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Objective In South Korea, the Gyeonggi Fire Services introduced a multi-tiered dispatch system for out-of-hospital cardiac arrest (OHCA) cases in July 2015. In this study, we investigated whether the multi-tiered dispatch system improved the pre-hospital return of the spontaneous circulation (ROSC) rate. Methods All non-traumatic adult OHCAs treated and transported by the 119 emergency medical system from July 2015 to December 2015 were included in the study. Demographic and pre-hospital Utstein element-data were collected from the emergency medical system OHCA database. The primary outcome was pre-hospital ROSC as measured at the scene. Results Of the included OHCAs, 1,436 (89.0%) were categorized to the single-tiered dispatch group and 162 (10.1%) to the multi-tiered dispatch group. The rate of administration of advanced airway ventilation (61.1% vs. 48.0%, P=0.002) and intravenous access (18.5% vs. 12.5%, P=0.037) was higher in the multi-tiered group compared to that in the single-tiered group. The use of epinephrine was higher in the multi-tiered group (4.9% vs. 1.5%, P=0.002). The pre-hospital ROSC rates in the multi-tiered group were higher when compared with the single-tiered group, but the difference was not significant (10.5% vs. 7.5%, P=0.218). The adjusted odds ratio for pre-hospital ROSC rates in the multi-tiered group was 1.29 (95% confidence interval, 0.69 to 2.40). Conclusion The multi-tiered dispatch system was not associated with a significant increase in the pre-hospital ROSC rate during the early phase of its implementation, even though advanced maneuvers were performed more frequently.

This study developed a nursing process database based on the object-oriented database model for the development of the nursing process computerization program. Received (September 15, 2015), Review Result(Octorber 02, 2015) Accepted(October 22, 2015), Published(December 31, 2015) 41156 Dept. of Medical Informatics, Kyungpook National Univ., 680, Gukchaebosang-ro, Jung-gu, Daegu, Korea email: phs510@naver.com 41156 Dept. of Medical Informatics, Kyungpook National Univ., 680, Gukchaebosang-ro, Jung-gu, Daegu, Korea email: medinfo@knu.ac.kr 27136 Dept. of Nursing, Semyung Univ., 65, Semyeong-ro, Jecheon-si, Chungcheongbuk-do, Korea email: ag392@naver.com (Corresponding Author) 38610 Faculty of Medical Industry Convergence, Daegu Haany Univ., 1, Hanuidae-ro, Gyeongsan-si, Gyeongsangbuk-do, Korea email: pulala@dhu.ac.kr Development and application of the nursing process database based on the object-oriented database model Copyright c 2015 HSST 168 The database coded the data of the North American Nursing Diagnosis Association (NANDA) 2015-2017, Nursing Outcomes Classification (NOC) 5th edition and Nursing Interventions Classification (NIC) 6th edition, and it produced the appropriate entities based on the class diagram to design data structure in an object-oriented perspective. The nursing process database is composed of classification systems, patient information and nursing process, user information entities, and it has the separate structure that all of the information is dependent on user and patient information entity. That is, the database developed can integrate and develop the computerized program without a separate process by resetting only the relationship between the core entities. In order to take advantage of these object-oriented database model, this study developed a part of the nursing process education program by using the Java programming language, Java Swing, JDBC Connector. The further studies are scheduled to develop the complete program which includes standard protocol transfer function for the standardization of nursing practice, the interoperability between other information systems, and the nursing process macro function.

With the shift from an industry-based society to a knowledge-based one, there has been a gradual increase in the importance of intangible assets such as technologies and information. Patents are a representative intellectual outcome of intangible assets and can be used as an objective measure of the level of technology or innovation of individuals, firms, and countries. In addition, patents can be regarded as a rich source of data for the provision of technological and commercial information. Patent data facilitate research on technological advances and innovation; hence, an analysis of this data can provide important insights into innovation activity and technology management strategies. This paper presents a method for extracting core technologies from core fuel cell vehicle (FCV) patents registered with the United States Patent and Trademark Office by using a data mining technique. Core patents are determined by analyzing patent citations, and the data mining technique identifies those firms with core FCV technologies and reveals the overall research focus of the firms by deriving patent portfolios and and technology recommendations considering the extracted core technologies.

The existing Systematized Nomenclature of Medicine - Clinical Terms (SNOMED-CT) toolkit includes only a clinical term search, and its output functions are not linked to a particular database, making it difficult for users to map biological data, and the use of biobanks requires much time and effort. This study developed a SNOMED-CT toolkit using an optimized search, allowing users to map clinical items for efficient utilization and standardization of biobank resources. The toolkit was developed using the Java programming language and Java Database Connectivity to connect to a previously developed research database. The user interface was implemented using Swing. The functions and interfaces of the toolkit were developed after a requirement analysis by SNOMED-CT experts. Using the toolkit, the user can search SNOMED-CT concepts. Using pre-and post-coordinated mapping of clinical items with the toolkit, it is possible to maximize the semantic interoperability of the previously developed database.

The purpose of this study was to build Ontology based database for efficient operation and interoperability of the human resource bank. The team 7,197,252 of human resources information was collected through previous studies and classifies the 1,796 clinical item through high quality work. For a clear expression of clinical terminology mapping and item of international standard terminology Received (April 15, 2015), Review Request(April 16, 2015), Review Result(May 01, 2015) Accepted(May 21, 2015), Published(June 30, 2015) 700-842 Dept. of Medical Informatics, Kyungpook National Univ., Gukchaebosang-ro, Jung-gu, Deagu, Korea email: yth2320@naver.com 712-715 Dept. of Faculty of Medical Industry Convergence, Daegu Haany Univ., Yugok-dong, Gyeongsan-si, Gyeongsangbuk-do, Korea email: daspula@daum.net (Corresponding Author) 700-842 Dept. of Medical Informatics, Kyungpook National Univ., Gukchaebosang-ro, Jung-gu, Deagu, Korea email: medinfo@knu.ac.kr Study on OWL-based database built for the efficient operation of human resources bank Copyright c 2015 HSST 56 SNOMED-CT it was found to have 826 different synonyms of the term and value types, the data type for the international standard code. In this study, we selected a preferred term of 76 to minimize the redundancy due to the synonyms. Also define the relationship between synonyms and preferred terms using the OWL for interoperability between human resources banks and were stored in XML and databases. OWL-based database built in this study has a common terminology, it can be interchangeably without complex mapping process between the human resource banks.

