Build a community based regional health care system referral information
system
--- South of the district health
information system as an example network of referral
Establishing a community-based regional referral system
- An example of a referral system in southern medical network Zhang sound a CAI Lu Yang Zequan d c b Ming-Jer Tsai
a Department of Medicine, National Cheng Kung University, Assistant Professor, Office & Hospital Information Technology Division nckmic@mail.ncku.edu.tw
b National Health Insurance Southern Branch Manager cl@mail.nhisb.gov.tw
c National Cheng Kung University Hospital Emergency Department Director t2195@mail.ncku.edu.tw
d Associate Professor of Business Administration, National Cheng Kung University yong@mail.ncku.edu.tw
Summary
In this paper, build a community based regional health care referral system, information systems, and south of the district health network referral information system for experience, for example, to promote the process of facing all levels of
organization and cross-organizational issues difficulties, and then discussed and recommendations will help Taiwan build a new generation of medical and health information and knowledge networking system to speed up the development of community health care system.
Keywords: referral information system, health care networks, community medical group
Abstract
A community-based regional referral system is proposed and the implementation experience of a referral system in southern medical network is discussed in this paper. Some critical
interorganizational challenges confronted in the implementation process are explored, and some suggestions and conclusions are recommended. Those implementation experiences are expected to help establishing a next-generation healthcare information and knowledge network as well as accelerating the development of a community-based system in the future.
Key Words: referral system, medical network,
community medical group
I. Preface
Experienced a SARS crisis early last year to promote Taiwan's medical system faces review the issue. Previous immunization process can be broadly classified into several directions Review: The Role of medical institutions at all levels and functions of vague, people sought medical treatment at a loss, the referral system is not implemented, the myth of privatization of public hospitals and so on [1 ].
Medical institutions at all levels including the role and function, the Medical Policy Conference and a number of experts claim, universal immunization must be a community health care to start from the clinics, the joint review of its medical needs for people, and as necessary, appropriate referrals to family physicians play function. In addition, primary care and community hospitals should work
together with the composition of community health care network, providing general services to the public, should play a critical care medical center and teaching and research role. Expected by the hierarchical and cooperative medical system in the operation of their duties, so that public health can be best protected and well-being.
To enhance medical cooperation during the post-SARS system efficiency, information technology and Internet applications to play an important strategic role. Medical institutions in Taiwan National Health Insurance since 1995, the widespread use of information technology in hospital management, clinical
services have recently also gradually increase the application of basic information to patients, pathological examination, inspection reports and medical records such as medical imaging, storage in the computer system. Although the medical institutions committed to hospital management and clinical services for computerization, but the hospital information system has long been an
independent development, resulting in easy system integration, resulting in inter- hospital medical information exchange difficult to form the flow of information between health care cooperation system obstacles [2]. Court to resolve the issue of international information exchange and improve operational efficiency across the organization, this paper, build a community based regional health care referral system, information systems, and south of the district health network referral information system for experience, for example, each level of the impetus of our institutions face difficulties in inter-organizational issues and then discussed and recommendations put forward, hoping for Taiwan 建构 new generation of medical health information and Zhishiwanglu system to speed up the development of community health care system.
Two, the regional health care networks,
community medical groups and referral system
Department of Health, started five years since the implementation of the Republic of 70 "medical network plan" to establish regional health care network and the classification system of health care operations. 63rd Medical Law provides that "the central health authorities to promote the balanced
development of medical resources, overall planning of existing public and private medical institutions and human rational distribution of health care should be divided into regions, the establishment of the medical classification system for medical care network implementation plan . " Istration from the fourth medical
network plan, re-planning of the medical area and the Central Health Insurance Bureau and the various branches of the same administrative region, the medical division of the Taipei District, North Medical District, Central Medical District, South District Medical District, Kaohsiung and Pingtung Medical District, Eastern Medical District, six major regional health care system [3].
Taiwan's medical institutions according to the facilities and expertise in
implementation of the scheme, in order to ensure that patients receive the most appropriate medical care, efficient use of overall health care resources, the referral system was set up to encourage grade referral in order to achieve the Department of Health set up "medical net "target [3]. Medical Law 5th 10 provides that "special hospitals, clinics due to limited equipment and expertise, can not determine the cause or provide a complete patient treatment, patient referral should be recommended. ... In the preceding paragraph referral, medical referral should fill out a summary to the patient without undue delay or refusal. "
Therefore, promoting the referral system has long been a regional medical network one of the important tasks.
