Development History and Composition of Korea Tuberculosis Network System

Abstract

Objectives

Since 2000, South Korea has been continuously developing and improving the Korea Tuberculosis Network System (KTB-Net). This article aims to present how the system has digitalized and systematized the processes of detecting, diagnosing, treating, and monitoring tuberculosis patients.

Methods

This study has examined the history, structure, data holdings, and user roles of the KTB-Net system, drawing on informatization project reports and the KTB-Net database.

Results

Initiated in 2000 with a reporting management system, the KTB-Net has undergone continuous development. In 2009, the system was integrated, and in 2014, the reporting system was comprehensively overhauled. Currently, the KTB-Net comprises six subsystems and has accumulated over 9,103,281 records. It effectively supports tuberculosis patient management through linkages with six external organizations.

Conclusions

The KTB-Net has become a core system for tuberculosis management, contributing significantly to the nation’s efforts to eliminate tuberculosis. Continuous improvements will be made to enhance the system’s consistency, comprehensiveness, efficiency, and user-friendliness. Through these efforts, the KTB-Net will further solidify its role as a key tool in achieving the goal of tuberculosis eradication.

Key messages

① What is known previously?

Tuberculosis (TB) is a highly fatal infectious disease, with over 10 million new cases annually worldwide. Countries have adopted integrated approaches to manage TB.

② What new information is presented?

The Korea Tuberculosis Network System, established since 2000, digitalizes the entire TB management process from reporting to treatment and enhances efficiency by linking various government agencies.

③ What are implications?

The advancement of TB management and integration with different sectors is crucial for the success of TB control. Digital innovation and data analysis are key for the system’s future development.

Introduction

Tuberculosis (TB) has been a major infectious disease throughout human history and remains one of the most serious public health concerns globally. According to the World Health Organization, more than 10 million new patients are diagnosed with TB each year, which has one of the highest mortality rates among infectious diseases [1]. The high incidence of TB, especially among high-risk and vulnerable populations, has led to the heightened societal importance of TB control [2]. In response to these challenges, countries are adopting an integrated approach to TB prevention and control. These efforts have led to the creation of data-driven management systems that utilize information technology.

Since 2000, Republic of Korea has gradually established and developed the Korea Tuberculosis Network System (KTB-Net) to improve TB management efficiency. The system computerizes and systematizes the entire process of detection, diagnosis, treatment, and follow-up of patients with TB, contributing to a higher level of TB control. This study aims to evaluate the progress of the KTB-Net on an annual basis, with a focus on the components and data holdings of the system, as well as their respective roles, and to examine the impact of the system on TB control.

Results

1. Key Milestones in the Implementation of the Korea Tuberculosis Network System

The KTB-Net has been established and operated to electronically process, record, and manage data and information necessary for TB control programs in accordance with Article 7, Paragraph 2 of the Tuberculosis Prevention Act [3]. TB is managed separately from the Integrated Information System for Infectious Disease Control and Prevention, which is operated by the Korea Disease Control and Prevention Agency (KDCA) to monitor and respond to infectious diseases, owing to its long treatment period and differences in management methods from other legal communicable diseases in terms of infectious disease reports, case investigations, and epidemiological investigations. The following is a summary of the annual progress of construction of the KTB-Net.

In 2000, the Korea Tuberculosis Surveillance System (KTBS) was established, and reports of TB patients began to be computerized and reported. In 2005, the Tuberculosis Laboratory Management Information System (TBIS) was established, and in 2006, the Tuberculosis Picture Archiving Communication System (TBPACS) was established to support diagnosis and management using image information.

Between 2007 and 2009, the Integrated TB Information Management System, the predecessor of the KTB-Net, was established. This system integrated the KTBS, TBIS, and TBPACS into a unified structure with the objective of enhancing data management efficiency and laying the foundation for the current system by organizing the overall TB management. The system also linked test information with the Ministry of Health and Welfare (MOHW)’s regional healthcare information system. In 2011, the system was integrated and upgraded to the TB management system within the integrated disease and health management system. In this process, TB epidemiological investigation (family contacts) and patient management program functions were incorporated, including support for contact examination fees, support for patient management fees, and hospitalization orders.

Between 2013 and 2014, the surveillance system was rebuilt, and the database was redesigned. During this period, a personal identification number was introduced to fortify the integrated management system for patients with TB. The Ministry of the Interior and Safety (MOIS)’s resident registration address information was linked to designate and expand public health centers corresponding to the address in the patient’s resident registration as patient management health centers. Furthermore, it has incorporated the administration of health center family screening and healthcare organization contact screening, as well as the establishment of a public facility epidemiological survey management function.

