PURPOSE: To estimate the impact of a health information exchange (HIE) pilot project on ophthalmology department care. METHODS: Study sites included 4 ophthalmic clinics in three regions participating in the HIE pilot project (group A), and 12 clinics with similar distances and numbers of patient referrals as group A but who were not participating in the HIE pilot project (group B). The mean wait time, total medical costs, and ophthalmic examinations of referral patients were analyzed. RESULTS: The mean wait times were 8.4 ± 8.0 days in group A, which included 83 patients, and 11.7 ± 15.4 days in group B, which included 417 patients. The wait time was significantly shorter in group A (p = 0.005). Sensitivity analyses also indicated shorter wait times in group A. In 247 patients in group B who were referred to tertiary referral hospitals automatically through the conventional clinical cooperation center with group A, the wait times were 8.4 ± 8.0 and 7.7 ± 8.8 days, respectively, and the total cost of medical care was 260.6 ± 271.4 and 257.0 ± 251.7 thousand Won, respectively. No differences in these factors were found between the groups (p = 0.503, 0.913, respectively). There were no significant differences in participation in the HIE pilot project regarding ophthalmic examinations conducted within 2 weeks since patient referral (p > 0.050 for all). CONCLUSIONS: The HIE is advantageous because it results in shorter wait times to see an ophthalmologist, due to the automatic referral method based on medical records. However, there are no benefits in reducing total costs of medical care or the number of clinical examinations.
Health Communication ; Health Information Exchange ; Humans ; Medical Records ; Methods ; Ophthalmology ; Pilot Projects ; Referral and Consultation ; Tertiary Care Centers ; Tertiary Healthcare

OBJECTIVES: A clinical data warehouse (CDW) is part of our hospital information system, and it provides user-friendly ‘data search and extraction’ interfaces for query composition. We carried out a risk factor analysis for the extended use of opioids after coronary artery bypass grafting (CABG), taking advantage of the CDW system. METHODS: From 2015 to 2017, clinical data from 461 patients who had undergone either isolated or concomitant CABG were extracted using the CDW; the extracted data included baseline patient characteristics, various examination results, and opioid prescription information. Supplementary data that could not be extracted with the CDW were collected via manual review of the electronic medical records. RESULTS: Data from a total of 447 patients were analyzed finally. The mean patient age was 66.8 ± 10.9 years, 332 patients (74%) were male, and 235 patients (53%) had diabetes. Among the 447 patients, 90 patients (20.1%) took some type of opioid at the 15th postoperative day. An oral rapid-acting agent was the most frequently used opioid (83%). In the risk factor analysis for extended opioid use, duration of operation was the only significant risk factor (odds ratio = 1.004; 95% confidence interval, 1.001–1.007; p = 0.008). CONCLUSIONS: Longer operation time was associated with the risk of extended opioid use after CABG. CDW was a helpful tool for extracting mass clinical data rapidly, but to maximize its utility, the data should be checked carefully as they are entered in the system so that post-processing can be minimized. Further refinement of the clinical data input and output interface is warranted.
Analgesics, Opioid ; Coronary Artery Bypass ; Coronary Vessels ; Database Management Systems ; Electronic Health Records ; Hospital Information Systems ; Humans ; Male ; Prescriptions ; Risk Factors