Community medical group mainly by primary care physicians and family doctors to provide holistic, coordinated, continuous, comprehensive medical and
preventive care of the service, adhere to health-oriented, community-oriented, information-oriented, quality oriented, cost-effectiveness considerations aims to provide community based, individual-centered integrated health care services, to achieve the purposes of promoting community public health [6]. Community
medical group established by the health management information system, department and community-oriented primary care and community hospitals to provide two-way between the referral, consultation and referral of ancillary functions, in order to achieve the ideal of healthy communities. In addition to providing community medical group referral function, the internal network of major hospitals except for medical evacuation hospital designated to accept referral patients, the hospital's own patients in order to increase the source of increased utilization of emergency department and hospital, often with the referral co-operation of small hospitals. The small and medium size hospitals in remote areas where lack of resources or shortage of some specialist, often
through referral to cooperate with health services among the patients receiving a referral by the hospital to provide, to form the complementary value activities among hospitals.
Although the regional medical network, community medical and health insurance policies are strongly promoting the referral system, but at present the referral of patients between hospitals still use manual key referral form, apart from time and effort, lack of timeliness, the medical content resembles incomplete. Institute for the existing medical institutions for the development of international electronic referral system is still hesitant, the following reasons: (1) referral system was not implemented, (2) Most hospitals are not related to the computerization of medical records, (3 ) the legality of electronic medical records have not been expressly provided [4,5]. As the International Court involves the development of electronic referral system between the various medical institutions such as referral and medical summary of the electronic exchange of information, if consistent with each other do not follow the standard medical information, you can not fast electronic exchange of information by which to reach patients referral purposes.
Therefore, this study suggests that regional integration from the perspective of regional health care network for the range, build an integrated model of two-way referral system, and with the area of community medical information system for the referral link exchange, should be necessary; so not only to establish hospitals and clinics cooperation and division of labor, clinics and hospitals can be
strengthened between the two-way referral mechanism, the network will contribute to the establishment of community care and community health care system development.
Parameters, system architecture
To use information technology to strengthen community health system
development, this study area south of the referral network of medical information system as an example of build a community based regional health care referral system, information system development experience. 93 year (hereinafter referred to as the current year) to achieve the layered medical network operation of the health care system, medical network information services in Southern District, set the following main tasks: "to promote the Southern District of medical information networks two-way referral inspection systems, training cooperation personnel and hospital information system vendors for HL7 standard practical applications of medical information capabilities to the establishment of regional information platform for international information exchange applications of hospital based health care system to build community, boost the goal of primary health care services "[7].
Based on the above mission objectives, to build a regional referral information system, first of all to overcome the various levels of medical institutions of the international standard hospital information exchange problems. As a result of a long time and hospital information systems their development does not
communicate with each other, so the build in the Southern District of regional referral information system (hereinafter referred to as the System), is placed in the Southern District planning a medical network sites public service system, which is a Web-based design system architecture, its features are as follows: (1). to the Internet browser institute international information exchange system. (2).
Electronic medical records database of the international application to hospital- based, independent of the existing hospital information system (Hospital Information System, HIS). (3). Designed to exchange information database
integration interface standards, and provide three kinds of integration with the HIS application mode.
Meanwhile, to address different levels of information technology in hospitals and heterogeneous platform issues, the system In addition to the exchange of
information referral system database interface standard HL7 integration and proposed model closely, loosely coupled mode, browser mode of three application model for the selection, so the hospital information system for the application mode can be used with the system integration. In other words, the pilot can either use this set of hospital care network referral systems might follow the standard model of the system self-built server in hospitals within the system through the implementation of the Inter-hospital Referral operations; usually large hospitals consideration of system integration, will be used in close connection with model, while the medium and small hospitals are more often adopted the other two modes. In addition, hospitals may choose to write their own software provides standard HL7 message sent. These inter-hospital referral of HL7
messages Jieke medical network through the South to exchange referral system to achieve inter-hospital medical information exchange and circulation. The referral system and to provide standardized operational mode, HL7 referral information exchange standards and standards of electronic medical records (in HL7/CDAto version), and joined the Department of Health, "Medical Certificate Authority" (HCA) issued by physicians / medical institutions ICcard and the security control
mechanism to build a secure regional e-referral environment [5].
