Implementation of Consolidated HIS: Improving Quality and Efficiency of Healthcare

김진욱,최진욱,서정욱,정천기,김경환,김주한,김종효,Eui Kyu Chie,조현재,구진모,이혁준,위원량,Sang Mo Nam,임미선,Young-Ah Kim,Seung Hoon Yang,Eun Mi Jo,Min-A Hwang,Wan Suk Kim,Eun Hye Lee,Su Hi Choi 대한의료정보학회 2010 Healthcare Informatics Research Vol.16 No.4

Objectives: Adoption of hospital information systems offers distinctive advantages in healthcare delivery. First, implementation of consolidated hospital information system in Seoul National University Hospital led to significant improvements in quality of healthcare and efficiency of hospital management. Methods: The hospital information system in Seoul National University Hospital consists of component applications: clinical information systems, clinical research support systems, administrative information systems, management information systems, education support systems, and referral systems that operate to generate utmost performance when delivering healthcare services. Results: Clinical information systems, which consist of such applications as electronic medical records, picture archiving and communication systems, primarily support clinical activities. Clinical research support system provides valuable resources supporting various aspects of clinical activities, ranging from management of clinical laboratory tests to establishing care-giving procedures. Conclusions: Seoul National University Hospital strives to move its hospital information system to a whole new level, which enables customized healthcare service and fulfills individual requirements. The current information strategy is being formulated as an initial step of development, promoting the establishment of next-generation hospital information system.

Development and Validation of the Radiology Common Data Model (R-CDM) for the International Standardization of Medical Imaging Data

박철형,유승찬,전호균,정창원,최진욱,박래웅 연세대학교의과대학 2022 Yonsei medical journal Vol.63 No.-

Purpose: Digital Imaging and Communications in Medicine (DICOM), a standard file format for medical imaging data, contains metadata describing each file. However, metadata are often incomplete, and there is no standardized format for recording metadata, leading to inefficiency during the metadata-based data retrieval process. Here, we propose a novel standardization method for DICOM metadata termed the Radiology Common Data Model (R-CDM). Materials and Methods: R-CDM was designed to be compatible with Health Level Seven International (HL7)/Fast Healthcare Interoperability Resources (FHIR) and linked with the Observational Medical Outcomes Partnership (OMOP)-CDM to achieve a seamless link between clinical data and medical imaging data. The terminology system was standardized using the RadLex playbook, a comprehensive lexicon of radiology. As a proof of concept, the R-CDM conversion process was conducted with 41.7 TB of data from the Ajou University Hospital. The R-CDM database visualizer was developed to visualize the main characteristics of the R-CDM database. Results: Information from 2801360 cases and 87203226 DICOM files was organized into two tables constituting the R-CDM. Information on imaging device and image resolution was recorded with more than 99.9% accuracy. Furthermore, OMOP-CDM and RCDM were linked to efficiently extract specific types of images from specific patient cohorts. Conclusion: R-CDM standardizes the structure and terminology for recording medical imaging data to eliminate incomplete and unstandardized information. Successful standardization was achieved by the extract, transform, and load process and image classifier. We hope that the R-CDM will contribute to deep learning research in the medical imaging field by enabling the securement of large-scale medical imaging data from multinational institutions.

Study on User Interface of Pathology Picture Archiving and Communication System

Dasueran Kim,Peter Kang,윤정민,박성혜,서정욱,박범 대한의료정보학회 2014 Healthcare Informatics Research Vol.20 No.1

Objectives: It is necessary to improve the pathology workflow. A workflow task analysis was performed using a pathology picture archiving and communication system (pathology PACS) in order to propose a user interface for the Pathology PACS considering user experience. Methods: An interface analysis of the Pathology PACS in Seoul National University Hospital and a task analysis of the pathology workflow were performed by observing recorded video. Based on obtained results, a user interface for the Pathology PACS was proposed. Results: Hierarchical task analysis of Pathology PACS was classified into 17 tasks including 1) pre-operation, 2) text, 3) images, 4) medical record viewer, 5) screen transition, 6) pathology identification number input, 7) admission date input, 8) diagnosis doctor, 9) diagnosis code, 10) diagnosis, 11) pathology identification number check box, 12) presence or absence of images, 13) search, 14) clear, 15) Excel save, 16) search results, and 17) re-search. And frequently used menu items were identified and schematized. Conclusions: A user interface for the Pathology PACS considering user experience could be proposed as a preliminary step, and this study may contribute to the development of medical information systems based on user experience and usability.

