Education Tics

1: BMC Public Health. 2008 Apr 27;8:139.
What they fill in today, may not be useful tomorrow: lessons learned
from studying Medical Records at the Women hospital in Tabriz,
Iran.
Pourasghar F, Malekafzali H, Kazemi A, Ellenius J, Fors U.
Department of Learning, Informatics, Management and Ethics, Karolinska

Institute, Stockholm, Sweden. Faramarz.pourasghar@ki.se
BACKGROUND: The medical record is used to document patient's medical

history, illnesses and treatment procedures. The information inside is useful when
all needed information is documented properly. Medical care providers in Iran
have complained of low quality of Medical Records. This study was designed to
evaluate the quality of the Medical Records at the university hospital in Tabriz,
Iran. METHODS: In order to get a background of the quality of documentation,
300 Medical Records were randomly selected among all hospitalized patient
during September 23, 2003 and September 22, 2004. Documentation of all
records was evaluated using checklists. Then, in order to combine objective data
with subjective, 10 physicians and 10 nurses who were involved in documentation
of Medical Records were randomly selected and interviewed using two semi
structured guidelines. RESULTS: Almost all 300 Medical Records had problems
in terms of quality of documentation. There was no record in which all
information was documented correctly and compatible with the official format in
Medical Records provided by Ministry of Health and Medical Education.
Interviewees believed that poor handwriting, missing of sheets and imperfect
documentation are major problems of the Paper-based Medical Records, and the
main reason was believed to be high workload of both physicians and nurses.
CONCLUSION: The Medical Records are expected to be complete and accurate.
Our study has unveiled that the Medical Records are not documented properly in
the university hospital where the Medical Records are also used for educational
purposes. Such incomplete Medical Records are not reliable resources for medical
care too. Some influencing factors external to the structure of the Medical
Records (i.e. human factors and work conditions) are involved.
Publication Types:
• Research Support, Non-U.S. Gov't
PMID: 18439311 [PubMed - indexed for MEDLINE]

PMCID: PMC2377263
2: BMC Med Educ. 2008 Apr 22;8:24.
Requirements for effective academic leadership in Iran: a nominal

group technique exercise.
Bikmoradi A, Brommels M, Shoghli A, Sohrabi Z, Masiello I.
Medical Management Centre, Department of Learning, Informatics, Management

and Ethics, Karolinska Institutet, 171 77 Stockholm, Sweden.
ali.bikmoradi@ki.se
BACKGROUND: During the last two decades, medical education in Iran has
shifted from elite to mass education, with a considerable increase in number of
schools, faculties, and programs. Because of this transformation, it is a good case
now to explore academic leadership in a non-western country. The objective of
this study was to explore the views on effective academic leadership requirements
held by key informants in Iran's medical education system. METHODS: A
nominal group study was conducted by strategic sampling in which participants
were requested to discuss and report on requirements for academic leadership,
suggestions and barriers. Written notes from the discussions were transcribed and
subjected to content analysis. RESULTS: Six themes of effective academic
leadership emerged: 1)shared vision, goal, and strategy, 2) teaching and research
leadership, 3) fair and efficient management, 4) mutual trust and respect, 5)
development and recognition, and 6) transformational leadership. Current Iranian
academic leadership suffers from lack of meritocracy, conservative leaders,
politicization, bureaucracy, and belief in misconceptions. CONCLUSION: The
structure of the Iranian medical university system is not supportive of effective
academic leadership. However, participants' views on effective academic
leadership are in line with what is also found in the western literature, that is, if
the managers could create the premises for a supportive and transformational
leadership, they could generate mutual trust and respect in academia and increase
scientific production.
PMCID: PMC2374778
3: Stud Health Technol Inform. 2008;132:411-6.
,
Asynchronous teaching of psychomotor skills through VR
annotations: evaluation in digital rectal examination.
Rissanen MJ, Kume N, Kuroda Y, Kuroda T, Yoshimura K, Yoshihara H.
Dept. of Social Informatics, Grad. School of Informatics, Kyoto University,

Japan.
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.
Publication Types:

4: Med Teach. 2007 Sep;29(7):706-10.
Medical curriculum reform in Sun Yat-sen University: implications

from the results of GMER evaluation in China.
Xiao H, Xian L, Yu X, Wang J.
Sun Yat-sen Medical School, Sun Yat-sen University, Guangzhou, P.R. China.
Created by interlocking economies, a global language, the informatics revolution

and rapid travel, globalization has penetrated all aspects of human life including
science, environment, public health and medicine. Physicians are now members
of a global community. The global physician should possess universal core
essential competences required for medical practice throughout the world. The
Institute for International Medical Education (IIME), created by the China
Medical Board (CMB) of New York, has developed the " global minimal essential
requirements" (GMER) that define the knowledge, skills, professional behavior
and ethics that all physicians must have regardless of where they received their
general medical education and training. The IIME initiated a pilot project in China
in October, 2003, to evaluate the graduates of the 7- or 8-year track program of
eight leading medical schools, including Medical School of Sun Yat-sen
University. The results of GMER evaluation indicated strengths and areas for
improvement of our school in relation to international standards, which greatly re-
invigorate our enthusiasm on medical curriculum reform on the new 8-year track
program in Medical School of Sun Yat-sen University. The modifications of our
medical curriculum for the new 8-year track program based on the results of
GMER evaluation are discussed in this paper.

5: BMC Med Educ. 2008 Jan 20;8:5.
Perceptions of graduating students from eight medical schools in

Vietnam on acquisition of key skills identified by teachers.
Hoat LN, Son NM, Wright EP.
Biostatistics and Medical Informatics Department, Faculty of Public Health,

Hanoi Medical University, Dong Da, Hanoi, Vietnam. luungochoat@hn.vnn.vn
BACKGROUND: The eight main Vietnamese medical schools recently

cooperated to produce a book listing the knowledge, attitudes and skills expected
of a graduate, including specification of the required level for each skill. The
teaching program should ensure that students can reach that level. The objective
of this study was to determine the perception of graduating students on whether
they had achieved the level set for a selection of clinical and public health skills
as a guide for the schools to adjust either the levels or the teaching. METHODS:
From all eight schools, 1136 of the 1528 final year students completed
questionnaires just before completed all the requirements for graduation, a
response rate of 87% overall (ranging from 74-99% per school). They rated their
own competence on a scale of 0-5 for 129 skills selected from the 557 skills listed
in the book, and reported where they thought they had learned them. The scores
that the students gave themselves were then compared to the levels proposed by
the teachers for each skill. The proportions of the self-assessed achievement to the
levels expected by the teachers, means self-assessed scores and the coefficients of
variation were calculated to make comparisons among disciplines, among schools
and among learning sites. RESULTS: Most students felt they had learned most of
the skills for key clinical departments to the required level; this varied little
among the schools. Self-assessed skill acquisition in public health and minor
clinical disciplines was lower and varied more. Sites outside the classroom were
especially important for learning skills. The results revealed key similarities and
differences between the teachers and the students in their perception about what
could be learned and where CONCLUSION: Revising a curriculum for medical
schools demands inputs from all stakeholders. Graduating class students can
provide valuable feedback on what they have learned in the existing system.
Learning objectives should always be checked with students who have followed
their study under existing teaching conditions. The information from the
graduates helped to identify potential problem areas where either the objectives or
the teaching need adjustment.
Publication Types:
PMCID: PMC2248186
6: HIM J. 2007;36(1):13-22.
Determining the most important evaluation indicators of health care

information systems (HCIS) in Iran.
Shahmoradi L, Ahmadi M, Haghani H.
School of Management and Medical Information Sciences, Iran University of

Medical Sciences, Tehran, Iran. L2000shahmoradi@yahoo.com
Accurate evaluation of healthcare information systems (HCIS) relies upon the

choice of appropriate indicators. Iranian healthcare and health industry
professionals were surveyed, by means of a descriptive cross sectional study, in
order to identify the indicators they considered most relevant to the evaluation of
healthcare information systems currently in use in Iran. It was concluded that
effective evaluation of HCIS should encompass a variety of perspectives and
methodologies (including qualitative methodologies), focus upon technical,
economic and organisational concerns, and involve diversely constituted research
teams.

7: J Ayub Med Coll Abbottabad. 2007 Apr-Jun;19(2):70-1.
,
Training in reference management software--a part of new medical
informatics workshops in Pakistan.
Hashim MJ, Rahim MF, Alam AY.
Section of Medicine, Department of Community Medicine, Shifa College of

Medicine, Islamabad, Pakistan. jawad.has@gmail.com
BACKGROUND: Researchers in Pakistan can increase writing productivity,

reduce errors in manuscripts and improve quality of their papers by hands-on
workshops on bibliographic reference software. METHODS: A workshop was
conducted in an interactive tutorial format using an overhead projector to show
screenshots of software at each step. Our Workshop included: starting the Endnote
program (www.endnote.com); manually entering a reference of a journal article;
searching and importing references from PubMed; inserting a reference in
Microsoft Word document in a journal-specific format; essentials of journal
article formatting; and the ethics of respecting other peoples of intellectual effort
by proper citations and avoiding plagiarism. RESULTS: A post-workshop test was
administered to assess whether instructional objectives were attained. All the
participants passed the post-workshop multiple choice questions and 85% rated
the workshop as good, very good or excellent. CONCLUSION: A workshop on
reference formatting in research writing is useful to promote high quality research
work. We recommend holding workshops twice a year on research article
formatting and reference software at medical colleges in Pakistan and other
developing countries.

8: Int J Clin Oncol. 2007 Dec;12(6):440-7. Epub 2007 Dec 21.
A study of cancer information for cancer patients on the internet.
Morita T, Narimatsu H, Matsumura T, Kodama Y, Hori A, Kishi Y, Kusumi

E, Hamaki T, Kobayashi K, Yuji K, Tanaka Y, Nakata Y, Kami M.
Division of Exploratory Research, the Institute of Medical Science, the University

of Tokyo, Tokyo, Japan.
BACKGROUND: There have been few studies of the information provided for
cancer patients on the internet. METHODS: Using the Japanese language, we
searched for cancer-related web pages, using the Google search engine, and
evaluated the characteristics of the 150 top-ranked search results. We collected
information on the operators of the websites, number of links, existence of a
search function, and advertisements on the site. According to their contents, the
150 websites were classified into seven categories, of which five (numbers 1, 2, 3,
4, and 6) each accounted for 20% of the websites. The categories were: (1) media-
related websites (e.g., newspapers and publishers), and portal sites; (2) patient
association websites, patient's diaries, blogs by patients and/or their families (n =
33); (3) websites of medical institutions (e.g., hospitals; n = 27); (4) websites of
research institutions (e.g., universities; n = 35); (5) websites of pharmaceutical
companies; (6) other websites providing medical information (n = 32); and (7)
other websites that did not belong to categories 1-6. Outgoing links were common
in websites created by media-related organizations (median, 13) or patients and
their families (median, 15), but such links were not common in the other types of
websites (median, 0-4). Eight of the 13 cancer based hospitals in Japan, as well as
the National Cancer Center were publishing general cancer information on their
websites. Of the 13 cancer based hospitals, 12 included a link to the National
Cancer Center. The National Cancer Center had the largest amount of information
(736 575 words), exceeding the amount provided by the other cancer based
hospitals (1 622-155 515 words). Two of the 7 websites of academic associations
(included in category 6) had cancer information for patients, but the document
sizes were small (3230-44 091 words). CONCLUSION: The website of the
National Cancer Center is the most prominent source of general cancer
information for patients, but it still has room for improvement in its usability.
Publication Types:

9: BMC Public Health. 2007 Oct 18;7(147):294.
Consistency between education reported in health survey and

recorded in death certificate.
Khang YH, Kim HR, Lynch JW.
Department of Preventive Medicine, University of Ulsan College of Medicine,

Seoul, Korea. youngk@amc.seoul.kr
BACKGROUND: Education level is one indicator of socioeconomic position

which, in several countries including South Korea, is provided though death
certificate data. Its validity determines the usefulness of death certificate data for
exploring the association between socioeconomic position and mortality. This
study was to compare education recorded on the death certificate with that
reported before death in a nationally representative cohort of participants in the
National Health and Nutrition Examination Survey (NHANES). METHODS: The
1998/2001 NHANES data contained unique 13-digit personal identification
numbers that were individually linked to death certificate data from the Korean
National Statistical Office. Duration of mortality follow-up was 7.1 years. The
data from 513 deaths were used to determine sensitivity and specificity of
education in death certificate and estimate agreement rates of education level
between NHANES data and death certificate data. Odds ratios for agreement in
education were also estimated. Covariates considered in the analyses were gender,
age, duration between NHANES and death, and cause of death. RESULTS: The
proportion of deaths without recorded education in death certificate was very low
(0.2%). A total of 29.4% discordant pairs were found. Sensitivity and specificity
for college or higher education were 0.84 (95% confidence interval 0.71-0.97) and
0.99 (0.98-1.00). However, sensitivity was poor for middle school education. The
overall agreement rate was 70.7% (66.8%-74.6%) when education was
categorized into five groups and increased up to 88.9% (86.2%-91.6%) when
three education categories were used. The magnitude of validity and reliability for
education did not generally vary with age, duration between health survey and
death, and cause of death. However, a significantly smaller likelihood of
agreement was found for middle and elementary school education after adjusting
for covariates. CONCLUSION: Low percentage of missing information on
education in South Korean death certificate data could provide a great potential to
monitor mortality inequalities. A more collapsed categorization in education
would be recommended when a more definitive conclusion on educational
mortality inequality is required.
Publication Types:
• Validation Studies
PMCID: PMC2175513
10: Stud Health Technol Inform. 2007;129(Pt 2):1442-6.
Conceptual model of health information ethics as a basis for

computer-based instructions for electronic patient record systems.
Okada M, Yamamoto K, Watanabe K.

Department of Health Informatics, Kawasaki University of Medical Welfare,
Japan.
A computer-based learning system called Electronic Patient Record (EPR)

Laboratory has been developed for students to acquire knowledge and practical
skills of EPR systems. The Laboratory is basically for self-learning. Among the
subjects dealt with in the system is health information ethics. We consider this to
be of the utmost importance for personnel involved in patient information
handling. The variety of material on the subject has led to a problem in dealing
with it in a methodical manner. In this paper, we present a conceptual model of
health information ethics developed using UML to represent the semantics and the
knowledge of the domain. Based on the model, we could represent the scope of
health information ethics, give structure to the learning materials, and build a
control mechanism for a test, fail and review cycle. We consider that the approach
is applicable to other domains.

A Japanese model of disease management.
Nakashima N, Kobayashi K, Inoguchi T, Nishida D, Tanaka N, Nakazono H,

Hoshino A, Soejima H, Takayanagi R, Nawata H.
Department of Medical Informatics, Kyushu University Hospital, Japan.

nnaoki@info.med.kyushu-u.ac.jp
We started a disease management model, Carna, that includes two programs: one
for primary prevention of lifestyle diseases and one for secondary/tertiary
prevention of diabetes mellitus. These programs support the family doctor system
and education for participants to allow the concept of disease management to take
root in Japan. We developed a critical pathway system that can optimize health
care of individual participants by matching individual status. This is the core
technology of the project. Under the primary prevention program, we can perform
the health check-up/ instruction tasks in the 'Tokutei Kenshin', which will start for
all Japanese citizens aged 40-74 years in April 2008. In the diabetic program,
Carna matches doctors and new patients, prevents patient dropout, supports
detection of early-stage complications by distributing questionnaires periodically,
and facilitates medical specialists' cooperation with family doctors. Carna
promotes periodic medical examinations and quickly provides the result of blood
tests to patients. We are conducting a study to assess the medical outcomes and
business model. The study will continue until the end of 2007.
Publication Types:

12: Comput Inform Nurs. 2007 Sep-Oct;25(5):301-6.
Strategy development for the implementation of telenursing in

Korea.
Yun EK, Park HA.
College of Nursing, Seoul National University, Seoul, Korea.
This study aimed to evaluate the feasibility of telenursing, to analyze the issues
that should be considered for the development of telenursing in the future, and to
provide efficient strategies for the implementation of telenursing in Korea. The
authors used the Delphi survey method and a strengths, weaknesses,
opportunities, and threats analysis. A total of 30 experts and specialists in the field
of nursing informatics and telemedicine contributed to a three-round Delphi
survey. The results of the study suggest that telenursing can potentially be
implemented in Korea. However, to implement telenursing in Korea, it is
necessary to identify telenursing specialties, to construct an infrastructure within
which telenursing can function, to develop a business model, and to integrate
strategies with government plans to develop the e-health industry. The issues that
emerged as important requirements for the successful introduction of telenursing
were classified as systematic, economic, societal, or technical. Issues such as
driving force, target market, and expense sharing were examined in detail from
both ideal and realistic points of view. The results of this study will enable health
professionals to appreciate the feasibility of implementing telenursing in Korea.
In addition, the study suggests that telenursing could be used efficiently in a
variety of environments as a practical strategy to improve healthcare in Korea.
Publication Types:
• Evaluation Studies

,
Nurses' experiences using a nursing information system: early stage

of technology implementation.
Lee TT.
National Taipei College of Nursing, Taipei, Taiwan. tingting@ntcn.edu.tw
Adoption of information technology in nursing practice has become a trend in

healthcare. The impact of this technology on users has been widely studied, but
little attention has been given to its influence at the beginning stage of
implementation. Knowing the barriers to adopting technology could shorten this
transition stage and minimize its negative influences. The purpose of this study
was to explore nurses' experiences in the early stage of implementing a nursing
information system. Focus groups were used to collect data at a medical center in
Taiwan. The results showed that nurses had problems with the system's content
design, had insufficient training, were concerned about data security, were
stressed by added work, and experienced poor interdisciplinary cooperation. To
smooth this beginning stage, the author recommends involving nurses early in the
system design, providing sufficient training in keyboard entry skills, redesigning
workflow, and improving interdisciplinary communication.
Publication Types:

14: Nurse Educ Today. 2008 May;28(4):458-68. Epub 2007 Sep 10.
A curricular approach to improve the information literacy and

academic writing skills of part-time post-registration nursing
students in Hong Kong.
Tarrant M, Dodgson JE, Law BV.
Department of Nursing Studies, The University of Hong Kong, 4/F, William M.W.
Mong Block, Li Ka Shing Faculty of Medicine, 21 Sassoon Road, Hong Kong.
tarrantm@hku.hk
In today's environment of rapidly changing health care and information
technology, nurses require a broad range of skills. One of the key skills required
of all health professionals in this environment is information literacy. For
registered nurses returning to a university setting to study for their baccalaureate
degree, becoming information literate is one of many challenges they face. Also
key to students' ability to use and communicate information in an appropriate and
effective manner is their writing skills. This article describes a curricular
intervention designed to develop and strengthen post-registration nurses'
information literacy and academic writing competencies. An introductory
information management module was developed and provided to three successive
cohorts of students (n=159). Students were predominantly female (85.4%) with a
mean age of 34.2 years (SD=6.8). Prior to commencing the program, students
reported low information literacy and writing skills, especially in accessing and
searching electronic databases and using referencing formats. The post-test
evaluation of skills showed substantial and statistically significant increases in all
assessed competencies. This intervention demonstrated that with structured but
flexible learning activities early in the curriculum, post-registration nursing
students can quickly become information literate.
Publication Types:

15: J Prev Med Pub Health. 2007 Jul;40(4):259-64.
[Introduction and evaluation of communicable disease surveillance

in the republic of Korea]
[Article in Korean]
Park O, Choi BY.
Center for Disease Control, Korea Centers for Disease Control and Prevention,
Department of Preventive Medicine, Hanyang University College of Medicine,
Korea.
Effective communicable disease surveillance systems are the basis of the national
disease prevention and control. Following the increase in emerging and re-
emerging infectious diseases since late 1990 s, the Korean government has strive
to enhance surveillance and response system. Since 2000, sentinel surveillance,
such as influenza sentinel surveillance, pediatric sentinel surveillance, school-
based sentinel surveillance and ophthalmological sentinel surveillance, was
introduced to improve the surveillance activities. Electronic reporting system was
developed in 2000, enabling the establishment of national database of reported
cases. Disweb, a portal for sharing communicable disease information with the
public and health care workers, was developed. In general, the survey results on
usefulness and attributes of the system, such as simplicity, flexibility,
acceptability, sensitivity, timeliness, and representativeness, received relatively
high recognition. Compared to the number of paid cases of national health
insurance, reported cases by national notifiable disease surveillance system, and
various sentinel surveillance system, the result of the correlation analysis was
high. According to the research project conducted by KCDC, the reporting rate of
physicians in 2004 has also greatly improved, compared with that in 1990 s.
However, continuous efforts are needed to further improve the communicable
disease surveillance system. Awareness of physicians on communicable disease
surveillance system must be improved by conducting education and information
campaigns on a continuous basis. We should also devise means for efficient use of
various administrative data including cause of death statistics and health
insurance. In addition, efficiency of the system must be improved by linking data
from various surveillance system.
Publication Types:
• English Abstract

16: BMC Med Educ. 2007 Jun 28;7:19.
Practicing doctors' perceptions on new learning objectives for

Vietnamese medical schools.
Hoat LN, Dung do V, Wright EP.
Biostatistics and Medical Informatics Department, Faculty of Public Health,

Hanoi Medical University, Dong Da, Hanoi, Vietnam. luungochoat@hn.vnn.vn
BACKGROUND: As part of the process to develop more community-oriented

medical teaching in Vietnam, eight medical schools prepared a set of standard
learning objectives with attention to the needs of a doctor working with the
community. Because they were prepared based on government documents and the
opinions of the teachers, it was necessary to check them with doctors who had
already graduated and were working at different sites in the community.
METHODS: Each of the eight medical faculties asked 100 practising recent
graduates to complete a questionnaire to check the relevance of the skills that the
teachers considered most important. We used mean and standard deviation to
summarize the scores rated by the respondents for each skill and percentile at four
points: p50, p25, p10 and p5 to describe the variation of scores among the
respondents. Correlation coefficient was used to measure the relationship between
skill levels set by the teachers and the perception of practicing doctors regarding
frequency of using skills and priority for each skill. Additional information was
taken from the records of focus group discussions to clarify, explain or expand on
the results from the quantitative data. RESULTS: In many cases the skills
considered important by teachers were also rated as highly necessary and/or
frequently used by the respondents. There were, however, discrepancies: some
skills important to teachers were seldom used and not considered important by the
doctors. In focus group discussions the doctors also identified skills that are not
taught at all in the medical schools but would be needed by practising doctors.
CONCLUSION: Although most of the skills and skill levels included in the
learning objectives by the teachers were consistent with the opinions of their
graduates, the match was not perfect. The experience of the graduates and their
additional comments should be included as inputs to the definition of learning
objectives for medical students.
Publication Types:
PMCID: PMC1925073
17: BMC Med Educ. 2007 May 29;7:14.
Organizational role stress among medical school faculty members in

