• 한국정보통신학회:학술대회논문집
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• 한국정보통신학회 2014년도 춘계학술대회
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• pp.609-612
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• 2014

최근의 IT의 발달로 스마트 단말의 보급이 확산되고 있고, 원격진료 및 전자의무기록(EMR) 등의 보편화로 인하여 장소를 가리지 않는 의료 환경으로 디지털화 되어 발전되고 있다. 이러한 정보화 트렌드에 맞춰 스마트 단말을 활용한 모바일 의료정보시스템 구축에 증대되고 있다. 본 논문에서는 최근의 의료정보기술 표준화 동향을 살펴보고, 향후 의료정보시스템 전망을 예측하여 본다. 또한 모바일 의료정보시스템의 보안적 측면을 살펴보고 국내에서의 모바일 기반 의료정보시스템의 필요한 동향 및 표준에 대하여 논의한다.

• Archives of Plastic Surgery
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• 제48권3호
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• pp.295-304
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• 2021

Clinical photography is an essential component of patient care in plastic surgery. The use of unsecured smartphone cameras, digital cameras, social media, instant messaging, and commercially available cloud-based storage devices threatens patients' data safety. This paper Identifies potential risks of clinical photography and heightens awareness of safe clinical photography. Specifically, we evaluated existing risk-mitigation strategies globally, comparing them to industry standards in similar settings, and formulated a framework for developing a risk-mitigation plan for avoiding data breaches by identifying the safest methods of picture taking, transfer to storage, retrieval, and use, both within and outside the organization. Since threats evolve constantly, the framework must evolve too. Based on a literature search of both PubMed and the web (via Google) with key phrases and child terms (for PubMed), the risks and consequences of data breaches in individual processes in clinical photography are identified. Current clinical-photography practices are described. Lastly, we evaluate current risk mitigation strategies for clinical photography by examining guidelines from professional organizations, governmental agencies, and non-healthcare industries. Combining lessons learned from the steps above into a comprehensive framework that could contribute to national/international guidelines on safe clinical photography, we provide recommendations for best practice guidelines. It is imperative that best practice guidelines for the simple, safe, and secure capture, transfer, storage, and retrieval of clinical photographs be co-developed through cooperative efforts between providers, hospital administrators, clinical informaticians, IT governance structures, and national professional organizations. This would significantly safeguard patient data security and provide the privacy that patients deserve and expect.

• Journal of Korean Biological Nursing Science
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• 제24권3호
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• pp.161-170
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• 2022

Purpose: The purpose of this study was to investigate polypharmacy and potentially inappropriate medication (PIM) use in elderly patients admitted to hospitals after falls. Methods: The study surveyed 283 patients 65 or older admitted January 1-December 31, 2016. Data were collected from electronic medical records, and medications administered immediately prior to admission were examined. PIM use for patients was investigated using the Beers criteria, and data were analyzed by Chi-square test and independent ttest. Results: The average age of participants was 79.42± 8.16, and the study included 226 women (79.9%) and 57 men (20.1%). The average number of self-administered medications daily was 4.94± 3.68, and 55.1% took five or more medications. PIM use was found in 107 patients (37.8%). There was a significant difference in polypharmacy according to age, and the proportion of medical aid beneficiaries and prevalence of cardiocerebrovascular, endocrine, and other chronic diseases were higher in the polypharmacy and PIM use patients than in the non-polypharmacy and non-PIM use patients. The number of chronic diseases and medications taken were significantly high among polypharmacy and PIM use patients. Conclusion: It is necessary to minimize polypharmacy and PIM use, and establish a system for systematically evaluating and managing medication use to prevent falls in the elderly.

• 대한한의학회지
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• 제30권1호
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• pp.40-50
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• 2009

Objectives: The clinical document forms, a format for collecting clinical data, is the most fundamental object of standardization. Doctors must have a mutual understanding of the clinical chart. Methods: Clinical document forms were developed by investigating existing conditions in hospitals and conducting demand surveys, doing literature research, and seeking expert advice for the improvement of version 1.0. In addition, an organization of a network of 19 Oriental medical doctors and nurses, 190 patients, and users of collected and assessed data was formed to come up with version 2.0. Results: The overall format was divided into different portions that the patient, nurse, and doctor must fill out, respectively. The patient's section consists of demographic data, lifestyle details, history, and symptoms. The data to be supplied by the nurse include the patient's vital signs and anthropometric parameters. As for the doctors, they are to supply data regarding the patient's palpitation, the detailed symptoms of the patient's head, ophthalmological and otorhinolaryngological symptoms (mouth), respiration, circulatory organ and chest conditions, digestive-organ conditions (thirst), neuropsychiatric conditions, reproductive system, musculoskeletal system, skin (depilation), etc. Conclusions: Common clinical chart development is the prior question to Traditional Korean Medicine standardization. A web-based clinical document format should be developed to support diagnosis and treatment, and furthermore EMR (electronic medical record system) and EHR (electronic health record) developed. Clinical information could be shared through a network of medical institutions and be useful Traditional Korean Medicine for evidence-based medicine.

