Recently, the increasing digitalization of medical information in healthcare facilities has enriched medical safety checks and information-sharing functions for staff members; however, this has not completely prevented the occurrence of incidents. By organizing system roles from the perspective of “positively conveying information,” we demonstrate the need to add mechanisms tasked with information transmission to existing hospital information systems, and propose integrated design and implementation that treats the entire infrastructure of system as a “medical information transmission platform.”
 During the renewal of the Integrated Medical Information System (IMIS) at Kochi Medical School Hospital in January 2013, we attempted to realize such a platform by constructing an Integrated Medical Information Infrastructure (IMII). The implementation of such a system required that we choose a mobile device for individual use and develop an application to be run on the device as well as construct a wireless LAN environment capable of stable connections. The overall design and construction of infrastructure of hospital information systems based on the idea of “medical information transmission platforms” is crucial for medical safety, and this concept can be applied to and implemented in a variety of healthcare facilities.

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 Among clinical information, body site is fundamental because it may be a part of other important information such as patients’ conditions and procedures. Therefore the technique to catch the information is one of the most important components in clinical information processing. It requires normalization: to resolve notational variants and identify the concepts they indicate. But there is no promise that body site information used in clinical settings corresponds to exactly one anatomical concept. This paper studies correspondence relationship between body site expressions appeared in case reports and concepts defined in the Japanese anatomical ontology. The result shows that reduction occurred in 18.8% (29/154) of the body site expressions and 27.3% (42/154) correspond to two or more concepts. The detailed research of each cases demonstrates that the implementation of normalization technique require anatomical knowledge including regions and directions and a synonym dictionary in addition to internal structure analyzer of body site expressions.

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 The Arden Syntax (AS) was developed to standardize the representation of medical logic for clinical decision support. However, the AS adoption had been a problem because of two issues. First, it is difficult to supply skilled developers. Second, there is no standardization of data access methods in AS, and every healthcare has to implement specific queries for their data source. There is no unified method to manage bulk messages from a variety of data sources. In this study, we developed a novel scheme to overcome these issues. [Methods] We implemented internal DSL on Ruby that closely conformed to the AS specification. Mapping between standardized DWH schema and Fast Healthcare Interoperability Resources (FHIR) was developed to absorb various database structures. [Results] We were able to translate the clinical decision support rule written in AS into our developed DSL with equivalence and expressivity. This significantly reduced the amount of data query code and made simple rules. [Discussion] Compared to a pure AS DSL, our approach has the advantage of availability of a modern development environment; for example, test-driven development may contribute to build solid rules representing complex clinical guidelines.

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 Practical design of ICT systems and workflow of real time telemedicine requires understanding of communication processes in telemedicine. This study reports the first trial of communication analysis in a simulated tele-auscultation experiment as the primary study for communication analysis in telemedicine. In the experiment, a remote doctor instructs a helper with no auscultation skills to put a chest piece of a stethoscope on a target point by using a vision-based tele-navigation system. An auscultation trainer is used as a client to simulate lung diseases. Communication between the remote doctor and the helper is analyzed with survey of questionnaire and interview to the subjects, and observation of multi angle videos such as the views in the tele-auscultation support system and the external appearance of the experiment. The results show basic knowledge of tele-auscultation communication analysis such as multimodal and multichannel interactional patterns of remote stethoscope navigation.

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