Analysis of Information Security Management Systems at 5 Domestic Hospitals with More than 500 Beds / 대한의료정보학회지

OBJECTIVES: The information security management systems (ISMS) of 5 hospitals with more than 500 beds were evaluated with regards to the level of information security, management, and physical and technical aspects so that we might make recommendations on information security and security countermeasures which meet both international standards and the needs of individual hospitals. METHODS: The ISMS check-list derived from international/domestic standards was distributed to each hospital to complete and the staff of each hospital was interviewed. Information Security Indicator and Information Security Values were used to estimate the present security levels and evaluate the application of each hospital's current system. RESULTS: With regard to the moderate clause of the ISMS, the hospitals were determined to be in compliance. The most vulnerable clause was asset management, in particular, information asset classification guidelines. The clauses of information security incident management and business continuity management were deemed necessary for the establishment of successful ISMS. CONCLUSIONS: The level of current ISMS in the hospitals evaluated was determined to be insufficient. Establishment of adequate ISMS is necessary to ensure patient privacy and the safe use of medical records for various purposes. Implementation of ISMS which meet international standards with a long-term and comprehensive perspective is of prime importance. To reflect the requirements of the varied interests of medical staff, consumers, and institutions, the establishment of political support is essential to create suitable hospital ISMS.

Evaluation of Unpreparedness When Issuing Copies of Medical Records in Tertiary Referral Hospitals / 대한의료정보학회지

OBJECTIVES: As a baseline study to aid in the development of proper policy, we investigated the current condition of unpreparedness of documents required when issuing copies of medical records and related factors. METHODS: The study was comprised of 7,203 cases in which copies of medical records were issued from July 1st, 2007 through June 30th, 2008 to 5 tertiary referral hospitals. Data from these hospitals was collected using their established electronic databases and included study variables such as unpreparedness of the required documents as a dependent variable and putative covariates. RESULTS: The rate of unpreparedness of required documents was 14.9%. Multiple logistic regression analysis revealed the following factors as being related to the high rate of unpreparedness: patient age (older patients had a higher rate), issuance channels (on admission > via out-patient clinic), type of applicant (others such as family members > for oneself > insurers), type of original medical record (utilization records on admission > other records), issuance purpose (for providing insurer > medical use), residential area of applicant (Seoul > Honam province and Jeju), and number of copied documents (more documents gave a lower rate). The rate of unpreparedness differed significantly among the hospitals; suggesting that they may have followed their own conventional protocols rather than legal procedures in some cases. CONCLUSIONS: The study results showed that the level of compliance to the required legal procedure was high, but that problems occurred in assuring the safety of the medical information. A proper legislative approach is therefore required to balance the security of and access to medical information.

An Awareness Survey on the Protection and Use of Personal Health Information Focused on Applicants for Copies of the Medical Record / 대한의료정보학회지

OBJECTIVE: To supplement a previous study on the management of medical records with a view to preparing a system capable of ensuring basic patient rights regarding the protection of confidential medical information. The study objectives are to provide detailed guidelines to regulate the access and protection of medical information by analyzing patients' understanding and views regarding the dissemination of medical records. METHODS: A self-administered questionnaire was administered to 781 patients who visited five University hospitals located in Seoul, Busan, Gyeonggi, Chungnam and Jeonnam from July to September, 2008 and asked for copies of medical records to be issued. Data were analyzed by using the statistical program SPSS 13.0. RESULTS: More than 70% of respondents wanted to access their medical records after confirming the required documents. The highest distribution in the range of persons able to receive copies of medical records without the individual patient's consent or required documents was 'only personally' in each variable. Copies of medical records were issued mostly within 1 hour, while the appropriate time of issuing the copies was within one day. Half of respondents approved of a subscription system that did not require a doctor consultation. The results regarding changes in the ways to request/issue copies of medical records to improve the convenience for applicants differed significantly according to age. CONCLUSION: Considering the sensitivity of personal health information, medical records should only be issued with the patient's consent and by confirming the identity of the designated person with required documents. Furthermore, people should be aware of the importance of protecting personal health information, and medical institutes should inform the requirements for bringing the relevant documents. Medical institutes play an important role in protecting personal records, which necessitates generalized guidelines.

