Architecture for networked electronic patient record systems

There have been two major approaches to the development of networked electronic patient record (EPR) architecture. One uses object-oriented methodologies for constructing the model, which include the GEHR project, Synapses, HL7 RIM and so on. The second approach uses document-oriented methodologies, as applied in examples of HL7 PRA. It is practically beneficial to take the advantages of both approaches and to add solution technologies for network security such as PKI. In recognition of the similarity with electronic commerce, a certificate authority as a trusted third party will be organised for establishing networked EPR system. This paper describes a Japanese functional model that has been developed, and proposes a document-object-oriented architecture, which is-compared with other existing models.     

Contributions of university hospitals to local health integration networks

The use of ICT (Information and Communication Technology) has supported the widespread sharing of healthcare data. Collaboration among medical or health facilities in the community using a telemedicine infrastructure has been promoted by the Strategy of IT-related Structural Reform (the Acceleration and Advancement of e-Japan Priority Policy Program) of the Japanese government. Many university hospitals have been playing leading roles of facilitating collaboration with community healthcare. Through advances in broadband networking and security technology, we have made great progress from the trial stage to the practical stage in the electronic sharing of clinical data. Although many efforts are being made spread the cooperation areas or widen the scope of information sharing for utilization in disease prevention or clinical trials of newly developed drugs as well as medical information, university hospitals have to continue working on these areas to support patients and staff as core hospitals in the community.     

Willingness to pay for Japanese cedar pollinosis: comparison between pollination and non-pollination seasons]

Allergic rhinitis is not fatal illness, but its high prevalence and several symptoms result in substantial medical cost. There is increasing interest in the use of economic evaluations in healthcare; therefore, we investigated patients' willingness to pay (WTP) for prevention and cure from Japanese cedar pollinosis (JCP), and compared WTP values assessed in non-pollination season (June 1998) and pollination season (February-March 2003). Japanese economic woes got worse in 2003 than in 1998. Patients were randomly selected from ENT clinical sites in Osaka, 175 and 645 patients completed WTP questionnaire in 1998 and 2003, respectively. WTP value was lower in 2003 than in 1998, which related to part-time employees and housewives' reducing WTP. Declining WTP value did not associated with the differences in patient characteristics between 1998 and 2003 including age, duration of disease, nasal symptom severity and comorbid condition. These results show that we have to take employment status into account in economic evaluations. Decline in WTP for JCP in 2003 was strongly affected by Japanese sluggish economy, and the WTP seemed to be stable value in individual patients.     

The efficacy of short-term administration of 3 antihistamines vs placebo under natural exposure to Japanese cedar pollen.

BACKGROUND: Japanese cedar pollinosis, a common disease with morbidity of approximately 20% in the Japanese population, is characterized by subjectively irritating symptoms during an annual 3-month period. OBJECTIVE: To investigate the effectiveness of cetirizine hydrochloride, loratadine, and fexofenadine hydrochloride in reducing pollinosis symptoms induced while walking in a park during the pollen season. METHODS: A randomized, double-masked, placebo-controlled trial was conducted in 113 individuals with Japanese cedar pollinosis during 2 days in March 2003 in Osaka Expo Park, Osaka, Japan. Participants (aged 20-57 years) were divided into 4 groups according to treatment assignment: cetirizine hydrochloride, 10 mg/d; fexofenadine hydrochloride, 120 mg/d; loratadine, 10 mg/d; and placebo (lactose), twice daily. Symptoms were recorded hourly during the study. Furthermore, all the patients completed the Japanese version of the Rhinoconjunctivitis Quality of Life Questionnaire before and after the trial. RESULTS: Self-evaluated symptom scores in all 3 active treatment groups showed significant improvements compared with the placebo group. Furthermore, the cetirizine group showed significant improvement in the domains of frequency of nose blowing and nasal obstruction compared with placebo. In addition, improvement in Japanese Rhinoconjunctivitis Quality of Life Questionnaire scores was higher in the cetirizine group than in the loratadine and placebo groups. CONCLUSION: Cetirizine seems to be more effective than fexofenadine and loratadine at reducing subjective symptoms in this study population.     

