Seoul National University Bundang Hospital (SNUBH)

Suburbs of Seoul (budang-Gu, Seongnam-Si, Gyeonggi-Do), South Korea

• First stage 7 hospital outside of North America
• Annual revenue of $275 million
• 515 physicians, 780 nurses, 640 staff
• 8 specialty clinic centers, 23 clinical departments
• 4,000 outpatient visits per day
• First full digital general hospital

Challenge
In 2001, Seoul National University Bundang Hospital (SNUBH) decided to open the world's first fully digital general hospital. The challenge was twofold: 1.) build a comprehensive EMR system with a 'go live' date of May, 2003 and 2.) design an effective training program enterprise-wide once the new system was implemented.

However, at this time in South Korea, there was no fully developed EMR solution on the market as of yet. Although, the CPOE (Computerised Physician Order Entry) system was widely used, no comprehensive EMR system existed. Although SNUBH's technology needs were premature relative to market readiness, they moved forward with their development strategies:

• Developing a flexible structured system, which can actively handle a new business process and a new organisational structure
• Attracting users active participation, and coordinating healthcare and IT through developing, applying and training
• Planning and developing the system which has the concepts of structured data, idealization of practice, process integration and care delivery centralization.
• Creating the synergy through organising clinical providers, management and IT solution providers

The new system was to be named BESTCare that stands for "Bundang Hospital Electronic System for Total Care".

EHR Solution: ezCareTech

Implementation Solutions
ezCareTech was contracted to develop and implement an EMR solution involving a 22 month system development. In May 2003, SNUBH became the world's first fully digital hospital boasting a complete EMR environment. Prior to its opening, SNUBH tackled its second major challenge-how to train all the users with different needs and different schedules - all without compromising patient care when the hospital opened.

Training Solution

• Early adapter groups to train users: Early adapter groups were organised to teach within each department. For example, nurses trained clinicians/nurses and the administrators trained their staff.
• EMR practical training based on the large number of scenarios: In addition to training of EMR functions, based on the scenarios prepared by the early adaptor group, more in-depth EMR training was phased in over a period of time.
• Accessing "Any Time" training: Flexible training options were made available to accommodate vastly diverse schedules and needs. Recognizing the ROI of EHR Implementation

Financial ROI

• $116,000 (USD) annual income attributed to the EMR system

Patient Safety and Quality

• A closed loop medication administration system with RFID has reduced recording time and prevented administration errors.
• Thanks to a health information exchange system based on CDA (Clinical Document Architecture) a patient's medical information was shared with 36 nearby clinics using different systems.
• Medical error reduction rate is about 2%. With CDW (Clinical Data Warehouse) CPR survival rate and postsurgical antibiotic usage can be more accurately monitored.
• Patient safety is currently assured with using CDSS (Clinical Decision Support System) of medication alters, such as drug dosage checking, drug-drug interaction, drug-allergy interaction, contraindication (for age, combination, child, pregnancy, and breast feeding), overlapped prescription, and renal dosing system.
• With mobile EMR system, patient information can be searched and consulting details can be accessed anywhere using smart phone

Lessons Learned
Once you've implemented it, you're never done.

1. Patient-centered EMR system: Patients are the highest priority to decide to accept healthcare IT. If healthcare IT is continuously invested in order to improve patient safety and increase care quality, IT will be the necessary area for medical treatment.
2. Strong leadership to build a full digital hospital: Without active investment and support for IT, healthcare IT never be led, nor successfully introduced. Therefore, it is extremely important that the hospital management team strategically supports IT.
3. System development through collaboration of peoples of different backgrounds: The successful acceptance and management of a system need not only supporting from the management but also cooperating with IT experts, developers and current sites. This brings the well-developed, user-friendly system which applies a best-practice workflow.
4. Continuous improvements of a system through quality assurance (QA) activities: Ongoing QA activities can continuously improve patient safety, care quality and work efficiency, so knowledge, know-how and workflows can also be developed.
5. Flexible system for fast response to users' requests: In order to improve users' satisfactions, a flexible system is needed to response quickly to any requests

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