[in Japanese]

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A plan of highly automated hospital system-a total system-is described. In designing a hospital system, the “systems engineering” method, which is the most effective tool for such a complex outlay, is indispensable.
The fundamental purpose of the system is to improve the quality of medical care in the hospital by means of a highly organized information system. In addition, economy in manpower of paramedical personnel and betterment of hospital services for patients are also important derived benefits in an automated hospital.
Systems analysis was first performed on the present job at The Center for Adult Diseases, Osaka, and a possible plan was proposed on the basis of the conclusion derived from the analysis.
The requirements for hospital information systems are to store all the necessary medical data on an appropriate file, and to retrieve them easily in the hospital. To this end, an on-line computer system has been introduced and direct access of medical data has been considered, i. e., physician's orders, laboratory test results, findings of physiological examinations are fed as input through specially designed terminals (ODIK) or directly from automated laboratory machines. Hospital business is also computerized in this plan.
A highly automated laboratory has been planned, adopting various kinds of automatic processing devices, which are controlled by satellite computers to give autonomy to the subsystems. Spacial design of the laboratory room and the flow of specimens in the laboratory were basic matters for consideration. In physiological examinations ECG and pulmonary function test have been fully computerized, and continuous monitoring systems have also been considered. There is further possibility of automating the rest of examinations.
Introduction of automated transportation system, reformation of nursing, control of environmental factors in a ward are the other features to be taken into account in hospital automation. Traffic control and other ways of improving hospital services in outpatient department are discussed.

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This is a view related to automation of diagnosis and therapy, written by an engineer in the field of computer. He considers why computers are not so generally used in the medical field as in the other fields. The reasons cited are : 1) the biomedical mechanism of human being is not yet fully clear, 2) it is very difficult to simulate by computer the thinking process of the doctor, especially the pattern recognition is not easy for the present conventional computer, 3) the electronics-oriented person and the physicians are speaking different languages and 4) there are diverse understandings about the word “diagnosis”.
The author hypothesizes the process of diagnosis by a doctor from the computer side, and considers the role of medical questioning, demonstrating the system with an example of the flow-chart.
He also introduces some actual examples of trials toward automation of diagnosis, therapy and patient care, mainly in the United States.

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The electronic computer which had not been used as actively in medicine and medical treatment as in the various other fields, is now being applied quite extensively in Japan. During recent years, there has been an increased interest in introducing the electronic computer to the hospital administration as a step towards developing a new and rational hospital automation system.
The development and application of a computer processing system at our hospital is introduced and our plans for the future are outlined in this report. The current application includes preparation of claims for remuneration of examination and treatment expenses; calculation of salaries and wages of the hospital staff; recording of purchases and maintaining of inventory of drugs, equipments and supplies; controlling of medical charts, health status, nursing information and patient meals; scheduling of appointments and preparation of various hospital statistics.

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The automation of clinical laboratory can be achieved from two sides. One is the automation of process of measurements and the other is the data processing in relation to receiving samples or reporting results of tests.
A typical example of the automatic measurements is automated chemical analyzers, which are already a part of clinical laboratories in many hospitals. There are, however, still many tests which have not been automated because of technical difficulties and this unbalance has to be overcome in future.
The processing of data generated in laboratory is also an important problem in recent laboratories. We discuss here our system which utilizes minicomputer and production control terminals. Since the laboratory data need be processed in real-time, minicomputers will play an important role in clinical laboratory where total hospital information system is not available.

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It is a recent trend to install electronic data processing system (EDPS) in hospitals as a tool to centralize the information, and such systems have been developed in some hospitals in the U. S. A. and Sweden. In the computerized hospital information system, it is the most important to collect information directly from where it occurs and store it in conveniently organized files so that it can be retrieved easily at a later time.
A new system, Clinical Integrated Information Control System (CLINICS), has been designed and it has been functioning since April 1971 in our clinic.
Registration of subjects, booking of schedules, ordering of examinations and fee accounting are processed through an on-line system, while the results of examinations are collected and processed by an off-line batch process. The graphic patterns, such as X-ray pictures and retinograms, are read by doctors and the diagnosis expressed in code is fed into EDPS. The original graphic pattern records are stored on microfilms. Codes, which represent more information with less requirement for memory capacity, are very important for effective use of EDPS. There should be prepared many kind of codes, such as personal identification code, examination code, occupation code and so on.
The file format is the variable-field/variable length record. The record consists of two parts, the identification items and the medical records. The former is fixed; the latter is variable containing the examination code, results, fee and date. A unit length of the comment is 20 characters. It is provided on another file and chained to the main file by the address.
The long-term goal in the hospital data processing is to be completely automatic with a real time information system using conveniently on-line terminals, mass direct access devices and more sophisticated control programs.

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The medical treatment and incidental affairs in the hospital are all carried on in the realm of physical information transaction. Desk work is also carried on there at the same time, memorizing, transmitting and regulating information. A number of hospitals. these days are gradually turning towards computer processing of such information.
When all the hospital information is fed as input into the computer, we are freely able to retrieve necessary portions thereof for the management. It will be a great help to. promote the management efficiency.
The decision making of the management will be done by alternative judgment, yes or no, from comparison of the standard pattern of action with certain action information.
On the other hand, the decision making of top-management will be executed by judgment on the probability of numerous data that may vary or that may be anticipated in the future. The computer will not be of so much help in this field. We should not misunderstand this point, because only our excellent human brains are instrumental in achieving results in this field.