OBJECTIVES: The objective of this study was to investigate the clinical decision support (CDS) functions and digitalization of clinical documents of Electronic Medical Record (EMR) systems in Korea. This exploratory study was conducted focusing on current status of EMR systems. METHODS: This study used a nationwide survey on EMR systems conducted from July 25, 2018 to September 30, 2018 in Korea. The unit of analysis was hospitals. Respondents of the survey were mainly medical recorders or staff members in departments of health insurance claims or information technology. This study analyzed data acquired from 132 hospitals that participated in the survey. RESULTS: This study found that approximately 80% of clinical documents were digitalized in both general and small hospitals. The percentages of general and small hospitals with 100% paperless medical charts were 33.7% and 38.2%, respectively. The EMR systems of general hospitals are more likely to have CDS functions of warnings regarding drug dosage, reminders of clinical schedules, and clinical guidelines compared to those of small hospitals; this difference was statistically significant. For the lists of digitalized clinical documents, almost 93% of EMR systems in general hospitals have the inpatient progress note, operation records, and discharge summary notes digitalized. CONCLUSIONS: EMRs are becoming increasingly important. This study found that the functions and digital documentation of EMR systems still have a large gap, which should be improved and made more sophisticated. We hope that the results of this study will contribute to the development of more sophisticated EMR systems.
Appointments and Schedules ; Decision Support Systems, Clinical ; Electronic Health Records ; Health Information Exchange ; Hope ; Hospitals, General ; Humans ; Inpatients ; Insurance, Health ; Korea ; Medical Informatics ; Medical Records ; Medical Records Systems, Computerized ; Surveys and Questionnaires

OBJECTIVES: Home-based nursing care services have increased over the past decade. However, accountability and privacy issues as well as security concerns become more challenging during care provider visits. Because of the heterogeneous combination of mobile and stationary assistive medical care devices, conventional systems lack architectural consistency, which leads to inherent time delays and inaccuracies in sharing information. The goal of our study is to develop an architecture that meets the competing goals of accountability and privacy and enhances security in distributed home-based care systems. METHODS: We realized this by using a context-aware approach to manage access to remote data. Our architecture uses a public certification service for individuals, the Japanese Public Key Infrastructure and Health Informatics-PKI to identify and validate the attributes of medical personnel. Both PKI mechanisms are provided by using separate smart cards issued by the government. RESULTS: Context-awareness enables users to have appropriate data access in home-based nursing environments. Our architecture ensures that healthcare providers perform the needed home care services by accessing patient data online and recording transactions. CONCLUSIONS: The proposed method aims to enhance healthcare data access and secure information delivery to preserve user's privacy. We implemented a prototype system and confirmed its feasibility by experimental evaluation. Our research can contribute to reducing patient neglect and wrongful treatment, and thus reduce health insurance costs by ensuring correct insurance claims. Our study can provide a baseline towards building distinctive intelligent treatment options to clinicians and serve as a model for home-based nursing care.
Asian Continental Ancestry Group ; Certification ; Computer Security ; Delivery of Health Care ; Electronic Health Records ; Health Information Exchange ; Health Personnel ; Health Smart Cards ; Home Care Services ; Home Health Nursing ; Humans ; Information Dissemination ; Insurance ; Insurance, Health ; Methods ; Nursing ; Nursing Care ; Privacy ; Social Responsibility

BACKGROUND: Current international recommendations in generating and using evidence in Health Research Priority Setting (HRPS) include the use of systematic reviews, and systematic or scientific situational analysis. In the Philippines, the Philippine National Health Research System's (PNHRS) National Guidelines for Health Research Prioritization recommends the use of either a Combined Approach Matrix (CAM) or situational analysis in generating and using evidence for HRPS. At present, there is a lack of a gold standard in generating and utilizing evidence in HRPS.

OBJECTIVE: The primary objective of this paper is to document a practical yet alternative/innovative approach on how evidence was generated and utilized in the process of HRPS as observed in the development of the National Unified Health Research Agenda (NUHRA) in the Philippines. Specifically, it identifies the types of knowledge products produced and their role in the process of health research agenda setting; how evidence was used and managed in the course of NUHRA development; and, the lessons learned from the experience.

METHODS: This case study is descriptive of the experience of generating and utilizing evidence for HRPS in the Philippines. The study utilized primary and secondary data. Knowledge Management (KM) was used as a lens to describe the process of generating and managing information for the NUHRA. Document analysis was used in comparing and aligning data with the integrated KM framework.

