Munakata District with a population of 150,000 constitutes the secondary medical region with Munakata Medical Association Hospital as its core medical institution. The hospital is leading the way with its liaison system for electronic medical records.

 The following project system has been established:

1) It has been introduced to handle administrative duties and records of examinations and treatment at the hospital, as well as to enable it to provide digitalized information.

2) A system where by clinics can provide information using electronic medical records

3) A system where by information can be obtained from web sites

The mobile phone data communication system is not connected to the Internet.

 A validity experiment was carried out from December 2001 to February 2002. 90% of the patients surveyed judged it to be convenient while one out of 22 (4.5%) felt anxiety about using the system. They also stated that communication by Personal Handyphone System did not feel unnecessarily slow. The system is easy to install and provides greater flexibility for users over a wider area. Thus, it has proven to be a useful tool for information communication in regional medical care.

 We developed a widely distributing electronic patient record network system for diabetes mellitus based on public key infrastructure using HL7 version3 RIM as a message exchange protocol. The system consists of a general-purpose database, a patient basic information management system, a user recognition system, a clinical record certification system, a electronic patient record system for diabetes mellitus and a data converting system from existing two data bases. We conducted a system operation test for three months in 47 medical institutes in Fukuoka city. There were no major troubles in the system function and the network communication. The questionnaire to the medical staffs and the patients showed that the medical staffs have a high expectation in the system to increase medical service efficiency and quality. The large majority of the patients favorably accepted the system.

 In order to promote cooperation between medical facilities using computer network, we constructed the electronic introduction system (EIS) and ASP type electronic patient record system for clinics on the ADSL network with local IP and PKI. In EIS, 18 clinics and 4 hospitals are connected with message exchange server located in the service center, and introductions in J-MIX XML format are exchanged via the server. We set a relay station in each hospital which delivers and receives introductions between the consultation rooms in the hospital and outside clinics. Using this system, 77 actual patients were introduced among medical facilities. All of the doctors and patients were satisfied with this system. ASP type EPR system for clinics is the system in which server is located in the service center and terminals located in each clinics. We applied the hospital information system to the system, where message queue was used for data exchange, and patient data was stored not only in the server database but also in the client database. This system architecture tolerate the slow network and users did not feel the response be slow on the patient data transmission. This system architecture though to be put into practice as EPR system for clinics.

 This paper is devoted to the introduction of the community health care networking system having dynamic access control of health record of each patient, which is being developed in Mie Prefecture. The system is a closed network created on CATV network by using VPN technology. Vast varieties of health sectors in Mie prefecture have participated in this development, such as doctors working at clinics and/or hospitals, public nurses, rescue parties working at fire departments, health care administrators at the municipal and prefectural governments, etc. The network is topologically a star-like network, having a Backup-Center in the center. The largest characteristics of this system are; (1) it facilitates a dynamic control of information flow by introduction of an idea of directional access level control, (2) the automatic creation of an appropriate structure of the back-up database from DTD information, so that it can be possible to make a back-up of any records of XML format for which DTD information is known a priori, (3) and due to this property, the system can make communicate, theoretically, with any other electronic medical record (EPR) system such as ORCA, (4) to ease the mutual communication the letters of introduction and the reports to them is woven as templates of EPR. Some findings obtained through this project are also presented.

 This paper proposes modeling of human behavior and a method of finding abnormal human behavior. Initial experimental results demonstrated usefulness of proposed model and method. Firstly, by analyzing human behavior based on observation of human habitual life, the analysis shows that human behavior can be regarded as probabilistic finite automata. Then a method of constructing human behavior knowledge and an algorithm to distinguish abnormal behavior different from habitual life behavior are described based on Hidden Markov Model. Finally, significance of proposed method is shown by some experimental results.

 In order to authenticate accurately and safely an user as the authorized person who could access to a system, we devised a new authentication system employing method of “a question to an user and the answer from him/her” which can be applied to any environment of computer and communications, and we evaluated degree of accuracy and security and operability of our system. In our system, the server side sends an user questions which could be answered only by reflecting his/her private life or past private events. The system does not require any special hardware nor software to be implemented beforehand. The result of evaluation showed obvious superiority of the level of accuracy, security, operability and even robustics over conventional password method. From the results of our study, we could reconfirm that our proposed method could realize accurate and effective authentication even though users had to prepare their own questions and answers beforehand.

 Hospital information systems (HIS) have been introduced since 1980's and improved clinical practice in Japan. However, statistical evaluation of HIS has not been reported enough. In this paper, HIS was evaluated by interviewing all the medical doctors, including residents at Shimane medical university hospital. The results can be summarized into the following three points. First, doctors answered that HIS improves the clinical environment, compared with paper-oriented system in some way with respect to the calculation of payment and laboratory reports. Secondly, they answered that waiting time for outpatient clinic, consultation hours, clinical research has been improved and that HIS has an effect to education to medical students and residents. Finally, they answered that HIS does not improve the medical accidents and incidents, including the mistakes of prescription and injection orders.