Iran: dealing with role conflict.
Ahmady S, Changiz T, Masiello I, Brommels M.
Department of Learning, Informatics, Management, and Ethics, Karolinska

Institutet, Stockholm, Sweden. soleiman.ahmady@lime.ki.se
BACKGROUND: Little research has been conducted to investigate role stress

experienced by faculty members in medical schools in developing countries. This
becomes even more important when the process of reform in medical education
has already taken place, such as the case of Iran. The objectives of this study were
to investigate and assess the level and source of role-related stress as well as
dimensions of conflict among the faculty members of Iranian medical schools.
Variables like the length of academic work, academic rank, employment position,
and the departments of affiliation were also taken into consideration in order to
determine potentially related factors. METHODS: A survey was conducted at
three different ranks of public medical schools. The validated Organizational Role
Stress Scale was used to investigate the level of role stress and dimensions of role
conflict among medical faculty members. The response rate was 66.5%.
RESULTS: The findings show that role stress was experienced in high level
among almost all faculty members. All three studied medical schools with
different ranks are threatened with relatively the same levels of role stress.
Specific differences were found among faculty members from different
disciplines, and academic ranks. Also having permanent position and the length of
services had significant correlation with the level of role stress. The major role-
related stress and forms of conflict among faculty members were role overload,
role expectation conflict, inter-role distance, resource inadequacy, role stagnation,
and role isolation. CONCLUSION: The most role-related stressors and forms of
conflict among faculty members include too many tasks and everyday work load;
conflicting demands from colleagues and superiors; incompatible demands from
their different personal and organizational roles; inadequate resources for
appropriate performance; insufficient competency to meet the demands of their
role; inadequate autonomy to make decision on different tasks; and a feeling of
underutilization. The findings of this study can assist administrators and policy
makers to provide an attractive working climate in order to decrease side effects
and consequences of role stress and to increase productivity of faculty members.
Furthermore, understanding this situation can help to develop coping strategies in
order to reduce role-related stress.
PMCID: PMC1892550
18: Prosthet Orthot Int. 2007 Jun;31(2):138-46.
A prospective study on the development of critical thinking skills for

student prosthetists and orthotists in Hong Kong.
Wong MS.
Department of Health Technology and Informatics, Hong Kong Polytechnic

University, Hong Kong, China. m.s.wong@polyu.edu.hk
Critical thinking skill is considered to be one of the important attributes to nurture

students to cope with the challenges coming from this ever-changing world. The
training of critical thinking skill could be quite different from the conventional
education. Thus, special arrangements should be considered in the curriculum
design and effective assessment method should be employed to test the
subsequent learning outcome. This study was to evaluate prospectively the
development of critical thinking disposition of the student prosthetists and
orthotists in Hong Kong and a validated instrument, the California Critical
Thinking Disposition Inventory (CCTDI) was used. The results showed that there
was significant improvement in 5 out of the 7 domains, namely Truthseeking,
Open-mindedness, Systematicity, Analyticity, Critical thinking self-confidence,
Inquisitiveness and Maturity of judgment in 3 years' time. Further curriculum
enhancements were suggested as the sum of all the domains was just slightly
above the threshold of positive tendency.
Publication Types:

19: Eur J Gastroenterol Hepatol. 2007 Jun;19(6):499-506.
High prevalence of reflux oesophagitis among upper endoscopies of

Iranian patients.
Rezailashkajani M, Roshandel D, Shafaee S, Zali MR.
Health Informatics Department, Research Center for Gastroenterology and Liver

Diseases, Shaheed Beheshti Medical University, Tehran, Iran.
docreza@yahoo.com
BACKGROUND AND AIM: To reinvestigate the prevalence of reflux esophagitis

among upper endoscopies in a series of Iranian patients, considering the high
prevalence of reflux esophagitis (76%) reported by an earlier Iranian study and
the scanty data regarding prevalence of gastroesophageal reflux disease from Iran
and the Middle East. METHODS: Patients referred for upper endoscopy to an
outpatient gastroenterology clinic in Tehran (May 2005-January 2006) were
interviewed using a questionnaire before endoscopy. Gastroesophageal reflux
disease was defined as having any degree of reflux esophagitis on endoscopy, or
having heartburn or regurgitation on a weekly basis during the preceding 3
months. Reflux esophagitis was diagnosed and graded using Los Angeles
classification. Check-up patients were excluded. Gastroesophageal reflux disease,
nonerosive reflux disease, and reflux esophagitis groups were compared with non-
gastroesophageal reflux disease patients with regard to the following factors: sex,
age, body mass index (BMI), hiatus hernia, smoking, alcohol use, and level of
education. RESULTS: Out of 501 consecutive patients undergoing upper
endoscopy (195 men, 306 women; mean+/-SD of age, 44.7+/-15 years; mean+/-
SD of BMI, 24.9+/-4.4), 50 and 48% had reflux esophagitis with and without
exclusion of the patients on acid-suppressing drugs in the past 2 weeks,
respectively. Most had grade A (90%) or B (9%) reflux esophagitis. Only one
patient (0.2%) had Barrett's esophagus. By Rome-II criteria, 116 had dyspepsia
symptoms (predominant), of whom 41% had reflux esophagitis. High BMI (>25)
and hiatus hernia both showed statistically significant associations with
gastroesophageal reflux disease, whereas nonerosive reflux disease and reflux
esophagitis were associated only with high BMI and hiatus hernia, respectively.
Although the nonerosive reflux disease patients were of a lower education level
than non-gastroesophageal reflux disease patients, no significant association of
education level with gastroesophageal reflux disease and reflux esophagitis was
found. CONCLUSION: This study showed a significantly higher prevalence of
reflux esophagitis among Iranian upper-endoscopy outpatients compared with the
findings of non-Iranian studies.
Publication Types:

20: Nippon Rinsho. 2007 Feb 28;65 Suppl 2 Pt. 1:645-7.
[Actual condition of Japanese infection prevention and control]
[Article in Japanese]
Okubo T.
Division of Infection Prevention and Control, Department of Healthcare

Informatics, Tokyo Healthcare University.
Publication Types:
• Review
A novel approach for training of surgical procedures based on

visualization and annotation of behavioural parameters in
simulators.
Rissanen MJ, Kuroda Y, Nakao M, Kuroda T, Nagase K, Yoshihara H.
Graduate School of Informatics, Kyoto University, Japan. mikko@kuhp.kyoto-

u.ac.jp
Recording performance during training sessions on simulators is becoming a new

standard for assessment of surgical skills and thus a significant part of training.
Typical simulator-based training can be assessed using criteria that cover the
whole procedure to make distinction between skill levels. Studies so far have
rarely addressed the challenge of how to provide better feedback about the user's
performance on a surgical simulator. Our approach for surgical training is
Annotated Simulation Records (ASRs) and visualization of behavioural
parameters of interaction in surgery. This paper briefly outlines a framework for
building user-defined skill models and presents initial results. We demonstrate the
ASR-based approach in force exertion tasks on elastic objects by utilizing a
cardiovascular surgeon's recorded interaction on an aorta palpation simulator.
Publication Types:

22: J Sports Sci. 2007 Feb 15;25(4):381-91.
The continuous measurement of the springboard reaction force in

gymnastic vaulting.
Sano S, Ikegami Y, Nunome H, Apriantono T, Sakurai S.
Graduate School of Human Informatics, Nagoya University, Nagoya, Japan.

sano@htc.nagoya-u.ac.jp
A new method was established for the continuous measurement of force applied
from a springboard to a gymnast in vaulting (board reaction force). Male
gymnasts performed a handspring vault using a springboard mounted on force
platforms. A high-speed video camera sampled the springboard motion at 500 Hz.
The springboard was initially partitioned into 29 segments. The force due to the
accelerative motion of the springboard was determined by summing the forces of
the individual segments. The board reaction force acting on the gymnast was
calculated by subtracting the force due to the accelerative motion of the
springboard and weight from the force recorded by the force platform. The new
method succeeded in illustrating transient changes of the board reaction force.
The horizontal and vertical components of the peak values of the board reaction
force were three and two times greater respectively than the average values. A
series of tests was conducted to determine whether the number of segments of the
springboard model could be reduced without affecting accuracy. A model
consisting of only four segments produced almost the same accuracy as the 29-
segment model. The simplified model is recommended as a more efficient method
to measure board reaction force.

23: AMIA Annu Symp Proc. 2006:878.
Are Google or Yahoo a good portal for getting quality healthcare

web information?
Chang P, Hou IC, Hsu CL, Lai HF.
Institute of Health Informatics and Decision Making, National Yang-Ming

University, Taipei, Taiwan/R.O.C.
We examined the ranks of 50 award-won health websites in Taiwan against the

search results of two popular portals with 6 common diseases. The results showed
that the portal search results do not rank the quality web sites reasonably.
PMCID: PMC1839683
24: Isr Med Assoc J. 2006 Dec;8(12):865-9.
,
The use of medical informatics as a management tool for community
health services during the 2006 Israel-Lebanon War.
Kokia ES, Marom R, Shalev V, Jan Y, Shemer J.
Maccabi Healthcare Services, Tel Aviv, Israel. kokia_e@mac.org.il
BACKGROUND: During war the health management organizations have

tremendous difficulty monitoring members' needs according to geographic spread.
OBJECTIVES: To describe how an HMO used its health information technology
in a way that enables its management to receive updated online information on the
needs of the insured, according to their distribution throughout the country during
the time of the war in Lebanon in July-August 2006. METHODS: Data were
derived from the computerized medical records of Maccabi Healthcare Services--
the second largest HMO in Israel, providing care to more than 1.7 million
members nationwide. Data on healthcare utilization by northern members were
compared to the geographic distribution of clinics. RESULTS: The war was
characterized by the massive evacuation of citizens southwards. During this
period there was an abrupt decline in the utilization of medical services by
northern members in the northern region. This decline returned to normal 10 days
after the ceasefire. A reciprocal increase was noted in the use of health services by
citizens from the north in other regions. This increase returned to normal after the
war. No such pattern was noticed during the same period in 2005.
CONCLUSIONS: Real-time surveillance of trends in consumption of health
services by citizens in times of regular daily living as well as during emergencies
and wars is a vital management tool for medical directors responsible for
providing health services.

25: Kansenshogaku Zasshi. 2006 Nov;80(6):680-9.
[A collective review of Vibrio vulnificus infection in Japan]
Oishi H, Ura Y, Mitsumizo S, Nakashima M.
Ariake Sea Research Project, Saga University.
Vibrio vulnificus is found globally in marine coastal waters. Infection with this
organism, via ingestion of raw shellfish or exposure to marine water, can cause
necrotizing fasciitis and sepsis, which have high mortality and short latency. In
Japan, many cases have been reported since 1980, mainly from hospitals in
western prefectures. However, because of the sporadic nature of infection
outbreaks, a thorough epidemiologic survey has not been done. We studied the
epidemiological and clinical characteristics of Vibrio vulnificus infections
reported in Japan from 1975 to 2005. We identified 185 cases using the medical
article search engines Ichushi (Japan Medical Abstracts Society), CiNii (Citation
Information by National Institute of Informatics), and PubMed over 30 years. The
median age of patients was 59. The number of male patients was eight times the
number of female patients; however, no significant difference in mortality was
found between genders. In yearly distributions of patients, 20 cases were reported
in 2001, a year in which we experienced more rainfall and a longer rainy season
in Northern Kyushu. In monthly distribution, about 80% of cases were reported
from July to September when sea water temperatures rise. About 40% of cases
were reported in four prefectures around the Ariake Sea. The underlying disease
indicated liver dysfunction in 90% of patients, but mortality was the same
regardless of the infection pathway (oral ingestion or wound). Because of its rapid
aggravation and high mortality rate, public education is important to prevent new
cases. It is also highly recommended that patients with preexisting liver
dysfunction avoid raw fish and limit exposure to marine water during the summer.
Publication Types:
• Review

26: Pediatr Int. 2006 Dec;48(6):555-61.
Promoting measles vaccination in attendees not yet immunized at

day-care centers in Kyoto City.
Matsumura T, Nakayama T, Hamagashira N.
Department of Health Informatics, Kyoto University School of Public Health,

Kyoto, Japan.
BACKGROUND: Due to the low measles vaccination rate, localized measles

epidemics occasionally occur in Japan with the majority of sufferers being
children under 2 years of age. Despite an increased risk of infection at day-care
centers, the measles vaccination coverage for day-care attendees is lower than
children who are reared-at-home or attend kindergartens. This study aims to
describe the current state of measles prevention policy at day-care centers and to
examine factors associated with vaccine promotion. METHODS: A cross-
sectional study using anonymous self-administered questionnaires were
distributed to the director or person-in-charge at 250 all licensed day-care centers
in Kyoto City, Japan, in 2004. The preventive measures against measles at day-
care centers and factors related to carrying out the promotion of measles
vaccination were examined. Descriptive statistics and odds ratios (OR) using a
logistical model were presented. RESULTS: Out of 250 day-care centers, 187
questionnaires were returned (response rate, 74.8%). Measles vaccination history
was taken at 161 day-care centers (86.1%) at the time of enrollment; only 61 day-
care centers (32.6%) took a history during the school year. A total of 101 day-care
centers (54.0%) promoted measles vaccination in day-care attendees who had not
yet been immunized. Day-care centers which promoted it were more likely to be
'public facility' (OR, 3.09) and 'having opportunities to learn about vaccination'
(OR, 5.55). After adjustment, 'having opportunities to learn about vaccination' and
'having knowledge that measles vaccination is best under the age of 15 months'
were significantly related to carrying out the promotion of measles vaccination
(OR, 6.47; 95% confidence interval, 2.52-18.61; OR, 3.12; 95% confidence
interval, 1.45-6.95, respectively). CONCLUSION: Preventive measures for
measles at day-care centers are currently insufficient. Increasing opportunities to
learn about vaccination may encourage promotional behavior.

27: J Prof Nurs. 2006 Nov-Dec;22(6):359-66.
Epidemiology of needlestick and sharps injuries among professional

Korean nurses.
Smith DR, Choe MA, Jeong JS, Jeon MY, Chae YR, An GJ.
International Center for Research Promotion and Informatics, National Institute of

Occupational Safety and Health, Tama-Ku, Kawasaki, Japan.
smith@j.jniosh.go.jp <smith@j.jniosh.go.jp>
Although needlestick and sharps injuries (NSI) are known to affect professional
nurses at high rates, most studies depend on officially reported data and few have
been undertaken in Korea. Thus, we surveyed a large cross-section of nurses from
a hospital in Gangneung (response rate, 97.9%). Four hundred thirty-two
incidents of NSI were reported by 263 nurses (79.7%) in the previous 12-month
period (average, 1.31 events/nurse/year). Syringe needles were the most common
devices, affecting 67.3% and comprising 52% of all NSI events. Sixty percent of
all NSI events involved contaminated devices. Opening an ampoule or vial was
the most common cause (affecting 35.2% of all nurses and accounting for 15.9%
of all NSI events). Logistic regression indicated that nurses working in "other"
departments were 5.4 times more likely to suffer any NSI (odds ratio [OR] = 5.4;
95% confidence interval [95% CI] = 2.0-15.2; P < .05) and 4.7 times more likely
to incur a syringe-needle injury than nurses in intensive care units or inpatient
departments (OR = 4.7; 95% CI = 2.0-11.6; P < .05). Younger-than-average nurses
(< 27 years) were 4.5 times more likely to suffer NSI (OR = 4.5; 95% CI = 1.7-
12.6; P < .05) and 3.1 times more likely to incur a syringe-needle injury (OR =
3.1; 95% CI = 1.4-7.0; P < .05). Working mixed shifts also increased the risk of
any NSI (OR = 4.0; 95% CI = 1.7-10.4; P < .05) or syringe-needle NSI (OR = 4.4;
95% CI = 2.0-10.1; P < .05). Overall, our study suggests that NSI are common
among Korean hospital nurses and represent a significant occupational burden for
this large Asian demographic. Intervention and preventive strategies to help
reduce their NSI exposures are urgently required in this country.

28: Rinsho Byori. 2006 Oct;54(10):1038-43.
[Introduction of Department of Diagnostic Medicine, Graduate

School of Medical Sciences, Kumamoto University]
Ando Y.
Department of Diagnostic Medicine, Graduate School of Medical Sciences,

Kumamoto University, Kumamoto 860-0811.
Pathologic informatics is an analysis of mechanism of pathogenesis using various

medical information. Biologic reactions by many reactants are studied on
molecules, cells, organs, and individuals by using various methods. Themes of our
laboratory are as follows: 1) to analyze of the pathogenesis of various diseases by
using novel diagnostic methods, 2) to elucidate amyloid formation mechanism in
amyloidosis and to develop novel therapies, 3) to develop the methods for tests
and diagnosis for DIC, 4) to study on activation mechanism of ribosomal proteins
in the tissues by the blood cell function, 5) to study on the expression and
suppression of neogenesis of blood vessels by physical invasion in the organ
failure, and 6) to develop the diagnostic methods for autonomic dysfunction and
to analyze the pathogenesis.
Publication Types:
29: Stud Health Technol Inform. 2006;122:999.
The effect evaluation of the nursing information application on the

fall down precautionary measures of inpatients.
Shan H, Chi MF, Yang LH, Tsai LY.
Nursing Department of Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
The research is to establish the nursing information system of fall down

dangerous cause estimation, build up the standard working process of fall down
precaution, reduce the patients' fall down rate and injury rate. I) Build up a
complete information system for standard working process of fall down
precaution. II) After nurses intervened the education, there are remarkably
positive promote on knowledge, attitude and action. III) After intervened the
precautionary measures, the fall down rate and the injury rate are remarkably
reduced.

The evaluation criteria of internet health information.
Kang NM, Kim S, Hong S, Ryu S, Chang HJ, Kim J.
College of Nursing, Konkuk University, Seoul, Korea.
The Internet has great powerful forces for health information and education. This
describes the development of a web-based evaluation criteria for internet health
information. The purpose of this study was to explore the evaluation criteria (tool)
of internet health information for Korean. This utilized a cross-sectional design
with four sections: (1) CAHPS (Consumer assessment of health plans studies); (2)
Health consumer terminology and understanding review; (3) web based
interactive tool construction; (4) semantic web technology application. The
findings showed follows; (1) literature review related quality evaluation tool for
internet health information; (2) case study; (3) development of evaluation
prototype; (4) validity assessment of tool; (5) Evaluation system information
strategic planning.
Report on improved information literacy in students at the Nagano

Red Cross Nursing School.
Miyazawa M, Kobayashi Y, Hatakeyama E.
Red Cross Nursing School, Nagano, Japan. m.miyazawa@nagano-med.jrc.or.jp
Our new environment can afford one PC (personal computer) for every two
students in the course of PC classes as well as for research. It has been clarified
that the students acquired greater information literacy through this new
environment and PC classes.

Redesigning the nursing informatics education for nurse managers.
Yamanouchi K, Asanuma Y.
Faculty of Nursing, Iwate Prefectural University, Japan.
In order to redesign our short course for reeducating nurse managers, we

investigated a pre-lecture score and a post-lecture score to find out the
background knowledge of Japanese nursing managers in nursing informatics, and
to ascertain the effects of a preliminary short course. The results helped us to
select five topics out of all topics for which more time was necessary, for teaching
our new short course for nursing managers.

Construction and evaluation of e-learning system for medical

treatment safety measures.
Morikawa T, Moriguchi H, Nose T, Ohoka H.
Medical Informatics, The University Tokushima Hospital, Tokushima, Japan.
To consider effective medical treatment safety measures, various factors that lead
to malpractice should be understood and analyzed objectively. An incident report
system was constructed at the University of Tokushima hospital. A safety
management room was set up in the university hospital. The system collected
information and analyzed submitted incidents in order to contribute to safer
medical treatment. However, the current educating system is not able to
effectively teach the incident reports system to the 1,000 or so staff members.
This is due to a busy hospital atmosphere which leaves little time for educational
instruction. In response to this problem the E-learning system was developed in
order to effectively administer the medical treatment safety education. This E-
learning system was evaluated by the participating "learners" who were hospital
staff members.

A study of network education application on nursing staff

continuing education effectiveness and staff's satisfaction.
Lin JS, Yen-Chi L, Lee TT.
Department of Nursing Shin Kong Wu Ho-Su Memorial Hospital, Taiwan, ROC.
The rapid development of computer technology pushes Internet's popularity and

makes daily services more timely and convenient. Meanwhile, it also becomes a
trend for nursing practice to implement network education model to break the
distance barriers and for nurses to obtain more knowledge. The purpose of this
study was to investigate the relationship of nursing staff's information
competency, satisfaction and outcomes of network education. After completing 4
weeks of network education, a total of 218 nurses answered the on-line
questionnaires. The results revealed that nurses who joined the computer training
course for less than 3 hours per week, without networking connection devices and
with college degree, had the lower nursing informatics competency; while nurses
who were older, at N4 position, with on-line course experience and participated
for more than 4 hours each week, had higher nursing informatics competency.
Those who participated in the network education course less than 4 hours per
week were less satisfied. There were significant differences between nursing
positions before and after having the network education. Nurses who had higher
nursing information competency also had higher satisfaction toward the network
education. Network education not only enhances learners' computer competency
but also improves their learning satisfaction. By promoting the network education
and improving nurses' hardware/software skills and knowledge, nurses can use
networks to access learning resources. Healthcare institutions should also enhance
computer infrastructure, and to establish the standards for certificate courses to
increase the learning motivation and learning outcome.

