The objective of medical services is to provide quality care for the citizen. It requires the information for quality evaluation. It is rather difficult to establish definitive indicators for qualities of medical services, thus relative indicators will be preferable. In order to compare the quality of services, the common basis is necessary. DPC is such a basis. The most important point is that DPC makes it possible to compare the performance of different medical facilities. This situation facilitates the managerial revolution of hospitals. The keywords of DPC introduction are standardization of medical information, transparency and accountability. The real objective of DPC project is to make quality of medical services “visible”.

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 The operation related systems are one of the most difficult systems to implement. We describe the current state of operation related systems in Osaka, Akita, Saga, Kyushu, and Tokai University Hospital and present the subjects in implementing them. An operation relates an operation system which deals with operation application, anesthesia order, operation schedule, and records of an operation, an anesthesia record system which receives vital sign data from biological monitor system and records anesthesia and injection drugs used in an operation, and a physical distribution management system which is for preparing and records the materials used in an operation. Furthermore, an operation requires the system for blood order entry and records of transfusion, pathological test order, radiological examination order with image reference, and operation reports. One of the subjects is how to enter the medical materials used in each operation into the system, and how to use these data for management of distribution and purchase of material or billing. Another subject is how to interface the data of injection drugs and anesthesia entered in the anesthesia record system to electronic medical record system and accounting system. To successfully implement the system, careful job analysis is needed and the effective implementation step considering with cost-effectiveness is essential.

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 The necessity for the power supply in a hospital becomes higher with the hospital becomes larger. Large hospitals for advanced medicine can perform neither inspections nor operations without an electric power supply. However, the usage of the power supply in a hospital has much of variably, and claims also differ according to usage. Considering to the necessity for the capacity, stability, the backup at the time of a power failure, and surveillance of use situation etc., we think it is necessary to divide the power supply according to usage.
 Especially, as computers have been installed into the hospitals, the power supply for medical equipment and the power supply for computers should be dissociated completely. Therefore, here we explain the following points of the clinical power supply, claims postulated needed for the classification according to use and each of the power supply in a medical institution, notes on each usage, and backups.

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 Hospital performance management has become one of the urgent and important issues. In order to facilitate hospital staff involvement for these activities, paper-based information including quantitative data from managerial and other departments have been circulated but not used effectively for the staff’s decision making to improve performance. To overcome the situation, we have developed the hospital information system(HIS)— intranet system that shows key performance indicators (KPIs) utilized in the balanced score card (BSC), especially focusing on financial scope for “Mieru-Ka (visualization)” since June 2006. The method providing information through the intranet and the contents of the indicators were assessed by the questionnaire to the hospital staff. Approximately 170 questionnaires were collected and the analysis has shown that the intranet system is more effective than the conventional paper-based method. There exist some variations among medical and managerial staff in the level of recognition about usefulness of KPIs for performance improvement in each department. Continuing identification of KPIs in the other scopes of BSC such as quality, patients, and employees and security of the intranet system operation will be developed for hospital performance management.

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 Since February 2005, we have shifted from the paper based medical records to EMR. Owing to this shift, now we can easily refer to the content of the paper based medical records. We scanned the paper based medical records and digitized them. We took the way to store them into our own ‘Karute’ image server. We had already done this scanning work for three years before this shift and now we have finished digitizing about 30,000 paper based medical records. The digitized paper based medical records are delivered by WEB(the URL includes patient ID). So it has come to be able to refer to them on EMR. When we want the old data, it is needless for us to carry the paper based medical records with us. Now we have finished digitizing about 50,000 active paper based medical records and we are proceeding the work to digitize about 200,000 paper based medical records stocked in our hospital.

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 Hokkaido Information University (HIU) has provided e-learning education service for more than 10 years, and established effective learning programs performed by Internet. This system has been usable for all the students registered to HIU and Electronics Development Computer College (EDC), who need a wide range of practical skills. In this study, we examined a novel e-learning system established by basic technologies of HIU and EDC, which is subjected for education and practical training for students of medical record and information management and medical information technology. As education tools, we used personal computers and cell phones, to which students can access without time and space restrictions. We encouraged the students to use the internet-based educational system through mentoring supported by system managers. Along with constructing this system, several students have developed their skill of “Instructional design” by joining this program. To complement this program, we deployed “a drill for technical terms”, “a game for medical knowledge”, and “an examination for medical information technologists”. As a goal, we plan to construct our original e-learning system useful for medical staffs concerning promotion of their basic educational levels with enjoyment and satisfaction.

