www.khidi.or.kr, www.khiss.go.

kr

_ 2017. 3. 13 _ _
Vol. 232

DHC
, , , ,

Contents

.1

.2

.3

1
1. 
() .(:
HI14C2756)

2.  2015
( ,
HI14C2756) .

3.  KHIDI (www.khidi.or.kr)
(2 )


 , ,

2015 1 (Precision Medicine Initiative)

ICBM(IoT+Cloud+Big Data+Mobile) , AI,

 2015 71.3%
[1]

- : 100%, 91%, 76%, 61%

- : 4.8%

 (Office of the National Coordinator for Health Information

Technology, ONC) , ,

- , ,

- ONC ONC

(Meaningful Use, MU) (Centers for Medicare and

Medicaid Services, CMS)

- 232 1 2 (2016.12.20)

, , ,

- 6 21 ,

- 16 (2016.2.5) (

) [2]

(, )

- (2017.1.1)

4(, , , ) ,

[3][4]

(Health Information Exchange, HIE)

[5]

[6]


[3]

[4]

 CDA ,

- (Repository) ,

(Registry)

Message
CDA

CDA

CDA

[1][7]

 , ,

NHIN(National Health Information Nework)

Canada Health Infoway EHR

(Health Information Access Layer, HIAL)

,
NPfIT(National Programme for IT) 2003 30,000 GP(General

Practitioners) 300 NHS(National Health Service)

, , ,
PCEHR(Personally Controlled Electronic Health Record) DB

(Standardized Structured Medical record Information eXchange, SSMIX)

(, , , )
(Repository) () ,

 , , , ,

- ONC HITECH(Health Information Technology for Economic and Clinical Health Act, 2009)

(Electronic Health Records, EHR)

220 EHR

EHR ,

, , CMS

MU(Meaningful Use) EHR MU Stage , ,

MU Stage1 ,

, , ,

EHR

MU Stage2 , ,

IT

MU Stage3 , , , ,

2014, 2015 EHR MU Stage2, 3 2018 MU Stage3

[8]

- NPfIT 11.3 2003 10 30,000 GP 300

NHS(National Health Service)

1998 2000

NPfIT IT NHS

 ,

- CHIMA(Canadian Health Information Management Association)

, ,

, ,

Top-down Bottom-up

, ,

1: (, )

2: (, , )

3: ( )

4:

, ,

- ONC , , , ,

- Health Infoway 2000 e-Health ,

- e-Health , .

 , ,
, -IT

IHE ATNA
NMPI, IHE PIX

(Ministry of Health Registry HL7 CDA XDS IHE PDQ

and Welfare) Repository IHE CT

IHE DSG

XDS
NHIN (National
HL7 C-CDA XDR(Cross-
Health Information IHE PIX
(Consolidated Enterprise
ONC (Office of Nework) IHE PDQ(Patient
CDA) Document Reliable
the National Demographics
HL7 CCD Interchange)
Coordinator) network- of- Query) IHE CT
(Continuity of Care XCPD(Cross-
network IHE ATNA
Document) Community Patient

Discovery Profile)

Canada Health
Infoway Electronic
Health Record
Infostructure
CHIMA (Canadian
(EHRi)
Health Information Infoway XDS
HL7 CDA Privacy&Security
Management XDS-I
Conceptual
Association) EHR
Architecture: The
ISO17799: 2005;
ISO27001
IHE ATNA

NEHTA (National

e-Health
PCEHR HL7 CDA XDS
Transition

Authority)

NHS(National NPfIT
Programme for NHS

healthcare system (National Health HL7 CDA XDS

development in Service)
England)

IHE ATNA
IHE CT
IHE DSG
ASIP Sant DMP(Dossier (Document Digital
XDS
(Agence des Medical Signature)
XDS-SD
Systmes d Personnel) HL7 CDA IHE PDQv3
XUA
Information (Patient
XDS-I.b
Partags de Sant) Demographics
QueryHL7v3)
IHE MU(Metadata
Update)

MOH(Ministry of MOH(Ministry
HL7 CDA XDS
Health) of Health)

SS-MIX
(Standardized
MHLW (Ministry
Structured Medical HL7 CDA XDS
of Health, Labour
record Information MFER XDS-I
and Welfare)
eXchange)


, 2016

2016
4 , ,

 201661 2017422 745

277

35

30

25

20

15

10

0
6 2
6 3
6 4
6 5
7 1
7 2
7 3
7 4
7 5
8 1
8 2
8 3
8 4
9 1
9 2
9 3
9 4

1 1
1 2
1 3
1 4
1 5
2 1
2 2
2 3
2 4
3 1
3 2
3 3
3 4
4 1
4 2
4 3
6 1

1
2
3
4
5
1
2
3
4
1
2
3
4

10 10 10 10 10 11 11 11 11 12 12 12 12

: (2017),

[ 1]

