Accompanying the establishment of information systems to nursing tasks, it is expected for users and developers to be able to clarify the range of nursing tasks that can be supported by electronic medical record system (EMRS) and the problem of its function. As an attempt toward this aim, in this research, the situation of nursing tasks supported by EMRS was examined between two wards using our fieldwork technique. Comparing the tasks by means of task-category maps, we found that 87.4% of all tasks was common and different tasks were limited to 12.6%. In the common tasks, EMRS could support the tasks related to information acquiring, referring, sending, and offering that are factors of highly intellectual works, but there existed some tasks in which the functional lack of EMRS was compensated with the adaptive management from user (nurse) side. The revealed fact that EMRS could support most tasks both in the different wards is contrary to our apprehension that many inconsistencies would be found between the complex and diverse nursing tasks and the applied EMRS.

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 Templates are widely used as an input support tool for formularized data on EMR. However, conventional EMRs store data provided via templates as simple texts in a certain format. As an EMR is important not only as a patient record for daily clinical activity but also as a data bank for clinical research, the data provided through templates should be stored as structured data sets into databases. Kyoto University Hospital makes EMR to handle the data given through templates as structured data in its new HIS system in 2005. As a result, applications to retrieve data provided via template are widely used, especially for clinical purposes such as intra-hospital cancer data collection, or as media to collect clinical accounting information. On the other hand, clinicians made full use of data retrieval service provided by IT sector with the structured database. However, many clinicians used the service to provide data for their own existing databases for clinical research. The result indicates that further development to incorporate the existing database of each research group into HIS is indispensable in enabling clinicians to make good use of clinical data in their clinical research without additional labor.

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 An application service provider system for healthcare with a data mining function has been developed. The system provides computer-based healthcare service over the Internet to advice customers on how to improve their lifestyles on the basis of association rules relevant to their health and lifestyle data. These association rules can be automatically extracted using a data mining technology on the server computer on the basis of customers' stored time-series health and lifestyle data that are transferred through their mobile phones or PCs. The healthcare adviser can send comments made up of the rules to the customers over the Internet.

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 The Japanese phrase Tokutei Shikkan refers to intractable diseases that result from unidentifiable causes and that are very difficult to treat, as there no treatment procedures have been established. Typically, the treatment of these diseases requires long-term care and medicines, which causes great financial and mental stress on the patient's family, so these treatments are subsidized at public expense. Given the lack of statistical information on these rare diseases, The Specified Disease Treatment Research Program was established in 1972, and 56 intractable diseases are currently included as Tokutei Shikkan. The program has been very successful, and many clinical research groups have gained new insight into intractable diseases. Unfortunately, no cross-sectional studies of these diseases have been conducted due to semantic differences among clinical research forms, which are designed mainly to apply for administrative funds and which contain little clinical information. We redesigned the forms as openEHR-based templates and mapped specific clinical notations for intractable diseases onto the archetypes in CKM (Clinical Knowledge Manager). The openEHR project is a current reference implementation of ISO/CEN 13606. We are now trying to bridge the gaps between international standards and criteria and those unique to Japan. This paper shows how we mapped the clinical information on intractable diseases onto the archetypes and how we implemented a clinical research form entry system that is coordinated with electronic medical records.

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 This paper describes the development of a medical information exchange system based on PKI. Using the developed secure relay system, medical institutions can transmit and receive encrypted medical information with secure MIME format, and only destination institution can decrypt the target information. This encrypted message exchanging is based on a developed public key directory service of medical institutions. In addition, we developed a function of storing medical information for emergency medical care on the system. For both exchanging and storing medical information, operations must be performed in the patient's agreement, so we also developed a status monitoring and controlling capability by patients of their own medical information on the system. The developed public key directory service is necessary for wide-area PKI based applications among medical institutions.

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