© copyright ibm corporation 2005 digitalization of medical record in japan naoki nakashima, md, phd...

© Copyright IBM Corporation 2005

Digitalization of Medical Record in Japan

Naoki Nakashima, MD, PhDDepartment of Medical InformaticsKyushu University Hospital, JAPAN


Digitalization of Medical Information in JAPAN

• There are 9,000 hospitals and 90,000 clinics in Japan.• Japanese government has strongly promoted

digitalization of medical record from 2001.• Digitalization rate (installation ratio of electronic

medical record system=EMR) still remained only at the 20% level in 2005 in spite of the government’s effort.

• The government decided to use 100% online reimbursement system for medical fee between medical institutes and insurers by 2011.


Problems of Electronic Medical Record System in Japan

• Inefficient Standardization and Interoperability of Medical Information in Japan

• Insufficient Service of Public Infrastructure (PKI, medical VPN, etc)

• Too Many Variation of Medical Work Flow

• Recent Attention of Safety Management and Patient Privacy

• Too Much Cost for EMR Installation


System Configuration of Hospital Information

System in Kyushu University (Venus 3) (Since 2007)

SAN (Storage Area Network) IBMIBM

HIS_NetworkHIS_Network

Order-entry system ／Electronic Medical Record

i5/OS6way / 30GB

Reimbursement system

i5/OS1way / 6GB

Radiologyi5/OS

1way / 2GB

Back upAIX5L

4way / 8GB

DS8100*Order-entry ／ Electronic Medical Record … 3TB*Receipt data … 700GB*Radiology sector

Tape library for back up[3584-L52]*6-drive

SAN-Switch [2005-B32]

Interconnect_SG

Management_SGExternal_SG (Intranet)

i5 570 (2.2GHz) x2 CPU: 8way Memory: 38GB

p5 55A

Branch system Ｇ／

Ｗ

Branch system servers

Branch system and Branch Ｇ／Ｗ

Security system

Information Reference Sector

Referential Medical Record

Referential Data Ware

House

DS4800*Referential ＤＢ … 1.5TB*Report reference… 1TB*images （ old ）… 1TB*Data ware house ･･･1TB

Network management system

Document creation support system server ﾞWin2003


Order-entry systemIntegration of medical and dental

Electronic medical record

Nursing supportsystem

Critical pathway

Sector B

Payment system

Physical distribution system

Medical information transition system

information disclosure system

Other medical institutes

Patients

Data ware house

Hospital business management

Safety Management

For patient’s satisfaction

Reports to Health, Labour and Welfare Ministry

Conceptual Figure of Venus 3 (Kyushu U Hosp system)

Support of clinical researches

PACS(Filmless System)

70TB

Sector C

Sector D

Sector X

Sector A

bi-direction


Scales of the Entire System

• Economical;– Lease Contract of Venus 3 with IBM for 5years

• Application and hard (Venus 3, IBM) = 22 million US$/5ys

– Network (IBM) = 4 million US$

– Filmless system (Fujifilm medical) = 5 million US$

• Physical;– Servers = 21

– Clients =2000 (including clients of filmless system)

* There are many other branch sector systems

(drug, blood examination, physical examination, endoscope, rehabilitation, feeding service, etc)


To keep patient medical record properly

• Confidentiality

• Integrity

• availability


To assure confidentiality in KU hospital

• Formulated operating rules, privacy policy and clarification of administrators

• Installation of registration authority office (thorough going registration, revision and deletion)

• Authentication by finger print• Interruption from Internet• Restriction to place client PCs only in the premise of

the hospital • Remove all media ports from client PCs• Automatic log off and screen saver


To assure integrity in KU hospital

• Time stamps

• Automatic monitoring of the discs

• Anti-virus software

• Prevention of falsification (but not by PKI)

• Multiple-back up

• Network redundancy


To assure availability in KU hospital

• Location management of information storage

• Reference function of all items on EMR

• Switching function to back up server

• Web EMR (only reference) at the time of maintenance or system down

• Secure server rooms in earthquake resistant building


Future issues in Kyushu University Hospitaland probably in entire Japan

• Adoption of Healthcare-PKI

• Adoption of standardized master/code and protocols (HL7, DICOM, and IHE) of medical information

• Enlightenment of concept of sharing electronic medical data in the local area


Pay attention to present and future medical information system!

Thank you, and

Enjoy your stay in Hawaii !!

© copyright ibm corporation 2005 digitalization of medical record in japan naoki nakashima, md, phd...

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