Japanese children's family drawings and their link to attachment

This study explored the applicability of family drawings as a tool to estimate attachment security in a sample of Japanese six-year-olds (N?=?47), applying Kaplan and Main's ( 1986 ) Family Drawing system. Maternal secure/insecure attachment status judged by the Adult Attachment Interview predicted family drawings' secure/insecure distinction produced by Japanese six-year-olds. However, insecure Japanese drawings took forms not seen in the original Berkeley drawings, such as a lineup of faces alone. Further examination of the Japanese children's drawings using global rating scales (Fury, Carlson, & Sroufe, 1997 ) yielded significant gender differences, rarely reported in the attachment literature, with girls scoring higher in scales that predict attachment security and boys scoring higher in scales that predict attachment insecurity. However, attachment security, as captured in the drawings, was not related to attachment security, observed behaviorally using Main and Cassidy's ( 1988 ) sixth-year reunion system. Implications of the findings are discussed in light of measurements, gender, and culture.     

Outbreak of sapovirus infection among infants and children with acute gastroenteritis in Osaka City, Japan during 2004-2005

One hundred and twenty five fecal specimens were collected from sporadic cases of acute gastroenteritis in a pediatric clinic in Osaka City, Japan from July 2004 to June 2005 and tested for the presence of rotavirus, norovirus, sapovirus, astrovirus, and adenovirus by RT-multiplex PCR. Among diarrheal viruses detected, norovirus was the most prevalent (19.2%, 24 of 125), followed by group A rotavirus (18.4%, 23 of 125), astrovirus (1.6%, 2 of 125), and adenovirus (0.8%, 1 of 125), respectively. Interestingly, sapovirus infection was identified with high incidence of 17.6% (22 of 125). Sapovirus was subjected to molecular genetic analysis by sequencing. It was found that sapovirus detected in this study was classified into four genotypes (GI/1, GI/4, GI/6, and GI/8), and sapovirus GI/6 was predominant, followed by GI/8 and accounted for 81.8% (18 of 22) and 9.1% (2 of 22), respectively. It was noteworthy that sapovirus GI/6 infection was apparently confined within the period of 5 months (August 2004 through December 2004). This pattern of infection implied the outbreak of sapovirus GI/6 in these patients, which was the first outbreak of acute gastroenteritis attributed to sapovirus in Osaka City. Another interesting feature of the study was the appearance of two novel, naturally occurring recombinant sapoviruses circulating in the Japanese population studied. This report confirmed the presence as well as the importance of sapovirus causing acute gastroenteritis among Japanese infants and children.     

Stress and Coping Styles are Associated with Severe Fatigue in Medical Students

Fatigue is a common complaint among medical students and researchers consider it to be related to poor academic outcomes. The authors' goal in the present study was to determine whether stress and coping strategies were associated with fatigue in medical students. The study group consisted of 73 second-year healthy students attending the Osaka City University Graduate School of Medicine. Participants completed a questionnaire about fatigue (Japanese version of Chalder Fatigue Scale), stress, stress coping (Japanese version of the Coping Inventory for Stressful Situations), overwork, and nocturnal sleeping hours. On univariate and multivariate logistic regression analyses adjusted for age and gender, stress was positively associated with fatigue. In addition, after adjustment for age, gender, and emotion- and task-oriented stress coping activities, avoidance-oriented stress coping activity was associated with fatigue. The results suggest that stress and the coping style are correlated with fatigue in medical students.     

Security concept in 'MyAngelWeb((R))' a website for the individual patient at risk of emergency

We describe the Security Plan for the 'MyAngelWeb' service. The different actors involved in the service are subject to different security procedures. The core of the security system is implemented at the host site by means of a DBMS and standard Information Technology tools. Hardware requirements for sustainable security are needed at the web-site construction sites. They are not needed at the emergency physician's site. At the emergency physician's site, a two-way authentication system (password and test phrase method) is implemented.     