 The rapid development of the recent information technology promotes actuality possibility of information sharing between medical workers with electric patient record system, and the standardization of the nursing terminology becomes a problem of the urgency. However, what does not exist still is true for terminology system recognized as the common language, which describes the nursing practice. Since it is different by medical system and culture of this country for needs for the nursing, the international standardization work is not easy. And, it is similar in this country. In this study, action name and action content were investigated for the purpose of the standardization of nursing action name used in nursing practice of our country, and both correspondence situations were analyzed. To begin with, the research method was developed, and the data was collected using the technique, and the analysis was carried out. As the result, rate of correspondence between action name and action content was quantitatively shown (adult nursing 86%, pediatric nursing 77%, psychiatric nursing 81%, home health nursing 80%, maternity nursing 41%).

 The primary viewpoint on evaluating the medical information system should be put on the achievement and the completeness of the initial objects and targets of the system. The economic viewpoint of the cost-effectiveness is not primary, but secondary. The reliable evaluation of the achievement can be obtained by properly choosing measures of evaluation in each information system. This evaluation method is very reasonable and appropriate, and it can be clearly settled how the system should be managed after evaluation. The reasonableness of this evaluation method was proven, concretely evaluating three medical information systems (the supply and management system of injection drugs, the online medical image viewing system, the computerized nursing records system) developed at Kochi Medical School Hospital.

 This paper examines the economic effect of the tele-home-care system being implemented in Kamaishi City. The economic benefit analyzed here is based upon WTP (willingness to pay), which was the question posed to its users in our survey. WTP per user is calculated as ¥4,519, and the total benefit of the system is obtained by multiplying this figure by the number of users. The cost items of the system include those of initial introduction and maintenance: the former includes costs of equipment and software, whereas the latter the salaries of staff and others. We conclude that the ratio of benefit to cost (B/C ratio) is more than one, which indicates that benefits exceed its costs in the case of Kamaishi City.

 Another characteristic of the paper lies in its analysis as to how the benefits expressed in terms of WTP are attributed in exact monetary terms to factors such as stabilization of illness, enhancement of health consciousness, dissolution of uneasiness, and decrease in medical expenditures. It shows who bears the cost of the system, namely, the amounts paid by individual users and public medical insurance. Thus, this paper suggests that the tele-home-care system be financially supported by public funds.

 Medical application service provider (ASP) and internet data center (IDC) will be useful to informationization of hospitals and the clinics, and to exchange medical information among them. However, it is necessary to know the total amount of medical information to design the medical ASP/IDC. Also the knowledge of patient migration is necessary to design how to distribute the IDCs. In this study we analyzed these problems using statistic data of Ministry of Labor, Health and Welfare. First, it was found that medical information generated in the entire Japan is about three petabytes per a year. This data can be accommodated in about 1000 racks of storages. Therefore, it can be concluded that the medical ASP/IDC can be realized from the point of the amount of information. Second, it was found that most of patients receive medical services in hospitals and clinics in the same prefecture they live. This result suggests that it may be good that the medical association in each prefecture manages the IDC.

 To evaluate the effectiveness of a template-based electronic patient record (EPR) system, we developed a standalone prototype EPR System. Each template contains specific items for physical examination results and lab data concerning each problem (disease). Input of data in the form of free-format sentences, arranged in SOAP classification, is also available. Doctors can display any temporal lab data combined with prescription and physical examination data graphically in relation to time; the system is thus useful for explanation for patients as well as diagnoses. Twenty templates are provided to cover mainly for common diseases. The EPR prototype system was used 920 times for 292 patients. We evaluated the time required to operate the system for each patient and the inputted data volume. The results indicated that the volume of contents of the EPR system was almost double compared to conventional paper records, while the operation time for consulting one patient increased by one minute. Thus they imply the EPR system has a lot of advantages that make the extra effort involved in its operation worth while. This trial highlighted the advantages of the EPR system in regard to diagnosis and patients’ comprehension. On the other hand, it must be noted that the EPR system also has disadvantages; for example, face-to-face consultation is more difficult because PC operation is required at the same time.

 We have developed a health card system for self care. We can use every electronic media for the card. It contains all the results of the past health examinations. The card is carried by each citizen. It is possible to display data of the person graphically as time series charts and radar charts. The card system is being made use of by the health consultation of Isehara City. The anonymous self-administered questionnaires were given out by public health nurses following the health consultation. Valid questionnaires were 64 (66.0%). The people who answered that it found out one's condition of health from the indication screen are 97% and there were many people who answered that it found out one's condition of health by time series charts and radar charts (P<0.001). The people who answered that this health card system is useful for self care are 91%. The holder has come to take care of one's health.

