How South Korea is fixing problematic hospital data

In a 2018, a survey by Stanford Medicine found that 59% of American primary-care doctors felt that their health information systems needed an overhaul. Common complaints included the increased burden of data entry and distrust in inaccurate recommendations. Why might South Korean insights be useful? It boasts one of the world’s longest-running fully digitized hospitals, connected to its leading university. Seoul National University Bundang Hospital (SNUBH) opened as one of the first paperless hospital in the world in 2003.

The hospital has been formally asking its staff what they need from their digital systems for almost 18 years. A steering committee and research teams deal with ongoing modification requests from clinical and non-clinical staff. In a Nature article on digital health in 2019, Robert Wachter, who leads the department of medicine at the University of California, San Francisco, largely blamed an ongoing American physician burnout crisis on user interfaces that hide crucial clinical information behind dozens of clicks.

“Most of the current digital health products on the market fail to visualize longitudinal data in a meaningful and relevant way for physicians,” agrees SNUBH President Rong-Min Baek, a reconstructive surgeon. In 2013, SNUBH designed a new adjustable physician module that visualizes a patient’s most important longitudinal information with the least number of clicks.

A 2013 upgrade focused on usability, says Baek. Realizing the gap globally, the 900-plus-bed hospital looked at more than 3,000 issues and ideas sourced from hospital clinicians and users. The result included a one-glance patient overview (surgical procedures, diagnoses, discharge summaries, test results, and medications.); archived images from areas such as cardiology and radiology, as well as the ability to compare images in a single window; larger, more high definition monitors; and the ability to individually configure the interface. Communication technologies, such as email, phone, messenger, video calls, and video conference systems, were also integrated.

Holistic systems needed

The South Korean hospital’s digital developments haven’t been part of a rapid roll-out of regulatory incentives, unlike 80% of hospitals in the United States, where digitization is the most widespread. This has allowed the hospital to sidestep a piecemeal and third-party driven approach to system development that is now creating interface problems, says Baek. SNUBH has a hospital-wide web-based set-up called BESTCare. It includes most ancillary systems, such as the physician, nurse, pharmacy and laboratory systems involved in the admission, discharge and transfer process.

In 2017, in a paper published in The Lancet, data and administration duties were identified as leading contributors to burnout in more than 50% of physicians in the United States. But done right, digital systems should lead to less human error, and data entry and administration efficiencies, says Baek. After pilot trials and analysis, SNUBH has added sensor-driven equipment and workflow tracking. Radio-frequency identification (RFID) technologies and barcoding help track everything from medication returns, and blood samples and transfusions to drug delivery, medical administration and food/nutrition management. “We went on to integrate a big data analytics tool to provide real-time monitoring and feedback on various quality and efficiency measurements,” adds Baek.

Digital health’s benefits should be huge for patients. Algorithms developed at the hospital have helped to improve SNBUH’s vaccine management system, renal dosing system and acute renal injury prediction system, among others. Baek points to data gathering and analysis that led to a 4.6% in drop in unnecessary antibiotics use at SNUBH, reducing the risks of antimicrobial resistance. With rapidly improving machine learning, outcomes like this should exponentially increase.

With this in mind, South Korea is building a standardized national-level public health record system and hopes to move towards AI-based population health management. BESTCare is already used by 50% of South Korean hospitals and has recently been rolled out in the Middle East and the United States. A cloud-based system designed to be affordable for smaller hospitals has also been recently launched.

But even for national-level efforts, the soft skills of listening to the experiences of real users is fundamental, says Baek. Developing systems that encourage less routine data entry means the quality of data improves, and eventually this combined with machine learning will make personalized and precision medicine possible. “What good is it if you put in the time to tick all the boxes in the system, but the return is lacklustre?” says Baek. “Figuring out how best to support the accumulation of quality health data means we will be able to be agile about analytics in the future.”

Using BESTCare, SNUBH became the first Stage 7 HIMSS EMRAM certified hospital outside the United States in 2010. It is internationally certified by ONC-HIT and HIPPA. It also strictly follows globally standardized terminologies, adopting SNOMED CT, ICD-10, RxNorm, LOINC and ICNP.