National Cancer Incidence for the Year 2002 in Korea / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Since the revised Cancer Act of October 2006, cancer registration was reactivated, based on the Statistics Law. MATERIALS AND METHODS: The incidence of cancer during 2002 was calculated on the basis of the information available from the National Cancer Incidence Database. Crude and age-standardized rates were calculated by gender for 18 age groups (0~4, 5~9, 10~14, every five years, 85 years and over). RESULTS: The overall crude incidence rates (CRs) were 269.2 and 212.8 per 100,000 for males and females, and the overall age-standardized incidence rates (ASRs) were 287.8 and 172.9 per 100,000, respectively. Among males, the five leading primary cancer sites were stomach (CR 62.4, ASR 65.7), lung (CR 45.4, ASR 51.0), liver (CR 43.2, ASR 43.7), colon and rectum (CR 30.7, ASR 32.7), and prostate (CR 8.0, ASR 9.6). Among females, the most common cancer sites were breast (CR 33.1, ASR 26.9), followed by stomach (CR 32.8, ASR 26.0), colon and rectum (CR 23.1, ASR 18.5), thyroid (CR 19.1, ASR 15.7), and uterine cervix (CR 18.2, ASR 14.7). In the 0~14 age group, leukemia was the most common cancer for both genders. For males, stomach cancer was the most common cancer in the 15~64 age-group, but lung cancer was more frequent in men 65 or older. For females, thyroid cancer among the 15~34 age-group, breast cancer among 35~64 age-group and stomach cancer in women 65 years or older were the most common forms of cancer for each age group. The quality indices for the percentage of deaths, by death certificate only, were 4.7% for males and 4.5% for females. CONCLUSIONS: Since the National Cancer Incidence Database was started, the annual percent change of cancer cases increased by 4.8% (4.1% for males, 5.7% for females) during 1999~2002. This value reflects the increase in prostate cancer for males and breast and thyroid cancer in females during 2002. The timely reporting of improved quality of cancer registration is needed for evidence-based decisions regarding cancer control in Korea.

Analysis of Surgical Blood Use and Determination of Maximum Surgical Blood Order Schedule at Dankook University Hospital / 대한수혈학회지

BACKGROUND: The aim of our study is to determine maximum surgical blood order schedule (MSBOS) in elective surgery through analyzing usage of blood products such as packed red cells and whole blood at Dankook University Hospital. We would like to establish the guidelines for effective utilization of blood products by introducing MSBOS to our hospital. METHODS: We calculated average amount of transfused blood for each elective surgery based on the discharge records of patients from January 1997 to December 1998 at Dankook University Hospital. Only those operations performed more than 5 times were included in this study. Average number of transfused units per patient of each operation was selected for MSBOS. RESULTS: For two years, the total number of surgery was 15,497 and the number of transfused operations was 1,682 (10.85%). Operation groups transfused below 10% was 77.3% of all 199 operation groups. The number of operation groups whose average of transfused blood was below 0.5 units was 80.3%. Type and screen (T&S) was recommended in 140 (70.4%) of all the operation groups. Of total groups MSBOS of 2 units was estimated in 4 groups (2.0%), of 3 in 14 groups (7.0%), 4 of 4 groups (2.0%), 5 of 2 groups (1.0%), 6 of 4 groups (2.0%), 7 of 7 groups (3.5%), and 8 in 2 groups (1.0%), respectively. CONCLUSION: We established MSBOS through the previous transfusion data of surgical operations over two years. To enforce MSBOS is needed for better medical services, which would decrease blood disuse and medical cost.

Improvement of Underlying Cause of Death Determination Using Health Related Data Bases from Death Certificates in Which Causes of Death Recorded as Cardiopulmonary Arrest, Nonspecific Symptom, Senility / 대한의료정보학회지

We performed this study to show that it is possible to identify underlying causes of de ath not identif ied by issued death certificates by mapping and adding information from National Database(DB) such as health insurance DB or KUHDDS(Korea Uniform Hospital Discharge Data Sets) with death certificates. We collected 2,986 death certificates issued at Cheonan, Asan provinces and 458 death certificates issued at 3 general hospitals at Chenoan city. Mapping of death certificate data with health insurance DB was possible in 77.4%(Cheonan, Asan provinces) and 87.3%(3 general hospitals at Cheonan city) of cases. Rate of underlying causes of death identified from records on death certificates before mapping was 64.4% and 68.3% each. After mapping and adding information from health insurance DB, the rate increased to 79.8% and 79.2% each. This work was done by skilled medical record officers. We also selected death certificates which recorded the causes of deaths as old age, cardiopulmonary arrest, or nonspecific symptoms. The possibility was shown that old age, ca rdiopulmonary a rrest, and nonspecific symptoms can be corrected by information from mapped health insurance DB and KUHDDS. With these results, we discussed some cause of incorrect recording practices. And we suggested simple but practical method to improve the correctness of death certificates; there is a possibility that comparing death certificates with KUHDDS before it is issued, where available, can improve the quality of death certificate.