A project to improve the computerization procedure of emergency

nursing record.
Ya WP, Huang SL, Tang WL, Shu SS, Shan-Huang , Chun LY.
Emergency Department, Kaohsiung Chang Gung Memorial Hospital, Taiwan,

ROC.
This project is to implement the computerization procedure of emergency nursing

record. The nursing record must be complete and correct enough to present the
uniqueness of different specialty. We encouraged nurses to participate in
classroom lessons of informatics technology in nursing records. We then used the
standardized version of the emergency nursing records. We also set up criteria for
computerization of nursing records. As a result, the nursing records become more
complete. It was improved by 8.5% as compared to manual records. The
satisfaction of nurses was improved by 82.1%. It is much more time-saving and
convenient to check the nursing records. In conclusion, the emergency nursing
profession and quality surveillance did improve from the computerization. The
patients will receive better nursing care quality.
Publication Types:

,
Integrating hospital medical care data with pharmaceutical
education materials for diabetes self management.
Wu SJ, Yeh YT, Li CC, Chiu YT, Huang JF, Liu CT.
Graduate Institute of Medical Informatics, Taipei Medical University, Taipei,

Taiwan.
Diabetic patients need long-term treatment and follow-up exams as well as

appropriate self-care pharmaceutical education to get the disease under control
and to prevent possible complications. Pharmaceutical treatment plays an
essential role in diabetes. If patients don't understand the medicines and dosages
they take, their blood glucose control may be affected. In addition, the possibility
of developing hypoglycemia may be increased. In this paper, we enhance the
POEM system, previously developed for diabetic patient education, by providing
diabetic patients' pharmaceutical education. The new system integrates both
diabetic patients' pharmaceutical education information and medical care
information to provide them with more comprehensive personalized medication
information so that they can access the on-line system afterwards. It also
strengthens patients' understanding of pharmaceutical functions, side-effects and
relevant knowledge thus increasing patients' adherence of medication orders and
having better control in their blood glucose levels.

Qualitative analysis of end user computing strategy and experiences

in promoting nursing informatics in Taiwan.
Hou IC, Chang P, Wang TY.
Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan

ROC.
The purpose of this study was to analyse end user computing strategy and
experiences in promoting nursing informatics in Taiwan. In February 2004, an 8-
day NI technology training campaign was held in Taipei for 60 clinical nurses.
Excel VBA was used as the tool to teach the clinical nurses, who had never
written any programs, but were very interested in informatics. Three projects were
determined after detailed discussion and evaluation of clinical needs and technical
feasibility between the nurses and the technical support team, which was
composed of one experienced informatics professor and one clinical NI assistant.
A qualitative analysis was used to interview the three pairs of programming
clinical nurses and their direct supervisors with a structured but open
questionnaire. Representative concepts were categorized from the data until all
were categorized. The concepts were organized under three categories: the
purposes, the benefits and the challenges of system development. According to
this study, end user computing strategy with Excel VBA was successful so far.

Theory development in health care informatics: Information and

communication technology acceptance model (ICTAM) improves the
explanatory and predictive power of technology acceptance models.
An JY.
College of Nursing, New York University, New York, NY 10003, USA.

jiyoung.an@nyu.edu
The purpose of this web-based study was to explain and predict consumers'
acceptance and usage behavior of Internet health information and services.
Toward this goal, the Information and Communication Technology Acceptance
Model (ICTAM) was developed and tested. Individuals who received a flyer
through the LISTSERV of HealthGuide were eligible to participate. The study
population was eighteen years old and older who had used Internet health
information and services for a minimum of 6 months. For the analyses, SPSS
(version 13.0) and AMOS (version 5.0) were employed. More than half of the
respondents were women (n = 110, 55%). The average age of the respondents was
35.16 years (S.D. = 10.07). A majority reported at least some college education (n
= 126, 63%). All of the observed factors accounted for 75.53% of the total
variance explained. The fit indices of the structural model were within an
acceptable range: chi2/df = 2.38 (chi2 = 1786.31, df = 752); GFI = .71; RMSEA =
.08; CFI = .86; NFI = .78. The results of this study provide empirical support for
the continued development of ICTAM in the area of health consumers'
information and communication technology acceptance.
Publication Types:

39: Int J Med Inform. 2007 Sep;76(9):688-700. Epub 2006 Aug 23.
Building a reference functional model for EHR systems.
Sumita Y, Takata M, Ishitsuka K, Tominaga Y, Ohe K.
Department of Planning, Information and Management, The University of Tokyo

Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. yukis-
tky@umin.ac.jp
INTRODUCTION: Our aim was to develop a reference functional model for

electric health record systems (RFM). Such a RFM is built from functions using
functional descriptive elements (FDEs) and represents the static relationships
between them. This paper presents a new format for describing electric health
record (EHR) system functions. METHODS: Questionnaire and field interview
survey was conducted in five hospitals in Japan and one in the USA, to collect
data on EHR system functions. Based on survey results, a reference functional list
(RFL) was created, in which each EHR system function was listed and divided
into 13 FDE types. By analyzing the RFL, we built the meta-functional model and
the functional model using UML class diagrams. The former defines language for
expressing the functional model, while the latter represents functions, FDEs and
their static relationships. RESULTS: A total of 385 functions were represented in
the RFL. Six patterns were found for the relationships between functions. The
meta-functional model was created as a new format for describing functions.
Examples of the functional model, which included the six patterns in the
relationships between functions and 11 verbs, were created. DISCUSSIONS: We
present the meta-functional model, which is a new description format for the
functional structure and relationships. Although a more detailed description is
required to apply the RFM to the semiautomatic generation of functional
specification documents, our RFM can visualize functional structures and
functional relationships, classify functions using multiple axes and identify the
similarities and differences between functions. The RFM will promote not only
the standardization of EHR systems, but also communications between system
developers and healthcare providers in the EHR system-design processes. 2006
Elsevier Ireland Ltd
Publication Types:

,
A feasible strategy of promoting nursing informatics by End User

Computing.
Hou IC, Chang P.

University, Taipei, Taiwan, ROC.
The purpose of this study was to report our experiences in promoting NI training
and professorship using the strategy of End User Computing in Taiwan. An
interview-based survey was made to better understand the pros and cons of this
strategy from three successful projects. The results appear promising and cost-
effective.
PMCID: PMC1560560
41: Comput Inform Nurs. 2006 May-Jun;24(3):159-66.
Computer courses in the undergraduate nursing curriculum in

Turkey.
Yavuz M.
Ege University School of Nursing, Izmir, Turkey. yavuz@hemsirelik.ege.edu.tr
This study surveys computer courses in undergraduate nursing schools in Turkey.

To accomplish this, the investigator gave an assignment to first-year students at
the Ege University School of Nursing as part of a computer course in 2003-2004.
The assignment consisted of having students use their computer skills and do
research on the Internet to obtain information about computer classes at other
Turkish nursing schools. The objective of this assignment was to correspond by e-
mail with first-year students at these institutions. Because of this assignment, at
least 70 contacts were established, and information has been exchanged between
nursing students at 45 different universities in Turkey. This study shows that one
method used by undergraduate nursing schools in Turkey to educate their students
in modern nursing practices is to integrate computer courses in their curricula,
thereby providing students important practical technology skills.
42: J Telemed Telecare. 2006;12(3):109-10.
Global health care - bridging the gap.
Lugn NE.
Perceptive Informatics, Waltham, MA 02451, USA. nlugn@yahoo.com
The World Health Assembly has acknowledged that telehealth could play an
important role in providing access to health care for populations at risk
worldwide. The Cambodia Teleconsultation Programme or Village Leap
Programme connects those in need of health care, with those willing to share their
medical expertise. Telemedicine clinics are run every other week at one of two
villages in northern Cambodia. The nurse is responsible for gathering medical
information and transmitting it by email to physicians in the USA, and to the
Sihanouk Hospital of Hope in Phnom Phen. Poorer countries do not and are not
likely to have national telemedicine programmes in the near future. But as the
experience in Cambodia shows, grass-root telemedicine programmes can make a
difference. The need is great and we can no longer wait for governments to lead.
Thoughtfully implemented telemedicine programmes providing medical
education, health care and screening may change the health of the world.

43: Rinsho Byori. 2006 Mar;54(3):295-8.
[Extensive educational program for high performance medical

technologists]
Yorifuji S, Iwatani Y, Kawano S, Inagaki S, Sugiyama H, Matsuura N,

Yamanura T, Yamamoto Y, Higashi T, Horio M, Oji Y, Yamaguchi H,
Watanabe M, Kawaguchi N, Ohoka Y, Hirata M, Ishigami M, Eguchi H,
Hamada Y.
Laboratory Science, Allied Health Sciences, School of Medicine, Suita 565-0871.

The education system for medical technologists has recently been revolutionized,
their educational periods vary from 2 to 9 years, and some already have doctoral
degrees. In such a new situation, our faculty thinks that the most important point
for new medical technologists is the ability to have a broad view of the clinical
fields, especially the view of patients. Special training in bed-side education and a
stint in several divisions, such as the surgical operation room, rehabilitation.
radiological examination room, pharmacy, central storage room of medical
records, and medical informatics, and so on, of the hospital is a powerful tool to
obtain a broad view of the various clinical fields and can be essential for
developing high performance medical technologists. As nine years have passed
since starting this education, we evaluated this practice through systematic
personal communication. As a result, it was found to be extremely effective for
many reasons such as having a continuous image of the patient when they
examine the blood sample in the hospital laboratory, showing advanced laboratory
performance, and having no mental barrier to visiting the wards and so on. The
abilities of our alumni are praised highly by many large scale hospitals around the
country and 50% of them are working in the clinical laboratory division of these
hospitals. About 40% are working in the division of research and development in
various companies. We express sincere thanks to the director and all cooperative
individuals for this course in the Osaka University Hospital.
Publication Types:

44: Med Teach. 2006 Feb;28(1):36-9.
Developing and evaluating professionalism.
Elcin M, Odabasi O, Gokler B, Sayek I, Akova M, Kiper N.
Department of Medical Education and Informatics, Hacettepe University Faculty

of Medicine, Ankara, Turkey. melcin@hacettepe.edu.tr
Professional behaviour, being one of the domains of professionalism, is an area of

medical education that has long been of concern to medical educators. At
Hacettepe University, our main goal is to have students become conscious of
professional identity, values, responsibilities and the physician-patient
relationship. We welcome our new students with an opening ceremony on their
first day and two months later, the students start the course called "Health-Illness
Concepts and Medical Professional Identity". Students are expected to discuss the
subjects given to them as scenarios or arguments. The aim of our study is to
determine whether the course leads to a positive change in students' attitudes,
indicating the attainment of those attributes that reflect professionalism. On the
first and the last days of the course, a questionnaire was delivered to the students.
Any positive change in preferences between the two questionnaires is identified
as an achievement of that attribute. As a result we found that in all of the seven
attributes there were positive changes in the students' attitudes. Positive changes
varied from 48% to 84% and all were statistically significant. Using more
interactive techniques helped the students to make larger percentage changes in
their awareness of these professional attributes.
Publication Types:

45: Med J Malaysia. 2005 Oct;60(4):432-40.
Perceived skill and utilisation of information technology in medical

education among final year medical students, Universiti Putra
Malaysia.
Lim TA, Wong WH, Lim KY.
Anaesthesiology Unit, Faculty of Medicine and Health Sciences, Universiti Putra

Malaysia, Hospital Kuala Lumpur, Jalan Masjid, 50586 Kuala Lumpur.
The objective of this survey was to obtain a self-reported assessment of the use of
information technology (IT) by final year medical students. Two hundred and
sixty five students responded to a questionnaire survey. 81.5% of students
considered their computer skills adequate, while 87.9% had access to computers
outside the campus. Most students reported adequate skills at word processing, e-
mailing and surfing the Internet. Fifty three percent of students spent three hours
or more each week on the computer. While students indicated a general
willingness to access Internet-based materials, further steps need to be taken to
increase the use of this method of instruction.

46: Natl Med J India. 2006 Jan-Feb;19(1):14-7.
,
Usefulness of an observational database to assess antiretroviral
treatment trends in India.
Cecelia AJ, Christybai P, Anand S, Jayakumar K, Gurunathan T, Vidya P,

Solomon S, Kumarasamy N.
YR Gaitonde Cente for AIDS Research and Education, Chennai, Tamil Nadu,
India.
BACKGROUND: Human immunodeficiency virus (HIV) observational cohorts,

which are established worldwide, support comparative studies across different
regions. They have played an important role in developing international and
country-specific HIV treatment and care guidelines. We describe the YRG CARE
Chennai HIV observation database (YCHOD) and highlight its utility in
monitoring trends in antiretroviral treatment use and HIV disease outcomes in
India. METHODS: The baseline characteristics, time trends in antiretroviral
treatment, trends in incidence of acquired immune deficiency syndrome (AIDS)-
defining illness and mortality following the introduction of highly active
antiretroviral therapy (HAART) in India were assessed using YCHOD.
RESULTS: Till January 2005, 7647 HIV-positive patients had registered in
YCHOD. A majority of the patients were men (69%) and had a mean age of 32
years. At baseline, 14% had an existing AIDS-defining illness. Among patients
who required therapy by the WHO criteria, 14% initiated antiretroviral therapy
(ART) in 1996 and 35% in 2000. Since the dramatic cost reduction of generic
HAART in 2001, there has been an increase in the proportion of patients receiving
ART to 57% in 2004. In patients who were started on HAART, the incidence of at
least one AIDS-defining illness was 2% in 2001, and this decreased to 0.48% in
2004. CONCLUSION: We feel observational cohorts are useful as a surveillance
tool for monitoring trends in treatment and disease progression. Standardized
observational data collected systematically on HIV-infected individuals will help
to assess the cost-effectiveness of ART and in planning ART strategies for India.

47: Nutrition. 2006 Mar;22(3):283-7.
New Quantitative Index for Dietary Diversity (QUANTIDD) and its

annual changes in the Japanese.
Katanoda K, Kim HS, Matsumura Y.
Division of Health Informatics and Education, National Institute of Health and

Nutrition, Tokyo, Japan. katanoda-tky@umin.ac.jp
OBJECTIVE: A diverse diet is recommended in many dietary guidelines.
However, because there are no unified standards for measurement methods,
objective comparisons across different populations or time points is difficult. This
report proposes a new dietary diversity index based on quantitative distribution of
consumed foods to allow objective measurement of dietary diversity. METHODS:
A Quantitative Index for Dietary Diversity (QUANTIDD) is proposed:
QUANTIDD=(1-summation operatorjn prop[j]2)/(1-1/n), where prop(j) is the
proportion of food group(s) j that contributes to total energy or nutrient intake, n
is the number of food groups, and j = 1,2,...,n. The numerator is the probability
that the two foods taken out of an aggregation of consumed foods belong to
different food groups. The denominator is its maximum value. The index ranges
from 0 to 1. By using the officially released average data from the National
Nutrition Survey in Japan from 1957 to 2000, we investigated annual changes in
the QUANTIDD. We also investigated the distribution of the index by using
individual data from the National Nutrition Survey in Japan in 1996. RESULTS:
The QUANTIDD increased from the 1960s to the 1970s. This was the era of rapid
economic growth in Japan, during which the dietary habits of the Japanese
underwent rapid changes. The distribution of the QUANTIDD was skewed to the
left, but logit-transformation decreased this asymmetry and made it similar to a
normal distribution. CONCLUSION: Because this index can measure dietary
diversity objectively and is suitable for statistical handling, it is useful as a
method to compare dietary patterns across different populations or time points.
Publication Types:

48: J Clin Monit Comput. 2005 Oct;19(4-5):279-94.
Scientific Grid activities and PKI deployment in the Cybermedia

Center, Osaka University.
Akiyama T, Teranishi Y, Nozaki K, Kato S, Shimojo S, Peltier ST, Lin A,

Molina T, Yang G, Lee D, Ellisman M, Naito S, Koike A, Matsumoto S,
Yoshida K, Mori H.
Cybermedia Center, Osaka University, Osaka, Japan. akiyama@cmc.osaka-u.ac.jp
The Cybermedia Center (CMC), Osaka University, is a research institution that

offers knowledge and technology resources obtained from advanced researches in
the areas of large-scale computation, information and communication, multimedia
content and education. Currently, CMC is involved in Japanese national Grid
projects such as JGN II (Japan Gigabit Network), NAREGI and BioGrid. Not
limited to Japan, CMC also actively takes part in international activities such as
PRAGMA. In these projects and international collaborations, CMC has developed
a Grid system that allows scientists to perform their analysis by remote-
controlling the world's largest ultra-high voltage electron microscope located in
Osaka University. In another undertaking, CMC has assumed a leadership role in
BioGrid by sharing its experiences and knowledge on the system development for
the area of biology. In this paper, we will give an overview of the BioGrid project
and introduce the progress of the Telescience unit, which collaborates with the
Telescience Project led by the National Center for Microscopy and Imaging
Research (NCMIR). Furthermore, CMC collaborates with seven Computing
Centers in Japan, NAREGI and National Institute of Informatics to deploy PKI
base authentication infrastructure. The current status of this project and future
collaboration with Grid Projects will be delineated in this paper.
Publication Types:

49: Nippon Koshu Eisei Zasshi. 2005 Sep;52(9):817-23.
[Establishment of Healthy Japan 21 Regional plans according to

local community type]
Katanoda K, Hirota K, Matsumura Y.

Nutrition, Japan.
OBJECTIVE: To examine the establishment of Health Japan 21 regional plans

according to the local community type. METHODS: We sent all the Japanese
local governments a questionnaire regarding the establishment of health Japan 21
regional plans with a request to provide a hardcopy of established regional plans.
RESULTS: Of the respondent 1954 local communities, the proportions regarding
establishment of plans (including "Completed" and "In the course of") according
to the community type were: major, middle sized cities and Tokyo metropolitan
wards, 100%; other cities, 64.9%; towns, 40.7%; and villages, 38.8%. Of the 500
local communities which answered "Completed establishment", the proportions
with release onto the internet (including "Completed" and "In the course of")
were: major cities, 100%; middle sized cities, 67.7%; Tokyo metropolitan wards,
85.7%; other cities, 38.8%; towns, 13.5%; and villages, 14.3%. We examined
whether each of the 462 collected regional plans included each of the national
Health Japan 21's target themes and items, and found a tendency for smaller
community' regional plans to be less likely to give comprehensive coverage.
CONCLUSION: More support for smaller local governments is necessary to
achieve establishment and effective implementation of Health Japan 21 regional
plans.
Publication Types:

50: J Epidemiol. 2005 Jul;15(4):107-12.
Japan's ethical guidelines for epidemiologic research: a history of

their development.
Nakayama T, Sakai M, Slingsby BT.

Japan. nakayama@pbh.med.kyoto-u.ac.jp
During the latter half of the 1990s, Japanese healthcare professionals and policy-
makers recognized the value of an "evidence-based" approach. At the same time,
an increased social awareness of the need to protect research participants and
personal information began to appear. Recognition of an evidence-based approach
further promoted epidemiologic research while regulations on personal
information protection imposed certain limitations on this same research. In April
2000, as a solution to this conflict, a working group funded by Japan's Ministry of
Health and Welfare (MHW; currently the Ministry of Health, Labour and Welfare:
MHLW) proposed a first draft of ethical guidelines for epidemiologic research.
Over the next two years, the collection of domestic and foreign data by working
groups and governmental ad hoc committees, questions raised by the mass media,
and public statements made by organizations, such as the Science Council of
Japan and the Japan Epidemiologic Association (JEA), led to a collaborative
effort between the Ministry of Education, Culture, Sports, Science and
Technology and the MHLW. This effort led to the creation of the Ethical
Guidelines for Epidemiologic Research in June 2002, which was revised in 2004.
Furthermore, JEA also announced the Ethical Guidelines for Conducting of
Epidemiologic Research in October 2002. While the development of these ethical
guidelines has been a challenge for Japanese epidemiologists, it has also allowed
the epidemiologic community to understand their role in society. This review aims
to provide insight into the interaction between the epidemiologic community and
society by assessing historically the developmental process of these ethical
guidelines.
Publication Types:
• Historical Article

51: Int J Colorectal Dis. 2006 Jul;21(5):433-40. Epub 2005 Aug 19.
Related Articles, Links
Knowledge of disease and health information needs of the patients

with inflammatory bowel disease in a developing country.
Rezailashkajani M, Roshandel D, Ansari S, Zali MR.
Health Informatics Department, Research Center for Gastroenterology and Liver

Diseases, Shaheed Beheshti University of Medical Sciences, Tehran, Iran.
docreza@yahoo.com
BACKGROUND AND AIMS: This study was performed to have a first-time

assessment on the knowledge level of a population of inflammatory bowel disease
(IBD) patients in a developing country like Iran and to identify their health
information preferences. METHODS: One hundred over 18-year-old IBD patients
presenting to an outpatient gastroenterology clinic in Tehran from April to
November 2004 were asked to complete Persian-translated version of 24-item
Crohn's and Colitis Knowledge (CCKNOW) score questionnaire and an
additional questionnaire collecting their favorite disease-related knowledge topics.
RESULTS: All of the patients (64 females, 36 males) wished to know more about
their disease. The cause of IBD and the medications were the most favorite
knowledge topics. The mean and median of CCKNOW score of the patients was
4.65 and 4.0 (out of 24), respectively. Women showed significantly higher scores
than men (p=0.006). There was also a weak positive correlation between the level
of education and CCKNOW score (Spearman's rho=0.23, p=0.02). No significant
correlation was found between age, duration of disease, self-estimated level of
suffering from disease, and CCKNOW score. The most severe knowledge deficit
was evident in knowledge on IBD complications. CONCLUSION: Despite the
overt inclination of Iranian IBD patients to know more about their disease, their
knowledge levels were significantly lower than the IBD patients in developed
countries. The more profound knowledge deficit in IBD complications may lead
to disastrous aftermaths such as late diagnosis of colorectal cancer induced by
prolonged IBD. Vigorous patient education programs for the Iranian IBD patient
are suggested focusing on areas of knowledge deficit and their favorite topics.
Publication Types:

52: Int J Med Inform. 2005 Dec;74(11-12):952-9. Epub 2005 Aug 22.
Analysis of nursing records of cardiac-surgery patients based on the

nursing process and focusing on nursing outcomes.
Kim YJ, Park HA.
Asan Medical Center, Seoul, Korea.
This study analyzed what nurses wrote in narrative nursing notes for cardiac-
surgery patients. The nursing notes of 46 patients were analyzed based on the
nursing process. Eight patterns were extracted according to different combinations
of nursing process components, of which an assessment alone was the most
frequent nursing phrase (45.8%), followed by assessment or diagnosis-
intervention-outcome (25.9%). The content of the nursing notes was also
classified into 15 categories, of which nursing outcomes were recorded more
frequently in nursing care driven mainly by physician's order such as disease-
related symptom management, insomnia care, respiratory care, and pain control,
than in independent nursing care such as education and emotional care. A survey
on the attitudes of nurses toward the nursing record revealed that they do not
document nursing outcomes as much as they think they do. The main reasons for
this discrepancy were insufficient time for recording and lack of knowledge about
why, how, and what to evaluate. Even though there is room for improvement,
nursing notes represent a useful resource for determining nursing contributions to
patient outcomes.

