Digitalization of Medical Record in

Japan

Naoki Nakashima, MD, PhD

Department of Medical Informatics
Kyushu University Hospital, JAPAN

© Copyright IBM Corporation 2005

Digitalization of Medical Information in JAPAN

• There are 9,000 hospitals and 90,000 clinics in Japan.

• Japanese government has strongly promoted
digitalization of medical record from 2001.
• Digitalization rate (installation ratio of electronic
medical record system=EMR) still remained only at
the 20% level in 2005 in spite of the government’s
effort.
• The government decided to use 100% online
reimbursement system for medical fee between
medical institutes and insurers by 2011.

© Copyright IBM Corporation 2005

 Problems of Electronic Medical
Record System in Japan
• Inefficient Standardization and Interoperability of Medical
Information in Japan

• Insufficient Service of Public Infrastructure

(PKI, medical VPN, etc)

• Too Many Variation of Medical Work Flow

• Recent Attention of Safety Management and Patient Privacy

• Too Much Cost for EMR Installation © Copyright IBM Corporation 2005
 System Configuration of Hospital Information
System in Kyushu University (Venus 3) (Since 2007)
DS4800 DS8100 Tape library for
*Referential ＤＢ … 1.5TB *Order-entry／Electronic Medical back up
*Report reference… 1TB Record … 3TB [3584-L52]
*images（old）… 1TB *Receipt data … 700GB *6-drive
*Data ware house ･･･ 1TB *Radiology sector

SAN (Storage Area Network)

IBM IBM

SAN-Switch [2005-B32]

Order-entry system／
Referential Electronic Medical Record Reimburseme Radiology Branch
Referential Back up
Data Ware i5/OS nt system i5/OS system Ｇ／Ｗ
Medical AIX5L
Record House 6way / 30GB i5/OS 1way / 2GB 4way / 8GB
1way / 6GB
Information Reference p5 55A Branch
i5 570 (2.2GHz) x2
system
Sector CPU: 8way Memory: 38GB servers
Document
creation
support Branch system and
HIS_Network system Branch Ｇ／Ｗ
Interconnect_SG
serverﾞ
Management_SG
Win2003
External_SG (Intranet)

Security system
Network management system
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 Conceptual Figure of Venus 3 (Kyushu U Hosp system)
Payment Physical distribution
system system
Other
Sector A medical institutes

Sector B Electronic Nursing support Medical information

medical record system transition system
Critical
pathway

Sector C
Order-entry system information
Integration of medical and dental disclosure system
Sector D PACS
(Filmless
Patients
bi-direction System)
Sector X 70TB
Data ware house
For patient’s satisfaction

Reports to
Hospital business Health, Labour and Welfare Ministry
Safety Support of
management Management clinical researches © Copyright IBM Corporation 2005
 Scales of the Entire System
• Economical;
– Lease Contract of Venus 3 with IBM for 5years
• Application and hard (Venus 3, IBM) = 22 million US$/5ys
– Network (IBM) = 4 million US$
– Filmless system (Fujifilm medical) = 5 million US$

• Physical;
– Servers = 21
– Clients =2000 (including clients of filmless system)
* There are many other branch sector systems
(drug, blood examination, physical examination, endoscope,
rehabilitation, feeding service, etc) © Copyright IBM Corporation 2005
To keep patient medical record properly

• Confidentiality
• Integrity
• availability

© Copyright IBM Corporation 2005

To assure confidentiality in KU hospital
• Formulated operating rules, privacy policy and
clarification of administrators
• Installation of registration authority office (thorough
going registration, revision and deletion)
• Authentication by finger print
• Interruption from Internet
• Restriction to place client PCs only in the premise of
the hospital
• Remove all media ports from client PCs
• Automatic log off and screen saver
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 To assure integrity in KU hospital
• Time stamps
• Automatic monitoring of the discs
• Anti-virus software
• Prevention of falsification (but not by PKI)
• Multiple-back up
• Network redundancy

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 To assure availability in KU hospital

• Location management of information storage

• Reference function of all items on EMR
• Switching function to back up server
• Web EMR (only reference) at the time of maintenance
or system down
• Secure server rooms in earthquake resistant building

© Copyright IBM Corporation 2005

Future issues in Kyushu University Hospital
and probably in entire Japan
• Adoption of Healthcare-PKI
• Adoption of standardized master/code and protocols
(HL7, DICOM, and IHE) of medical information
• Enlightenment of concept of sharing electronic
medical data in the local area

© Copyright IBM Corporation 2005

Pay attention to present and future
medical information system!

Thank you, and

Enjoy your stay in Hawaii !!

© Copyright IBM Corporation 2005