Most national hospitals and sanatoriums were reorganized into independent administrative corporations, and the National Hospital Organization was established in April 2004. The planning of the feature articles, entitled “Information sharing and the knowledge base in the National Hospital Organization” in this journal is very well-timed, and the articles will be useful for considering what the nation wide hospital network should be in Japan. In these opening remarks, I will survey the knowledge management and comment on some relevant technical terms.

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In the past several years a number of national hospitals in Japan have implemented a hospital information system (HIS). Different approaches to HIS are presented in regard to the order entry system for laboratory test orders, prescription orders, injection orders and others. Every hospital has its own approach to handling these orders with their HIS. There is no consensus as to the best approach to the relationship between order entry and medical records. But those who try to make good use of HIS are able to evaluate and understand the specific challenges that exist for other hospitals.

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Sharing of patient information has become important to enable cooperation in consulting and for the referencing of clinical or management data in all the National Hospital Organization (NHO) hospitals. To share patient information, ethical and legal problems must be solved such as acquisition of informed-consent and information protection. Questionnaires on the sharing of patient information were sent to NHO hospitals and national centers. Some facilities have already solved the ethical and legal problems, but there are many facilities where measures haven't been completed yet. In the future, ethical and legal problems such as informed-consent and information protection must be dealt with by NHO as a whole, and not by each individual facility.

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The following three issues are the major issues to be dealt with in order for NHO hospitals to deal with DPC.
1) Standardizing databases including ICD coding methods.
2) Database construction in hospitals and accuracy improvement of databases.
3) Improvement of data collection ability in National Hospital Organization and use of database in hospital management.
This paper reports on the possibility of HOSPnet use in the DPC system by illustrating the daily procedures in our medical information management office.

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Control of documents is a key in the medical quality control. To assure the conformity with the external regulations, external documents must be controlled and processed precisely. To use the documents effectively, knowledge of reference to the existing document must be included in the processes and procedures. In NHO hospitals, document archiving is regulated under the rules. But the rules deals primarily with paper documents. With the introduction of the HOSPnet as an intranet, more efficient document archive on the intranet can be established. The author reviewed the current document management in a NHO hospital, and the online document database. To improve the quality of procedures, more effective online document database is proposed and is running by the HOSPnet user's group. Advantages and disadvantages of our online document database are discussed with the scope of knowledge management.

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Policy-based medical network construction of each field is advancing. When completed, his will include almost all the contents of medical field, and a huge virtual national general hospital (e-Hospital Japan) will come to be built.
By utilizing the security of HOSPnet as a closed network to the maximum, if e-Hospital Japan is built, EBM for the management strategy which employed the economy of scale efficiently, and medical-examination support can be created.
It gazes at each National Hospitals and Sanatorium after the shift to independent administrative agency shift, and HOSPnet study group serves as a subject, the research study was carried out about the information management for using effectively management-economical and the personnel equipment health resource of each institution, and the research study about the methodology of the knowledge management at the time of e-Hospital Japan construction was performed that the grand design for employing organically and efficiently across boundaries the concrete proposal for e-Hospital Japan construction, i. e., the policy-based medical network of 19 by which vertical division was carried out, should be created.
We have constructed an automatic reception systems, for a society and study group, for the efficacy and the cost benefit of freeware to the example, as application of this methodology, the separate attachment paper “Design and Implementation of an operation recording module for an electronic health recording system” was shown as an example of a design and development/mounting, and, specifically, that usefulness was proved. (March 4-6, 2004: the 15th Data engineering workshop of 6 institute of electronics, information and communication engineers/2nd Japan database society annual meeting announces. A paper is in printing.)

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What kind of actual reference when one has to do a certain business procedure for the first time? Probably former documents (forms) are read before practice. Correct working sequence should be: grounds (e. g. statutory basis)→business process→records or reports in regular forms. However it is almost impossible for a worker who has no knowledge of certain business to perform that business in correct sequence. When a worker does not have enough knowledge, administrative workflow is efficient in a reverse order. The weak point of this method is that the business is completed without reaching the basis, and it is only apply to routine work. If there is a workable solution for the problems by electronically collecting administrative forms, reverse working sequence will be able be thought as the structure to build knowledge base for National Hospital Organization.

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