53: Teach Learn Med. 2005 Summer;17(3):269-73.
Synchronous distance interactive classroom conferencing.

Oz HH.
Faculty of Medicine, Akdeniz University, Medical Informatics Department,

Antalya, TURKEY. hamioz@akdeniz.edu.tr
BACKGROUND: New medical schools have been opened in the eastern and
southeastern regions of the country. They are also in great need of basic medical
science teachers. However, due to security reasons over the past two decades,
teachers from the established universities do not desire to travel to these medical
schools for lectures. The objective of this study was to develop a synchronous
classroom conferencing system to teach basic science courses between two
general purpose technology enhanced classrooms of two different universities--
Istanbul University (IU) and Istanbul and Harran University (HU), Urfa--located
1,500 miles apart in Turkey. DESCRIPTION: I videostreamed the instructor,
content from document camera, Power Point presentations at IU, and the students
at both places, IU and HU. In addition, I synchronously broadcast two
whiteboards by attaching two mimio devices to the two blackboards in the IU
classroom to capture and convert everything written or drawn on them into
broadcasting over the intranet. This technique is called "boardcasting," which
allows users to stream ink and audio together over the Internet or intranet live. A
total of 260 students at IU and 150 students at HU were involved. Off-campus HU
students also have asynchronous access to the stored lecture video materials at
any time. Midterm and final examinations were administered simultaneously
using the same questions at both sites in two universities under the observation of
the teaching faculty using the very same system. EVALUATION: This system
permitted interaction between the students in the class at IU and remote-campus
students at HU and the instructor in real time. The instructors at IU were able to
maintain a significant level of spontaneity in using their multimedia materials and
electronic whiteboards. The mean midterm and final exam scores of students at
both universities were similar. CONCLUSION: The system developed in this
study can be used by the medical faculty at the main teaching hospitals to deliver
their lectures in real time to the medical students when they are on placement in
general practices, ambulatory clinics, and district hospitals in rural areas or to the
students of other medical schools. This is an efficacious system in developing
countries where availability of high-speed networks and cost of communication
are major concerns.
Publication Types:

54: Nutrition. 2005 Sep;21(9):964-6.
Is the national nutrition survey in Japan representative of the entire
Japanese population?
Katanoda K, Nitta H, Hayashi K, Matsumura Y.

Nutrition, Tokyo, Japan. katanoda-tky@umin.ac.jp
OBJECTIVE: We examined the representativeness of the sample used in the

National Nutrition Survey in Japan (J-NNS). METHODS: The distribution of the
J-NNS sample from 1995 to 2000 was compared with that of the national census
with respect to gender, age group, place of residence, and number of household
members. RESULTS: In the survey sample, as compared with the national census
distributions, the proportion of females was 1% to 2% larger, the proportion of
individuals who were 20 to 39 y of age was a few percentages smaller, and a
slight bias toward rural areas was seen. Among individuals who were 20 to 59 y
of age, the proportion of individuals who lived in single-person households was
50% to 66% of that found in the national census. Observed disparities between the
sample and the population were minimal except in the case of the proportion of
individuals who lived alone. CONCLUSIONS: The sample used in the J-NNS is
generally representative of the entire Japanese population with the exception of
individuals in single-person households.
Publication Types:

55: Int J Med Inform. 2005 Jul;74(6):447-59.
Internet use by a referral gastroenterology clinic population and

their medical information preferences.
Roshandel D, Rezailashkajani M, Ansari S, Zali MR.
Research Center for Gastroenterology and Liver Diseases, Shaheed Beheshti

University of Medical Sciences, Tehran, Iran. delnaz53@yahoo.com
BACKGROUND: Internet use is growing rapidly in Iran. However, little is

known about the rate of Internet access and Internet use habits of gastroenterology
patients and their health information preferences in the country. METHODS: A
two-part questionnaire was presented to a convenience sample of 401 consecutive
outpatients (mean age: 43.7 years) of a referral gastroenterology clinic in Tehran
from February 21 to March 13, 2004. RESULTS: Of all literate patients (92%),
62% self-estimated their disease-related knowledge as nothing to little. The most
common sources of information were media (62%) and printed materials (58%).
Printed material (57%) and media (35%) were the most preferred means of
receiving health information; the Internet was the most preferred means among
Internet users and almost all of them were interested in getting online medical
services. The cause (65%) and treatment (56%) of disease were the most favorite
knowledge topics. Of all patients 28% could use Internet. Males, more educated
and younger subjects were more likely to use the Internet. Of the Internet users,
37% had already performed at least one search for medical information.
CONCLUSION: Though Internet is not yet a popular means of patient education
in Iran, considering the speedy growth of Internet use and its undeniable
advantages and prospects in a young country like Iran, it seems wise for private
and public health sectors to start more vigorous planning to develop web-based
patient education systems run by trusted bodies and encourage and cultivate its
use among patients.
Publication Types:

56: BMC Public Health. 2005 Jun 4;5(1):59.
Measles vaccine coverage and factors related to uncompleted

vaccination among 18-month-old and 36-month-old children in
Kyoto, Japan.
Matsumura T, Nakayama T, Okamoto S, Ito H.

Kyoto, Japan. takayo-m@mbox.kyoto-inet.or.jp
BACKGROUND: Due to low vaccine coverage, Japan has not only experienced
outbreaks of measles but has also been exporting it overseas. This study aims to
survey measles vaccine coverage and the factors uncompleted vaccination among
community-living children. METHODS: Subjects were the parents whose
children had undergone either an 18-month or a 36-month checkup publicly
provided by Kyoto City during November 2001 to January 2002. An anonymous
self-administered questionnaire survey was conducted. RESULTS: The coverage
was 73.2% among the 18-month-old children (n = 2707) and 88.9% among the
36-month-old children (n = 2340), respectively. The following characteristics of
mothers were related to uncompleted measles vaccination: aged below 30,
working, concerned about the adverse events of the vaccine, and had insufficient
knowledge. Similarly, the following characteristics among children were related
to uncompleted measles vaccination: not the first-born child, interacting with
other children in group settings. The coverage was the lowest among the children
whose mothers were concerned about the adverse events of the vaccine without
proper knowledge of measles and its vaccination. CONCLUSION: To increase
vaccine coverage among children, parents' awareness about measles and
vaccination against it should be promoted, especially for working mothers. Efforts
to enhance access to vaccination services and to communicate with parents about
changing vaccination schedules are necessary.
PMCID: PMC1177963
57: J Med Syst. 2005 Apr;29(2):125-41.

The state of medical informatics in India: a roadmap for optimal

organization.
Sarbadhikari SN.
Amrita Vishwa Vidyapeetham, Ettimadai, Coimbatore 641105, India.

supten@amrita.edu
In India, the healthcare delivery systems are based on manual record keeping
despite a good telecommunication infrastructure. Unfortunately, Indian policy
makers are yet to realize the importance of medical informatics (including tele-
health, which comprises e-Health and Telemedicine) in delivering healthcare. In
the medical curriculum also, nowhere is this treated as a subject or even as a tool
for learning. The final aim of most of the medical and paramedical students
should be to become good users, and if possible, also experts for advancing
medical knowledge base through medical informatics. In view of the fast
changing world of medical informatics, it is essential to formulate a flexible
syllabus rather than a rigid one for incorporating into the regular curriculum of
medical and paramedical education. Only after that one may expect all members
of the healthcare delivery systems to adopt and apply medical informatics
optimally as a routine tool for their services.

58: Methods Inf Med. 2005;44(2):310-4.
Health Risk Appraisal using Internet technology.
Suka M, Yoshida K.
Department of Preventive Medicine, St. Marianna University School of Medicine,

2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan.
suka@marianna-u.ac.jp
OBJECTIVE: To develop a Web-based Health Risk Appraisal (HRA) system as a

tool for health education based on personal health examination data. METHODS:
A Japanese health examination database was analyzed to develop models for
HRA, which were designed to predict each of ten laboratory values in a year with
and without lifestyle modifications. The HRA models were embedded into a
server. RESULTS: The Web-based HRA system has been introduced into a
Japanese health care association having 37 branch centers. Following a health
examination, an individual health education program using the Web-based HRA
system is provided to a given client at each branch center or at a client's office. A
measured laboratory value and corresponding predicted laboratory values in a
year with and without lifestyle modifications are displayed on the screen in forms
of both numerical values and graphs. A trained nurse or another health care
provider operates the system and explains the HRA result. CONCLUSION: The
Web-based HRA system will be a practical tool for individual health education
following health examination.
Publication Types:

59: Methods Inf Med. 2005;44(2):293-8.
The SARS epidemic in Hong Kong--a human calamity in the 21st

century.
Lee SH.
Community Medicine, The Chinese University of Hong Kong, Centre for Health
Education and Health Promotion, 4th Floor, Lek Yuen Health Centre, 9 Lek Yuen
Street, Shatin, New Territories, Hong Kong, China. shlee@cuhk.edu.hk
PURPOSE: This paper reviews the epidemiology and control measures of the
SARS epidemic in Hong Kong. It sets out proposals for better preparedness to
tackle the disease in future. BACKGROUND: Severe Acute Respiratory
Syndrome (SARS) started to strike Hong Kong in March 2003. A total of 1,755
SARS cases with 298 deaths were reported. Prior to the occurrence of the disease
in Hong Kong, an intense outbreak of atypical pneumonia was reported in the
nearby Guangdong Province in Mainland China. RESULTS: There were three
phases in the epidemic. The first phase in March 2003 involved a teaching
hospital. The infection originated from a visiting professor from Guangdong, He
developed SARS in Hong Kong and died in a Hong Kong hospital. The second
phase in April was the spread of the infection from the hospital to the community.
The third phase in May was the declining period which ended in June following
the removal of Hong Kong from the list of infected areas by WHO.
CONCLUSION: Hong Kong was ill-prepared at the early stage of the epidemic.
The epidemic produced not only health but also social, economic and
humanitarian problems. The epidemic, however, created a strong sense of unity
among all sectors of the population in the fight against the disease.

60: Southeast Asian J Trop Med Public Health. 2004 Sep;35(3):711-6.
Pneumonia surveillance in Thailand: current practice and future

needs.
Kanlayanaphotporn J, Brady MA, Chantate P, Chantra S, Siasiriwattana S,

Dowell SF, Olsen SJ.
Bureau of Epidmemiology, Ministry of Public Health, Nonthaburi, Thailand.

jirapat@health.moph.go.th
We reviewed reported pneumonia cases and deaths in Thailand since 1975 to

evaluate the pneumonia surveillance system. In Sa Kaeo Province, we analyzed 3
years in detail (1999--2001) from electronic surveillance data, and compared
deaths reported through surveillance to death certificate data in 1999 and 2000. In
addition, we interviewed surveillance personnel who collected the data from all 7
hospitals and from a 10% random sample of health centers. Since the mid-1980s,
reported illnesses and deaths from pneumonia have been increasing. In Sa Kaeo,
an average of 925 pneumonia cases were reported each year, for an estimated
average annual incidence of 211 per 100,000. The age-specific incidence peaked
at 1,418 per 100,000 in children less than 5 years. In 1999 and 2000, there were 7
and 6 pneumonia deaths, respectively, reported through the surveillance system,
compared with 28 and 53, respectively, reported by death certificate. Sixty-two
(82%) of the 72 surveillance personnel reported receiving some training, but most
of this was informal. Although written criteria to diagnose pneumonia were
established in 1996, those who report cases did not know these criteria. A
combination of physician, nurse, and public health workers diagnoses were used.
According to the written criteria, cases of suspect or rule out pneumonia should be
reported, but when asked about specific examples only 79% of persons
interviewed said they would report "tuberculosis with pneumonia" and 44%
would report "bronchitis, rule out pneumonia." Seventy-four percent of persons
interviewed completed the surveillance report within one day of patient
admission.

61: J Nurs Res. 2004 Sep;12(3):227-36.
The development of intelligent, triage-based, mass-gathering

emergency medical service PDA support systems.
Chang P, Hsu YS, Tzeng YM, Sang YY, Hou IC, Kao WF.

University, ROC. Polun@ym.edu.tw
The support systems for the Emergency Medical Services (EMS) at mass
gatherings, such as the local marathon or large international baseball games, are
underdeveloped. The purposes of this study were to extend well-developed,
triage-based, EMS Personal Digital Assistant (PDA) support systems to cover pre-
hospital emergency medical services and onsite evaluation forms for the mass
gatherings, and to evaluate users ' perceived ease of use and usefulness of the
systems in terms of Davis ' Technology Acceptance Model (TAM). The systems
were developed based on an established intelligent triage PDA support system and
two other forms the general EMS form from the Taipei EMT and the customer-
made Mass Gathering Medical form used by a medical center. Twenty-three
nurses and six physicians in the medical center, who had served at mass
gatherings, were invited to examine the new systems and answer the TAM
questionnaire. The PDA systems were composed of 450 information items within
42 screens in 6 categories. The results supported the potential for using triage-
based PDA systems at mass gatherings. Overall, most of the subjects agreed that
the systems were easy to use and useful for mass gatherings, and they were
willing to accept the systems.
Publication Types:

62: J Nurs Res. 2004 Sep;12(3):213-26.
Important computer competencies for the nursing profession.
Jiang WW, Chen W, Chen YC.
Department of Information Management, National Taipei College of Nursing,

ROC. jiang6@ntcn.edu.tw
Nursing requires computer competencies. This study aimed at identifying those

competencies required for the nursing profession in Taiwan. The Delphi technique
was deployed in this study. In the Delphi questionnaires, computer competencies
were sorted into seven domains: concepts of hardware, software, and networks;
principles of computer applications; skills of computer usage; program design;
limitations of the computer; personal and social issues; attitudes toward the
computer. In three Delphi questionnaires, nursing informatics experts gave us
their opinions on the importance of each computer competency for the nursing
profession. The experts also designated when the competency should be
cultivated. This study provides a comprehensive list for nursing professionals to
check on their computer competence. The results of this study should also serve
as good references for teachers and schools in designing related curriculums.
Publication Types:

Differences in the effects of filters on health information retrieval

from the Internet in three languages from three countries: a
comparative study.
Su KC, Waldren SE, Patrick TB.
Department of Health Management and Informatics, School of Medicine,

University of Missouri-Columbia, 62111, USA. sukui@missouri.edu
We selected twenty search terms on woman's health from various sources and
tested them on Google, once with strict filter on and once with filter off. Searches
were specified to three countries (Mainland China, Germany, USA), in three
languages (Simplified Chinese, German, US English). We found that the
proportion of relevant women's health web sites that were blocked was quite high.
For the Chinese language web sites originated in China, 72.6% of the blocked
web sites were relevant. For the German language web sites originated in
Germany, nearly half (49.4%) were relevant. For the US English web sites
originated in the US, 95% were relevant. We concluded that people might
unknowingly miss potentially important health information due to information
filtering.
Publication Types:
• Comparative Study
• Research Support, N.I.H., Extramural
• Research Support, U.S. Gov't, P.H.S.

64: Zhonghua Liu Xing Bing Xue Za Zhi. 2004 May;25(5):403-6.
[Role of mass media during the severe acute respiratory syndrome

epidemic]
[Article in Chinese]
Zhang SX, Jiang LJ, Zhang QW, Pan JJ, Wang WY.
Shenzhen Center for Disease Control and Prevention, Shenzhen 518020, China.
OBJECTIVE: To understand the impact of effective interaction between public

and media on the prevention and control of severe acute respiratory syndrome
(SARS). METHODS: Based on the theory of field epidemiology, the traditional
and modern technologies were brought forward. In the late period of SARS
epidemic, investigation on knowledge, attitude and practice on SARS prevention
and control among general population was conducted. RESULTS: During the 3
month period of SARS epidemic in Shenzhen, techniques of the "E-health and
public health informatics" as an emerging fields were used to focus on population
to eventually improve the health of entire population. Methods as television,
radio, newspapers, magazines, printing and distribution of specific materials on
SARS were included, and hotlines of telephone and mobile phone, web-based
sites, electronic screening advertisements, and consultation or forum for the
public etc. were used. Among 3405 subjects interviewed, more than 95% gave
right answers on the SARS related questions. Most of them held the optimistic
and scientific attitude. 80% of the population had taken the measures as
recommended. 82.4% of the citizens were happy about the local government's
action and 93.8% thought hospitals and healthcare workers should be respected
and honored. CONCLUSION: Dealing with the urgent public health problems
and emerging infectious diseases outbreak, epidemiologists need to keep good
relations with media, and making use of modern electronic technologies to
communicate with the public.
Publication Types:

65: Korean J Gastroenterol. 2004 Jun;43(6):370-5.
[Telemedicine with digital video transport system]
[Article in Korean]
Hahm JS, Shimizu S, Nakashima N, Byun TJ, Lee HL, Choi HS, Ko Y, Lee
KG, Kim SI, Kim TE, Yun J, Park YJ.
Department of Internal Medicine, Hanyang University College of Medicine,

Seoul, Korea. hamjs@hanyang.ac.kr
BACKGROUND/AIMS: The growth of technology based on internet protocol

has affected on the informatics and automatic controls of medical fields. The aim
of this study was to establish the telemedical educational system by developing
the high quality image transfer using the DVTS (digital video transmission
system) on the high-speed internet network. METHODS: Using telemedicine, we
were able to send surgical images not only to domestic areas but also to
international area. Moreover, we could discuss the condition of surgical
procedures in the operation room and seminar room. The Korean-Japan cable
network (KJCN) was structured in the submarine between Busan and Fukuoka.
On the other hand, the Korea advanced research network (KOREN) was used to
connect between Busan and Seoul. To link the image between the Hanyang
University Hospital in Seoul and Kyushu University Hospital in Japan, we started
teleconference system and recorded image-streaming system with DVTS on the
circumstance with IPv4 network. RESULTS: Two operative cases were
transmitted successfully. We could keep enough bandwidth of 60 Mbps for two-
line transmission. The quality of transmitted moving image had no frame loss
with the rate 30 per second. The sound was also clear and the time delay was less
than 0.3 sec. CONCLUSIONS: Our study has demonstrated the feasibility of
domestic and international telemedicine. We have established an international
medical network with high-quality video transmission over internet protocol. It is
easy to perform, reliable, and also economical. Thus, it will be a promising tool in
remote medicine for worldwide telemedical communication in the future.
Publication Types:

66: Med Teach. 2004 Jun;26(4):295-8.
How we derived a core curriculum: from institutional to national--

Ankara University experience.
Kemahli S, Dökmeci F, Palaoğlu O, Aktuğ T, Arda B, Demirel-YIlmaz E,

Karahan T, Ozyurda F, Akan H, Ayhan IH.
Department of Medical Education and Informatics, Faculty of Medicine, Ankara

University, Ankara, Turkey. kemahli@medicine.ankara.edu.tr
As the first phase of a major curricular change in a large medical school the core
curriculum had to be determined. The criteria for the inclusion of topics in the
core curriculum were defined for both clinical and basic sciences. A large group
of faculty members have worked in 11 sub-groups to determine the core
knowledge, skills and attitudes for undergraduate medical students. During this
work 608 clinical topics have been reviewed. Four-hundred and eighty five of
them (79%) have been included in the core curriculum. Clinical and basic science
knowledge, skills and attitudes relevant to these topics have been defined and
classified. A total of 1610 cognitive, 428 psychomotor skills and 247 attitudes
have been named. Thus the core curriculum defined is not just a set of diseases,
conditions and symptoms but also includes the details of each and every topic.
Starting from this point the medical school has participated actively in defining
the national core curriculum, which has also been determined according to the
same criteria.

67: J Korean Med Sci. 2004 Jun;19(3):364-8.
Assessing the quality and contents of asthma-related information on

the Korean internet as an educational material for patients.
Park HW, Min KU, Kim YY, Cho SH.
Department of Internal Medicine, National Rehabilitation Hospital, Seoul, Korea.
Despite the substantial amount of asthma-related information available on the

internet, little is known about the quality of such information. We assessed
asthma-related information on the Korean internet intended as an educational
material for asthma patients. By entering the key word, 'asthma', into 4 popular
search engines, 32 web sites were identified and categorized with respect to
authorship. The core asthma educational concepts and Health On the Net Code of
Conduct principles were used to evaluate informational value and justifiability of
unreliable information. Eight of 32 web sites were categorized as western
physician, seventeen as oriental physician, four as commercial, and three as
others. The mean number of core asthma educational concepts on the whole web
sites was 2.7 out of 8. By type of authorship, 1.7 on the commercial sites, 2.1 on
the oriental physician sites, 3.5 on the western physician sites, and 5.0 on the
others sites in decreasing order. One of the western physician sites, two of the
commercial sites, and all of the oriental physician and others sites contained
unreliable information. However all of them except one site failed to satisfy our
criteria of justifiability. Asthma-related information currently available on the
Korean internet is highly variable in quality and lacks core asthma educational
concepts and justifiability.

