MEDICAL RECORD EMR Electronic medical record 1 EMR

의무기록(MEDICAL RECORD)

EMR Electronic medical record 1세대 EMR � EMR 중 IT 기술을 이용하여 자동화가 용이한 order 만을 system으로 개발 OCS (order communicating system) 2세대 EMR OCS + 종이 의무기록을 디지털화 한 기록 � Text based, not organized, not queryable � 3세대 EMR (EHR) � Queryable, Semantically interoperable, exchangable � Standardized

INTRODUCTION TO BESTCARE

FIRST PAGE OF BESTCARE Our Electronic Medical Record System is Web-based, and uses dual monitor display. Each frame of the window display different piece of information, including ….

“Form”: Structured Data Input Present illness Form for Nephrology We made over 1, 400 “Forms” associated with specific clinical situations. Users can make or modify these forms in a WYSIWYG manner.

User-defined “Template”: Frequently-used Contents Text template for any text field in EMR We also have a lot of text or image “Templates”, which are frequently-used contents in the Forms. These can be also modified by users. Image template for image input field

Terminology Mapped to Standard Vocabulary Medical terms were mapped to standard vocabulary, mainly to SNOMED-CT.

Single Sign-on This launches PACS viewer without entry of his ID and password, Logging in …

BLOOD LAB RESULTS In the same manner, he can see the blood lab results,

ECG Report And also ECG with a report

The y-axis represents clinical events including admission, clinic visiting, and various tests. These items can be modified for each user’s preference. Flow Sheet The x-axis represents the time sequence. To see a “Flow Sheet”.

CLINICAL DECISION SUPPORT SYSTEM

Drug Overdose & Drug Interaction Now, the physician wants to prescribe some Then the system alerts to the physician. medicines, but he overdosed or did not consider drug interaction by mistake. Overdose: tenormin 500 mg/day Drug Interaction: azathioprin + allopurinol

BILLING SYSTEM & PRESCRIPTION Finally, the patient goes to a kiosk and inserts his ID card. The machine asks the patient to insert his credit card to pay, and then prints the receipt and prescription.

EHR+PACS: HEALTHCARE OS EHR+PACS는 모든 의료, 건강관련 정보가 모이는 infrastructure EHR+PACS는 대부분의 healthcare industry의 기반

환경변화 EHR Healthcare Device EHR = Backbone Healthcare Medical Information Framework의 핵심 S/W임

MEDICAL INFORMATION PRODUCER AND CONSUMER

FUTURE EMR+PACS REQUIREMENT Can Use It Every. Where � Can run on and present to various platform web is a best candidate, HTML 5 + Javascript +Native. Client +Web. CL(open. CL, CUDA) Mobile, desktop, smart. TV…. Can communicate and exchange data freely – HL 7, dicom, , CCM Can query and retrieve everywhere - Distributed system

CURRENT INDUSTRY STRUCTURE Stds orgs + Professional bodies GOVs / Mo. Hs docs data dictionarie s VENDOR / INTEGRATOR Proprietary form definitions GUI code Msg specs XSD DOCs & Patients . . . use systems Present ’n APPS & SYSTEM S . . . manual Write docs, create message specs . . . Write data specs, minimum data sets, schemas for Discharge summary, referral etc . . . consume documents and msg specs developers. . . make up what they don’t understand PROVIDERS Buy (poor) Solutions

CURRENT INDUSTRY STRUCTURE Stds orgs + Professional bodies GOVs / Mo. Hs docs Chaotic, data dictionarie Expensive, s non-computable Msg VENDOR / INTEGRATOR Proprietary form definitions Ad hoc code XSD . . . manual . . . Write data specs, minimum data sets, schemas for DS, referral etc . . . use systems GUI Lock-in specs Write docs, create message specs DOCs & Patients Poor SYSTE interop. MS erability Expensive, . . . consume developers low reuse documents and. . . make up msg specs what they don’t understand Present ’n APPS & PROVIDERS Buy (poor) Solutions

