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Electronic Health Records (EHRs) are at the heart of reforms aimed at improving the efficiency and quality of healthcare services provided to citizens. Although there is still some skepticism, open source (OS) EHR is a growing phenomenon in health informatics. Given the widespread adoption of OS software (OSS) in several domains, including operating systems, and enterprise systems, the repeated shortfalls faced by healthcare organizations with dominant proprietary EHRs create an opportunity for other alternatives, such as OSS to demonstrate their abilities in addressing these well-documented problems, including inflexibility, high costs, and low interoperability. However, scholars have expressed extensive concerns about the sustainability of OS EHR. Recognizing that OSS project sustainability relies on their governance arrangements, this case study reports on the evolution of the governance and sustainability of a Japanese OS EHR project and provides rich insights to other open source EHR initiative stakeholders, including physicians, developers, researchers, and policy-makers.

Background: There are limited data on the prevalence and burden of severe eosinophilic asthma (SEA) both in Japan and globally. This study aimed to assess the prevalence and burden of SEA i...

Electronic Health Records (EHRs) are at the heart of reforms aiming for improving the efficiency and quality of citizens healthcare services. Although there is still some skepticism, open source (OS) EHR is a growing phenomenon in health informatics. Given the widespread adoption of OS software (OSS) in several domains, including operating systems, and enterprise systems, the repeated shortfalls faced by healthcare organizations with dominant proprietary EHRs create an opportunity for other alternatives, such as OSS to demonstrate their abilities in addressing these well-documented problems, including inflexibility, high costs, and low interoperability. However, scholars have expressed extensive concerns about the sustainability of OS EHR. Recognizing that OSS project sustainability relies on their governance arrangements, this case study reports on the evolution of the governance and sustainability of a Japanese OS EHR project and provides rich insights to other open source EHR initiative stakeholders, including physicians, developers, researchers, and policymakers.

Medication processes are consisted with multiple steps by professionals and consumers. Physicians prescribe drugs to patient with conformance, but sometimes they were changed to other drugs. We designed concept models to capture medication workflow process records by openEHR archetype models, and four templates were determined with each step of the medication process. We will show the detail of clinical modeling about medication workflow in this article.

Medical Markup Language (MML) is a standard format for exchange of healthcare data among healthcare providers. Following the last major update (version 3), we developed new modules and discussed the requirements for the next major updates. Subsequently, in 2016 we released MML version 4 and used it to obtain clinical data from healthcare providers for a nationwide electronic health records (EHR) system. In this article we provide an overview of this major update of MML version 4 and discuss its interoperability for clinical data.

Shared clinical information is an important contribution to regional medicine. Clinical information sharing with patients is also recommended to motivate patients and promote health. On the other hand, the threat of information leaks, caused by internet connected records, is critical to hospitals. The traditional approach is complete isolation of hospital networks, instead of information sharing. The authors propose methods here to maximize information sharing by following hospital preferences for electronic health records.

Many isolated EHRs in Japan hinders the availability of patients' clinical data who need treatment in a region outside the scope of their local EHR. We propose a timelier approach that increases availability of patient clinical data to unknown doctors and has the patient and their representative involved; they can grant access to doctors who are anonymous to the patients' local EHR domain.

openEHR is a widely used EHR specification. Given its technology-independent nature, different approaches for implementing openEHR data repositories exist. Public openEHR datasets are needed to conduct benchmark analyses over different implementations. To address their current unavailability, we propose a method for generating openEHR test datasets that can be publicly shared and used.

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 patient's 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.

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.

Many VR technology based training systems use expert's motion data as the training aid, but would not provide any short-cut to teaching medical skills that do not depend on exact motions. Earlier we presented Annotated Simulation Records (ASRs), which can be used to encapsulate experts' insight on psychomotor skills. Annotations made to behavioural parameters in training simulators enable asynchronous teaching instead of just motion training in a proactive way to the learner. We evaluated ASRs for asynchronous teaching of Digital Rectal Examination (DRE) with 3 urologists and 8 medical students. The ASRs were found more effective than motion-based training with verbal feedback.

Recently, simulation platform and libraries are provided from several research groups. However, development of VR-based surgical simulator takes much effort not only for implementing simulation modules but also for setting surgical environment and choosing simulation modules. Surgical manual describes knowledge of manipulations in surgical procedure. In this study, language processing is used to extract anatomical objects and surgical manipulations in a scene from surgical manual. In addition, benchmark and LOD control of simulation modules optimize the simulation. We propose a framework of semi-automatic development of optimized simulator with surgical manuals. In the framework, SVM based machine learning is adapted in extracting surgical information and XML file was made. Simulation programs were created from XML file using a simulation library in different system configurations.

This study aims to provide physics-based force feedback system on distributed system for simulating invasive operation such as ablation. conventional PC-based VR surgical simulators with haptic interaction are hard to provide sufficient computational resources for the simulation of physics-based soft tissue fracture. For proper presentation of force feedback as real operations, physics-based simulation is inevitable. At the same time finite element method requires huge computational complexites. In this paper, the authors propose server-side speculative operation method on application layer for hiding the calculation latencies. The proposed method would achieve the response acceleration without the decomposition of conventional simulation process. The theoritical estimates of speculation parameters are mentioned.