PACS Implementation Challenges in a Public Healthcare Institution: A South African Vendor Perspective

Romain Abbas,Yashik Singh 대한의료정보학회 2019 Healthcare Informatics Research Vol.25 No.4

Objectives: Conventional radiological processes have been replaced by digital images and information technology systems within South Africa and other developing countries. Picture Archiving and Communication Systems (PACS) technology offers many benefits to institutions, medical personnel and patients; however, the implementation of such systems can be a challenging task. It has been documented that South Africa has been using PACS for more than a decade in public hospitals with moderate success. The aim of this study was to identify and describe the PACS challenges endured by PACS vendors during implementation in the South African public healthcare sector. Methods: This was achieved by engaging in a methodological approach that was qualitative in nature collecting data through semi structured interviews from 10 PACS experts/ participants which were later analysed qualitatively. Results: The findings show that PACS vendors have countless challenges, some of which include space, insufficient infrastructure, image storage capacity, system maturity and vendor related concerns. It was clear that the PACS experts readily offered contextually appropriate descriptions of their encounters during PACS implementations in South African public healthcare institutions. Conclusions: PACS vendors anticipate these challenges when facing a public healthcare institution and it is recommended that the hospital management and potential PACS stakeholders be made aware of these challenges to mitigate their effects and aid in a successful implementation.

영상정보교류 실태 파악을 위한 의사 설문조사

최문형,정승은,김성준,신나영,용환석,우현식,정우경,진광남,최선형 대한영상의학회 2018 대한영상의학회지 Vol.79 No.5

The purpose of this study was to summarize the results of a survey for physicians with specialties other than radiology about imaging studies of patients referred from other institutions. The survey was promoted through individual contacts or social network service and physicians who voluntarily responded to the survey were the subjects of the study. The questionnaire consisted of 11 questions about basic information and referrals about medical imaging. A total of 160 physicians from 30 specialties participated in the survey and 95.6% of the respondents worked in tertiary care center or general hospital. Patients were frequently referred with outside medical images. The most frequently referred imaging modalities were computed tomography and magnetic resonance imaging. However, radiological reports from outside institutions were rarely referred. Most physicians thought that reinterpretation for outside imaging is necessary to acquire a secondary opinion. In conclusion, considering that outside radiological reports are frequently missing and there are high demands on reinterpretation for outside imaging, guidelines for referral of radiological reports with medical imaging, basic elements of radiological reports, and reinterpretation need to be developed. 이 연구의 목적은 영상정보교류의 효용성을 높이기 위한 영상 품질 기준 연구에서 영상정보교류의 실태를 파악하고 영상정보교류에 대한 의사들의 의견을 수렴하기 위해 시행한 설문조사의 결과를 정리하는 것이다. 설문조사는 개별 접촉 또는 소셜 네트워크 서비스를 통해 홍보하였고, 자발적으로 참여한 의사가 설문조사의 대상이다. 설문조사는 기본 정보 및 영상정보교류에 대한 11개의 문항으로 구성되었다. 총 30개 진료과의 전문의 160명이 설문조사에 참여하였고, 95.6%의 응답자가 상급종합병원 또는 종합병원에 근무하는 상태였다. 외부 병원에서 영상검사를 시행한 후 의뢰되는 환자가 빈번하였다. 하지만 판독소견서가 함께 교류되는 경우는 드물었고, 의뢰받은 의료기관의 영상의학과 전문의에 의한 재판독을 통해 이차적인 의견을 구하고자 하는 요구가 많았다. 결론적으로, 외부 판독소견서가 누락되는 경우가 많으므로 판독소견서가 영상정보와 함께 교류될 수 있도록 하는 방안의 마련이 필요하다. 또한 외부 판독이 있더라도 재판독이 필요하다는 의견이 많은 점을 고려할 때 판독소견서에 반드시 포함되어야 할 기본적인 판독소견서의 요소 및 외부 검사의 재판독에 대한 가이드라인이 필요할 것으로 생각된다.

