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In our hospital, we managed an electronic health record system and many section subsystems as a hospital information system. By the expansion of these information systems, a system becomes complicated, and maintenance and operative cost increased. Furthermore, the environment that is available to medical information is demanded anywhere anytime by expansion of the computerization. However, the expansion of the information use becomes necessary for the expansion such as the personal protection of information for security. We became rebuilding and the private cloud of the hospital information system by the virtualization technology to solve such a problem. As a result, we were able to perform a decrease in number of the servers which constituted a system, a decrease in network traffic, reduction of the operative cost.

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.

The Fukuoka Prefectural Medical Health Care Network for Seriously Intractable Neurological Diseases was initiated in 1998 to improve the care of patients for seriously intractable neurological diseases. The network, now, consists of 15 basic cooperative hospitals, and 105 general cooperative hospitals. Two medical care coordinators manage the transfer of network patients based on information of the patient's condition and the capacity of cooperative hospitals using information about the number of available beds in cooperative hospitals. A total number of patients with seriously intractable neurological diseases who were referred to the network for the last eight years was 277, 163 of whom were amyotrophic lateral sclerosis (ALS) patients and of which 75 of them were under mechanical ventilation. Of these 277 patients, 253 were successfully transferred to chronic care hospitals or referred to regional visiting physicians through the network. Cooperative and non-cooperative hospitals accepted 157 and 49 patients, respectively, while 38 were referred to visiting physicians. A number of medical care consultations has increased year by year, and reached 17,652 in the eighth year. The main issues for these consultations were to make hospital arrangements for a patient. Comprehensive long-term care is necessary for Japanese ALS patients because one-third is under mechanical ventilation. Despite this, it is still difficult to secure available beds for such patients who require long-term care. In the future, it will be necessary to improve the support for an environment for home care and to make the system in which cooperative hospitals support patients during the home care.

To enhance medical cooperation between the hospitals and clinics around Osaka local area, the healthcare network system, named Osaka Community Healthcare Information System (OCHIS), was established with support of a supplementary budget from the Japanese government in fiscal year 2002. Although the system has been based on healthcare public key infrastructure (PKI), there remain security issues to be solved technically and operationally. An experimental study was conducted to elucidate the central and the local function in terms of a registration authority and a time stamp authority in contract with the Japanese Medical Information Systems Organization (MEDIS) in 2003. This paper describes the experimental design and the results of the study concerning message security.

We used virtual reality technology to improve the quality of life and amenity of in-patients in a children's hospital. Children in the hospital could enjoy a zoo, amusement park, and aquarium, in virtual. They played soccer, skiing and horse riding in virtual. They could communicate with persons who were out of the hospital and attend the school which they had gone to before entering hospital. They played music with children who had been admitted to other children's hospitals. By using this virtual technology, the quality of life of children who suffered from psychological and physiological stress in the hospital greatly improved. It is not only useful for their QOL but also for the healing of illness. However, these methods are very rare. Our systemic in our children's hospital is the first to be reported in Japan both software and hardware of virtual reality technology to increase the QOL of sick children need further development.

The University Medical Information Network (UMIN), established in 1989, is a network service organization for national university hospitals in Japan. It has provided various medical information services to medical professionals, including database, electronic mail, and news services. Although its initial network was constructed as a closed network using N1 protocol, it now adopts TCP/IP protocol and is open to other medical professionals via the Internet. The next UMIN network system is planned to be constructed as a secure virtual closed network on the Internet, using cipher technology, and to provide secure information services to national university hospitals via the closed network, and to other medical professional via the Internet. User friendly interface and flexible system development were made possible by adopting TCP/IP, and the number of users dramatically increased accordingly. However, the database, software design, and human organizations developed in the N1 era have now proven to be of great value, and contribute to todayís flourishing state of the UMIN.

The National Cancer Center, Japan, has two hospitals at present, and these two hospitals are in the process of sharing their respective split clinical functions. On the other hand, patients may visit one or both hospitals, in many cases depending on their need and convenience, for which both hospitals should maintain the same clinical level to comply with the needs of the patients by a common access to the individual medical data and information. Therefore, the possibility of transmitting such medical information between the two hospitals using the IS & C system has been studied, and such a system has almost been completed for the transmission of endoscopic images. No problems exist in terms of interchangeability; however, it is necessary to integrate it with the hospital information system to avoid a complicated keyboard process before practical endoscopic examination.

Image Save And Carry (IS&C) was planned to be an off-line information system for transmission and exchange of medical images and information between a medical facility's different divisions as well as between other hospitals. The IS&C committee defines file format for magneto-optical disk, the data format and representation, media compatibility and data security and technological assessment. A 'zone management method' which contributes to a rapid access of data in the recording media is used for IS&C file management. The IS&C standard holds as much conformation as possible in order to coordinate with ACR-NEMA (American College of Radiology-National Electrical Manufacturers' Association) and MIPS (Medical Information Processing Systems) standards. The IS&C data format is based upon the ACR-NEMA/MIPS standard. A major difference between the ACR-NEMA/MIPS standard and IS&C standard is that the IS&C standard is expected to serve for recording all kinds of medical information (e.g., diagnostic reports, endoscopic images and electrocardiograms), including X-ray images. Applications to PACS, teaching files, personal electronic health and medical records are promising. The booklet of IS&C standard will be published in the spring of 1992 by the IS&C committee.