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It is uncommon for many patients in Japan to make an appointment of medical consultation with doctor a few days before visiting the hospital. As a result all the patients crowd into the outpatient clinic and waste time to wait for consultation.
Recently, a computerized appointment system has been set up at the Heart Institute Japan, Tokyo Women's Medical College, and it has proved to be of great use in saving time, in estimating the load of task at the hospital.
This paper reports the successful result of computerized appointment system and refers to the coming contribution of such system towards hospital management, especially in the field of Hospital Information System.
This system consists of four devices, including a processor of 1 KW memory, magnetic drum of 16 KW memory, typewriter and operator console. It is a compact system for appointment only and is easy to operate. An operator of this system is not required to have any knowledge of computer. It can reserve 600 cases of appointment every day during 4 weeks. Approximately 250 patients visit this hospital daily and over 80 per cent of them utilize the system. Each patient saves on an average about one and a half hour of awaiting time.
Although the appointment system is also realized by hand operation with notebook, computerized system is more effective. Only one person is enough to operate the system, , against 5 clerks for manual system of about the same scale. Moreover, the computerized system prepares the list of anticipated patients, which offers the Hospital Information System an advantage of minimizing the capacity for active file of patient records.

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The rapid progress has resulted in more intensified and diversified “needs” which are required of the medical care by people. In order to cope with this trend, the problem of medical care has been re-studied from the standpoint of the system engineering, and the various functions of total health care system have been clarified, and the respective functions have been improved.
The idea of Automated Multiphasic Health Testing (AMHT) has been conceived in the circumstances mentioned above. This testing method is considered to be very effective in spite of the great number of examinees to be tested in a very short time. We have completed the Health Check-up System mainly for our employees at the Toshiba Central Hospital, and we are continuing with testing of about 30 examinees daily.
This report describes the concept of our AMHT, explaining the outline of some problems involved in the system operation.

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Data communication, referred to as Computer Communication or Remote Data Processing in Western countries, has enabled acquision of numerous data over a wide range and to send back or switch messages to and fro, through linking of the on-line real-time computer data processing and the simultaneity and extensiveness of telecommunications. In the medical fields, three applicable areas for data communication are conceivable as in the general industrial fields.
The first area is the centralized storing of medical information for responding to inquiries from remote terminals. The Swedish public health system is an example of this area. It covers the whole population in Sweden under the countrywide network of medical care and keeps the medical records in the personal files of the mass-storage center, based on the central population register.
The second is the data communication system to analyse automatically the biomedical signals and raw data from medical examinations. The Medical System Development Laboratory (MSDL), U. S. Public Health Service (USPHS) has been developing the automatic analysis system of the electrocardiograph and the forced expiratory spirogram connecting computers, telephone lines and remote terminals.
The third application is the shared data processing system in which the participating users share a computer system and its resources for economical reason. The Minnesota Blue Cross's shared data processing system is an example of this kind.
The expected future application of data communication is the remote diagnostic system with the specialist physicians in the center; it will be based on the development of the computer and communication technologies and progress made in technical methods of combining telephone networks with medical instruments.
The availability and extensiveness of data communication in the medical fields are herein presented.

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There is an increased confusion during consultation hours in Japanese hospitals functioning for out-and in-patients with the same importance. To manage the business promptly, the conveyance system is necessarily required to be automatic. To cope with this demand, the following becomes an issue.
1. Air chute. To convey medical charts, X-ray films and specimens for laboratory examinations.
2. Case conveyer. To convey cases containing medical charts. One chart system for one patient is recommended even in consultation in two or more clinical departments.
3. Box conveyer. To convey cassettes for X-ray films and medicine bags.
The JNR Central Hospital operates a highly automatized establishment in the above three systems which make it possible to convey materials either vertically or horizontally in hospital rooms under the centralized control.

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The MEDICA II, a medical data processing system for “Multiple Health Examination (MHE)” in the Center for Adult Diseases, Osaka, is described. This system with its basic functions fully studied has been developed as an experimental model of automated medical record system. The computer used is NEAC 2200/Model 100 with a core memory of 32 K characters.
In the MEDICA II, medical records conventionally handwritten and filed are copied and coded on a specially designed “Casesheet”, and keypunched onto eight 80-column punched cards for each case. The records are then processed by a computer and transferred to a magnetic tape file- “Basic Medical File (BMF)” for storage.
On completion of BMF, the “MHE Report” and other reports are automatically printed out. This processing is performed weekly and BMF and the “Index File” are up-dated at the same time. With the MEDICA II, more than 5 000 records have been processed and stored.
BMF can be readily retrieved by any available key words such as the patient's name, sex and birth date, identification number or file number, using a single parameter card carrying key words on it.
Another notable feature in this system is the patient's identification system. The identification number is automatically given, based on the name, sex and birth date to be used as an important key word.
Since analysis of the stored data is one of the important purposes of the MEDICA II, many programs for statistical analysis have been made.
Discussions are made of the future application of a computer to hospital information systems and further development of the MEDICA II system.

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The utilization of computer analysis of electrocardiograms is expected to spread further through the establishment of a transmission system which could cover a broader area. Our investigation system in developing has been as follows : <BR. (1) A frequency modulation was used to transmit ECG, where the carrier frequency of FM was settled upon 1 kHz. The modulated ECG were transmitted through a coaxial cable. It was also scheduled to transmit the modulated ECG over the telephone network and/or wireless channel. The received waves were demodulated and recorded on a magnetic tape. In order to confirm the fidelity of the system, the original and the transmitted ECG were transformed into power spectra by Fourier analysis. The power spectra showed no significant difference between the transmitted ECG and the original ECG.
(2) The transmitted ECG were measured automatically with a digital computer, and 54 parameters for differential diagnosis were settled and were picked out with the computer. A logical matrix with 54 symptomatic parameters and 123 entities of diagnosis was prepared. The clinical survey was undertaken upon a few cases of cardiac patients, and the practical application of this system were evaluated.

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