Tadamasa Takemura

A Data Capture System for Outcomes Studies that Integrates with Electronic Health Records: Development and Potential Uses

In conventional clinical studies, the costs of data management for quality control tend to be high and collecting paper-based case report forms (CRFs) tends to be burdensome, because paper-based CRFs must be developed and filled out for each clinical study protocol. Use of electronic health records for this purpose could result in reductions in cost and improvements in data quality in clinical studies. The purpose of this study was to develop a data capture system for observational cancer clinical studies (i.e. outcomes studies) that would integrate with an electronic health records system, to enable evaluation of patient prognosis, prognostic factors, outcomes and drug safety. At the Outpatient Oncology Unit of Kyoto University Hospital, we developed a data capture system that includes a cancer clinical database system and a data warehouse for outcomes studies. We expect that our new system will reduce the costs of data management and analysis and improve the quality of data in clinical studies.

Embedded Ubiquitous Services on Hospital Information Systems

Hospital information systems (HIS) have turned a hospital into a gigantic computer with huge computational power, huge storage, and wired/wireless local area network. On the other hand, a modern medical device, such as echograph, is a computer system with several functional units connected by an internal network named a bus. Therefore, we can embed such a medical device into the HIS by simply replacing the bus with the local area network. This paper designed and developed two embedded systems, a ubiquitous echograph system, and a networked digital camera. Evaluations of the developed systems clearly show that the proposed approach, embedding existing clinical systems into HIS, drastically changes productivity in the clinical field. Once a clinical system becomes a pluggable unit for a gigantic computer system, HIS, the combination of multiple embedded systems with application software designed under deep consideration about clinical processes may lead to the emergence of disruptive innovation in the clinical field.

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.

A New Accounting System for Financial Balance Based on Personnel Cost After the Introduction of a DPC/DRG System

A hospital director must estimate the revenues and expenses not only in a hospital but also in each clinical division to determine the proper management strategy. A new prospective payment system based on the Diagnosis Procedure Combination (DPC/PPS) introduced in 2003 has made the attribution of revenues and expenses for each clinical department very complicated because of the intricate involvement between the overall or blanket component and a fee-for service (FFS). Few reports have so far presented a programmatic method for the calculation of medical costs and financial balance. A simple method has been devised, based on personnel cost, for calculating medical costs and financial balance. Using this method, one individual was able to complete the calculations for a hospital which contains 535 beds and 16 clinics, without using the central hospital computer system.

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.

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.

An extraction of medical knowledge on text mining for ubiquitous medicine

Just now, ubiquitous computing that means anyone, anyplace, and anytime we are able to use computer and those technologies exist unconsciously, is beginning. The important point concerning ubiquitous computing is interface between human and information. So, we would like to focus attention on natural language that is kind of human interface in medicine because natural language is an essential tool for healthcare professionals and patients to communicate. If natural language processing is realized, it is easy that various information is recorded anytime and anywhere and anyone with mobile, in addition, we can use data of text, speech and so on, and we are able to acquire medical knowledge from it. We have tried to extract medical knowledge with methods of text mining. To put it concretely, we have developed a new tool and medical dictionary called co-occurrence relation illustration system with medical terminology including basic property to every word. This system is able to show one of the expression and meaning of medical language. Consequently, natural language data as convenience media for input information but inconvenient media for output information to computing are useful actually and we can use computer system for medicine as talking with it ubiquitously.

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.