WMA-HDB-Seoul_HSU

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Ministry of Health and Welfare
Ethical, Legal and Social
Implications of Health Databases
– The experience of Taiwan National Health
Insurance Research Database
Ministry of Health and Welfare, Taiwan
Dr. Min-Huei Hsu
Ministry of Health and Welfare
Features of Taiwan’s Health System
• Universal health coverage provided by a
single payer
• Robust Health IT infrastructure
• National electronic medical records
exchange system
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Ministry of Health and Welfare
Taiwan National Health Insurance
Providers
Claims Data
NHIA
Insured
Payments
Premium
Healthcare Services
Copayment
NHI IC Card
Single-payer payment
system
• 496 hospitals
• >20,000 clinics
• 23 million
population
NHIRDB
Researchers
Ministry of Health and Welfare
At least 1 paper published per day since 2014
1 1 1 1 4 10 14 10 23 21
52 55 59
138
205
294
420
688
0
100
200
300
400
500
600
700
800
199619971999200120022003200420052006200720082009201020112012201320142015
Year
Keyword: Taiwan national health insurance database
Source: PubMed
Papers Published by Using NHI Research
Database (1996-2015)
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Ministry of Health and Welfare
Taiwan NHI Research Database
• Claims database
• De-identified
• Non-commercial Utilization
Ministry of Health and Welfare
Disputes of NHI Research Database
• Privacy Protection
• Data Ownership
• Self-Determination
• Research Ethics
• Commercial Utilization
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Ministry of Health and Welfare
NHI Research Database Related Acts
• The Freedom of Government Information Law
• Medical Care Act (medical record management, privacy
protection)
• Physicians Act and Other Acts Regarding Medical Personnel
• Human Subjects Research Act
• National Health Insurance Act
• Personal Information Protection Act
• Statistics Act
• Human Biobank Management Act
Ministry of Health and Welfare
NHI Research Database Involving Agencies
• Ministry of Health and Welfare
• Ministry of Science and Technology
• Ministry of Justice(Personal Information
Protection Act)
• National Development Council(open data)
• Directorate-General Budget, Accounting and
Statistics
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Ministry of Health and Welfare
Renewed Plans
• Managerial
– National Steering Committee in charge of
dataset application
• Technical
– Use cloud-based architecture to centralize
dataset
– Use VPN for all remote access sites
– Log all query activities for audit trail
Ministry of Health and Welfare
Center Ministry
Center
management
Data
exchange
Original
Database
Security control
VPN
Data management
Check
Operation Data processing
Administration
virtual
environment
Selected
Database
Cloud
Applying VPN on Health database
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Ministry of Health and Welfare
Taiwan Biobank
• Purpose: to construct cohorts for disease
incidence and progression
• 200,000 subjects from communities + 100,000
patients of common chronic diseases
Ministry of Health and Welfare
Next step…
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Ministry of Health and Welfare
Ministry of Health and Welfare