The previous HL7 interface should be developed as a separate package or conversion module for each version to process HL7 messages from different versions. This study designed and developed an HL7 parser compatible among different versions based on the requirements of compatibility defined in HL7 V2.5. According to the structure of the parser, the inheritance concept in object-oriented programming was adopted so that the class object of the HL7 message from the lower version could be inherited to the class object of the upper version. Therefore, every version’s HL7 messages could be processed using only the upper class’ object regardless of the version. To evaluate the compatibility of the developed parser, 700 data sets about inpatients with rheumatoid arthritis were used. The 700 cases underwent the compatibility test successfully. In the near future, further research on the Inter-compatibility HL7 parser is planned.

Hypertension is one of the major causes of death in the world as it is related with cardiovascular or cerebrovascular disease, so it is needed to provide continuos management for blood pressure. This study selected Health Level 7 Fast Health Interoperability Resources (HL7 FHIR) as a bio-signal data exchange service model that can provide constant blood pressure management in the rapidly growing mobile health care environment. The HL7 FHIR framework developed communicates with the IEEE 11073-10407 Personal Health Device (PHD) protocol through the bluetooth Health Device Profile (HDP) between the manager (smart phone) and the agent (hemomanometer) and acquires information about blood pressure. According to the test results, it performed its tasks successfully including hypertension patients’ blood pressure monitoring, management on measured records, generation of document, or transmission of measured information. Because in the actual, clinical environment, it is possible to transmit measured information through the TCP/IP protocol, it will be needed to conduct constant research on it and vitalize it in the field of mobile health care afterwards. ☞ keyword : Bluetooth Health Device Profile, HL7 FHIR, Hypertension, Personal Health Device, mobile Healthcare 1 Dept. of Medical Informatics, Kyungpook National Univ., Daegu, 700-422, Korea. 2 College of Nursing, Kyungpook National Univ., Daegu, 700-422, Korea. 3 Dept. of Medical Information Technology, Daegu Haany Univ., Kyungsan, 712-715, Korea. * Corresponding author (hshong@knu.ac.kr) [Received 27 January 2014, Reviewed 29 January 2014, Accepted 01 April 2014] ☆ 이 논문은 2009년과 2013년 정부(교육부)의 재원으로 한국연 구재단의 지원을 받아 수행된 기초연구사업임 (NRF-2009-0066546, NRF-2012R1A1A2004829) 1. 서 론 2012년 세계보건통계(World Health Statistics) 보고서에 의하면 전 세계 성인의 1/3이 뇌졸중 및 심장질환의 원인 인 고혈압이 있다고 조사되었다[1]. 또한 고혈압은 사망 에 이르게 하는 위험한 요소 중 하나이다[2]. 2000년 전 세계 성인 인구의 고혈압 발병률은 26%이었고 2025년에 60%로 증가할 것이라고 전망하였다[3]. 2008년 심장 질 환, 뇌졸중, 암, 만성 호흡기 질환 그리고 당뇨 등과 같은 만성질환으로 사망한 인구 비율은 전 세계 사망자의 58% 를 차지하였다. 동일한 기간에 심혈관계 질환으로 사망한 ISSN 1598-0170 (Print) ISSN 2287-1136 (Online) http://www.jksii.or.kr http://dx.doi.org/10.7472/jksii.2014.15.3.21 고혈압 관리를 위한 헬스레벨 7 FHIR 기반 생체정보 교환 서비스 모델 구현 22 2014. 6 인구 비율은 만성질환으로 사망한 인구의 30%이고 그 수 는 1700만 명이다[4]. 또한 2011년 국내 통계청 발표에 의 하면 고령자 사망원인 1, 2, 3위는 각 암, 뇌혈관 질환, 심 장 질환 등으로 조사되었다. 동일한 기간의 3대 질병 사 망률이 전체 사망자의 47.4%를 차지하였고 심장 질환으 로 인한 사망자 비율은 49.8%로 전 년도에 비해 2.9% 증 가하였다[5]. 고혈압 환자 수는 점차 증가하고 있고 사망 원인으로 부각되고 있으므로 고혈압 관리와 예방을 할 수 있는 기술이 절실히 필요하다. 최근 건강관리를 위한 서비스 기술은 모바일 기기와 인터넷의 의한 원격 Healthcare, 모니터링 그리고 의료영 상의 융합이 특징적이다. 특히 실시간으로 생체신호를 모 니터링 하는 유비쿼터스 센싱, mHealth 환경에서 구현을 위한 홈 안전의 지원, 생체 신호기록 및 기기 표준 그리고 소셜미디어 활용센서 등을 제시하고 있다[6]. mHealth는 eHealth의 한 형태이며, 용어는 Robert Istepanian로부터 2005년에 발간된 “새롭게 부상하는 모바 일 헬스 시스템” 서적을 통해 처음 사용되었다[7]. mHealth는 광범위하게 모바일과 무선 보건의료서비스전 달체계와 통합된 것으로 모바일 통신 또는 멀티미디어 기술들을 포함한다[7]. 2011년 GlobalData 사의 조사에 따르면 모바일 응용프 로그램과 원격 환자 모니터링 기기를 포함한 mHealth 시 장의 가치는 12억 이었고 2018년에는 118억으로 늘어날 것으로 전망하였다. 미국의 mHealth 시장은 세계시장의 50% 이상을 차지하고 연평균성장률(Compound Annual Growth Rale, CAGR)은 39% 이다. mHealth 시장 비중은 소프트웨어와 서비스 분야가 80%로 가장 크고 이다음 하 드웨어와 네트워크가 각 12%를 차지한다. 그리고 어플리 케이션 사용자는 70%가 일반 소비자용이며, 30%가 의료 전문가용으로 나타났다[8]. HIMSS 사의 모바일 기술 조 사에 의하면 임상전문가의 80%는 환자 진료의 환경을 개 선하기 위한 직접적인 영향력을 행사하는 장비를 이용하 며 93%는 모바일 기기를 매일 이용한다. 또한 65%는 임 상 검사의 결과나 환자 정보를 조회하기 위해 어플리케 이션을 이용한다[9]. Frost와 Sullivan 사는 고성능을 가진 어플리케이션의 개발이 촉진될 것이라고 전망하였다. 오 늘날 임상관련 어플리케이션 대부분은 정보 입력 또는 참조만 가능하다. 향후의 어플리케이션은 활력징후를 모 니터링 하는 시스템으로써 모바일 기기에 작은 측정기를 연결하여 생체 신호를 검사하고 진단 기능이 강화될 것 이라고 예측하였다[10]. 모바일 폰은 사용자가 서비스에 빠르고 편리하게 접근할 수 있는 장치이다. 고혈압 환자가 매일 병원을 방문하여 지속적인 치료 및 관리를 받는 것은 한계가 있다. 본 연구에서는 국제표 준인 Bluetooth Health Device Profile (HDP), IEEE 11073 PHD 그리고 HL7 FHIR(Fast Health Interoperability resources)을 이용하여 환자가 매일 병원 방문을 하지 않 고도 mHealth 환경에서 지속적인 혈압 관리가 가능한 FHIR 기반의 생체정보 교환 시스템 모델을 설계하고 구 현하였다.

