진료정보교류 인센티브사업에 대한 이해관계자 조사연구 = Stakeholder Survey on the Incentive Program to Promote the Adoption of Health Information Exchange

다국어 초록 (Multilingual Abstract)

Health Information Exchange (HIE) is expected to improve the quality and efficiency of care by allowing providers online access to healthcare information generated by other providers at the point of care. However, the adoption of the technology in Korea has been slow since its pilot program in 2007~2010 at Seoul National University Bundang Hospital. The objective of this study was to survey stakeholders on the incentive program for the facilitation of HIE adoption. We surveyed 39 experts representing 6 categories of stakeholders-provider, insurer, government, information service firms, customers, and medical informatics experts for the interviews. Interview questions included program objectives, program participation requirements, incentive payment method, and administrative burden for program participation. Experts indicated that the quality of care was the most important value the program should aim to achieve through the HIE adoption. They suggested that the requirements and administrative burden for participation should be kept at minimum to recruit a large number of providers to the program, which is an indicator of program success.
Experts were divided on the payment method whether the incentive should be paid as a part of the fee payment scheme operated by the National Health Insurance (NHI) or should be a payment made independent of the NHI. The source of the divide was conflict of interest among stakeholders as to who pays for the program, and the insurer and consumer groups were against the NHI taking the financial burden. It appeared to be the most significant factor for the successful program launching to resolve the gap in perceptions about benefits of the technology among stakeholders and to win the willingness to pay for the program.

목차 (Table of Contents)

• 1. 서 론
• 2. 문헌 및 사례고찰
• 3. 연구 방법
• 4. 연구 결과
• 5. 토론 및 결론

참고문헌 (Reference)

1 정진주, "보건의료분야에서의 질적연구의 적용" 대한가정의학회 29 (29): 553-562, 2008

2 Tzeel, A., "‘Hidden’value : How Indirect Benefits of Health Information Exchange Further Promote Sustainability" 5 (5): 333-340, 2012

3 Herzlinger, R. E., "Why Innovation in Health Care Is So Hard" 84 : 58-66, 2006

4 Kern, L. M., "Which Components of Health Information Technology Will Drive Financial Value?" 18 (18): 438-445, 2012

5 Ben-Assuli, O., "Using Electronic Health Record Systems to Optimize Admission Decisions : The Creatinine Case Study" 21 (21): 73-88, 2015

6 Gadd, C. S., "User Perspectives on the Usability of a Regional Health Information Exchange" 18 (18): 711-716, 2011

7 Maass, M. C., "Usefulness of a Regional Health Care Information System in Primary Care : A Case Study" 91 (91): 175-181, 2008

8 Rudin, R. S., "Understanding the Decisions and Values of Stakeholders in Health Information Exchanges : Experiences from Massachusetts" 99 (99): 950-955, 2009

9 Blumenthal, D., "The"Meaningful Use"Regulation for Electronic Health Records" 363 (363): 501-504, 2010

10 Walker, J., "The Value of Health Care Information Exchange and Interoperability" 24 : W5-10-W5-18, 2005

11 Dullabh, P., "The State HIE Program Four Years Later : Key Findings on Grantees’ Experiences from a Six-State Review"

12 Vest, J.R., "The Potential for Community-based Health Information Exchange Systems to Reduce Hospital Readmissions" 22 (22): 435-442, 2015

13 Johnson, K. B., "The MidSouth eHealth Alliance : Use and Impact in the First Year" 333-337, 2008

14 Ben-Assuli, O., "The Impact of EHR and HIE on Reducing Avoidable Admissions : Controlling Main Differential Diagnoses" 13 (13): 1-, 2013

15 Frisse, M. E., "The Financial Impact of Health Information Exchange on Emergency Department Care" 19 (19): 328-333, 2012

16 Steward, W.T., "The Essential Role of Reconfiguration Capabilities in the Implementation of HIV-related Health Information Exchanges" 81 (81): e10-e20, 2012