Study on Establishment of Disease Database and Query System Through Internet Using Uniform Hospital Discharge Data Sets / 대한의료정보학회지

It is necessary to have accurate statistical data of disease for planning and evaluating public health policy as well as assessing population health index. The national health insurance data is the only data to assess incidence of diseases nation-wide. However, inaccuracy of the data pose serious limitations of use of the data. The Medical Record Departments of individual health facilities have used discharge summary information for hospital management and clinical research, but a nation-wide integrated database of diseases has not been setup and utilized. We applied previously developed Korean Uniform Hospital Discharge Data Sets to collect discha rge summary data from health care facilities and establish integrated database. We also made the question and answer column about disease of the database in the internet. We collected patient discharge data from a tertiary-care hospital for one year using the electronic discharge summary data collection system, except for health care costs. The internet querying system provided optional selection of columns or rows, individual and/or disease groups and surgical procedures. To make query easy, the system provided various functions like querying codes of diseases and/or surgical operations, reviewing questions, downloading results via excel files, help functions of query. The establishment of disease database and the interactive system through internet is in its inception, further studies may be necessary to make it a user friendly and accurate system. There is a need of an accurate assessment of current population-based health status and future trends in Korea. It is hoped that this study may trigger to establish national accurate database for enhancing studies of health policy making, clinical research and vital health statistics by expanding data collections to the se condary- care and primary- care institutions.

The Fact-finding Survey for medical Information Security Management / 대한의료정보학회지

The possibility of a large quantity of information outflow has been growing since patients' private and medical information is being transmitted to inside and outside of the hospital because of the country's medical record computerization system. Accordingly, it has been threatening patient's privacy and the duty of confidentiality of medical people, and the introduction of security policy is needed which is required for patient information protection. We evaluated medical treatment facilities of diagnostic information security management by conducting questionnaire survey of medical documentation office about their standard of medical information security management, range of medical information access sanction to inside users, outside users' request for information and it's purpose. In the data of medical information user identification and authentication, about the grant of the ID and Password to official in charge, "All have it" has the most high percentaged as 60.0%, "Officer who's most needful have it" is the second as 15.7%, "one's post share it" is the third as 12.9%, but treatment facilities all show similar distribution. About the request for information by patients, All medical institution opened the information on occasion that patients themselves visited the institute and asked information, but in case of telephone inquiry, the only score 0.08 of the institutes accepted. This research, I hope, could be utilized for basic materials for medical recorder who control medical information to manage medical information security and to evaluate operation, and for individual hospital to manage the bound of opening to public and authority to access considering specificity of medical information, and supervisor. Also, the Goverment should set up a definite legal support about the political and technological plan to protect private information in the medical record.

Statistical Analysis of Diseases with Discharge Data Set / 대한의료정보학회지

This study was performed to investigate the factors concerning the structures of diseases in Korea. The data were collected from the 11 tertiary referral hospitals and the number of investigated patients were 242.038 and the diagnoses were based on 21 chapters of Korean Standard Classification of Diseases(KCD-3). The results were as fellows: 1. The number of investigated patients were 242,038 Among them male(51.1%) was a little more than female 48.9%). In age distribution, the group of 45-64 was the highest(25.5%) and 30-49year age group was 20.9%. under l4year age group was 20.3%. and above 65years age group was the lowest( 15.3%). 2. In single diagnosis group division by 21 chapters of KCD-3. diseases of the respiratory system were the highest(11.3%) , injury. poisoning and the next were certain other consequences of external causes( l0.39% ) and neoplasms(10.0%) . The low est were diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism(0.7%). in single diagnosis group, sex, age. season, region and operation and procedures were statistically significant in the x2-test analysis. 3. In multiple diagnoses group. neoplasms were the highest (17.0%). and the next were pregnancy, chirdbirth and the puerperium(l0.6%) and the diseases of the circulatory systems(9.2%). The lowest was diseases of the blood and blood forming organs and certain disorders involving the immune mechanism(0.6%). In multiple diagnoses group, sex. ace. season, region and operation and procedures were statistically significant iii the x2-test analysis.

A Survey Study of Organizational Situation of Medical Record Department for Producation of Disease Statistics on National Basis / 대한의료정보학회지

The purpose of this study was to survey the organizational situation of medical record department(MRD) in hospitals to identify the factors influencing the production ol disease statistics in Korea. 134 hospitals answered for the structured questionnaires mailed to the 218 hospitals. This studs results are as follows. 1 ) There were three types in organizational situation of MRD: independent department (70.1%) a unit in other department (26.1 %) .and in the rest 3.7%. there were no MRD or unit. 2) The differences of work performed in MR ~) or on it in the second referral level hospitals and the third referral level hospitals were statistically significant in incomplete medical record management(p<0.05) DRG coding supplying research data, quality improvement activity. cancer registration(p<0.01) and transeription of medical record( p<0.0l). 3) 66.4% of the target hospitals were performing the recheeking of disease classification data after reponsible physicians completed the incomplete record 4) statistically significant variables which affect works performed in MRD are organizational situation of MRD(<0.001) and the number of medical record professionals. 41.3% of variation of works performed in MRD was explained by variation of organizational situation and the number of medical record professionals.

