In this paper, the new method to support the communication between doctors and patients using computers is proposed. The method is aimed at visualization of topic structure to contribute to “narrative-based medicine(NBM)”. NBM becomes emphasized in the clinical medicine. The dialogue between a doctor and a patient is segmented into blocks, the text objects. Correlations between each text object are calculated using the numbers of common words in text objects. The dialogue is visualized by drawing lines of the thickness according to strength of correlation between text objects. The methods were applied to two dialogues. One of them was introduce as proper, and the other was inappropriate. It was naturally thought that there were patters of lines between text objects in each step in NBM. In the former dialogue, it was observed that the patterns which appear when NBM was practiced appropriately. While the patterns was not observed in the latter one. As a result, the effectiveness of the proposed method was confirmed.

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 An operation of efficient and inter-organ of medical equipments for clinical engineering is an effect in the improvement of hospital management and safety in medicine.
 In order to achieve this purpose, we developed an analysis of reliability of analysis and the operation of saving for medical equipments operating inspection by tablet PC(Windows XP Tablet PC Edition 2002, Microsoft). We then defined the medical equipment registration, maintenance and operating inspection inventory. This system for medical equipments uses data synchronization to reliably the operating inspection for ventilator and monitoring equipments. Life cycle of medical equipment is both-tab curve simulated early failure, random failure and wear-out failure period. An indication of early failure period is a mean time to first failure(MTTFF). An indication of random failure period for exponential distribution is a mean time between failures(MTBF), confidence level 90% of MTBF by χ², and confidence level 5% of MTBF by χ². An indication of wear-out failure period for normal distribution is a mean time to repair(MTTR), steady availability, and maintenance costs.
 As a result, we could enhance an operation of saving and efficient of operating inspection for medical equipments. In addition, we could detect a wear-out failure, random failure and early failure period of life cycle for medical equipments.

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 In general, it is said to be impossible to manage the clinical record collectively in a large-scale hospital. We put wireless IC tag(RFID: Radio Frequency Identification) on the clinical record in the hospital of about 3,000 people in the number of outpatients, and constructed the clinical record whereabouts management system that was able to track the clinical record in real time. This system is the first case where the clinical record is used so that RFID of 2.45GHz may instantaneously read individual patient ID. We report on the important finding obtained for the selection and the operation method of RFID. However, to use the terminal of an existing system, we needed a lot of time and the labor for cooperation with an existing system though we adopted the web application.

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 The ability of prompt administering of the drug and frequent modification of the order is required for the order-entry system in the intensive care unit. In order to correspond to this demand, we employed Hospital information system(HIS) and Department information system(DIS) and mutually jointed system was constructed. The system construction of HIS is usually classified into two parts depending on the timing of the supply of the medicine. One is the order to the section drug stock which is created after the medicine was given to the patient, and the other is the order to the pharmacy which is created before the medicine is given. Two kinds of the above-mentioned way also exist in DIS. We chose the latter method that DIS makes the order later by using the site stock. Physicians created the order-entry, nurses checked the order summary. They gave medicine to the patient, and recorded dose of drug. Afterwards DIS sampled the results information on the given drug from the medical record. DIS sent this message to HIS. Dealing this information, HIS made insurance billing and drug delivery. System construction to be able to deal with a frequent instruction change in the intensive care unit have been done by this method. We evaluated this system compared to HIS which creates the order information before the drug is given to the patients.

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 An useful radiology reporting system for immediate reading of all images was set up. We analyzed the time required to generate a CT report. We also investigated the ratio of patients who had CT exams seeing the referring physician on the day of the examination to discuss the results. The impact of the system on the management of outpatients are discussed. Radiology reports of emergency examinations could be completed in about 14 minutes. The average turnaround time of a CT examination was 40 minutes and the reading time was about 20 minutes, so patients could get their results within one hour. The majority of outpatients(55.1%), were able to get the results of their CT examination on the same day. These immediate readings facilitate the improvement of the quality of medical care and service for patients.