OPENEHR APPROACH Stds orgs + Professional bodies GOVs / Mo. Hs terminolo gy template s archetype s VENDOR / INTEGRATOR Operation al template T O O L templat es DOCs & Patients GUI . . . use systems TD O Present ’n APPS & XSD SYSTE MS Platform TOOL build archetypes & terminology that define their Information – e. g. via IHTSDO TOOL . . . build templates and issue as standards e. g. Discharge Summary TOOL . . . consume std templates and create their own, making OPTs TOOLS developers build SOLUTIONS based on the platform PROVIDERS buy Solutions

OPENEHR APPROACH Stds orgs + Professional bodies GUARANTEED SEMANTICS GOVs / Mo. Hs VENDOR / INTEGRATOR terminolo gy Open, template s archetype reusable s Joining point Operation al template T O O L templat es DOCs & Patients GUI . . . use systems TD O Present ’n APPS & XSD Interop. SYSTE MS erable Easy Standard tools Development Platform TOOL build archetypes And terminology that define their Information – e. g. via IHTSDO TOOL . . . build templates and issue as standards e. g. Discharge Summary TOOL . . . consume std templates and create their own, making OPTs TOOLS developers build SOLUTIONS based on the platform Cheaper, faster PROVIDERS buy Solutions

CHALLENGES IN E-HEALTH TODAY Semantic interoperability: how do computers know what our data mean? Patient-centric view: how to build a patient-centric longitudinal EHR across enterprises? � For decision support, Care pathways, Medical research Continual change and complexity: how to build systems that keep up with reality?

…AND THE DISTRIBUTED ENVIRONMENT LSP NW&WM LSP NE LSP Eastern Spine LSP Southern LSP London • Record location • Record update • Cache • Authorisation

…AT VARIOUS LEVELS… LSP NW&WM LSP NE LSP Eastern LSP London Whittington Shared EHR Hospitals LSP Southern Royal Marsden Mental health Lawson Practice General practice

…AS WELL AS ACROSS FUNCTIONS…. Knowledge Discovery Care Pathways Decision Support

PATIENT-CENTRIC VIEW – WHAT HAPPENS ACTION start Patient GP ORDER celebrex ACTION dose ACTION freq ORDER ACE inhib Specialist Hospital ORDER Cor bypass ACTION resume ACTION schedule ADMIN ACTION admission suspend perform ADMIN discharge

PATIENT-CENTRIC VIEW – WHAT WE NEED ORDER Celebrex (GP) ACTION Start (patient) ACTION dose (GP) ORDER ACE inhib (GP) ORDER Cor bypass (specialist) ACTION Resume (GP) ACTION freq (GP) ACTION Schedule (specialist) ADMIN ACTION Admission Suspend Perform (hospital) ADMIN Discharge (hospital)

DISTRIBUTED VERSIONING EHR System A (cache) v 1 v 3 EHR Centre 2 v 1 EHR Centre 1 EHR System A (cache) v 1 v 3 v 2 EHR System C (cache) Logical EHR v 3 v 2

KEY INNOVATIONS “Two-level Modelling” – separation of models of information into 2 layers: � Hard-coded information model (domain-invariant) � Archetypes (domain-specific) � Software is only built from the first layer Scientific process model of basic information Distributed Semantics

PRINCIPLE The components of the Reference Model are like LEGO brick specifications Archetypes = instructions/designs constraining the use of LEGO pieces to create meaningful structures Information model Instances Archetype A Archetype B

ARCHETYPES AND TEMPLATES Diabetic checkup Tingling feet Feeling tired 76 kg 124/92 7. 5% Excellent control Archetypes FH Weight BP Antenatal visit Back pain 66 kg 102/64 mm. Hg Hb. A 1 c 142/min Issues NAD, see 4/52 Assess Template

ARCHETYPES ARE SEMANTIC SINGLE-SOURCE MODELS

Home Page OCS EMR PACS Template designer Template Parser EHR reference library(C/C++) Network Framework No. SQL DB