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Introduction of Hira ICT System

Health Insurance Review & Assessment Service

National health insurance program has greatly improved Korea's public health in the last 35 years and brought about remarkable development in medical infrastructure.The Health Insurance Review & Assessment Service, which has played a pivotal role, is a public organization that reviews the medical fees and assesses the quality of care and ensures rational and efficient allocation of medical resources.

Year after year, we have seen a continuous increase in cases to be assessed.We reviewed 1.3 billion cases in 2010 and predict 1.9 billion cases in 2015.To handle this increasing volume, we went from paper billing to electronic billing and finally to a billing portal, resulting in a significantly-reduced medical review billing period from 40 down to 15 days. 50% of all cases are assessed through an automatic data processing system that we incorporated in 2003, increasing efficiency and effectiveness of the assessment process.

In addition, we have introduced medical assessment techniques such as the medical evidence-based assessment method and multi-dimensional analysis, positioning us as a specialized and competitive health care evaluation and review institution.

HIRA's information system exists for the people. Our most solid system is the EDI system and the medical billing portal.HIRA provides convenient services based on the EDI system and the electronic medical billing portal from reviewing claims and providing and sharing results in the form of electronic documents.This has laid the foundation for the informatization of medical institutions.

After an advanced quality control process, the accumulated data is managed through the Data Warehouse (DW), HIRA's health care information system. The DW System boasts the world's largest capacity in the health care sector with 210 TB.It has the capacity to perform automatic data searches and produce over 230 types of statistical reports and an unlimited amount of informal reports.By intellectualizing data and as a medium for value creation, it boasts social and economic benefits as it provides background and proof for determining salaries, drug reviews, policy support, decisions, enforcement, and research, and public opinion.

In addition to evaluation, we are building a medical institution-centered evaluation system combining evaluation of the aptitude of medical treatment and drug programs.

The DUR Service, a drug prescription*filling support service, exists so that citizens can enjoy safe drug use.Patients' prescriptions are sent through HIRA's central server to the doctor or pharmacist so that patients can enjoy safer access to drugs.

Since the DUR service is directly related to patients' health, we utilize a separate server and network to provide real time services 24 hours a day, 365 days a year.

The portal service boasts user-centric personalized medical service.Medical institutions can use the portal to report all matters and receive assessment results. Patients can also obtain customized health insurance information through the portal, and can use that information to consult with a customer service representative at our call center.

HIRA shares a real-time information exchange system with the Ministry of Health & Welfare, Korea Food & Drug Administration, and numerous health centers to manage medical equipment, personnel and facilities for the network of medical institutions nationwide.

By managing pharmaceutical production, import, distribution and use, we also strive for the advancement and transparency of drug distribution.

This information and communication system is a comprehensive internal control and security system that provides uninterrupted service in real-time.Personal information is encrypted and processed through an extremely secure system.We also operate a separate health care disaster recovery center, allowing us to provide uninterrupted service even during disasters, and provide tight security in conjunction with the Ministry of Health & Welfare's Cyber Security Center.

the key institution for Korea's health care policy, HIRA has been recognized as the #1 public agency in terms of informatization.We have been continuously raising our competitiveness through convergence of people and technology using our globally-acclaimed information communication system.

Currently, we are building a next-generation interactive web-based assessmentevaluation system with open access to information.And through our e-prescription delivery system that converts all prescriptions into the digital format, and our e-video information delivery and health information exchange system, we are building a green economy and leading the development of a safe, cost-effective medical system.In this way, we are preparing to become a smart, patient-centric Health Insurance Review & Assessment Service.

HIRA strives to improve the health of our citizens!
An earnest desire for public health... Technology and expertise...
We strive for Smart-Health.

For a healthier Korea!
For a happier Korea!

Now, with our cutting-edge health care assessment system, we willmove forward to become a global Health Insurance Review & Assessment Service through reliable and fair health care review & assessment

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2 Introduction of Hira ICT System 2013-10-14
1 HIRA VIDEO 2011-12-21