A Document-Based EHR System That Controls the Disclosure of Clinical Documents Using an Access Control List File Based on the HL7 CDA Header.

Electronic health record (EHR) systems are necessary for the sharing of medical information between care delivery organizations (CDOs). We developed a document-based EHR system in which all of the PDF documents that are stored in our electronic medical record system can be disclosed to selected target CDOs. An access control list (ACL) file was designed based on the HL7 CDA header to manage the information that is disclosed.

Method to Identify Diagnostic Rules for Pancreatic Cancer Using Laboratory Data Based on Bayesian Estimation.

Early diagnosis and treatment of pancreatic cancer is challenging. We attempted to find diagnostic rules for pancreatic cancer from laboratory data in the Osaka University Hospital's data warehouse using Bayesian estimation. We calculated the pretest odds based on the number of laboratory tests and the cutoff value at which the diagnostic accuracy is over 20%. By this method, we identified diagnostic rules of 6 types for one item and 79 types for 2 items. Pancreatic cancer is difficult to detect from only general laboratory tests. However, this method may be promising in early diagnosis.

Cross-institutional document exchange system using clinical document architecture (CDA) with virtual printing method.

Recently one patient received care from several hospitals at around the same time. When the patient visited a new hospital, the new hospital's physician tried to get patient information the previous hospital. Thus, patient information is frequently exchanged between them. Many types of healthcare facilities have implemented an electronic medical record system, but in Japan, healthcare information exchange is often done by paper. In other words, after a clinical doctor prints a referral document and sends it to another hospital's physician, another hospital's doctor receives it and scans to store the EMR in his own hospital's system. It is a wasteful way to exchange healthcare information about a patient. In order to solve this problem, we have developed a cross-institutional document exchange system using clinical document architecture (CDA) with a virtual printing method.

Usage experience with the document archiving and communication system for the storage and retrieval of medical records.

Standard Japanese electronic medical record (EMR) systems are associated with major shortcomings. For example, they do not assure lifelong readability of records because each document requires its own viewing software program, a system that is difficult to maintain over long periods of time. It can also be difficult for users to comprehend a patient's clinical history because different classes of documents can only be accessed from their own window. To address these problems, we developed a document-based electronic medical record that aggregates all documents for a patient in a PDF or DocuWorks format. We call this system the Document Archiving and Communication System (DACS). There are two types of viewers in the DACS: the Matrix View, which provides a time line of a patient's history, and the Tree View, which stores the documents in hierarchical document classes. We placed 2,734 document classes into 11 categories. A total of 22,3972 documents were entered per month. The frequency of use of the DACS viewer was 268,644 instances per month. The DACS viewer was used to assess a patient's clinical history.

A scheme for assuring lifelong readability in computer based medical records.

Medical records must be kept over an extended period of time, meanwhile computer based medical records are renewed every 5-6 years. Readability of medical records must be assured even though the systems are renewed by different vendors. To achieve this, we proposed a method called DACS, in which a medical record is considered as an aggregation of documents. A Document generated by a system is transformed to a format read by free software such as PDF, which is transferred with the document meta-information and important data written on the XML to the Document Deliverer. It stores these data into the Document Archiver, the Document Sharing Server and the Data Warehouse (DWH). We developed the Matrix View which shows documents in chronological order, and the Tree View showing documents in class tree structure. By this method all the documents can be integrated and be viewed by a single viewer. This helps users figure out patient history and find a document being sought. In addition, documents' data can be shared among systems and analyzed by DWH. Most importantly DACS can assure the lifelong readability of medical records.