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Use of classifications in Korea
The 6th Meeting of the Asia Pacifi c Network of the WHO Family of International Classifi cationsBangkok
July 18, 2013
Korean Collaborating Center Sukil Kim
Current status of ICD in Korea• Maintenance• Usage
Changing health information envi-ronment• Change of hospital information system• New roles of health information man-
ager• Action to be taken for the future
Contents
By the Statistics Korea under the law• Practically by Korean Medical Record
Association (KMRA) Local extension by large scale hospi-
tals KCD-6 since 2011
• Modification of ICD-10 2008version
Maintenance
Vital statistics Administration, clinical care and re-
search• Health insurance claims (Fee For Ser-
vice)• Hospital administration• Electronic Medical (Health) Record• OECD reports
Use of mortality and morbidity data
National death registration system• Operation
• Ministry of Security and Public Adminis-tration
• Submission of death certificates signed by doctors to regional district office
• No funeral without the document
• Ministry of Health and Welfare
• Annual report• By Statistics Korea since 1980
Mortality statistics
Status of mortality data in Korea by Colin D. Mathers, et al. Mar. 2005, WHO Bulletin• Coverage: 88%• ill-defined code: 14%
Mortality statistics
1980 1990 2000 2010
Health insurance program for public officers and private school employees
Health insurance program for private companies
Health insurance for all Korean
Health insurance reformSeparation of prescribing and dispensing of drug
Softwarefor medical claims
EMR market for private clinics
EDI for insurance clams
CPOE
e-prescription
Concept of EHR
Hospital EMR
Partial approval of electronic prescription, Electronic health record, Telehealth by revision of the law
Trend of health information system in Ko-rea
Diagnosis No. of pt. LOS %
1 Liver & Bile duct cancer 6760 11.3 8.4
2 Chronic ischemic heart disease 3689 5.7 4.6
3 Stomach cancer 3337 9.3 4.1
4 Lung cancer 2035 4.5 2.5
5 Chronic renal failure 1885 9.3 2.3
6 Cholelithiasis 1820 9.7 2.3
7 Cataract 1590 2.1 2.0
8 Liver cirrhosis 1481 12.6 1.8
9 Leukemia 1096 21.0 1.4
10 Breast cancer 1063 12.3 1.3
……………. … … …
100 Necrosis of bone 148 17.2 0.2
Total 59128 (83371)
9.3 (8.7)
73.3(100)
Hospital morbidity statistics by the main con-dition of patients in an university hospital
Use of ICD for Hospital manage-ment
•
• 1.61
• 1.27
• 0.90
• 1.31• 1.17
• 1.42• 1.42
• 2.03
• 0.94 • 0.79• 0.71
• 0.28• 0.25
• 0.92
• 0.46• 0.59
• 0.0
• 0.5
• 1.0
• 1.5
• 2.0
• 2.5
• 월 • 화• 수• 목 • 금• 토 • 일• 공휴일
• 2002 • 2001• 2002 전체 • 2001 전체
Average LOS of patients with cataract •
• 0.83• 0.75
• 0.63
• 0.93
• 1.35• 1.38
• 0.83• 1.08
• 0.88
• 1.29• 1.32
• 1.02
• 1.10
• 0.54
• 1.13
• 0.83
• 0.0
• 0.5
• 1.0
• 1.5
• 2.0
• 2.5
• 월• 화• 수• 목• 금• 토• 일• 공휴일
• 2002 • 2001• 2002 전체 • 2001 전체
Average LOS of patients with ton-sillectomy
90% of private sector One and only one national health in-
surer Legal submission of medical claims
to reviewer (Health Insurance re-view and assessment service)
Fee For Service system for both out-patient and inpatient services
Healthcare system
HIS (Hospital Information System) - EMR, OCS(CPOE), CRM, FACS, ERP
EDIDisk (CD, DAT)
Multiple Bar
Coded Paper
Web
Reimbursement of health insur-ance and claims review
HIRA
Reimbursement purposes• Code shift – main condition• Too many additional codes
Health Information Manager• Involved in the valid data for research
and internal management of hospitals
Obstacles
Coding education included in HIM program• University• College
National license since 1985 Continuing education
• By Korean Medical Record Association
Clinical coders in Korea