• Tuberculosis and Respiratory Diseases
• /
• v.59 no.5
• /
• pp.480-486
• /
• 2005

Since the year 2000, lung cancer has become the leading cause of cancer death in South Korea as in many other parts of the world. The current multidisciplinary approach for lung cancer includes a wide range of modalities, not only surgery, radiotherapy, medical drug therapy but also pain control, as well as social and psychological support. Therefore, thoracic surgeons, radiologists, nuclear medicine specialists, anesthetists, psychologist, nurses and social workers as well as medical doctors care for lung cancer patients. Sharing a common treatment protocol and optimal communication are vital aspects of shared care both from a medical and cost-effectiveness point of view. We developed a shared electronic medical record (SEMR) for treating patients with lung cancer in a university hospital to facilitate the sharing protocols and communications between doctors involved in a lung cancer clinic. A SEMR system was developed within a order communication system(OCS) for a lung cancer clinic. The records of radiological, laboratory and pathological studies as well as the records of surgery, chemotherapy, and radiotherapy were stored and presented to all doctors who treat the same patient. Every doctor was allowed to change his/her own records. They could review other doctor s records but could not alter them. With the SEMR, it was expected that the time to complete the medical records for one patient could be reduced because it was easy to review all the data from the other doctors who share the same patient. In addition, the confidence of the doctors who share a common treatment protocol would be higher. Therefore, a shared electronic medical record is expected to improve the quality of patient care.

• Journal of Korean Medical classics
• /
• v.30 no.1
• /
• pp.17-29
• /
• 2017

Objectives : Many curative methods are used utilized in order to rid human body of disease when people become sick. Traditional Korean medicine generally prescribe methods that involve acupunture, moxibustion, or herb formulae. However, different types of foods are sometimes used as well. While wondering the history and efficacy of Qi-elevation foods that were consumed by Koreans in the past, the author discovered that a record from the Joseon Dynasty, called The Daily Record of Royal Secretariat of Joseon Dynasty, henceforth the Records, contained information about different types of porridge. Hence, the author looked through the records of porridge as written in the historical material in an attempt to learn the examples and efficacy of medicine-porridge consumed in Joseon's royal palace. Methods : After searching for the keyword, 'porridge', in the Records as provided by the National Institute of Korean History, the author extracted the porridges recorded during the Yeongjo period that each has its own special name. Results : Different types of porridge were recorded in the Records as following: arrowroot porridge, bean-leaf porridge, mung bean porridge, bean porridge, malt-rice porridge, oriental arborvitae seed porridge, crucian porridge, lotus seed porridge, adlay porridge, red bean porridge, welsh onion porridge, milk porridge, seashell porridge, ginko nut porridge, black sesame porridge, and mandarin porridge. Each porridge was used for the purpose of alleviating any disease that afflicted the king Yeongjo or his royal family members in relation with the ingredient herb's medicinal function. Conclusions : These porridges consumed by the king Yeongjo and his royal family members were used not only with a purpose of aiding their body's recovery from disease, but with the goal to actively curing them of ailments.

• Journal of Korean Academy of Fundamentals of Nursing
• /
• v.15 no.4
• /
• pp.438-448
• /
• 2008

Purpose: The purpose of this study was to identify nursing activities and to analyze patient outcomes related to indwelling urinary catheterization. Method: A review was done of 628 medical records from five units for patients admitted between January 1 and June 30, 2006. Twelve nurses who worked in the same units were interviewed. Results: In the interviews, nurses reported considering several non-invasive interventions prior to catheterization but there were no medical records of this activity. Results from the in-depth interviews showed that infection control activities such as urinary bag management were conducted but again there were no medical records. Seventy-five percent of the catheters were removed without prescription. In the medical records there were no notes for approximately 15%, on the time of first voiding and 80%, on volume of first voiding after removal of catheter. There was a significant difference in hospitalization days between the group catheterized for 5 days or less and the group catheterized for 6 days or more. Conclusion: Results indicate a need to close the gap between recorded and described activities and between current and best evidence based practice. Further study is needed to develop a standard recording system and guidelines related indwelling catheterization to decrease the gaps identified in this research.