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 We believe a significance of input templates for a medical images reporting system. They would make us enable not only data transport, but quality control of medical records. The forms of templates were divided into three types: a) a form that consisted chiefly of a textbox(ex. A report for radiological studies), b) a form that consisted chiefly of the fields which require numeric data(ex. A report for echocardiography studies), c) a multi-layered report form(ex. A report for gastrointestinal endoscopies implemented MST(Minimal Standard Terminology)). We analyzed the requirements of each template types, and developed “Customizable Framework System(CFS)” which provides flexible preparation of templates meet them. CFS is running as a Web application server that provides us a large number of user interfaces through a web browser. The system has a great advantage of at aching personal templates to a reporting database. The templates generated by CFS will give us a useful input environment and an output form. We suggested “multi-sequence reporting system” which allows physicians making two or more reports for one study. Multi-sequence reports are available when we need report fields for a second opinion or for a special protocol of a clinical trial.

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 Currently, nurses, licensed practical nurses, caregivers and others in related fields at long-term health facilities for recuperation give support to patients in their daily lives while sharing nursing information among themselves. At a certain long-term health facility for recuperation, a nursing observation instruction system was devised as part of a nursing process support system to improve nurses’ and caregivers’ practical abilities and support their evaluation, in hopes it would be possible to use standardized observation items as terms to express observation instructions within nursing orders. After the introduction of this system with a complete survey of the input conditions of actual observation instruction items, it was thought that by making it possible to conduct not only a character search but a joint search together with observation items that had been separated into several key words, it would enable observation instruction items to be chosen from a standardized patient observation master even more quickly and concisely.

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 To avoid medical accidents, it is needed to handle with two approaches: Systems Approach and Person Approach(Reason, 2000). Systems Approach is an organizational effort and has already been practiced in many hospitals. On the other hand Person Approach is on individual problems such as the need of safety consciousness. This research is about the Person Approach. Under present circum-stances incident reports are not fully used in hospitals. It is the point this research focuses on, and analyses have been made in relationship between the incident reports and the attitude survey as the Person Approach. Investigations were conducted in two hospitals so far and the analyses have been made on relationship between the occurrence rate of incidents and safety attitude based on individual personalities. We classified them into a high-risk(H) group and a low-risk(L) group based on the number of medical errors caused. As a result, significant difference is recognized in clinical manuals understanding and personality test(Egogram and POMS) in two groups of those who are the so-called “repeaters” and those who are not. As for the results of relations between personality test and the two groups, the value of AC and T-A was higher in the H group than in the L group.

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 This paper discusses the applicability of ICNP^® as a basis for dictionaries to be used in the semantic processing of text data stored in an Electronic Medical Record(EMR). As a candidate for the basis for these dictionaries, we focus on the multi-axial structure of ICNP^®(International Classification for Nursing Practice). We have compared the words contained in ICNP^® with those contained in “Bunrui-goi-hyo”, a Japanese thesaurus. We have also evaluated the redundancy of the words in ICNP^® and the generatability of the NANDA nursing diagnoses and NIC interventions from ICNP^®. It turns out that 32% of the Japanese translations of the words contained in ICNP^® are also in “Bunrui-goi-hyo”, but that it is difficult to use the taxonomic hierarchy of “Bunrui-goi-hyo” as it is. It also turns out that a certain part of the multi-axial structure of ICNP^® can be used as a semantic feature system. The generatability evaluation suggests the necessity of synonym sets.

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 Appropriate estimation of inpatient cost is difficult especially among the complicated cases with several complications or combination of specific treatments. We made a regression model to estimate inpatient cost per admission for hepatocellular carcinoma(HCC) with or without decompensated complications. 260 patients hospitalized due to HCC in our hospital were tracked retrospectively. For each case, the period of hospitalization and records of underwent specific medical interventions during it were extracted from the insurance claim data.
 Relationship between the total costs(insurance reimbursement) included basic hospital charge and each 0-1 variable corresponding to execution of the specific medical interventions for each complication or HCC therapy(resection, percutaneous ethanol injection, Chemo-lipiodol therapy or parental anticancer agent injection, etc.) was investigated using univariate and multivariate analysis.
 As a result of multivariate analysis, a model consisted of several variables of medical intervention: resection, Chemo-lipiodol therapy and parental anticancer agent injection, and complication: ascites and edema, and variceal bleeding in addition to the period of hospitalization was obtained. It predicted total inpatient cost with the high correlation coefficient(0.89) among HCC cases of separated data set for validation.
 This study suggested that the model consisted of several specific medical interventions corresponding to each complication or treatment obtained from insurance claim data can reveal significant factors causing considerable variance of costs and predict more precisely cost of the complicated disease status.

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