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

(ymchae@yumc.yonsei.ac.kr)

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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)

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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

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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

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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

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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)

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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

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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

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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)

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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

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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

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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

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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

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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

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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

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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