본 연구는 임상실습을 하는 간호학생들의 간호과정 스마트폰 애플리케이션의 사용의도를 조사하고, 이 프로그램의 적용효과를 평가하기 위해 시도되었다. 연구대상자는 대구 지역 일개의 간호대학 3학년 학생으로, 2012년 9월부터 2013년 9월까지 외과 병동 성인간호학 실습을 나가는 60명이다. 연구결과 간호과정 스마트폰 사용의도는 학습의 용이성, 사회적 영향, 자기효능감과 유의한 관계가 있었다. 그리고 대상자에게 적용된 간호과정 앱 애플리케이션은 급성통증에 대한 진단, 중재, 결과에 대한 목록이 가장 많았고, 프로그램 사용 만족도는 4.35점이었다. 이 연구결과를 통해 간호과정 앱은 임상실습 현장에서 간호과정 앱 사용에 대한 더 많은 기회와 교육을 제공하고, 그것의 활용에 관하여 손쉽게 적용될 수 있는 방안이 마련되어야 할 것이다. 【This study examined the intention to use a nursing process application on a smart phone by nursing students who undertake clinical practices, and evaluated the application effect of this program. As research subjects, the study assessed juniors in the college of nursing in Daegu, who had undertaken field training in adult nursing in surgical wards from September 2012 to September 2013. The results showed that the intention to use nursing process application has a significant relationship with effort expectancy, social influence, and self-efficacy. In addition, the nursing process application applied to the research subjects has the largest list of diagnoses, interventions and outcomes regarding acute pain. In addition, the satisfaction with the use of the program was 4.35 points. Through this study, the application of the nursing process presents more opportunities for its use and training in the clinical practice field, and measures that can be applied easily regarding its utilization should be provided.】

The Middle East Respiratory Syndrome (MERS) crisis in Korea is coming to an end, but that's not the end of the story. The World Health Organization (WHO) has warned that the MERS crisis was a 'wakeup call.' Like Severe Acute Respiratory Syndrome (SARS) in 2003 and swine flu in 2009, epidemic outbreaks will continue to happen anywhere. Korea was simply unlucky. In retrospect, it is regrettable to say that we could have done much better. Scholars and colleagues in the medical informatics field should take a moment and think hard about how we can work to fight against another epidemic invasion in the future. The Ebola epidemic of 2013 is the largest such outbreak on record, influencing many nations in Africa as well as other countries [1]. The WHO expert panel has pointed out the inadequate emergency care response and has recommended more effective mechanisms for research and development. Others have strongly recommended WHO to innovate because recent Ebola outbreaks have been radically different from previous events, and they have tended to be simultaneous and parallel: "Highly mobile populations, the spread of Ebola into densely populated cities ... made this epidemic of many outbreaks difficult to control [2]." Other criticisms also include outdated therapeutic protocols, irrelevant information, untimely communication, delays in decision-making due to uncoordinated leadership, unreasonable social behavior, and so on. The recommendations for responding to MERS may not be radically different from those for Ebola. Though international health regulations (including MERS) were adopted after the SARS outbreak, little effort has been made to follow through with the initial commitments. Such delays and mismanagement could lead to a global disaster if preparation is not thorough enough in the next epidemic [3].

XML-based standards such as CCD(Continuity of Care Document) and CCR(Continuity of Care Record) have been developed for representation, integration, and exchange of personal health record(PHR), and various of researches on PHR based on the standards have been conducted. These researches have developed and used CCD/CCR parsers each with their own different ways, but it can be hard to develop and update the parsers because of the structural complexity of the standards. Moreover, inter-exchange between CCD and CCR documents in the PHR-related medical information systems should be possible for the interoperability of the systems. Therefore, we proposed a designing method to develop the tools treating XML-based CCD/CCR documents. And we implemented CCD/CCR parser based on the proposed method and developed a converter from CCD to CCR using the parsers. To confirm the usefulness of the developed tool, we performed an experiment of creating CCD documents using the personal health data gathered from chronically ill patients in Kyungpook National University Hospital and of converting from the CCD documents to CCR documents.

As changed the clinical environment, the interest on u-Healthcare service and systems has been increased. The ubiquitous healthcare(u-Healthcare) systems are constructed at the integrated environment that consists of various devices and systems basically such as personal health devices(PHDs) measuring body signals, information aggregators gathering the data transmitted from PHDs through wireless technology, and health information systems storing and managing personal health information transmitted from the information aggregators. International standards such as IEEE 11073 and HL7 have been specified for the interoperability of PHDs and health information systems, but the research on u-Healthcare systems that were developed and applied in the real clinical environment by adopting the standards was rarely conducted. Therefore, we developed an u-Healthcare system which can manage personal health information, such as blood glucose, blood pressure, and body composition, based on health information exchange standards. Moreover, we verified the stability of the developed system through clinical trial in patients with endocrine disease at the Kyungpook National University Hospital, and listed problems occurred during clinical trial and found their solutions.

The purpose of this research paper is to develop Mobile application-based Nursing Process Programs on `Nursing Diagnosis`, `Nursing Interventions` and `Nursing Outcomes Classification` targeting nurses and nurse students. To achieve it, this paper uses `standard classification-focused research data` on the basis of Nursing Diagnosis Classification established by NANDA (North American Nursing Diagnosis Association), NIC (Nursing Interventions Classification) and NOC (Nursing Outcomes Classification) mainly developed by Iowa State University. The existing research methods are difficult to be applied to patients, since such methods put a restriction on choosing, developing, and generalizing `Nursing Process Programs` in clinical spheres. But, this research thesis focuses on developing guidelines applicable to any clinical experiences, with the use of the framework in mutual links with all the nursing diagnosisoutcomes- interventions. In this regard, the Korean version programs were developed and registered in App store in March. Thus, it is expected that these programs would be wildly-available as tools for nursing education.

