1. 1
National Health Information System in Korea
Young Moon Chae, Ph.D.
Graduate School of Public Health
Yonsei University, Korea
ymchae@yuhs.ac

2. Table of Contents
BackgroundBackgroundII
National Health Information SystemNational Health Information SystemIIII
Community Health Information SystemCommunity Health Information SystemIVIV
1. National plan for health information system
2. Standards and law
1. Problems of old community health information systems
2. New community health information systems
3. Telemedicine
1. IT environment
2. e-Health status in Korea
Future e-Health /u-Health ModelFuture e-Health /u-Health ModelVV
Hospital Information SystemHospital Information SystemIIIIII

3. 3
Community Health Information System
Ⅱ. National Health Information System
IV.
Future e-Health modelV.
Hospital Information SystemⅢ.
BackgroundI.

4. 4
Health Status in Korea
4
Health Indicators OECD Korea
Average Life Expectancy 78.6 78.5
Infant Mortality Rate 5.4 5.3
No. of Beds per 1,000 5.6 7.9
No. of MD per 1,000 3.0 1.6
No. of CT per 1 million 20.6 32.2
No. of Outpatient Visits 6.8 11.8
No. of Admissions 9.9 13.5
Alcohol Consumption per Person (l) 9.5 8.1
% of Smokers 24.3 25.3
% of Overweight 47.6 30.5
% of Medical Expenditure for Public
Sector
72.8 55.1

5. 5
International Comparison of Health Status
5.0 7.0 8.0 11.0 13.0 15.0
100
90
80
70
60
50
40
30
% of Medical Expenditure out of GDP
Healthcare Performance Score
(by the Conference Board of Canada, Feb. 2006)
Korea (5th
)
(5.6, 82)
Japan
Italy
France
Swiss
Germany
Canada
U.S.A.

6. 6
보건 의료 사업 방향 변화
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1970 1980 1992 2002 2017 2030 2050 2100
64세 이상
15~64세
0~14세
3.1% 3.8% 5,1% 7.9%
45.0%
37.6%
23.9%
13.6%
Over 64
15-64
0-14
Population Composition
Increasing elderly population
Decreasing children

7. 7
Healthcare Systems in Korea
U.K. Singapore France Germany Japan U.S.A Korea
91% 80% 75% 62% 36% 18% 11%
Percentage of Public Sector
Private sector dominance
• Share of private hospitals: >90% of all hospitals
• Clinics: all private
• Public health center: provision of public health services
and basic ambulatory services

8. 8
95
94
94
93
90
89
87
86
79
77
74
74
73
70
67
36
34
7
2
1
South Korea
Argentina
Australia
Belgium
Switzerland
United States
Canada
Spain
Japan
Sweden
Germany
Netherlands
France
Italy
nited Kingdom
Brazil
Mexico
India
China
Russia
Power in Broadband
Reach,1
Percentage of Total Households Reach,1
Millions of Total Households
93.5
37.3
28.2
17.3
16.9
16.9
15.4
14.8
14.4
10.8
10.4
8
7.3
7.3
5.2
4.4
3.9
3.2
3.1
0.3
United States
Japan
Germany
France
Brazil
United Kingdom
South Korea
Italy
India
Spain
Canada
Mexico
China
Australia
Netherlands
Argentina
Belgium
Switzerland
Sweden
Russia
319 million house-
holds within reach
of broadband
networks
1
Households within reach of broadband networks in top 20 economies (ranked by GDP) as
of 2002. Source: McKinsey Proprietary Broadband Research
Broadband in Korea

9. 9
Subscribers of High-speed Internet in Korea
731 1,634
3,103
10,860
19,040
24,380
26,270
28,610
0
5000
10000
15000
20000
25000
30000
' 96.12 ' 97.12 ' 98.12 ' 99.12 ' 00.12 ' 01.12 ' 02.12 ' 03.6
(1,000 people)
Internet Users of Korea –28,610,000
Number of High-Speed Internet Service Subscriber in Korea
11,427,998
[Source : MIC (Ministry of Information and Communication) 2004]

10. 10
0
500
1,000
1,500
2,000
2,500
3,000
3,500
4,000
4,500
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
Wired Phone Wireless Phone Broadband Internet
IT-strong Korea : Subscribers
No. 1 in the Digitalization Index in 2005

11. 11
Korean IT market has grown at about 25% annually since 2000
Growth of Korean Hospital IT market
2,500
4,095
0
1,000
2,000
3,000
4,000
5,000
6,000
2001 2002 2003 2004 year1000 million
Won
5,119
3,150
26%
30%
25%
• Separation of prescription from dispensing
drug (2000)
• MOHW “Information sharing between
hospitals”
• Legalization of EMR and telemedicine (2003.3)
G
E
• Increasing competition between hospitals
• Opening of hospital market to foreign
countries according to WTP agreement
• Web technology, ASP application in hospitals
• PACS/OCS/EMR, E-CRM, ERP, E-Procurement
T
• Increasing number of malpractice suite
• Increasing demand for quality care
• Increasing need for productivity improvementt
S
Environmental factors for Hospital IT market
Trends in Korean IT Market

12. Applications
Status of e-Health (%)
Specialty tertiary
Hospitals (n=41)
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)

13. 13
History and Plan for the e-Health in Korea
1980 1990 2000 2010
Medical insurance for teachers
and government workers
Nationwide
Medical
Insurance
Separation of
ordering and
dispensing
Programs for
insurance claims
Information
system for health
center
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
* CPOE: Computerized physician order entry system

14. 14
Current Status of e-health in Korea
• Information systems for hospitals (as of 2005.10)
- Insurance billing, admission and discharge: 100%
- Computerized Order Entry System for tertiary hospital: 100%
- Electronic medical record (EMR): 15%
• Information systems for clinics (as of 2005.1)
- EMR: over 70%
- Insurance billing: over 90%
• Insurance claims by EDI (Electronic data interchange) as of 2004.12
- Tertiary hospitals: 100%
- Secondary hospitals: 67.5%
- Clinics: 92.7%
- Pharmacies: 92.9%

15. 15
Community Health Information System
Ⅱ. National Health Information System
IV.
Future e-Health modelV.
Hospital Information SystemⅢ.
BackgroundI.

16. Framework for the NHIS in Korea
Information
infrastructure
Information
services
Standards
Privacy and
confidentiality
Architecture Network
Driving
forces
Organization Finance
Information
specialist
Law
EHR e-prescription
Consumer
health
Professional
Information
services
• Improve quality of services
• Improve health status
• Reduce medical expenses

17. 17
Electronic Health Record (EHR)
• Individual patient's medical record in digital format for lifetime
• Contains complete history for health maintenance
- Full listing of illness
- Laboratory tests and treatment ,etc
• Need interoperabilty

18. 18
NHIS Plan 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~ )
- Implementation of information system (‘08.7 ~)
• 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 (~’08.12)

19. 19
Health Information StandardsHealth Information Standards
Terminology for health
services
Terminology for health
services
Nursing terminologyNursing terminology
Terminology for health
statistics
Terminology for health
statistics
Medical terminologyMedical terminology
Terminology for drug and
traditional medicine
Terminology for drug and
traditional medicine
Terminology for diagnosis and
laboratory
Terminology for diagnosis and
laboratory
Health LawHealth Law
PrivacyPrivacy
National health information
center
National health information
center
Health information sharing
among health institutes
Health information sharing
among health institutes
Health Information Standards and Law

20. 20
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
• Insurance reimbursement

21. 21
Obstacles to National Health Information System
• Asymmetry of Cost and Benefit of EHR
-Cost is high
-Benefit goes to Insurers and patients
-Increased workload to physician
-Cost to hospital
-Difficult to obtain patient consent
• Absence of standard and consensus of interoperability
• Concern about security and privacy

22. 22
Overview of Hospital Information System
ERP
• Healthcare Portal
• Telemedicine
• CRM(Customer
Relationship Mgmt)
• e-Procurement
• e-Marketplace
Supply
Customer
Sister Hospital
Pharmacy
E-
Prescription
B2B
(Biz to Biz) B2C
(Biz to Customer)
ASP
Health Ministry
Academic Ass.
Health Insurance Co
Knowledge Management System
ERP
HIS
SEM
Data Warehouse
Group Ware
ERP
Administration, /Research
Bank
• HIS : Hospital Information System
• OCS : Order Communications System
• PACS : Picture Archiving and Communications System
• EMR : Electronic Medical Record
• ERP : Enterprise Resource Planning
• ASP : Application Service Provider
• EDI : Electronic Data Interchange
• EDMS : Electronic Document Management System
CDSS
OCS
EMR
PACD(s,d)
PoC
• PoC : Point of Care
• CDSS : Clinical decision Support System
• SEM : Strategic Enterprise Management
• DW : Data Warehouse
EDI
Customer
Integrated Medical Information System
u-Severance

23. 23
Community Health Information System
Ⅱ. National Health Information System
IV.
Future e-Health modelV.
Hospital Information SystemⅢ.
BackgroundI.

24. 24
u-Hospital
u-Hospital systems at Severance Hospital
ⓝ-Zone
Wireless
LAN

25. 25copy right; u-SMART, July, 2006
U-Severance Diagram
Integrated HIS
CDR
Mobile
PACS
EMR
ERP
DW
OA
Cardiovascular cine PACS
Youngdong PACS
Dental PACS(Infinit)
SEM
ABC
Severance PACS(GE)
DentalOCS
KM
PI
Integrated
Homepage
HP
EIP
CRM
2nd Project
GW
1st Project
SeveranceOCS
YongdongOCS
Sister
Hosp

26. 26
Data Warehouse
ERP (SAP R/3)
• FI
• CO
• MM
• HR
Provide BW – CEO
-Recognize status of business information
-Provide information for decision making
+
SEM
( Balance Score
Card)
SAP BWBW
HIS (OCS + EMR)
• PM
• PS
• Medicine
• Med. support
• administration
• Medical EMR
• Nursing EMR
• Integrat. MI EMR
Establish Datawarehouse and SEM
 EUC for end-user
-Use can access data warehouse to analyze
(reduce dependency to the IT)
BW: business warehouse, EUC: end user computing

27. 27copy right; u-SMART, July, 2006
U-Severance
Point of Care

28. 28
EHR – PACS image EHR – PACS image EHR – PACS image
PDA Monitor (240 X 320 pixel)
POC - EHR
Point-of-Care (Pocket PC)

29. 29
Benefits of Hospital Information Systems
• Reduced Medical Costs
• Improved Medical Care/service
• Increased Patient Access to personal health information
• Enables integration of fragmented health data of a patient
-Share data with new doctor
• Improved productivity of hospital workers
• Reduced operating costs
• Increased hospital revenues (due to reduced waiting time and length of stay)

30. 30
Community Health Information System
Ⅱ. National Health Information System
IV.
Future e-Health modelV.
Hospital Information SystemⅢ.
BackgroundI.

31. 31
Overview of Community Health Information System
Registration
CPOE
Lab.
Pharmacy
MCH
TB
Infectious
disease
Clinic
Health
Promotion
Mental
health
Residents
Provincial / city
government
Hospital
Mental
Hospital
VHS
Telemedicine
ARS
EDI
Expert System
Home
National registration
Network
Insurance Network
Telemedicine
Demographic
data
Physical exam
& utilization
data

32. 32
Health instituteHealth institute
Provincial
government
Provincial
government MOHWMOHW
Planning/ and Performance evaluation
Paper-based
reporting
Paper-baed
reporting
Residents
Health
statistics
Health AdministrationHealth Administration Medical ServiceMedical Service Health ServiceHealth Service
Percentage of information support 60%
Manual reporting takes more than a month to
evaluate program performance
73%43% 62%
Inadequate
information support
to health center
activity
Inadequately
account for
community
needs
Health Service Management under Old System
Difficult to develop regional health plan and to evaluate quality of service

33. 33
Health
Center
Health
Center
MOHWMOHWManual processing of
health statistics
Partial integration
ProvinceProvince
Duplication
Individual
insurance claim
No integration
Other
Health center
Other
Health center
Partial
integration
City
District
City
District
KCDCKCDC
NCI
NTBI
NCI
NTBI
Paper-based
sharing
Paper-based
sharing
Information Flow for the Old Health Center System
Inefficient information flow results in under-utilization of health information
HIRAHIRA
NCI: National Cancer Institute, HIRA: Health Insurance Review Agency
NTBI: National TB Institute. KCDC: Korea Center for Disease Control

34. 34
National Health Information
Center
NHIS
NMICNMIC
Physical exam
KCDC
Disease surveillance
HIRAHIRA
NCI
NTBI
TB surveillance
Cancer registration
City,
district
City,
district
National
registration
information
Insurance
claim
Integration with the related systems
Information Sharing by New Web-based ASP System
Improve information sharing by integration with the related systems
NMIC: National Medical Insurance Corporation

35. 35
Number of TB Patients by Detection Modes
Year
Detection Modes
Follow-up Total
Health
center
Physical
exam by
NMIC
Mobile
exam
Family
exam
HIV
exam
Sub-total
2001 500,421 1,895,057 539,792 23,639 81 2,958,990 72,296 3,031,286
2002 460,779 2,161,037 452,662 22,225 601 3,097,304 50,457 3,147,761
2003 435,491 2,264,063 440,034 19,779 337 3,159,704 43,037 3,202,741
2004 447,468 2,483,314 412,802 17,107 319 3,361,010 38,481 3,399,491
2005 384,012 2,466,281 484,492 16,292 255 3,351,332 33,171 3,384,503

36. 36
Central Reading
Center
Tele-radiology system for
TB control
Web PACS
Server
Image
Storage
PACS
PACS
Health center
PACS
PACS
PACS
Local
Storage
Local
Storage
PACS
Local
Storage
Local
Storage
Local
Storage
Regional hospital B
PACS
Local
Storage
Local
StoragePACS
Local
Storage
Local
Storage
Local
Storage
Regional hospital A
PACS
복십자PACS
Web_PACS
Client
Health center
PACS
PACS
PACS
PACS
Web PACS
Viewer
Internet
A city NationwideB city
Images Images
Patient
Other health center
Public TB doctor
Request for
reading
Internet
Reading results
Sending image
Internet Internet
Results
Web PACS for TB Control
TB
Specialty
hospital

37. 37
Infectious Disease
Surveillance System
Early warning
Decision
Support
Disease
Prediction
Prevention
of
epidemics
Infectious Disease Surveillance
and Reporting System
• Web Robot for
data collection
• Data push for
information
distribution
• News group for
announcement
• Website for
infectious disease
- Disease prevention
- Disease outbreak
- Disease
information
• Provision of survey
statistics
• Support early prevention of
epidemics
• Support prevention program
development for region

38. 38
Improve access to health center Improve vaccination services
Improve civil services Improve quality of follow-up care
Residents
Benefits to Community Residents
Residents can receive services from
any health center because their
electronic health records can be
accessed from any health center
TB patients and chronic disease patients
can receive continuous follow-up care
because their electronic health records can
be accessed from any health institutes
Residents can receive automatic
vaccination notice from health
center by SMS or e-mail
Various certificates including
vaccination and birth certificates
can be obtained by internet

39. 39
Improve home visiting services Improve quality of community health plan
Improve inventory management
Health worker
Benefits to Health Workers
Home visiting nurse can enter
patient information directly to EHR
by PDA or internet at patient’s
home and this reduces duplicate
data entry
Health manager can develop better
health plan by using information from
various health institutes including
National Medical Insurance Corporation
Health centers can share inventory
information and therefore they can share
vaccine or other medicine in case of their
shortage

40. 40
Reduce time for collecting
policy information
Improve effectiveness of
program evaluation
Improve information sharing
between NMIC and health institutes
Central government
officials
Benefits to Central Government Officials
Time for collecting policy information at
MOHW can be reduced because
information on health programs for
every public health institutes are stored
at the central data warehouse
Effectiveness of program evaluation of
public health institutes can be greatly
improved because various program
information can be easily accessed from
central data warehouse
NMIC used to receive paper-based claims data
for the physical exam from health institutes, but
this will be replaced by electronic form

41. 41
Community Health Information System
Ⅱ. National Health Information System
IV.
Future e-Health modelV.
Hospital Information SystemⅢ.
BackgroundI.

42. 42
Future e-Health Model for Public Sector
HealthHealth
centercenter
HealthHealth
subcentersubcenter
HealthHealth
postpost
MOHWMOHW
RegionalRegional
hospitalshospitals
NationalNational
MedicalMedical
CenterCenter
NationalNational
hospitalshospitals
Reduction in duplicate tests and
Waiting time by improving referring system
Reduction in health expenditure
by integrating medical services
with public health services for
discharge patients
ResidentsResidents
Development of lifetime healthcare system byDevelopment of lifetime healthcare system by
information sharing among public health institutesinformation sharing among public health institutes
Medical Services Public Health Services

43. 43
u-Health Components
Measured
Data
SensingSensing MonitoringMonitoring FeedbackFeedbackAnalyzingAnalyzing
Data
Tx
Long-term
Analysis
Results
Bioinformatics Feedback / Value-Added Service
Measuring
biological signals
Filtered &
Analyzed Data
Display
Long-term Data storage
Trend analysis
 Behavior modification
 Emergency Alert
 Feedback-Action
(Prescription, exercise, etc)
U-Health
Solution
Medical Devices

44. 44
Ubiquitous-Health SystemUbiquitous-Health System
u-Health
Service
Portal
Emergency
Medical System
Monitoring System
Home Server
Multimedia
Wellbeing
Chair
Home
Platform
Office
Platform
EMR sharing/Cooperation
Fitness
Center
Wellbeing
Toilet
Wellbeing
Bath
Wellbeing Bed
Well-being House
Wellbeing Cars Well-being
Mobile Applications
Wearable Portable
various
e-Health tools
Registration
Mobile
Platform
GPS
EMR Achieves
Medical Records
Sharing Dev.
Home
monitoring
Ships
Kiosk Terminal
Cell Phone
EMR Card
Kiosk Terminal