Shunji Wakamiya

What are the standard functions of electronic clinical pathways

PURPOSE The present study was performed to determine the standard functions of electronic clinical pathways (eCP) embedded in electronic medical records with regard to demand definition. METHODS The standard functions of eCP were decided by the required functions determined from interviews with hospital staff, those derived from the implementation of paper-based clinical pathways (CPs), and additional functions generated through the shift from a paper-based to an electronic system. Moreover, the proposed standard functions and those of eCP embedded in electronic medical records for large hospitals were compared by interviews with five vendors. RESULTS Seventeen functions were deemed necessary for eCP, and these were classified into six categories: displaying, recording, ordering, editing, variance, and statistics. Although most of these functions are already included in eCP products, their implementations differ between products. CONCLUSIONS We propose 17 standard functions required for eCP embedded in electronic medical records. The functions for editing patient checklists, checking the occurrence of variance, and statistics are especially important and should be implemented as standard functions. This study will aid in the future development of eCP embedded in electronic medical records.

A new approach to systematization of the management of paper-based clinical pathways

The present study was performed to explore a new approach to systematization of the management of paper-based clinical pathways by developing a new system requiring little capital investment. A new system was developed and incorporated into an existing network at a hospital with a paper-based clinical pathway management system. The effectiveness of this new system was examined by comparing the management efficiency of clinical pathways before and after its introduction, and by comparison of the new system with other such systems currently in place at other medical institutions with regard to efficiency. In addition, the acceptability of the system for other medical institutions was examined by providing free access to the software on the Internet. The development costs of the new system were low. Although the new system has been in place for more than 3 years, no problems have yet been encountered in either the existing network system or in the management system itself. The new system allows the processing of statistics and analysis of circulation or variance automatically, neither of which were possible in the original paper-based system. We provided open access to the system as free software on the Internet, and it has since been downloaded by many medical institutions and enterprises in Japan. This system is very useful for institutions where it is difficult to introduce expensive new systems for systematic management of clinical pathways, such as electronic medical records, because of problems regarding capital or system management, and it may also be useful in other countries.

Objective evaluation of the degree of pigmentation in human induced pluripotent stem cell-derived RPE.

PURPOSE For the transplantation of human induced pluripotent stem cell-derived retinal pigment epithelium (hiPSC-RPE), determination of the maturation status of these cells is essential, and the degree of pigmentation (dPG) can serve as a good indicator of this status. The aim of this study was to establish a method of objectively and quantitatively evaluating the dPG of hiPSC-RPE. METHODS Two observers determined the dPG subjectively by observing recorded images of hiPSC-RPE as follows: the dPG of a single cell was classified into three different pigmentation stages, and the overall dPG was compared between two cell groups to identify the group with the higher dPG. The κ statistic was applied to assess interobserver reproducibility. Next, the dPG of single cells and cell groups was objectively determined by the lightness of the hue, saturation, and value (HSL) color space, and the correlation between the subjective evaluation and time-dependent change in the objective dPG of hiPSC-RPE was investigated. RESULTS The κ statistic was 0.88 and 0.81 in the single-cell and cell-group observations, respectively. The objective dPG of single cells and cell groups was highly correlated with the subjective dPG. However, the observers were occasionally unable to subjectively determine the group with the higher dPG. The objective dPG increased in a time-dependent manner. CONCLUSIONS The lightness of the HSL color space can be used to objectively and quantitatively evaluate the dPG of hiPSC-RPE in culture. The objective evaluation was consistent and was able to better identify small differences than subjective evaluation.

Quantitative evaluation trial for functions included in currently available electronic clinical pathways products

Summary No quantitative method is available to evaluate the functions of electronic clinical pathways embedded in electronic medical records. Therefore, we developed new evaluation sheets. The standard functions of electronic clinical pathways published in 2007 were modified to facilitate their quantification, and functions requested at Kawasaki Medical School Hospital were added when electronic medical records were introduced. Electronic clinical pathways products by four vendors were evaluated quantitatively and each function was given a weight according to its importance. Moreover, we compared this quantitative evaluation with the subjective evaluation of four staff from the Committee of Clinical Pathways. The results indicated that the implementation of many functions differed among the four vendors, and the quantitative evaluations were comparable. The weights of each function may differ among hospitals due to differences in their medical background, and further studies regarding weighting are necessary. It can be concluded that the method described in this study will be useful for quantitative evaluation of electronic clinical pathways functions.

Management System of Paper-Based Critical Pathways Developed in Each Hospital: Comparison between Medical School Hospital and General Hospital

Management system of paper-based critical pathways which had developed in a general hospital has been modified and introduced to a medical school hospital, and the differences of specifications are discussed.