사회책임경영보고서 - Yuhan · 2015-09-14 · 4 그림으로 보는 유한킴벌리 경영 유한킴벌리 205 사회책임경영보고서 5 사회적 영향 •사회책임경영
Hospital Information System in...
Transcript of 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:
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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 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
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)-
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• 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
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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
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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
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EMR
OCS
PACS
EMR and other HIS
MIS EMR
OCS
PACS MIS
Structure of BESTcare
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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
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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
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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
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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
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PACS MODALITIES
EMR
Client PC
Interface machine
PACS Management
Integration of EMR-PACS
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Single LOG-ON for PACS and EMR
Characteristics of PACS
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bestcare button
Interface between PACS and EMR
Characteristics of PACS
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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
Characteristics of PACS
EMR in BEST care
EMR development
EMR design
Characteristics of EMR
Estimated economic benefit of EMR
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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
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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
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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
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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
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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 field which is defined by users
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2. Medical terminology mapped to Standard Vocabulary Chief complaint Diagnosis Operative procedure Drug Nursing terms
Characteristics of EMR in BEST care
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
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2. Medical terminology mapped to Standard Vocabulary Mapping chief complaint to SNOMED CT
Characteristics of EMR in BEST care
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
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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
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OVERDOSE-tenormin 500mg/day DRUG INTERACTION- azathioprin+allopurinol
3. Clinical Decision Support Systems
Characteristics of EMR in BEST care
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4. Integration with other systems 1) Interface with test machines: HL7, DICOM, XML 2) 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 Card USB Port
User
Hospital DataBase
Cheching Password
Data Input
Applying Authentication
Hospital DataBase
Data + Authentication
+
Authenticated Data
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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
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
Characteristics of EMR in BEST care
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Primary Database Standby Database
Archive Log Archive 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-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
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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
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Long term vision
1. Shared EHR
* Standardization
Syntactic standardization
Semantic standardization
* Networking
? ubiquitous healthcare
2. Patient centered EHR
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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!