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U-Healthcare Chronic Disease and Health Management System
Guro District office, Seoul

The Problem

Korea has the world's fastest aging population, and eating habits have been westernized. As a result, nine out of ten elderly and more than half of the adult population suffers from chronic metabolic diseases such as hypertension, diabetes, and obesity. Healthcare costs are skyrocketing and the medically vulnerable population (low-income group , the disabled, and elderly persons living alone) cannot easily access hospitals because of their problems resulting in 80 percent of cases of chronic diseases being neglected. In response to this situation, the Guro-gu Public Health Center developed the u-Healthcare Chronic Disease and Health Management System and put it into action on April 1, 2007 to offer quality medical services to these very people, without limitation to time or space.

Solution and Key Benefits

 What is the initiative about? (the solution)
Access to medical services for medically vulnerable people with chronic diseases has been improved and convenience in the use of the services has been ensured by the adoption of field-centered health management and cutting-edge information technologies. In the end of November 2007, u-Healthcare medical services had already been provided to 10,200 medically vulnerable people. A total of 1,486 new patients, including those with hypertension and/or diabetes, were identified, medically treated, and followed up, thereby preventing complications. Moreover, a health management program was provided for each patient individually at risk of contracting certain diseases. These efforts considerably improved the health of residents. Medically vulnerable people's satisfaction with public medical services increased significantly because the system did much to improve equity in healthcare. The establishment of a quality medical information database on chronic disease patients has allowed for generation of key statistical indexes, such as the incidence of high blood pressure and diabetes, treatment rates, and control rates. This has in turn helped make healthcare administration more efficient by facilitating the setting of proper objectives and direction for public health policies and by other such means.

Actors and Stakeholders

 Who proposed the solution, who implemented it and who were the stakeholders?
The Guro-gu Public Health Center played a central role in coming up with the idea. The Future City u-Health Project Team of Korea University developed the software and content and provided the hardware. A u-Healthcare cooperative structure was established with Korea University Guro Hospital, an upper-level medical institution in the area, and an agreement was reached on the development of the u-Healthcare Chronic Disease and Health Management System and joint academic research on medical examination and treatment. On January 30, 2007, a Memorandum of Understanding (MOU) was exchanged among a public organization (the Guro-gu Public Health Center), university, and university hospital. Medical service projects based on the u-Healthcare Chronic Disease and Health Management System have been launched since April 1, 2007 to transform Guro-gu into a health and e-government district that applies IT to health and medical administration. The Guro-gu Public Health Center played a central role in operating the system, and Korea University Guro Hospital offered academic support for the u-Healthcare Chronic Disease and Health Management System. In addition, when the primary care provider sent patients to the Korea University Guro Hospital, the hospital treated the patients and continuously provided feedback. The Future City u-Health Project Team of Korea University was in charge of providing the needed financial support.

(a) Strategies

 Describe how and when the initiative was implemented by answering these questions
 a.      What were the strategies used to implement the initiative? In no more than 500 words, provide a summary of the main objectives and strategies of the initiative, how they were established and by whom.
An attempt was made to break away from the fixed social idea that medical services should be provided by medical institutions (public health centers). The online u-Healthcare Chronic Disease and Health Management System was set up at dong (village) offices, which are easily accessible by medically vulnerable people. Afterwards, one visiting nurse was dispatched to each of 19 dong offices. One nutritionist and one exercise prescriptionist visit the dong offices. As can be seen, field-centered, real-time customized services are being provided by going to the patients. Dong offices, which are located close to patients, are being used as advance bases, thereby allowing for separate management of those patients who can move freely and those patients who have trouble moving; and increasing accessibility to medical services by permitting visiting nurses to go to patients at their homes. Each dong office functions as a subcenter of the public health center, and they have won a favorable response from the patients.

(b) Implementation

 b.      What were the key development and implementation steps and the chronology? No more than 500 words
Patients who can move can now come to the dong office and use the u-Healthcare remote measurement device (WebDoc) to measure their blood sugars, blood pressure, and body composition. This information is sent to the u-Healthcare server. The results are sent in real time to the mobile phone of the patient and the PC of a nurse by an artificially intelligent function called the Clinical Decision Support System (CDSS). If any of the measurements is out of normal range, a doctor immediately intervenes. The attending physician at the public health center provides counseling in real time and takes necessary steps. A nurse with a PDA visits each immobile patient at home and conducts the same examination, and the results are immediately sent wirelessly to the PDA.
In other words, as soon as measurements are made, the information is automatically sent to a server in real time. Whenever something wrong is found, the attending physician at the public health center provides counseling in real time. The individual's medical treatment and examination information is recorded onto an electronic chart to enable remote management of his/her health.