영상정보학: 인공지능-빅데이터-데이터 과학 시대의 영상의학을 위한 새 지평

김종효 대한영상의학회 2019 대한영상의학회지 Vol.80 No.2

인공지능과 빅데이터가 만들어내는 4차 산업혁명의 흐름은 전 산업과 일상을 흔들고 있으며관련된 학문 영역의 지형은 빠르게 변하고 있다. 유전체 해독과 분석기술의 도입 이후 생물학과 의학의 주류는 데이터 과학으로 전환되고 있다. 영상의학도 데이터 과학으로의 본격적인 전환이 요구되는 시기에 놓여있다. 이 종설에서는 인공지능과 빅데이터 시대에 영상의학의 미래 지평을 열고 발전을 견인할 기틀로서 영상정보학을 주목한다. 정보학의 한 갈래인영상정보학의 기본 개념을 소개하고, 영상정보학의 토대인 의료영상저장전송시스템과 의료용 디지털 영상 및 통신 표준의 정보학적 특징을 짚어본다. 영상정보학의 주요 분야인 영상유전체학과 방사선영상체학에 대해 기본개념과 차이점, 현황 등을 고찰한다. 인공지능의 기본 개념을 이해하고 영상의학분야에서의 최근 적용 사례들을 살펴보고, 빅데이터의 성공적구축 요인과 구축 사례를 고찰한다. 끝으로 미해결 이슈들과 선결 과제들을 짚어보고 발전방향을 조망한다. We are witnessing the big wave of Industrial Revolution 4.0, enabled by artificial intelligence (AI) and big data, which has shaken the entire industry and day-to-day life as well as rapidly changed the landscapes of related academic disciplines. After the introduction of genome sequencing and analysis technology, biology and medical sciences have been rapidly transforming into data science. Radiology is facing a challenging period of transformation into a data science. This review article draws attention to imaging informatics as a vehicle to open a new horizon and to drive to the future path for radiology in the AI and big data era. We introduce the basic concepts of imaging informatics and consider the informatics features of picture archiving and communication system and digital imaging and communications in medicine. We discuss the concepts and differences of radiogenomics and radiomics, which are important specialties of imaging informatics. We introduce the basics of AI and its recent applications in radiology as well as requirements for the successful construction of big data for imaging informatics. We conclude by discussing unresolved issues, potential solutions, and directions for future developments.

Integration and Evaluation of Clinical Decision Support Systems for Diagnosis Idopathics Pulmonary Fibrosis (IPF)

Yunhee Lee,채영문,Sungwan Jeon 대한의료정보학회 2010 Healthcare Informatics Research Vol.16 No.4

Objectives: The purpose of this study was to develop clinical decision support systems (CDSS) that are integrated with hospital information systems for the differential diagnosis of idiopathic pulmonary fibrosis (IPF). Methods: The integrated CDSS were validated and evaluated by physicians. Knowledge modeling for diagnosing IPF was performed by knowledge working groups, composed of radiologists and respiratory specialists. In order to develop the model for CDSS diagnosis, the clinical cases were collected from 290 cases from Seoul National University Hospital and Sevrance Hospital of Yonsei University. For the evaluation of integrated CDSS, interviews were conducted with respiratory specialists and radiologist 2 weeks after applying CDSSs in clinical settings. The CDSS was integrated with the computer vision system (CVS) and diffuse parenchymal lung diseases (DPLD), CDSS developed in our previous project. Results: Eighteen cases diagnosed as IPF were applied to the collection of diagnostic knowledge and the refined knowledge, the former diagnosed 1 case (6%) and the latter diagnosed 14cases (78%). Therefore, the refined knowledge performed better than collected knowledge. The validation results of integrated CDSSs showed that 81 cases (74.3%) were diagnosed correctly. Conclusions: There were 109 cases of IPF diagnosed and initiated on treatment. The significance of this study is in developing integrated CDSS with PACS by acquiring and redefining the knowledge needed for IPF diagnosis. In addition, it is significant for the integration of CDSS to verification and clinical evaluation.