68: Rinsho Byori. 2004 Apr;52(4):307-11.
Postgraduate education in laboratory medicine and certification/re-

certification of clinical pathologists in Taiwan.
Sun CF.
Department of Pathology, Chang Gung Memorial Hospital, Taipei, Taiwan.
The Taiwan Society of Clinical Pathologists (TSCP) plays a central role in

postgraduate education of laboratory medicine and the certification/re-
certification of clinical pathologists in Taiwan. For the certification of clinical
pathologists, TSCP establishes "Guidelines and Scope of Resident Training" and
"Standards for Training Hospitals in Clinical Pathology(CP)", administers board
examinations, and issues board certifications/re-certifications. There are two types
of CP resident training programs, including a straight CP program with 3 years of
CP training for a CP certificate and a combined program with 3 years of Anatomic
Pathology training and 2 years of CP training for both the CP and AP certificates.
The core curriculum for CP training includes: (1) Clinical Chemistry (at least 4
months), (2) Clinical Microscope with Parasitology (at least 3 months), (3)
Clinical Hematology (at least 4 months), and (4) Clinical Microbiology with
Clinical Virology (at least 4 months), (5) Immunohematology and Blood Banking
(Transfusion Medicine) (at least 3 months), (6) Clinical Serology and
Immunology(at least 4 months), and (7) Laboratory Management (at least 2
months). The curriculum for third-year training is not specified and may be in any
field. In recent years, the board examination has emphasized the topics of
Molecular Biology and Laboratory Informatics. The TSCP has also established an
accreditation and inspection program for the CP resident raining hospitals. Each
accredited CP training hospital is required to have a detailed teaching protocol of
CP training. Quotas are assigned according to the available CPs of the accredited
hospitals. The accreditation period is 3 years. Through sponsoring scientific and
educational programs, the TSCP offers credit hours of education in laboratory
medicine, which are required for re-certification of CPs in Taiwan. The members
of the TSCP meet at least twice a year for scientific presentations and seminars. In
addition, two to four symposia, offering 8 credit hours each, are held each year in
various subspecialties of CP. In 2003, 22 hospitals were accredited as CP training
hospitals for a total quota of 26. Until 2003, the TSCP had certified 116 CPs. At
the present time, only 103 certified CPs are actively practicing laboratory
medicine. Re-certification requires 100 credit hours of continuing education. The
requirements for board certification and re-certification are the two main driving
forces for CPs in Taiwan to seek continuing education. Our model of education
for CPs has proven to be effective. The number of practicing CPs increased from
21 (one per 3,083 beds) in 1991 to 103 (one per 929 beds) in 2002. Most of the
CPs are associated with medical centers(62/103, 60.2%) and regional
hospitals(38/103, 36.9%).
Publication Types:
• Lectures

69: BMJ. 2004 May 15;328(7449):1193-6.
Digital bridges need concrete foundations: lessons from the Health

InterNetwork India.
Kuruvilla S, Dzenowagis J, Pleasant A, Dwivedi R, Murthy N, Samuel R,

Scholtz M.
Health InterNetwork, World Health Organization, 1211 Geneva, Switzerland.
Publication Types:
PMCID: PMC411107
70: Int J Med Inform. 2004 May;73(4):383-9.
Development and evaluation of an integrated pharmaceutical

education system.
Liu CT, Yeh YT, Chiang IJ, Chen HY, Lee TI, Chiu WT.
Graduate Institute of Medical Informatics, Taipei Medical University, 250 Wu-

Xing Street, Taipei, Taiwan. ctliu@tmu.edu.tw
There is increasing evidence that patient safety can be improved by the

introduction of an integrated computer-based medical care system in hospital
settings. In this paper, we describe an integrated pharmaceutical information
system (IPIS) in which a patient's profile including his/her medication records and
prescriptions are collected from physician order entry systems and pharmaceutical
systems along with the history of patient care in the hospital. Based on an
individual patient's profile the IPIS can provide pharmaceutical education
information specifically to meet the patient's needs. The IPIS has been developed
and installed at Taipei Medical University Wanfang Hospital (TMUWFH) since
July 2002. Evaluation of the system showed that it can help patients to effectively
acquire drug information. This enables them to have a much better understanding
of the pharmacological properties of the medicines they are taking, including
adverse drug reactions and side-effects. In our opinion the system has the
potential to improve both patient safety and treatment outcomes.
Publication Types:

Comment in:
• Natl Med J India. 2004 Jan-Feb;17(1):5-7.
Computer use among medical students in an institution in southern

India.
Inamdar SC, Rotti SB.

Department of Preventive and Social Medicine, Jawaharlal Institute of
Postgraduate Medical Education and Research, Pondicherry 605006, India.
BACKGROUND: This cross-sectional, descriptive study was conducted in

Pondicherry from May to October 2002 to assess computer and internet use
among medical students. METHODS: The participants were four batches of
undergraduate students, one batch of interns and two batches of postgraduate
students. A pre-tested questionnaire was used to collect data from 394 subjects.
Written informed consent was obtained from all the participants. RESULTS:
Computer knowledge was found to be higher among postgraduates (93.3%)
compared to undergraduates (84.5%). Students learnt computers by self-learning,
attending classes and using manuals. Writing letters was the most common use of
the computer (postgraduates [100%] and undergraduates [87.5%]). Seventy-one
per cent of the postgraduates and 43% of the undergraduates used English
language dictionaries. About 61% of the undergraduates used computers for
playing games. Students also used computer for watching movies. MS Office was
the most commonly used software (postgraduates [100%] and undergraduates
[72.2%]). The use of software for visual designing and drawing was low.
Undergraduates used audio players more often than postgraduates. Most students
used the internet for e-mail (postgraduates [100%] and undergraduates [97.3%]).
Undergraduate students used the internet for chatting and entertainment. Online
banking was also used to some extent. Most of the students were willing to
undergo training. All the groups unanimously felt that the institute should provide
free training in medical informatics. CONCLUSION: This study revealed high
computer use among medical students in an institution with good computer
facilities. The majority expressed their willingness to undergo further training.
Publication Types:

Comment on:
• Natl Med J India. 2004 Jan-Feb;17(1):8-10.
Information technology and medical education in India.
Aggarwal R, Pandey R.
Publication Types:
• Comment
• Editorial

73: BMJ. 2004 Apr 3;328(7443):839.
South Asian health: what is to be done? Skills of evidence based

medicine need to be taught.
Chryssafidou E, Arvanitis TN, Khan KS, Coomarasamy A.
Publication Types:
• Letter
PMCID: PMC383391

Clinicians' perceptions and the relevant computer-based

information needs towards the practice of evidence based medicine.
Jiang G, Ogasawara K, Endoh A, Sakurai T.
Department of Medical Informatics, Hokkaido University Graduate School of

Medicine, Sapporo, Japan.
We conducted a survey among 100 clinicians in a university hospital to determine

the clinician's attitudes and the relevant computer-based information needs
towards the practice of evidence-based medicine in outpatient setting.
PMCID: PMC1480090
Critically Appraised Topics (CAT) peer-to-peer network.
Castro J, Wolf F, Karras B, Tolentino H, Marcelo A, Maramba I.
Medical Education and Biomedical Informatics, University of Washington,

Seattle, WA, USA.
A peer-to-peer network of Critically Appraised Topics or CATs would allow

sharing of relevant clinical information regarding specific clinical problems
among physicians. This proposed network would enable clinicians to develop and
share CATs to other users within the network. This poster describes a proposed
implementation of a peer-to-peer internet based sharing of critically appraised
topics in the Philippines.
PMCID: PMC1480064
76: Soc Sci Med. 2003 Nov;57(10):1925-37.

Strengthening capacity in developing countries for evidence-based

public health: the data for decision-making project.
Pappaioanou M, Malison M, Wilkins K, Otto B, Goodman RA, Churchill

RE, White M, Thacker SB.
Office of Global Health, Mailstop D-69, 1600 Clifton Road, Atlanta, GA 30333,
USA. mxp1@cdc.gov
Public health officials and the communities they serve need to: identify priority
health problems; formulate effective health policies; respond to public health
emergencies; select, implement, and evaluate cost-effective interventions to
prevent and control disease and injury; and allocate human and financial
resources. Despite agreement that rational, data-based decisions will lead to
improved health outcomes, many public health decisions appear to be made
intuitively or politically. During 1991-1996, the US Centers for Disease Control
and Prevention implemented the US Agency for International Development
funded Data for Decision-Making (DDM) Project. DDM goals were to: (a)
strengthen the capacity of decision makers to identify data needs for solving
problems and to interpret and use data appropriately for public health decisions;
(b) enhance the capacity of technical advisors to provide valid, essential, and
timely data to decision makers clearly and effectively; and (c) strengthen health
information systems (HISs) to facilitate the collection, analysis, reporting,
presentation, and use of data at local, district, regional, and national levels.
Assessments were conducted to identify important health problems, problem-
driven implementation plans with data-based solutions as objectives were
developed, interdisciplinary, in-service training programs for mid-level policy
makers, program managers, and technical advisors in applied epidemiology,
management and leadership, communications, economic evaluation, and HISs
were designed and implemented, national staff were trained in the refinement of
HISs to improve access to essential data from multiple sources, and the
effectiveness of the strategy was evaluated. This strategy was tested in Bolivia,
Cameroon, Mexico, and the Philippines, where decentralization of health services
led to a need to strengthen the capacity of policy makers and health officers at
sub-national levels to use information more effectively. Results showed that the
DDM strategy improved evidence-based public health. Subsequently, DDM
concepts and practices have been institutionalized in participating countries and at
CDC.
Publication Types:
• Research Support, U.S. Gov't, Non-P.H.S.

77: Igaku Butsuri. 2003;23(1):4-15.
Related Articles
[Development of telepathology systems between different types of

terminals based on the standard for image collaboration command
protocol]
Tofukuji I, Nakagawa S, Suzuki A, Saito M, Hara S, Tsuchihashi Y, Shiraishi

T, Ooshiro M, Sawai T, Kaihara S.
Product Development Department, Diagnostic Equipment Division Olympus

Optical Co., Ltd. ikuo_tofukugi@ot.olympus.co.jp
In Japan telepathology systems have been developed in medical or pathological

environment such as a shortage and an uneven distribution of pathologists. More
than 100 telepathology terminals are working mainly for intraoperative quick
diagnosis. They cannot communicate with different types each other. In March
2000 the Medical Information System Development Center(MEDIS-DC)
successfully demonstrated the interconnection between different types of
telepathology terminals based on the Standard for Image Collaboration Command
Protocol (SICCP). Nikon, NTTdata and Olympus had joined the development. In
February 2002 MEDIS-DC examined these systems for pathological consultations
in the fields of Okinawa-Kyoto, Kyoto-Mie and Mie-Okinawa. These successful
examinations let us know that telepathology systems need new observation
methodologies for telecytology and teleconsultation in addition to the flow for
intraoperative quick diagnosis, new GUI guidelines for telepathology terminal
design and, education and support for users of their smooth operation. Outcomes
of MEDIS-DC activities encourageed us to challenge the next generation
telepathology. We found some new trends in telepathology or pathology
informatics such as virtual slide technologies and the internet applications in US
and Europe. In order to keep Japanese priority, MEDIS-DC telepathology
comittee has started investigations to construct a strategy for development of
Japanese next generation telepathology.
Publication Types:
• Review

78: Rinsho Byori. 2003 May;51(5):476-9.
[Fundamental curriculum in University Education of Medical

Technologists: special practice for clinical medicine and
biotechnology]
Yorifuji S.
Department of Laboratory Sciences, School of Allied Health Science, Faculty of

Medicine, Osaka University, Suita 565-0871.
This is the summary of my talk about the new concept of education for medical
technologists. In Osaka University, the course for laboratory medicine changed
from a 3-year to a 4-year training course, and our faculty started a new curriculum
of special practice in clinical medicine and biotechnology for first-year
undergraduate students from 1997. This special practice in clinical medicine
consists of three parts, encompassing learning in the essential divisions of the
hospital, bedside learning, and presentation in case conferences. Students visit
from time to time to seven divisions, outpatients' clinic, surgical operation room,
laboratory for radiological examination, rehabilitation rooms, pharmacy, central
storage room for medical records, and the department of medical informatics. The
aim of this round practice is to broaden their review of clinical medicine. They
also go to the bed side of one patient in the ward for 4 weeks especially for
learning about values of laboratory data. They follow up the laboratory data and
go with the patient to clinical physiological examinations. Finally, they present
their case to all their teachers and class mates in a semi-congress style and are
evaluated with scores by the staffs.
Publication Types:

Graduate students' experiences in web site development: a project

assignment for nursing informatics class.
Kim J.
Yonsei University College of Nursing, Seoul, Korea. jekim@yumc.yonsei.ac.kr
As healthcare delivery systems' requirements change, nurses will not only have to
process and communicate more information, but the nature and types of this
information as well as the communication methods will also dramatically change.
Nurses must comprehend that information technology is the key to these changes.
Korean nurses and nursing students need to enhance their computer technology
knowledge and skills as the Korean health delivery system rapidly embraces
technological innovations. Yonsei University College of Nursing in Seoul, Korea
has the longest history in nursing education and the first graduate nursing
programs in Korea. It offered its first nursing informatics (NI) class in 1998,
making it one of the first informatics programs in Korean nursing education. The
purposes of this project were to develop nursing informatics coursework that
enabled students to build skills in developing Web sites, and to measure the effect
of the coursework in terms of the students' satisfaction and their confidence level.
The author believes that this experience could be a helpful model for an
international audience, although this is not an innovative project for some more
advanced countries.
Publication Types:

80: Southeast Asian J Trop Med Public Health. 2002;33 Suppl 2:86-90.
Clinical pathologist in Korea--training program and its roles in

laboratories.
Cho HI, Lee KN, Park JW, Park H, Kwak YS.
Department of Clinical Pathology, Seoul National University Hospital, Seoul,

Korea.
A rapid development of practice of laboratory medicine in Korea owes its success

to the clinical pathologists (CP), who have played a role of a pathfinder for
laboratories. The Korean CP postgraduate education (residency) program is
unique in that it is exclusively for laboratory medicine. The training program for
clinical pathologists includes diagnostic hematology, diagnostic immunology,
clinical microbiology, clinical chemistry, blood bank, diagnostic genetics,
informatics and laboratory management. The program has produced a strong
group of about 600 laboratory physicians, officially clinical pathologists since
1963. Most of Korean clinical pathologists work as laboratory directors, directors
of university hospital laboratories or teaching faculty members in medical
schools. The roles of clinical pathologists are laboratory management,
interpretation of laboratory test results, clinical consulting services to clinicians
and patients, ordering secondary tests after reviews of requested test results and
utilization management. The clinical pathologists have developed clinical
laboratories to be a main contributor for improved medical practice. During the
last 40 years under the turbulent healthcare system, clinical pathologists have
significantly contributed to safeguard the laboratory interests. The education
program and the role of clinical pathologists are described.

81: BJOG. 2003 May;110(5):500-7.
Pathways to evidence-based reproductive healthcare in developing

countries.
Geyoushi BE, Matthews Z, Stones RW.
Opportunities and Choices Reproductive Health Research Programme, University

of Southampton, UK.
OBJECTIVE: Developing country clinicians are aware of the discourse of

evidence-based medicine but heavily constrained in their ability to access and
apply new knowledge. This study aimed to obtain primary descriptive data about
access to and application of reproductive health-related medical knowledge in
developing countries. DESIGN: Qualitative study using semi-structured
interviews. SETTING: India and Yemen. SAMPLE: Forty-one doctors working in
obstetrics, gynaecology, general practice and family planning services.
METHODS: Interviews were tape recorded and transcribed verbatim. A theory-
driven approach was conducted to carry out thematic analysis. MAIN
OUTCOME MEASURES: Descriptions of experiences, attitudes and needs.
RESULTS: Doctors felt the need to update their knowledge but this was not
always achieved due to time and financial constraints. Alternative knowledge
sources were described including the Internet, scientific meetings, medical family
networks and speciality medical societies but access to these was limited by the
expense of equipment, unfamiliarity with the technology and restricted
advertisement of scientific meetings and conferences. Institutional hierarchy and
conflict of generations were identified as barriers to change. Demoralisation was a
common obstacle. On the positive side, involvement in medical education was a
powerful driver for seeking new knowledge and applying research evidence to
clinical practice. CONCLUSIONS: Priorities are to identify needs specific to
different countries and medical settings in the developing world, access for all to
full text journals and educational activities that fully engage practitioners in the
early stages of their careers. Clinical teachers are the nodal group with the
strongest incentive to obtain and use new knowledge.
Publication Types:

82: Med J Malaysia. 2002 Dec;57 Suppl E:58-66.
Utilization of information technology in medical education: a

questionnaire survey of students in a Malaysian institution.
Nurjahan MI, Lim TA, Yeong SW, Foong AL, Ware J.
Section of Family Medicine, International Medical University, Kuala Lumpur.
OBJECTIVE: The objective of this survey was to obtain a self-reported

assessment of the use of Information and Communication Technology (ICT) by
medical students at the International Medical University, Malaysia. MATERIALS
AND METHODS: Students' perceived skills and extent of usage of ICT were
evaluated using a questionnaire. Chi-square analysis were performed to ascertain
the association between variables. Further statistical testing using Chi-square test
for trend was done when one of the variables was ordered, and Spearman rank
correlation when both variables were ordered. RESULTS: Overall, (98%) of
students responded to the questionnaire. Twenty seven students (5.7%) did not use
a computer either in the university or at home. Most students surveyed reported
adequate skills at word processing (55%), e-mailing (78%) and surfing the
internet (67%). CONCLUSION: The results suggests that in order to increase the
level of computer literacy among medical students, positive steps would need to
be taken, for example the formal inclusion of ICT instruction in the teaching of
undergraduate medicine. This will enhance medical students' ability to acquire,
appraise, and use information in order to solve clinical and other problems
quickly and efficiently in the course of their studies, and more importantly when
they graduate.

83: J Nutr Sci Vitaminol (Tokyo). 2002 Oct;48(5):423-32.
National Nutrition Survey in Japan--its methodological transition

and current findings.
Katanoda K, Matsumura Y.
Division of Health Informatics and Education, National Institute of Health &

Nutrition, 1-23-1 Toyama, Shinjuku-ku, Tokyo 162-8636, Japan.
The National Nutrition Survey in Japan (J-NNS), an annual nationwide survey on

nutrition and diet of the Japanese people, is reviewed. J-NNS was started in the
Tokyo Metropolitan area in 1945 following the end of World War II. The survey
area was gradually expanded and became nationwide in 1948. The current survey
obtains data from more than 12,000 persons of approximately 5,000 randomly
selected households. The survey consists of three parts: a physical examination, a
dietary intake survey and a dietary habit questionnaire. The physical examination
includes anthropometric measurements and a blood test, the dietary intake survey
examines nutrient/food intake with a semi-weighed recording method, and the
dietary habit questionnaire monitors nutrition/diet-consciousness and dietary
habits. In this review, the aim and brief history of the survey are outlined in the
first section. The following section, explains its administrative framework, target
population, sampling method, annual schedule and question items, focusing on
their historical transition. Then the findings of the J-NNS are summarized, which
highlights annual changes in the intake of energy, macronutrients, micronutrients
and food groups. The current findings of the dietary habit questionnaire are also
given in brief.
Publication Types:
• Review
84: Asia Pac J Public Health. 2002;14(1):35-9.
Changing emphases in public health and medical education in health

care reform.
Patrick WK, Cadman EC.
WHO Collaborating Center for Leadership Development, International Health &

Medicine.
Globalisation of economies, diseases and disasters with poverty, emerging

infectious diseases, ageing and chronic conditions, violence and terrorism has
begun to change the face of public health and medical education. Escalating costs
of care and increasing poverty have brought urgency to professional training to
improve efficiency, cut costs and maintain gains in life expectancy and morbidity
reduction. Technology, genetics research and designer drugs have dramatically
changed medical practice. Creatively, educational institutions have adopted the
use of: (1) New educational and communication technologies: internet and health
informatics; (2) Problem based learning approaches; Integrated Practice and
Theory Curricula; Research and Problem Solving methodologies and (3)
Partnership and networking of institutions to synergise new trends (e.g. core
competencies). Less desirably, changes are inadequate in key areas, e.g., Health
Economics, Poverty and Health Development, Disaster Management &
Bioterrorism and Ethics. Institutions have begun to adjust and develop new
programs of study to meet challenges of emerging diseases, design methodologies
to better understand complex social and economic determinants of disease, assess
the effects of violence and address cost containment strategies in health. Besides
redesigning instruction, professional schools need to conduct research to assess
the impact of health reform. Such studies will serve as sentinels for the public's
health, and provide key indicators for improvements in training, service provision
and policy.
Publication Types:
• Review

85: Trop Doct. 2003 Jan;33(1):41-2.
Healthcare workers' knowledge of lymphatic filariasis and its

control in an endemic area of Eastern India: implications on control
programme.
Babu BV, Satyanarayana K.
Division of Epidemiology & Informatics, Regional Medical Research Centre,

Indian Council of Medical Research, Bhubaneswar-751 023, India.
babuv@satyam.net.in

86: Int J Med Inform. 2003 Jan;69(1):57-62.
International distance-learning outreach: the APEC EINet

experience.
Kimball AM, Shih L, Brown J, Harris TG, Pautler N, Jamieson RW, Bolles J,
Horwitch C.
Department of Health Services, University of Washington, Seattle, WA, USA.

akimball@u.washington.edu
BACKGROUND: The Emerging Infections Network is a mature electronic

network that links Public Health professionals in the Asia Pacific through regular
e-mail bulletins and an extensive Web site (http://www.apec.org/infectious).
Emerging infections is a new area of study; learning materials help foster
education. Our objective is to quantify the response of the network to the
introduction of distance-learning materials on the Web site. METHODS:
Distance-learning materials, developed by the University of Washington School
of Public Health, were field tested and launched on the site. Publicity was carried
out prior to the launch of the materials. Access was tracked prospectively using
server counts of page downloads. RESULTS: Web access increased substantially
during the month after the materials were launched, especially among Asia based
computers. The effect was isolated to the distance-learning pages, and not general
to the site. CONCLUSIONS: This Web site appears to be responsive to the
advertisement and to the materials. Prospective Web-site monitoring proved
useful. Copyright 2002 Elsevier Science Ireland Ltd.