• Quality Improvement in Health Care
• /
• v.9 no.1
• /
• pp.52-64
• /
• 2002

Background : Coding of principal diagnosis is essential component for producing reliable health statistics. We performed this study to evaluate the current practice of principal diagnoses determination and coding, and to give some basic data to improve coding of principal diagnosis. Method : Nineteen medical record administrators (MRAs) of 3 university hospitals participated in coding principal Dx. from August 1, 2001 to August 31, 2001. From each hospital, 10 medical records of patients with high frequency disease were selected randomly. Each 10 medical records were grouped into three (A. B, C). Then, these 30 medical records were given to each MRAs for coding. At the same time questionnaire was given to each of them. Questions were to prove how they decide and code the principal diagnosis among many current diagnoses; how they decide and code the principal diagnosis when they see irrelevant diagnosis recorded as the principal diagnosis in medical record, when only tentative diagnoses were recorded without final diagnosis, and when different diagnoses were recorded in different sheets of same record. Agreement of coding among 3 hospitals were compared and survey results were analysed with SAS 6.12. Results : Agreement of coding was found in medical records 5-6 of each 10 medical records. Causes of disagreement were as follows. Difference of clinician's opinion from each hospital; mixed use of guideline from KCD-3 and guideline from DRG; difference in 4th digit classification according to the absence of pathology report in the medical record; difference of abbreviations among hospitals. 57.9% of MRAs selected the principal diagnosis recorded by physician, 42.1% of MRAs decided principal diagnosis after consulting to KCD-3 guideline. When there were difficulties in determining the principal diagnosis, 42.1% of MRAs decided principal diagnosis after discussion with the physician, 26.3% after discussion with fellow MRAs. Conclusion : There were differences in codings among hospitals. To minimize the difference, we suggest the development of disease-specific guidelines for coding in addition to the current general guideline such as KCD-3. To do this, Coding Clinic which can produce guidelines is needed.

• The Journal of Korean Medical History
• /
• v.26 no.1
• /
• pp.41-53
• /
• 2013

In this paper, King Kyung-Jong's strange diseases which had been exacerbated by the Sinim-Sahwa(辛壬士禍) are researched and discussed. The subject will be described mostly based on health and medical records from "The Daily Records of Royal Secretariat of Chosun Dynasty(承政院日記)" and "The Annals of the Choson Dynasty(朝鮮王朝實錄)". Sinim-Sahwa had occurred for two years. It is thought that the beginning of it was 'a controversy on a proclamation of a crown prince, Yeon Ing Goon'. At the first year of Kyung-Jong's ruling, August 21, the No-Ron demanded a king's heir be decided as soon as possible, the king asked Yeon Ing Goon as his successor because of his 'strange diseases'. In October of the same year, the conflict between No-Ron and So-Ron parties reached its peak after a dispute about 'regency from behind the veil for the crown prince' at that time. Kyung-jong added that he had a mysterious and heavy disease and there was little hope to recover from it. Some opposing courtiers emphasized the king was in his good health and there weren't any actual diseases he suffered. But Kyung-Jong stubbornly persisted the diseases he had were so heavy that he couldn't get well readily. In detail, he announced his disease had so deeply rooted in internal organs that he could feel some kind of heat and fire arousal form his heart, then rage and resent soaring. Eventually, on 16th, the No-Ron party followed the king's demand, thus the king's health and illness condition itself was gradually getting off the subject. It seems that Kyung-jong's strange diseases was hwa-byung(火病). His symtoms are similar to the symtoms of hwa-byung. Environment he lived, was enough to cause hwa-byung. as a result, Sinim-Sahwa was the event what his hwa(火) was erupted.

• The Journal of Korean Medical History
• /
• v.23 no.1
• /
• pp.105-113
• /
• 2010

Seungjeongwon Ilgi["承政院日記"], the Diaries of Royal Secretariat of the Joeson Dynasty is the most massive compilation of records in Korean history. Medical records in Seungjeongwon Ilgi have been studied but the procedures of clinical discussion[議藥] have not yet been studied. In this paper, main agents of clinical discussion, formation of participant doctor system, particularity of clinical discussion in Royal Court and problems derived from it will be discussed. Main agents of clinical discussion were court doctors[內醫], royal doctors[御醫] and participant doctors[議藥同參]. The king himself decided ultimately as a matter of form. Head of the Medical Dpt. of the Palace[藥房都提調] was in charge of attending to king, but head of the court doctor[首醫] led the actual discussion of deciding treatment. The Medical Dpt. of the Palace[內醫院] was divided into three sectors-court doctor division, acupuncture doctor division and participant doctor division. Palace doctors payed a great attention to avoid serious error. This tendency led them occasionally to passive management. Sometimes aggressive treatment is needed in the course of treating disease, but palace doctors tended to choose slow and gradual methods. It induced minor conflict between palace doctors and participant doctors from outside palace, because doctors from outside palace subordinated effectiveness. Their opinion had not been always recognized by court doctors. However, their role was meaningful because they provided flexibility to the rigidity of clinical discussion in the palace. It is important to evaluate clinical records in Seungjeongwon Ilgi["承政院日記"]. If we have broader eye on the clinical procedure in the palace, we can estimate the value of the contents more objectively and accurately.

