Update on the National Health Information Exchange project

Byung Kwan Choi, M.D.

Pusan National University Hospital

Republic of Korea

Contents

History

Implementation

Statistics

Discussion

Conventional Way of referral

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History

History of Korean HIE

Pilot project2009

Local RepositoriesImage HIE Platform

2017

HIE Model Verification2009 ~ 2015

History

HIELegislation

HIE Standard Announcement

National-Scale HIE Platform

2016

Expanding Numbers of Hospitals and Repositories 2018 ~ 2019

History of Korean IHE

2009 2014 2016 2017

History

Repositories

Hub

Hospital

Participating

Hospitals

EMR

EMR

CDA Module

Implementation

CDA Module

LocalDocumentRepository

LocalDocumentRepository

LocalDocumentRepository

LocalDocumentRepository

Meta Data

Documents

Implementation

MPIOIDBPPC

IHE standards of Korea

Implementation

National IHE platform

Architecture Document DocumentSharing

Security

NMPI

CentralRegistry

Multiple Repository

HL7 CDA

XDS

XDS.b

XDS-I.b

IHE ATNA

IHE PIX

IHE PDQ

IHE CT

IHE DSG

Terminologies

Field Standard

Diagnosis KCD-7(≒ICD-10)

Medication ATC, KD

Operation ICD9-CM

Lab EDI, LOINC

Implementation

Documents

• Refer Request Form

• Care Record Summary

• Radiology Report

• Back-Referral Form

Implementation

Patient Identification

Unique Social Security Number

OIDs

Implementation

Radiologic Image Exchange System

• One image data repository

• Web-based Dicom Viewer

Implementation

Refer Request Form

Implementation

Care Record Summary

Implementation

Document Example

Implementation

Number of Participating Hospitals

50

100

200

1000

2000

4000

2009

49

2014

118

2016

201

2017

1322

2316

2018

3806

2019

Statistics

% of Participating Hospitals

Statistics

Total number of Hospitals= 37,042

Number of participating Hospitals= 3,806

=10.27%

South Korean population=51,470,000(2017)

EMR use> 95%

Regional HIE Hub Hospitals

2009

2014

2016

2017

2018

2019

Statistics

Number of HIE Consents ‘18~’19

Statistics

Jan Feb Mar Apr May Jun Jul Aug

2019 3,251 2,711 3,504 4,300 3,902 3,814 4,308 4,034

2018 1,465 1,188 1,390 3,642 3,884 3,574 3,611 3,416

-

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

9,000

Number of Patient Consent

Age Distribution

Statistics

-

2,000

4,000

6,000

8,000

10,000

12,000

14,000

0th 10th 20th 30th 40th 50th 60th 70th 80th 90th

Medical Image HIE

-

1,000

2,000

3,000

4,000

5,000

6,000

7,000

Seoul Busan Daegu Daejeon GyeongKi JeonNam JeonBuk

2019(Jan~Aug)

2018

Statistics

National HIE Documents

16 17 18

Number 3747 10476 41581

0

5000

10000

15000

20000

25000

30000

35000

40000

45000

Counts

Number of Exchanged Documents

Statistics

2016

2017

2018

PNUH Case

HIE Total Referral %

2017 190 4,994 3.80%

2018 772 8,212 9.40%

2019(~Aug) 760 6,224 12.21%

Statistics

Number of Refer Request to PNUH

PNUH Case

Statistics

Back-Referral Request from PNUH

HIE Total Return %

2017 340 3,014 11%

2018 876 4,098 21%

2019(~Aug)

1,241 3,330 37%

Benefits of HIE

• Patients’ Convenience

• Medical Cost reduction

– 11 % in OPD

– 20 % in IPD

Discussion

Pros and Cons (Interoperability & Governance)

• Too many EMR vendors

• One National HIE Standard

• Operating EMR > 95%

• Government manages coordinated collective action

Discussion

Pros and Cons(Financial)

• Financial Incentives

• Direct and Indirect cost of HIE

– Implementation an Maintenance

– Update and Upgrade

– Workforces to manage Standard

• Disincentives

Discussion

Pros and Cons(Motivation)

• Patients’ Convenience

• Government Side

– Assessment of hospitals

• Medical Professionals

– More work, data entry

• Hospital

– Longer and Complicated work process

Discussion

Hospitals are mostly Concerned about……

Budgets to buy IHE system(241)

Credibility of Maintenance(63)

• Ex) update, upgrade, budgets..

Interoperability(53)

Uncertain ROI(return on investment)

Maintaining Hospital IT staff

Cyber Security

Out of 580 poll answers (2015 survey)

Discussion

Hospitals mostly Want info about…..

Medication

Lab results

Diagnosis

Record by physician(progress note….)

Radiology Image, Report

Patient Info(age, sex, )

Out of 580 poll answers (2015 survey)

Discussion

Summary

Beginning stage

Obviously expanding, advancing

Motivation issue

Financial Incentives & Government Support warranted

Thank you!