In 2015, the information regarding the individuals eligible for family contact screening and payment for the screening was linked with the National Health Insurance Service (NHIS) to support the commissioning of family contact screening fees. In 2016, the functions of priority management of foreign nationals with TB, management of Mycobacterium tuberculosis (M. tuberculosis) testing and genotype testing, generation of TB control indicators, and feedback were incorporated. Furthermore, in cooperation with the Ministry of Justice (MOJ), the information on the arrival and departure of foreign nationals subject to priority management was linked. In cooperation with the NHIS, the reports of patients with TB eligible for the special coverage, as well as the treatment results for the termination of the special coverage, were linked.

In 2017, to facilitate the reformed screening and treatment management of latent TB infection (LTBI), including the mandatory screening for LTBI, functions were added to manage LTBI screening conducted by entrusted organizations and other ministries/agencies and to manage the adverse events of LTBI treatment. The system also integrated the testing and treatment management of LTBI, which were previously managed separately as epidemiological surveys, family contact screening, and LTBI screening programs. In the same year, it linked the testing and treatment information with the Military Manpower Administration to integrate the testing and treatment data, thereby facilitating the management of LTBI among individuals undergoing military service screening.

From 2018 onwards, detailed functional developments have been performed on an annual basis, including the management of patients with multidrug-resistant TB, Vulnerable to TB group Screening management, inventory management of pharmaceuticals, and pre-review system for new drugs. Changes to the existing system owing to format revisions and linkages with related organizations are being made for work convenience and data accuracy (Table 1, Figure 1).

Table 1. History of the Korea Tuberculosis Network System.

Year	Progress
2000	Establish a Korea Tuberculosis Surveillance System (KTBS)
2005	Establish a Tuberculosis Laboratory Management Information System (TBIS)
2006	Establish a Tuberculosis Picture Archiving Communication System (TBPACS)
2007–2009	Establishment a Korea Tuberculosis Network System (TBnet)a)
2011	Integration and modernization of TB systems within the integrated disease and health control systemb)
2013–2014	Rebuilding the surveillance system and database resetting -Establishing an integrated management system by assigning personal identification numbers -Designate and expand the reporting information manager to the health center where the TB patient’s resident registration address is located -Integrate health center family screening with hospital contact screening management -Contact investigation in congregate settings function development -Integrated status board (My work) development -(Ministry of the Interior and Safety) Residential address of TB patients
2015	(National Health Insurance Service) Personal information of screening recipients and reimbursement information
2016	Foreign patients function development Management Mycobacterium tuberculosis testing, genotype testing function development (2015–2016) TB management indicators function development (Ministry of Justice) Linked arrival and departure information for TB foreign priority persons (National Health Insurance Service) Partial declaration information of TB patients (National Health Insurance Service) Linkage of costs for LTBI treatment (Ministry of the Interior and Safety) Link to number of household members with TB patients
2017	Development of an episode-based group management system for tuberculosis patients Development of source case investigation for children under the age of 5 years Development of an integrated management system for LTBI (contact investigation in congregate settings, contact investigation in households, LTBI screening, etc.) (2016–2017) (Military Manpower Administration) Connecting data on individuals excluded from LTBI screening and those who tested positive
2018	Development of a notification and management system for multidrug-resistant tuberculosis patients Enhancement of health screening management for vulnerable populations (Military Manpower Administration) LTBI treatment information linkage
2019	Introduction of a system for authenticated stamping seal of LTBI test results (introduction of anti-counterfeiting solution) Development of inventory management of pharmaceuticals Development of a system for TB notification cases, analyzing, and weekly statistics (Ministry of Justice) Changes to the linked method for arrival and departure information for TB foreign priority persons
2020	Development of pre-review system for new drugs Development of field response vehicle schedule management Development of an integrated approval system for genotype testing, IGRA, and pre-review system for new drugs (Ministry of the Interior and Safety) Additional linkage of households member (2020)
2021	Development of a system for vulnerability assessment and case counseling, welfare services and specialized care Development of tracking and monitoring system for contact investigation in congregate settings, contact investigation in households
2022	Development of system for management of Korean TB cohort (National Fire Agency) Partial declaration information of TB patients
2023	Development of a monitoring system for missed or delayed reporting of tuberculosis cases Development of additional items for KTB-EIS and data quality control
2024	Incorporation of revised contact list format for epidemiological investigations (National Health Insurance Service) Linkage of workplace information on health insurance for TB patients

TB=tuberculosis; LTBI=latent tuberculosis infection; IGRA=interferon-gamma releasing assay; KTB-EIS=Korea Tuberculosis-Epidemiologic Investigation System. ^a)Integration of KTBS, TBIS, TBPACS. ^b)Development of functions for tuberculosis control programs, such as contact screening fee support, patient management fee support, and hospitalization orders.