• 정보보호학회논문지
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• 제30권6호
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• pp.1103-1113
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• 2020

병원에서는 의료 기록저장 시스템 EMR (Electronic Medical Record)을 통하여 개인 정보 및 건강 정보를 저장 및 관리한다. 그러나 병원의 정보 공유를 위한 다양한 서비스를 제공함에 따라 취약점과 위협이 증가하고 있다. 따라서 본 논문에서는 EMR에서 환자 정보의 전송으로 인한 개인 정보 유출을 방지하기 위한 모델을 제안하였다. 환자의 의료 기록이 저장된 병원으로부터 환자 정보를 안전하게 수신 및 전달할 수 있는 권한을 부여하기 위한 방법을 OAuth 권한 위임 토큰을 사용하여 제안하였다. OAuth Token에 의사 정보와 환자가 원하는 기록 열람 제한을 적용하여 전달함으로써, 안전한 정보 전달이 가능하도록 프로토콜을 제안하였다. OAuth Delegation Token은 환자 정보를 열람할 수 있는 권한, 범위, 파기 시점 등을 작성하여 전달 가능하다. 이를 통하여 안전한 환자 정보 전달 및 환자 정보 재사용 금지를 방어할 수 있다. 또한, 불법적인 환자 정보 수집을 방지하고 전달 과정에서 발생할 수 있는 개인 정보의 유출을 방지한다.

• 한국산업정보학회논문지
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• 제14권2호
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• pp.32-50
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• 2009

의료 정보화는 정보기술 발전과 사회환경의 변화와 더불어 양질의 진료와 고객관리 및 경영효율화의 필요성으로 1990년부터 처방전달시스템(OCS)을 도입하면서부터 시작되었다. 의료계의 정보화는 빠른 속도로 발전하고 있으며, 원격진료 시스템 도입과 각종 U-Health Care 관련 제품 및 의료 서비스 등 유비쿼터스 환경으로 새로운 변화를 맞고 있다. 최근 의료계와 정부는 병원에 발생하는 모든 진료기록을 디지털화 하여 관리하는 전자의무기록(EMR)에 관심을 가지게 되었다. 특히 환자 진료데이터 기록은 계속적인 진료관리와 치료 내용을 기록한 것으로 매우 중요하며, 대형 의료기관을 중심으로 EMR시스템 도입이 늘고 있다. EMR시스템은 진료 중 발생한 환자의 진료정보를 전산화함으로써 고객서비스 향상, 대기시간 단축, 진료의 질 향상, 진료정보의 다양한 활용, 정확한 진료, 비용 절감, 진료부서 및 진료 지원부서 등의 업무효율화를 가져와 병원의 경쟁력을 확보하게 한다.

• Clinics in Shoulder and Elbow
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• 제27권2호
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• pp.176-182
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• 2024

Background: This study compares the outcomes of Latarjet-Patte procedures (LPs) performed for primary glenohumeral instability in the setting of critical bone loss (LP-BL) versus salvage surgery performed after a failed arthroscopic Bankart repair (LP-FB). Methods: LP's performed by senior author from 2017 to 2021 were separated into cohorts by LP indication. Data abstracted from electronic medical records included demographic information, preoperative clinical scores, radiological imaging, and complications. Postoperative clinical outcome scores collected after a 2-year minimum follow-up included: patient-reported outcomes measurement information system (PROMIS) upper extremity (UE), PROMIS pain interference, PROMIS pain intensity, American Shoulder and Elbow Surgeons (ASES), and visual analog scale pain scores. Results: A total of 47 patients (LP-BL: n=29, LP-FB: n=18) with a mean age of 29 years (range, 15-58 years) were included in this study. Both cohorts achieved good upper extremity functionality without significant differences as indicated by mean PROMIS UE (LP-BL: 52.6±10.0 vs. LP-FB: 54.6±7.6, P=0.442) and ASES score (LP-BL: 89.9±15.7 vs. LP-FB: 91.5±14.4, P=0.712). However, the LP-FB cohort reported lower levels of pain (LP-FB: 0.5±1.1 vs. LP-BL: 1.9±2.7, P=0.020) at their latest follow-up. There were no significant differences in complication rates including re-dislocation between cohorts (LP-BL: 2/29 [6.9%] vs. LP-FB: 2/18 [11.1%], P=0.629). Conclusions: When performed after failed Bankart repair, the LP results in similar postoperative functional outcomes and similar rates of complications and re-dislocations when compared to the primary indication of recurrent glenohumeral instability in the setting of critical bone loss.