17 Gelijns, A., "The Dynamics of Technological Change in Medicine" 13 : 28-46, 1994

18 Messer, L.C., "The Development of a Health Information Exchange to Enhance Care and Improve Patient Outcomes among HIV+Individuals in Rural North Carolina" 81 (81): e46-e55, 2012

19 Byrne, C. M., "The Department of Veterans Affairs’(VA)Implementation of the Virtual Lifetime Electronic Record(VLER) : Findings and Lessons Learned from Health Information Exchange at 12 Sites" 83 (83): 537-547, 2014

20 Bouhaddou, O., "The Department of Veterans Affairs, Department of Defense, and Kaiser Permanente Nationwide Health Information Network Exchange in San Diego : Patient Selection, Consent, and Identity Matching" 135-143, 2011

21 Pemble, K.R., "The Business Case for Payer Support of a Community-based Health Information Exchange : A Humana Pilot Evaluating its Effectiveness in Cost Control for Plan Members Seeking Emergency Department Care" 4 (4): 207-216, 2011

22 Saff, E., "The Bay Area HIE. A Case Study in Connecting Stakeholders" 24 (24): 25-30, 2009

23 Kan, J. T., "The 2011 Medicare Electronic Health Records Incentive Program" 7 (7): 271-272, 2011

24 Sicotte, C., "Success in Health Information Exchange Projects : Solving the Implementation Puzzle" 70 (70): 1159-1165, 2010

25 Nykänen, P., "Success and Failure Factors in the Regional Health Information System Design Process-results from a Constructive Evaluation Study" 45 (45): 85-89, 2006

26 Yonhapnews, "Strategy for the Utilization of Healthcare Big Data"

27 The Centers for Medicare and Medicaid Services, "Stage 2 Overview Tipsheet"

28 Miller, R.H., "Satisfying Patient-consumer Principles for Health Information Exchange : Evidence from California Case Studies" 31 (31): 537-547, 2012

29 McGowan, J.J., "Rural RHIOs : Common Issues in the Development of Two State-wide Health Information Networks" 528-532, 2007

30 Iezzoni, L., "Risk Adjustment for Measuring Healthcare Outcomes" Health Administration Press 2012

31 Ozkaynak, M., "Revisiting Sociotechnical Systems in a Case of Unreported Use of Health Information Exchange System in Three Hospital Emergency Departments" 19 (19): 370-373, 2013

32 Frohlich, J., "Retrospective : Lessons Learned from the Santa Barbara Project and their Implications" 26 : w589-w589, 2007

33 The Office of the National Coordinator for Health Information Technology of the Department of Health & Human Services, "Request for Comment Regarding the Stage 3 Definition of Meaningful Use of Electronic Health Records(EHRs)"

34 Slavitt, A., "Replacing Meaningful Use, Advancing Care Information"

35 Morris, G., "Query-Based Exchange : Key Factors Influencing Success and Failure"

36 Campion Jr, T. R., "Push and Pull : Physician Usage of and Satisfaction with Health Information Exchange" 77-84, 2012

37 Park, M., "Provide Hospital Medical Data Analysis to Pharmaceutical Companies" Dongailbo

38 Kern, L. M., "Promoting Interoperable Health Information Technology in New York State" 28 (28): 493-504, 2009

39 Lobach, D. F., "Proactive Population Health Management in the Context of a Regional Health Information Exchange Using Standards-based Decision Support" 473-477, 2007

40 eHealth Initiative, "Post HITECH : The Landscape of Health Information Exchange"

41 Lee, S. I., "Physicians’ Perceptions and Use of a Health Information Exchange : A Pilot Program in South Korea" 18 (18): 604-612, 2012