Feasibility Study of Application of UHDDS Items for Hospital Discharge Abstract and Analysis in Tertiary Care Hospitals / 대한의료정보학회지

The purpose of this study is to identify standardized items from Hospital Discharge Abstract and Analysis data by using UHDDS(Uniform Hospital Discharge Data Sets in USA) and to ascertain the computerization in tertiary hospitals. The data were collected by questionnaire survey, responded 38 hospitals(86.4%) out of 44 tertiary hospitals, and the conclusions are as follows. 1. As for the general characteristics of patient; hospital registration number, patient name, sex and social identification number were reported to 0.92%. 2. As for admission and discharge aspects; admission date was showed 0.92, type of admission and insurance were 0.87%, discharge date 0.92%, the code of primary condition, other diagnoses and primary procedure were 0.89%, disposition of discharge was 0.61%. 3. As for the other characteristics; attending physician license number and name of operating physician were showed 0.87%, birth weight of newborn 0.74%, nationality 0.44%. 4. As for the order communicating system, computerization for the medical record management was showed 57.9%, administration of outpatient 53.6%, administration of inpatient 44.7%, administration of emergency care 28.9%. Judging from the study, the development of Korean Uniform Hospital Discharge Data Sets using Discharge Abstract and Analysis System is applicable to the national wide collection of statistics on the diseases for the discharged patients.

The relationship of common reasons for encounter and major diagnoses of patients admitted to a hospital

BACKGROUNDS: It is important to know the contents of health problems in patients in a primary care setting. The aim of this study was to explore the main chief complaints and major diagnoses of patients, who were admitted to a hospital using the ICD-10 and to observe difference according to each department and admission route and how diagnoses were made. METHODS: A total of 18,560 patients who were admitted to a hospital located in Chungnam Province from 1 Jan 1998 to 31 Dec 1998. Main chief complaints and major diagnoses made through the admissions departments were chosen as subjects (medical vs. surgical) and by admission route (emergency vs. OPD)were analyzed. How the diagnoses were derived from the most common chief complaints among medical and surgical departments were analyzed by admissions departments and by admission route. RESULTS: The most common 10 chief complaints revealed no significant difference by admission route in medical departments, but there was some difference in surgical departments. There was some difference in the most common 10 major diagnoses by admission routes in both medical and surgical departments. Abdominal and pelvic pain, which was the most common chief complaints, became a significantly different diagnosis by admission route in both departments. CONCLUSION: Main chief complaints were similar regardless of admission routes, but the diagnoses were different. ICD-10 classification may be useful to classify the diagnoses, but have limitations to classify chief complaints or reasons for encounter. It is necessary to introduce a new classification such as ICPC-2 for reasons for encounter in order to explore the dimension of health problems.

A Survey on the Status of Health Statistics Generation by the Medical Record Offices of Hospitals and its Automation Rate / 대한의료정보학회지

We surveyed the generation rate of health statistics by medical records offices of the 78 hospitals and its automation rate using computerized hospital information system. Structured questionnaire was given to one medical record officer of each hospital. Items in the questionnaire was selected from statistics required for hospital service evaluation or OECD health statistics. More than 50% of the medical record office generated questioned health statistics, and most of them was automated. Because many of the medical record offices of the hospitals are producing essential health statistics and automated, there is a possibility that we can collect and use these datas to build up national health database if adequate standardization procedure can be implemented.

A Study on the Medical Record Technicians Manpower Relation by Before and after Computerization of Medical Record / 대한의료정보학회지

This research investigated on the medical recorder manpower relation by before / after medical record computerization for the object of 51 hospitals in 1998 year. Judging from the situation before / after computerization shown on this investigation, the number of personnels was more increased since computer work than manual work, and the medical recorder present conditions by years show that they have been gradually increasing. This is considered why affairs diversely change according to computerization, the auxiliary recorder present conditions shows the reduction of 98 year in comparison with 94 year. This is regarded that personnels were reduced by facilities like existing transporting pipes. Accordingly, vast data are produced and utilized in the medical record department(room) too, therefore information will be quickly / correctly dealt for this. The times invested for simple affairs will be easily diminished by making existing simple affairs be computerized, and so personnels will have to be invested to earnestly / diversely utilize vast information not to reduce personnels in proportion to diminished times.