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Chronic disease management system using IT
Guro District Office

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 suffer from chronic metabolic diseases such as hypertension, diabetes, and obesity. One of the major problems is the fact that healthcare costs are skyrocketing and the medically vulnerable population (Those who belong to low-income group, the disabled, and elderly persons living alone) can not have easy access to hospitals. Since they can not have medical attention properly, their health conditions worsen resulting in 80 percent of cases of chronic diseases which are being neglected. After conducting series of Guro District resident’s health problem survey, the District office found out that large amount of people need to have immediate medical-care because of their hypertension, diabetes, smoking and obesity.

Solution and Key Benefits

 What is the initiative about? (the solution)
In response to this situation, the Guro District Public Health Center developed the U(ubiquitous)‐Healthcare Chronic Disease and Health Management System and put it into action on April 1, 2007 to offer quality medical services, which enable users(medical providers) to have medical attention from anywhere and any time, to the medically vulnerable people. In the end of December 2008, U-Healthcare medical services had already been provided to 11,760 medically vulnerable people. A total of 1,579 new patients, including those with hypertension and/or diabetes, were identified, medically treated, followed up and could prevent any complications that might be caused by neglecting chronic diseases. 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. As of December of 2008, the prevalence of hypertension was 25.5% and for diabetes 14.9%. And thanks to U-healthcare system, blood pressure and sugar control rate was improved from 51.1% to 65.8% in hypertension and in diabetes, control rate improvement was taken place from 74.3% to 77.6%. Among registered medically vulnerable population(11,760 people) we analyzed 225 people, who were randomly sampled and proportionately stratified according to 15 different Dongs(Korea’s administrative unit of city; subordinate unit of ‘Gu’, or the District) of Guro District, and as a result we could conclude that patients’ frequencies of visiting hospitals and local clinics and having treatment from the hospitals had decreased by 3 to 4 times at least. Additionally our program received positive inputs and high score in various surveys.

Actors and Stakeholders

 Who proposed the solution, who implemented it and who were the stakeholders?
The Guro District 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 District 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 District into e‐health government district that applies IT to health and medical administration. The Guro District 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.
Main objectives were to create a program which allows Guro District residents to have medical attention and treatment from anywhere and in convenient time through utilizing IT, which is the main advantage of Guro District, and the fact that Digital Guro District is known as the Silicon Valley of Korea due to many active IT businesses are operational here. And strategies we planned after composing a Task Force Team and series of strategy meetings are as following. The first one is to invest on IT so that there will be better and faster Internet network and cable, fiber-optics, and wireless Internet environment. At second, we provide continuous training and education for visiting nurses and doctors. And the last one is to support Internet education(including using Internet and computer) for those of who are not familiar with computer and Internet in order to spread and encourage use of WebDoc(remote measuring device) and U-Health System. Through these strategies mentioned before, we are able to break prejudice that only medical organizations, such as hospitals and clinics, can provide medical service. We installed a WebDoc device which enables remote measurement in 15 Dong offices and dispatched nurses to each office so that residents of Guro District can receive medical treatment in the nearest Dong office. There is only one Guro Public Health Center but, each Dong office acts as 2nd Public Health Center using our WebDoc and U-Healthcare program. For physically impaired patients, we have nurses visited their houses. Through these services every Guro resident can have better and convenient medical attention and treatment for their chronic diseases.

(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 sugar, blood pressure, and body composition. This information is sent to the U‐Healthcare server. Then, 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
Major targets of U-Healthcare system are population with low income and senior citizens who have digital divide, meaning that they do not have good access to Internet and cellular phones. It means that these people still cannot have any digital messages from doctors because they do not have any digital devices. Henceforth, Guro District provided free Internet education for using U-Healthcare system for those of who are independently mobile and medically vulnerable and allowed them to use free Internet in each Dong office. Using free Internet in Dong office, they can have direct access to their outcome of treatment and comment from doctors concerning their health condition. And for those of who are immobile, we allow doctors and patients to see each other face to face through monitor by using UMPC(Ultra Mobile Personal Computer).
Additionally there were strong resistance and disagreement from primary level medical centers, such as hospitals and local clinics because we provided medical treatment and consultation without any charge. We overcame this struggle by using collaboration with private sectors that allows newly found chronic disease patients who use U-Healthcare system to find the nearest primary level medical center and provided patient-trace & management-system. We suggested that Guro Public Health Center is a partner who can be helpful in introducing new patients to clinics and hospitals rather than a competitor. We emphasized that this is a Win-Win program that is beneficial for both sides.

(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 about $19,100(1$=1343won); labor costs for 21 persons, including visiting nurses, total $191,000 (central government expenditures: 50 percent; gu expenditures: 50 percent); operating costs of offices for visiting nurses amount to $25,000; u‐Health care medical device costs and telecommunication fees total $43,410; and PR costs are $5,212, making the grand total $283,000. Excluding the labor costs for visiting nurses, which were already being incurred before the u‐Healthcare project, the total budget is $92,700. In addition, the u‐Health Project Team of Korea University gave financial support of $62,500 to fully cover the program costs, medial device costs, and telecommunication fees. The net budget executed was $30,200. 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 District 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 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 can not 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?
By providing U-Healthcare service to the medically vulnerable population, who has been suffering from increased cost of medical-care fee which prevented them from visiting private medical center, Guro District can deter the increasing trend of medical-care cost. This will be possible and realized because the U-Healthcare system enables the medically vulnerable population to have appropriate and immediate medical service that will prevent them from having more serious diseases that may cause series of complication .Eventually and ultimately U-Healthcare system will contribute significantly in making Guro District residents to have healthier lives. Since we easily find ourselves surrounded by digital environments, such as IT(Information Technology), IS(Information System) and so many digital devices, not only civil but also public administration can not meet the expectation of residents and users unless the administration services are processed using IT or IS.
Among those IT or IS, Guro District Public Health Center learned valuable lessons and achieved successful outcomes by applying IT in health and medical service. The lesson we learned was very simple. When it comes to providing service, the first thing the service developer considers is to meet user’s needs. And the service should be easily accessible to the majority of population and simple. Since we spent the most of time taking these lessons into consideration, our project finally succeeded. The major reasons why we confidently say that our project was successful are as followed. At first, the primary reason why we could succeed in this project is our choice of selecting Dong office, which is the smallest city administrative unit of Korea and where every Guro District resident has easy access to, as the place our project take place into. At second, we maximize the trust and recognition level of the users by having great network and connection with near university hospitals and primary medical centers. High trust and recognition level of users allow them to participate in our project actively and widely. At third, we created U-Healthcare Webpage that offers convenient ‘health threatening factors check-ups’ by customizing our U-Healthcare system as Guro District’s exclusive system. Since this system is designed and contributed to residents of Guro District it became significantly easier for us to provide patients management program and to compose statistics index(incidence rate, control rate, prevalence, and treatment). Lastly, our continuous investment on IT, education, integration of Information System and balanced harmony between organization and management are the key successful factor of our U-Healthcare project.

Contact Information

Institution Name:   Guro District Office
Institution Type:   Government Department  
Contact Person:   Dae Woong Yang
Title:   Mayor  
Telephone/ Fax:   82-2-860-3228
Institution's / Project's Website:   82-2-860-2651
E-mail:   tgh1224@guro.go.kr  
Address:   435, Guro-dong Guro-gu,Seoul, Korea
Postal Code:   152-701
City:   Seoul
State/Province:  
Country:  

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