RESULTS: Pre-selected data were captured and created; shared and disseminated; and subsequently acquired and applied voluntarily by stakeholders during the process of HRPS. Relevant data was presented into various information products designed with a specific stakeholder in mind. Technical papers were developed to cater to national level stakeholders and focused on broad, nationally-relevant issues. Regional situational analysis reports focused on regional and local data and were designed for regional stakeholders to use during the development of Regional Unified Health Research Agenda (RUHRA). Infographics were developed to present the findings of the technical papers creatively and concisely and the NUHRA methodology and were presented to both national and regional stakeholders. The RUHRAs and the NUHRA were the outputs of the health research prioritization activities and will be made available through local and national channels of the PNHRS.

RECOMMENDATIONS: Opportunities for formalization and institutionalization of knowledge management for generating and using evidence in HRPS may be explored to address health information fragmentation across the health research system.

OBJECTIVES: Information technology involves a risk of privacy violation in providing easy access to confidential information,such as personal information and medical information through the Internet. In this study, we investigated medical information security to gain a better understanding of trends in research related to medical information security. METHODS: We researched papers published on ‘의료정보’ and ‘medical information’ in various Korean journals during a 10-year period from 2005 to 2015. We also analyzed these journal papers for each fiscal year; these papers were categorized into the areas of literature research and empirical research, and were further subdivided according to themes and subjects. RESULTS: It was confirmed that 48 papers were submitted to 35 academic journals. There were 33 (68.8%) literature review articles, and analysis of secondary data was not carried out at all. In terms of empirical research, 8 (16.7%) surveys and 7 (14.6%) program developments were studied. As a result of analyzing these papers according to the research theme by research method, 17 (35.4%) papers on laws, systems, and policies were the most numerous. It was found that among the literature research papers on medical personnel were the most common, and among the empirical research papers, research on experts in information protection and medical personnel were the most common. CONCLUSIONS: We suggest that further research should be done in terms of social perception, human resource development, and technology development to improve risk management in medical information systems.
Computer Security ; Electronic Health Records ; Empirical Research ; Hospital Information Systems ; Humans ; Industrial Development ; Information Systems ; Internet ; Jurisprudence ; Korea ; Medical Informatics ; Methods ; Privacy ; Risk Management ; Social Perception

OBJECTIVES: We assessed the public acceptance of a health information exchange (HIE) and examined factors that influenced the acceptance and associations among constructs of the Technology Acceptance Model (TAM). METHODS: We collected data from a survey of 1,000 individuals in Korea, which was administered through a structured questionnaire. We assessed the validity and reliability of the survey instrument with exploratory factor analysis and Cronbach's alpha coefficients. We computed descriptive statistics to assess the acceptance and performed regression analyses with a structural equation model to estimate the magnitude and significance of influences among constructs of TAM. RESULTS: Eighty-seven percent of the respondents were willing to use the technology, and the average level of agreement with the need for the technology was 4.16 on a 5-point Likert scale. The perception of ease of use of the technology significantly influenced perceptions of usefulness and attitudes about the need for HIE. Perceptions of usefulness influenced attitude and behavioral intention to use HIE, and attitude influenced intention. Age showed a wide range of influences throughout the model, and experience with offline-based information exchange and health status also showed noteworthy influences. CONCLUSIONS: The public acceptance of HIE was high, and influences posited by TAM were mostly confirmed by the study results. The study findings indicated a need for an education and communication strategy tailored by population age, health status, and prior experience with offline-based exchange to gain public buy-in for a successful introduction of the technology.
Diffusion of Innovation ; Education ; Health Information Exchange* ; Intention ; Korea* ; Public Opinion ; Reproducibility of Results ; Surveys and Questionnaires