In line with this year's National Health Insurance Bureau to promote the Southern District of "Family Physician Integrated Care System", the system is working with
community medical health management information system to integrate and link referral system. Community Medical Group of the Health Management
Information System which the residents of health information management include: (1) household data,(2) personal health information, (3) patient,
hospitalization and emergency treatment information, (4) preventive health care information and(5) referral of electronic medical records and other five major components. The electronic records of household data, including family members, family history, name, ID number, sex, blood type, marital status, occupation, phone, address. Electronic medical records are based on the referral health care referral details in mind the requirements of a single unit of the original referral information, patient medical history summary, referral purpose of
receiving information referral units, clinics and the findings and recommendations, etc. [6]. Community medical health management information system data
aggregation diagram shown as Figure 1 [6]:
The health system and community medical referral system management
information system data integration and system architecture diagram as shown in Figure 2:
The system architecture diagram, the two systems integration and data exchange method, which carried out the following steps: (1), grass-roots
institutions to referral and co-household data were uploaded to the hospital side of the community medical system and the household regional referral system. As
the end of the clinic is a clinic patient referral system between the system of additional features, only one-way referral, the results can not accept referral
income, so from the Southern District health network referral system to receive and reply to messages and check e-referral medical record review function. (B),
when the case was referred to cooperation in hospital for treatment, the co- transferred out of the hospital clinics reply reply message, and the batch from HIS compile a referral in the referral of cases of electronic medical record summary, transmitted back to households referral system Southern medical network system and referral database. (C), grass-roots institutions can cooperate hospital referral system side of the household, or check the website of the Southern District of medical information referral response. The two systems usingHL7 referral information and the three steps to complete the regional referral systems and community medical referral links and integration of information systems, making the community medical clinics, hospitals and regional health care network co- responsibility of the hospital referral between the flow of information across organizations, and sharing.
Wantonly, system functions and discussion
Establishment of the Institute of regional two-way referral system, and
community medical clinics in cooperation with the hospital side of the terminal and system integration methods, the system function examples enumerate the following:
In line with this system this year to promote community medical groups, in promoting primary health care, the choice to participate in the Central Health Insurance Bureau, "Family Physician Integrated Care System," the 10 private clinic as the target. Primary care physicians to meet the family physician system to promote, in addition to use community health information system input healthy family members of the household, medical and preventive health care and other information, and can use the system and communities to hospitals Shuangxiang referrals. Cooperation in community hospitals, choose the same family physician participation in the pilot program targeted at regional hospitals, two, two affiliated medical groups, hospitals and cooperation of the five primary care clinics, the pilot project can be regulated by the closely related and organization, to work together to form a community health care system. In medical centers, select the two co-responsible for supporting the hospital's medical centers, its play critical care, teaching and research and support role. To enhance the health care
network of community health care system efficiency, medical network in Southern District, two-way referral system implementation, not only in the region of the referral information to exchange, to improve international referral hospital efficiency and relevance of information technology in play the strategic application of community health care network.
Lu, conclusions and recommendations
Since this system is a regional organization of public services across the system, deployment and promotion of the difficulties encountered during the hospital information system much more. Following the building process to discuss issues identified and recommendations: (a), and workflow amendment: Although the use
of health insurance for all medical institutions laid down by Bureau of National Health Insurance referral list, but have different operating procedures for referral, even manual operation handle, so you must first set the referral co-general of the procedures and operating standards, and the pilot hospitals also need to work with the revised referral hospital of the steps. (B), the technical standards adopted: the system in the hospital adopted the international exchange standard edition of the Department of Health referral HL7 international standards, because the information systems of all medical institutions have made no use of HL7 standards so students will need help from the IT staff or vendor standard conversion work. Also various information systems platform, architecture and design methods, how can the hospital system integration and taking into account the international hospital standards of information exchange, is an additional burden on the medical institutions to the problems. (C), center coordinator there:
any of the inter-organization information system center coordinator who must have appeared, from the Southern District of this system is the responsibility of the hospital as a health care network, providing the pilot referral hospital of the International Institute Contact coordination, systems development, set standards and the necessary certification. The pilot hospitals because the system can be developed to share and reduce duplication of manpower and software investment, this system development model can also be applied to future community health care network of other public service systems. (D), the establishment of
partnerships: The system established a community health care system among members of the e-partnership. To enable cross-organization coordination mechanism to operate smoothly in order to maintain cooperation between the follow-up, recommended that hospitals should regularly review the assessment of the pilot, establish appropriate channels of communication and decision-making in order to avoid potential conflicts.
Southern Medical Network two-way referral system implementation can save the referral hospital for the treatment of patients with the international time, reduce the cost of logistics activities outside the hospital, and provide patients with appropriate medical care immediately, so that the members of the community health care system each benefit. Experience from the system implementation of view, application of information technology not only helps layered vertical and horizontal integration of health care can play in the post-SARS period the functions of community health networks to enhance medical cooperation system efficiency.
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Thanks: thank the Department of Health 93 years, "Southern Regional counseling and medical resources, medical integration plan" of subsidies, and the "National Taiwan University College of Medicine Community Medicine Research Group" of technical assistance.