As the ARRA enacted recently in the United States, the interest in EHR systems have been increased in the field of medical industry. The passage of the ARRA presents a program that provides incentives to office-based physicians and hospitals adapting the EHR systems to guarantee interoperability with various medical standards. Thanks to the incentive program, a great number of EHR systems have been developed and lots of office-based physicians and hospitals have adapted the EHR systems certified by CCHIT. Keeping pace with the rapid changes in the market of healthcare, some enterprises try to push in to the United States healthcare market based on the experience acquired by developing EHR systems for hospitals in Korea. However, the developed system must be customized because of the different medical environment between Korea and the United States. In this paper, therefore, we design and develop an integrated EHR platform to guarantee the interoperability between different medical information systems based on medical standard technologies. In the developed platform, an integrated system has been composed by integrating various basic techniques such as data transmission standards and its methods, medical standard terminologies and its usage, and knowledge management for medical decision-making support. Moreover, medical data can be processed electronically by adapting an HL7 interface engine and the terminologies for exchanging medical information and the standardization of medical information. We develop SeniCare, an EHR system for supporting ambulatory care of the office-based physicians, based on the platform, and we verify the usability of the platform by confirming whether SeniCare satisfies the criteria of "meaningful use" issued by CMS or not.

Various standard terminologies in medical field are composed in dividually to different structure. Therefore, information on crosswalking between the termino logies is needed to combine and use the terminologies. Lots of mapping tools have been developed and used to create the information. However, since those tools deal with specific terminologies, the information is restrictly created. To overcome this problem, some tools have been developed, which perform mapping tasks by com-posing various terminologies. However, the tools also have diff iculty of composing automatically the terminologies because the terminologies have different structures. Therefore, in this paper, we propose a method for composing and using the terminologies in the developed mapping system with keeping the original structure of the terminologies. In the proposed method, additional terminologies could be added on the mapping system and used by making metadata involving in-formation on location and structure of the terminologies. And t he mapping system could cope flexibly with the changes of the structure or context of the terminologies. Moreover, var ious types of mapping informat ion could be defined and cre-ated in the system because mapping data are constructed as trip lets in ontology. Therefore, the mapping data can be transformed and distributed in different formats such as OWL, R DF, and Excel. Finally, we confirmed the usefulness of the mapping system based on the proposed method through the experiments about creating mapping data.Key Words : Standard medical terminology, Mapping system, Ontology, SNOMED-CT, ICD, NANDA, NIC, NOC

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.Key Words : Electronic medical records system, Semantic interoperability, Mapping tool, Remote method invocation† 교신저자, 정회원 : 경북대학교 의과대학 의료정보학과 연구교수E-mail : pulala@paran.com.*비 회 원 : 경북대학교 의료정보학과 박사후연구원** 비 회 원 : 경북대학교 간호대학 간호학과 박사과정***비 회 원 : 경북대학교 의과대학 의료정보학과 교수 접수일자 : 2010년 10월 16일 최종완료 : 2010년 12월 14일

We propose the creation of a standard data model for medication administration activities through the development of a clinical document architecture using the Health Level 7 Development Framework process based on an object-oriented analysis and the development method of Health Level 7 Version 3. Medication administration is the most common activity performed by clinical professionals in healthcare settings. A standardized information model and structured hospital information system are necessary to achieve evidence-based clinical activities. A virtual scenario is used to demonstrate the proposed method of administering medication. We used the Health Level 7 Development Framework and other tools to create the clinical document architecture, which allowed us to illustrate each step of the Health Level 7 Development Framework in the administration of medication. We generated an information model of the medication administration process as one clinical activity. It should become a fundamental conceptual model for understanding international-standard methodology by healthcare professionals and nursing practitioners with the objective of modeling healthcare information systems.

Kyungpook National University School of Medicine, Daegu, Kore a Purpose: The purpose of this study is to understand student recognition of CBT as well as its strengths and weaknesses, and to explore the improvement methodologies for the effective development and implementation of CBT. Methods: A questionnaire survey was conducted twice(before and after implementation of CBT) with a total of 17 multiple-choice and 2 essay-type questions. The multiple-choice ques-tions were analyzed by frequency analysis and the essay-type questions were coded by content analysis. Results: The results are as follows. First, the overall satisfaction with CBT was shown to be high. Second, students listed the merits of CBT as follows: simple correction of answers(before: 89.4%; after: 80.8%), presentation of realistic materials(before: 72.9%; after: 84.7%), prompt feedback on grades(before: 60.3%; after: 71.1%), shortened exam time and effective time scheduling(before: 86.5%; after: 66.4%), accurate estimation of abilities (before: 70.2%; after: 36.6%), and assistance in academic improvement(before: 70.9%; after: 22.1%). Drawbacks of CBT were: inconvenience of review(before: 70.9%; after: 22.1%), inconvenient screen organi-zations(before: 0%; after: 48.1%), possibility of cheating(before: 73.9%; after: 31.8%), and equality issue of test(before: 47.3%; after: 17.3%). Conclusion: Assessment paradigms are currently shifting from summative evaluation to forma-tive evaluation, from one-off assessment to continuous assessment, and from output assessment to process assessment. Therefore, CBT must be expanded to move from result-oriented sum-mative evaluation to formative evaluation continuously monitoring the student learning process. 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏Key Words: Computer-based test, Evaluation, Medical education

The Resource Description Framework (RDF) is widely used for sharing biomedical data, such as gene ontology or the online protein database UniProt. SPARQL is a native query language for RDF, featuring regular expressions in queries for which exact values are either irrelevant or unknown. The use of regular expression indexes in SPARQL query processing improves the performance of queries containing regular expressions by up to two orders of magnitude. In this study, we address the update operation for regular expression indexes in RDF databases. We identify major performance problems of straightforward index update algorithms and propose a new algorithm that utilises unique properties of regular expression indexes to increase performance. Our contributions can be summarised as follows: (1) we propose an efficient update algorithm for regular expression indexes in RDF databases, (2) we build a prototype system for the proposed algorithm in C++ and (3) we conduct extensive experiments demonstrating the improvement of our algorithm over the straightforward approaches by an order of magnitude.

