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National Information System Plan for Health and WelfareNational Information System Plan for Health and Welfare by 2010 by 2010
Young Moon Chae, Ph.D.
Dean, Graduate School of Public Health
Yonsei University
2
Table of Contents
I. IT Environment
II. National Health Information Systems (NHIS) in Korea
III. National Standards
IV. Telemedicine
V. Hospital Information System
VI. District Health Information System
VII.Policy Implication for NHIS
Applications
Status of e-Health (%)
Specialty tertiary Hospitals
General Hospitals Hospitals Total
1999 2005 1999 2005 1999 2005 1999 2005
Outpatient CPOE 81.8 97.6 46.9 84.2 22.7 66.9 50.5 75.6
Inpatient CPOE 81.8 97.6 43.6 84.2 18.2 58.4 47.9 70.6
Pharmacy 83.3 100 78.1 88.2 42.9 53.4 68.1 69.1
Laboratory 83.3 97.6 50 86.7 23.8 54.1 52.4 68.5
Radiology 83.3 97.6 51.6 88.2 23.8 53.4 52.9 68.7
Specialized tests 83.3 97.6 46.9 82.2 15.0 43.1 48.4 60.9
ADT 100 100 96.9 98.7 96.0 95.4 97.6 96.8
Administration 91.7 100 93.8 63.1 87.5 62.6 91.0 73.0
Insurance claim 100 100 96.9 100 87.5 89.4 94.8 93.5
Referral 75.0 97.6 41.4 69.1 9.5 36.4 42.0 53.8
PACS 16.7 90.5 6.5 78.6 5.0 22.6 9.4 47.1
Inpatient EMR - 21.4 - 14.5 - 21.0 - 19.6
Outpatient EMR 16.7 19.1 0.0 14.8 9.5 23.4 8.7 20.7
Insurance claims by EDI 100 90.5 92.4 94.8
(Source: Chae et al. National survey on e-health status. Health Insurance Review Agency. 2005.12
Status of e-Health in Korean Hospitals (Comparison of 1999 and 2005) Status of e-Health in Korean Hospitals (Comparison of 1999 and 2005)
4
CategoriesHealth Center (N=74) Health Subcenter (N=136)
Computerized Response(%) Computerized Response(%)
Health promotion 19(52.8) 36(48.6) 16(45.7) 35(25.7)
Health education 22(59.5) 37(50.0) 13(40.6) 32(23.5)
Oral health 43(82.7) 52(70.3) 26(66.7) 39(28.7)
Nutrition 15(38.5) 39(52.7) 5(19.2) 26(19.1)
Infectious disease management 32(72.7) 44(59.5) 18(51.4) 35(25.7)
AIDS 22(55.0) 40(54.1) 2(9.1) 22(16.2)
TB Control 64(100.0) 64(86.5) 37(77.1) 48(35.3)
Maternal and Child health 59(96.7) 61(82.4) 67(95.7) 70(51.5)
Elderly health 16(42.1) 38(51.4) 26(60.5) 43(31.6)
Primary health care 63(98.4) 64(86.5) 97(99.0) 98(72.1)
Laboratory, Radiology 64(100.0) 64(86.5) 38(76.0) 50(36.8)
Telemedicine 5(15.6) 32(43.2) 2(9.5) 21(15.4)
Electronic Medical Record 16(42.1) 38(51.4) 13(43.3) 30(22.1)
PACS 1(3.3) 30(41.1) 0(0.0) 20(14.7)
Status of Computerization in Health centers and Health subcenters in 2005
5
Upbringing e-Health Industry
• Manage Health Structure
• Applying e-Health to Health Insurance
• Launch and Development e-Health Industry
• World Best e-Health Products
• Construction of
e-Health Net• u-Health Mobile
Service • U-Korea/u-city
To do for e-Health
Korea e-Health StrategyKorea e-Health Strategy
• Apply e-Health to
Military• Military
e-Health Devices
• Research
e-Health
technology• Launch e-Health
infrastructure
Ministry ofHealth
and Welfare
Ministry ofInformation andcommunication
Ministry ofNational Defense
Ministry ofScience & Technology
Ministry ofIndustry,
commerce andenergy
6
History and Plan for the e-Health in Korea
1980 1990 2000 2010
Medical insurance for teachers and government workers
Medical insurance for non-government workers
Nationwide Medical Insurance
Separation of ordering and dispensing
Programs for insurance claims
EMR for clinics
Insurance claims by EDI
Hospital CPOE*
e-prescription
EHR
EMR for hospitals
Legalization of EMR, e-prescription, and telemedicine
e-health environment
e-health business
* CPOES: Computerized physician order entry system
7
NHIS Activities in Korea
National Standards Phase 1 (‘04.12~’05. 5): Development of standards for the public health center and secondary
hospitals Phase 2 (‘05. 6~‘06. 5): Development of standards for the tertiary hospitals Phase 3 (‘06. 5~): Legalize standards and implementation of the pilot projects
Information systems for the Public Health Center Development of the Information Strategy Plan (~’05.7) Development of the information systems for the public health center (~’05.12) Implementation of pilot project (’06.1~ )
Electronic Health Record (EHR) Establishment of the Center for Intelligent Medical Support and Information Sharing Establishment of the Center for the EHR Establishment of the Center for Medical Knowledge and Ontology Establishment of the Center for Biomedical Information
Law and regulation for e-health Revision of the medical law (~’06.12)
8
Framework for the NHIS in Korea
Information infrastructure
Information services
StandardsPrivacy and
confidentialityArchitecture Network
Drivingforces Organization Finance
Informationspecialist Law
EHR e-prescriptionConsumer
health
ProfessionInformation
services
• Improve quality of services• Improve health status • Reduce medical expenses
9
Phased
approach
Phased
approach
(Building Infrastructure, ’04 – ’05 )
(Building Public information Systems, ’06 – ’08)
(Applying to Public Sector, ’08 – ’10)
Phase 1Phase 1
Phase 2Phase 2
Phase 3Phase 3
• Creating specialist working groups and committees
• Initiating R & D projects for IT and EHR
• Developing ISP
• Revising laws and regulations
• Applying and testing standards to public health information systems
• Building infrastructure for consumer health informatics
• Implementing demonstration project for telemedicine
• Disseminating standards and EHR to the private sector
• Building nationwide EHR
Strategy for building NHIS
10
Stepwise development of healthcare information standards
Stage I (Dec. 2004~May 2005) 10 subcommittees Vocabulary standards for health centers and acute hospitals with less than 300 beds Simple collection of concepts
Stage II (June 2005~May 2006) 10 + 3subcommittees (clinical documents, security & privacy, and vocabulary in radiology) Vocabulary standards for acute hospitals with more than 300 beds and university hospitals Integration of standards through mapping into UMLS
Stage III (June 2006~ ) Implementation of standards into health center information system, public hospitals and
cooperative private hospitals Validation, maintenance and dissemination of standards Building vocabulary structure (Ontology)
11
Legal Issues for Telemedicine in Korea
•Definition of Telemedicine and Telehealth
•Forms of Telemedicine
•Authorization to Practice Telemedicine
•Privacy and Confidentiality
•Quality of Care and Safety in Telemedicine
•Accountability and Responsibilities of the Physician
•Reimbursement
12
Scope of Telemedicine
Type I
(doctor – doctor)
- Medical services specified under the current medical law
(medical knowledge. Diagnosis, prescription, and consultation)
Type II
(doctor-nurse)
- Consulting physician: medical knowledge and consultation
- Referring health professionals: services specified under the current medical law
Type III
(doctor – patient)
- Routine visits with the chronic diseases
- Same disease as diagnosed at the first visit
- Limited to diagnosis and prescription (not surgery)
- Both doctor and patient have quality facility and equipment for tele-homecare
Type IV
(web doctor)
- Consultation on health promotion and health education
- Not allowed to provide prescription and diagnostic information
• Direct Benefit
Traditional benefit items (e.g. saving of personnel costs)
• Value Acceleration
Benefits from improved information flow (e.g. saving of travel costs)
• Value Restructuring
Benefits from restructuring of organization (e.g. increased no. of patients due to new services or new hospital policy)
• Value Linkage
Benefits from the combined effects (e.g. saving of medical costs due to early detection of disease)
Benefit (value) items of Telemedicine by information economics
Cost Items
• Treatment Costs
• Depreciation and Interests of Equipment and Facilities
• Operating Costs
Maintenance costs for equipment
Electricity costs
Communication costs
• Personnel Costs
(doctor, nurse, resident, technician)
Cost items of Telemedicine
Patient Health Center
Univ. Hosp. Net Benefit(B/C ratio)
Cost and Benefit
Cost
Direct Benefit
Value Linkage
(Unit : US$/month)
(B/C ratio = Benefit / Cost ratio)
56.5
9587.3
11452.4
14762.4
4723.9
7980.8
561.8 -19517.5 (0.14)
-9930.4 (0.56)
4748.3 (1.24)
Value Restructuring 19175 5322.5 1123.8 - 6857.0 (0.90)
* No of Patients were increased by two times due to reorganization
Value Acceleration
Economic Analysis of Telemedicine
1.3
0.80.6
1
1 1/3 1/2 2/3
B/C Ratio
0.0
1.0
2.0
(Decrease of the Costs for Equipment and Communication)
Sensitivity Analysis on Equipment and Communication Costs
17
Slipless Filmless
Chartless Paperless
Integration
Customer
Drug
Reservation
Treatment
Medical supporting
Others
CPOE
Clinical research
Reseource management
Purchasinginventory
Humanresources
Accounting Others
OA
EMR
Data entry Scanning
Digitalize Security
Total Integration
D/W & ERP
PACS
4-less Approach to u-Hospital
18
Card reader
LAN카드키보드
Mouse
Monitor
메모리
CPU
Hard disk
Identification EMR and e-prescription Bank card, traffic card, PKI (authentification)
Identification EMR and e-prescription Bank card, traffic card, PKI (authentification)
Use of Smart card at U-Hospital
Memor
y
LAN card Keyboa
rd
19
Patient
Supplier
Hospital
Pharmacy
Public MedicalOffices
• Efficient management• EMR, PACS, HMIS • ERP, CRM..• eIP, eMP..
• Internet reservation• Health Portal • Telemedicine
Physician orderentry EDI
Insurance claims EDI
• Drug B2B• ERP• CRM• SCM• Health Care Portal B2G
B2B
B2C
B2B
B2G• Efficient management• Medical DB • e-Government
G2C
B2C
•EMR : Electronic Medical Record * PACS : Picture Archiving & Communication System. • * HMIS : Hospital Management Information System
e-Health Model in the hospital setting
20
Policy Implication of EHR-based Health Promotion Programs
• Development of a nationwide EHR
• Reorganization of community-based health promotion programs using EHR at health centers
• Initiation of the worksite health promotion programs using EHR at worksites
• Initiation of the government actions (e.g. legal action, pilot projects, budgets, etc.) to allow exchange of EHR among health centers, worksites, and other health institutions
• Implementation of pilot projects for health promotion using a personal EHR card in order to experiment its technical feasibility and usefulness
21
Dissemination of Telemedicine
• Initiation of tele-homecare for chronic patients who need refill of previous prescription
• Initiation of the government pilot projects on tele-homecare for the elderly in order to determine whether it should be covered by the new health insurance for the elderly which is scheduled to be started in 2008
• Development of policies and guidelines for telemedicine with foreign countries
• Development of insurance fee schedule for telemedicine
• Development of a model for health delivery (or referral) system using telemedicine and implement a pilot project to test its feasibility