심사평가 정보수집체계 개편 로드맵 개발

Abstract

Review system has been reformed focusing on connecting medical validity and quality of care and the need to improve data collection system is gaining more and more attention. The Health Insurance Review and Assessment Service (HIRA) has collected health outcome for value measurement using health insurance claim data and additional survey, but it required to build a system that can assure diversity and efficiency in the type and process of data collection. As such, HIRA has established and operated HIRA e-Image and e-Form System in order to reduce providers’ burden for data submission and streamline review and assessment process. The main objective of this study is to propose a road map for review and assessment data collection system revision. More specifically, i) to review efficient data collection system by researching data collection and utilization cases from Korea and abroad, ii) to set up a direction for data collection in consideration of review and assessment system reform, and iii) to propose a step-by-step road map to improve data collection system. To conduct review and assessment service,‘specific-statements’of health insurance claim statement need to be utilized in the short term, and a data submission system for review and assessment needs to be implemented in the long term. In order to expand HIRA e-Image and e-Form System, four mid and long-term strategies and nine sub-tasks were presented. First, it is necessary to decide clear objectives and utilization of data collection and define standardization template in order to switch to HIRA e-Image and e-Form System. In other words, standardization of list of collected data should precede to enhance predictability of providers and data accuracy. Second, data connection system between HIRA e-Image and e-Form System and providers’ EMR needs to be developed and data key-in principles need to be systematized. If HIRA developed and distributed a standardized data connection system or guideline, the system building period could be shortened. Also, clear principles for data key-in method should be presented to enhance data reliability. The guideline for EMR data will improve providers' understanding of data key-in, and narrow down gaps in data input. Third, legal and institutional basis should be prepared for data collection to encourage utilization of HIRA e-Image and e-Form System. System expansion mechanism and data reliability validation method are also required. To expand HIRA e-Image and e-Form System, it is essential to secure not only non-financial support like development and distribution of standardized EMR connection system, but also financial support to aid data connection system development cost. And data reliability should be checked before collection process. Forth, data collected through HIRA e-Image and e-Form System are important clinical data, such as test results and health outcome. Therefore, the value of collected data needs to be maximized through secondary utilization. A collaboration system should be discussed and reviewed to connect the HIRA e-Image and e-Form System with other healthcare information projects.