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I. Introduction
The modern society has exceeded the concept of 'information-oriented' so that it is called the society of ubiquitous computing, smart computing, and cloud computing. The information technology develops in a way of combining with relevant technology system, and especially, the medical industry business in ubiquitous circumstance drags many attentions about mobile medical information service area [1]. So, the health care field has shown various combinations between the health care and medical technology as it has been called as tele-medicine, tele-health, e-health, m-health, however, since 2000s, it has been unified as the u-health care, which was the combination of ubiquitous and health care. Recently, there are new types of u-health care services appear because of the popularity of smart phone and tablet PC.
Based on the cutting-edge technology, the recent trend of hospital is the establishment of new hospital system securing the 'patient-oriented' and 'patient-safety'. To keep pace with and actively lead the trend, Gachon University Gil hospital is making effort to fulfill u-healthcare system, which maximizes the convenience of medical staffs and parents, and improves the quality of medical service by connecting the ubiquitous solution that is one of the newest technologies to medical system. Gachon University Gil hospital conducts various researches combining medical and IT technologies, and the result is applied to the field. By these effort, Gachon University Gil hospital turning into the best hospital providing the best medical service to patients [2]. Hospital information department has been equipped with new mainframe, implementing main system from data general in 1985 and 1987. In March 1987, as Gil hospital order communication system (OCS) has been implemented to input prescription. In addition, medical image information system, remote service system, resource management system and electronic medical card system has been implemented in order.
This study introduces Gachon University's information system and system for work process improvement and personal health record (PHR) system, basis of self health management service system.
II. Case Description
1. Architecture of Gil Hospital Information System
The information system of Gachon University Gil hospital consists of OCS, electronic medical record (EMR) system, picture archiving and communication system (PACS), enterprise resource planning (ERP) system, data warehousing (DW) system and web system.
Hospital information system should collect, manage and use enormous quantity of data. Figure 1 is overall architecture of the information system for Gachon University Gil hospital. The information system of Gachon University Gil hospital is connected organically. So the data, which is created in the administration, is collected at the final destination, ERP and DW, and the group ware has been built to assist decision making.
Figure 2 is the hardware architecture of Gil hospital information system. The system of OCS and EMR consist of database application and file server. The database server is dualized by coupling Unix OS and Sybase database on the IBM AIX (HACMP), the application server and file server are based on Microsoft Windows which are dualized (Microsoft cluster service, MSCS).
The ERP system uses OracleR11i package, and the operation server consists of Unix OS and Oracle DB on the IBM AIX server so that the database and application are operated on the identical server.
The DW system consists of data storage enterprise application integration (EAI) tool, Business Objects OLAP tool, and Oracle database. The DW server consists of Unix OS on the IBM AIX and the Business Objects have been built for Windows.
PACS system consists of database, storage, and application and the dataset server has been built on the IBM AIX using Oracle. The storage consists of IBM NS6040 (NAS) and the application has been integrated on the BladeCenter in Windows circumstance.
Web system also uses Windows server. The Web Server mainly consists of internet information server (IIS) and database consists of Microsoft structured query language (MS-SQL), and both of them are integrated on the BladeCenter to save the space and cost.
The software for Gachon University Gil hospital information system has been built considering characteristics of each work. Like hardware system, the software system has been also divided in the OCS, EMR service, PACS service and Web service, and its construct has been shown for each of works.
The EMR system consists of three tiers. The database uses Sybase, the application consists of COM+ of .Net Framework and ADO.Net, and the user interface has been developed by Win Forms on the .Net Framework.
The OCS system consists of two tiers. The database uses Sybase, the Business logic mainly processes by stored procedure and the user interface has been developed using Visual Basic.
The ERP system consists of three tiers. The database is based on Oracle and Oracle application R11i package provides business logic process and user interface.
The PACS system consists of two tiers. The data based is based on Oracle and the user interface has been developed by C++ and uses the network access server (NAS) storage.
The Web system consists of three tiers. The system circumstance differs by characteristics of each work but database for most of systems is based on the MS-SQL. The Web server uses IIS and the user interface has been developed by the active server page (ASP).
