Shigeki Tani

Electromagnetic interference on medical equipment by low-power mobile telecommunication systems

There have been a number of reports of electromagnetic interference (EMI) on electronic medical equipment caused by mobile telecommunication systems. In Japan, the use of the personal handy-phone system (PHS) has greatly expanded within urban areas, PHS handsets transmit EM signals at a frequency of 1.9 GHz and have a peak radiated power of 80 mW. This power level is lower than that of other mobile telecommunication systems. Two studies were carried out. One was to determine whether or not PHS interferes with electronic medical equipment in hospitals. We observed no EMI on electronic medical equipment when the PHS handset was in either the speaking mode or on standby. The second study was to observe EMI from 1.9-GHz signals at several radiation power levels. Although EMI was not observed at the radiated peak power of the PHS handset, EMI on some of the tested equipment was observed when the radiated power was ten or more times higher than that of the PHS handset.

SS-MIX: a ministry project to promote standardized healthcare information exchange.

OBJECTIVES To promote healthcare information exchange between providers and to allow hospital information systems (HIS) export information in standardized format (HL7 and DICOM) in an environment of wide-spread legacy systems, which only can export data in proprietary format. METHODS Through the Shizuoka prefecture EMR project in 2004-2005, followed by the ministrys SS-MIX project, many software products have been provided, which consist of 1) a standardized storage to receive HL7 v2.5 messages of patient demographics, prescription orders, laboratory results, and diagnostic disease in ICD-10, 2) a referral letter creation system, 3) a formatted document creation system, 4) a progress note/nursing record system, and 5) an archive/viewer to incorporate incoming healthcare data CD and allow users to view on HIS terminal. Meanwhile, other useful applications have been produced, such as adverse event reporting and clinical information retrieval. To achieve the above-mentioned objectives, these software products were created and propagated, because users can use these software products, provided that their HIS can export the above information to the standardized storage in HL7 v2.5 format. RESULTS In 20 hospitals of Japan, the standardized storage has been installed and some applications have been used. As major HIS vendors are shipping HIS with HL7 export function since 2007, HIS of 594 hospitals in Japan became capable of exporting data in HL7 v2.5 format (as of March 2010). CONCLUSIONS In high CPOE installation rate (85% in 400+ bed hospitals), though most of them only capable of exporting data in proprietary format, prefecture and ministry projects were effective to promote healthcare information exchange between providers. The standardized storage became an infrastructure for many useful applications, and many hospitals started using them. Ministry designation of proposed healthcare standards was effective so as to allow vendors to conform their products, and users to install them.

Randomized double‐blind comparison of the effects of intramyometrial and intravenous oxytocin during elective cesarean section

Obstetricians sometimes administer intramyometrial oxytocin to stimulate uterine contraction during cesarean section, but its effects have not been well investigated. We performed a randomized, double‐blind study to test the hypothesis that a small dose of intramyometrial oxytocin would induce acceptable uterine contractility more quickly and with fewer hemodynamic side‐effects than the same dose administered intravenously.

Standardizations of clinical laboratory examinations in Japan

In this paper we introduce Japanese activities concerning laboratory examinations by illustrating three major categories. The first is the contribution of JCCLS to ISO/TC212 clinical laboratory testing and in vitro diagnostic test systems, with NCCLS and CEN TC140. The second is the establishment and promotion of JLAC Classification and Coding for Clinical Laboratory Tests by The Japan Society of Clinical Pathology. The third is a clinical data exchange format between healthcare facilities using MML/MERIT-9 standard, started as a Ministry research project.

JJ1017 committee report: image examination order codes--standardized codes for imaging modality, region, and direction with local expansion: an extension of DICOM.

The digital imaging and communications in medicine (DICOM) standard includes parts regarding nonimage data information, such as image study ordering data and performed procedure data, and is used for sharing information between HIS/RIS and modality systems, which is essential for IHE. To bring such parts of the DICOM standard into force in Japan, a joint committee of JIRA and JAHIS established the JJ1017 management guideline, specifying, for example, which items are legally required in Japan, while remaining optional in the DICOM standard. In Japan, the contents of orders from referring physicians for radiographic examinations include details of the examination. Such details are not used typically by referring physicians requesting radiographic examinations in the United States, because radiologists in the United States often determine the examination protocol. The DICOM standard has code tables for examination type, region, and direction for image examination orders. However, this investigation found that it does not include items that are detailed sufficiently for use in Japan, because of the above-mentioned reason. To overcome these drawbacks, we have generated the JJ1017 code for these 3 codes for use based on the JJ1017 guidelines. This report introduces the JJ1017 code. These codes (the study type codes in particular) must be expandable to keep up with technical advances in equipment. Expansion has 2 directions: width for covering more categories and depth for specifying the information in more detail (finer categories). The JJ1017 code takes these requirements into consideration and clearly distinguishes between the stem part as the common term and the expansion. The stem part of the JJ1017 code partially utilizes the DICOM codes to remain in line with the DICOM standard. This work is an example of how local requirements can be met by using the DICOM standard and extending it.

Problems and Efficiencies of PC-order Entry System for Prescription.

We have converted our hospital information system used in Hamamatsu University School of Medicine from a host on-line system to a client-server system (PC-ordering). Problems and efficiencies in the use of this new order entry system for prescriptions were subsequently evaluated.Several merits were identified such as contraindicational drug use, drug interaction and duplication checking systems, but many problems still remain to be overcome in the PCordering system package produced by NEC.We classified these problems into three categories:(1) data transfer problems, (2) system conversion problems, and (3) client-server system problems.