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Digitalization of Medical Record in Japan

Digitalization of Medical Record in Japan. Naoki Nakashima, MD, PhD Department of Medical Informatics Kyushu University Hospital, JAPAN. There are 9,000 hospitals and 90,000 clinics in Japan. Japanese government has strongly promoted digitalization of medical record from 2001.

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Digitalization of Medical Record in Japan

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  1. Digitalization of Medical Record in Japan Naoki Nakashima, MD, PhDDepartment of Medical InformaticsKyushu University Hospital, JAPAN

  2. There are 9,000 hospitalsand 90,000 clinics in Japan. Japanese government has strongly promoted digitalization of medical record from 2001. Digitalization rate (installation ratio of electronic medical record system=EMR) still remained only at the 20% level in 2005 in spite of the government’s effort. The government decided to use 100% online reimbursement system for medical fee between medical institutes and insurers by 2011. Digitalization of Medical Information in JAPAN

  3. Inefficient Standardization and Interoperability of Medical Information in Japan Insufficient Service of Public Infrastructure (PKI, medical VPN, etc) Too Many Variation of Medical Work Flow Recent Attention of Safety Management and Patient Privacy Too Much Cost for EMR Installation Problems of Electronic Medical Record System in Japan

  4. System Configuration of Hospital Information System in Kyushu University (Venus 3) (Since 2007) DS4800 *Referential ＤＢ … 1.5TB *Report reference… 1TB *images（old）… 1TB *Data ware house･･･ 1TB DS8100 *Order-entry／Electronic Medical Record … 3TB *Receipt data… 700GB *Radiology sector Tape library for back up [3584-L52] *6-drive SAN (Storage Area Network) IBM IBM SAN-Switch [2005-B32] Branch system Ｇ／Ｗ Referential Data Ware House Order-entry system／Electronic Medical Record i5/OS 6way / 30GB Referential Medical Record Back up AIX5L 4way / 8GB Reimbursement system i5/OS 1way / 6GB Radiology i5/OS 1way / 2GB p5 55A Branch system servers i5 570 (2.2GHz) x2 CPU: 8way Memory: 38GB Information Reference Sector Document creation support system serverﾞ Win2003 Branch system and Branch Ｇ／Ｗ Interconnect_SG HIS_Network Management_SG External_SG (Intranet) Security system Network management system

  5. Conceptual Figure of Venus 3 (Kyushu U Hosp system) Payment system Physical distribution system Other medical institutes Sector A Electronic medical record Nursing support system Sector B Medical information transition system Critical pathway Sector C Order-entry system Integration of medical and dental information disclosure system Sector D PACS (Filmless System) 70TB Patients bi-direction Sector X Data ware house For patient’s satisfaction Reports to Health, Labour and Welfare Ministry Hospital business management Safety Management Support of clinical researches

  6. Economical; Lease Contract of Venus 3 with IBM for 5years Application and hard (Venus 3, IBM)= 22 million US$/5ys Network (IBM) = 4 million US$ Filmless system (Fujifilm medical) = 5 million US$ Physical; Servers = 21 Clients =2000 (including clients of filmless system) * There are many other branch sector systems (drug, blood examination, physical examination, endoscope, rehabilitation, feeding service, etc) Scales of the Entire System

  7. Confidentiality Integrity availability To keep patient medical record properly

  8. Formulated operating rules, privacy policy and clarification of administrators Installation of registration authority office (thorough going registration, revision and deletion) Authentication by finger print Interruption from Internet Restriction to place client PCs only in the premise of the hospital Remove all media ports from client PCs Automatic log off and screen saver To assure confidentiality in KU hospital

  9. Time stamps Automatic monitoring of the discs Anti-virus software Prevention of falsification (but not by PKI) Multiple-back up Network redundancy To assure integrity in KU hospital

  10. Location management of information storage Reference function of all items on EMR Switching function to back up server Web EMR (only reference) at the time of maintenance or system down Secure server rooms in earthquake resistant building To assure availability in KU hospital

  11. Adoption of Healthcare-PKI Adoption of standardized master/code and protocols (HL7, DICOM, and IHE) of medical information Enlightenment of concept of sharing electronic medical data in the local area Future issues in Kyushu University Hospitaland probably in entire Japan

  12. Pay attention to present and future medical information system! Thank you, and Enjoy your stay in Hawaii !!

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