OBJECTIVES: The demand for hospice has been increasing among patients with cancer. This study examined the current hospice referral scenario for terminally ill cancer patients and created a data form to collect hospice information and a modified health information exchange (HIE) form for a more efficient referral system for terminally ill cancer patients. METHODS: Surveys were conducted asking detailed information such as medical instruments and patient admission policies of hospices, and interviews were held to examine the current referral flow and any additional requirements. A task force team was organized to analyze the results of the interviews and surveys. RESULTS: Six hospices completed the survey, and 3 physicians, 2 nurses, and 2 hospital staff from a tertiary hospital were interviewed. Seven categories were defined as essential for establishing hospice data. Ten categories and 40 data items were newly suggested for the existing HIE document form. An implementation guide for the Consolidated Clinical Document Architecture developed by Health Level 7 (HL7 CCDA) was also proposed. It is an international standard for interoperability that provides a framework for the exchange, integration, sharing, and retrieval of electronic health information. Based on these changes, a hospice referral scenario for terminally ill cancer patients was designed. CONCLUSIONS: Our findings show potential improvements that can be made to the current hospice referral system for terminally ill cancer patients. To make the referral system useful in practice, governmental efforts and investments are needed.
Advisory Committees ; Cancer Care Facilities ; Health Information Exchange* ; Health Level Seven ; Hospices* ; Humans ; Investments ; Methods ; Patient Admission ; Referral and Consultation* ; Terminally Ill* ; Tertiary Care Centers

OBJECTIVES: This paper describes an evaluation study on the effectiveness of developing an in-hospital medical device safety information reporting system for managing safety information, including adverse incident data related to medical devices, following the enactment of the Medical Device Act in Korea. METHODS: Medical device safety information reports were analyzed for 190 cases that took place prior to the application of a medical device safety information reporting system and during a period when the reporting system was used. Also, questionnaires were used to measure the effectiveness of the medical device safety information reporting system. The analysis was based on the questionnaire responses of 15 reporters who submitted reports in both the pre- and post-reporting system periods. RESULTS: Sixty-two reports were submitted in paper form, but after the system was set up, this number more than doubled to 128 reports in electronic form. In terms of itemized reporting, a total of 45 items were reported. Before the system was used, 23 items had been reported, but this increased to 32 items after the system was put to use. All survey variables of satisfaction received a mean of over 3 points, while positive attitude, potential benefits, and positive benefits all exceeded 4 points, each receiving 4.20, 4.20, and 4.13, respectively. Among the variables, time-consuming and decision-making had the lowest mean values, each receiving 3.53. Satisfaction was found to be high for system quality and user satisfaction, but relatively low for time-consuming and decision-making. CONCLUSIONS: We were able to verify that effective reporting and monitoring of adverse incidents and the safety of medical devices can be implemented through the establishment of an in-hospital medical device safety information reporting system that can enhance patient safety and medical device risk management.
Electronic Health Records* ; Equipment Safety* ; Hospital Information Systems ; Korea ; Patient Safety ; Risk Management ; Safety Management

OBJECTIVES: This study aimed to identify problems and issues that arise with the implementation of online health information exchange (HIE) systems in a medical environment and to identify solutions to facilitate the successful operation of future HIE systems in primary care clinics and hospitals. METHODS: In this study, the issues that arose during the establishment and operation of an HIE system in a hospital were identified so that they could be addressed to enable the successful establishment and operation of a standard-based HIE system. After the issues were identified, they were reviewed and categorized by a group of experts that included medical information system experts, doctors, medical information standard experts, and HIE researchers. Then, solutions for the identified problems were derived based on the system development, operation, and improvement carried out during this work. RESULTS: Twenty-one issues were identified during the implementation and operation of an online HIE system. These issues were then divided into four categories: system architecture and standards, documents and data items, consent of HIE, and usability. We offer technical and policy recommendations for various stakeholders based on the experiences of operating and improving the online HIE system in the medical field. CONCLUSIONS: The issues and solutions identified in this study regarding the implementation and operate of an online HIE system can provide valuable insight for planners to enable them to successfully design and operate such systems at a national level in the future. In addition, policy support from governments is needed.
Electronic Health Records ; Health Information Exchange* ; Health Information Management ; Health Level Seven ; Information Systems ; Primary Health Care