 The combination of IC-cards and Biometrics is effective for personal authentication through the open network. Authentication using biomedical-information is widely studied. Medical institutes of various fields can share their information by using the IC-cards with Electronic Medical Records in them. In this paper, we point out the possible danger of relying too much on the tamper resistance alone in terms of security. Furthermore, we examine the necessity of the security system using cryptography technology and Biometrics via the open network and examine the condition of security against various attacks.

 This study investigated the confidentiality of patient privacy during undergraduate clinical experiences of nursing students. The students received advice many times not to take patient records outside of the nursing center in order to avoid the violation of privacy. The students were administrated not to mention patient’s private matters in inappropriate places. Students received more instruction from the teaching staff of the university than from the clinical nurses. During their clinical trials, the students found three security holes in the existing computerized medical record system. These results showed that an educational program demonstrating how to maintain the confidentiality of computerized patient records was necessary for our students.

 Patients’ rights have become very hot topics in health care. Privacy is one of these rights. Nurses in clinical settings deal with the information on many patients and share it within the nursing team because nursing is practiced as a team. Sometimes, sharing patients’ information may put the privacy of a patient at risk. To explore how the nurses perceive patients’ privacy and how they share that information and to what extent, we conducted a questionnaire survey with 179 hospital nurses. We obtained 141 (79%) valid answers. Major findings are as follows: 1) on information directly related to nursing care, nurses perceived patients’ privacy lower than their own, 2) patients' information that was recorded on the chart tended to be shared by all nurses in the ward, on the other hand, information needed to nursing care tend to be shared within the team concerned with the patients’ care, 3) the main reason for limitation of the range of information sharing was whether or not it was necessary for nursing care.

 With the aim of the hospital opened in the region, it is important that the support to which be useful for the regional medicine organization is made to be compatible with the direct support for the patient as the future one directivity which the medical information system should fulfill.

 From this viewpoint, the ideal way of FAX sending service of the outside prescription is reexamined, and navigation system for the improvement of patient convenience and automatic FAX sending system of the outside prescription information which makes safety improvement of prescription in the insurance pharmacies are developed. In this paper, to begin with, the outline of development purpose and function of the system is explained. In addition, the usefulness of this system is shown based on operational results which started in the Hiroshima University medical hospital from October, 2001.

 Medicine can be inputted automatically for hospitalized patients if the following two computer programs are developed.

 The first computer program is the following. If we input medicine into the computer, the automatic tablet-packing machine will pack the medicine for only one day.

 So if we input medicine today, the machine will pack the medicine for one day by the first program.

 The second program is the following. If we do not input tomorrow’s medicine by midnight today, tomorrow’s medicine will automatically be the same as today’s medicine.

 Then the machine will pack tomorrow’s medicine for one day again by the first program tomorrow.

 Even if we do not operate the computer at all, the medicine will automatically be packed every day forever.

 We usually prescribe medicine for 7 days at one time for hospitalized patients. Even if we find out that the medicine is not effective two days after we have prescribed the medicine, we usually do not change the medicine until the patient takes all the medicine for 7 days, because changing medicine is a lot of work. In my one-day prescription idea, we can change the medicine whenever we want to. So we can always prescribe the most effective medicine.

 We investigated the effect of the transtelephonic ECG and blood pressure monitoring at home to mental condition in patients with paroxysmal atrial fibrillation who have remarkably obstructed QOL. 10 patients (male 9, female 1, mean age 59±10.3 yrs.)with refractory paroxysmal atrial fibrillation given by anti-arrhythmic drugs of 5±2.0 kinds were studied. 1313 ECG recordings and 1012 blood pressure measurements during observation period of 20±7.1 weeks were transmitted by the patient to the center, and analyzed by investigators. In final stage of the observation period, the questionnaire survey concerning the transtelephonic system was executed to the patient. All of patients had anxiety feeling and 90 % of patients showed the nervous character, then 80% of patients did not go out to the distance because it worries about the trouble. After using the system, all of patients showed improved mental condition and better QOL. We concluded the transtelephonic ECG and blood pressure monitoring system improved the mental condition.

 The medical support systems evolve in proportion to rapid improvements of the computers and network technology. The most important purpose for making to higher technologies should be the improvements of the patient’s satisfaction. So it is important to evaluate the patient’s satisfaction scientifically. To evaluate the satisfaction, some mathematical and statistical models used in psychology are suitable. The application methods of analytic hierarchy process(AHP) and multi-dimensional scaling(MDS) to evaluate the patient’s satisfaction for the medical information systems are described. And the methods of the problem shootings are considered.