Identifying information technology competencies needed in

Singapore nursing education.
Yee CC.
Nanyang Polytechnic, School of Health Sciences, Singapore.
chia_choon_yee@nyp.gov.sg
The purpose of the study was to identify Singapore's healthcare industry's

minimum information technology (IT) performance standard expectations for
nurses' competencies. A needs assessment was conducted with a panel
representing nursing education, nursing management and nursing practice. The
findings in this study would provide suggestions to improve the current diploma
and advanced diploma nursing programs curricula to meet the present workforce
demands. The experts agreed that information technology is necessary and there
were two main categories of IT skills identified, basic IT skills and work-related
IT skills.

88: J Med Syst. 2002 Oct;26(5):439-44.
A method to convert HDTV videos of broadcast satellite to

RealSystem multimedia contents.
Yamakawa T, Hashiba M, Koyama T, Akazawa K.
Department of Medical Informatics, Graduate School of Medical and Dental

Sciences, Niigata University, Japan.
Recently, the Internet is widely used in the field of medicine. Daily use of e-mail
for medical communication is very common. Also various information regarding
hospitals can be accessed via the network. Apart from this practical use of the
computer network, the mediums of telemedicine, tele-education, and telecare are
also available. The Medical Information Network via Communications Satellite
for University Hospital (MINCS-UH; http://www.umin.ac.jp/mincs/) was
constructed by the Ministry of Education, Culture, Sports, Science and
Technology. These programs feature high quality images viewed on High
Definition Television (HDTV) through the Broadcast Satellite (BS). We have
compiled a video library of MINCS-UH program contents with W-VHS tapes for
HDTV and VHS or S-VHS tapesfor NTSC, available to medical staff in our
university hospital through the Hospital local area network (Hospital intranet). We
have also constructed a web-based streaming system that is a low cost, user-
friendly multimedia delivery system capable of providing medical lectures. This
system was constructed using the RealSystem package with the Internet Protocol
(IP) network. Although the image quality of RealSystem is inferior to that of the
original video, users can review lectures and medical congress presentations with
video and audio through Hospital intranet, at any time that is convenient to them.
This system can also be an efficient tool for distance learning and supports the
diffusion of up-to-date information and technology to busy physicians via the
Internet.
Publication Types:

Nursing informatics in Korea.
Park HA.
College of Nursing, Seoul National University, 28 Yongon-dong, Chongno-gu,

Seoul 110-799, Korea. hapark@plaza.snu.ac.kr
The use of computers in the Korean healthcare system began in the late 1970s to
expedite insurance reimbursements when the national health insurance system
was introduced. Their application in nursing came much later because the
insurance fee schedule does not include nursing services. This article explores the
history and activities of nursing informatics in Korea in professional organization,
education, research, clinical practice, and professional outreach. Suggestions are
given on meeting the challenges of information technology for nursing in Korea.

90: BMC Public Health. 2002 May 16;2:7.
Verbal autopsy of 48 000 adult deaths attributable to medical causes

in Chennai (formerly Madras), India.
Gajalakshmi V, Peto R, Kanaka S, Balasubramanian S.
Division of Epidemiology, Cancer Institute (WIA), Chennai, India.

gaja_1@hotmail.com
BACKGROUND: In the city of Chennai, India, registration of the fact of death is

almost complete but the cause of death is often inadequately recorded on the
death certificate. A special verbal autopsy (VA) study of 48 000 adult deaths in
Chennai during 1995-97 was conducted to arrive at the probable underlying cause
of death and to measure cause specific mortality rates for Chennai. METHODS:
Trained non-medical graduates with at least 15 years of formal education
interviewed the surviving family members or an associate of the deceased to write
a report on the complaints, symptoms, signs, duration and treatment details of
illness prior to death. Each report was reviewed centrally by two physicians
independently. The reliability was assessed by comparing deaths attributed to
cancer by VA with records in Vital Statistics Department and Chennai Cancer
Registry. RESULTS: The VA reduced the proportion of deaths attributed to
unspecified medical causes and unknown causes from 37% to 7% in early adult
life and middle age (25-69 yrs) and has yielded fewer unspecified causes (only
10%) than the death certificate. The sensitivity of VA to identify cancer was 94%
in the age group 25-69. CONCLUSION: VA is practicable for deaths in early
adult life or middle age and is of more limited value in old age. A systematic
program of VA of a representative sample of deaths could assign broad causes not
only to deaths in childhood (as has previously been established) but also to deaths
in early adult life and middle age.
Publication Types:
PMCID: PMC113750
91: J Med Invest. 2001 Aug;48(3-4):198-209.

The development of a pollen information system for the

improvement of QOL.
Moriguchi H, Matsumoto M, Nishimoto Y, Kuwada K.
Division of Medical Informatics, University Hospital, University of Tokushima

School of Medicine, Kuramoto-cho, Tokushima 770-8503, Japan.
The Kochi Prefecture Japanese Cedar and Cypress Pollen Information System (P-
Net Kochi) was established in 1991 on the initiative of the Pharmaceuticals and
Sanitation Division to improve the quality of life of people in Kochi Prefecture,
particularly patients with pollinosis. Kochi Prefecture has the highest forests
percentage (84%) in Japan. In addition, 40% of the population of the prefecture is
concentrated in Kochi City. The average pollen count at 10 observation points an
one year was about 20,000/cm2 during the observation period, but it exceeded
110,000/cm2 in 1995, when it was also high nationwide. Kochi Prefecture
organized a system to promote people's understanding of pollinosis in connection
with environmental problems, and to enlighten people on appropriate preventive
measures. The system has been improved in the rapid and efficient transmission
of information over the years with technological advances. The introduction of an
automatic monitoring system not dependent on human labor and the support of
the users proved to be indispensable for the maintenance of the system.

The construction of a public key infrastructure for healthcare

information networks in Japan.
Sakamoto N.
Division of Medical Informatics, Kyushu University Hospital, Fukuoka 812-8582,

Japan. nori@med.kyushu-u.ac.jp
The digital signature is a key technology in the forthcoming Internet society for
electronic healthcare as well as for electronic commerce. Efficient exchanges of
authorized information with a digital signature in healthcare information networks
require a construction of a public key infrastructure (PKI). In order to introduce a
PKI to healthcare information networks in Japan, we proposed a development of a
user authentication system based on a PKI for user management, user
authentication and privilege management of healthcare information systems. In
this paper, we describe the design of the user authentication system and its
implementation. The user authentication system provides a certification authority
service and a privilege management service while it is comprised of a user
authentication client and user authentication serves. It is designed on a basis of an
X.509 PKI and is implemented with using OpenSSL and OpenLDAP. It was
incorporated into the financial information management system for the national
university hospitals and has been successfully working for about one year. The
hospitals plan to use it as a user authentication method for their whole healthcare
information systems. One implementation of the system is free to the national
university hospitals with permission of the Japanese Ministry of Education,
Culture, Sports, Science and Technology. Another implementation is open to the
other healthcare institutes by support of the Medical Information System
Development Center (MEDIS-DC). We are moving forward to a nation-wide
construction of a PKI for healthcare information networks based on it.
Publication Types:

93: Hokkaido Igaku Zasshi. 2001 Sep;76(5):349-60.
[Talks on evaluation of students' writing (discussion)]
Terazawa K, Otaki J, Abe K.
Department of Forensic Medicine and Medical Informatics, Hokkaido University

Graduate School of Medicine, Sapporo 060-8638, Japan.
We talked about the evaluation of students' writing; this is thought to be difficult

for teachers. We have a class "history of medicine" for freshmen in the second
semester of the medical course. Students give lecture by themselves on famous
historical persons in medicine such as Hippocrates, Vesalius, Pasteur and Sackett,
referring to their historical significance in present medicine. As the final work of
the subject they write report on "clinical medicine or medical researches 20 years
in future and myself". We talked generally about educational evaluation in various
aspects, concerning the methods for writing. We discussed mainly on two
themes--ability to write and originality in thinking. We give a larger point to the
originality, which correlates to ability to write, though we feel difficult in
evaluating students' originality only by reading their reports. We also emphasize
the importance of active interaction between students and teachers, and to
evaluate educational activities of teachers in Japanese universities.
Publication Types:

94: Bull World Health Organ. 2001;79(9):850-5. Epub 2001 Oct 23.
Information and communication technologies and health in low

income countries: the potential and the constraints.
Chandrasekhar CP, Ghosh J.
Centre for Economic Studies and Planning, School of Social Sciences, Jawaharlal
Nehru University, New Delhi 110 067, India. cpc@vsnl.com
This paper outlines the potential offered by technological progress in the

information and communication technologies (ICTs) industries for the health
sector in developing countries, presents some examples of positive experiences in
India, and considers the difficulties in achieving this potential. The development
of ICTs can bring about improvements in health in developing countries in at least
three ways: as an instrument for continuing education they enable health workers
to be informed of and trained in advances in knowledge; they can improve the
delivery of health and disaster management services to poor and remote locations;
and they can increase the transparency and efficiency of governance, which
should, in turn, improve the availability and delivery of publicly provided health
services. These potential benefits of ICTs do not necessarily require all the final
beneficiaries to be reached directly, thus the cost of a given quantum of effect is
reduced. Some current experiments in India, such as the use of Personal Digital
Assistants by rural health workers in Rajasthan, the disaster management project
in Maharashtra and the computerized village offices in Andhra Pradesh and
Pondicherry, suggest creative ways of using ICTs to improve the health conditions
of local people. However, the basic difficulties encountered in using ICTs for such
purposes are: an inadequate physical infrastructure; insufficient access by the
majority of the population to the hardware; and a lack of the requisite skills for
using them. We highlight the substantial cost involved in providing wider access,
and the problem of resource allocation in poor countries where basic
infrastructure for health and education is still lacking. Educating health
professionals in the possible uses of ICTs, and providing them with access and
"connectivity", would in turn spread the benefits to a much wider set of final
beneficiaries and might help reduce the digital divide.

95: J Am Med Inform Assoc. 2001 Sep-Oct;8(5):515-7.
Medical informatics and health care in Oman.
Dhar A.
Publication Types:
• Letter
PMCID: PMC131050
96: Int J Med Inform. 2001 May;61(2-3):117-29.

Review of telemedicine projects in Taiwan.

Chen HS, Guo FR, Chen CY, Chen JH, Kuo TS.
Department of Medical Informatics, Section 1, 1 Jen-Ai Road, 100, Taipei,

Taiwan. chenhs@me.ee.ntu.edu.tw
Taiwan is a heavily populated country, with a small land area and many
mountains and isolated islands. Because medical resources are unequally
distributed, high quality accessible medical care is a major problem in rural areas.
Medical personnel are unwilling to practice in rural areas because of fear of
isolation from peers and lack of continuing medical education (CME) in those
areas. Telemedicine provides a timeless and spaceless measure for
teleconsultation and education. The development of telemedicine in Taiwan began
under the National Information Infrastructure (NII) Project. Distance education
and teleconsultation were the first experimental projects during the initiation
research stage. The cost and effectiveness of the hardware and network bandwidth
were evaluated. In the promotion research stage, applications in different medical
disciplines were tested to promote multipoint videoconference, electronic journals
and VOD. Investigation of user satisfaction put on more emphasis on improving
application functions. In 1998, a new Cyber Medical Center (CMC) international
collaboration project was begun, integrating technologies of multimedia,
networking, database management, and the World Wide Web. The aim of the
CMC is to create a multimedia network system for the management of electronic
patient records, teleconsultation, online continuing medical education, and
information services on the web. A Taiwan mirror site of Virtual Hospital and two
international telemedicine trials through Next Generation Internet (NGI) were
done at the end of 1998. In the future, telemedicine systems in Taiwan are
expected to combine the Internet and broadband CATV, ADSL, and DBS
networking to connect clinics, hospitals, insurance organizations, and public
health administrations; and, finally, to extend to every household.
Publication Types:

97: Med Inform Internet Med. 2000 Oct-Dec;25(4):239-45.
Application of the RealAudio package to computerized medical

lectures.
Hashiba M, Inagawa K, Matsuto T, Motonaga A, Yamakawa T, Akazawa K.
Department of Medical Informatics, Niigata University Medical Hospital, Niigata

University, Japan. hashiba@med.niigata-u.ac.jp
We created a multimedia system to computerize past lectures using RealAudio
software. Physicians, medical researchers and students can browse the contents of
lecture slides and handouts with synchronous audio using the Internet. The
audience can easily review the most interesting parts of lectures and medical
students can listen to complete medical lectures from remote sites with narration
and slide depiction, whenever convenient. We have created three multimedia
programs; the memorial lecture of a professor's retirement, a new method of hand
washing for surgical procedures and a lecture on medical informatics. The cost of
this system and the results of the evaluation by medical students are described.
The ease of using this application makes it a potentially valuable tool for
clinicians and researchers.
Publication Types:

98: Methods Inf Med. 2000 Dec;39(4-5):343-7.
Disaster drills and continuous medical education using satellite-

based Internet.
Okada Y, Haruki Y, Ogushi Y.
Department of Medical Informatics, Tokai University, School of Medicine,

Kangawa, Japan. yoshikaz@is.icc.u-tokai.ac.jp
We designed and evaluated a satellite-based Internet system for use in medical

applications. Many experimental telemedicine projects use satellites, but we
combined digital satellite communication with an ordinary telephone network to
realize an economical countrywide network for emergency medicine and
continuous medical education. The system appears to be a useful and practical
technology for daily clinical activities.
Publication Types:

A personalised Healthcare Information Delivery System: pushing
customised healthcare information over the WWW.
Abidi SS, Goh A.
Health Informatics Research Group, School of Computer Sciences, Universiti

Sains Malaysia, Penang, Malaysia.
Easier and focused access to healthcare information can empower individuals to

make 'informed' choices and judgements about personal health maintenance. To
achieve 'optimum' patient empowerment, we need to re-evaluate and potentially
re-design the processes of healthcare information delivery. Our suggestion is that
healthcare information should be personalised according to each individual's
healthcare needs and it should be pro-actively delivered, i.e. pushed towards the
individual. We present an intelligent Personalised Healthcare Information
Delivery Systems that aims to enhance patient empowerment by pro-actively
pushing customised, based on one's Electronic Medical Record, health
maintenance information via the WWW.

100: Healthc Inform. 1999 Oct;16(10):33-6.
India: health informatics begins to grow.
Nadarajah I.
PMID: 11143127
101: Jpn Hosp. 2000 Jul;(19):53-9.
Patient access to medical records: problems and strategies for

inpatient charts.
Nawa H, Ohhara T, Mashiko K, Murakoshi A, Miyamoto J, Numabe H,

Kitamura M, Nishino T.
Department of Informatics, Tokyo Medical University, 6-7-1 Nishishinjuku,

Shinjukuku, Tokyo 160-0023, Japan. hnawa@tokyo-med.ac.jp
Fasing the impending introduction of patient access to medical charts, we have

attempted to include a more substantial description of medical activity in specific
areas. Using the guidelines published jointly by the Ministry of Health and
Welfare and the Tokyo Metropolitan Office in October 1998, the staff of the
medical records division examined and evaluated the layout and description of
items on individual hospital charts, with excellent results. To encourage the
continued improvement of medical chart recording in the future, incentives should
be implemented to avoid insufficient descriptions, encourage regular chart
inspections, and promote education regarding the need for a systematic approach
to charts and chart recording.

102: Rinsho Byori. 2000 Jul;48(7):639-46.
A study on task-analysis of clinical pathologists as medical

consultants in Nihon University Hospital--a Japanese perspective by
comparison with current status in the USA.
Kumasaka K, Yanai M, Hosokawa N, Iwasaki Y, Hoshino T, Arashima Y,

Hayashi K, Murakami J, Tsuchiya T, Kawano K.
Department of Clinical Pathology, Nihon University School of Medicine, Tokyo,

Japan.
To identify our role and the customers' satisfaction, the on-call consultation
service records of the Department of Clinical Pathology, Nihon University School
of Medicine, Itabashi Hospital (NUIH), were analyzed. Between 1995 and 1998,
1,789 consultation services were recorded, and approximately 40% were from
physicians, and 50% were from medical technologists. During office hours, many
physicians made contact with us at the office of clinical pathology, the clinical
laboratory and other places in the hospital by various means. They asked us to
interpret multidisciplinary laboratory data, and to provide the specific information
that might affect clinical management. Medical technologists asked for clinical
information of patients with extreme measured values and requested that we
contact with physicians. In contrast, on weekends/holidays or after routine
working hours, physicians sometimes requested non-automated laboratory tests
such as peripheral blood smears/bone marrow smears or Gram stains. The major
contents of our responses to medical technologists were concerned with blood
banking and handling of instruments not to be operated in routine work. These
results reconfirm that we are still required to have clinical competence for
common laboratory procedures and to have the capability of interpretation of
multidisciplinary laboratory data in the university hospital. Traditionally, most
Japanese clinical pathologists have been focused their attention on bench work in
research laboratories. However, the present study shows that the clinical
pathologists need to bridge the real gap between laboratory technology and
patient care. Our on-call service system can enhance the education of clinical
pathologists, and improve not only laboratory quality assurance but also patient
care. In addition, in response to a need for customer access to this service with a
shortage of clinical pathologists, a more effective method would be to set up a
proactive systemic approach in a more rigorous academic environment adopting
advances in medical informatics.
Publication Types:

103: Nippon Rinsho. 2000 Jan;58 Suppl 1:627-31.
[Distribution of blood pressure in university students in Japan:

cardiovascular risk factors disclosed from the annual examination of
health]
Miura Y, Noshiro T, Kawasaki T, Uesono K, Takeya S.
Health Administration Center/Department of Informatics on Pathophysiology,

Tohoku University Graduate School.
Publication Types:
• Review

104: Comput Nurs. 2000 Sep-Oct;18(5):240-7.
Introduction of nursing informatics in the nursing baccalaureate

program at the American University of Beirut.
Marini SD.
American University of Beirut-11236, School of Nursing, Lebanon.

sd01@aub.edu.lb
The rapid expansion of computer use for various nursing activities has made
computer technology an important part of the curriculum in many schools of
nursing across the world. Computer technology has become an alternative tool for
teaching practice skills to students in a variety of educational settings and
disciplines. Information technology (IT) is not yet well recognized in the
Lebanese nursing curricula. This article traces the events of planning, developing,
integrating, and evaluating nursing informatics on the Bachelor of Science in
Nursing (BSN) Program of the School of Nursing (SON), at The American
University of Beirut (AUB), Lebanon.

105: Res Microbiol. 2000 Mar;151(2):121-8.
Functional genomics of Escherichia coli in Japan.
Mori H, Isono K, Horiuchi T, Miki T.
Research and Education Center for Genetic Information, Nara Institute of Science
and Techonology, Ikoma, Japan. hmori@gtc.aist-nara.ac.jp
Completion of the genome sequence of the model bacterium Escherichia coli has
produced nearly 2000 open reading frames (ORFs) that remain to be functionally
characterized. To accomplish this goal, we have organized a working project team
in Japan and have begun construction of clones containing each of the putative
ORFs. The procedure has been conceived such that we shall be able to perform
systematic analysis of the shut-off as well as forced expression in vivo of each
ORF and purification of its protein product for further biochemical studies. In
addition, we have started a collection of various genetic and biochemical data of
E. coli published in the past, and analyses of the data from a bio-informatics point
of view. Thus, we aim at reaching complete understanding of this model organism
in the near future.
Publication Types:
• Review

Telemedicine in the Malaysian Multimedia Super Corridor: towards

personalized lifetime health plans.
Abidi SS, Yusoff Z.

The Malaysian Telemedicine initiative advocates a paradigm shift in healthcare

delivery patterns by way of implementing a person-centred and wellness-focused
healthcare system. This paper introduces the Malaysian Telemedicine vision, its
functionality and associated operational conditions. In particular, we focus on the
conceptualisation of one key Telemedicine component i.e. the Lifetime Health
Plan (LHP) system--a distributed multimodule application for the periodic
monitoring and generation of health-care advisories for all Malaysians. In line
with the LHP project, we present an innovative healthcare delivery info-
structure--LifePlan--that aims to provide life-long, pro-active, personalised,
wellness-oriented healthcare services to assist individuals to manage and interpret
their health needs. Functionally, LifePlan based healthcare services are delivered
over the WWW, packaged as Personalised Lifetime Health Plans that allow
individuals to both monitor their health status and to guide them in healthcare
planning.

107: J Formos Med Assoc. 1999 Nov;98(11):767-72.
Recent advances in telemedicine.
Chen HS, Guo FR, Lee RG, Lin CC, Chen JH, Chen CY, Kuo TS, Hou SM.
Department of Medical Informatics and Family Medicine, National Taiwan

University, Taipei, Taiwan.
With continuing advances in information technology, the applications of

computers in medicine are increasing rapidly. Modern information technology not
only affects the delivery of health care, but also significantly influences the
doctor-patient relationship. Since the 1990s, technologic developments in high-
bandwidth telecommunications systems and digitizing devices have led to a surge
of interest in telemedicine. In recent years, the Internet, with its powerful
penetration and scalability, has become an increasingly popular medical
information resource and a new platform for telemedicine. The impact of modern
technology on the advancement of telemedicine in Taiwan started with the 1995
National Information Infrastructure project, which uses networks of different
bandwidths for teleconsultation and distance education programs. In 1998,
National Taiwan University and Taipei Medical College in Taiwan, and the
University of Pittsburgh and the University of Iowa in the USA, began
cooperation on a new Cyber Medical Center (CMC) project that integrates the
technologies of multimedia, database management, a multiple-site
videoconferencing system, and the World Wide Web. The aim of the CMC is to
create a multimedia network system for the management of electronic patient
records, teleconsultation, online continuing medical education, and information
services on the Web. In the future, telemedicine systems in Taiwan are expected to
combine the Internet and cable television to connect clinics, hospitals, insurance
organizations, and public health administrations; and, finally, to extend health
services to every household.
Publication Types:

• Review

The future of health informatics.
Cesnik B.
Centre of Medical Informatics, Faculty of Medicine, Monash University,

Frankston, Victoria, Australia. branko.cesnik@med.monash.edu.au
Whatever a future vision for health informatics entails, it must take into account
the evolving nature of the field, a growing trend towards primary and preventive
care and the explosive growth in global networking as exemplified by the
Internet. While, historically, storage and retrieval of data has been the main target
for information systems development, the need to capture knowledge itself is
becoming the focus for development. In parallel, education in health informatics
for tomorrow's healthcare professionals is now essential. The Asia Pacific
Association for Medical Informatics (APAMI) is a regional group of the
International Medical Informatics Association (IMIA). While the newest of the
IMIA regional organizations, its growth and activities in the Asia Pacific region
aim to advance health informatics. Its triennial conferences act as a means of
promoting and monitoring the growth of our field in this region, APAMI itself is a
part of the future of health informatics.

