Sequential access log data of nurses to the electronic medical record (EMR) over 3 weekdays at one ward of a municipal hospital were extracted. The logs of 23 nurses who worked between the start of day-shift and the point of nurse's morning round on their assigned patients were analyzed to examine screen transition patterns of the EMR in nurses' data acquisition process. Of a total of 141 patients' information acquisition processes there were 53 sequence patterns of screen transition. The result of maximum 4 screens visit per the information acquisition session indicated efficient information collection of a patient in a short time with limited access patterns. Although nurses used various 11 types of EMRs screens for the information gathering, the top 5 screens represented 638 views (97.7%) and the collection was substantially completed with only 5 screens. Of these, the frequent use of a patient data screen were “Care Record” and “Care Flow Sheet“. The EMR Vendor might assume that the “Care Flow Sheet” screen would act as a core menu for nursing duties. However, the study showed that, in real-world use by nurses for information collection, “Care Record” screen had played a major hub role. In order to collect information efficiently with a few screen visits, nurses effectively utilized customized links instead of preset links (7 customized links vs. 3 presets). This result will provide the basis for usability of nurses' EMR for data gathering.

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 Authors conducted an analysis on how same examinations were applied to same patient in the month of referral at different healthcare providers, using sampling dataset of October 2011 from Japan Ministry of Health reimbursement claim database.
 Frequencies of cases of same examinations applied to a patient at different healthcare providers in the same month of referral fee claimed were counted. Results were; alpha-FP 2/151=1.3%, HbA1c 40/2,394=1.7%, CT 35/2,445=1.4%, MRI 10/2,025=0.5%. There was no duplicated PET examination.
 Reported preceding survey to doctors showed that majority does not apply the examination again to same patient when they were given results of the same examination of one month ago. Through calibrations with this and other factors such as examination body part, preciseness, percentages of examinations may not have to be applied were supposed as; alpha-FP 2.7%, HbA1c 3.3%, CT 0.61%, MRI 0.25%.
 Each examination cost times these percentages gives followings; alpha-FP 68 yen, HbA1c 16 yen, CT 133 yen, MRI 48 yen. This justifies 100-200 yen each way premium on referral when examination results were attached electronically.

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 Implementing the electronic patient record (EPR) in emergency rescue (ER) is difficult because ER staff must not only attend to the patient but record many treatment actions (acts) quickly and without delay. We are currently using a “Card-type” electronic patient system, which was created by adding a customized interface layer between FileMaker Pro and a vendor-made EPR system. With this system, we were able to implement the EPR for ER (EREPR) and have used it for one year. We analyzed one year's data consisting of about 19,000 treatment acts and averaging 32 treatment acts per patient. The average interval time to enter the act was 2 minutes and 29 seconds, and 47% of all acts were entered within one minute after the previous acts. We found the most frequent interval was 10-20 seconds among the acts entered within one minute of the previous act. Analysis of ER treatment has been difficult, but with EREPR, which digitizes treatment data, analysis is now possible.

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 The quality depth and breath of nursing care records varies depending on each care worker's years of experience. It is difficult to share a complete picture of care receivers' information among other care workers just by recording the mere facts. Care workers who see care receivers on a daily basis require detailed nursing care records to supplement and confirm their own observations. With these records, they can improve the care they provide and can better educate other people engaged in care work. To further improve care work operations, it is necessary to solve the issues stated earlier and to develop detailed care record systems using electronic devices. In this study, key vocabulary from care records was used to compare different care receivers and provide care workers with additional information and insights on their care receivers. This study also examines the contents of care records, which enables sharing the condition of care receivers among care workers using TETDM (Total Environment for Text Data Mining). As a result, it is conceivable that TETDM's analysis will help provide care workers with the best information to care for care receivers. This study shows possibilities both in analyzing care records via TETDM and in designing care record systems using electronic devices.

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 For a typical and reproducible pattern in data extraction from data warehouses (DWH), applications with program-mediated support for users are needed. Our department of medical informatics has developed in-house applications to address these demands whenever possible. Here I report the manner in which our applications were used. These applications were developed for use in the following fields: clinical practice, medical safety, nutrition support, pressure ulcer care, infection control, and tasks in the specialized departments and those at the reception. A survey on the status of access to the applications during a period of six months was conducted. It was observed that the application “comments on inpatients”, developed for the protection of inpatients' privacy, was the most frequently accessed, followed by the applications “species-specific search for identified patients” for infection control and “anti-MRSA drug TDM data” in that order. In-house applications are convenient for users in that they allow developers to interact with the users on a regular basis and promptly respond to their requests, including those for revision, even after their release. Therefore, it is preferable to develop in-house applications for the use of DWH to respond to current demands.

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