Yonsei University Health System (YUHS) was founded in 1885 as the first modern medical institution in Korea by the American medical missionary, Dr. Horace N. Allen. It began as a small hospital under the name Kwanghyewon, which changed to Chejungwon and then Severance Hospital. As the hospital expanded over the years to include various colleges and research centers, the Yonsei University Health System was born (see Severance Hospital history for more information). YUHS has been the leader of medicine and is respected as the protector of Korean health.
Furthermore, the roots of Christianity, modern medical education and medical care in Korea can all be linked to YUHS. YUHS is led by its CEO and President, who also serves as Vice-President for Health Sciences of Yonsei University. As such, he oversees 2 graduate schools (Public Health and Nursing), 3 colleges (Medicine, Dentistry, Nursing) and 5 hospitals (Severance Hospital, Gangnam Severance Hospital, Yongin Severance Hospital, Severance Mental Health Hospital, and the Dental Hospital). Other YUHS facilities include the Medical Library, Medical Research Center, Medical Technology and Quality Evaluation Center, Multidisciplinary Endoscopic Center, Clinical Trials Center and various Research Institutes.
Administrative support facilities include Internal Auditing, Planning and Coordination, Public Relations, Medical Informatics, Administration, International Relations, Fundraising Affairs, the Chaplaincy and a Medical Mission Center. There are approximately 7,000 employees throughout the Health System, which include some 2,000 physicians and 5,000 support personnel. In addition, a total of 24,000 students have graduated from the colleges and graduate schools. The hospitals have around 3,700 beds and see around 3 million outpatients and 1 million inpatients annually.
The total lot size is 95,000 Pyung (77 acres) with a building size of 18,000 Pyung (59,508m²=640,538ft²), and a total floor area of 140,000 Pyung (462,840m²=4.98 million ft²). All facilities under YUHS are modern, house state-of-the-art medical equipment, and are operated by a ubiquitous information system that digitally links all organizations together efficiently. With these infrastructures, YUHS continues to develop by balancing education, research and patient care, which together are helping it to realize its mission of freeing humankind from disease and suffering with the love of God. Based on more than 120 years of experience in medicine, YUHS will strive to be a leader in the industrialization and globalization of medicine, thus helping it to achieve its goal of becoming the medical hub of Northeast Asia.
Yonsei University Health System (YUHS) is well known for not paper-based, but digitalized record and management of all the information in regards to medical services. It is also highly appraised for its statistical and analytic environment for such information. Among other statistical and analytic systems of YUHS, the Clinical Data Retrieve System (CDRS) draws special attention from other medical institutions. In 2007, YUHS started operating the CDRS, a Business Intelligence (BI) platform providing a wide range of statistical and analytical information necessary for clinical research.
While using the BI platform, the medical institution in 2010 raised the usage value of its CDRS to a higher level via a shake-up of its operational system: it has its medical record staff, not its formation system department, take care of abstracting, processing and delivering researchers-requested data. This is because the medical record staff has ample knowledge of clinical terms and analysis, and also has a keen insight into systematic information in regards to medical record data. Resultantly, YUHS enjoys highly enhanced usability of the CDRS.
Yonsei University Health System (YUHS) early and mid 2000s had its systems including OCS, EMR, PACS, ERP, and data warehouse integrated and linked to pave the foundation for u-Severance. This digitalization of medical service-related workflows and records led to a momentum of changing and innovating its clinical research environment via IT technology.
This is how the medical institution carried out the Clinical Data Retrieve System (CDRS) development to reinforce its capacity in education, research and medical treatment. It was 2006 when YUHS started a study on the CDRS project. At the time, YUHS thought that it needed more efficient support for clinical research and paper writing of the several hundreds of faculty members. Regarding this, Hyung-il Lee, Vice-Chief of Medical Information Division of YUHS recalled,
“As all of the work related to medical treatment record became digitalized, we needed a system to provide more efficient support for research activities designed to raise the quality of our medical services.” “The existing system took a long course of administrative procedures before providing analytical information. Thus, we had trouble with providing efficient support,” he added. With no CDRS implemented in the institution, YUHS suffered a long time of administrative process mainly due to private information protection. It is one of the features of medical services that protection of patients’ private information is given the utmost importance to. At the time when YUHS implemented u-Severance, one of the things that it gave priority was also management of patients’ private information.
In the same token, the medical institution had to apply very strict guidelines on data use for clinical research. Besides such an administrative process, mutual adjustment until the final delivery of the required records added to the bottleneck in the delivery of research-purpose statistical and analytical information: The IT experts who took care of extracting and processing required information did not have much medical knowledge. Thus, it resulted in a significant communication gap, leading to repeated work process.
