INFORMATION
TECHNOLOGY FOR
UNIVERSAL HEALTH
COVERAGE (IT4UHC)
25 -27 September 2013
Manila, Philippines
National eGov Architecture and
its’ impact on IT4UHC systems
Chae Young Moon
KOICA
September 25, 2013
Young Moon Chae, Ph.D.
Yonsei University Graduate School of Public Health
Contents
e-Government of Korea
National eGov Architecture
Korea health insurance systems
Impact of national eGov on IT4UHC
IT4UHC Privacy Protection and
Information disclosure
4
Contents
e-Government of Korea
National eGov Architecture
Korea health insurance system
Impact of national eGov on IT4UHC
IT4UHC Privacy Protection and
Information disclosure
5
What is e-Government?
• The employment of the Internet for delivering
government information and services to the citizens
(UN, 2006).
• The utilization of IT to improve and/or enhance on
the efficiency and effectiveness of service delivery in
the public sector.
• e-Government uses technologies to facilitate the
smooth operation of government functions, and the
disbursement of government information and services
to the people
6
Growth of eGov of Korea
7
Korea ranks first in UN’s e-government index
8
Critical Success Factors for eGov
(Source: Song HJ. E-Government of Korea. Informatization Policy, 2008)
9
Government Information Sharing
10
Online Civil Services
11
e-Procurement
12
Towards a Smart eGov
13
Contents
eGov of Korea
National eGov Architecture
Korea health insurance system
Impact of national eGov on IT4UHC
IT4UHC Patient Privacy Protection and
information disclosure
14
What is Enterprise Architecture?
• EA is a digital tool that controls and manages public
projects of each government agency based on its own
standards and criteria.
• It was designed to prevent an overlap of projects
between ministries and subsequently improve the
efficiency and quality of public services.
• Korea-made Enterprise Architecture (EA) came away
a winner of UN Public Service Awards in 2013.
15
Properties of EA
• EA provides bases for standardization as well as
system qualities enhancement, business/IT
optimization, IT investment rationalization and
government-wide shared services
• EA provides models and tools to support
interoperability which is important in the public
sector where collaboration between public agencies is
necessary to realize the notions of seamless services
and one-stop government.
Terminology
• Architecture: Architecture is the structure of components, their
interrelationship, and the principles and the principles and
guidelines governing their design and evolution over
time[Webster Dictionary]
• Framework: A logical structure for classifying and organizing
complex information [Practical Guide Federal Enterprise
Architecture : FEAPMO]
• Government-wide Enterprise Architecture Framework
(GEAF): A logical structure for arranging and classifying
components and their interrelationship among government IT
projects
17
Korea eGov Adopted GEAF
• Goal of GEAF in Korea eGov
– To achieve integration and interoperability among
public IT projects
– To support collaborations between public agencies
• Factors considered for developing GEAF
– Characteristics of IT projects for public sector
– Support for the entire system development life cycle
(SDLC)
– Single or Multi-Organization
18
Other EA Framework
• The Open Group Architecture Framework
(TOGAF)
– The aim of TOGAF is to assist in the design, evaluation
and development of EAs for an organization.
– TOGAF tries to provide a technology-standard for
developing EAs
• Federal Enterprise Architecture (FEA)
– FEA aims to assist in the development and maintenance of
cross-agency, consistent EAs.
– FEA deliberately omits business processes, focusing more
on performance assessment of IT investments
19
Technical Reference Model (TRM) of GEAF
(Source: National Computerization Agency, Korea e-Gov’t EA and Standard Framework, 2011)
20
Approach to Achieve Integration
Resource Integration
with Compatibility
EA
Consolidated Data Center
e-Gov Network
Business Reference Model
Process Integration
Sharing Administrative Information
Internet Civil Services
Service Integration
e-Industry Single Window
e-Trade Services
Benefits of EA
(Source: Ministry of Security and Public Administration)
22
EA Adoption in Public Agencies
75.8% of government agencies adopted EA in 2010
23
Contents
eGov of Korea
National eGov Architecture
Korea health insurance system
Impact of national eGov on IT4UHC
IT4UHC Patient Privacy Protection and
Information disclosure
24
Insurance Coverage and Expenditure
Population
coverage
• 97% of the total population (48.9 million
persons) covered with NHI
• Medical Aid Scheme for the low income
covers the rest (3% of the total population)
Benefit coverage
• Inpatient costs: NHI pays 80% or more
according to disease (ex. NHI pays 90% for
cancer patients)
• Outpatient costs: NHI pays 50%~70%
Annual
expenditure
$ 43 billion (Medical Aid: $ 5 billion)
25
NHI Information Systems: NHIC and HIRA
Ministry of
Health & Welfare
NHIC
Payer
4. Review &
Assessment
Results
4. Review &
Assessment
Results
3.
Sending
Claims
Request for
Verification of Fee &
Benefit Coverage
Health
Check-up
1. Premium
Healthcare
organizations
Provision of
Benefit and Fee
Information
2. Co-payment
The
Insured
2. Health Care
Services
5. Payment for Claims
(Source: Park YT. Management of National Health Insurance System using IT. HIRA, 2012.4)
26
Data Warehouse at HIRA
HIRA gathers the dispersed disease information, stores in DB, and provides
information requesters with diverse information in real-time
Review System
Government
DW System
Loading data by review order
Reim. Storage
DB
SAM File
ETL
ODS DB
ETL
OLAP, SAS, etc. tools
Monthly data loading
People
ETL
DW DB
Mart DB
Providing information
SAM File
Verification File sending File loading
Creating the file
with batching
data loading by
review order
Sending the file
to DW
Insurers
Specific data loading by rev.
Monitoring
data re-loading
Management DB
ETL: Extraction, Transformation, Loading; ODS: Operational Data Store; OLAP : On-Line
Analytical Processing, Accumulated data volume are 150 billion records of 210 Terabyte
The Number of accesses to DW by Users (other than users in IT department)
Healthcare
providers
Healthcare
Research
Associations
Media companies,
consumer groups
2011.10
Month
Jan.
Feb.
Mar.
Apr.
May
June
July
Aug.
Sep.
All
37,204
17,041
44,117
32,228
14,262
85,082
36,678
43,928
37,028
27
Contents
eGov of Korea
National eGov Architecture
Korea health insurance system
Impact of national eGov on IT4UHC
IT4UHC Privacy Protection and
Information disclosure
28
Integration of Four Social Insurances
Health
Insurance
Pension
•
•
•
Aging
Handicap
Death
Workman’s
compensation
• Workplace
injury
•
•
Disease
Injury
Four
Social
Insurances
Unemployment
insurance
29
Integrated Information Systems for the
Social Insurances
Social Insurance Portal
(www.4insure.or.kr)
• Individual inquiry
• Individual reporting of
changes
Portal
Information
integration
center at
NHIC
Windows
Interface
Sharing common DB
• Interface 4
insurance systems
using EA
• Maintain common
DB
Processing of mutual services
• Eligibility reporting
• Using the common forms by
internet
30
HIRA Expanded EDI Claims Systems
31
HIRA Quality Assessment System
Government
Information for
policy development
Provider
feedback &
education
Assessment
Results
review and other
process, etc
HIRA
public
report for
choices
Consumer
results
and related incentives
Insurer
32
HIRA Drug Utilization Review (DUR) System
4 Issue Prescription
Pharmacy
Providers
7 Confirm Revise of Prescription
8
3
6
2
1
Real Time Internet transmission
5
•DB of DUR Standard
-Patient-based Prescription
Information DB
1
5 Prescription Information
Transmission
2
6 Review Results
Transmission
HIRA
3
8 Completed Prescription
Transmission
Protect from the drug accident and save cost by ensuring the drug safety and
restraining the duplicate or inappropriate drug use
(Source: Park YT. Management of National Health Insurance System using IT. HIRA, 2012.4)
33
Contents
eGov of Korea
National eGov Architecture
Korea health insurance system
Impact of national eGov on IT4UHC
IT4UHC Privacy Protection and
information disclosure
34
Information Disclosure and Privacy Protection
Information
disclosure
Privacy protection
Law
Information disclosure Personal information
Act 5242 (‘96. 12.31) protection Act (‘12.3.31)
Intent
Recognize people’s
right to know
Improve transparency
Protect patient privacy
Scope
All public information
Patient’s personal
information
Target
All public agencies
organizations
All public agencies
35
Act on Disclosure of information by Public Agencies
• Act No. 5242 was enacted on Dec. 31. 1996 and was revised in
2004
• Article 1 (Purpose): The purpose of this Act is to ensure the pe
ople’ s right to know and to secure participation of the people in
state affairs, and transparency
• Article 3 (Principle of Information Disclosure): The public
agency shall make available to the public the information
possessed and managed by the same public agency
• Article 5 (Duties of Public Agencies):
– The public agencies shall apply this Act and maintain other
related Acts in such a manner so as to uphold the rights of
the people requesting disclosure of information.
36
(cont.)
• Article 6 (Holder of Right to Request Disclosure of
Information)
– The people shall hold the right to request disclosure of
information.
• Article 7 (Information of Non-Disclosure):
– The public agencies may decide not to disclose information
falling under any of the 8 exceptions.
– The basic rule is that all public information should be open,
considering the essentials of disclosure of information
37
Significance of the Information Disclosure Act
• Korea became the 12th nation to enact and enforce
information disclosure law in the world
• Discussion to enact both a law on protecting privacy
and secrets of the people and a law of disclosing
information were actively carried out in the 1980s in
step with a rapid development of information society.
• The constitutional foundation for information
disclosure act is the right to know of the people
38
New Personal Information Protection Act
• The new personal information protection Act was enacted on
March 31, 2012
• The new Act replaces the existing Public Agency Data
Protection Act in whole and in relation to the private sector it
replaces in part the Act on Promotion of Information and
Communications Network Utilization and Information
Protection, etc. (ICN Act)
• More than 3.5 million public entities and private businesses
are now regulated by common criteria and principles, and
common enforcement mechanisms
• The new South Korean law is stronger in its requirements than
any other Asian data privacy law (Greenleaf, 2011)
39
(cont.)
• Korea’s new Act includes all of the basic
requirements of the OECD’s privacy Guidelines and
its derivative, the APEC Privacy Framework.
• The Act first makes a general statement of Data
Protection Principles (A 3), and Rights of the Data
Subject (A 4) and then provides detailed obligations
in relation to all Principles (As 15-39)
• The new Act strengthens the range of remedies and
actions that are available in data privacy disputes.
40
Key Points of the Act
• A 16 (1): Only the minimum collection of personal
data necessary for the purpose of collection is
allowed
• A 20: Notification to the data subject is required
when personal data is collected from third parties
• A 21: Deletion of personal data is required after the
purpose of processing is complete, or any other
retention period completed.
41
(cont.)
• A 23: Sensitive data cannot be processed without
consent
• A 24: Alternatives to identification other than the
Residence Registration Number (RRN) must be
provided
• A 31: A Privacy Officer must be appointed, with
detailed duties
42