neuroandy@snubh.org EMR 2007.5.10.
Contents 1. EMR / (..) 2. EMR 3. 4. 5. EHR 2/ 92
Introduction 3/ 92
Introduction of SNUBH Opened in May 2003 Has 900 beds + 3500 outpatients/day 400 MD + 700nurses Performs over 50,000 radiological exams / month Over 1400 personal computers are connected to the HIS. 4/ 92
National EHR Project ( 5/ 92
EMR CDR( ) CP,FLOWSHEET 6/ 92
BESTCare Integrated HIS of SNUBH PACS EMR OCS MIS, Groupware Filmless Chartless Slipless Paperles s Digitalized Image DICOM Digitalized medical record Digitalized order Communication Structured Data Input Drug Interaction Clinical Decision Support Drug side effect Standard Medical Terminology Drug Information Account Management ADT Ancillary services 7/ 92
Introduction of SNUBH Full digitalized 8/ 92
1. EMR / (..) 9/ 92
1-1. EMR / 10 / 92
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EMR 13 / 92
EMR 14 / 92
1-2. / 15 / 92
EMR 16 / 92
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CDSS : Alerting 18 / 92
Flowsheet 19 / 92
Scan 20 / 92
CDW 21 / 92
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USE Smart Drive Smart card USB Smart Drive : 23 / 92
1-3... 24 / 92
-1 25 / 92
-2 26 / 92
-3 27 / 92
-4 28 / 92
2. EMR 29 / 92
? IT EMR EHR Financial interface Interface Financial, Some Clinical Financial, Some Clinical, Continuum of Care Financial, Clinical, Continuum of care Multifacility, Nation-wide Clinical, Continuum of Care System Integrity 30 / 92
? Healthcare Managed care 1980 1985 1990 1995 2000 CONVERGE EDI www Connectivity EMR Electronic Medical claim Financially Focused Clinically focused Information Technology 31 / 92
? 32 / 92
? - EMR DB 33 / 92
? ( ) Virginia Mason Medical Center : FULL EMR 1760 / Charge capture - faster submission - elimination manual data entry - reduction staff number - enhanced charge capture : 2% : 960 / Lab. and order entry - reduction order time - reduction in processing order - reduction in working staff : 110 / Pharmacy order entry - reduction in adverse reaction - reduction in useless drug ordering - reduction in staff : 310 / Documentation - reduction transcription cost : 100 / Availability of information at the point of care - - : 270 / 34 / 92
? Medical Error Estimated annual mortality( persons/year) Air travel deaths 300 AIDS 16,500 Breast cancer 43,000 Highway fatalities 43,500 Preventable medical errors 44,000 ~98,000 Costs of Preventable Medical Errors : $290 overall /year 1999 Institute of Medicine (IOM) Report 35 / 92
? / 1., 2. 3. 4. 5. Chart On-line 36 / 92
'04 : 4,154 (163, 3.9% ) '04 : 715 (146, 20.4% ) 37 / 92
( /,,, ),,, (),,,, (, ),,, /,,,,,, ( ), 38 / 92
,,,,, refer,, 1,,,,,, (,,, ) 48,,,,,,,,,,,,, /,,,,,,,,, aneurysm repair, CABG,,,,,, Incidental appendectomy, Bi-lateral cardiac catheterization,, Laparascopic cholecyctectomy 39 / 92
3. 40 / 92
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Alert : 42 / 92
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Alert System 44 / 92
Guideline 45 / 92
Guideline 46 / 92
3-2. Critical pathway 47 / 92
3-2. Critical pathway 48 / 92
3-3. (Clinical Data Warehouse) CDW 3 3.. 49 / 92
3-3. (Clinical Data Warehouse) 50 / 92
Clinical Data Repository 51 / 92
(Indicator),, (Clinical Indicator) If you can t measure it, You can t manage it. -Peter Drucker- 52 / 92
Service provider Consumer Service Quality 53 / 92
,,,,, refer,, 1,,,,,,,,, 48,,,,,,,,,,,,, /,,,,,,,,, aneurysm repair, CABG,,,,,, Incidental appendectomy, Bi-lateral cardiac catheterization,, Laparascopic cholecyctectomy 54 / 92
