초록

본 연구는 서울 시내 5개 대학병원의 의무기록 관리자들이 생각하는 전자의무기록시스템 구현 시 기록관리 메타데이터 표준 요소의 중요도를 설문조사하였다. SPSS 20.0(ver)을 이용하여 중요도 점수는 5점 척도의 평균으로 도출하여 순위를 정하였고 응답자 특성에 따른 중요도 차이를 분석하였다. 90%의 응답자가 국가기록원에서 기록관리 메타데이터 표준을 고시하고 있음을 모르고 있었다. 가장 중요도가 높은 요소는 ‘비밀등급 설정’ 이었으며 ‘의무기록 접근행위종류’, ‘내부직원 권한 설정’, ‘의무기록 이용접근자’ 요소가 그 다음 순위를 보여 기록정보보호 측면에서의 관리 기능 강화를 필요로 함을 알 수 있다. 개인 프라이버시 보호를 위하여 ‘외부공개’는 중요도가 낮은 관리요소로 평가되었으나, 전자의무기록 도입 7년 이상인 기관의 관리자들은 7년 미만의 관리자 보다 유의하게 이 세 가지 요소의 중요도를 높게 평가하였다. 이는 정보 축적에 따라 의학연구, 의학교육 등에서의 정보 이용에 대한 관리 기준과 시스템상의 적용이 필요함을 보여준다.

Abstract

To comprehend the importance and necessity of record management metadata standard implemented in an electronic medical records system, a survey was undertaken to 50 medical records managers in charge of 5 major hospitals in Seoul. Analysis of the survey results was performed by averaging the responses given by those who answered the survey. SPSS was utilized for statistical analysis. Managers of medical records placed importance on metadata that are related to security of records, such as “levels of security”, “types of access to medical records”, “levels of authorization granted to personnel”, and “users accessing medical records”. It shows that these managers need the functions of privacy protection in ERMS. Metadata on “external disclosure” had the lowest level but those surveyed with more than 7 years of experience placed greater importance in this area more those surveyed with less than 7 years of experience in a hospital. This shows that managers need the functions of external disclosure to meet the needs of third partiesfor medical research and medical education.

초록

많은 병원이 ‘디지털 병원’을 실현하기 위해 전자의무기록을 도입하고 있지만, 기록물 관리 및 보존에 있어서 많은 문제점이 존재한다. 전자의무기록 시스템은 병원마다 서식과 용어 등이 상이하며 의무기록 생산시스템과 의무기록관리의 표준이 없는 상황에서 OCS, PACS, EMR 등의 시스템이 독립적으로 운영됨에 따른 많은 문제점이 나타나고 있다. 의무기록을 효율적으로 관리하기 위해서는 분산 관리되고 있는 종이의무기록과 전자의무기록을 통합관리 할 필요가 있다. 따라서 본 연구에서는 의무기록관리 현황과 문제점을 알아보기 위해 J 대학병원을 대상으로 의무기록관리 현황에 대한 분석과 함께, ISO 15489의 기록관리과정을 기반으로 의무기록관리를 위한 개선방안과 통합의무기록관리시스템을 통한 의무기록관리 프로세스를 제안하였다.

Abstract

Many hospitals introduce the electronic medical record systems (EMRS) to implement a digital type of hospital. However, there are various problems in managing and preserving medical records. Systems, such as OCS, PACS, and EMR, are independently operated without formal standards related to medical records management. To manage medical records effectively, distributed medical records including paper- and electronic-type should be managed in an integrated manner. With its analysis of the current status in the management of medical records of J University Hospital, this study proposes methods to solve the problems extracted from the results of the analysis, and a management model for an integrated medical records management based on the process of records management of ISO 15489.

초록

우리나라 대부분의 의료기관이 전자의무기록을 도입하고 있지만, 의료기관이 폐업했을 경우의 기록물 관리 및 보존에 있어서 많은 맹점이 존재한다. 폐업 의료기관의 기록은 적법한 절차에 따라 체계적으로 관리될 필요가 있음에도 불구하고 보건소로 기록을 이관하는 폐업 의료기관의 수가 현저히 적고, 전자의무기록을 사용하는 의료기관마다 사용하는 시스템 및 서식이 상이하기 때문에 이관을 받는 보건소에서도 해당 기록을 열람조차 하지 못하는 경우가 많다. 또한, 보건소의 현실과 전자의무기록이라는 특수성에 부합한 관리기준 및 지침 또한 부재한 상황이다. 최근 폐업 의료기관의 의료기록에 대한 보건소의 보관책임 강화 법안이 통과함에 따라 본 연구에서는 관할 보건소의 효율적인 기록물 관리를 위한 방안 마련에 주목하였다. 이를 위해 관계 법령을 살펴보고 관리⋅보존이 미흡한 폐업 의료기관 전자의무기록 관리 현황을 파악하기 위한 문헌조사를 비롯한 정보공개청구 및 전화인터뷰 등의 조사를 실시하였으며, 그 문제점을 분석하여 제도적⋅기술적⋅행정적인 측면에서의 개선방안을 제안하였다.