Regional comparison of patient-reported outcomes in Japanese cedar pollinosis]

BACKGROUND: There is little information about the relationship between local pollen counts and pollinosis symptoms of the local patients. In this study, we compared patient-reported outcomes (PROs) of Japanese cedar pollinosis (JCP) according to regions. METHODS: The study was conducted between February 24 and March 8, 2003 (peak pollen season), and 1200 patients were recruited from 15 ENT clinical sites in 4 regions : central Osaka (n = 576), southern Osaka (n = 195), northern Wakayama (n = 234), and southern Wakayama (n = 195). PROs consisted of nasal symptoms, ocular symptom, learning and work impairment, and QOL (SF-36). RESULTS: In non-treatment group, there were significant differences in ocular symptom and learning and work impairment among regions. On the other hand, patients with longer duration of treatment had better symptom relief regardless of pollen level in early treatment group. As to QOL, SF-36 summary scores did not differ among regions in both groups. CONCLUSION: This study shows that patients without early treatment seemed to be affected by pollen level on their ocular symptom and its related outcomes. In patients with early treatment, however, the treatment duration had bigger impact on PROs than the local pollen counts.     

Effect of concreteness of target words on verbal working memory: an evaluation using Japanese version of reading span test

Effects of concreteness and representation mode (kanji/hiragana) of target words on working memory during reading was tested using Japanese version of reading span test (RST), developed by Osaka and Osaka (1994). Concreteness and familiarity of target words and difficulty of sentences were carefully controlled. The words with high concreteness resulted in significantly higher RST scores, which suggests the high efficiency of working memory in processing these words. The results suggest that high concrete noun-words associated with visual clues consume less working memory capacity during reading. The effect of representation mode is different between subjects with high-RST and low-RST scores. Characteristic of the high concrete words that may be responsible for the effectiveness of processing are discussed.     

Founding and development of the Croatian Health Information System

Information systems, either computer or paper based, are the key to business effectiveness and efficiency of healthcare organizations. The rationale of starting a large healthcare informatics project by the Ministry of Health and Welfare may be argued by two needs: (1) the need of medical data transformation into the information required for public health policy decision-making; and (2) measures in the field of health and pharmacoeconomics, i.e. systematic surveillance of healthcare costs that define the prospects for savings without lowering the level of service (estimated at 20%-30% of potential savings), along with the need of transparency and adoption of European Union directives and standards. Implementation of the proposed system results in two groups of fundamental functions: (1) the creation of a central public health information system which facilitates real-time tracking of primary healthcare cost generators, which in turn are used for creating health economics policy, and (2) to automatize the process of generating a consolidated national health budget including the Croatian Institute of Health Insurance and hospitals as well as consolidated financial reports for all those involved in the healthcare system. The model of the National Health Information System of the Republic of Croatia is described.     

Mutations of the p53 gene in nasal NK/T-cell lymphoma

Mutations of the p53 tumor suppressor gene are reported in various kinds of malignancies including lymphomas. However, p53 gene mutations in nasal NK/T-cell lymphoma have not been reported because most parts of tumors are necrotic and a small amount of living tumor tissues is available for the molecular study. Expression and mutations of the p53 gene were examined in the paraffin-embedded specimens of the nasal lesions from 42 Chinese (Beijing and Chengdu) and Japanese (Okinawa and Osaka) patients with nasal NK/T-cell lymphoma by the immunohistochemistry and single strand conformation polymorphism (SSCP) analysis of polymerase chain reaction (PCR) amplified products followed by direct sequencing. Thirty single-nucleotide substitution mutations were observed in 20 of 42 cases (47.6%). Among the 30 mutations, 18 were missense (mainly G:C to A:T transitions), 9 were silent, and 1 was a nonsense mutation. The remaining 2 mutations involved intron 5 and exon 5 terminal points. Abnormal expression of the p53 protein was also observed in 19 of 42 (45.2%) cases. The incidence was significantly (4-fold) higher in the cases of Osaka than those in other areas, although the incidence of p53 mutations in the cases of Osaka was one-half to one-third of those in the other three areas. The results may suggest some racial, environmental, or lifestyle differences in the cause of nasal tumorigenesis.     

