Located in Bundang, Gyeonggi Province, Seoul National University Bundang Hospital is paperless ― quite literally.

Here, kiosks and computers replace people and paper documents. All of the medical charts have been digitalized, along with the personal data of the patients. Visitors make reservations, pay and browse their medical histories through kiosks and smart devices.

Doctors and nurses know exactly how many hours ― or even minutes ― they have for each and every patient. Even during meetings and rounds, what they each carry is a smart tablet, not a pile of documents and pens.

The hospital is one of the major health care facilities in South Korea that is entirely “paperless” ― meaning it has a completely electronic medical record system, including data archiving and disaster recovery services.

Unlike the U.S. and other countries, where hospitals are encouraged to adopt EMR systems by the government, hospitals in South Korea ― one of the most wired countries in the world ― are not required to go digital. But the number of facilities with the system has still increased dramatically here throughout the past decade.

“I think the achievement has to do with South Korea’s contemporary culture, which is uniquely IT-driven,” said Yun Jong-hoar, the medical information manager at SNUBH.

“(In this country), no one wants an unnecessary wait. Everyone has smartphones. Efficiency is one of the most appreciated values. (In any sector), the ideal is to have the maximized output with minimal cost and (human) resources. And the local medical industry has obviously been affected by such a culture and sense of value as well.”

The South Korean government currently does not keep track of the number of hospitals with a complete EMR system because “there is no legal obligation for local facilities to do so,” said Yoo Joon-young from the state-run Health Insurance Review and Assessment Service.

But according to a 2011 study by the Korean Society of Medical Informatics ― a nongovernmental research institute organized by medical doctors and scholars of various fields ― the adoption rate of EMR systems has greatly increased in South Korea, from 21.4 percent in 2005 to 77.3 percent in 2010. The use of EMR, as well as the use of clinical decision support systems has significantly reduced the number of medication errors, as well as the documentation and management costs here, according to the study.

In the U.S., health care facilities that switch to EMR systems by this year can expect to receive incentive payments totaling some $2 million or more through Obama’s HITECH Act.

Hospitals that fail to adopt the system by this year or 2015 will face a 1 percent Medicare reimbursement penalty. In spite of the government’s efforts, only 3.2 percent of more than 5,400 U.S. hospitals have a complete EMR system as of this year, according to the nation’s Healthcare Information and Management System Society. 

SNUBH is the first non-American hospital to achieve the HIMSS Analytics Stage 7, an honor given to facilities with the highest Electronic Medical Record Adoption Model. There are currently 185 hospitals worldwide with the HIMSS Stage 7 honor, including SNUBH. Among them, 181 are American facilities, one is Chinese and two are European.

In July, the hospital and South Korea’s wireless telecommunication operator SK Telecom together signed a 70 billion won ($67 million) contract to build an IT system for Saudi Arabia’s Ministry of National Guard.

“I think one of the factors that made our system effective is the participation of medical doctors (when developing the system),” said Kim Hwan, the spokesperson of SNUBH.

“Visitors often ask us why our monitor screens are so big. It was a decision made based on our doctors’ requests during the development period of the system. They wanted big screens that are able to show as much information as possible on each patient, so they can learn about their condition and medical history in the most efficient, timely manner.”

Once hospitalized, patients are given a tablet PC, and have a computer screen connected to their beds ― these inform them about their health care costs, expected waiting times and scheduled appointments for treatments, and when and where they will receive surgeries, meals and medications.

Special censors installed across the property are connected with a 3-D map of the hospital ― a feature included in its smartphone application ― which users can navigate when trying to visit specific departments. The sensors make sounds to let visitors know where they are in the building and lead them the right way.

Every hospitalized patient is also required to wear a digital tag around on the wrist, which medical staff use to double-check their identities. For example, nurses scan the tag of a patient ― which contains his or her name, condition and required treatment ― before giving him or her medication, to make sure the patient is getting the right drugs. “The tag is also used before surgical procedures,” said Kim from SNUBH. “Even when a patient is anesthetized and completely unconscious, it is possible to identify the person and the medical history and information as long as he or she has the tag around the wrist.”

While SNUBH works with SK Telecom, Samsung Medical Center, another major Korean hospital, collaborates with its subsidiary Samsung Electronics on its EMR system. For example, its patients and doctors use the Samsung Galaxy Tab, Android-based tablet computers produced by Samsung, while giving and receiving medical treatments.

“Using the tablet PC and smartphones enables us doctors to monitor our patients’ conditions regardless of our location and it certainly improves the quality of health care,” said doctor Yoon Sung-hyun from the hospital.

While studies have proved that EMR systems reduce the number of medication errors, a number of ethical concerns remain, including issues of security and confidentiality regarding deceased patients’ medical records.

At SNUBH, all of the medical charts and records are being stored and regulated in its own server, not on the Internet. The hospital also runs a backup system that is located in a separate facility. “Because our system is not based on the Internet, it’s almost impossible to access the information unless someone physically breaks into the facility where our server control data is stored,” said Yun Jong-hoar from SNUBH. “And whenever they enter the server room, our staff members go through three stages of identification.”

Yun said there must be discussions on what to do with electronic records of deceased patients and on strengthening the current security system. “Paper-based records have existed for thousands of years, but EMRs have been around for just about 10 years,” he told The Korea Herald. “We have to come up with rules on what to do with electronic medical records of those who have already died ― who will have access to the information and for what purposes. And because the technology will only evolve and develop, we should do our best to strengthen the backup and security systems to keep up with the inevitable changes in the future.”

By Claire Lee (dyc@heraldcorp.com)