Abstract

Although most medical institutions in Korea use electronic medical records (EMR), there are many problems in the management and preservation of records when such medical institutions are closed. Records of closed medical institutions need to be systematically managed; however, the rate of closed medical institutions transferring records to public health centers is significantly low. Given that each medical institution has a different system and format, public health centers often cannot access records. In addition, there are no management standards that suit the reality of public health centers and the specificity of EMR. Recently, a strengthened Medical Law has been passed wherein records of closed medical institutions should be kept by health centers; therefore, this study focused on drawing up measures for efficient records management by public health centers. To this end, the relevant laws and management status were identified and an interview was conducted. After analyzing the problems, improvement plans in institutional, technical, and administrative aspects were proposed.

초록

공공기관이자 의료기관인 인천광역시의료원의 특성을 반영하는 부서인 인천광역시의료원 임상연구윤리심의위원회(이하 IRB)는 2013년 설치되었으며, 의료원에서 시행된 연구의 윤리성을 심의·검증함으로써 연구자와 연구대상자를 보호하고 지역책임의료기관 역할 수행에 기여하고 있다. IRB는 지금까지 총 80여 건의 인간대상연구 및 인체유래물연구 계획을 검토하였으며, 현재 의료원장 직속의 독립된 처리과로 존재하고 있다. 본 고에서는 IRB 관련 기록물의 등록 및 보존, 기록관리기준표 및 관련 규정, 문서고의 정비에 관하여 설명하고, 기록물 공개와 활용, 분류에 있어 한계 및 개선 사항을 제시하고자 한다.

Abstract

The Incheon Medical Center Institutional Review Board (IRB), a department that reflects the characteristics of Incheon Medical Center, a medical and public institution, was established in 2013. IRB contributes to performing its role as a local accountable care hospital and protecting researchers and subjects by proving the ethics of research conducted at the medical center. So far, IRB has reviewed a total of 80 research proposals for human subject research and human-derived material research, and it currently exists as an independent department directly under the president of the medical center. This paper aims to explain the registration and preservation of IRB-related records, the maintenance of the Records Management Standard Table and related regulations, and archives, as well as to present limitations and improvements in the disclosure, utilization, and classification of records.

초록

기관의 업무 기능에 따라 기록을 업무기능에 따라 분류하기보다는 사안(Case)을 중심으로 분류해야 하는 경우가 있다. 사건기록, 수사기록, 소송기록, 재판기록, 인사기록, 병원진료기록, 환자기록, 상담기록, 프로젝트기록 등이 그 전형적인 예이다. 사안파일로 조직화되어 관리되는 기록은 일반적으로 정형화된 업무절차에 의해 만들어지는 기록들이다. 사안파일에는 시작부터 끝에 이르는 일련의 활동기록이 순차적으로 축적된다. 또한, 사안파일에는 다양한 기능 수행 결과로 만들어진 기록이 모여 입체적으로 사안의 진행과정을 재현한다. 이 연구는 대표적인 사안파일인 소송기록의 구성을 상세히 살펴보고 관리상의 특징을 도출하여 사안파일 기록관리의 시사점을 정리하고 있다. 이를 위해 첫째, 구체적인 소송기록의 특성을 살펴보기 위해 민원인을 대리하여 소송을 진행해주는 대한법률구조공단이 업무과정 중 생산, 관리하고 있는 소송파일이 어떤 기록들로 구성되는지 분석하고 있다. 둘째, 일반적인 사안파일의 특성이 대한법률구조공단 소송기록에 어떻게 반영되고 있는지 확인하고 있다. 셋째, 결과적으로 사안파일인 소송기록을 어떻게 관리하고 이용하는 것이 좋은지 대한법률구조공단의 사례를 통해 살펴보고 있다.

Abstract

Some records have to be classified not according to their business function but according to their case because of the characteristics of the organization’s business. Examples of this are case files, criminal files, lawsuit files, personal files, medical files, and project files. The case files are made according to standard business processes. Case files are filled with records of a series of activities and these records, which are made while carrying out various functions, reenact the multilevel process of a case. This study organized the implications of managing case files by examining the composition of lawsuit records and deducting characteristics in management. To do this, first, this study analyzed the composition of the lawsuit records that Korea Legal Aid Corporation produced and managed. Second, this study confirmed how the characteristics of case files are reflected in the lawsuit records of Korea Legal Aid Corporation. Third and lastly, this study searched how the lawsuit files are managed and used through the example of Korea Legal Aid Corporation.