109: Stud Health Technol Inform. 1998;52 Pt 1:193-6.
An integrated multimedia medical information network system.
Yamamoto K, Makino J, Sasagawa N, Nagira M.
Dep. of Medical Informatics, Shimane Medical University, Japan. yam@shimane-

med.ac.jp
An integrated multimedia medical information network system at Shimane

Medical university has been developed to organize medical information generated
from each section and provide information services useful for education, research
and clinical practice. The report describes the outline of our system. It is designed
to serve as a distributed database for electronic medical records and images. We
are developing the MML engine that is to be linked to the world wide web
(WWW) network system. To the users, this system will present an integrated
multimedia representation of the patient records, providing access to both the
image and text-based data required for an effective clinical decision making and
medical education.

The Asia Pacific Association for Medical Informatics (APAMI) and

World Organisation of Family Doctors (WONCA) Consortium on
General and Family Practice Informatics--a statement of intent.
Liaw ST, Kidd M, Cesnik B, Lun KC, Goh LG, Yoo T, Wun YT.
Department of Public Health & Community Medicine, University of Melbourne.
This paper describes the establishment of a consortium to advance health and

medical informatics in general/family practice in the Asia Pacific Region. The
objectives, current activities currently taking place in the region and key activities
planned will be outlined.

Curriculum for building medical resources on the Internet--

experience in Taiwan.
Li YC, Jian WS, Chiu WT.
Graduate Institute of Medical Informatics, Taipei Medical College, Taiwan, ROC.

jack@tmc.edu.tw
This paper describes our experience with a one-semester course on how to build a
medically-related homepage on the Internet, designed for fourth-year medical
students. Based on the assumption of limited technical knowledge of the Internet,
this class taught students Internet-exploring skills, multimedia authoring and
HTML (Hypertext Markup Language) in the first eight-week period. Students
were then divided into four-person teams and asked to select a topic for a
homepage. These teams were then asked to collect the necessary resources for the
development of the homepage both through individual work and, consultation
with an advisor. Each group project for building medically-related homepage was
accomplished and presented in the remaining four-week period. The resultant
projects of these fourth-year medical students were of surprisingly good content
and high quality. Medical students rapidly learned to use the software tools, and
through proper instruction and provision of equipment, they were able to build
significant medical resources on the Internet that can potentially be useful in
education, clinical applications and research.

112: Rinsho Byori. 1998 Nov;46(11):1083-6.
[JSCP Technical Committee on Laboratory Informatics; its 10th

anniversary and future perspective]
Kawai T.
International Clinical Pathology Center, Tokyo.
The Technical Committee on Laboratory Informatics of the Japan Society of

Clinical Pathology (JSCP) was established in 1988 by the late Professor Takaoki
Miyati, Department of Clinical Laboratory Medicine, Yamaguchi University
School of Medicine at the 35th JSCP Annual Meeting. Since then, the
chairpersons have been succeeded by Prof. Nobuyoshi Matsuda (Kawasaki
Medical University) and currently Prof. Masayuki Kambe (Hiroshima University
School of Medicine). Open committee meetings have been held twice a year; the
one during the JSCP Annual Meeting and the other independently in Spring.
There have been many important subjects discussed at the past 20 meetings,
including optical card utilization, laboratory information system, quality
assurance in clinical laboratory, laboratory data base, outputs and presentations of
laboratory results, reference values and intervals, medical support and expert
systems for laboratory results, practice guidelines in laboratory medicine,
laboratory support systems for medical education and research, and medical
consultation in clinical laboratory. Roles of laboratory informatics will increase
steadily in the circumstances of computer-multimedia networks.
Publication Types:

113: Int J Med Inform. 1998 Jun;50(1-3):81-5.
Medical informatics education by medical professors within their

discipline.
Ishijima M.
Institute of Biomedical Engineering, Tokyo Women's Medical University, Japan.
A system for medical informatics education for medical students has been
developed in the medical school. This paper describes the concept underlying the
development of this system and its progressive outcomes over 8 years. In order to
stimulate students to acquire computer-related knowledge and skills, this subject
has been integrated into the course works of various medical subjects such as
physiology. In addition, acquired knowledge and skills are evaluated within each
subject by the production of reports for example, using computers. This provides
a concrete example for students of the relevance of the information sciences to the
solving of medical problems. A well equipped computer facility for the study of
medicine also plays a significant role in inspiring student incentive. A computer
room equipped with Macintosh computers was opened adjacent to the main
medical library and is used in the same manner as the library, with books replaced
by computers. In addition, all new students acquire their own Macintosh
PowerBook. These various initiations have facilitated concept that the computer
may be applied to medical problem solving at any time or place and may become
as commonplace as a pen in daily medical practice.

Integrated medical informatics with small group teaching in medical

education.
Chen HS, Guo FR, Liu CT, Lee YJ, Chen JH, Lin CC, Hou SM, Hsieh BS.
Department of Medical Informatics, College of Medicine, National Taiwan

University, Taipei. chenh@me.ee.ntu.edu.tw
National Taiwan University College of Medicine (NTUCM) introduced small

groups of teaching and basic-clinical integrated courses for medical students in
1992. By using computer network and multimedia techniques, this study tried to
overcome barriers to learning in small group teaching. The Department of
Medical Informatics of NTUCM established campus networking and computer
classrooms and provided Internet and intranet network services including mail,
netnews, bulletin board systems (BBS), world wide web (WWW), gopher, ftp and
local file servers. To implement an interactive learning environment, the authors
first tried mail lists, newsgroups and BBS. Next an integrated learning system
prototype on the WWW was developed to provide functions including online
syllabus, discussion boards simulated to BBS, online talk, interactive case studies,
virtual classroom with video on demand (VOD) and Internet medical resources.
The results showed that after the medical students completed the required course
of medical informatics and had good network access using a network to
communicate with each other became a daily practice. In the future, the system
will extend to the tutoring of clinical practice and continuing medical education.
The authors expect a national medical education network and more international
cooperation and exchange.

115: J Med Syst. 1997 Aug;21(4):211-8.
Remote connection to the Kyushu University Medical Center LAN

using digital and analog telephone lines.
Antoku Y, Hanada E, Akazawa K, Kenjo Y, Nose Y.
Kyushu University, Faculty of Medicine, Department of Medical Informatics,

Fukuoka, Japan.
SOHO (Small Office/Home Office) has recently become popular, as it makes

working at home possible. Computers or Local Area Networks(LAN) connected
to the office network from home are necessary for the implementation of this
concept. Kyushu University has begun a service connecting home computers to
the campus LAN for researchers, staff and students of the Faculty of Medicine.
We have two different telephone connection methods. One connects the campus
LAN and the home computer LAN using routers through the Integrated Services
Digital Network (ISDN). The other connects computers at home to the
workstation in the university, using modems and the PPP (Point to Point Protocol)
through a public telephone analog line. This paper outlines our university SOHO
connection system and discusses the merits and demerits of using telephone line
connections.

Informatics technology in health care in India.
Chawla R, Bansal AK, Indrayan A.
University College of Medical Sciences, New Delhi, India.

An informatics education for improved nursing by introducing an

easy data base system.
Narita Y, Satou R, Takahashi H, Miura K, Takemoto Y.
Department of Computer Engineering, Mining College of Akita University, Japan.
We began to explore the subject of nursing information systems nine years ago.
Since then, we have advocated a system that is intended to be used by nurses for
their own purposes. We have developed an easy database management system
(Native Data Base Management System, called NDBS hereafter) that is feasible to
operate in the nursing situation. We also have developed an educational training
system for information technology, which is appropriate for nursing students as
well as for experienced nurses. Both systems have helped to greatly improve
nursing services. In fact, nurses have already created several beneficial databases
which are tailored to their nursing needs.

118: Int J Biomed Comput. 1995 Oct;40(2):81-3.
Informatics in family practice--an Asia-Pacific perspective.
Kidd M.
Department of Community Medicine, Monash University, East Bentleigh,

Australia.
Recent advances in computer hardware, software and telecommunications, and

particularly in the development of the electronic medical record, mean that family
practitioners around the world now have access to a multiplicity of tools which
offer the potential for significant time savings and improved quality of health care
provision. Areas such as practice management medication management and
prescription generation, clinical record keeping, decision support, medical
research and continuing medical education can all be aided through the use of
information technology in a family practice setting. Yet family medicine, or
general practice, has largely been slow to take up the challenge of implementing
information technology in most parts of the Asia-Pacific region. This contrasts
sharply with many other areas of medicine which have been very active in
embracing this technology. This paper examines the potential advantages and the
difficulties of computerisation for general practitioners and their patients in the
Asia-Pacific region. It is hoped that the lessons already learned in some countries
in this region can be adapted and applied elsewhere.

119: Med Inform (Lond). 1995 Oct-Dec;20(4):343-8.
Multimedia search system for a textbook of urology in Japanese.
Okada Y, Yamashita Y, Takahashi T.
Department of Medical Informatics, Tokai University, School of Medicine

Isehara, Kanagawa, Japan.
A search system for the textbook of urology has been developed and evaluated.
The textbook is written in Japanese with 1.4 megabytes of text and has about
1000 pictures. The contents of the textbook can be seen with English or Japanese
medical terms. The system contains a dictionary of Japanese medical terms. The
dictionary has a network structure based on Japanese ideographic characters. Such
a search system is useful for physicians because of its speed and the widely spread
medical knowledge of many authors of the textbook.

120: Medinfo. 1995;8 Pt 2:1603-7.
Health informatics from theory to practice: lessons from a case

study in a developing country.
Jayasuriya R.
Department of Public Health and Nutrition, University of Wollongong, New

South Wales, Australia.
Implementation of IT in developing countries has had successes and failures. The

theory of successful implementation has mainly been researched in developed
countries. There is now evidence that there are other issues that are of importance
to developing country health systems. Case studies allow us to identify pitfalls
that implementors can fall into. The implementation of a computerized Field
Health Information System in the Philippines provides insight into some factors
of importance. While there are similarities to issues in developed countries, there
are also many differences.

121: Medinfo. 1995;8 Pt 2:1265-9.
On the foundation and structure of medical informatics.
Li Z, Mitchell J, Tian A, Rikli A.
Medical Informatics Group, University of Missouri-Columbia, Columbia, MO

65211, USA.
The authors from China and the United States take medical informatics from
theory to practice by improving its research, application, and dissemination and
by expanding its educational potential. We built a theoretical model and discussed
its definition, approach, foundation, principles, and structure. Medical informatics
is the interdisciplinary study of information science applied to medicine and
health care. Its developing approach is transplantation. The foundation of medical
informatics has "building blocks" of knowledge. They are: information procedure
models; information classification principles; information processing
methodologies; and functional hierarchical principles of information systems. The
structure of medical informatics includes the main knowledge branches and their
logical relations. There are four big branches: computer tools and systems
methods; engineering equipment and methods; medical fields information
systems; and health care management systems. Based on the investigation of the
professional status (its theory and application, and its forms and the contents) of
medical informatics, it can be seen that this new discipline is becoming mature.

122: Medinfo. 1995;8 Pt 2:1255-9.
Reorganization of the information technology program at a United

States medical school: is there a lesson for academic medical
informatics in Japan?
Inoue Y, Beck JR.
Office of Information Technology, Baylor College of Medicine, One Baylor

Plaza, Texas Medical Center, Houston, Texas 77030, USA.
Reorganization of the information technology program at Baylor College of

Medicine commenced with the goal of obtaining a client-focused organization
instead of a classically departmental structure. Legacy organizations
independently established by request or serendipity had gaps and overlaps in
services and could no longer respond to new issues, such as integration of several
hospitals, resource sharing of health care delivery, administration of a shared
library, and an academic informatics program. The renewal of the information
technology program has led to departments of Telecommunications, Enterprise
Services, Client Services, and Medical Informatics, and has also allowed cross-
departmental projects led by a technology architect. In contrast with that of
Baylor, the approach of the Yamaguchi University School of Medicine in Japan
may be construed as economic efficiency at the cost of client services. Effective
client services by friendly and efficient staff groups is the most important factor
for an academic information technology program, if the goal is to reorganize in
anticipation of future challenges to the medical center.
Publication Types:

123: Medinfo. 1995;8 Pt 2:1230.
Computer-assisted instruction of arrhythmia for MS-windows.
Takeuchi A, Nara Y, Ikeda N, Miyahara H, Mitobe H.
Medical Informatics, School of Medicine, Kitasato Universito, Sagamihara,

Kanagawa, 228, JAPAN.
1. INTRODUCTION. Training in the diagnosis of arrhythmias is an important

part of the curriculum for medical students, postgraduates, and paramedical staff.
Although several CAI for arrhythmia have been developed [1-3], we could not get
CAI software for arrhythmia for the MS-Windows environment. In this report, we
present a newly-developed computer-assisted reference system for arrhythmia that
functions in the Windows environment. 2. DESCRIPTION OF THE SYSTEM.
The system consists of a program and two data files. An MS-Windows program
(ECG9405.EXE, 180kB) was compiled using Borland's C++ v.3.1. A binary file
(ECPAT.BAS 33kB) includes data of normal and abnormal wave segments of
ECG: P wave, PQ interval segment, and QRs complex with/without T wave. A
mother file (ECG9405.sys, 57kB) includes 85 data sets to generate ECG
waveforms of arrhythmia. Each data set contains a sequence of wave form
numbers, the text for questions and answers, and the commands strings. There are
five major commands: 1) to create a new window as "wave window"; 2) to make
electrocardiogram data; 3) to plot the data on the window; 4) to create a "dialog
box" for questions and explanations; and 5) to check the answers. he program gets
a data set from the data according to the user's choice. The program then
interprets the data set and executes the commands. The wave segment data are
plotted in a "wave window" at every 10 milliseconds; this is controlled by the
MS-Windows' timer. The timer interval can be changed by selecting the speed
button. The ECG waveforms are displayed on a window just like an ordinary
ECG monitor with beat sound. Many windows can be created by the user and
many ECG waves simultaneously plotted on CRT. 3. USAGE OF THE SYSTEM.
The "main window" has a menu that has three items corresponding to the training
course: BASIC, TRY, and TEST. Thirty-five types of arrythmias are listed in the
"list box" of the windows in BASIC course e.g., sinus arrhythmia, atrial flutter,
atrial premature contraction, ventricular extrasystole, ventricular flutter, etc. If the
user selects one of them on the list by double clicking, some textual explanations
of the wave are described in a dialog box. Ten multiple choice questions are
displayed in the dialog box in course of learning TRY and TEST; the answers to
these are requested. In the TEST course, the system offers random access to each
arrhythmia. he user can send the pictorial ECG data in the window to other
graphics programs through a clip board. 4. DISCUSSION. It was successfully
used in a lecture of electrocardiogram for medical students. They seem to be
interested in this system because of its simple usage and the dynamic drawing of
ECG waves on CRT. Multiple computer-based medical resources can be run on
MS-Windows. The system is able to run simultaneously with other programs,
such as an electronic reference system [4]. The system may be obtained from the
authors upon request.

124: Medinfo. 1995;8 Pt 2:1158-61.
Education on medical informatics integrated in the campus

information network system at Shimane Medical University.
Yamamoto K, Sasagawa N, Kamae I.
Department of Medical Informatics, Shimane Medical University, Iztirno 693,

Japan.
An integrated campus information network system at Shimane Medical

University has been developed to organize medical information generated from
each section and provide information services useful for education, research, and
clinical practice. This report outlines: the education-research system in connection
with a campus information network system, the MUMPS programming self-
directed learning software, and the curriculum of education on medical
informatics.

125: Medinfo. 1995;8 Pt 1:598-601.
Hospital information systems in China.
Song Y, Luo A.
Department of Medical Informatics, Zhenjiang Medical College, Jiangsu, P.R.

China.
The hospital information system (HIS) is an important aspect of computer

application in hospitals. China is a developing country, and its HIS has been in the
process of being developed since the 80s. In this paper the process of developing
the HIS in China is reviewed. By comparing it with the developed countries, we
found some existing problems in the HIS. The key problem for us is to design and
implement a Chinese HIS. Backward models need to be discarded and new ideas
of development encouraged.
Publication Types:

126: Proc Annu Symp Comput Appl Med Care. 1995:756-60.
The role of the information architect at King Faisal Specialist

Hospital and Research Centre.
Sittig DF, Sengupta S, al-Daig H, Payne TH, Pincetl P.
King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
Successful implementation of integrated clinical information system requires

modification of the institution's long range strategic plans and its personnel's
behavior. The changes warrant a concerted effort on the part of many different
individuals; this paper describes the role of the Information Architect whose
primary functions are to steer the process to fulfill stated objectives and build
consensus where divergent forces are at work. The workings of the Architect is
presented in context of a unique Middle-Eastern institution currently undergoing
automation of clinical information.

127: J Med Syst. 1994 Jun;18(3):117-24.
The organization of statistical activities at medical research

institutions.
Akazawa K, Sakamoto M, Nishioka Y, Kinukawa N, Nose Y.
Department of Medical Informatics, Faculty of Medicine, Kyushu University,

Fukuoka, Japan.
In this paper, we discuss the organizational structure for the conduct of statistical
activities at medical Colleges and Universities. Here, we have particularly focused
on two significant statistical activities, i.e., statistical consultation and research.
The consulting service for medical researchers consists of practical statistical
analysis, instruction on computer manipulation and software, response to
reviewer's comments and statistical design of prospective studies. From our
various experiences, we describe the actual implementation of statistical
consultations for medical researchers. It has played an important role in
supporting medical research. In addition, we also outline some research, with
respect to new ways of applying statistics in medical science. This paper
concludes that it may be practical for the existing computer center or department
of medical informatics, in charge of the computing service, to conduct statistical
activities until formal organizations are established at the academic institution. To
realize the conduct of statistical activities by Department of Medical Informatics,
it needs a team of biostatisticians, data analysts and computer personnel.
Publication Types:

128: Environ Res. 1993 Nov;63(2):219-28.
Occupational influences relative to the burnout phenomenon among

Japanese nursery school teachers.
Hisashige A.
Suzuka University of Medical Science and Technology, Department of Health

Care Informatics, Mie, Japan.
To identify and evaluate recent working conditions and job content of nursery
school teachers in Japan, as well as the prevalence of the burnout phenomenon
and the occupational influences responsible for it, a questionnaire survey was
carried out. The subjects consisted of 719 nursery school teachers and 204
municipal clerical workers as the control group. Working conditions and workload
burdens were more severe among nursery school teachers than those of the
clerical workers. The burnout phenomenon among the nursery school teachers
was characterized by emotional exhaustion. Moreover, the rate ratio and
multivariate analyses indicated that a great variety of occupational factors, not
only interpersonal relationships, but also the general working conditions and
specific physical or mental workloads, influenced the burnout phenomenon as
well. Therefore, in examining measures dealing with the burnout phenomenon
among nursery school teachers, it is important to evaluate the occupational factors
systematically and comprehensively.

129: Med Inform (Lond). 1993 Jan-Mar;18(1):1-10.
The important role of international exchange in the development of

medical informatics in developing countries: a report from China.
Wang C.
Section on Medical Informatics, Suzhou Medical College, PR, China.
China is a developing country, and so is inferior to the developed countries in

many aspects of science and technology. It is similarly a new member in the
world ranking of the application of computers in biomedicine. However, since
implementing the policy of reform and opening to the outside world in 1976,
China has achieved greater success in biomedical signal and image processing,
biomedical data processing, computer-aided diagnosis, computerized hospital
management, etc. China's development shows that international exchange and
cooperation are very important for the development of medical informatics in
developing countries, and the application of computers in biomedicine has
progressively spread all over the world and is increasingly taking root in the
hearts of the people.
Publication Types:
• Review

130: Toxicol Ind Health. 1991 Sep-Nov;7(5-6):485-94.
Risk assessment/management and education for medical decision

making in Japan.
Hisashige A.
Department of Public Health, Kochi Medical School, Japan.
PMID: 1780892
101: Jpn Hosp. 2000 Jul;(19):53-9.
Patient access to medical records: problems and strategies for
inpatient charts.
Nawa H, Ohhara T, Mashiko K, Murakoshi A, Miyamoto J, Numabe H,

Kitamura M, Nishino T.
Department of Informatics, Tokyo Medical University, 6-7-1 Nishishinjuku,

Shinjukuku, Tokyo 160-0023, Japan. hnawa@tokyo-med.ac.jp
Fasing the impending introduction of patient access to medical charts, we have

attempted to include a more substantial description of medical activity in specific
areas. Using the guidelines published jointly by the Ministry of Health and
Welfare and the Tokyo Metropolitan Office in October 1998, the staff of the
medical records division examined and evaluated the layout and description of
items on individual hospital charts, with excellent results. To encourage the
continued improvement of medical chart recording in the future, incentives should
be implemented to avoid insufficient descriptions, encourage regular chart
inspections, and promote education regarding the need for a systematic approach
to charts and chart recording.