42 Hincapie, A. L., "Physicians’ Opinions of a Health Information Exchange" 18 (18): 60-65, 2011

43 Myers, J.J., "Perceptions Regarding the Case of Use and Usefulness of Health Information Exchange Systems among Medical Providers, Case Managers and Non-clinical Staff Members Working in HIV Care and Community Settings" 81 (81): e21-e29, 2012

44 Cromwell, J., "Pay for Performance in Health Care : Methods and Approaches" RTI Press Publication 2011

45 Park, H., "Patients’ Perceptions of a Health Information Exchange : A Pilot Program in South Korea" 82 (82): 98-107, 2013

46 Mäenpää, T., "Outcomes Assessment of the Regional Health Information Exchange" 50 (50): 308-318, 2011

47 Dobalian, A., "Organizational Challenges in Developing One of the Nationwide Health Information Network Trial Implementation Awardees" 36 (36): 933-940, 2012

48 Carr, C. M., "Observational Study and Estimate of Cost Savings from Use of a Health Information Exchange in an Academic Emergency Department" 46 (46): 250-256, 2014

49 The Organisation of Economic Co-operation and Development, "OECD Health Statistics 2016"

50 Altman, R., "Notifications of Hospital Events to Outpatient Clinicians Using Health Information Exchange : A Post-implementation Survey" 20 (20): 249-255, 2013

51 The Centers for Medicare and Medicaid Services, "Notice of Proposed Rulemaking :Advancing Care Information Fact Sheet"

52 Vest, J.R., "More Than Just a Question of Technology : Factors Related to Hospitals’ Adoption and Implementation of Health Information Exchange" 79 (79): 797-806, 2010

53 Huang, M. E., "Merit-Based Incentive Payment System : Preparing Your Practice for Upcoming Change" 8 (8): 792-797, 2016

54 Thomas, E.J., "Measuring Errors and Adverse Events in Health Care" 18 (18): 61-67, 2003

55 McCarthy, D. B., "Learning from Health Information Exchange Technical Architecture and Implementation in Seven Beacon Communities" 2 (2): 1060-, 2014

56 National Law Information Center, "Law of Cloud Computing"

57 Blumenthal, D., "Launching HITECH" 362 (362): 382-385, 2010

58 Dullabh, P., "Large Scale Health Information Exchange : Implementation Experiences from Five States" 192 : 613-617, 2012

59 Foldy, S., "Inventory of Electronic Health Information Exchange in Wisconsin" 106 (106): 120-125, 2006

60 The Organisation of Economic Co-operation and Development, "Improving Health Sector Efficiency : The Role of Information and Communication Technologies" OECD Publishing 2010

61 Magnus, M., "Improved HIV-related Outcomes Associated with Implementation of a Novel Public Health Information Exchange" 81 (81): e30-e38, 2012

62 Phillips, A.B., "Implementing Health Information Exchange for Public Health Reporting : A Comparison of Decision and Risk Management of Three Regional Health Information Organizations in New York State" 21 (21): e173-e177, 2014

63 Herwehe, J., "Implementation of an Innovative, Integrated Electronic Medical Record(EMR)and Public Health Information Exchange for HIV/AIDS" 19 (19): 448-452, 2012

64 Lang, E., "Impact of an Electronic Link between the Emergency Department and Family Physicians : A Randomized Controlled Trial" 174 (174): 313-318, 2006

65 Afilalo, M., "Impact of a Standardized Communication System on Continuity of Care between Family Physicians and the Emergency Department" 9 (9): 79-86, 2007

66 Adjerid, I., "Impact of Health Disclosure Laws on Health Information Exchanges" 48-56, 2011

67 Kierkegaard, P., "How Could Health Information Exchange Better Meet the Needs of Care Practitioners?" 5 (5): 861-877, 2014

68 Miller, A.R., "Health Information Exchange, System Size and Information silos" 33 : 28-42, 2014

69 Jones, S. S., "Health Information Exchange, Health Information Technology Use, and Hospital Readmission Rates" 644-653, 2011