The purpose of this study was to develop and evaluate a mobile health application (Self-Management mobile Personal Health Record: "SmPHR") to ensure the interoperability of various personal health devices (PHDs) and electronic medical record systems (EMRs) for continuous self-management of chronic disease patients. The SmPHR was developed for Android 4.0.3, and implemented according to the optimized standard protocol for each interface of healthcare services adopted by the Continua Health Alliance (CHA). That is, the Personal Area Network (PAN) interface between the application and PHD implements ISO/IEEE 11073-20,601, 10,404, 10,407, 10,415, 10,417, and Bluetooth Health Device Profile (HDP), and EMRs with a wide area network (WAN) interface implement HL7 V2.6; the Health Record Network (HRN) interface implements Continuity of Care Document (CCD) and Continuity of Care Record (CCR). Also, for SmPHR, we evaluated the transmission error rate between the interface using four PHDs and personal health record systems (PHRs) from previous research, with 611 users and elderly people after receiving institutional review board (IRB) approval. In the evaluation, the PAN interface showed 15 (2.4 %) errors, and the WAN and HRN interface showed 13 (2.1 %) errors in a total of 611 transmission attempts. Also, we received opinions regarding SmPHR from 15 healthcare professionals who took part in the clinical trial. Thus, SmPHR can be provided as an interconnected PHR mobile health service to patients, allowing `plug and play' of PHDs and EMRs through various standard protocols.

Objectives This study developed an integrated database for 15 regional biobanks that provides large quantities of high-quality bio-data to researchers to be used for the prevention of disease, for the development of personalized medicines, and in genetics studies. Methods We collected raw data, managed independently by 15 regional biobanks, for database modeling and analyzed and defined the metadata of the items. We also built a three-step (high, middle, and low) classification system for classifying the item concepts based on the metadata. To generate clear meanings of the items, clinical items were defined using the Systematized Nomenclature of Medicine Clinical Terms, and specimen items were defined using the Logical Observation Identifiers Names and Codes. To optimize database performance, we set up a multi-column index based on the classification system and the international standard code. Results As a result of subdividing 7,197,252 raw data items collected, we refined the metadata into 1,796 clinical items and 1,792 specimen items. The classification system consists of 15 high, 163 middle, and 3,588 low class items. International standard codes were linked to 69.9% of the clinical items and 71.7% of the specimen items. The database consists of 18 tables based on a table from MySQL Server 5.6. As a result of the performance evaluation, the multi-column index shortened query time by as much as nine times. Conclusions The database developed was based on an international standard terminology system, providing an infrastructure that can integrate the 7,197,252 raw data items managed by the 15 regional biobanks. In particular, it resolved the inevitable interoperability issues in the exchange of information among the biobanks, and provided a solution to the synonym problem, which arises when the same concept is expressed in a variety of ways.

The Resource Description Framework (RDF) is widely used for sharing biomedical resources, such as the online protein database UniProt or gene database GeneOntology. SPARQL is the native query language for RDF databases and it features regular expressions in queries for which the exact values are either irrelevant or unknown. A recent paper by Lee et al. presented an efficient indexing support for such queries adopting multigram indexes for regular expressions. In this paper we contribute to their work by addressing index updates. As a result, we identify a major performance problem of straightforward implementations and design a new algorithm that utilizes unique properties of multigram indexes. Our contributions can be summarized as follows: 1) we propose an efficient update algorithm for regular expression indexes in RDF databases; 2) we build a prototype system for the proposed framework in C++; 3) we conduct extensive experiments to demonstrate the properties of our algorithm. The experiments show that our algorithm outperforms the straightforward implementations by an order of magnitude.

Problems of having different vocabularies pointed at the same terminology for health care parties are today's issue. Communication problem of this kind in health information system around the globe are still without answers. By fast growing Intelligent Agent technology in the medical field, this issue becomes large enough to halt the progress. Agents for valid communication need to have same understanding over the terminology. Misunderstanding about meaning of a specific terminology by human is as same as misunderstandings of intelligent agents about meaning of a term-which concludes a fault communication-with the difference that agents are connected to each other and can exchange though at no time. The problem is where an agent can report for a valid knowledge base and correct meaning of a term. This paper is addressing this issue by presenting a Medical Vocabulary Interpreter as an Agent (We assume it to be a well known software, waiting to answer questions about original meaning of a terminology and ready to reply-first in first out service) to share a vast amount of complex information pointing to the same root.

An efficient middleware has been developed to support medical device communication. HL7 is known to be best international standard to facilitate clinical device data transfer to information systems in hospital. In this study, we developed a middleware with capability of receiving data from mCare 300 Vital signs monitoring device and converting to HL7 data type format.

This note corrects an error in title. The correct title should be "Value of Analog in Medicine: A Digital Compromise to Teach an Old-Timer a New Trick".

In general, hospital information systems are operated independently of each other. We propose a next-generation hospital information system (HIS) based on the HL7 clinical document architecture (CDA) including also an electronic health record (EHR) and a clinical data repository (CDR) to enable the sharing of medical information among health and medical institutions. We designed an XML schema through which an effective clinical document was generated from the HIS after defining the item regulations and the templates for the release form and radiation interpretation form. The schema was analyzed according to the HL7 reference information model, and HL7 V2.4 was used as the transmission protocol. In addition to proposing a new HIS, we attempted to define the CDA of a release form and create a generation, saving, and control system for the release form based on that definition, the first such undertaking in Korea.

We have developed a CDA (Clinical Document Architecture) based PACS, by which we can search and refer to the patient's medical images and information with few restrictions of time and space for diagnosis and treatment. We'll make more effort to develop the application which insures the better quality of medical images. The medical image history manages the patient's image flies and medical records like film chart in connection with time. This trial will contribute to the reduction of the economical loss caused by unnecessary devices and improve the quality in the medical services. The demand on the development of the program which refers to the medical data quickly and keeps them stable will be continued by the medical institute. This will satisfy the client's demand and improve the service to the patients in that the program will be modified from the standpoint of the users. The system is trying to keep user-oriented policy and to apply the benefit of the analog system to the digital environment. It is necessary to lead the public to the better understanding that the systematic management and referring of the medical images is as important as the quality of the images. And, target model of this research limited to HIS (Hospital Information Systems) of hospital have 200 beds.

A basic assumption of Health Level Seven (HL7) protocol is 'No limitation of message length'. However, most existing commercial HL7 interface engines do limit message length because they use the string array method, which is run in the main memory for the HL7 message parsing process. Specifically, messages with image and multi-media data create a long string array and thus cause the computer system to raise critical and fatal problem. Consequently, HL7 messages cannot handle the image and multi-media data necessary in modern medical records. This study aims to solve this problem with the 'streaming algorithm' method. This new method for HL7 message parsing applies the character-stream object which process character by character between the main memory and hard disk device with the consequence that the processing load on main memory could be alleviated. The main functions of this new engine are generating, parsing, validating, browsing, sending, and receiving HL7 messages. Also, the engine can parse and generate XML-formatted HL7 messages. This new HL7 engine successfully exchanged HL7 messages with 10 megabyte size images and discharge summary information between two university hospitals.

