Naoto Kume

Development of Fundamental Infrastructure for Nationwide EHR in Japan

The movement of create medical information systems that is now taking place involves both progress in EMR (Electronic Medical Records)—computerization of records at hospitals and clinics, and also in EHR (Electronic Health Records) in which information is shared with individual regions. However, the geographical coming and going of people in modern society is extremely active. Naturally the places these people move to are not necessarily within the same region. For this reason, even if the basic unit for the health care supply system is in practical terms limited to the local level, if services are restricted to only one region, many persons may be unable to receive the benefits of health care cooperation. In this study, we constructed a mechanism for a medical cooperation system which links the EHR systems of individual regions and is able to create a one-patient, one-record system on the national level. In this paper, we will provide a report of this mechanism and of the 4-year operational trial.

Impact of position tracking on the outpatient navigation system

Reduction of waiting time of patients and idle time of doctors is one of the most important factors of outpatient ward management. Although conventional in-hospital outpatient navigation and re-scheduling systems free the patients from waiting rooms, the systems often cause additional idle times for the doctors and even several clinical incidents. This paper designed a new patient navigation and re-scheduling system equips position tracking. The authors introduced the system into Kyoto University Hospital. As a result, the system decreased more than 100 hours a day of wasted time and irritations of the patients and the clinical staffs. The results tell that the context-aware feature makes not only the system user friendly but also the users friendly.

Vertex-preserving Cutting of Elastic Objects

This paper proposes vertex-preserving cutting methods on finite element models for interactive soft tissue simulation. Unlike existing methods, we aim to shape variety of incisions using only initial vertices of tetrahedral meshes. Neither tetrahedral decomposition nor vertex creation is used. The number of vertices is preserved. This avoids increase of computation cost as well as allows fast update of physical status of finite element models. To preserve 3D shape and sharp feature of initial meshes through on-the-fly mesh modification, constraints are introduced to the topological update scheme. In our model, the size of stiffness matrix is constant. Our framework efficiently simulates several varieties of smooth incisions with sufficient quality for surgical simulation, and also achieves interactive performance in complex meshes with thousands of elements.

Tele-auscultation support system with mixed reality navigation

The aim of this research is to develop an information support system for tele-auscultation. In auscultation, a doctor requires to understand condition of applying a stethoscope, in addition to auscultatory sounds. The proposed system includes intuitive navigation system of stethoscope operation, in addition to conventional audio streaming system of auscultatory sounds and conventional video conferencing system for telecommunication. Mixed reality technology is applied for intuitive navigation of the stethoscope. Information, such as position, contact condition and breath, is overlaid on a view of the patients chest. The contact condition of the stethoscope is measured by e-textile contact sensors. The breath is measured by a band type breath sensor. In a simulated tele-auscultation experiment, the stethoscope with the contact sensors and the breath sensor were evaluated. The results show that the presentation of the contact condition was not understandable enough for navigating the stethoscope handling. The time series of the breath phases was usable for the remote doctor to understand the breath condition of the patient.

Annotated surgical manipulation for simulator-based surgical skill-transfer using SiRE – simulation record editor

This paper outlines the efforts for developing a framework for annotation of recorded surgical procedures toward the goal of simulator-based skill-transfer in surgery. The framework is based on SiRE – Simulation Record Editor – an application that allows medical teachers to produce variations and make perfect example surgical procedures even without surgical manipulation skills. By using SiRE, physical properties of the recorded manipulation can be modified interactively and accurately. Edited examples can be annotated as they are intended as self-learning media in surgical training of the future

Towards ambient communication support for power grid maintenance and repair

Abstract In the power industry various companies have a crucial responsibility of sustaining infrastructure for electricity service. Maintenance and repair of electrical devices out in the field is potentially dangerous and sometimes complicated in nature. Effective and safe fieldwork requires clear and accurate communication between fieldworkers repairing and maintaining devices outdoors and operators monitoring and controlling the power grid in a control room. Operators and fieldworkers have to synchronize their activities for maintaining steady electricity service. Current Information and Communication Technology (ICT) support for fieldwork consist of mobile phones, mobile software applications and workforce management systems, but much of the necessary communication is still conducted orally over the phone. We propose ambient communication support that improves communication between operators and fieldworkers by digitalizing and automating trivial messaging. The concept is based on mobile navigation and work order management application, image-processing techniques for wearable sensor based activity recognition methods. In theory we can eliminate three of eight logical steps in a typical work scenario. We present work-in-progress in form of preliminary prototypes and discuss the technological advances needed to make the concept real.

