In training of medical informatics, students used to learn mainly computer literacy. As information technology has been widely diffused, the paradigm of the training needs to shift from computer literacy to information literacy and problem-based learning. This means how to solve clinical problems by means of information technology.

 Recently, evidence-based medicine (EBM) strongly attracts attention and medical students should learn how to practice EBM. Therefore, we have renewed medical informatics training and incorporated the concept of EBM into it. Each student in a group is assigned two different practical model cases from six: one case as a doctor, and another as a patient or patient’s family. They learn literature search, critical appraisal, how to read and write medical record, clinical decision analysis, etc. Finally students explain their decisions based on best evidence as a medical doctor, and ask questions as a patient or patient’s family. In order to evaluate the training, the students are asked to fill out questionnaires. According to their answers, the training is interesting, useful, and acceptable in difficulty.

 The need to teach informatics in a medical school has been increasing. But what and how we should teach is discussed now. We have teaching experiences in Tokai University School of Medicine according the guideline which we established for private universities in Japan. It is described that the teaching course should be divided into three steps as basic, advanced and specialized ability to utilize information. We are considering that the advanced ability is mostly desired for students in medical schools. But, some students do not have experiences to use computers until they enter medical schools. A basic course is needed for such students. Practices are more effective than lectures. We are using Internet, softwares on the market and information systems which we have developed. The evaluations by students are performed and they are effective for teachers to improve education courses. But we are discussing additional evaluation methods.

 In recent years, the importance of tutorials in medical education is recognized. We have investigated the assessment quantitative for small group learning in the medical informatics practice. Latent structures for the students in Shimane Medical University filled out a tutorial assessment sheets, in which composed 19 items and 4 categories were analyzed by latent structure analysis and path analysis. ‘Important theme’ and ‘knowledge arrangement’ as exogenous variables were related with ‘presentment and extraction’ as endogenous variable by path analysis, but disturbances in other exogenous variables were high values. Two latent classes named ‘interesting in practice’ and ‘uninteresting practice’ were involved in latent structure of tutorial assessment sheets by latent structure analysis. In these results, students had considerable interest in practice and upskilling for medical infomatics.

 For more than ten years, we have been developing software for the physiological training of ECG mapping. Though each of these programs are small, they are effective in education because they were produced by the faculty for the convenience. From 1999, we have been installing the internet and intranet system to improve the quality of training. In such educational environment, students learn not only physiological expertise but how to reach them by themselves.

 Recent rise of some new medical students with a basic background in the field of information literacy forced the present curriculum contents to shift to more sophisticated level. The underlying basic concept we have had was that the information technology was effective to be taught in a medical discipline but not in the information discipline in a medical school. Keeping that in mind, the curriculum was modified. It was found that the incentive to the information technology was not deteriorated, and more over, the classes were approaching closer to our original concept.

 Recently, much attention is paid to synthetic and systematic service system, what is called local area comprehensive medical service system. There are problems that now confront the system. Those are the ideal method of medical home care in an aging society and reconstruction of emergency medical care system bearing the important social roll to protect life and body of citizens.

 In this paper, we take up the latter. And we analyze the congestion of emergency medical care center, which provides emergency night services that are not available elsewhere. So we take a Sapporo City medical association night emergency hospital, as an example. First, we analyze congestion of telephone consultation, and calculate the number of the line for needed. Next, we analyze the congestion about examination of the center. We calculate the logical waiting time and length of queue with logical queueing systems, using the actual data collected from the center.

 The “Headache Diary” which records the time course of pain severity for 4 weeks, has been used in our clinic. The severity of the headache is recorded by logging its severity over time using a visual-analogue scale from 0 to 10. To quantitatively evaluate the severity of the headache, we defined the “headache volume” as the area under the headache curve. The system automatically measures and calculates the indices, headache volume, maximum severity, duration and frequency of the headache for each day during 4 weeks. It is executed on a specific web browser (Internet Explorer 4.1 or higher), and is consisted of an Active X control and an HTML file. The control (TKS.ocx (100 kB), developed by using Microsoft VC++6.0) takes a job of an image processing for digitizing data, feature extraction, and measurements. The HTML file includes a graphical interface control and computation scripts. The scripts handle the input data as the file name, line color and job number to the control, and display the measured values in a form of table. The headache volume and the related values well reflected the patient condition, so therefore are useful as a quantitative index of headache. The system may be obtained from http://info.ahs.kitasato-u.ac.jp/tks/tkssetup.htm.

 In Information Society, ordinary people, besides medical specialists, begin to access medical information like other fields. In this situation, it is very important to know how people recognize medical information. To grasp the recognition of people for medical information contents, processing, senders and receivers, and their demands, we conducted a content analysis of articles mentioning medical information in Asahi Shinbun, which is one of major Japanese national daily newspapers. We find these points in this study,

 1 Social interests for medical information are increasing.

 2 Patients want to have more personal communications with specialists like doctors or nurses.

 3 People consider electric media as important information tools.

 The Japan Medical Association consists of over 150,000 members. It is important to use information technologies in order to manage such a large organization effectually and efficiently. As a function of the information network system for all medical associations in Japan, the Japan Medical Association built the mailing list system for information directors of all prefectural medical associations. In this paper, the questionnaire survey of the present condition of utilizing information technology was carried out with this mailing list system. We analyzed the results, and studied the roles of each medical association and problems in developing and using the information network system.

 In September 1999 the Conference on Japanese Medical Mailing List (ML) were held. We conducted an investigation on 33 different mailing lists and gathered 31 responses. The mailing lists ranged in size from 30 members to those of over one hundred. The mailing lists were available at no cost and were usually used for communication between ML members. The smaller ML groups were often long established and used their ML for communication within each group, while the newer large groups, founded as discussion groups focused on a specific field, were Internet based and multi-disciplinary.