                                    MIS
                                                                                                                                    Dev. Server

                                                                        EMR Server
                                                  Image Server
                                                                                                                   MIS/EMR
              Starage               Backup                                                                         DB Server


                                                                                                                  Storage         Backup
                                                       Policy Server
                                                                             EMR Dev.
                                                                             Server
                                                                                                                                14

    Components of MIS in BEST care

          Account                          Management of medical service                            Ancillary systems


                                                                                   test
Reservation         Claim                                                                      Clinical Path     Radiology
                                   patient
                                               Outpatient   Inpatient
                                 information                                                   Anatomic Path.   Blood trasf.
    ADT        reimbursement                                                     medication    Rehabilitation      Supply
                                           Emergency room Nurse depart.
                                                                                                Special test      Pharmacy
  Billing             EDI
                                     POE                                                         Infection       Nutrition
                                 information                               other resources
medical code    Statistics                      OP room         ICU                            Medical record   Health center




                    Statistics                              User's information


   General Management

                 Personnel Manag.                     Purchasing/stock                    Financial affairs




                                        Administration Information
                                                                                                                                    15

  Back bone of PACS


                                                              DLT jukebox         MDCT data
                                                                                                     HIS Broker
                                                             Storagetek L40     storage server      Compaq ML370
                                                                 1.6TB           Compaq ML370
                                                                                     300GB
DS3000            Rapidia




                        100Mbps Fast Ethernet
                                                                                Web1000 server                          Cache
                                                                                                 Acquisition server
                                                                                 Compaq ML570                       Clarix FC4700
                                                TEST modules                         800GB
                                                                                                      SUN V880
                                                                                                                         6TB


         CS5000


                                                                                                                   DLT jukebox
                                                                                     DB server     Backup server
                                                                                                                 Storagetek L700
                                                                                      SUN V880       SUN V880
                                                                                                                      13TB


                                                                                                        Giga bit




                                                                      ExWeb server
                                                  Firewall
                                                                     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,                 Endoscope (15)
  URO US) (31)                                                     Colonoscope (2)
        Direct DR (2)                                             GFS (2)
        CR (6)                                                    EUS (1)
        Digital mammography                                       Bronchoscope (1)
        BMD (2)                                                   ENT (3)
        US (10)                                                   OR (3)
        16-MDCT (1)                                               Arthroscope (2)
        MR (1)                                                    Cystoscope (1)
        Angiography (2)                                     Cardiac Cath (3)
        Digital fluoroscopy (4)                                 Echocardiography (2)
        C-arm (2)                                               Cardiac angiography (1)
        Intraoral digital readiography (1)                  OT (4)
 NM (4)                                                           US (1)
      Gamma camera (1)                                            FAG (1)
      SPECT (2)                                                   Specular microscope (1)
      PET (1)                                                     Photo slit lamp (1)
                                             17

 Integration of EMR-PACS




                  PACS Management   EMR




                     Interface
PACS MODALITIES
                      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
                                                           Internal WEB1000
   VDSL, ADSL
                                                           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
                                                               Networking
                                               Stage 3        Nationwide DB

                       Expansion
                                            EMR for special section
                         Stage 2            Clinical research
                                            Data Warehouse



EMR Infrastructure       primary forms
                         Lab
           Stage 1
                         Scan support
                         Job flow without chart delivery
                                                            23

      EMR Design

Structure of EMR frame
   • Web-based UI with 2 monitors

                Patient information



              retrieval         input                 POE




   • Structured data input; flexible and adjustable

   • Common record frame; universal
                                                                                    24

                  Characteristics of EMR in BEST care
1. Structured data input in medical record
    Based on analysis of paper medical record in SNUH

