By the conspicuous development of the information technology in recent years, researchers’ demand for using medical records to statistical studies has increased from year to year. And also, it is necessary to be careful about patients’ privacy. We conducted an opinion survey of patients and nurses on clinical information usage for epidemiological researches from the point of view of informed consent (IC). Self-questionnaires were used and respondents were got at Tokyo University Hospital. The number of people whose answers were valid were total 1,008 (outpatients: 697, nurses: 311). The result was that the number of people who could permit researchers using their clinical information to epidemiological researches on condition that they got IC at their consultation were 651 (93.4%) at patients and 274 (90.1%) at nurses. Also, the number of people who thought IC at the consultation was not enough significantly decreased when Institutional Review Board was prepared (p<0.01). Therefore, this study showed that IC at the consultation could be permissible at the present time and also it was important to prepare organizations which could intermediate between patients and researchers about privacy protection.

 This paper will report progress of the development of a XML document model that represents the Calculation-Rulebook of Medical Service Fee (CRMSF). First, we analyzed present CRMSF written by natural language especially in part of “Laboratory Test” section. Then, we transformed it into XML-based documents including logic part. As a result, only 8 rules were required to represent the logic part by XML. It was also found that the use of XML helped to point out and also to exclude the existing ambiguous statements in CRMSF. As a next approach, we developed a trial version of automatic calculation-program generator in Java language. The program generates source code for calculating medical service fee from XML-based CRMSF. This approach strongly suggests that XML-based CRMSF and the automatic program generator have promising futures.

 The verification on the ATM network was performed in the test milieu in which a continuous and quantitatively heavy traffic could be generated through the 155 Mbps and 25 Mbps switches. The network monitoring device proved the almost full throughput for 155 mega link while generating 200 M constant traffic. When the constant bit rate was reserved (CBR), the connection between the image server and the client was succeeded as evaluated by ping and ftp command functions. In contrast, no connection was established without the reservation of the bit rate.

 After the artificial removal of the cable connecting two ATM backbone switches, the recovery of the connection was found in 53 seconds. From these results, it is concluded that the QoS (quality of service), the throughput, and the redundancy were verified.

 MRI and arthroscope are used in the inspection of the meniscus, and the computerized tomography is not used. The similarity of CT value of the meniscus and that of cartilage which covers the femur and the tibia makes it difficult to extract the meniscus from the computerized tomography image. Because the computerized tomography is excellent in space resolving power and the prevalence is higher than the MRI, it seems to be not meaningless to observe the meniscus using the computerized tomography. In computerized tomography and MRI, the supplemental utilization can be expected, since the measurement mechanism in the organization is different. By using the original image processing method, we succeeded in extracting the meniscus image from computerized tomography. Because only the part of the meniscus is merely displayed in each cross section, it is difficult to imagine the whole image of the meniscus from each cross section. The whole image of the meniscus should be displayed by making the three-dimensional image from two-dimensional images using the computer. Because the cartilage, which is on the surface of the femur and the tibia, is not easily separated from meniscus in a horizontal section image of computerized tomography, it is difficult to show a complete image of meniscus using the original image of computerized tomography. By making a sagittal section image from the horizontal section image, separation of the cartilage from the meniscus became easier and a complete image of meniscus was obtained successfully.

 Recently, the consumer’s consciousness to health care is increasing in Japan. The Ministry of Health, Labor and Welfare did the deregulation in terms of advertisement in health care in March 1st, 2001. On the other hand, the legal help, such as Health Insurance Portability and Accountability Act (HIPAA), has built in 1996 in the US. For example, the American people join in clinical trials easily. It is not only due to their volunteer spirits but also the literacy and infrastructure for healthcare information. The infrastructure for the consumers to get the correct health information should be built in Japan like that in the US.

 This document is a Japanese translation from the final report and recommendations of the G-8 Global Healthcare Applications Sub-project-4, ‘International Concerned Action on Collaboration in Telemedicine.’ Telemedicine activities often include international connections among countries. Therefore, G-8 countries decided to state recommendations for improving interoperability on telemedicine activities worldwide. Five forums and business meetings were held from 1995 to 1999 which found many issues on telemedicine activities, and experts from G-8 and the other countries discussed the issues. The recommendations consist of five sections: standards, network reliability, security and applications, organizational issues, human factors, evaluation of telemedicine and telehealth and medico-legal aspects. It is strongly recommended to comply with the items on telemedicine activities henceforth.