The ubiquitous-hospital project is very extensive and therefore carried out in several stages (Figure 1). The first stage consisted of completing the infrastructure by integrating and interconnecting the core systems of medical institutions, i.e., OCS, EMR, picture archiving and communication system (PACS), and enterprise resources planning (ERP). The second stage involved implementing electronic health records (EHR) with service enhancements, while the third stage involved expanding the knowledge base for research with a repository for clinical data and medical care information and extending it to the clinical decision support system (CDSS).

YUHS finished the third stage with the opening of a clinical data repository in 2008, which involved implementing EMR, as the basis of EHR, to manage individual health records from birth to death including health examination information complete with the clinical histories of family members. The scope of this work included applying user-defined XML templates, constructing .NET-based advanced architecture, and establishing a standard terminology system.

The EMR system of YUHS consists of HP integrity superdome servers embedded with Intel® Itanium® chips, using MS SQL for the database management system and MS Windows for the operating system. To maximize internal business efficiency and customer satisfaction, improvement of user convenience was given the highest priority. Despite initial concerns about safety when we switched to a Windows environment, the systems are now operating perfectly without any faults [1]. Prescriptions and patient records are integrated on one screen and data structuring is enabled through the use of standard forms.

The YUHS is a customer-oriented institution developed to manage the care cycle from admissions to discharge and afterwards. Patients save both cost and time by making reservations and checking examination results on the internet at home. These enhancements have enabled the hospital to reduce waiting times, greatly improving customer satisfaction. The u-Severance system also utilizes smart cards for services such as parking, guide kiosks, u-stations, certificate issuance, and viewing of visitor information. For example, when patients use their smart card to enter the hospital's carpark, their entry time is recorded, while their appointment is reflected on the OCS. Furthermore, when they scan their smart card at a u-severance guide kiosk, their card is verified, their registration number called-up, and the OCS accessed to bring up the patient's medical schedule. This significantly reduces waiting times for customers.

With the success of EMR, YUHS is also looking into making medical records available to patients and referral physicians online, to further enhance business efficiency and reduce costs. It is also exploring the possibilities of providing treatment statistics and index data online, as well as a clinical research system, and a more efficient collaboration and treatment delivery system. The benefits realized through the ubiquitous-hospital project have allowed YUHS to channel efforts toward reinforcing its status as a reliable and leading research institute and premier medical institution.

EMR can clearly distinguished procedures based on information regarding prescriptions and clinical record information. Various forms are necessary to input, save, and manage information without limitations. In the case of traditional information management, there is a shortcoming in that too many forms of similar types are produced. EMRs use Medical Record (MR) ITEM units for the management of information. For this project, all forms related to hospital staff activity were collected and re-sorted by classification (record sheet, result sheet, agreement, legal form). The management aspect and linearity of medical treatment records were accommodated through the generation of new forms based on MR ITEM. The MR ITEM concept was also applied to surgery nursing records, and anesthesia nursing records, as well as nursing informatics research forms. An additional merit to using MR ITEM is that the flow of record information is easily understood from the end user's point of view.

ENR is based on the Severance nursing process model and systematically organized as 3Ns (NANDA, NIC, NOC), providing a foundation for easy realization of the ENR system and allowing for efficient visualization of the activities of the clinical nurses. Systematic nursing procedures lead to high-quality record keeping. Through the systematization of inference algorithms it is easy to determine nursing diagnosis and interventions based upon information of hospital admission and discharge, test result, diagnosis, surgery, clinical observation information, etc.

EMR/ENR information is also useful for medical treatment statistics, indicator data, activity based cost analysis, etc. Access history of these systems, detailing who read what record when, should be saved for all medical records [2,3].

The OCS was flexibly designed to allow physicians to not only choose things from each examination group through a menu bar but also a user or user group can initiate 'User set' permitting examinations and drugs to be prescribed in a short period of time. Also, by entering 2 or 3 words of a product or chemical name or diagnosis, prescription order can be selected from a related pop-up list.