 201671 2017415
1,967 2,096, 118

120

100

80

60

40

20

0
7 1
7 2
7 3
7 4
8 1
8 2
8 3
8 4
8 5
9 1
9 2
9 3
9 4

1 1
1 2
1 3
1 4
1 5
2 1
2 2
2 3
2 4
3 1
3 2
3 3
3 4
4 1
4 2
1
2
3
4
5
1
2
3
4
1
2
3
4
10 10 10 10 10 11 11 11 11 12 12 12 12

(1,967) (118) (2,096)

: (2017),

[ 2]

 , , ,
2, 3

ONC , ,

EuroRec EHR Quality Seal

- , ,

10
 -

- , , ,

CMS Meaningful Use(MU) 180

ONC , , ,

(repositories) 20

- , (General Practitioner,

GP)

- ,

, ,

 -IT

- ONC HITPC(Health IT Policy Committee) HITSC(Health IT Standards Committee)

- ,

) SAM file(Sequential Access Method File) : .

11


- ,

1
[7]

Patient ID Feed MPI 1 Registry & n Repository

Patient PID(Patient ID: Key)
API
Index
PID

PID

Registry
Meta Document ID/ (PID )
Patient Info
Entry

Retrieve

/Repository /Repository

Meta Meta
Database Database

PID Metadata Metadata

(Privacy & Security)

1(Client) 2(Client) 3(Client) 4(Client)

[ 3]

 Registry, Repository, Client, , Privacy & Security MPI

 ,

12


Registry Repository MPI & OID

Metadata

Metadata

HIE Utility & Privacy & Security

[ 4]

,
Registry

, Document Consumer
Repository

ID ,
MPI OID

,
. Registry MPI ,

,
, KCD-7, KD, ATC, ICD-9-CM, EDI,
LOINC

HIE Utility

Notify ,

,

,
Privacy and , ,
Security , / ,

13


() , KCD-7

() KD, ATC

() , EDI

() , ICD-9-CM

()

()

(/) , LOINC

(Registry)

(Repository)

CDA(Clinical Document Architecture)

HL7 Messaging Standard

XDS.b(Cross-Enterprise Document Sharing-b )

XDS-I.b(Cross-enterprise Document Sharing for Imaging-b)

PIX(Patient Identifier Cross-Referencing)

PDQ(Patient Demographics Query)

MPI(Master Patient Index)

OID(Object IDentifier)

BPPC(Basic Patient Privacy Consents)

TLS(Transport Layer Security)

ATNA(Audit Trail and Node Authentication)

CT(Consistent Time)

DSG(Document Digital Signature)

14


: , KCD-7

- Local

()

- KCD-7(Korean Classification of Diseases 7)

: KD, ATC

- (KD, Korea Drug Code)

, KD (ATC)

: , EDI

EDI

: , ICD-9-CM

- ICD-9-CM

- CT, MRI

15


: Registry

- Metadata

: Repository

CDA: Clinical Document Architecture

- HL7

HL7 Messaging Standard

XDS.b: Cross-Enterprise Document Sharing-b

- , ,

XDS-I.b: Cross-enterprise Document Sharing for Imaging-b

- , ,

PIX: Patient Identifier Cross-Referencing

- ID

ID

PDQ: Patient Demographics Query

MPI: Master Patient Index

- , , Index

OID: Object IDentifier

- ID

BPPC: Basic Patient Privacy Consents

16
 TLS: Transport Layer Security

- TCP

ATNA: Audit Trail and Node Authentication

- ,

CT: Consistent Time

- actor 1

DSG: Document Digital Signature

3
[3]

: R(), R2( *), O()

CRS

R Y Y Y R

O
R2 Y Y Y
R

17


CRS

R
R2 Y Y Y
R

R2

R

R2 Y Y Y
R

R2

R
R2 Y Y Y
R

R2

R
R2 Y Y Y
R

R2

R2 Y Y Y R

R2 Y Y Y R

18
 CRS

R2 Y R

O
R2 Y
() O

() O

R
O Y
R

R
O Y
R

O
R2 Y
O

R2
R2 Y Y
R2

R2 Y R2

R2 Y R2

R2 Y R2

R2
R2 Y
O

* R2:

19


[1] (1), 2015.11,

[2] , 2016.8, 2016-140

[3] , 2017.1, 2016-233

[4] (), 2016.10,

[5] , 2011.01,

[6] Key Issues of Technical Interoperability Solutions in eHealth and the RIDE Project, 2007.02, D.
Asuman, N. Tuncay, O. Alper, L. Gokce, K. Yildiray and E Marco

[7] (2), 2016.11,

[8] https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/index.html

[9] 2012 -IT , 2013.06,

: DHC , , , , : 043-713-8790

,
.

(http://www.khiss.go.kr) PDF
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Korea Health Industry Development Institute