The needs and the current status in medical informatics education at the national medical schools in Japan were investigated by questionnaires.
1. In most of the national medical schools, the department of medical informatics was engaged in the education.
2. Curriculum development with a standardized courseware material, methods of computer-based training and computer-assisted learning and a standardized accreditation seemed mandatory for the education.
3. Establishment and/or reinforcement of the postgraduate course seemed a key for qualified specialists (teaching staffs and researchers) involved in the education.
The information available (i.e. book) on physicochemical changes observed in mixing injectable drugs is difficult to be applied to the practical situation. The major reason is the lack of information on more than 4 injectable drugs mixing. So, the pharmacy committee of University Hospital Medical Information Network (UMIN) has examined the computer system which could collect and retrieve the information about stability and compatibility of injectable drugs observed in the clinical setting for several years.
In September of 1999, the system based on the examination results of the UMIN pharmacy committee was developed in Kanazawa University Hospital, which could collect the detected episodes (i.e. decomposition, crystallization, color change) and retrieve the database via Internet. This system was planned to protect the personal data as much as possible and to input and retrieve the data easily.
After the Hanshin Awaji Earthquake, many manuals preparing for natural disasters or major accidents have been made. However, almost these manuals are text-based, and have no systematic construction. So it is very hard to retrieve appropriate information for medical personnel on the real urgent scene. As a solution to this issue, we developed an electronic guideline system as a medical disaster-response (MDR) system. We extracted action rules from the disaster response manual of Kobe university hospital, and implemented these rules to our system. Our system is composed as a client-server system and designed to combine any department for disaster-response through computer networking. The server system has the rule database and distributes the action guideline to each terminal. Each terminal has a multi user interface so that medical personnel can obtain proper information in response with their function.
We developed a computerized system of the result of truth telling the diagnosis of cancer to pharmacist as a new function of prescription order entry system already in operation. This system works as follows, when a doctor prescribes anticancer agents in order entry system, level of truth telling are displayed as “yet,” “already” or “others” for selection. If the level “already” is selected, it means that the patient has already been told the true diagnosis of cancer. The level “yet” means that the patient has not been told yet and the level “others” means anticancer agents are used not for the treatment of cancer. Only when the level “already” is selected, the figure “〇” is printed on prescription sheet as a sign of truth telling. Confirming the sign on prescription sheet, pharmacist is able to know the result of truth telling.
The rate of patient told the truth of cancer diagnosis was investigated by analysis of prescription data in out-patients between June and October 1999. The rate of truth telling was 78% of cancer patients in our hospital, but there were significant differences in the rate among clinical departments or age of patients.
These results indicate that truth telling the diagnosis of cancer was generally carried out in our hospital, however some patients still remained without it. Therefore, it is very important for pharmacist to confirm the result of truth telling before they provide drug information about anticancer agent to patient. By our new system, pharmacist in our hospital or in community pharmacy now can provide medication instruction more property than ever.
The home page for drug information (URL: http//www.pharmasys.gr.jp) offered by OPSR (The Organization for Pharmaceutical Safety and Research) that became available on May 31, 1999 provides not only the text of package insert accompanying drugs but also examples of cases of adverse incidents. This new development means that drug information is no longer only made available to the medical professions. Public disclosure of drug information suggests the current needs of pharmacists not only to provide “simple and readily understandable information” but also to provide “sufficient information” from the point of risk management against medico legal disputes. For the purpose of providing enough information such as efficacy and effectiveness, precautions and guidance for proper use, contradictions, symptoms at the early stage of adverse reactions, a larger printing space and a faster printing speed than that of conventional printer system are required. And in case of printing drug information on the paper separated from the medicine package, the operational work load of putting this printed paper into the medicine package may interfere with efficiency of dispensary practice. Under these circumstances we explored the possibility of adding a function of providing drug information on a medicine package. The system that we have developed provides both the medicine package information such as patient name, dosage and the drug information such as efficacy and effectiveness, adverse reactions in a medicine package form through the way of putting this printed paper into the one-sided transparent package. This system is considered to realize a more efficient drug information providing operation without altering the existing dispensary process.
In past, the Ministry of Education delivered official documents printed on paper to each university hospital. We developed and now use a WWW-based, on-line official document delivery system for the university hospitals of UMIN (University Medical Information Network). This system authenticates users by ID and password, and provides documents as PDF images or files such as MS WORD, EXCEL, Lotus123, and Ichitarou. This system also has a full text search function for these documents. Notification of new document is sent to a mailing list of persons in charge at each university hospital, who forward the E-mail or notice to persons within their hospital. Our questionnaire research shows that 86% of users have a favorable impression of this system, mainly due to its convenience and quick document delivery. Most negative impressions are due to the users’ lack of skill and practice. We believe that network-based document delivery is very useful and efficient, and will become more popular in the near future.
It is likely that the inventory management of pharmacy is important for the development the separation of the medical practice and drug dispensing. Therefore, we constructed the Database of Pharmacy Stocks through Internet and the Inventory Management System of Pharmacy. Active server pages (ASP) is used in the database. Pharmacy’s managers can hold the stock information reciprocally with the each other using the database through Internet. If a manager needs drugs that he doesn’t usually stock, and his store is far from the stock center, he wants to buy the drugs in near the pharmacy. In this case, he can easily determine where he trade in drugs with the system. The management system is easily to provide the new and exact stock data and keep the database freshly.
We expect that the systems contribute many benefits to the separation of medical practice and drug dispensing, and develop the cooperation between the stock center and the pharmacy, or pharmacy and each other, and pharmacist would be able to respond the doctor or patient’s demand more than ever.
We introduced the database to the nursing practice record for enhance education effect and the efficient nursing practice.
It was clarified about the nursing students response to the introduced the database for their nursing practice, and it considered the problem. Nursing students response to the new electronic record system admitted, it is easy to do the information collection but take time about record.