Figure 1. History of the Korea Tuberculosis Network System.

TBIS=Tuberculosis Laboratory Management Information System; PHIS=Public Health Information System; TB=Tuberculosis; KTB-CMS=Korea Tuberculosis - Case Management System; KTB-EIS=Korea Tuberculosis - Epidemiologic Investigation System; KTB-Screen=Korea Tuberculosis - Screening System; KTB-LTBI=Korea Tuberculosis - Latent Tuberculosis Infection; MDR-TB=multidrug resistant tuberculosis.

2. Organization and Operation of the KTB-Net

1) Configuration of the KTB-Net

The KTB-Net is comprised of multiple subsystems that collectively orchestrate the comprehensive TB control system. Each component plays an important role in the prevention, diagnosis, treatment, and follow-up of TB, and each has its own purpose and function.

First, the KTB-Surv is a system that systematically manages the notification and reporting of patients with TB. This system processes reports from patients with TB and analyzes their basic information through case investigation, thereby supporting expeditious treatment management of reported TB cases.

Second, the Korea Tuberculosis - Case management system (KTB-CMS) supports programs related to TB case management. Vulnerability assessment of patients with TB, case counseling, referral to health and welfare services, and personalized medication care are used to aid in the successful treatment of patients. Furthermore, the system offers a range of priority management functions, including non-compliant patient management, hospitalization order management, foreign national priority management, and multidrug-resistant TB patient management. In addition, it provides Management of Korean TB Cohort and pre-review system for new drugs functions.

Third, the Korea Tuberculosis - Epidemiologic Investigation System (KTB-EIS) is a comprehensive program that includes contact investigation in congregate settings, contact investigation in households, field response vehicle schedule management, and source case investigation for children under the age of 5 years. The KTB-EIS utilizes manage workplace suspensions to minimize the spread of infection.

Fourth, the Korea Tuberculosis - Latent Tuberculosis Infection (KTB-LTBI) is a system that manages the screening and treatment of LTBI. The system is designed to record and manage mandatory screening for LTBI (state-funded), issue screening confirmation certificates, and report adverse events that occur during the treatment of LTBI.

Fifth, the Korea Tuberculosis - Screening system (KTB-Screen) is responsible for the identification of TB carriers through health checkups and chest X-ray examinations. The system facilitates the detection and treatment of TB in high-risk groups by managing TB screening for vulnerable populations.

Sixth, the Korea Tuberculosis - Diagnostic Test System (KTB-Dx) manages the results of diagnosis and analysis of TB, including tuberculin test, genotype test, and interferon-gamma releasing assay during LTBI tests. Management the level of TB testing is implemented to ensure the reliability of test results and support efficient TB management by dataizing the test results.

Finally, the Korea Tuberculosis - Other System is responsible for the compilation of statistics and the maintenance and management of the system. The system provides statistical data, including the status of TB case notifications, weekly incidence of epidemiological surveys, TB control indicators, and PPM monitoring. It also maintains the stability and efficiency of the system through institutional management, code management, and linkage monitoring.

Consequently, KTB-Net encompasses the entire process of TB control by leveraging the organic interconnections among its components, thereby facilitating the seamless progression of TB control programs (Figure 2).

Figure 2. Organizational chart of the Korea Tuberculosis Network System.

KTB-Surv=Korea Tuberculosis-Surveillance System; TB=Tuberculosis; KTB-CMS=Korea Tuberculosis - Case Management System; KTB-EIS=Korea Tuberculosis - Epidemiologic Investigation System; KTB-LTBI=Korea Tuberculosis - Latent Tuberculosis Infection; LTBI=latent tuberculosis infection; KTB-Screen=Korea Tuberculosis - Screening System; KTB-Dx=Korea Tuberculosis - Diagnostic Test System; IGRA=interferon-gamma releasing assay; KTB-OS=Korea Tuberculosis - Other System; PPM=Public-Private Mix; DB=database.

2) Data availability by subsystem and linked external organization source

The KTB-Surv, initiated in 2000, has registered and processed 1,172,376 cases, while the KTB-CMS, introduced in 2011, manages data on 480,838 cases. The KTB-EIS is divided into systems for contact investigation in households and contact investigation in congregate settings. The system for contact investigation in households, introduced in 2011, has 385,669 registered cases, and the system for contact investigation in congregate settings, introduced in 2013, has 1,388,201 registered cases. The KTB-LTBI has 1,550,801 registered cases since 2015, and the KTB-Screen, divided into the systems for General Health screening and vulnerable TB group, developed in 2011 and 2013, respectively, is managing 319,181 and 1,199,743 cases, respectively. The KTB-Dx system, developed in 2005, is managing 2,606,472 cases.

