How to Establish a Successful Health Information Exchange System? A Korean Case

Mr. Seo lives in Busan, but he underwent surgery at a tertiary hospital in Seoul, about 400 kilometers away from his home. Even after the surgery, there was a need for regular medication and tests, but going to Seoul every time became burdensome. So test results and other information were shared between the hospital near Mr. Seo's home and the hospital in Seoul through the Health Information Exchange System. This allowed him to receive post-surgery follow-up treatment at a nearby hospital without having to travel.

This would not have been possible only a few years ago, and the road to making it happen was a long one. How did Korea manage to accomplish this significant digital transformation? This article delves into the steps undertaken to achieve a health information exchange system and the reasons behind its extended timeline, and it aims to extract valuable insights.

Advancing Healthcare: The Secure Exchange of Patient Medical Information

The health information exchange project supports the secure electronic exchange of patient medical information among healthcare institutions. Through this initiative, patients can have their existing medical records accessed by new healthcare providers, even when transitioning to a different medical facility. Instead of submitting paper documents and CDs containing medical information, including treatment details, MRI, CT, and other imaging test results, electronically transmitting this information enhances patient safety and increases the convenience of healthcare services.

In December 2022, during the annual performance report meeting for health information exchange, the Ministry of Health and Welfare in Korea (MOHWK) and the Korea Health Information Service unveiled noteworthy progress: From its initiation in 2009, with one central medical institution, Seoul National University Bundang Hospital (a tertiary hospital), and 35 collaborative medical institutions (clinics/hospitals), participation had expanded to encompass 61 central medical institutions and over 7,500 collaborative medical institutions by 2022.

That year marked a notable achievement, as all tertiary hospitals joined the nationwide collaborative network --although the journey to universal participation took 13 years. The MOHWK laid the legal groundwork for Electronic Medical Records (EMR) in 2002. However, as of 2005, only 20.3% of tertiary hospitals, 14.7% of general hospitals, and 22.2% of hospitals had implemented them.

Navigating Challenges Towards Health Information Exchange

Recognizing the need for a standardized model for health information exchange, in 2005 the MOHWK formulated the "National Health and Medical Informatization 5-Year Comprehensive Plan". This plan aimed to establish the foundation for health and medical informatization, promote informatization of health and medical services, foster the health and medical information industry, and drive informatization in public health institutions (public health centers) and public medical institutions (national hospitals). The detailed project for building the foundation of health and medical informatization included measures such as revising relevant legislation and standardizing health and medical terminology.

In 2006, Seoul National University Hospital Bundang, the leading hospital regarding digital health, took a pioneering step by collaborating with medical IT companies to develop a system for medical information exchange between clinics/hospitals and tertiary hospitals. The pilot project demonstrated cost-saving effects. According to a study in 2015, the medical expenses for patients who electronically shared their medical records were 13% lower than that of the non-sharing group, with reductions in various tests, imaging, and prescription. However, its widespread adoption did not materialize.

Simultaneously, the Ministry of Science and ICT conducted a pilot project to secure successful cases of health information exchange among medical institutions, collaborating with the Daegu Metropolitan City government on a similar Initiative. Unfortunately, these efforts did not progress beyond the pilot stage. In the private sector, major general hospitals like Asan Medical Center and Samsung Medical Center exchanged partial medical records with affiliated clinics through their hospital websites, but the overall impact remained limited.

The reasons for these limitations can be broadly attributed to the following three factors:

• The absence of interoperable standards for EMR system.
• Public concerns about information protection and security.
• Lack of motivation for the participation of healthcare institutions.

The turning point for the struggling medical information exchange project came with successfully revising the Medical Service Actto enhance information security and facilitate exchange. Through its amendment in 2016, the MOHWK established the basis for the sending and transmission of medical records among medical institutions.

According to this Act, the Minister of Welfare can develop and operate an electronic information system and enable the delegation of this task to a relevant specialized agency, and specified the obligations of personal information protection that such agencies must adhere to. In 2017, the MOHWK also established the Standards for the Exchange of Medical Information, including the definition of standards, data formats, terminology codes, and transmission protocols necessary for the sharing of medical records and imaging information (CT, MRI).

A new medical fee related to medical institution requests and referrals was introduced to enhance the incentive for the participation of healthcare institutions. MOHWK provides additional reimbursement to medical institutions when collaborating hospitals make referrals and transfers of medical treatment information through the health information exchange. Most importantly, the MOHWK established the KHIS to strengthen the institutional foundation for implementing the EMR certification system. KHIS is an ICT-specialized agency in the healthcare treatment sector, and its main role is to improve the quality of healthcare information and its use during its life cycle by standardizing healthcare information.

Through these efforts, the annual exchange of health information and medical imaging information between healthcare institutions has continuously increased, reaching over 220,000 cases in 2020, 600,000 cases in 2021, 750,000 cases in 2022, and as of October 2023, a total of 880,000 cases. It represents a consistent growth compared to 2020, achieving a cumulative total of over 2 million cases.

The Korean experience highlights three key lessons: 1. The primary focus for preparing electronic medical information exchange should be system and standard readiness. 2. Establishing a legal and institutional foundation for personal information security and public persuasion based on this foundation is necessary. 3. Incentives for hospitals and healthcare professionals to participate must be financially viable, encouraging their openness to improved services. Do you know of other experiences regarding Health Information Exchange Systems?

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