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 The necessity of financial status analysis in hospital management as a method of internal analysis is increasing. The object of this study is to consider methods to develop a financial status analysis system for hospitals. The mandatory functions for financial status analysis are: 1) Define Indices, 2) Calculate Indices, 3) Evaluate Indices, 4) Find the Root Cause. The appropriate methods to realize those functions are considered to use rule-based, forward reasoning from the characteristics of the financial status data. The evaluation of the prototype by professional consultants suggested that analysis using non-financial information and functions to deepen end-users’ understanding would be necessary.

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 Voluntary reporting of incidents and sharing of experiences by the hospital personnel and immediate response of the management to the reports are indispensable for patient safety. We started the design and implementation of a web-based incident reporting system in May 2006. The design goals were, 1) an electronic registry with experience sharing function, 2) ease of use for all hospital personnel, 3) tools for risk managers including browsing and searching of the reports, individualized search pattern called “Favorites”, mail notification of new report, simple work flow management, real time statistics, and data export in Microsoft Excel(TM) format. We implemented the system and replaced the old paper-based reporting system in about 3 months time. Although new reporting system is far more comprehensive than previous paper one, its acceptance was good; the personnel continue to report incidents as often, about one thousand reports per month on line, and this resulted in rapid implementation of preventive measures. We expect this system to improve hospital employee’s awareness of errors and increase patient safety.

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 In conventional clinical studies, costs of data quality control and the burden of paper case report form collection tend to rise, because of making and filling out a paper case report form based on each clinical study protocol. The secondary use of electronic medical records is expected for cost reduction and quality improvement of clinical studies. The purpose of this study is to develop a data capture system for clinical studies to accumulate necessary information from electronic medical records, and to evaluate the prognosis, prognostic factors, outcomes of treatment and safety of that. In Outpatient Oncology Unit, Kyoto University Hospital, we developed a data capture system which includes a cancer clinical database system and a data warehouse for clinical studies. We are planning to promote the cancer clinical database system in other institutions and collect data to the data warehouse to establish large-scale database for clinical studies of cancer. Cost reduction and quality improvement of clinical studies are expected from this system.

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 In radioisotope examination, positron emission tomography (PET) spreads rapidly to help early detection of cancer. Our medical center introduced a positron emission tomography-computed tomography (PET-CT) device in October 2006. It is the device that PET was united with CT. PET-CT generates three kinds of images. (CT image, PET image and fusion image.) Therefore PET-CT has had a new problem by an electronic storage to picture archiving and communication system (PACS). We examined a problem of PET-CT from digital imaging and communications in medicine (DICOM) modality worklist management (MWM) information and tag information of PET-CT images. In addition, we analyzed operation methods for a problem. Three kinds of images made by PET-CT were classified into CT, PT and OT from tag information. These images were stored in one examination order (Accession Number) of PACS. Therefore we have the problem that a modality classification of PACS varies with a transfer sequence of PET-CT images. We have solved a problem by unifying image transfer sequence to PACS and saved all PET-CT images in a modality classification of PT.

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 We must plan measures and promotion of medical security recently while the news of a medical accident about a prescription mention error occurs successively. Development of a prescription making support system of a prescription order ring system is expected to obey proper use of medical supplies. A pharmacist treating a high-risk medicine performs patient safety measures by a prescription check. The prescription order ring system brought rationality for making of prescription. However, there is a prescription order term as a term of the handwriting times. This study is based on data of a prescription order term and doubt inquiry of prescription to relate to data of comment input freely, and it is analysis of a prescription order term.

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 In order to examine the systematic information processing ability required for middle-level nursing managers in Japan and the education for it, a questionnaire asked middle-level nursing manager and nursing staff at the facilities where computer systems including electronic medical chart have been introduced. As for the items asking nursing information processing ability, we adopted 70 items that conform to the conditions in Japan out of the four-level list of nurses shown by Staggers et al. As background elements, the following was surveyed; 1) Category of the nursing basic education courses they were graduated from, 2) Whether they have a computer for private use, 3) Whether they have an adviser for use of computers, 4) Whether they think they are good at using computers and 5) Whether they have been accustomed to the introduced system. We received replies from 522 clinical nurses at 5 hospitals. 522 nurses were classified into three groups of 114 nursing managers, 248 nursing staff at age 29 or younger and 160 nursing staff at age 30 or older. The significant difference among groups was evaluated. The result shows that nursing managers have significantly acquired the skill in many items, that is, 35 out of 48 computer skill items and 21 out of 22 information knowledge skill items. Regarding 30 items nursing managers have acquired, the relations with the background elements were examined. Possession of a computer for private use self-estimation of computer skills and familiarity with system were significantly related. It is shown that the computer skill is highly likely to be acquired through using computers daily and getting familiarize to the introduced system by means of frequent use of it, and that the need of education is relatively lower than information knowledge and skill items.

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