PURPOSE: This study was performed to propose an ontology methodology based on standardized nursing process as framework in obstetric and gynecologic nursing practice. METHODS: The instrument used in this study was based on the nursing diagnosis classification established by North American Nursing Diagnosis Association (NANDA) (2009-2011), fifth edition of the Nursing Interventions Classification (NIC) (2008), forth edition of the Nursing Outcomes Classification (NOC) (2008) developed by Iowa State University and systematized nomenclature of medicine clinical terms (SNOMED CT). The nursing records data were collected from electronic medical records of one hospital from August to October 2010. RESULTS: One hundred and forty-one nursing diagnosis statements used in obstetric and gynecologic nursing unit were linked standardized nursing classifications and constructed nursing diagnosis ontology including interoperability. CONCLUSION: Not only will this result be helpful to complete nurse's lack of knowledge and experience, it will also help to determine nursing diagnosis logically by using standardized nursing process. It will be utilized as the method to construct ontology including interoperability in other nursing units. It will be presented nursing interventions according to nursing diagnosis and thus will be easier to establish nursing planning. This can provide immediate feedback of the nursing process application.

Objectives Fuzzy cognitive maps (FCMs) representing causal knowledge of relationships between medical concepts have been used as prediction tools for clinical decision making. Activation functions used for inferences of FCMs are very important factors in helping physicians make correct decision. Therefore, in order to increase the visibility of inference results, we propose a method for designing certain types of activation functions by considering the characteristics of FCMs. Methods The activation functions, such as the sinusoidal-type function and linear function, are designed by calculating the domain range of the functions to be reached during the inference process of FCMs. Moreover, the designed activation functions were applied to the decision making process with the inference of an FCM model representing the causal knowledge of pulmonary infections. Results Even though sinusoidal-type functions oscillate and linear functions monotonously increase within the entire range of the domain, the designed activation functions make the inference stable because the proposed method notices where the function is used in the inference. And, the designed functions provide more visible numeric results than do other functions. Conclusions Comparing inference results derived using activation functions designed with the proposed method and results derived using activation functions designed with the existing method, we confirmed that the proposed method could be more appropriately used for designing activation functions for the inference process of an FCM for clinical decision making.

OBJECTIVES: We design and develop an electronic claim system based on an integrated electronic health record (EHR) platform. This system is designed to be used for ambulatory care by office-based physicians in the United States. This is achieved by integrating various medical standard technologies for interoperability between heterogeneous information systems. METHODS: The developed system serves as a simple clinical data repository, it automatically fills out the Centers for Medicare and Medicaid Services (CMS)-1500 form based on information regarding the patients and physicians' clinical activities. It supports electronic insurance claims by creating reimbursement charges. It also contains an HL7 interface engine to exchange clinical messages between heterogeneous devices. RESULTS: The system partially prevents physician malpractice by suggesting proper treatments according to patient diagnoses and supports physicians by easily preparing documents for reimbursement and submitting claim documents to insurance organizations electronically, without additional effort by the user. To show the usability of the developed system, we performed an experiment that compares the time spent filling out the CMS-1500 form directly and time required create electronic claim data using the developed system. From the experimental results, we conclude that the system could save considerable time for physicians in making claim documents. CONCLUSIONS: The developed system might be particularly useful for those who need a reimbursement-specialized EHR system, even though the proposed system does not completely satisfy all criteria requested by the CMS and Office of the National Coordinator for Health Information Technology (ONC). This is because the criteria are not sufficient but necessary condition for the implementation of EHR systems. The system will be upgraded continuously to implement the criteria and to offer more stable and transparent transmission of electronic claim data.

In Korea driving is no piece of cake as someone puts it: "Everyone is driving like crazy, with no one getting anywhere." Suppose you are driven into the frontline at intersection, waiting for the signal ready to drive on. Even during such a short while your mind is blown away or you may answer the cellular phone, letting you forget what you are waiting for. When signal turns green, a little chaos breaks out. Immediately one or two horn goes off, and the drivers behind you start ducking out left or right to go ahead of you. The single lane quickly turns into spaghetti and the degree of chaos grows exponentially. It could be much worse if a collision takes place. The whole disaster wouldn't happen if you responded the signal instantly. Without your negligence you life would stay on the fast lane, but in vain. The point is that a moment at the forefront is 100 times more precious than a moment in the rear. So be attentive when are running ahead of others. We were once frontliners for a quite while when the Korean Society of Medical Informatics (KOSMI) was founded in 1987. Despite a small number of KOSMI members, we were one of a mind and we accomplished many wonderful things such as MEDINFO '98. A large number of hospital information systems were successfully implemented due to continuing efforts of the KOSMI with the support of sophisticated information technology (IT) advancements. Before the turn of the 21 century, as a result, nearly all hospitals in Korea operated and running information systems so that electronic insurance claims and reimbursements using EDI global standard were highly promoted. As soon as Y2K crisis was overcome, Picture Archiving and Communication Systems (PACS) were rapidly facilitated in hospitals; thus Korea has been recognized as the most medical IT-strong nation worldwide. As of now, a few leading university hospitals start implementing Electronic Medical Record (EMR), for which government funded research related to Electronic Health Record (EHR) is under consideration. We are proud to say that behind every great achievements in medical IT, KOSMI was there. Suddenly from some time ago and on, Korea lost her touch in IT. Though IT governance and social networking services are spread wider and deeper, the software frontier spirits are vanishing. Retrospective study has indicated that collective intelligence is not always right for the majority of those who are strongly biased in the struggle of conflicts of interests. Finally, the Ministry of Information and Communication has been decomposed. Is it all "none-of-my-business" to KOSMI? I am afraid that is not the case. Where have all the good old spirits of medical informatics gone? The first decade of the 21 century appeared rather quiet compared to the second period. Since last year we have seen many striking changes such as TGIF (short for twitter, google, iPhone, facebook). It seems to me a whole new IT paradigm tides in. The unexpected south-east wind baffles many smart brains all over the world. The Korea's IT-strong legend is breaking apart as the whole world rapidly moves towards a wireless monolithic empire. KOSMI, along with Korea, believed to some extent that the prosperity we now have may continue for a long time but it turns out to be a daydream. Come to think of the past decades IT people in Korea were frontliners but their minds were blown away with something else. When TGIF comes up in the marketplace, competition is almost out of the question. Though major conglomerates in Korea are still breathing in the market, no one would dare to say that IT-Korea will rock the world again. I am pessimistic until information scientists in Korea redefine IT because IT-strong Korea is like a castle in the air. For example, the semiconductor is mistakenly classified as IT, although there is no software component in it. Data or information can be stored on a hardware platform, but IT must consist of content and software, not necessarily including hardware. The new agenda for the national growth engine includes medical industry to be a leading business entity for the 21 century. With tons of smart IT engineers in medical and healthcare fields, nothing would be impossible. I would say, however, "In hospital every IT engineer is developing crazy, with no application working anywhere right." National information infrastructure must upgrade to the level of global standards. No business in medicine can be established without standard network and legal infrastructure. On the other hand, I am optimistic for the future of medical informatics because active human participation is essential in the development of medical software that has been disregarded in many IT-centric implementations. Softwares of medical informatics must be developed patient-centric and contents must be validated by accredited healthcare professionals. Medicine is known to be more than 2,500 years old profession. Very recently and suddenly IT is exploding and expanding its magnitude and territory at the speed of light, therefore I have a dream that medicine and IT will be synergistically integrated to make both KOSMI and Korea proud. "My heart leaps up when I behold, A rainbow is in the sky." Medical informatics is like a rainbow to me. So was it when I started my degree, so is it now I am a KOSMI member, and so be it when I grow for retire. I have a vision with the faith that one day healthcare providers and IT engineers, sitting around the table being able to speak fluently to exchange and share profound multidisciplinary knowledge of the other's profession. The KOSMI tradition must continue and the good spirit must be kept. There is an old saying that "A good beginning is half done." Since we have begun the good beginning, we have high hopes for KOSMI to be a rolling stone for many decades to come in the medical and healthcare informatics societies.