Core nursing process improvement enabled by wireless services

The research by Maliranta and Rouvinen based on the Finnish industrial statistics confirms that the productivity improvements in firms correlate to organizational and process changes (Maliranta and Rouvinen, 2003 and Maliranta and Rouvinen, 2004). These results implied a further question: Which types of process changes create the most beneficial productivity improvements in different environments. This question should be of major importance when new services are applied or developed. The research on process improvements has been done in ETLA and in the University of Oulu, where the Three Viewpoint Methodology (3VPM) (Martikainen, 2007) was developed for productivity analysis. In this paper we apply the 3VPM methodology to analyze the nursing documentation process and the impact of documentation process improvement by wireless services on core nursing process in Kyoto University Hospital. The information was collected by interviews and server logs. We have analyzed the benefit of introducing wireless PDA (Personal Digital Assistant) devices to update patient data on place instead of writing it down by hand and later storing it into the system on PC (Personal Computer) and consider other possible solutions like sensors, wireless tracking and touch by device paradigm. Nursing documentation process can be clearly improved and the improvement of the nursing process can be as much as 14%. This means that the same patient intensity can be achieved with less number of nurses.

Development of a methodology for the detection of hospital financial outliers using information systems.

Comparison of financial indices helps to illustrate differences in operations and efficiency among similar hospitals. Outlier data tend to influence statistical indices, and so detection of outliers is desirable. Development of a methodology for financial outlier detection using information systems will help to reduce the time and effort required, eliminate the subjective elements in detection of outlier data, and improve the efficiency and quality of analysis. The purpose of this research was to develop such a methodology. Financial outliers were defined based on a case model. An outlier-detection method using the distances between cases in multi-dimensional space is proposed. Experiments using three diagnosis groups indicated successful detection of cases for which the profitability and income structure differed from other cases. Therefore, the method proposed here can be used to detect outliers.

Augmented reality-based block piling game with superimposed collapse prediction

Understanding what cannot be seen is difficult. Physical behavior can be explained on the basis of physical theories even if the behavior cannot be observed. Explanation of what is physically happening in the real world would become easy, however, if annotations were superimposed on the real objects. Herein, the authors demonstrate how an understanding of a physical event can be facilitated by overlapping a real-world situation with a simulation that predicts a future state. This idea is demonstrated in a game application in which a player stacks blocks into a pile until it collapses. In general, it is easy to estimate whether a block on the edge of a table will fall or not. However, it is more difficult to predict whether a stack of many blocks will collapse, and in what manner the stack will collapse. Even though previous research has demonstrated that the problem of how two-dimensionally stacked blocks collapse can be reduced to solving a sequence of convex quadratic programs, algorithms for convex quadratic programs require massive computational resources. Hence, the authors developed a fast and new algorithm based on a linear program. The proposed algorithm realizes real-time simulation based on physics that superimposes predicted collapse. The block that is predicted to fall is superimposed on the real block with a lit background projection. The system was evaluated in an experiment, and superimposed augmented reality annotation was observed to be efficient. The system was also demonstrated in game contests and received positive feedback and comments.

Laparoscopic Forceps with Force Feedback

There are two main aspects of safety and effectiveness in laparoscopic surgery. The first is ensuring an appropriate operation field and maintaining this throughout the procedure. The second is finding the correct tissue plane and applying appropriate traction and counter-traction. To accomplish these requirements, surgeons must know the appropriate pressure to apply to the target organ or tissue. For example, weak operation of the forceps in the left hand during laparoscopic surgery leads to poor visibility owing to a small operational field. Furthermore, poor traction at the point of incision on the dissected plane decreases the dissection efficiency. In contrast, when excessive force is applied, there is an increased risk of organ injury or bleeding from capillary vessels during traction; this is clearly detrimental to the overall safety of the procedure. It is difficult for surgeons to master a feeling for the appropriate pressure to apply. Imitating the techniques of skilled surgeons is essential; however, surgical techniques cannot be imitated on first sight. With the aim of assisting this learning process, we developed Forceps Guiding Correct Operation (FOGCOP), new laparoscopic forceps with sensors. Although they are the same shape as Maryland dissecting forceps, FOGCOP can measure the pressure applied on the shaft of the forceps in three axis directions (X, Y, and Z) and on the jaw. The measured pressures are displayed in real time. Surgeons can insert this device into a 5-mm trocar in the same manner as normal forceps. We conducted experiments to verify the effectiveness of the device. 30 students with no experience of laparoscopic surgery participated in this study. Using a training box, students performed a task to press and pull a rubber plate. We compared the performance of a group of students using FOGCOP (group 1, n = 10) with that of a group using conventional forceps (group 2, n = 10). The results suggest that the feedback provided by FOGCOP may be useful for understanding the force delivered by forceps. To verify the usefulness of the device, FOGCOP was also used in laparoscopic nephrectomy of a pig, a procedure that is part of the training course for laparoscopic surgery. It was possible to dissect a tissue plane in the same manner as with conventional forceps. However, the wire from the sensor sometimes interfered with operation. In future, we intend to upgrade FOGCOP by including a wireless sensor, to improve operability to be closer to that of normal forceps, and to allow this device to be used as an educational tool.