(c) Overcoming Obstacles

 c.      What were the main obstacles encountered? How were they overcome? No more than 500 words
The main obstacles experienced during the initial phase of the project were difficulties in system development for online health management of chronic disease patients and acquiring medical expertise. There were also too few professional personnel to serve the increasing number of people wanting medical examinations, and further difficulties arose due to non-cooperation from medical experts in the private sector during the initial phase of the project. In time, the needed medical expertise was acquired and system development was completed by establishing an industry-government-academy network with the Future City u-Health Project Team of Korea University and Korea University Guro Hospital. In addition, presentations were given on the project that encouraged local hospitals and clinics as well as the Guro-gu Doctors' Association to participate.

(d) Use of Resources

 d.      What resources were used for the initiative and what were its key benefits? In no more than 500 words, specify what were the financial, technical and human resources’ costs associated with this initiative. Describe how resources were mobilized
The budget used can be broken down into five areas. Program development and maintenance costs amount to 25.6 million won(1$=933won); labor costs for 21 persons, including visiting nurses, total 256 million won (central government expenditures: 50 percent; gu expenditures: 50 percent); operating costs of offices for visiting nurses amount to 33.5 million won; u-Health care medical device costs and telecommunication fees total 58.3 million won; and PR costs are 7 million won, making the grand total 380.4 million won. Excluding the labor costs for visiting nurses, which were already being incurred before the u-Healthcare project, the total budget is 124.4 million won. In addition, the u-Health Project Team of Korea University gave financial support of 83.9 million won to fully cover the program costs, medial device costs, and telecommunication fees. The net budget executed was 40.5 million won. The u-Health Project Team of Korea University also provided, free of charge, the technology and covered the costs of the development and supply of network-based remote measurement devices (WebDoc, PDA, pulmometer, and diabetes phone) used by the visiting nurses. In return, the public health center ascertained the level of convenience and effectiveness of medical services using information technologies.

Sustainability and Transferability

  Is the initiative sustainable and transferable?
There is a dire need to reduce the social and economic burden that is rising in tandem with the exponential increase in chronic disease patients, stemming from population aging and changes in eating habits and lifestyles. There is a strong need for a low-cost, highly efficient chronic disease management model, and the Guro-gu model should remain efficient as information technology continues to rapidly develop. We are confident that the system will be effectively used in remote areas (e.g., farming villages, fishing villages, and mountainous areas), where there are too few medical professionals.
The scope of the u-Healthcare Chronic Disease and Health Management System will eventually be expanded to include child obesity management, home-based cancer patient management, and sexual dysfunction management, in addition to chronic disease management. By integrating with a video medical examination and treatment system, the u-Healthcare environment will be upgraded so that basic health and medical services can be received at home or at the nearest dong office, thereby improving convenience, efficiency, and accessibility. This is an effective solution for people who cannot receive health and medical services because of their location and socioeconomic states.

Lessons Learned

 What are the impact of your initiative and the lessons learned?
One of the success factors is preventive intervention in the form of a health management program, such as exercise and dietary treatment, for patients with no disease, moving away from only disease treatment. Other success factors include addressing inconveniences faced by residents suffering from chronic disease; acquiring more professional experts and technological support by industry-academia-government cooperation and cooperation from medical personnel in the local community; the determination of the organization leaders in upgrading the health and medical sector and the strenuous efforts of the employees; and the improved institutional and legal framework, such as the Medical Service Act.

Contact Information

Institution Name:   Guro District office, Seoul
Institution Type:   Government Department  
Contact Person:   Dae Woong Yang
Title:   Mayor of Guro District  
Telephone/ Fax:   +82-2-860-2421
Institution's / Project's Website:   +82-2-860-2651
E-mail:   tgh1224@hanafos.com  
Address:   435,guro-dong,Guro,Seoul
Postal Code:   152-701
City:   Seoul
State/Province:   Seoul
Country:  

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