We have developed a regional health information exchange system for stroke care using IHE ITI technical frameworks. For stroke care, course of treatment is usually provided across several hospitals, there is a strong demand for sharing the clinical documents among them and collaborative critical pathway for stroke care has been introduced into several regions. Therefore this system is based on the standards of clinical document format and protocol of data exchange. Facilities in the system are connected with secure network, and a registry in the regional health data center is configured for managing information about the whereabouts of registered clinical documents. The main features are as follows. The first is early adoptive implementation in Japan of IHE ITI. The second is realizing the functions of access control and notification under the registry. The third is to have made the stroke pathway document format of HL7 Version3 CDA R2. The fourth is developing the CDA tool that converts flat XML data of clinical information into structured CDA document. In the pilot project, 31 facilities around Aichi-prefecture had been run for about a year. The lessons from the project are presented. In conclusion, the open issues about the regional health information exchange system were considered.

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 Recent decline in birthrate and aging of population has significantly boosted demand for home care services. The decision to reduce or abolish care facilities by 2011 reflecting the shift in government policy from facility-oriented to home-oriented care also has an impact. However, discrepancies in maintaining service quality are occurring due to chronic shortage and low pay of care professionals. Because care services are provided by diverse geographically-dispersed professionals of the medical, nursing, and caring fields, prompt sharing of knowledge among “team care” members is required to maintain service quality. Thus, we developed a knowledge distribution support system to support team care, aiming to maintain and improve care service quality. As important information source, we devised a “care card method” approach that collects in written form, and digitizes field tacit care knowledge over time of those cared and performed trials in the field to verify the system's validity.

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 The present investigation aimed to review present situations in the teaching plan to individual students introduced in school for special needs education from an aspect of International Classification of Functioning, Disability and Health (ICF). The description on present situations was provided from 202 students with intellectual disability registered with school for special needs education. Their present situations were categorized into the components (body functions and structures, activities, participations and environmental factors) and the first level items of ICF, and the description ratio was then calculated. The results indicated that the rate of description corresponding to body functions and structures was low. Higher description ratio above 70% was observed in 7 of 9 items of the first level classification of activities and it increased with school years according to elementary, lower secondary and upper secondary department. Description ratio of 60% was determined in participation however assignment to the first level items was restricted to 2 of 9 items. Description rate in environmental factor was 86% with difference in the rate among the first level items. These results suggest that the ICF-based comprehensive understanding of present situation is useful for promoting the teaching plan to individual students with disabilities.

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