Effects of drug adherence on patient outcomes to early treatment for Japanese cedar pollinosis]

Drug adherence is one of the important aspects in caring for patients with allergic rhinitis. To improve clinical efficacy of early treatment for Japanese cedar pollinosis (JCP), we evaluated the effect of drug adherence on patients' outcomes. Patients were randomly selected from 16 ENT clinical sites in Osaka and Wakayama between February 24 and March 8, 2003 (peak pollen season). Efficacy was assessed using patients' ratings of nasal and ocular symptoms and overall assessment in their condition compared with previous season ones. Costs include direct costs of the drugs used for treatment to JCP from January to February. Five hundred one patients taking early treatment were enrolled. Compared to low adherence patients, those who reported higher level of adherence significantly improved overall health condition, and achieved better symptom relief of rhinorrhea and nasal congestion. In multiple logistic regression analysis, the following factors were independent risk factors for low adherence: student (p=0.002), using OTC medications (p=0.006), and short-duration of medication (p=0.001). Low costs were also risk factor for low adherence. We conclude that taking medications for JCP for 22-28 days is the best way to enhance patients' outcomes.     

Patient Record Information System (PaRIS) for primary health care centers in Indonesia.

This study explores the Patient Record Information System (PaRIS) for primary health care centers in a developing country such as Indonesia. The specific geography of the thousand islands country Indonesia is the reason for transportation difficulties as well as communication problems. This causes a serious adverse effect on the public healthcare service especially in the rural area within the country. Hence, a sustainable system is required that makes use of appropriate Information and Communication Technology (ICT). We developed a clinical information system with modest communication technology combined with a unique database distribution system. The Internet and its free software are the main tools for this system. It is a good opportunity for a developing country such as Indonesia to apply open free software in regard to the healthcare sector. This cost effective and sustainable system can enhance the work of physicians in order to provide better and applicable public health care service.     

A search engine for virtual patient records.

Virtual patient records provide a means for integrated access to patient information that may be scattered around different healthcare settings. Within the boundaries of a health district providing all levels of care, this concept can be implemented in an Intranet environment to support longitudinal patient care activities across the participating healthcare providers. Since medical information is stored on multiple Intranet sites in various forms (e.g. codified data, transcribed documents, and images), a suite of appropriate tools is needed to enable access to such information in combined form. In most cases, however, access to medical information should be restricted to authorized users. To serve this purpose, a prototype search engine incorporating an authorization and access control functionality has been developed and presented in this paper. The system is based on the signature file access method and an experimental implementation written in JAVA is also described.     

Measuring mobile patient safety information system success: an empirical study

OBJECTIVE: The Health Risk Reminders and Surveillance (HRRS) system was designed to deliver critical abnormal test results of severely ill patients from Laboratory, Radiology, and Pathology departments to physicians within 5 min using cell phone text messages. This paper explores the success of the HRRS system. METHOD: This study employed an augmented version of the DeLone and McLean IS success model. Seven variables (system quality, information quality, system use, user satisfaction, mobile healthcare anxiety, impact on the individual and impact on the organization) were used to evaluate the success of the HRRS system. The interrelationships between the seven variables were hypothesized and the hypotheses were empirically tested. RESULTS: The results indicate that the information quality of the HRRS system is positively associated with both system use and user satisfaction. In addition, system use is positively associated with user satisfaction, which is also positively associated with mobile healthcare anxiety. Moreover, results indicate that impact on the individual is positively associated with both user satisfaction and mobile healthcare anxiety. Finally, the impact of the organization is positively associated with impact on the individual. CONCLUSION: The results of the study provide an expanded understanding of the factors that contribute to mobile patient safety information system (IS) success. Implications of the relationship between system use and physician mobile healthcare anxiety are discussed.     

Studying technology use as social practice: the untapped potential of ethnography

Information and communications technologies (ICTs) in healthcare are often introduced with expectations of higher-quality, more efficient, and safer care. Many fail to meet these expectations. We argue here that the well-documented failures of ICTs in healthcare are partly attributable to the philosophical foundations of much health informatics research. Positivistic assumptions underpinning the design, implementation and evaluation of ICTs (in particular the notion that technology X has an impact which can be measured and reproduced in new settings), and the deterministic experimental and quasi-experimental study designs which follow from these assumptions, have inherent limitations when ICTs are part of complex social practices involving multiple human actors. We suggest that while experimental and quasi-experimental studies have an important place in health informatics research overall, ethnography is the preferred methodological approach for studying ICTs introduced into complex social systems. But for ethnographic approaches to be accepted and used to their full potential, many in the health informatics community will need to revisit their philosophical assumptions about what counts as research rigor.