Analysis of yearly variations in drug expenditure for one patient using data warehouse in a hospital.

Medical expense has grown rapidly in Japan. It could be caused by the increase of the patient number and the increase of medical expense per patient. We studied the latter factor on drug expenditure from 1996 to 2002 using the prescription data stored in the data warehouse of one hospital. We found that the drug expenditure per patient had increased 1.32 times. The mean number of prescriptions per patient increased 1.23 times and the mean expenditure of one medicine increased 1.08 times. These results demonstrated that drug expenditure for one patient had gradually increased. This was caused by both the rise in the number of medicines taken by one patient and the rise in the prices of medicines. The data warehouse in the hospital was useful for the analysis of the trends in medical expenditure for one patient.

Creation of a master table for checking indication and contraindication of medicine from a knowledge base linked with a thesaurus.

To develop a system for checking indication and contraindication of medicines in prescription order entry system, a master table consisting of the disease names corresponding to the medicines adopted in a hospital is needed. The creation of this table requires a considerable manpower. We developed a Web-based system for constructing a medicine/disease thesaurus and a knowledge base. By authority management of users, this system enables many specialists to create the thesaurus collaboratively without confusion. It supports the creation of a knowledge base using concept names by referring to the thesaurus, which is automatically converted to the check master table. When a disease name or medicine name was added to the thesaurus, the check table was automatically updated. We constructed a thesaurus and a knowledge base in the field of circulatory system disease. The knowledge base linked with the thesaurus proved to be efficient for making the check master table for indication/contraindication of medicines.

Healthcare public key infrastructure (HPKI) and non-profit organization (NPO): essentials for healthcare data exchange.

To share healthcare information and to promote cooperation among healthcare providers and customers (patients) under computerized network environment, a non-profit organization (NPO), named as OCHIS, was established at Osaka, Japan in 2003. Since security and confidentiality issues on the Internet have been major concerns in the OCHIS, the system has been based on healthcare public key infrastructure (HPKI), and found that there remained problems to be solved technically and operationally. An experimental study was conducted to elucidate the central and the local function in terms of a registration authority and a time stamp authority by contracting with the Ministry of Economics and Trading Industries in 2003. This paper describes the experimental design with NPO and the results of the study concerning message security and HPKI. The developed system has been operated practically in Osaka urban area.

Detection of misery perfusion with split-dose 123I-iodoamphetamine single-photon emission computed tomography in patients with carotid occlusive diseases.

BACKGROUND AND PURPOSE: Patients with carotid occlusive disease and stage 2 cerebral hemodynamic failure, characterized by an increased oxygen extraction fraction (OEF) as measured by positron emission tomography (PET) and otherwise known as misery perfusion, have a high risk of cerebral ischemia and subsequent stroke. In clinical practice, the detection of patients with misery perfusion through the use of widely available, noninvasive, and cost-effective modalities such as single-photon emission computed tomography (SPECT) is extremely important. METHODS: We evaluated the relationships between the regional hemodynamic status of cerebral circulation, measured with split-dose [123I] N-isopropyl-p-iodoamphetamine SPECT (123I-IMP SPECT) and an acetazolamide challenge, and hemodynamic parameters, including OEF measured with PET, in 27 patients with both unilateral and bilateral carotid occlusive diseases. RESULTS: A significant negative correlation was found between the SPECT-measured cerebrovascular reserve after acetazolamide administration and both the PET-measured OEF and cerebral blood volume. Neither the cerebrovascular reserve nor the cerebral blood flow index, when expressed as a SPECT-measured cerebrum-to-cerebellum ratio, was useful for detecting lesions with an elevated OEF. However, a combination of the cerebrovascular reserve and cerebral blood flow index showed high sensitivity, specificity, and positive predictive value for the detection of misery perfusion. CONCLUSIONS: Our study suggests that split-dose 123I-IMP SPECT with an acetazolamide challenge could be useful for screening patients with misery perfusion in carotid occlusive diseases.