With regard to data linkage with external organizations, the MOIS linked 429,487 cases of resident registration address and number of household members with TB patients in 2014, and the NHIS linked 140,187 cases of the family contact cost delegation data in 2015, 298,445 cases of special coverage data in 2016, and 451 cases of health insurance workplace information data in 2024. The MOHW has linked 2,154,112 cases of M. tuberculosis testing data since 2008, and the Military Manpower Administration has linked 39,461 cases of LTBI screening and treatment data since 2017. The linkage with the MOJ began in 2016, which has since linked 2,415 cases of arrival and departure data of foreign nationals under priority management for TB, and finally, the linkage with the National Fire Agency began in 2022 and has since linked 120,905 cases of TB incidence data (Table 2).

Table 2. Data holdings by subsystem and external organization linkage.

Separation			Enrollment/linkage on start year	Data volume	Remark
Subsystems	KTB-Surv		2000	1,172,376
	KTB-CMS		2011	480,838
	KTB-EIS	Contact investigation in congregate settings	2013	1,388,201
		Contact investigation in households	2011	385,669
	KTB-LTBI		2015	1,550,801
	KTB-Screen	Health checkup	2011	319,181
		Vulnerable populations	2013	1,199,743
	KTB-Dx		2005	2,606,472
Connecting to external organizations	Ministry of the Interior and Safety		2014	429,487	Residential address of TB patients and number of household members
	National Health Insurance Service	Program is designed to reduce the financial burden for patients with tuberculosis	2016	298,445	Partial declaration information of TB patients
		Workplace information	2024	451	Workplace information on health insurance for TB patients
		Outsourcing family contacts	2015	140,187	Personal information of screening recipients and reimbursement information
	Ministry of Health and Welfare (Korea Social Security Information Service)		2008	2,154,112	About TB testing
	Military Manpower Administration		2017	39,461	About screening for and treating LTBI in military screening tests
	Ministry of Justice		2016	2,415	Arrival and departure information for TB foreign priority persons
	National Fire Agency		2022	120,905	Partial declaration information of TB patients

KTB-Surv=Korea Tuberculosis Surveillance System; KTB-CMS=Korea Tuberculosis - Case Management System; KTB-EIS=Korea Tuberculosis - Epidemiologic Investigation System; KTB-LTBI=Korea Tuberculosis - Latent Tuberculosis Infection; KTB-Screen=Korea Tuberculosis - Screening System; KTB-Dx=Korea Tuberculosis - Diagnostic Test System; TB=tuberculosis; LTBI=latent tuberculosis infection.

3) System users and user-specific roles

As the administrator of the KTB-Net system, the KDCA is responsible for the development of KTB-Net functions, informationization for maintenance, information security management of the system, personal information protection, and data quality management. The stability and usability of the system are continuously improved through the development and maintenance of functions, and the system is optimized to reflect new policy needs. Furthermore, technical and administrative protection measures, including the systematic management of users through reorganization of access rights and encryption of data, are implemented to prevent patient information from being leaked or used inappropriately. Data quality control is also implemented to guarantee the accuracy and consistency of data entered into the system.

Provincial and city health centers, healthcare organizations, institutes of health and environment, and the Korea National Tuberculosis Association are the primary users of KTB-Net, conducting reporting, case investigation, epidemiological investigation, and TB testing according to their respective roles. Notably, provincial and city health centers are leveraging the system to oversee the comprehensive management of TB within their respective jurisdictions. Furthermore, given that each organization is entrusted with the handling of personal information pertaining to patients with TB, it is imperative to implement robust measures to prevent the unauthorized disclosure of such information.

Conclusion

The KTB-Net is a representative system that has provided the basis for systematic and reliable information processing in TB prevention and control. In the nascent stage of implementation, the system’s functionality was confined to the management of patient reports and diagnostic information. However, it has undergone gradual upgradation and integration to systematically manage the entire process, from the detection of patients with TB to the completion of treatment, in line with the changes in the national TB control policy. Furthermore, user convenience and information accuracy have been improved through linkages with the information systems of other ministries/agencies.

To further develop the KTB-Net, a system that utilizes data analysis technology and digital innovation is necessary. KTB-Net will continue to support TB control programs to achieve the goal of 20 TB cases per 100,000 population and the successful implementation of the programs in the Third Tuberculosis Control Plan (2023–2027).