The most important evaluation index for hospital information system management is system operation rate. The hospital has very special work condition that must be operated for 365 days in a year without a break, because of the special characteristic of its work. Because of this trend of system, OCS, EMR system, PACS, and network operation rate are important items for medical service evaluation at a hospital. Figure 3 shows software architecture of Gil hospital's information system.
2. Characteristics of Gachon University Gil Hospital's Hospital Information System
Gachon University Gil hospital integrated its data through digital hospital project. Digital hospital project was started in 2004 through 2005 in cooperation with MCC and Oracle. Objectives of digital hospital project was to establish ERP and DW that include financial accounting (FI), supply chain management (SCM), activity based management (ABM), balanced score card (BSC) and data integrations between systems were essential task.
Cash recipients system was needed to convert to accrual accounting in accountancy system for data integration. Data alteration management system was applied to OCS and EMR data to establish occurrence base system. Data alteration management system creates one record of data, two altered data and one delete data per occurrence date. Data alteration management reduces ERP and DW system load by stacking only end date data.
Data integration was done in five phases. Data alteration management and distributed financial processing settlement management of accounts were applied in the first step. Enterprise data warehousing (EDW), which previous data and new data created through data cleansing by data alteration management were established in the second phase. Data interface were established in the third stage by establishing data mart (DM) per subject category, ERP SCM and FI module for on data in EDW.
By establishing ERP, pre-management system were established by providing financial information timely, which enables efficient fund management by occurrence based daily profit management and fund forecast by planning income and expenditure.
III. Results
Gachon University Gil hospital established systems to improve diagnosis process for patients' safety and efficient work after data and system integration through digital hospital project. Representative systems for process improvements are medical service system for emergency patients, online diagnosis system to support prescriptions based on previous subscriptions, and the mobile round support system.
1. Emergency Medical Service System
The medical information system for emergency patients is integrated information system to manage patients in emergency and severity, who take medical service at Gachon University Gil hospital emergency medical center. Figure 4 shows the structure of medical service system for emergency patients. Medical service system for emergency patients have auto call service (ATCS), emergency event monitoring service (E2S) and emergency patient announce service (EPS) is additionally built to conduct core functions of emergency medical system.
ATCS system automatically calls doctors of each department to the emergency center after the initial medical service. The system constantly calls doctor to come and treat patients through short message service (SMS) and beeper, until called doctors arrive at the emergency center and check their arrival with own radio frequency identification (RFID) card. Using the ATCS, wasted time to find proper doctors at emergency center has been redirected to be used to treat patients for medical service.
E2S is an alarm system to notify problems through web display, when emergency patients have problems during medical examination. The E2S system is an online system to let doctors know when visited patients have medical problems. It shows examination results and patients list in real-time, when they are out of normal range.
The EPS shows visited patients list of emergency center, districts for each patient, progress of X-ray, computed tomography (CT), LAB test, areas of medical service, and examination result, on the programmed data processor (PDP) display. Also, since most of patients visit hospital with their guardians, notices for guardians and status of usable hospital beds at emergency room are displayed. As shown on Figure 5, Among arrived patients, patients who are in urgent for their vitality are allocated at area R (intensive care room), patients of serious cases are allocated at O (orange) and Y (yellow), children patients are allocated at G (green), patients of medical cases are allocated at B (blue), patients having external injury are allocated at T (external injury treatment room), patients of light case are allocated at F (triage room), and patients with contagious disease are allocated at I (isolation room). Figure 6 is the displayed result of EMS systems provides status of ages, classes, each districts, case kinds for each serious case, and emergency patients process, are displayed in a form of graph in real-time.
To inform status of patients, automatic examination alarm service has developed, so that doctors can recognize the problems. For guardians, service progress status is shared through automated system, and medical staffs became to have higher concentrations.
2. Online Review System
The online review system is an advanced prescription process system to support that a doctor does not make medical errors when they prescribe online. Items for online review system consist of simplicity item and variety item. Detailed information about each item is on Table 1.
