National Information System Plan for Health and Welfare by 2010

1. National Information System Plan for Health and Welfare by 2010 Young Moon Chae, Ph.D. Dean, Graduate School of Public Health Yonsei University (ymchae@yumc.yonsei.ac.kr)

2. Table of Contents • IT Environment • National Health Information Systems (NHIS) in Korea • National Standards • Telemedicine • Hospital Information System • District Health Information System • Policy Implication for NHIS

3. Status of e-Health in Korean Hospitals (Comparison of 1999 and 2005) (Source: Chae et al. National survey on e-health status. Health Insurance Review Agency. 2005.12

4. Status of Computerization in Health centers and Health subcenters in 2005

5. Korea e-Health Strategy To do for e-Health • 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 • Research e-Health technology • Launch e-Health infrastructure • Apply e-Health to Military • Military e-Health Devices Ministry of Health and Welfare Ministry of Industry, commerce and energy Ministry of Information and communication Ministry of National Defense Ministry of Science & Technology Upbringing e-Health Industry

6. History and Plan for the e-Health in Korea e-health environment Separation of ordering and dispensing Medical insurance for teachers and government workers Legalization of EMR, e-prescription, and telemedicine Medical insurance for non-government workers Nationwide Medical Insurance 1990 2000 2010 1980 Programs for insurance claims Hospital CPOE* EHR Insurance claims by EDI EMR for hospitals EMR for clinics e-prescription 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 • Improve quality of services • Improve health status • Reduce medical expenses EHR e-prescription Consumer health Profession Information services Information services Information infrastructure Standards Privacy and confidentiality Architecture Network Information specialist Law Organization Finance Driving forces

9. Strategy for building NHIS Phase 1 (Building Infrastructure, ’04 – ’05 ) • Creating specialist working groups and committees • Initiating R & D projects for IT and EHR • Developing ISP • Revising laws and regulations Phased approach Phase 2 (Building Public information Systems, ’06 – ’08) • Applying and testing standards to public health information systems • Building infrastructure for consumer health informatics • Implementing demonstration project for telemedicine (Applying to Public Sector, ’08 – ’10) Phase 3 • Disseminating standards and EHR to the private sector • Building nationwide EHR

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

13. Benefit (value) items of Telemedicine by information economics • 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)

14. Cost items of Telemedicine 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)

15. Economic Analysis of Telemedicine (Unit : US$/month) Cost and Benefit Net Benefit (B/C ratio) Health Center Univ. Hosp. Patient Cost 56.5 14762.4 7980.8 Direct Benefit 4723.9 561.8 -19517.5 (0.14) -9930.4 (0.56) Value Acceleration 9587.3 - 6857.0 (0.90) Value Restructuring 19175 5322.5 1123.8 Value Linkage 11452.4 4748.3 (1.24) (B/C ratio = Benefit / Cost ratio) * No of Patients were increased by two times due to reorganization

16. Sensitivity Analysis on Equipment and Communication Costs B/C Ratio 2.0 1.0 0.0 (Decrease of the Costs for Equipment and Communication)

17. CPOE Customer Reservation Drug Treatment Medical supporting Others 4-less Approach to u-Hospital PACS Total Integration Slipless Filmless D/W & ERP Integration EMR Clinical research Purchasing inventory Data entry Scanning Chartless Paperless Reseource management Human resources Digitalize Security Accounting Others OA

18. LAN카드 키보드 메모리 Mouse Hard disk Monitor CPU Use of Smart card at U-Hospital • Identification • EMR and e-prescription • Bank card, traffic card, PKI (authentification) LAN card Keyboard Card reader Memory

19. e-Health Model in the hospital setting • Efficient management • EMR, PACS, HMIS • ERP, CRM.. • eIP, eMP.. • Internet reservation • Health Portal • Telemedicine B2C Hospital Physician order entry EDI B2B Patient G2C B2C B2B Insurance claims EDI Pharmacy • Drug B2B • ERP • CRM • SCM • Health Care Portal B2G • Efficient management • Medical DB • e-Government B2G Public Medical Offices Supplier • EMR : Electronic Medical Record * PACS : Picture Archiving & Communication System. • * HMIS : Hospital Management Information System

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