BIOGRAPHY: Hiroshi Takeda, M.D,.D.Sc. has had over 20 years of clinical experience and over 15 years of medical informatics experience. He has been engaged in a specialist of internal medicine, subsupeciality of cardiovascular disease. He was a post-doctoral fellow of clinical pharmacolgy at the Univerity of Chicago and was a senior specialist for scientific affairs in the Ministry of Education, Science and Culture in Japan. He is now the vice-director and associate professor of department of medical information science, Osaka University Hospital.
In the development of HUMANE, the pimary goals to be achieved were 1) POE (Physicians order entry) and good MMI(man-machine interface), 2) good response at a micro frame and 3) MMD (multi-media database).
Software menu of the HIS is divided into two categories. The one is interdepartmental or common application program and the other is department-specific application program. Common application programs are patient registration, accounting and billing, order entry ( prescription, laboratory test order, radiological examination order, admission order, operation order, food service order ), disease name registration, reporting system ( laboratory test and radiological examination), scheduling ( re-visit, special examination), admission management, nursing care system.
Infrastructure of the HIS consists of the two elements, backbone LAN and branch LAN. The looped backbone LAN has two FDDI based 100 Mbps LAN, one for HIS and another for PACS. The total length of the LAN is about 1 Km. Seventeen nodes for HIS, six nodes for PACS are installed to communicated with Bus type LAN, which is Ether net type (10 Mbps) and its length is about 1.6 Km.
Hardware of the HIS features MMML (main-medium-micro frame Link) that is the original configuration of the hospital information system in Japan. In order to solve the problem for ensuring the shorter response time, better human ware and stronger security within the nominal cost, we choose the vertical-horizontal-vertical distribution of the information processing. The role of main frame is to manage the database and on-line transactions. Medium frame works as a server of the micro frame and files basic patient clinical data and master tables. Micro frame function is to maintain a good MMI and assist POE.
2) Dynamic template; In order to register key words, defined as "atom", dynamic template are developed in this project. To solve the proble that text data are necessary but hard to store and retrive, the templare are ready in accordace with a major headline key words. For exapmple, if the key worl is "pain", a template is shown in display amd a clinician will choose second key words among pain-related word sets such as chest, abdomen, back and so on. If "chest" is selected, the template will then display next word set such as onset, duration, freqauency, relieved by rest and so on. This process are regulated with rule-based (knowledge-based in the future) dynamic teplate master file.
3) Order/Reporting system Link in HIS As moost clinical actions such as prescription, clinical test order and so on, will be made by means of ordering, the EPROU should have close link with ordering and reporting system in HIS. Accounting and billing system is also linked through ordering system.
4) problem oriented and retrograde tracking: Cure and care are always in a problem-solving process. Everyone whom is concerned with a patient should recognized and update the problems of the pateint. The EPROU is very conscious for the problem-oriewnted EPR. Besides for the three major category of the data structure, problem list file is also arranged. The relationship between problem and fact-assessment-action data are always linked, and the link provides the basis for retrograde tracking of problem-solving process.
5) Direct data entry by clinicians; The single greatest problem may be direct data entry by clinicians. Since oen hundred percent order entries are made by clinicians in our univeristy hospitals, it will be well accepted to mandate direct data entry of the EPROU in the boundary condition of quick resonce time, good man-machine interfance and high quality of utility and performance.
5) SGML editor interface Intrahospital EPR must convert to generalized standard EPR format as indicated in the national EPR project. Tentative guideline adopted SGML-EPR in Japan ans the EPROU must hve an interface to describe by means of SGML. DTD and other nevessary dictionaries will be given by the national project.
6)Secondary use applicable The EPROU which facilitates the acquisition, communication, storage and access of patient data will be a strong weapon to assist clinical research, and undergraduate education and postgraduate traning. Relational databse and its management system will be ready for the secondary use of the EPR system.
Master maintenance tool for the dynamic templates has already developed by co-workers and cardiovascular disease-oriented templates are generated by clinicians.