Objectives The Health Level Seven Interface Engine (HL7 IE), developed by Kyungpook National University, has been employed in health information systems, however users without a background in programming have reported difficulties in using it. Therefore, we developed a graphical user interface (GUI) engine to make the use of the HL7 IE more convenient. Methods The GUI engine was directly connected with the HL7 IE to handle the HL7 version 2.x messages. Furthermore, the information exchange rules (called the mapping data), represented by a conceptual graph in the GUI engine, were transformed into program objects that were made available to the HL7 IE; the mapping data were stored as binary files for reuse. The usefulness of the GUI engine was examined through information exchange tests between an HL7 version 2.x message and a health information database system. Results Users could easily create HL7 version 2.x messages by creating a conceptual graph through the GUI engine without requiring assistance from programmers. In addition, time could be saved when creating new information exchange rules by reusing the stored mapping data. Conclusions The GUI engine was not able to incorporate information types (e.g., extensible markup language, XML) other than the HL7 version 2.x messages and the database, because it was designed exclusively for the HL7 IE protocol. However, in future work, by including additional parsers to manage XML-based information such as Continuity of Care Documents (CCD) and Continuity of Care Records (CCR), we plan to ensure that the GUI engine will be more widely accessible for the health field.

Objectives: Reference values are highly required parameters for all tests in the clinical laboratory, and the supplementary provision of reliable reference intervals is an important task for both clinical laboratories and diagnostic test manufacturers. Despite the progress that has been made in the conceptual aspects of reference intervals, in practice their use is still not completely satisfactory. Most of the laboratories have used various methods to calculate statistic-based reference intervals, and they have mainly focused on extracted data, yet its use is considerably limited. We had to deal with the inconvenience of using a number of programs (SPSS or SAS, MS Excel) in order to calculate the results of reference intervals. Methods: In order to obtain standardized reference intervals, we developed an integrated program that can calculate, by a nonparametric method, reference intervals with using the Clinical and Laboratory Standards Institute (CLSI) processes as its guideline. We also developed a grouping interface that enables users to customize classification of each group (age, gender, blood group, race, etc) when calculating reference intervals. Results: To verify the developed program, we compared the reference intervals of the current data on 281 persons for 8 total areas, and the reference intervals were was already calculated beforehand with by using this new program. As a result, both results perfectly matched. Conclusions: This integrated program will be convenience for calculating reasonable values through continual datainspection at an inspection lab for calculating reference intervals. The newly developed program will improve the consistency and reliability of the statistics on reference intervals.

Objectives: We have developed a computerized WHO impairment grading for the clinical management of leprosy patients. The primary aim of this research is to redefine from the legacy disability grading to impairment grading recommended by ICF of WHO. Methods: The degree of impairment can be determined at the moment of clinical examination and directly entered by a physician. The computation of impairment sum scores, cumulative reports and analysis can be automated. Results: Annual report of health statistics is submitted with high degree of accuracy. Conclusions: WHO impairment grading and ICF terminology is found to be essential for the clinical management of leprosy patients, and can be a valuable basis for the development of information system in rehabilitation facilities. (Journal of Korean Society of Medical Informatics 14-2, 201-209, 2008)

Objective: We have developed a prototype Personal Health Record (PHR) system that can replace traditional paper based ‐ personal health diary with structured clinical details for healthcare. Because numerous disparate electronic versions of medical record systems are found unable to share medical information among hospitals, pharmacies and clinicians, the proposed PHR system can be used to facilitate patient care. Methods: The PHR system has been implemented on a flash memory (USB drive) that is found to be compact, light weight, cost effective and sufficient enough to handle a large ‐ amount of clinical data. International communication standard HL7 has recommended Continuity of Care Document (CCD) that can provide complete and accurate summary of an individual health and medical history. Care documents stored in USB can also support alerts, reminders, self management, and stakeholder communication in a standardized ‐ manner. Results: The proposed PHR system consists of modules that help collect distributed patient information from multiple sources to generate individual care document (CCD) as personal health record. The preliminary experiment has demonstrated an acceptable performance. That is, the PHR is found to integrate and share various clinical data such as medications, procedures, patient demographics from admission system, test results from LIS, DICOM images from PACS, bio signals from patient monitors. Especially, the PHR system was tested by connecting to standardized monitoring device ‐ (Mediana device) to collect ECG data. The PHR system had received 3410 HL7 messages for 1 hour, then generate CCD document. (Journal of Korean Society of Medical Informatics 14-3, 245-256, 2008)

