Recently, the reforms of the medical service system and the problem of medical malpractice are being watched with keen interest. We have reached the age where a hospital is being chosen by patients. Some enterprises which have formulated strategic goals under powerful leadership have already been experiencing this reality.
A hospital is not a commercial enterprise, however, a patient oriented hospital based on wholesome management is a recent social demand. Information technology is a necessary tool to realize this demand. But, it is important to clarify the purpose of a system construction after the establishment of management strategies of the organization to introduce the system.
The National Mie-chuo Hospital will imminently become an independence administrative corporation.
Before formulating plans for the next system, we applied the Balanced Scorecard to reconfirm our management strategies and to clarify the purpose of the system construction.
The Balanced Scorecard is one of the techniques to quantitatively establish the goals of a strategy-oriented organization from four points of view, customer satisfaction, financial index, business process, and learning and development.
As a result, “patient oriented medicine” with patient service and information, “standardized medicine” by critical-path, and “wholesome management” with low cost and high productivity were decided as our goals for the next hospital information system.

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One of the most serious complications of pancreaticoduodenectomy is leakage of pancreatic juice from the pancreaticojejunal anastomosis. The frequency of pancreatic juice leakage tends to be higher when the tissue of the residual distal pancreas is soft. When performing end-to-side pancreaticojejunostomy, the pancreatic duct-mucosal suture method or the pancreatic duct insertion method was usually used according to the status of the remnant pancreas in earlier studies. However, pancreatic juice leakage was often observed in patients treated by the duct insertion method, so the mucosal suture method is now selected irrespective of the extent of fibrosis. The main points of the mucosal suture method are as follows. Complete hemostasis is secured by a Z-suture of the pancreatic stump. A tube is left in the pancreatic duct for at least 3 weeks to drain all pancreatic juice. For duct-mucosal anastomosis, interrupted sutures are placed through the pancreatic duct and parenchyma together to avoid disruption. When the second layer of the anastomosis is performed, the cut end of the pancreas is entirely covered with jejunal wall. Abdominal drains are placed precisely to remove any leakage of pancreatic juice. The occurrence of leakage was reduced by the mucosal suture method, so this method is a reliable anastomotic technique that may reduce the risk of secondary fatal complications.

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We studied the clinical characteristics of tuberculosis in elderly patients aged 65 years of age and older, who make up the largest group of TB cases in Japan. 108 patients were admitted to the tuberculosis ward of National Nishi-Kofu Hospital from 1999 to 2000. Study subjects were 60 cases, aged 65 or more (elderly group), and the remaining 48 cases, aged 64 or under, were the control group. Clinical features of both groups were compared. Values of performance status were significantly higher in the elderly group. Serum alubumin levels were lower in the elderly group, but not ignificantly. Complications were noted more frequently in the elderly group. The prevalence of concomitant conditions, such as hypertension, history of abdominal operation, malignancy, and cerebrovascular disorders was higher in the elderly group, while diabetes mellitus was more frequently seen in the control group. There was no significant difference between the two groups regarding the frequency of liver diseases. Regarding lifestyles, in the control group, the proportion of cases who lived alone, led an irregular lifestyle, and had contact with TB patients, was significantly higher than that of the elderly group. The rate of changing drugs due to side effects was significantly higher in the elderly group, however the probability of having the standard treatment was similar in both groups. Therefore, the outcome was also similar in both groups.

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In the reorganization plan for national hospitals and sanatoriums revised in March, 1999, it was clearly stated in regard to the policy-based medical services for 19 intractable diseases that as part of the reorganization "“clinical research”, “education and training” and “information transmission ability” are included, in addition to medical care. By so doing, the entire rearrangement of the total information network is also declared.
It is considered that improvement of quality and efficiency of medical services in radiology based on information technology (IT) contributes to the promotion of the hospital service policy.
In this symposium, we reviewed from several aspects how radiological technologists should be concerned in IT to promote policy-based medical services.
Uegaki from Kyoto National Hospital and Tanaka from National Sanatorium Murayama Hospital reported on the present conditions and problems for IT and action in each field in the policy. Ogura from National Hospital Okayama Medical Center reported on the procedure to construct a significant hospital information system. System design based on the concept of the hospital, and a review and standardization of business contents is important. Tagami from Kokura National Hospital reported on the architecture and operative experience of a hospital-clinic cooperate system using the internet. Tsukada from National Cancer Center Central Hospital introduced the multi-spot television conference using The Cancer Care Facility Information Network and talked about practical uses of this method of networking to promote policy-based medical services.
To the use of IT varies by facility, but I think the contents of this symposium are very useful for various the facilities to build or expand networks in future.

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The Sakura National Hospital will be merged with the Chiba Higashi National Sanatoria Hospital in March, 2004. There is the necessity of keeping records of contents of the kidney biopsy materials with which it dealt with in the past 22 years. Those materials were analyzed by light microscopy, immunof luorescence microscopy, and electron microscopy. The total number of biopsies was 3, 363: IgA nephritis 1, 158 (34%), other primary renal diseases 1, 507 (45%), the secondary renal diseases including lupus nephritis 627 (19%), and tubulo-interstitial nephritis 71 (2 %). It became obvious that the concept of applicability for renal biopsies were various within nephrologist. Clinical symptoms such as hematuria, proteinuria, and nephrotic syndrome can be clarified by carrying out renal biopsy. Some important cases such as membranous glomerulopathy associated with colon cancer and renal sarcoidosis were additionally included. The case numbers of IgA glomerulonephritis, nephrotic syndrome (minimal change nephrotic syndrome, focal segmental glomerulosclerosis), crescentic glomerulonephritis and diabetic glomerulopathy was estimated in each year. However, there was no special tendency between the years 1981 and 2002. Compared with the total results from many institutions, the number of minimal change nephrotic syndrome were few and focal glomerulosclerosis were many.

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The law to secure the stable supply of safe blood products came into effect on July 31, 2002. Now that about a year has passed, we reviewed the management of blood transfusion in International Medical Center of Japan. Blood Transfusion Service has promoted a campaign for the appropriate management of blood transfusion in cooperation with Hospital Transfusion Committee since March 2000. Consequently, consumption of fresh frozen plasma halved from 10, 348 units in 1999 to 4, 240 units in 2002 and 1, 686 units of whole blood in 1999 decreased to zero in 2002. There were three cases of ABO-incompatible blood transfusion at two wards and ICU which occurred in the middle of the night. The main causes of transfusion error were change of blood bags by nurses and incorrect blood typing by doctors. For the optimal use of blood components, the establishment of a transfusion division plays a key role. Accordingly, the management of blood transfusion should be monitored 24 hours throughout the year by medical technologists. Moreover, a computer supervision system is necessary to minimize human error and also to assist with other tasks.

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