• Research in Community and Public Health Nursing
• /
• v.9 no.2
• /
• pp.303-312
• /
• 1998

The purpose of this study was to survey the knowledge level, attitude and practice of nurses toward their work. The subjects of the study were composed of 98 nurses from 3 general hospitals, 1 oriental medical hospital, 2 health centers and several community health posts and schools. Data were collected from May to October, 1998. In data analysis, an SPSS PC program was utilized for descriptions. 1) 16 nurses (16.3%) experienced medical accidents on the 7 nurses(7.1%) 1 time, 6 nurses (6.1%) 2 times, and 3 nurses(3.1%) 3 times. 2) Concerning knowledge of their legal obligations ; the prohibition of telling secrets was .89, the prohibition of reading medical records was .58, the keeping of medical records was 1.0 and the teaching of recuperation was. 79. The total mean score was. 86. Concerning attitude and practice; the prohibition of telling secrets was 81.6%, 63.3%. The prohibition of reading medical records was 61.2%, 60.2%. The keeping of medical records was 98%, 98%. The explanation for treatment, care and test was 91.8%, 66.3%. The teaching for recuperation was 63.3%, 63.3%. 3) Knowledge of their legal responsibilities; 29. 6% of the subjects thought that they should report a medical accident to their headnurse, but 75.5% of the subjects actually reported to the headnurse. 39.8% of the subjects thought that nurses were liable for the faults of nursing aides. The total mean score was .45. 46% of the subjects asked a senior staff's advide on difficult affairs. Nurses obeyed legal obligations when concern ing the protection of a client, but were passive when concerning self protection. Also, headnurses were required as adviser, guide and advocate.

• The Transactions of The Korean Institute of Electrical Engineers
• /
• v.60 no.1
• /
• pp.167-173
• /
• 2011

Most of the terminologies used in medical domain is not intended to be applied directly in clinical setting but is developed to integrate the terms by defining the reference terminology or concept relations between the terms. Therefore, it is needed to develop the subsets of the terminology which classify categories properly for the purpose of use and extract and organize terms with high utility based on the classified categories in order to utilize the clinical terms conveniently as well as efficiently. Moreover, it is also necessary to develop and upgrade the terminology constantly to meet user's new demand by changing or correcting the system. This study has developed a mapping tool that allows accurate expression and interpretation of clinical terms used for medical records in electronic medical records system and can furthermore secure semantic interoperability among the terms used in the medical information model and generate common terms as well. The system is designed to execute both 1:1 and N:M mapping between the concepts of terms at a time and search for and compare various terms at a time, too. Also, in order to enhance work consistency and work reliability between the task performers, it allows work in parallel and the observation of work processes. Since it is developed with Java, it adds new terms in the form of plug-in to be used. It also reinforce database access security with Remote Method Invocation (RMI). This research still has tasks to be done such as complementing and refining and also establishing management procedures for registered data. However, it will be effectively used to reduce the time and expenses to generate terms in each of the medical institutions and improve the quality of medicine by providing consistent concepts and representative terms for the terminologies used for medical records and inducing proper selection of the terms according to their meaning.

• Korean Journal of Acupuncture
• /
• v.28 no.2
• /
• pp.77-86
• /
• 2011

Objectives : This study is on the acupuncture and moxibustion treatment records of King Hyeonjong, classified according to diseases and chronology. Methods : Records on the acupuncture and moxibustion treatment of King Hyeonjong have been extracted from the web database of "The Daily Records of Royal Secretariat of Chosun Dynasty". First, all articles containing the keywords 'Yakbang (藥房)' and 'Euigwan (醫官)' have been extracted. Then, those during King Hyeonjong's reign have been rearranged in chronological order. Among these records, those regarding acupuncture and moxibustion have been used in this paper. Results : King Hyeonjong was mostly treated on eye diseases, musculoskeletal system disorders, deficient source qi, and tumor. Acupuncture treatment was preferred for eye diseases, and moxibustion treatment for musculoskeletal disorders. Medicine was used 50 times, acupuncture 4 times, and moxibustion 14 times to treat source qi deficiency, showing that acupuncture and moxibustion treatments were used for clear deficiency syndrome. Only on the case of tumor, the number of acupuncture treatments was bigger than that of medicine treatments. Conclusions : In the early days of his reign, King Hyeonjong suffered from hypochondria, as compared to source qi deficiency and septicemia during later days. He received frequent acupuncture and moxibustion treatments, and he especially preferred those treatments for eye diseases and musculoskeletal disorders.

• Knowledge Management Research
• /
• v.19 no.4
• /
• pp.119-131
• /
• 2018

In this paper, I research the issue of information security for medical information system of each parties. The outflow of the Personal medical information can lead to problems of medical systems and disadvantage to an individual. In this paper, we research the information security based on a blockchain. In addition, I have analyzed blockchain. I suggest a medical information system framework that can help to keep the privacy of patients by using a blockchain network. Also, In this paper try to explain using private blockchain for medical system. Blockchain can keep the integrity and transparency of the medical records. This research, shows how can build the private blockchain for medical records and how to get the integrity of Data from Private Blockchain and Distuributed Ledger Technology.