70 Ross, S.E, "Health Information Exchange in Small-to-medium Sized Family Medicine Practices : Motivators, Barriers, and Potential Facilitators of Adoption" 79 (79): 123-129, 2010

71 Vest, J.R., "Health Information Exchange and Healthcare Utilization" 33 (33): 223-231, 2009

72 Kern, L. M., "Health Information Exchange and Ambulatory Quality of Care" 3 (3): 197-209, 2012

73 Adler-Milstein, J., "Health Information Exchange among US Hospitals : Who’s in, Who’s out, and Why?" 2 (2): 26-32, 2014

74 Unertl, K.M, "Health Information Exchange Technology on the Front Lines of Healthcare：Workflow Factors and Patterns of Use" 19 (19): 392-400, 2012

75 National Law Information Center, "Health Information Exchange Standard"

76 Bailey, J. E., "Health Information Exchange Reduces Repeated Diagnostic Imaging for Back Pain" 62 (62): 16-24, 2013

77 Feldman, S.S., "Health Information Exchange Implementation : Lessons Learned and Critical Success Factors from a Case Study" 2 (2): e19-, 2014

78 Vest, J.R., "Health Information Exchange : Persistent Challenges and New Strategies" 17 : 288-294, 2010

79 Fontaine, P., "Health Information Exchange : Participation by Minnesota Primary Care Practices" 170 (170): 622-629, 2010

80 Nagykaldi, Z.J., "HIE-i—Health Information Exchange With Intelligence" 37 (37): 20-31, 2014

81 Ministry of Health and Welfare, "Guideline for Management and Maintenance of Electronic Medical Records"

82 Pan, E., "Guide to Evaluating Health Information Exchange Projects (Prepared for the Agency for Healthcare Research and Quality under Contract No. 290200900023-I) AHRQ Publication No.14-0015-EF"

83 Doherty, R. B., "Goodbye, Sustainable Growth Rate-Hello, Merit-Based Incentive Payment System" 163 (163): 138-139, 2015

84 Schabetsberger, T., "From a Paper-Based Transmission of Discharge Summaries to Electronic Communication in Health Care Regions" 75 (75): 209-215, 2006

85 Halamka, J., "Exchanging Health Information : Local Distribution, National Coordination" 24 : 1170-1179, 2005

86 Machan, C., "Evaluation of the Electronic Transmission of Medical Findings from Hospitals to Practitioners by Triangulation" 45 (45): 225-233, 2006

87 Tripathi, M., "Engaging Patients for Health Information Exchange" 28 (28): 435-443, 2009

88 J. Jardim, "Emphasizing Public Health within a Health Information Exchange : An Evaluation of the District of Columbia’s Health Information Exchange Program" 2 (2): 1090-, 2014

89 Thorn, S.A., "Emergency Physicians’ Perspectives on their Use of Health Information Exchange" 63 (63): 329-337, 2014

90 Dixon, B. E., "Electronic Laboratory Data Quality and the Value of a Health Information Exchange to Support Public Health Reporting Processes" 322-330, 2011

91 The Centers for Medicare and Medicaid Services, "Electronic Health Records Incentive Programs"

92 McCullough, J., "Electronic Health Information Exchange in Underserved Settings : Examining Initiatives in Small Physician Practices & Community Health Centers" 14 (14): 415-, 2014

93 Pagliari, C., "Electronic Clinical Communications Implementation(ECCI)in Scotland : A Mixed-Methods Programme Evaluation" 10 (10): 11-20, 2004

94 Ross, S.E., "Effects of Health Information Exchange Adoption on Ambulatory Testing Rates" 20 (20): 1137-1142, 2013

95 Center for Interoperable EHR, "EHR System Functionality and Health Information Exchange" Elsevier Korea 2010

96 The Centers for Medicare and Medicaid Services, "EHR Incentive Programs：2015 through 2017 (Modified Stage 2) Overview"