-,,,,,,,,,,,,,,,,,,,,, 55 / 92
CI TFT Pilot Study, 1 1 (05~06) (05~06) CI CI Boom Boom up up 2 CDR Patient safety & : Critical care Sentinel event (06~08) (06~08) CI CI : BSC CDR 3 (09~10) (09~10) CI CI Revision Revision CPG 56 / 92
data data Data Data ::,,,, :: data DB data DB Data Data ( ( server server )) :: :: data data data data chart chart review : review :,,, Prospective Prospective monitoring monitoring 57 / 92
1 (2005.4~2006.3) TFT 24 13 (41 parameter) CDR 3 (10parameter) CDR. 2(2006.4~2007.4) TFT 58 / 92
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Feedback 6-Sigma Quality ( / / ) / 62 / 92
4. 63 / 92
EHR 64 / 92
EHR 1 : EHR functionality 2 : CDA 3 : HL7 4 : EHR 5 : 65 / 92
2005 12 ~ 2007 10 signal, 66 / 92
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1(2006) : AS-IS, To-BE HL7 DSTU 2(2007) EHR (HL7 DSTU, CCHIT) & TO BE EHR 69 / 92
- 5 ezcare-emr CDA, WG WG : 2006. 8. ~ 2006. 12. :, 70 / 92
- CDA Clinical Document Architecture ANSI, XML Gateway Clinical Document Repository & Registry (CDR) CDA Gateway index 71 / 92
- - 72 / 92
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(Point of Care) : PDA, 74 / 92
2 2 5 5 5 5 5 5 1 1 2 1 2 2 APn6 APn7 5 2 2 5 5 5 5 1 1 APn1 5 2 2 1 2 APn2 APn3 7 APn4 APn5 75 / 92 ( ) ( ) n No. of AP: 7
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Vital Sign -Graph 77 / 92
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ECG,, feedback 1. 2. ZigBee 3. IP 4. / / 5. Medical reference U-Health Service Center zigbee Outdoor ( ) Indoor (IP ),,, view, 79 / 92
, RFID RFID Workflow (,,, ) RFID 80 / 92
: 2006.05.01~2008.03.31 : 18 (:7, :6, :5 ) RFID 1 2 RFID RFID 81 / 92
RFID 82 / 92
RFID 83 / 92
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5. EHR 86 / 92
EHR 2004.4.26 Bush...But one of the things that hasn't changed very much is the way doctors and hospitals do business. The 21st century health care system is using a 19th century paperwork system. Doctors use paper files to keep tracks of their patients. Pharmacists have to figure out the handwriting of a doctor. Vital medical information is scattered in many places.,......well, first you set a goal. Within ten years, every American must have a personal EMR. The federal government has got to take the lead in order to make this happens by developing what's called technical standards.... 1. 2004 EMR 2. -1 /, 2005 3. NHII Coordinator -David J Brailer, MD 4. Insentive 87 / 92
EHR (1) 1992 : NHS Executive s Strategy for Information Management and Technology 1997 : Infrastructure standard, connections... National Information Standards Procurement Information Management including record keeping and Network and applications data quality NHS-wide Clearing Confidentiality Protocols Service Record Headings/Structure NHS Strategic Tracing Clinical Terms Service Clinical Messaging National Electronic Library for Health NHS Number Application-level NHSnet Communications Networking 88 / 92
EHR (2) 1998 ~2005 Full implementation at primary care level of first generation person-based Electronic Health Records (1 EHR ) All acute hospitals with Level 3 EPRs The electronic transfer of patient records between GPs 24 hour emergency care access to patient records 2005 ( EMR) 89 / 92
( EHR, Electronic Health Record ),, : : :, 90 / 92
EHR(Electronic Health Record) Standardization EMR EHR Ubiquitous Integration Communication 91 / 92
EHR(Electronic Health Record) - - 92 / 92