The Medical Information Division of YUHS thought and thought how it could reduce the long-time administrative process and how it could reduce the time before delivering what researchers really wanted. The final idea was to provide an interactive online analysis environment whereby a researcher can directly enter what they want and take the lead himself/herself. That is, YUHS decided to take the technical solution of the Business Intelligence (BI) system in order to help researchers reduce their time in collecting and analyzing data out of their busy schedule. In late 2006, after one year of the introduction of EMR to YUHS, the Division began system formation together with Inbrein, and started operating the system in December 2007. The system that they formed was based on SQL Server 2005 Analysis Services, Integration Services, and Reporting Services. In addition, YUHS distributed software on statistics and analysis based on the modeling tool developed by Inbrein. Meanwhile, together with the CDRS development, the Division proceeded with lifting to the system level the information that remained in each of the researchers’ desktop yet was possibly helpful to research activities of the concerned department: that is, the Division made such information ready to be analyzed in connection with the information included in OCS or EMR. The EMR implementation enabled most of the data to become centralized, data in the PCs that kept hand-written information made in the time when paper charts was widely used.
There was, however, data that remained un-centralized. The system-level lifting work embraced such un-centralized data into the project so as to be used for researchers’ analysis. The opening of CDRS has removed all of the unnecessary administrative process. One time of log-in covers all of the security review and approval processes that a researcher had to go through in the ‘paper documentation’ time. Likewise, one could visually see the achievement in the process level. However, the usability part had much to be desired.
Hye-kyung Jung, Team Head of Medical Information Division of YUHS explained, “Many of the users could not easily make use of the CDRS. We could not expect our users to use the system being aware of the database structure and relationship. Still, however, our division could not do everything. We had only one staff member, who was already overwhelmed with development and education.”
Against this backdrop, YUHS’s CDRS in 2010 saw a new transitional time of ‘operational innovation’. While operating the CDRS for three years, the Division became to have a full understanding of CDRS, and it decided to have its support work in two tracks. Classifying its users into power users and ordinary users, it has had the Medical Record Team support the ordinary users who feel difficult with using the CDRS software. The main idea of the Division was this: first, carry out an in-depth education for medical record staff who has ample knowledge of clinical activities and terms; then, have this staff abstract from the CDRS and deliver data that ordinary users want.
Reinforced Research Capacity
The YUHS history of informatization can be divided into two: before and after u-Severance. In this regard, one of the most remarkable projects after u-Severance lies in the implementation of CDRS designed to secure the intellectualization foundation for research and treatment. It is not simply recording information. It is opening the gate so that information helpful to clinical research, including medical treatment-related statistics and indices, can be flowed to the medical faculty. Additionally, the 2010 shake-up has widened the canal so that more information can be flowed within the organization. Now, the YUHS medical faculty can make more active use of the medical information coming from OCS including diagnosis, surgery, treatment and examination, and EMR including patients’ medical records, for their clinical research and treatment.
Ms. Jung explained, “YUHS has had all of the information well structured. That is, one can easily get what he/she wants. In the case of information request for clinical research, however, it was inconvenient for users to have such requested information abstracted from CDRS or abstract such information himself/herself. This came from trouble with communication. IT experts were not familiar with clinical knowledge and terms, while researchers were not well aware of different properties of the date that the YUHS kept. In 2010, we had our medical record staff play the role of filling the gap from this discrepancy via data delivery as well as CDRS education.” In fact, the shake-up has led to synergy from the combination of u-Severance’s well-structured database infrastructure and the CDRS.
This has also contributed to higher competitiveness of YUHS’s research and treatment. In addition, the medical record staff is making efforts to standardize the analytical forms that researchers often use. Likewise, the usability of the CDRS of YUHS is on the increase.
Operational Innovation of CDRS
In the mid-and long-term, the CDRS of YUHS will be developed into a decision-making support system such as CDSS(Clinical Decision Support System). Vice-Chief Lee stated, “CDRS is very different from ordinary data warehouse. As a single piece of raw data has its own value and importance, it is very important to help researchers search what they want.” “That is,” he added, “CDRS is not a system which is completed once it is implemented. Its maturity becomes higher and higher by continuous supplementary work. One time of formation and modeling is not enough. In line with the changes of the society and research themes, we need to bring in a new model optimized to the demand of researchers. This kind of continuous efforts will contribute to higher maturity of CDRS.”
It is expected that medical record staff will play an important role in making the CDRS of YUHS advanced to higher levels and equipped with the optimal model and form so as to be ready for the changing environment. Ms. Jung mentioned, “The main work of the information system department lies in support via the information system, not data abstraction. However, the introduction of EMR led to increased requests for research-related materials. Now, with the CDRS development and reformation of the operational structure, the workload regarding data abstraction is on the decrease. ” She added, “medical record staff has a high understanding of clinical activities and is the main body of recording information in EMR. Thus, they were fast in gaining an understanding of the meaning, codes, and procedures of data, information that we explained. As a result, they can excellently carry out data comparison and analysis by combining or linking the research results, medicine prescriptions, and other data, and/or making conditions.”
Good Use of CDRS by Various Departments
The benefits of the efforts to make active use of CDRS have extended to various departments, not just several researchers. Ms. Jung stated, “Medical record staff provides support for clinical research via CDRS.
In addition, they also make active use of the system for their own work. They use the CDRS in finding out how, what and how many medical records are used for medical services and also making statistics and analysis on the level of loyalty in regards to EMR records. Besides, the nursing part uses information abstracted from the CDRS for nursing-related analysis. As such, we make use of the CDRS not only for research but also operational improvement. ”
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