97 Bailey, J. E., "Does Health Information Exchange Reduce Unnecessary Neuroimaging and Improve Quality of Headache Care in the Emergency Department?" 28 (28): 176-183, 2013

98 Lammers, E. J., "Does Health Information Exchange Reduce Redundant Imaging? Evidence from Emergency Departments" 52 (52): 227-234, 2014

99 Mainz, J., "Defining and Classifying Clinical Indicators for Quality Improvement" 15 (15): 523-530, 2003

100 The Office of the National Coordinator for Health Information Technology of the Department of Health & Human Services, "Defining Key Health Information Technology Terms"

101 Grossman, J.M., "Creating Sustainable Local Health Information Exchanges : Can Barriers to Stakeholder Participation be Overcome?" 2 : 1-12, 2008

102 Kern, L. M., "Community-based Health Information Technology Alliances : Potential Predictors of Early Sustainability" 17 (17): 290-295, 2011

103 Overhage, J.M, "Communities’ Readiness for Health Information Exchange : the National Landscape in 2004" 12 (12): 107-112, 2005

104 Feldman, S.S., "Collaboration in Electronic Medical Evidence Development :A Case Study of the Social Security Administration’s MEGAHIT System" 80 (80): e127-e140, 2011

105 Fairbrother, G., "Cincinnati Beacon Community Program Highlights Challenges and Opportunities on the Path to Care Transformation" 33 (33): 871-877, 2014

106 Vest, J.R., "Challenges, Alternatives, and Paths to Sustainability for Health Information Exchange Efforts" 37 (37): 9987-, 2013

107 Winden, T.J., "Care Everywhere, a Point-to-point HIE Tool : Utilization and Impact on Patient Care in the ED" 5 (5): 388-401, 2014

108 Park, H., "Can a Health Information Exchange Save Healthcare Costs? Evidence from a pilot program in South Korea" 84 (84): 658-666, 2015

109 Pirnejad, H., "Building an Inter-organizational Communication Network and Challenges for Preserving Interoperability" 77 (77): 818-827, 2008

110 Unertl, K.M., "Bridging Organizational Divides in Health Care：An Ecological View of Health Information Exchange" 1 (1): e3-, 2013

111 Cha, Y., "Big Data, Open an Era of the Personalized Care" Sisajournal-e

112 Korea Evaluation Institute of Industrial Technology, "Big Data Technology Realizes a Dream of the Bio-health Power"

113 Dixon, B., "Barriers to Achieving the Last Mile in Health Information Exchange : A Survey of Small Hospitals and Physician Practices" 27 (27): 55-58, 2013

114 Eden, K. B., "Barriers and Facilitators to Exchanging Health Information : A Systematic Review" 88 : 44-51, 2016

115 Vest, J.R., "Association between Use of a Health Information Exchange System and Hospital Admissions" 5 (5): 219-231, 2014

116 Hessler, B. J., "Assessing the Relationship between Health Information Exchanges and Public Health Agencies" 15 (15): 416-424, 2009

117 Shapiro, J.S., "Approaches to Patient Health Information Exchange and their Impact on Emergency Medicine" 48 : 426-432, 2006

118 Genes, N., "Adoption of Health Information Exchange by Emergency Physicians at Three Urban Academic Medical Centers" 2 (2): 263-269, 2011

119 Merrill, J.A., "A System Dynamics Evaluation Model : Implementation of Health Information Exchange for Public Health Reporting" 20 (20): e131-e138, 2013

120 Adler-Milstein, J., "A Survey of Health Information Exchange Organizations in the United States : Implications for Meaningful Use" 154 (154): 666-671, 2011

121 Silvester, B.V., "A Shared Electronic Health Record : Lessons from the Coalface" 190 (190): S113-S116, 2009

122 Overhage, J.M, "A Comparison of the Completeness and Timeliness of Automated Electronic Laboratory Reporting and Spontaneous Reporting of Notifiable Conditions" 98 (98): 344-350, 2008