In 2009, Kagawa University received funding for a campaign to treat diabetes. With this funding, we are developing a data-sharing system between clinics and hospitals for improving the quality of diabetes care. For this system, we are establishing a privacy policy based on that of a preexisting clinical data-sharing system called “Kagawa Medical Internet Exchange” (K–MIX). The Department of Basic Medicine at Kagawa University supports the campaign and plans to perform research on diabetes by analyzing the patients' blood and urine. Currently, we are revising the specific research protocol because it includes both long-term patient follow-up and needed research data. Written informed consent will be obtained from all patients prior to using their data and specimens for research. Although the research protocol is not yet finalized, we have a definitive policy to prevent patient identification by using the demographic information of the clinical data set. After setting the policy details, they will be applied to patients. The policy details for patients will be included in the final research protocol. We are also considering the information ethics for large e-health systems and privacy protection for patients having other diseases.

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 The systems of Medical Information Exchange among hospitals have widely been important issues in healthcare industry due to the non-interoperability of medical information in Korea. In this paper, to be able to consider more effective ways of sharing patients' medical information, we developed a new Medical Information Exchange System (MIES) based on Registry Server Model which the system enables us to interoperate different types of data made by various different systems. To develop MIES based on Registry Server Model, we deal with the standardized data transfer methods and the terminologies suggested by Center for Interoperable EHR (Electronic Healthcare Record) of Korea to guarantee the interoperability of each participating system in each hospital. By applying the EHR standard to the proposed MIES, we assure that a patient's medical information can be effectively exchanged under the different system environment. To ensure the information security, reference is made to the security guidelines suggested by the Center for Interoperable EHR of Korea. This study aimed at essential security systems for implementation of online services, such as encryption in the communication section, server security, database security, protection against web attacks, contents security and network security. The proposed MIES designed as centralized the Registry Server Model independently to guarantee the security for the sharing patient's medical information to minimize.

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 Researchers promoting epidemiologic studies and clinical studies must respect the Use Limitation Principle in the Organization for Economic Co-operation and Development (OECD) Guidelines on the Protection of Privacy and Transborder Flow of Personal Data in 1980. About the ethical issues on medical research, the national government in Japan has published 4 kinds of guidelines according to the study design; “Guidelines for researches about human genome and gene”, “Guidelines for clinical researches about gene treatment”, “Guidelines for clinical researches”, and “Guidelines for epidemiologic researches”. The “Guidelines for researches about human genome and gene” and “Guidelines for clinical researches about gene treatment” require subjects' informed consent in all the studies; therefore, there is no violence of the Use Limitation Principle. On the other hand, on the guidelines about clinical researches and epidemiologic ones, researchers using just only the existing data, such as individual clinical records, can use the data without informed consent with some processes, such as the approval of the institutional review board (IRB) and public offering of the information about the research according to the guidelines. These articles are reasonable because in some types of epidemiologic studies, such as studies for disease frequency, it violate the scientific accuracy due to selection bias if the researchers can use only data of those with informed consent. From the view point of the principle of individual participation, it should become better systems if the participants are able to know the fact that their data are used in the study even in the researched in which informed consent is not required according to the guidelines. Because the current rules in Japan are not acts but the guidelines, however, researchers using clinical data secondarily are in an awkward positions, and the situation should be improved.

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 Using a genetic algorithm, we designed the layout for the work room at the nursing staff station focusing on optimizing several parameters such as level of cleanliness, area for work, and distance from the doorway at each work related to specific equipment. The layout was successfully optimized in one of two different stations enrolled to the study. Then the layout of this station was actually modified according to the design, while the layout of the other station was adopted to improve the cause of failure, i.e. narrowness at certain places. Finally, staff evaluations indicated that both of these modifications were satisfactory. The recommendations derived from simulation by genetic algorithm include: separate a clean zone and an unclean zone linearly in the room, and equip emergency tools on a cart ready-to-move by doorway. It is suggested that these recommendations could be generally useful for optimizing the layout of the work room at the nursing staff station.

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