Design of a Hospice Referral System for Terminally Ill Cancer Patients Using a Standards- Based Health Information Exchange System

다국어 초록 (Multilingual Abstract)

Objectives: The demand for hospice has been increasing among patients with cancer. This study examined the current hospice referral scenario for terminally ill cancer patients and created a data form to collect hospice information and a modified health information exchange (HIE) form for a more efficient referral system for terminally ill cancer patients. Methods: Surveys were conducted asking detailed information such as medical instruments and patient admission policies of hospices, and interviews were held to examine the current referral flow and any additional requirements. A task force team was organized to analyze the results of the interviews and surveys. Results: Six hospices completed the survey, and 3 physicians, 2 nurses, and 2 hospital staff from a tertiary hospital were interviewed. Seven categories were defined as essential for establishing hospice data. Ten categories and 40 data items were newly suggested for the existing HIE document form. An implementation guide for the Consolidated Clinical Document Architecture developed by Health Level 7 (HL7 CCDA) was also proposed. It is an international standard for interoperability that provides a framework for the exchange, integration, sharing, and retrieval of electronic health information. Based on these changes, a hospice referral scenario for terminally ill cancer patients was designed. Conclusions: Our findings show potential improvements that can be made to the current hospice referral system for terminally ill cancer patients. To make the referral system useful in practice, governmental efforts and investments are needed.

참고문헌 (Reference)

• 1 김창곤, "한국의 호스피스완화의료정책" 한국호스피스완화의료학회 20 (20): 8-17, 2017
• 2 "Treating patients with cancer: reason for being popular, hospice care"
• 3 Kisekka V, "The effectiveness of health care information technologies: evaluation of trust, security beliefs, and privacy as determinants of health care outcomes" 20 (20): e107-, 2018
• 4 지혜림, "Technology and Policy Challenges in the Adoption and Operation of Health Information Exchange Systems" 대한의료정보학회 23 (23): 314-321, 2017
• 5 Jordhoy MS, "Quality of life in palliative cancer care : results from a cluster randomized trial" 19 (19): 3884-3894, 2001
• 6 Rhee YJ, "Hospice and palliative care services in South Korea supported by the National Health Insurance(NHI)program" 7 : 689-695, 2015
• 7 Parker C, "Health information exchanges : unfulfilled promise as a data source for clinical research" 87 : 1-9, 2016
• 8 Park SK, "Health information exchange standard adopting guideline" Korea Health Industry Development Institute 2017
• 9 "HL7/ASTM Implementation Guide for CDA R2 - Continuity of Care Document (CCD) Release 1" Health Level Seven International
• 10 Ministry of Health and Welfare., "Guideline for adopting standard health information exchange"
• 11 Worldwide Palliative Care Alliance, "Global atlas of palliative care at the end of life"
• 12 De Palma R, "Effectiveness of palliative care services : a population-based study of end-of-life care for cancer patients" 32 (32): 1344-1352, 2018
• 13 Health Insurance Review & Assessment Service, "Effect analysis of hospice care" Health Insurance Review & Assessment Service 2018
• 14 van Oorschot B, "Early integrated palliative care in cancer patients improves quality of life and encourages discussions about preferences for care at the end of life" 194 (194): 178-180, 2018
• 15 Hemati Z, "Dying with dignity: a concept analysis" 25 (25): 1218-1228, 2016
• 16 Kernan R., "Clinical Document Architecture (CDA), Consolidated-CDA (C-CDA) and their role in meaningful use (MU)" Office of the National Coordinator for Health Information Technology
• 17 Wright AA, "Associations between palliative chemotherapy and adult cancer patients' end of life care and place of death:prospective cohort study" 348 : g1219-, 2014