Objectives: LOINC?(Logical Observations Identifiers, Names, Codes) is being used as the global standard for sharing laboratory test information and standardization. However, difficulties have been encountered in transferring local code to LOINC. Use in existing laboratory information systems(LIS) is possible with maximized local codes and LOINC mapping. Since the existing mapping tool has parts that do not match domestic medical environments, it is difficult to use without modification or supplementation. To this end, we have developed algorithms for LOINC mapping and have evaluated their usefulness. Methods: We used 2,376 M-codes transformed from Pusan National University Hospital’s 1,150 local codes, and codes from various laboratory test domains(Diagnostic Hematology, Clinical Chemistry, Seroimmunology, Molecular and Cytogenetics, Microbiology, Transfusion Medicine). In materializing the automatic mapping algorithms, spread sheet programs(Excel, Microsoft) and existing mapping tools(RELMA, Regenstrief) were used. The accuracy of the mapped codes was verified by a specialist of the Laboratory Medicine Department. Results: Of the 2,376 M-codes, mapping on LOINC was found to be possible for 78.7%(1,871) while LOINC corresponding with the local codes could not be found for 21.3%(505). Of the mapped codes, 90.8%(1,699) were mapped accurately automatically, while the rest were mapped manually. Conclusions: The LOINC mapping algorithm that was developed in this study was useful for mapping various forms of local code with LOINC. (Journal of Korean Society of Medical Informatics 14-2, 123-135, 2008)

In this study, the authors compared a new rapid spin-echo magnetic resonance (MR) imaging method, biphasic MR, with cine MR in the determination of left ventricular volume and mass in healthy volunteers. Biphasic spin-echo MR images covering the entire heart were obtained with use of the electrocardiogram R wave and the downslope of the T wave at both end diastole and end systole, respectively. Biphasic MR-determined values correlated well with small standard errors of the estimate (end-diastolic volume = 7.82 cm3, end-diastolic mass = 10.20 g, end-systolic mass = 10.08 g, ejection fraction = 2.62%) and were more reproducible. Cine MR-defined end-systolic volume was significantly larger (P less than .01) and ejection fraction was significantly smaller (P less than .005) than biphasic MR-determined values probably because of the uncertainty in isolating end systole with cine MR. Left ventricular volumes, mass, and ejection fraction are more accurately and reproducibly quantified in a more time-efficient manner with use of biphasic MR than with cine MR because of its significantly shorter image acquisition and reconstruction times.

Objective: This study proposes a hospital information system through the design and actualization of the Health Level 7 Development Framework (HDF) as a medical standard data model to sharing medical records between different hospital systems. The Health Level 7 Development Framework is a technique designed to capture domain expertise in a manner that it to be structured to create and validate models, which are subsequently translated into messages. Methods: The process used Health Level 7 Development Framework methodology with Health Level 7 tools. Results: We drew diagrams for each steps of the Health Level 7 Development Framework and an Extensible Markup Language (XML) schema for chemotherapy order system. Conclusion: This study applied Health Level 7 Development Framework methodology to practice. It is a good reference for the hospital information system (HIS) and enables information sharing among healthcare institutions. (Journal of Korean Society of Medical Informatics 13-1,19-25, 2007)

OBJECTIVE: The needs of sharing clinical documents in order for health professionals to provide better diagnosis and treatment have been tremendously increasing. However, when a patient visits the hospital, current hospital information system doesn't allow for physicians to obtain patient's medical history even though she has some records in different hospital, because the lack of the standardization to overcome the incompatibility among heterogeneous systems. CDA(Clinical Document Architecture) of HL7(Health Level 7) is standardized technology in purpose of creating and exchanging various clinical documents. In this article, we discuss the method of exchanging, storing, and utilizing CDA and present the work of development and implementation based on CDR(Clinical Document Repository) framework reported earlier9). METHODS: We convert paper-based discharge summary from each health institutions into CDA format. And in order to exchange, manage, and utilize those CDA, Registry structure of ebXML is introduced and applied. RESULTS: The relationship among patients, physicians, clinical organizations, and clinical documents is well-organized and modeled. Because transfered CDA document can be easily registered and managed by complying with RIM structure of ebXML, this system can effectively exchange and share patient's CDA document when patient move to other area or among heterogenous systems. CONCLUSION: This system can be utilized to categorize and store various clinical documents such as, ECG and Radiology reading report. In addition, this system suggests the potential of Electronic Health Record system that is able to communicate among heterogenous systems and manage the CDA documents via this CDR system.

The almost existing commercial HL7 interface engines apply the string array method which is run in the main memory to HL7 message parsing process. But, if the HL7 message is big, this method will be possible to cause the computer system to raise critical and fatal problems because a long string array can carry a too heavy load to the main memory and the processor. Therefore, the image and the multi-media data which are needed for the modern medical records could be limited to be included into a HL7 message because the size is usually too big in comparison with the main body of a HL7 message and in result, it make the size of the HL7 message expanded. The purpose of this study is to suggest a new HL7 interface algorithm which can solve this problem by the method of the 'Streaming Algorithm'. This new method for HL7 message parsing apply the character-stream object which process character by character between the main memory and hard disk device with the consequence that the processing load on main memory could be alleviated. The main functions of this new engine are generating, parsing, validating, browsing, sending, and receiving of message. And also, this can parse and generate XML-formated HL7 message. This engine had been practically tested in the Discharge Summary Information Exchange System between Kyungpook National University Hospital and Chonnam National University Hospital for the purpose of proofing its usability for a month. Overall, the preliminary results of this test is considered as good, but it is pointed out that some improvement is needed relating to the speed of parsing which was predicted because this engine partly used the memory of hard disk device instead of the main memory. (Journal of Korean Society of Medical Informatics 10-1,17-33, 2004)

In order to elucidate employees satisfaction levels in using graphic user interface. (GUI) in a laboratory information system (LIS), users attitudes toward GUI versus CUI. (Character User Interface) in a similar LIS were surveyed one month after implementing upgraded version of LIS in a tertiary care university hospital laboratory. The outcome of the study showed that approximately two third of users preferred to have GUI in LIS. There was no difference in preference of GUI of users whether they had previous experience with GUI or not. However the female and older employees tend to shy away from GUI. The employee productivity was improved with GUI although it takes slightly longer program loading time than that of CUI. In conclusion, the laboratory employee satisfaction was higher with GUI than CUI and their productivity was improved with GUI.