Application of the Extended Technology Acceptance Model to Picture Archiving and Communication Systems in Dental Hospitals

장혜정 대한의료정보학회 2009 Healthcare Informatics Research Vol.15 No.3

Objective: With the rapid growth of picture archiving and communication systems (PACS) in the healthcare industry, this article describes the users’ satisfaction with PACS by employing functional PACS features and the two concepts of perceived ease-of-use (PEOU) and perceived usefulness (PU), based on the extended technology acceptance model (TAM). Methods: A cross-sectional survey was conducted with dentists in 25 dental hospitals which were cluster sampled from the national registry of 132 dental hospitals. Of the 204 respondents (response rate 81.6%), the data of 159 PACS users were analyzed using the structural equation modeling method. Results: The fitted model showed significant relations between the technical components and the TAM variables, via the following three significant paths: hardware to PEOU, and software to PEOU and also to PU. Moreover, the critical path of TAM variables was observed: PEOU→PU→SAT. Therefore, the model produced three significant routes: hardware→PEOU→PU→SAT, software→PU→SAT, and software→PEOU→PU→SAT. Conclusion: Contrary to expectations, the direct effect of PEOU on user satisfaction was not significant. The final model provided critical paths from technical components to user satisfaction, by utilizing PEOU and PU as intermediary, latent factors.

웹기술을 이용한 방사선 판독보고서의 단순 문자열 검색시스템

김태성,김명진,김희중,유형식,김기황 대한영상의학회 2004 대한영상의학회지 Vol.51 No.3

Purpose: The authors have developed a system that searches for radiologic reports, and we have evaluated the utility of this system for clinical application, research and medical education. Materials and Methods: The system retrieves radiologic reports from the OCS (ordering communication system) server and stores them in a separate computer. A CGI (common gateway interface) program was written to search the database with variable keywords given by the user. The system satisfied the requirements of functionality, accessibility and security. Results: Users could search for radiologic reports with variable keywords using the web browser, and the user could refine the results using combinations of these keywords. The system has been running successfully for 2 years, and radiologists have used this system for searching or collecting cases, keeping reports and gathering statistics. Conclusion: The simple text searching system has been developed in a short time period with only small costs and a bit of hard effort, and this system is practical for clinical use, research and medical education. 목적: 다양한 검색조건을 이용해서 필요한 방사선검사 판독보고서의 내용을 찾아낼 수 있는 시스템을 제작하여 진료 및 연구, 그리고 교육에 활용하고자 하였다. 대상과 방법: 병원의 처방전달시스템에 저장된 방사선 판독보고서의 내용을 별도의 컴퓨터의 데이터베이스에 자동으로 백업되도록 한 다음, 그 내용을 검색할 수 있는 프로그램을 개발하였다. 별도의 프로그램을 설치할 필요 없이 웹브라우저만을 이용하면 어디서든 접근할 수 있도록 하면서도 적절한 보안성의 조건도 만족시킬 수 있도록 하였다. 결과: 2년 여 동안 사용자는 다양한 검색조건과 검색어를 이용해서 필요한 판독보고서를 찾을 수 있었으며, 증례모음, 판독결과 보관 및 통계산출 등에 사용하였다. 결론: 단순 문자열 검색 시스템은 단기간에 적은 비용과 노력으로 구축되었으면서도 임상 연구와 교육에 매우 유용하게 사용되었다.

Significant radiologic factors related to clinical outcomes after arthroscopic rotator cuff retear repair

Min-Su Joo,Jeong-Woo Kim 대한견주관절의학회 2022 대한견주관절의학회지 Vol.25 No.3

Background: Healing of the tendon itself is not always related to successful clinical outcomes after rotator cuff repair. It was hypothesized that certain radiologic factors affecting clinical outcomes could exist in case of the retear after arthroscopic rotator cuff repair (ARCR) and the radiologic factors could help predict clinical process. The purpose of this study was to identify the radiologic factors associated with clinical outcomes of the retear after ARCR. Methods: Between January 2012 and December 2019, among patients with sufficient footprint coverage for ARCR, 96 patients with Sugaya classification 4 or higher retear on follow-up magnetic resonance imaging were included. The association between clinical outcomes such as American Shoulder and Elbow Surgeons (ASES) score, Constant score and range of motion and radiologic variables such as initial tear dimension, retear dimension, variance of tear dimension, critical shoulder angle, acromial index, and acromiohumeral distance was analyzed. Results: Preoperatively, the ASES and Constant scores were 59.81±17.02 and 64.30±15.27, respectively. And at the last follow-up, they improved to 81.56±16.29 and 78.62±14.16, respectively (p<0.01 and p<0.01). In multiple linear regression analysis, the variance of the mediolateral dimension of tear had statistically significant association with the ASES and Constant scores (p<0.01 and p=0.01). Conclusions: In patients with the retear after ARCR, the variance in the mediolateral dimension of tear had significantly negative association with the clinical outcomes. This could be considered to be reference as relative criteria and needed more sample and mechanical study.