102: Rinsho Byori. 2000 Jul;48(7):639-46.
A study on task-analysis of clinical pathologists as medical

consultants in Nihon University Hospital--a Japanese perspective by
comparison with current status in the USA.
Kumasaka K, Yanai M, Hosokawa N, Iwasaki Y, Hoshino T, Arashima Y,

Hayashi K, Murakami J, Tsuchiya T, Kawano K.
Department of Clinical Pathology, Nihon University School of Medicine, Tokyo,

Japan.
To identify our role and the customers' satisfaction, the on-call consultation
service records of the Department of Clinical Pathology, Nihon University School
of Medicine, Itabashi Hospital (NUIH), were analyzed. Between 1995 and 1998,
1,789 consultation services were recorded, and approximately 40% were from
physicians, and 50% were from medical technologists. During office hours, many
physicians made contact with us at the office of clinical pathology, the clinical
laboratory and other places in the hospital by various means. They asked us to
interpret multidisciplinary laboratory data, and to provide the specific information
that might affect clinical management. Medical technologists asked for clinical
information of patients with extreme measured values and requested that we
contact with physicians. In contrast, on weekends/holidays or after routine
working hours, physicians sometimes requested non-automated laboratory tests
such as peripheral blood smears/bone marrow smears or Gram stains. The major
contents of our responses to medical technologists were concerned with blood
banking and handling of instruments not to be operated in routine work. These
results reconfirm that we are still required to have clinical competence for
common laboratory procedures and to have the capability of interpretation of
multidisciplinary laboratory data in the university hospital. Traditionally, most
Japanese clinical pathologists have been focused their attention on bench work in
research laboratories. However, the present study shows that the clinical
pathologists need to bridge the real gap between laboratory technology and
patient care. Our on-call service system can enhance the education of clinical
pathologists, and improve not only laboratory quality assurance but also patient
care. In addition, in response to a need for customer access to this service with a
shortage of clinical pathologists, a more effective method would be to set up a
proactive systemic approach in a more rigorous academic environment adopting
advances in medical informatics.
Publication Types:

103: Nippon Rinsho. 2000 Jan;58 Suppl 1:627-31.
[Distribution of blood pressure in university students in Japan:

cardiovascular risk factors disclosed from the annual examination of
health]
Miura Y, Noshiro T, Kawasaki T, Uesono K, Takeya S.
Health Administration Center/Department of Informatics on Pathophysiology,

Tohoku University Graduate School.
Publication Types:
• Review

104: Comput Nurs. 2000 Sep-Oct;18(5):240-7.
Introduction of nursing informatics in the nursing baccalaureate
program at the American University of Beirut.
Marini SD.
American University of Beirut-11236, School of Nursing, Lebanon.

sd01@aub.edu.lb
The rapid expansion of computer use for various nursing activities has made
computer technology an important part of the curriculum in many schools of
nursing across the world. Computer technology has become an alternative tool for
teaching practice skills to students in a variety of educational settings and
disciplines. Information technology (IT) is not yet well recognized in the
Lebanese nursing curricula. This article traces the events of planning, developing,
integrating, and evaluating nursing informatics on the Bachelor of Science in
Nursing (BSN) Program of the School of Nursing (SON), at The American
University of Beirut (AUB), Lebanon.

105: Res Microbiol. 2000 Mar;151(2):121-8.
Functional genomics of Escherichia coli in Japan.
Mori H, Isono K, Horiuchi T, Miki T.
Research and Education Center for Genetic Information, Nara Institute of Science
and Techonology, Ikoma, Japan. hmori@gtc.aist-nara.ac.jp
Completion of the genome sequence of the model bacterium Escherichia coli has
produced nearly 2000 open reading frames (ORFs) that remain to be functionally
characterized. To accomplish this goal, we have organized a working project team
in Japan and have begun construction of clones containing each of the putative
ORFs. The procedure has been conceived such that we shall be able to perform
systematic analysis of the shut-off as well as forced expression in vivo of each
ORF and purification of its protein product for further biochemical studies. In
addition, we have started a collection of various genetic and biochemical data of
E. coli published in the past, and analyses of the data from a bio-informatics point
of view. Thus, we aim at reaching complete understanding of this model organism
in the near future.
Publication Types:
• Review
Telemedicine in the Malaysian Multimedia Super Corridor: towards

personalized lifetime health plans.
Abidi SS, Yusoff Z.

The Malaysian Telemedicine initiative advocates a paradigm shift in healthcare

delivery patterns by way of implementing a person-centred and wellness-focused
healthcare system. This paper introduces the Malaysian Telemedicine vision, its
functionality and associated operational conditions. In particular, we focus on the
conceptualisation of one key Telemedicine component i.e. the Lifetime Health
Plan (LHP) system--a distributed multimodule application for the periodic
monitoring and generation of health-care advisories for all Malaysians. In line
with the LHP project, we present an innovative healthcare delivery info-
structure--LifePlan--that aims to provide life-long, pro-active, personalised,
wellness-oriented healthcare services to assist individuals to manage and interpret
their health needs. Functionally, LifePlan based healthcare services are delivered
over the WWW, packaged as Personalised Lifetime Health Plans that allow
individuals to both monitor their health status and to guide them in healthcare
planning.

107: J Formos Med Assoc. 1999 Nov;98(11):767-72.
Recent advances in telemedicine.
Chen HS, Guo FR, Lee RG, Lin CC, Chen JH, Chen CY, Kuo TS, Hou SM.
Department of Medical Informatics and Family Medicine, National Taiwan

University, Taipei, Taiwan.
With continuing advances in information technology, the applications of

computers in medicine are increasing rapidly. Modern information technology not
only affects the delivery of health care, but also significantly influences the
doctor-patient relationship. Since the 1990s, technologic developments in high-
bandwidth telecommunications systems and digitizing devices have led to a surge
of interest in telemedicine. In recent years, the Internet, with its powerful
penetration and scalability, has become an increasingly popular medical
information resource and a new platform for telemedicine. The impact of modern
technology on the advancement of telemedicine in Taiwan started with the 1995
National Information Infrastructure project, which uses networks of different
bandwidths for teleconsultation and distance education programs. In 1998,
National Taiwan University and Taipei Medical College in Taiwan, and the
University of Pittsburgh and the University of Iowa in the USA, began
cooperation on a new Cyber Medical Center (CMC) project that integrates the
technologies of multimedia, database management, a multiple-site
videoconferencing system, and the World Wide Web. The aim of the CMC is to
create a multimedia network system for the management of electronic patient
records, teleconsultation, online continuing medical education, and information
services on the Web. In the future, telemedicine systems in Taiwan are expected to
combine the Internet and cable television to connect clinics, hospitals, insurance
organizations, and public health administrations; and, finally, to extend health
services to every household.
Publication Types:

• Review

The future of health informatics.
Cesnik B.
Centre of Medical Informatics, Faculty of Medicine, Monash University,

Frankston, Victoria, Australia. branko.cesnik@med.monash.edu.au
Whatever a future vision for health informatics entails, it must take into account
the evolving nature of the field, a growing trend towards primary and preventive
care and the explosive growth in global networking as exemplified by the
Internet. While, historically, storage and retrieval of data has been the main target
for information systems development, the need to capture knowledge itself is
becoming the focus for development. In parallel, education in health informatics
for tomorrow's healthcare professionals is now essential. The Asia Pacific
Association for Medical Informatics (APAMI) is a regional group of the
International Medical Informatics Association (IMIA). While the newest of the
IMIA regional organizations, its growth and activities in the Asia Pacific region
aim to advance health informatics. Its triennial conferences act as a means of
promoting and monitoring the growth of our field in this region, APAMI itself is a
part of the future of health informatics.
An integrated multimedia medical information network system.
Yamamoto K, Makino J, Sasagawa N, Nagira M.
Dep. of Medical Informatics, Shimane Medical University, Japan. yam@shimane-

med.ac.jp
An integrated multimedia medical information network system at Shimane

Medical university has been developed to organize medical information generated
from each section and provide information services useful for education, research
and clinical practice. The report describes the outline of our system. It is designed
to serve as a distributed database for electronic medical records and images. We
are developing the MML engine that is to be linked to the world wide web
(WWW) network system. To the users, this system will present an integrated
multimedia representation of the patient records, providing access to both the
image and text-based data required for an effective clinical decision making and
medical education.

The Asia Pacific Association for Medical Informatics (APAMI) and

World Organisation of Family Doctors (WONCA) Consortium on
General and Family Practice Informatics--a statement of intent.
Liaw ST, Kidd M, Cesnik B, Lun KC, Goh LG, Yoo T, Wun YT.
Department of Public Health & Community Medicine, University of Melbourne.
This paper describes the establishment of a consortium to advance health and

medical informatics in general/family practice in the Asia Pacific Region. The
objectives, current activities currently taking place in the region and key activities
planned will be outlined.

Curriculum for building medical resources on the Internet--

experience in Taiwan.
Li YC, Jian WS, Chiu WT.
Graduate Institute of Medical Informatics, Taipei Medical College, Taiwan, ROC.

jack@tmc.edu.tw
This paper describes our experience with a one-semester course on how to build a
medically-related homepage on the Internet, designed for fourth-year medical
students. Based on the assumption of limited technical knowledge of the Internet,
this class taught students Internet-exploring skills, multimedia authoring and
HTML (Hypertext Markup Language) in the first eight-week period. Students
were then divided into four-person teams and asked to select a topic for a
homepage. These teams were then asked to collect the necessary resources for the
development of the homepage both through individual work and, consultation
with an advisor. Each group project for building medically-related homepage was
accomplished and presented in the remaining four-week period. The resultant
projects of these fourth-year medical students were of surprisingly good content
and high quality. Medical students rapidly learned to use the software tools, and
through proper instruction and provision of equipment, they were able to build
significant medical resources on the Internet that can potentially be useful in
education, clinical applications and research.

112: Rinsho Byori. 1998 Nov;46(11):1083-6.
[JSCP Technical Committee on Laboratory Informatics; its 10th

anniversary and future perspective]
Kawai T.
International Clinical Pathology Center, Tokyo.
The Technical Committee on Laboratory Informatics of the Japan Society of

Clinical Pathology (JSCP) was established in 1988 by the late Professor Takaoki
Miyati, Department of Clinical Laboratory Medicine, Yamaguchi University
School of Medicine at the 35th JSCP Annual Meeting. Since then, the
chairpersons have been succeeded by Prof. Nobuyoshi Matsuda (Kawasaki
Medical University) and currently Prof. Masayuki Kambe (Hiroshima University
School of Medicine). Open committee meetings have been held twice a year; the
one during the JSCP Annual Meeting and the other independently in Spring.
There have been many important subjects discussed at the past 20 meetings,
including optical card utilization, laboratory information system, quality
assurance in clinical laboratory, laboratory data base, outputs and presentations of
laboratory results, reference values and intervals, medical support and expert
systems for laboratory results, practice guidelines in laboratory medicine,
laboratory support systems for medical education and research, and medical
consultation in clinical laboratory. Roles of laboratory informatics will increase
steadily in the circumstances of computer-multimedia networks.
Publication Types:

Medical informatics education by medical professors within their

discipline.
Ishijima M.
Institute of Biomedical Engineering, Tokyo Women's Medical University, Japan.
A system for medical informatics education for medical students has been
developed in the medical school. This paper describes the concept underlying the
development of this system and its progressive outcomes over 8 years. In order to
stimulate students to acquire computer-related knowledge and skills, this subject
has been integrated into the course works of various medical subjects such as
physiology. In addition, acquired knowledge and skills are evaluated within each
subject by the production of reports for example, using computers. This provides
a concrete example for students of the relevance of the information sciences to the
solving of medical problems. A well equipped computer facility for the study of
medicine also plays a significant role in inspiring student incentive. A computer
room equipped with Macintosh computers was opened adjacent to the main
medical library and is used in the same manner as the library, with books replaced
by computers. In addition, all new students acquire their own Macintosh
PowerBook. These various initiations have facilitated concept that the computer
may be applied to medical problem solving at any time or place and may become
as commonplace as a pen in daily medical practice.

Integrated medical informatics with small group teaching in medical

education.
Chen HS, Guo FR, Liu CT, Lee YJ, Chen JH, Lin CC, Hou SM, Hsieh BS.
Department of Medical Informatics, College of Medicine, National Taiwan

University, Taipei. chenh@me.ee.ntu.edu.tw
National Taiwan University College of Medicine (NTUCM) introduced small

groups of teaching and basic-clinical integrated courses for medical students in
1992. By using computer network and multimedia techniques, this study tried to
overcome barriers to learning in small group teaching. The Department of
Medical Informatics of NTUCM established campus networking and computer
classrooms and provided Internet and intranet network services including mail,
netnews, bulletin board systems (BBS), world wide web (WWW), gopher, ftp and
local file servers. To implement an interactive learning environment, the authors
first tried mail lists, newsgroups and BBS. Next an integrated learning system
prototype on the WWW was developed to provide functions including online
syllabus, discussion boards simulated to BBS, online talk, interactive case studies,
virtual classroom with video on demand (VOD) and Internet medical resources.
The results showed that after the medical students completed the required course
of medical informatics and had good network access using a network to
communicate with each other became a daily practice. In the future, the system
will extend to the tutoring of clinical practice and continuing medical education.
The authors expect a national medical education network and more international
cooperation and exchange.

115: J Med Syst. 1997 Aug;21(4):211-8.
Remote connection to the Kyushu University Medical Center LAN

using digital and analog telephone lines.
Antoku Y, Hanada E, Akazawa K, Kenjo Y, Nose Y.
Kyushu University, Faculty of Medicine, Department of Medical Informatics,

Fukuoka, Japan.
SOHO (Small Office/Home Office) has recently become popular, as it makes

working at home possible. Computers or Local Area Networks(LAN) connected
to the office network from home are necessary for the implementation of this
concept. Kyushu University has begun a service connecting home computers to
the campus LAN for researchers, staff and students of the Faculty of Medicine.
We have two different telephone connection methods. One connects the campus
LAN and the home computer LAN using routers through the Integrated Services
Digital Network (ISDN). The other connects computers at home to the
workstation in the university, using modems and the PPP (Point to Point Protocol)
through a public telephone analog line. This paper outlines our university SOHO
connection system and discusses the merits and demerits of using telephone line
connections.

Informatics technology in health care in India.
Chawla R, Bansal AK, Indrayan A.
University College of Medical Sciences, New Delhi, India.

An informatics education for improved nursing by introducing an

easy data base system.
Narita Y, Satou R, Takahashi H, Miura K, Takemoto Y.
Department of Computer Engineering, Mining College of Akita University, Japan.
We began to explore the subject of nursing information systems nine years ago.
Since then, we have advocated a system that is intended to be used by nurses for
their own purposes. We have developed an easy database management system
(Native Data Base Management System, called NDBS hereafter) that is feasible to
operate in the nursing situation. We also have developed an educational training
system for information technology, which is appropriate for nursing students as
well as for experienced nurses. Both systems have helped to greatly improve
nursing services. In fact, nurses have already created several beneficial databases
which are tailored to their nursing needs.

118: Int J Biomed Comput. 1995 Oct;40(2):81-3.
Informatics in family practice--an Asia-Pacific perspective.
Kidd M.
Department of Community Medicine, Monash University, East Bentleigh,

Australia.
Recent advances in computer hardware, software and telecommunications, and
particularly in the development of the electronic medical record, mean that family
practitioners around the world now have access to a multiplicity of tools which
offer the potential for significant time savings and improved quality of health care
provision. Areas such as practice management medication management and
prescription generation, clinical record keeping, decision support, medical
research and continuing medical education can all be aided through the use of
information technology in a family practice setting. Yet family medicine, or
general practice, has largely been slow to take up the challenge of implementing
information technology in most parts of the Asia-Pacific region. This contrasts
sharply with many other areas of medicine which have been very active in
embracing this technology. This paper examines the potential advantages and the
difficulties of computerisation for general practitioners and their patients in the
Asia-Pacific region. It is hoped that the lessons already learned in some countries
in this region can be adapted and applied elsewhere.

119: Med Inform (Lond). 1995 Oct-Dec;20(4):343-8.
Multimedia search system for a textbook of urology in Japanese.
Okada Y, Yamashita Y, Takahashi T.
Department of Medical Informatics, Tokai University, School of Medicine

Isehara, Kanagawa, Japan.
A search system for the textbook of urology has been developed and evaluated.
The textbook is written in Japanese with 1.4 megabytes of text and has about
1000 pictures. The contents of the textbook can be seen with English or Japanese
medical terms. The system contains a dictionary of Japanese medical terms. The
dictionary has a network structure based on Japanese ideographic characters. Such
a search system is useful for physicians because of its speed and the widely spread
medical knowledge of many authors of the textbook.

120: Medinfo. 1995;8 Pt 2:1603-7.
Health informatics from theory to practice: lessons from a case

study in a developing country.
Jayasuriya R.
Department of Public Health and Nutrition, University of Wollongong, New

South Wales, Australia.
Implementation of IT in developing countries has had successes and failures. The
theory of successful implementation has mainly been researched in developed
countries. There is now evidence that there are other issues that are of importance
to developing country health systems. Case studies allow us to identify pitfalls
that implementors can fall into. The implementation of a computerized Field
Health Information System in the Philippines provides insight into some factors
of importance. While there are similarities to issues in developed countries, there
are also many differences.

121: Medinfo. 1995;8 Pt 2:1265-9.
On the foundation and structure of medical informatics.
Li Z, Mitchell J, Tian A, Rikli A.
Medical Informatics Group, University of Missouri-Columbia, Columbia, MO

65211, USA.
The authors from China and the United States take medical informatics from
theory to practice by improving its research, application, and dissemination and
by expanding its educational potential. We built a theoretical model and discussed
its definition, approach, foundation, principles, and structure. Medical informatics
is the interdisciplinary study of information science applied to medicine and
health care. Its developing approach is transplantation. The foundation of medical
informatics has "building blocks" of knowledge. They are: information procedure
models; information classification principles; information processing
methodologies; and functional hierarchical principles of information systems. The
structure of medical informatics includes the main knowledge branches and their
logical relations. There are four big branches: computer tools and systems
methods; engineering equipment and methods; medical fields information
systems; and health care management systems. Based on the investigation of the
professional status (its theory and application, and its forms and the contents) of
medical informatics, it can be seen that this new discipline is becoming mature.

122: Medinfo. 1995;8 Pt 2:1255-9.
Reorganization of the information technology program at a United

States medical school: is there a lesson for academic medical
informatics in Japan?
Inoue Y, Beck JR.

Office of Information Technology, Baylor College of Medicine, One Baylor
Plaza, Texas Medical Center, Houston, Texas 77030, USA.
Reorganization of the information technology program at Baylor College of

Medicine commenced with the goal of obtaining a client-focused organization
instead of a classically departmental structure. Legacy organizations
independently established by request or serendipity had gaps and overlaps in
services and could no longer respond to new issues, such as integration of several
hospitals, resource sharing of health care delivery, administration of a shared
library, and an academic informatics program. The renewal of the information
technology program has led to departments of Telecommunications, Enterprise
Services, Client Services, and Medical Informatics, and has also allowed cross-
departmental projects led by a technology architect. In contrast with that of
Baylor, the approach of the Yamaguchi University School of Medicine in Japan
may be construed as economic efficiency at the cost of client services. Effective
client services by friendly and efficient staff groups is the most important factor
for an academic information technology program, if the goal is to reorganize in
anticipation of future challenges to the medical center.
Publication Types:

123: Medinfo. 1995;8 Pt 2:1230.
Computer-assisted instruction of arrhythmia for MS-windows.
Takeuchi A, Nara Y, Ikeda N, Miyahara H, Mitobe H.
Medical Informatics, School of Medicine, Kitasato Universito, Sagamihara,

Kanagawa, 228, JAPAN.
1. INTRODUCTION. Training in the diagnosis of arrhythmias is an important

part of the curriculum for medical students, postgraduates, and paramedical staff.
Although several CAI for arrhythmia have been developed [1-3], we could not get
CAI software for arrhythmia for the MS-Windows environment. In this report, we
present a newly-developed computer-assisted reference system for arrhythmia that
functions in the Windows environment. 2. DESCRIPTION OF THE SYSTEM.
The system consists of a program and two data files. An MS-Windows program
(ECG9405.EXE, 180kB) was compiled using Borland's C++ v.3.1. A binary file
(ECPAT.BAS 33kB) includes data of normal and abnormal wave segments of
ECG: P wave, PQ interval segment, and QRs complex with/without T wave. A
mother file (ECG9405.sys, 57kB) includes 85 data sets to generate ECG
waveforms of arrhythmia. Each data set contains a sequence of wave form
numbers, the text for questions and answers, and the commands strings. There are
five major commands: 1) to create a new window as "wave window"; 2) to make
electrocardiogram data; 3) to plot the data on the window; 4) to create a "dialog
box" for questions and explanations; and 5) to check the answers. he program gets
a data set from the data according to the user's choice. The program then
interprets the data set and executes the commands. The wave segment data are
plotted in a "wave window" at every 10 milliseconds; this is controlled by the
MS-Windows' timer. The timer interval can be changed by selecting the speed
button. The ECG waveforms are displayed on a window just like an ordinary
ECG monitor with beat sound. Many windows can be created by the user and
many ECG waves simultaneously plotted on CRT. 3. USAGE OF THE SYSTEM.
The "main window" has a menu that has three items corresponding to the training
course: BASIC, TRY, and TEST. Thirty-five types of arrythmias are listed in the
"list box" of the windows in BASIC course e.g., sinus arrhythmia, atrial flutter,
atrial premature contraction, ventricular extrasystole, ventricular flutter, etc. If the
user selects one of them on the list by double clicking, some textual explanations
of the wave are described in a dialog box. Ten multiple choice questions are
displayed in the dialog box in course of learning TRY and TEST; the answers to
these are requested. In the TEST course, the system offers random access to each
arrhythmia. he user can send the pictorial ECG data in the window to other
graphics programs through a clip board. 4. DISCUSSION. It was successfully
used in a lecture of electrocardiogram for medical students. They seem to be
interested in this system because of its simple usage and the dynamic drawing of
ECG waves on CRT. