Transcript Characteristics of EMR in BEST care

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
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.
3
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)
4
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
5
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
6
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)-
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
8
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
Digitalized Image
DICOM
EMR
Digitalized medical record
Structured Data Input
Clinical Decision Support
Standard Medical Terminology
OCS
Digitalized order Communication
Drug Interaction
Drug side effect
Drug Information
MIS
Account
Management
ADT
Ancillary
service
12
Structure of BESTcare
EMR and other HIS
MIS
EMR
EMR
PACS
OCS
PACS
MIS
OCS
13
Hardware System Structure
Internet
SNUnet
Client Part
Hotline to SNUH
Web&
Secutrity
...
GW Server
Router
IDS
L4 Switch
Si
DNS Server
FireWall
L4 Switch
L4 Switch
IDS
PACS Part
Mail Server
IDS
NMS
Web Server
Backbone
Acq. Server
Si
DB Server
Si
MIS Part
EMR Part
MIS
Dev. Server
EMR Server
Image Server
Starage
MIS/EMR
DB Server
Backup
Policy Server
Storage
EMR Dev.
Server
Backup
14
Components of MIS in BEST care
Account
Reservation
ADT
Management of medical service
Claim
Ancillary systems
test
patient
information
Outpatient
Inpatient
reimbursement
medication
Emergency room Nurse depart.
Billing
medical code
EDI
POE
information
Statistics
Statistics
OP room
ICU
other resources
Clinical Path
Radiology
Anatomic Path.
Blood trasf.
Rehabilitation
Supply
Special test
Pharmacy
Infection
Nutrition
Medical record
Health center
User's information
General Management
Personnel Manag.
Purchasing/stock
Administration Information
Financial affairs
15
Back bone of PACS
DLT jukebox
Storagetek L40
1.6TB
HIS Broker
Compaq ML370
Rapidia
CS5000
100Mbps Fast Ethernet
DS3000
MDCT data
storage server
Compaq ML370
300GB
TEST modules
Web1000 server
Compaq ML570
800GB
DB server
SUN V880
Cache
Acquisition server
Clarix FC4700
SUN V880
6TB
DLT jukebox
Backup server
Storagetek L700
SUN V880
13TB
Giga bit
Firewall
ExWeb server
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,
URO US) (31)

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
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

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)
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
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)
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US (1)
FAG (1)
Specular microscope (1)
Photo slit lamp (1)
17
Integration of EMR-PACS
PACS Management
PACS MODALITIES
EMR
Interface
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
VDSL, ADSL
Internal WEB1000
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
Stage 3
 Networking
Nationwide DB
Expansion
Stage 2
EMR Infrastructure
Stage 1




EMR for special section
Clinical research
Data Warehouse
primary forms
Lab
Scan support
Job flow without chart delivery
23
EMR Design
Structure of EMR frame
• Web-based UI with 2 monitors
Patient information
retrieval
input
• Structured data input; flexible and adjustable
• Common record frame; universal
POE
24
Characteristics of EMR in BEST care
1. Structured data input in medical record
Based on analysis of paper medical record in SNUH
73 primary
records
108 secondary
records
Test reports
171 ancillary 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
consulting note
6
consent form
7
medical certificate
3
doctor's opinion1
protocol
22
questionnaire
14
others
108
5
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
Diagnosis
Operative procedure
Drug
Nursing terms
Domain
Chief
complaint
SNOMED CT
ICD-10
ATC from WHO
ICNP
Number of term
concept
6746
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
mapped
80
70
220,800
Normalization
60 admissions
63,400
in SNUH
chief
partially mapped
50
for 7 years complaints
40
Broad in SNOMED
20
0
90.1
%
Broad in SNUH
30
10
6317
CCs
0.5%
6.7%
0.2%
1
2.5%
429
:user
defined
CCs
29
Characteristics of EMR in BESTcare
3. Clinical Decision Support Systems
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
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
USB Port
User
Cheching Password
Data Input
+
Hospital DataBase
Applying
Authentication
Data
+ Authentication
Authenticated
Data
33
Characteristics of EMR in BEST care
6. Mobile solution
Wireless noｔebooks
Wireless PDA
?
AP?7
AP?6
AP?4
AP?3
AP?2
No. of AP: 7
トイレ
耳鼻咽喉科
(男)
意思(医者)すっぱい
治療室
2燐(仁, 印)室
5燐(仁, 印)室
2燐(仁, 印)室
5燐(仁, 印)室
5燐(仁, 印)室
1燐(仁, 印)室
5燐(仁,
印)室
1燐(仁, 印)室
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
トイレ
(余(女, 与))
AP?5
34
Characteristics of EMR in BEST care
7. Disaster Plan
User
Disaster Server
User
Working Server
Switch Over
OP8/Disk Mirroring
Archive Log
Standby Database
Archive Log
Primary Database
35
Estimated economic benefit of EMR
(COST BENEFIT/YEAR, UNIT: million won-MW)
Effect
Medical
record
manage-ment
Aid nurse's
cost
Count(/800 beds)
Net
(MW)
medical coder (8→4)
4 persons ×35MW
Technician job
7 persons ×23MW×3.5/8hours
74
Part time job
4 persons ×9.3MW×3.5/8hours
16
Ward AN job
100 persons ×23MW×10%
230
OPD AN job
45 persons ×23MW×50%
518
Residency job
260 persons ×25MW×3%
195
Intern job
100 persons ×22MW×50%
1,100
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
非(比)高
140
Doctor's cost
Others
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!