Beginning in 1989, AMC implemented AMIS to become a requisition; slip-less, film-less and paperless hospital, and to efficiently manage hospital. AMIS includes an order communication system (OCS) such like as computerized physician order entry system (CPOE), a picture archiving communication system (PACS), an electronic medical record system (EMR), a data warehouse (DW) and an enterprise resource planning (ERP), and etc. (Table 1, Figure 1). Also a web-based healthcare service (e-AMIS, Web-PACS) is available to partner hospitals and clinics. AMC is affiliated with seven other Korean hospitals and our information-development team offers medical IT services to all colleagues. Most of AMC health IT services is in house built by our medical information-development team.

Both the computational power and the data capacity of our server have been gradually increased over the past 20 years. The main server and disk specifications are shown in Table 2.

AMC was increased almost three times in its size after the opening of the East building in 1994, the New building in 2008, and the number of patients has increased accordingly. To improve the patient care with large patient population, many specialized divisions of centers and clinics were established according to newest modalities and with specialized staffs. For these reasons, complexity and complication in medical service environment caused following issues.

Consolidating IT to healthcare, the new understanding has developed followed by whole new patient care procedures. IT dependency and complexity are increasing continuously in health care [3]. Thus, the provision of stabilized IT service and proactive support are accentuated as first priority. However, in real life it is difficult to operate and evolve IT departments in systematic manner. AMIS has been improved to solve these issues centered on patient safety, business efficiency and process integration.

The Institute for Healthcare Improvement has defined high-alert medications (HAMs) as those that are likely to cause significant harm to a patient, even in intended usage. The Joint Commission International has emphasize that HAM safety muse be improved. However, HAMs are not the only causes of adverse events [4-7]; other problems are also evident. A comprehensive strategy improving medication safety is nonetheless imperative.

In the interval since February 2008, implementation of the High Alert-Medication Recognition and Management System to Lower Errors and to Secure Safety (HARMLESS) project has effectively reduced the incidence of HAMs-related adverse events at AMC. HARMLESS solution lists were identified by error-type products and contributing factors analysis, and clinical process evaluation using activity diagrams relevant to HAMs. All core messages, adverse drug events, drug interactions, post-medication items to be monitored, similar drugs information, hospital clinical guidelines, and routine drug data, are entered into the OCS. A distinctive red round HAM icon is displayed before the HAM name appears on the OCS screen (Figure 2). The system emphasizes core messages, yet detailed information is also displayed, including information on prior adverse drug events (thus, reports from PI; Performance Improvement experts), hospital clinical guidelines including detailed dose protocols, and routine drug information (provided by pharmacists). Alert-trigger and maximum prescription doses are established using real hospital data.

Our integrated and severity-stratified alert system was developed to manage critical patients information effectively, and to alert medical staff to problems needing attention; we did not wish to disturb the flow of clinical decision-making. Three system input components have been important; Reporting, Censorship and Warning. Data input uses three types of information; Allergy, Infection and Others. The drug allergy input contains drug details, drug ingredients, and allergy symptoms. Infection data include information on antibiotic-resistance, and precautions taken to prevent infection from blood transfusions, air, contacts, absence of isolation, and droplets. Other information may include data on food, and metal allergies. A warning severity is indicated by color; the colors are red, yellow, green, and purple. Red indicates a major problem; yellow, moderate; green, low; and purple, an infection. Integrated alert information appears as a pop-up screen during operation of commonly used computer programs including EMR, OCS, and electronic nursing records (ENR). It is possible to reduce the number of alert messages featuring a combination of allergy data and infection medication. Thus, medical staff can stratify alert severity.

From the patient perspective, what was once a physicianpatient relationship is now more akin to a customer-company interaction. A patient expects his/her hospital to absorb everything relevant to a treatment contract and schedule, and medical history commencing at first contact (possibly by telephone) through to completion of care. A high-quality hospital seeks to deal with these issues and focuses on quality of patient care. An improvement in care quality is synonymous with enhanced patient satisfaction, which is thus paramount. A first-rate hospital information system must prioritize patient service [8]. In particular, long waiting times have a major negative impact on customer satisfaction. AMC has developed an Integrated Patient Monitoring System to deal with this problem. Four monitoring systems are operative; these allow integration of inpatient bed management, an outpatient wait scheduling system, an operation theatre management process system, and an integrated laboratory reservation monitoring system. Not all components are currently operative, but healthcare services will be more efficiently delivered in future (Figure 3).

Our Computerized Perioperative Diabetic Care Monitoring and Support System involves both promulgation of perioperative diabetic blood sugar control guidelines and implementation of a diabetes alert monitoring system. Computerized guidelines for diabetic blood sugar levels are applied to data from diabetics scheduled for operation. A simple text on blood sugar control is offered to all patients and appropriate prescriptions (computer-generated) are listed on a case basis.

Our diabetes alert monitoring system has two input formats. First, physicians may enter data from inpatients with diabetes using real-time clinical information (20 criteria are relevant). Briefly, the parameters may be categorized into three groups, exhibited by patient in whom blood sugar levels are unstable (thus with hyperglycemia or hypoglycemia), by patients for whom prescription of anti-diabetic agents (insulin, oral hypoglycemic agent) have not been effective, or by post-operative patients. The second mode of database entry is available to nurses in charge of monitored inpatients (thus, these healthcare professionals have preferred access). The Diabetes Alert Team reviews monitored inpatient lists and offers recommendations to attending doctors if their prescriptions seem inappropriate.

Our Clinical Indicator Management System gathers raw data from the AMIS environment and summarizes all relevant information compile indicative evidence. Four essential requirements are met. First, system burden is minimized. Second, data access is rapid. Third, changes to the existing system (with which most users are comfortable) are minimized. Finally, a great deal of diverse data must be handled in an (apparently) effortless manner. All useful information is immediately displayed and can be stored in a variety of user-friendly formats. Indicators for AMI, CABG, stroke, and several other conditions are flagged; these are but a few examples of power of the system (Figure 4).

In the interval since December 2008, our PROMISE (Patient Right Observance with Medical Information Security Enhancement Campaign) project has aimed to ensure the security of personal health information contained in AMC. PROMISE involved establishment of an Information Security Management System (ISMS), to ensure international privacy (with security certification) and to establish a privacy/security culture within our institution. An in-house privacy and security task force team developed AMC policy. Our reference text has 10 chapters (including 3 verses), and 67 articles. A Medical Information Security Enhancement Campaign is run annually. In August 2010, AMIS was certified as complying with ISO/IEC 27001:2005. "The ISMS at the ASAN Medical Center's medical information system is certified to comply with Standard ISO 27799".