Japanese EMRs and IT in Medicine: Expansion, Integration, and Reuse of Data / 대한의료정보학회지

OBJECTIVES: The prevalence of electronic medical record in Japan varies according to the size of the hospital which is 62.5% in major hospitals, 21.7% in medium, 9.1% in small size hospitals, and 16.5% in clinics. The complete paperless system is very limited, though some major hospitals are aiming at this system. Several regional network systems which connect different platforms of EMRs, have been developing in many districts, while the final picture of a regional network has not been clearly proposed. To develop a whole electronic health record or personal health records system from the regional network data, we have several obstacles to overcome such as standardization, a privacy act, unique national health number. METHODS: Some experimental trials have just been started. The reuse of the accumulated data has also just been initiated. We exploited text mining systems (term frequency-inverse document frequency method) to find similar cases and auto-audit Japanese diagnosis related group (DRG) coding by using discharge summaries. RESULTS: The same or even a more extreme phenomenon of huge data accumulation is occurring in genetic research and confluence of multi-disciplines of informatics is the next step, which has an enormous accumulation of data and discoveries of the relations beyond the dimension of each informatics. CONCLUSIONS: We need another approach to science apart from the conventional method, and data-driven approach with data mining techniques must be brought in for each field. Informaticians have new important roles as coordinators to link up numerous phenomena over dimensions.

Modelling and comparing hospitals' information systems in Japan and Germany / 대한의료정보학회지

Medicine and health care are developing to be and yet are driving economical factors worldwide and information and communication technology is one of their most important resources. Thus, there is a special need for effective and efficient information systems. These information systems have continually to be adjusted to changing demands stemming from innovation and trends in medicine (continuity of care, translational medicine), but also from trends in information technology and information management (e.g. SOA, "Green IT", ITIL). Teams worldwide meet the challenge and implement projects concerning information systems for hospitals, health care regions, or even nationwide health telematics like German teams do by introducing the electronic health card. Completing the IMIA "world.wide vision to improve the health of the world population" by application of information technology needs effective cooperation worldwide. As already stated in the bible (tower of babel) one common language is needed for cooperation. This requires a widely accepted terminology/ontology for describing information systems in health care, a common understanding of the domain and of the tasks to be supported by information systems, and shared methods for creating construction plans. As a small contribution we had proposed 3LGM(2) as an ontology to describe information systems, a reference model to describe the domain of health care information processing, and the 3LGM(2) tool to create models and plans for information systems in health care. In a joint project of the University of Leipzig (Germany) and Chiba University (Japan) we applied these concepts to systematically compare the information systems of the respective universities' medical centres. We regard this comparison as small but important step towards better cooperation between Asia and Europe in building health care information systems. The comparison unfolded e.g. differences concerning architectural styles, heterogeneity, redundancy, use of communication standards and organisation of information management between both hospitals. The confrontation of the information systems of both sites with each other using the same terminology provides new chances for sharing experiences and, thus, for cooperation. Despite of the differences, no reason could be found for rating one information system significantly better than the other. For doing this, a more thorough understanding of quality of information systems in health care and respective research is needed.

Clinical Tutorial System at Chiba University School of Medicine / 医学教育

Many institutions have applied a tutorial system to medical education since Tokyo Women's Medical College started doing so in 1990. Chiba University School of Medicine started a clinical tutorial system in April 1997 and has continued it for 4 years. Our system has employed problem-based learning using cases, with the goal of students' acquiring self-learning and problem-solving skills. This tutorial system has been positively evaluated by both students and instructors and is likely to be useful for clinical medical education.

An Evaluation System for Internal Medicine Residents / 医学教育

We developed a system to evaluate internal medicine residents in terms of general internal medicine and subspecialties and assessed whether the evaluation system was effective and satisfactory for them. Evaluations were performed by the residents and their instructors at 6 months, 12 months, and every year thereafter. A questionnaire was completed by the residents to assess the effectiveness of the evaluation system. In every field, the scores given by the residents themselves after 6 months of residency were an average of 1 grade lower (on a 5-grade scale) than those given by their instructors. The students thought that the evaluation system was effective but contained too many items and had obscure standards. Although evaluation systems for medical residents are uncommon in Japan, we found that the results of the residents' and instructors evaluations were closely correlated. Self-evaluation systems are important in postgraduate education; a standardized system is required for a uniform level of education throughout the country.