Quality Requirements for Electronic Health Record Systems*. A Japanese-German Information Management Perspective.

BACKGROUND: For more than 30 years, there has been close cooperation between Japanese and German scientists with regard to information systems in health care. Collaboration has been formalized by an agreement between the respective scientific associations. Following this agreement, two joint workshops took place to explore the similarities and differences of electronic health record systems (EHRS) against the background of the two national healthcare systems that share many commonalities. OBJECTIVES: To establish a framework and requirements for the quality of EHRS that may also serve as a basis for comparing different EHRS. METHODS: Donabedian's three dimensions of quality of medical care were adapted to the outcome, process, and structural quality of EHRS and their management. These quality dimensions were proposed before the first workshop of EHRS experts and enriched during the discussions. RESULTS: The Quality Requirements Framework of EHRS (QRF-EHRS) was defined and complemented by requirements for high quality EHRS. The framework integrates three quality dimensions (outcome, process, and structural quality), three layers of information systems (processes and data, applications, and physical tools) and three dimensions of information management (strategic, tactical, and operational information management). CONCLUSIONS: Describing and comparing the quality of EHRS is in fact a multidimensional problem as given by the QRF-EHRS framework. This framework will be utilized to compare Japanese and German EHRS, notably those that were presented at the second workshop.

A system for health promotion using tele-homecare technology in community.

We have developed a system for health promotion of regional inhabitants, using CATV network at Tsushima Island in Nagasaki, Japan from 2010 to 2012. This system was provided by five kinds of services such as safety confirmation system, monitoring system of vital signs, sharing system for healthcare information, supervised administration system (compliance check of medicines), and local community TV program. Based on this experience we have been challenging a new trial at Kinkai district in Nagasaki which is aimed to be sustainable and helpful servicesboth for patients and staffs.

Assessment of the intestinal permeability after a gastrectomy and the oral administration of anticancer drugs in rats: nitric oxide release in response to gut injury.

BACKGROUND: Although intestinal permeability is known to increase in conditions of stress (such as endotoxemia, septic shock, and ischemia-reperfusion), the mechanism of gut barrier dysfunction during chemotherapy remains to be elucidated. We designed an experiment in which a gastrectomy and anticancer drugs were administered to rats to assess the extent of damage or an increase in permeability of the intestinal mucosa. METHODS: The rats were separated into the following groups: group A, no operation without an anticancer drug (control rats); group B, a gastric operation; group C, chemotherapy; and group D, a gastric operation followed by chemotherapy. Six rats were placed in each group. The groups that were given the anticancer drug received 45 mg/kg for 7 and 14 days, respectively. Intestinal permeability was determined by an injection of fluorescein isothiocyanate-dextran (FITC-D) intravenously and the measurement of the amount of FITC-D leakage in the luminal lavage. The plasma nitric oxide concentrations were measured spectrophotometrically by the Griess reaction. The cell surface expression of CD44 in the rat small intestine was evaluated immunohistochemically. RESULTS: During the entire experimental period, the FITC-D levels in the anticancer drug that was administrated to rats (groups C and D) were significantly higher than the levels in groups A and B (P <.001). Similarly, the plasma nitric oxide concentration increased significantly not only in groups C and D but also in group B (P <.05). A linear regression analysis revealed a positive significant correlation between FITC-D and the plasma nitric oxide levels (r = 0.617; P <.001). When the anticancer drug was administered, the intestine histologically revealed so-called mucosal atrophy and a decreased expression of CD44 within the intestinal mucosa. CONCLUSIONS: The administration of anticancer drugs impairs the gut barrier function, possibly by reducing the cell-cell and cell-matrix interactions. This may contribute to the development of hyperpermeability that is induced by an overexpression of nitric oxide.