The items for online review are divided in to simplicity items and variety items are as shown in Tables 2 and 3. The online review shows the prescription index information and the approval index of medical insurance for the error check, and it also allows looking for the information about the sick and wounded when error occurs for the information. When there is an item with errors during the online review, the prescription for the patient is not allowed to be inserted and the prescription or the title of sickness should be changed in accordance with the registered information of online review master. The online review checks inserted prescriptions on the display and the history to check errors.
By adopting online review system, factors that the Health Insurance Review & Assessment Service can cut the medical expense claim are prevented, so that the loss decreases. It also improves the quality of work through system automation and so that the rolls of members in charge of the review have been changed from the functional to analytic process. Also, online review was established to pre-manage prescriptions and minimize review and waiting time for discharge patients.
3. Round Support System
Medical staffs continuously move in the hospital for rounds, surgery room for the surgery, doctor's office for the outpatient clinic, and others for various reasons. They do not simply stay at a spot for a group of patients. Considering these medical circumstances, the round support service system has been developed so that doctors can provide medical service at Gachon University Gil hospital through WIFI or 3G networks, which could not be done without PC. Hospital information system and user interface should support much information on the display. Thus it was built on the Galaxy tab. Figure 7 shows system composition of round support system.
In the past, mobile devices could connect to the medical information through closed wireless network, so that security issues were not critical. However, current mobile devices supports open mobile network, such as 3G, security problems can occur. To solve this problem, the mobile certification process has been built and only registered mobile devices in certification server can access to medical information.
The round support system, which was developed to promote efficiency of medical service, built mainly based on functions, which can be used during rounds for patients. With round support system, doctors can handle processes, which should have done with personal notes and PC, with mobile devices. In the past, medical staffs sometimes waited to use PC, however, these cases are decreasing after adopting round support system.
The messaging functions of round support system can manage emergency inform or call and personal workflow, and it enables medical team to response to requests of medical service cooperation, more rapidly. Figure 8 shows the overall menu structures of round support system.
IV. Discussion
Establishing hospital information system is focused on providing the best service for patient and improvement of medical service. There are wide ranges of domestic and international researches to adapt economic and effective technology to hospital information system. The information flow connects between departments of hospital and different hospitals [3]. Because of the increase of needs in health management service, the circumstance of health and medical care service needs interactions between people and hospitals. To reflect these changes of health and medical care services and provide comprehensive medical service focused on the quality of life, the system, such as PHR to collect lifetime health record is required [4]. PHR can decrease medical accidents and overall cost of health management as well as improves cooperation between patients and doctors through communications for personal disease care and treatment [5]. PHR can also be utilized to evaluate the completion and precision of medical information relevant to the remedy and test trial for specified diseases [6]. Especially, doctors think that the system with PHR is effective to improve quality and satisfaction about medical services [7]. PHR becomes an important medical basis for personalized medical service to understand characteristics of a person and choose appropriate remedy or prescribe medicine [8].
Along with the current trend of health and medical service, Gachon University Gil hospital developed personalized medical service, u-CAREnote, which is based on PHR. Since January 2012, the service started to provide personal disease history, medical administration record, test record, record of treatment and surgical procedures, surgery record and information about anticancer and radiation treatments for patients having cancers. Also, personal memo system, which is a health diary for side-effect of anticancer drug and pain management, is supported for self-management of cancer patients. Figure 9 shows output displays to manage medical administration of u-CAREnote, test result, cancer pain management, and anticancer drug side-effect management.
For interactions to expand and propagate PHR and exchange the PHR information, Gachon University Gil hospital started a research to establish PHR standardization and platform connecting with Seoul University Hospital, Ajou University Hospital, Busan University Hospital, and Korean Associations of Regional Public Hospitals.
Finally, health management services such as the PHR based personalized diet and exercise services are developed, patients using u-CAREnote can have high quality health care service. Also, home nursing service to provide medical service at home and home monitoring service keep being developed to provide the best medical service for patients.
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