                                                        adm. note             4
                                     73 primary
                                                        short term adm. note 33
                                         records        progression note      5
                                                        operation note        6
108 secondary
                                                        pre-anesthesia note   1
        records                                         anesthetist note      1
                                                        discharge note        17
                                                        outpatient note       6
                                                        test report           103
                            Test reports                consulting note for test    5
                                                        consulting note       6
                                                        consent form          7
                                                        medical certificate   3
                                                        doctor's opinion1
                                                        protocol              22
                                                        questionnaire         14
                                171 ancillary records
                                                        others                108
                                                                                    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
                                        SNOMED CT
      Diagnosis
                                        ICD-10
      Operative procedure
                                        ATC from WHO
      Drug
                                        ICNP
      Nursing terms
                           Domain      Number of term


           Chief             concept       6746
           complaint
                             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
            80                                              mapped

            70                                                6317
                 220,800              Normalization
            60 admissions
                                                               CCs
                             63,400
            50   in SNUH     chief    partially mapped       90.1
               for 7 years complaints                          %
            40                           Broad in SNUH
            30                 Broad in SNOMED
                                                              429
                                                             :user
            20
                                                            defined
                                 6.7%
            10          0.5%                  0.2%   2.5%     CCs
               0
                                          1
                                                                         29

             Characteristics of EMR in BESTcare
3. Clinical Decision Support Systems

             Contents                                        Installed
  Alert      drug overdose                                   2003.5-6
             drug interaction
             pregnancy and lactation-related drug alerting
             allergy
  Critique   antibiotics ordering system                     2003.8
             transfusion ordering system
             chemotherapy ordering system
  Reminder   user's scheduling for patients                  2003.8

  Help/      MICROMEDX                                       2003.9
  Link       drug information                                2003.5
             Other online medical site
                                                            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
                                             User
              USB Port
                                                Cheching Password




                                Data Input



                         Hospital DataBase                                  +
                                                    Applying
                                                    Authentication
                                                                     Data       + Authentication       Authenticated
                                                                                                       Data
                                                                                                  33

             Characteristics of EMR in BEST care
6. Mobile solution                                                             ?   No. of AP: 7

Wireless notebooks
Wireless PDA

                                                    AP?6           AP?7




                                                           AP?3                    AP?4
                                    AP?2
                                                   トイレ            トイレ
                               耳鼻咽喉科                (男)            (余(女, 与))
                               治療室        意思(医者)すっぱい
                            5燐(仁, 印)室    2燐(仁, 印)室
                                       2燐(仁, 印)室
                          5燐(仁, 印)室
                                     5燐(仁, 印)室
                        1燐(仁, 印)室
                      1燐(仁, 印)室    5燐(仁, 印)室                                              AP?5
                              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
                                                                                             34

             Characteristics of EMR in BEST care
7. Disaster Plan

                                                 User                           User




          Disaster Server                                    Working Server


                                 Switch Over



                                                                        OP8/Disk Mirroring
                       Archive Log             Archive Log

          Standby Database
                                                             Primary Database
                                                                                                          35

                   Estimated economic benefit of EMR
                                                   (COST BENEFIT/YEAR, UNIT: million won-MW)

                                                                                      Net
                             Effect                      Count(/800 beds)                      非(比)高
                                                                                     (MW)
                medical coder (8→4)           4 persons ×35MW                         140
  Medical
   record       Technician job                7 persons ×23MW×3.5/8hours               74
manage-ment
                Part time job                 4 persons ×9.3MW×3.5/8hours              16

 Aid nurse's    Ward AN job                   100 persons ×23MW×10%                   230
    cost        OPD AN job                    45 persons ×23MW×50%                    518

                Residency job                 260 persons ×25MW×3%                    195
Doctor's cost
                Intern job                    100 persons ×22MW×50%                  1,100

                Area for medical record       200 pyeong ×5MW                        1,000
                Paper cost for medical        New patient 30 thousand persons/year
   Others                                                                              24
                record                        ×800won
                Printing cost for medical
                                              60 MW/year                               60
                record
                                  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!

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:9
posted:8/13/2011
language:English
pages:41