This system also functions for the convenience of patients and has improved the process of medical treatment. In the outpatient clinic, patients can check-in directly through installed card reader at department reception desks which alert patients when it is nearly their turn for medical treatment without making them wait in front of the doctor's office. The system is also capable of sending short messaging system (SMS) according to medical treatment department and doctor by text message. Although it is policy to pay in advance prior to treatment, this system allows patients who initiate a deferred payment agreement contract to pay after medical treatment through the post receipt patient service.

As part of the strategy to eliminate overcrowding in the emergency room (ER), emergency medical treatment follows a 2-4-12 rule policy, that is, a decision with regard to hospitalization, transfer, or discharge must be made within 2 to 4 hours after admission and all emergency medical treatment must be concluded within 8 hours of having a decision or within 12 hours of admission. The emergency process is especially unique in that if ER doctor initially diagnoses a person as an emergency patient, relevant doctors and nurses are notified by the system and all processes progress urgently permitting a quick decision. This decrease in time to treatment is particularly important in cases involving stroke, myocardial infarction, sepsis, or bleeding.

Hospitalization treatments are organized by critical pathway (CP) contributing to improvement in medical treatment quality and customer satisfaction by registering and applying CPs determined according to diagnosis [4,5]. The registration of a CP includes prescription by date, record, and nursing diagnosis. When there is a decision for hospitalization in the outpatient clinic, the system can guide the CP determined by the diagnosis and indicate the intended patient to whom the CP will be applied. When an intended patient is registered for hospitalization from the administrative office, a patient to whom a CP will be applied is automatically registered as a CP patient. Doctors can evaluate the CP by date and treat the patient at the same time. Records are integrated and managed and incomplete records can be monitored on one screen. A nurse can explain a planned medical treatment procedure to a patient in advance and carry out nursing care according to the schedule confirming the nursing diagnosis by date.

The Case Pack Delivery System (CPDS) used in the operating room arranges expendables for use in surgery in advance by diagnosing department or family doctor, processes claims, as well as manages returns, minimizing the quantity of expendable supplies in the operating room while standardizing claims and returns. With Drug Utilization Review (DUR) the system confirms administration and checks whether specific drugs are appropriate for the patient when prescribed. Modules include drug to drug interactions, checks for duplication of prescriptions, safety ranges of dosages, attention guidelines for pregnancy and breast-feeding, use in children, etc. CDR (Clinical Data Repository or Clinical Data warehouse) provides a variety of clinical information to doctors in order to support their clinical research.

Integration of patient IDs among affiliated hospitals permits the integrated management of the administration process. Insurance claim/evaluation was designed for a speedy process of insurance claims and ease of claims review. The open card system, automatic payment system, custom guide system, Interactive Voice Response (IVR), Kiosk, IVRFAX, etc., all work to advance medical services for customers.

YUHS introduced the ERP system with the goal of improving financial management by optimizing the flow of financial information among various. Accurate performance evaluation was not possible because there were no objective standards and evaluation of financial performance. In addition, analysis of calculating profits and losses were not made properly so it was difficult to understand the capabilities of equipment and decide whether their operation was necessary or not. Automation was not easy to fulfill and there were too many indirect costs due to hospital features. An accurate activity analysis and reliable computations were needed, as well as high-quality customer service, convenience, and access to medical information [6].

From June 2004, YUHS has been pursuing an integrated information system to actively take advantage of e-Business opportunities. As the first condition for ERP, master data (i.e., goods and drug codes, personnel information, equipment, unit, and account information, etc.) were defined considering simplification through standardization of code systems and integration between hospitals. The scope of ERP was systematically established considering integration for the administration and research management fields [7,8]. As aspects of typical administration management task proficiency; a human resource system, a financial accounting system synchronized with goods, medical equipment prevention check and management, and accounting system for compilation of budget cost-analysis profitability were established. For research management a knowledge management system was established through digital management of research products, research objects, and clinical data links. A systematic change management system was also established to minimize confusion caused by accepting new processes and task re-distribution.

It is very important that the integrated medical information system of a large hospital have stability and a back-up for infra-structure, databases, and applications to protect against disaster. To achieve this, there are 4 disaster recovery systems, as well as a tripling and quadrupling of data, and storage of EMR data to a separate XML file.