• 한국임상약학회지
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• 제27권2호
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• pp.92-98
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• 2017

Background: Nebulized colistimethate is increasingly used, because there are problems such as renal dysfunction and low distribution within the lungs when colistimethate is administered intravenously. This study was designed to compare and analyze the changes in renal function by of nebulized colistimethate treatment for its safe administration. Methods: This study retrospectively reviewed the electronic medical records of adult patients above 19 years old, receiving only the nebulized colistimethate at least 4 days in Yonsei university health system from Nov 2014 to Aug 2015. Acute kidney injury (AKI) was determined by using the RIFLE criteria (Risk, Injury, Failure, Loss and End-stage renal disease) according to serum creatinine (SCr) levels before and after use of nebulized colistimethate. Results: 48 patients were included our study and their SCr increased significantly after nebulized colistimethate treatment ($SCr_0$ vs. $SCr_1$; $0.85{\pm}0.80$ vs. $1.00{\pm}0.82mg/dL$, n=48, p<0.001), but the changes were in normal range according to the standards at Yonsei university health $system^a$. Among 48 patients, 38 patients were in the non-AKI group (79.2%), and 10 patients developed AKI (20.8%). Within the AKI group, 2 patients were in the Injury group (20%) and the other 8 in the Risk group (80%). Conclusion: There was no significant difference in age, dosage and duration of treatment between AKI group and non-AKI group (p>0.05). The study has a significance in that it reviewed the safety of nebulized colistimethate only treatment to national patients, analyzing its nephrotoxicity. It has confirmed that nebulized colistimethate is a safer method than intravenous injection, and requires to establish a guideline for the use of nebulized colistimethate in further studies with broader patient groups. $^a$ : SCr Male 0.68-1.19 mg/dL, Female 0.49-0.91 mg/dL.

• 병원약사회지
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• 제35권4호
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• pp.391-399
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• 2018

Background : The Antimicrobial Stewardship Program promotes interdisciplinary interventions and targeted recommendations for the proper utilization of antibiotics. In particular, the aim of the program is to avoid indiscriminate use of broad-spectrum antibiotics based on the documented literature on the significant impact of unsystematic usage of antibiotics on the distribution of antibiotic-resistant microorganisms. To improve the care process for pneumonia treatment using antimicrobial agents, institution-level guidelines were established and disseminated at the Seoul National University Bundang Hospital in April 2016. In this study, we evaluated changes in the physicians'antibiotic prescribing patterns both before-and after-the implementation of the guidelines. Methods : The electronic medical records of inpatients who were prescribed with one or more antibiotics in May 2014 (Group A) and May 2016 (Group B) were reviewed. Data on demographic characteristics, clinical outcomes, and antibiotic prescriptions were collected and the prescription records were compared both before- and after- the implementation of the guidelines. Results : A total of 180 patients were included in the study: 77 patients in group A and 103 patients in group B. The baseline characteristics of the patients were not significantly different between the two groups. Community-acquired pneumonia was the most common diagnosis in both the groups and the difference was not significant (68.8% vs. 67.9%; p=0.67). The type of antibiotic prescriptions used for empirical treatment was not different between the two groups. The most commonly prescribed empirical antibiotics were cephalosporins, with no significant difference (p=0.31). One of the most inappropriately used antibiotics was piperacillin/tazobactam and the rate of prescription was similar in both the groups (p=0.68). The rates of appropriate empirical selection of antibiotics remained unaltered between the two groups (67.5% vs. 71.8%; p=0.53). Conclusions : Implementation of the guidelines only exhibited no significant effect on the antibiotic prescribing patterns of physicians for the treatment of pneumonia. To improve the adequate use of empiric antibiotics, more active interventions and closer monitoring of the feedbacks should be additionally considered and evaluated in future studies.

• 한국임상약학회지
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• 제25권3호
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• pp.138-144
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• 2015

Objective: It is to evaluate the drug interaction monitoring program as a pilot project to develop a pharmaceutical care model in a medical intensive care unit and to analyze the influencing factors of drug interactions. Method: Electronic medical records were retrospectively investigated for 116 patients who had been hospitalized in a medical intensive care unit from October to December in 2014. The prevalence of adverse reaction with risk rating higher than 'D' was investigated by Lexi-$Comp^{(R)}$ Online database. The factors related with potential drug interaction and with treatment outcomes were analyzed. Results: The number of patients with a potential interaction of drug combination was 92 (79.3%). Average ages, the length of stay in the intensive care unit and the numbers of prescription drugs showed significant differences between drug interaction group and non-drug interaction group. Opioids (14.4%), antibiotics (7.2%), and diuretics (7.2%) were most responsible drug classes for drug interactions and the individual medications included furosemide (6.4%), tramadol (4.9%), and remifentanil (4.5%). There were 950 cases with a risk rating of 'C' (84.6%), 142 cases with a risk rating of 'D' (12.6%), and 31 cases with a risk rating of 'X' (avoid combination) (2.8%). The factors affecting drug interactions were the number of drugs prescribed (p < 0.0001) and the length of stay at intensive care unit (p < 0.01). The patients in intensive care unit showed a high incidence of adverse reactions related to potential drug interaction. Therefore, drug interaction monitoring program as a one of pharmaceutical care services was successfully piloted and it showed to prevent adverse reaction and to improve therapeutic outcomes. Conclusion: Active participation of a pharmacist in the drug management at the intensive care unit should be considered.