Performance estimation procedure for the clinical image reference system with World Wide Web architecture is presented. Here, numerical modeling and simulation methods are employed. In the reference system, simultaneous requests for images initiated by each user might cause performance degradation. Both parallel processing and competitive usage of system resources such as hard disks and network are described exactly in the model, and implemented using in Java. Reliability of this model is confirmed by an experimental network system with 32 workstations. The time during fetching and displaying an image from the simulation agrees well to the experimental values, except in extremely heavy loads. An effective data transfer rate is defined here as the product of average data transfer rate derived from the simulation and number of workstations. This index is convenient to estimate the maximum number of workstations for the given system circumstances. For some cases of operations in the clinic with average image request interval of 5 minutes or 3 minutes, the relationship between maximum number of workstations and number of images at a request is estimated. We can conclude that this performance estimation procedure is quite useful for the design of the clinical image reference system.

 Lifestyle Evaluation System (LES) is a personal computer based system to display an electronic questionnaire on one’s lifestyle and present some advice to improve health referring to the answer. To improve productivity of computer-based inquiry system on public health field, an object-oriented application framework was developed based on LES.

 XML was adopted to describe questionnaires and advisory documents. Framework classes were implemented using Java language. User interface part was clearly separated from objects representing an answer and classes evaluating an answer. LES system on the Web (WebLES) was developed using the framework to evaluate productivity and performance.

 Using this framework, skills of computer programing were not necessary to compose or revise or translate questionnaires and advisory documents. Framework included many classes representing knowledge and concepts on public health field, therefore few knowledge of Java API was required to code evaluation algorithm of an answer. In WebLES, 3 out of 70 method calls were Java API, and others were the framework API.

 In developing LES-like electronic questionnaires, this framework provided a way to maintain electronic questionnaires and advisory documents without skill of computer programing and a way to code an evaluation algorithm without advanced knowledge of Java API.

 To clarify the advantage and limitation of epidemiologic study using the database in hospital information system (HIS), the investigation of patients with diabetes using Osaka University Hospital datawarehouse were performed and the results were compared with those of the investigation performed by Ministry of Health and Welfare. The results are following; the distribution of HbA_1C in the investigation of Osaka University Hospital is consistent with that of Ministry of Welfare in the patient with high value, the age distribution is shifted to younger in Osaka University Hospital, the ratio between male and female contains bias in the investigation of Ministry of Welfare, the complication ratios in diabetes patients are more proper in the investigation of Osaka University Hospital than that of Ministry of Welfare, the treatment requiring high skill is selected more often in the investigation of Osaka University Hospital than that of Ministry of Welfare. We investigated the affection of severity, age and treatment on 1 year progress of HbA_1C. The epidemiologic study using HIS database sometimes contains bias but is sometimes more proper than population base study. It has an advantage in dealing with detail data and follow up study. Furthermore, it can be perform by overwhelmingly less cost and labor.

 In the division of nursing in Saga Medical School, the new curriculum was introduced in 1997, four years after the establishment of the division of nursing. The curriculum in the field of Information Science was also revised. The revisions were based on the evaluation of the previous curriculum, the curriculum improvement plan in the Ministry of Health and Welfare, and the one in our school. In this study, we surveyed the level of knowledge and understanding in the field of Medical Information before and after the lecture of Information Science under the previous and the new curriculum with the same questionnaire. As the result, though the lecture time decreased for more than 20 hours, there was no significant difference between two curriculums. It was suggested that early computer literacy education, LAN (Local Area Network) environment improvement, and positive use of LAN for lectures were effective.

 In order to grasp the actual condition of community health care and to exchange medical policy and information quickly, the Japan Medical Association is pushing a project to build the Japan Medical Association Information Network System that all district medical association offices participate in.

 In these situations, it is necessary to grasp the present state of introducing information technology in all district medical association. Then the resources to promote the spread of information technology can be used efficiently from the viewpoint of the whole organization.

 In this paper, the situations of introducing information technology about district medical association office in November 1998 were grouped into each prefecture, and were graded. And we compared the result with the situations in July 2000 and studied the cases that made progress.

 As a result, it is cleared that a different understanding of importance and validity of information technology and support from prefectural medical association influence the present situation of introducing information technology.