초록

Abstract

This study investigates the current preservation and management of four records and documentary heritage in Korea that is in the UNESCO's Memory of the World Register. The study analyzes their problems and corresponding solutions in digitizing those world records heritages. This study also reviews additional four documentary books in Korea that are in the wish list to add to UNESCO's Memory of the World Register. This study is organized as the following: Chapter 2 examines the value and meanings of world records and documentary heritage in Korea. The registry requirements and procedures of UNESCO's Memory of the World Register are examined. The currently registered records of Korea include Hunmin-Chongum, the Annals of the Choson Dynasty, the Diaries of the Royal Secretariat (Seungjeongwon Ilgi), and Buljo- Jikji-Simche-Yojeol (vol. Ⅱ). These records heritage's worth and significance are carefully analyzed. For example, Hunmin-Chongum(「訓民正音」) is consisted of unique and systematic letters. Letters were delicately explained with examples in its original manual at the time of letter's creation, which is an unparalleled case in the world documentary history. The Annals of the Choson Dynasty(「朝鮮王朝實錄」) are the most comprehensive historic documents that contain the longest period of time in history. Their truthfulness and reliability in describing history give credits to the annals. The Royal Secretariat Diary (called Seungjeongwon-Ilgi(「承政院日記」)) is the most voluminous primary resources in history, superior to the Annals of Choson Dynasty and Twenty Five Histories in China. Jikji(「直指」) is the oldest existing book published by movable metal print sets in the world. It evidences the beginning of metal printing in the world printing history and is worthy of being as world heritage. The review of the four registered records confirms that they are valuable world documentary heritage that transfers culture of mankind to next generations and should be preserved carefully and safely without deterioration or loss. Chapter 3 investigates the current status of preservation and management of three repositories that store the four registered records in Korea. The repositories include Kyujanggak Archives in Seoul National University, Pusan Records and Information Center of National Records and Archives Service, and Gansong Art Museum. The quality of their preservation and management are excellent in all of three institutions by the following aspects: 1) detailed security measures are close to perfection 2) archiving practices are very careful by using a special stack room in steady temperature and humidity and depositing it in stack or archival box made of paulownia tree and 3) fire prevention, lighting, and fumigation are thoroughly prepared. Chapter 4 summarizes the status quo of digitization projects of records heritage in Korea. The most important issue related to digitization and database construction on Korean records heritage is likely to set up the standardization of digitization processes and facilities. It is urgently necessary to develop comprehensive standard systems for digitization. Two institutions are closely interested in these tasks: 1) the National Records and Archives Service experienced in developing government records management systems; and 2) the Cultural Heritage Administration interested in digitization of Korean old documents. In collaboration of these two institutions, a new standard system will be designed for digitizing records heritage on Korean Studies. Chapter 5 deals with additional Korean records heritage in the wish list for UNESCO's Memory of the World Register, including: 1) Wooden Printing Blocks(經板) of Koryo-Taejangkyong(高麗大藏經) in Haein Temple(海印寺); 2) Dongui-Bogam(「東醫寶鑑」) 3) Samguk-Yusa(「三國遺事」) and 4) Mugujeonggwangdaedaranigyeong(「無垢淨光大다羅尼經」). Their world value and importance are examined as followings. Wooden Printing Blocks of Koryo-Taejangkyong in Haein Temple is the worldly oldest wooden printing block of cannon of Buddhism that still exist and was created over 750 years ago. It needs a special conservation treatment to disinfect germs residing in surface and inside of wooden plates. Otherwise, it may be damaged seriously. For its effective conservation and preservation, we hope that UNESCO and Government will schedule special care and budget and join the list of Memory of the Word Register. Dongui-Bogam is the most comprehensive and well-written medical book in the Korean history, summarizing all medical books in Korea and China from the Ancient Times through the early 17th century and concentrating on Korean herb medicine and prescriptions. It is proved as the best clinical guidebook in the 17th century for doctors and practitioners to easily use. The book was also published in China and Japan in the 18th century and greatly influenced the development of practical clinic and medical research in Asia at that time. This is why Dongui Bogam is in the wish list to register to the Memory of the World. Samguk-Yusa is evaluated as one of the most comprehensive history books and treasure sources in Korea, which illustrates foundations of Korean people and covers histories and cultures of ancient Korean peninsula and nearby countries. The book contains the oldest fixed form verse, called Hyang-Ka(鄕歌), and became the origin of Korean literature. In particular, the section of Gi-ee(紀異篇) describes the historical processes of dynasty transition from the first dynasty Gochosun(古朝鮮) to Goguryeo(高句麗) and illustrates the identity of Korean people from its historical origin. This book is worthy of adding to the Memory of the World Register. Mugujeonggwangdaedaranigyeong is the oldest book printed by wooden type plates, and it is estimated to print in between 706 and 751. It contains several reasons and evidence to be worthy of adding to the list of the Memory of the World. It is the greatest documentary heritage that represents the first wooden printing book that still exists in the world as well as illustrates the history of wooden printing in Korea.