The Inequality of Patient Profile Information in Japanese Hospitals.

A model dataset of patient profile information was created based on the items used at five Japanese university hospitals, the patient information data elements in Health Level 7 (HL7) v2.5, and the standard datasets for medical information exchange used in Japan. In order to check the validity of the model dataset, a cross-sectional survey was performed. A preliminary analysis of 20 Japanese hospitals found that most items were implemented at some hospitals, but the number of items implemented at many hospitals was rather small. This result strongly shows the necessity for a standardized dataset of patient profile information.

The recommendations from the 2009 SiHIS working conference in Hiroshima--Issues on trustworthiness of health information and patient safety.

Held on 21st to 23rd November 2009 in Hiroshima, the SiHIS working conference aimed at finding solutions to approach to an idealistic society where (1) the individual can trust information with full understanding and responsibility, (2) the individual can allow the use of information backed by sound legitimated environment, (3) information can play its role for better healthcare and the improvement of medicine. The purpose of this paper is to propose recommendations from this working conference.

The guideline of the personal health data structure to secure safety healthcare. The balance between use and protection to satisfy the patients' needs.

PURPOSE: To inform about the impact of a recent movement towards a policy to develop integrative networked electronic health record (EHR) as a basis for cooperation among care teams and with patients and in support of safe patient care in Japan. METHODS: The author headed a commission developing policy for health record (HR) structure and its computerization. It executed two questionnaire surveys as the basis for its work. One survey assessed the current state of computerization of health record in the hospitals certified by Japan Council for Quality Health Care (JCQHC). The other survey assessed the attitudes towards a specific EHR system in the Hiroshima University Hospital and its affiliate hospitals. RESULTS: The survey of the above hospitals showed that most have computer supported administrative procedures, but only few computer-based health records. The attitudes of the Hiroshima EHR users show that while they expect efficiency and quality improvements, there is also apprehension that the system in use might lower practical efficiency and compromise patient safety. Accordingly, health recording requirements and storage policy have been restructured and communicated to the hospitals. CONCLUSION: These insights led to the initiation of curricula educating "Health Information Technologist" which is promoted by Japan Association Medical Informatics and the criterion of Chart Review Promotion of JCQHC. They will also lead to recommendation for improved and advanced EHR.

Patient characteristics in ticlopidine hydrochloride-induced liver injury: Case-control study.

BACKGROUND: Ticlopidine hydrochloride-induced liver abnormalities have been reported in the world. In Japan, the five-year (1995-2000) spontaneous serious reports of ticlopidine finds that liver injury accounts for about half of the reports. OBJECTIVE: Clinical characteristics of ticlopidine-induced liver injury were investigated to establish the prevention strategy. METHODS: We used a medical information system at Hiroshima University Hospital and analyzed statistically. RESULTS: In this study 288 cases were reviewed. Sixty-two cases were identified as the Cases that showed liver function abnormality after ticlopidine administration. And 226 cases were identified as the Controls. There were no significant differences in gender, age or daily dose between the two groups. Fluctuation of liver function was observed within 30 days in the most of Cases and cholestatic type accounted for about 60%. The risk of this abnormality increased significantly in patients with pre-existing abnormal liver or renal function [odds ratio (95% CI): 2.96 (1.43-6.13), p=0.005; 2.47 (1.13-5.39), p=0.037]. The renal protective agent, an oral carbonaceous adsorbent, reduced the risk of ticlopidine-induced liver function abnormalities in patients with renal abnormalities significantly [odds ratio (95% CI): 0.04 (0.002-0.767), p=0.004]. CONCLUSIONS: Liver function tests should be checked frequently, especially in cases with pre-existing liver or renal function abnormalities.

A clinical management system for patient participatory health care support. Assuring the patients' rights and confirming operation of clinical treatment and hospital administration.

We conducted a drastic change in our hospital information system to support patient participatory health care provided in the New Hiroshima University Hospital (HUH). The new information system in HUH (HU-MIND II-Hiroshima University Hospital Medical Intelligence and Notice Delivery system II) is designed as "clinical management system" (CMS). The core of this CMS is the electronic health record (EHR), which aims to assure both the patients' right to know, and the attendants' accountability. It is evident that the team practice including patients requires close communication. Data in the EHR are written not only by physicians, but also by all coworkers, which will enable them to realize the team communication and the ordering in a reliable way and to leave the evidence of conducted practices. Moreover, the bedside information systems were set-up at all 700 beds. Patients can access their anamnesis and future clinical care procedures themselves. Based on the demand outlined above, the new regulations of HUH are composed of 21 requirements, conditions of information collection, accumulation and use. Our focus was how to make patients' right compatible with attendants' accountability. As the data owners, patients have the facility to access their own data at their bedsides. They can view their own health condition and treatment program and can control the data flow.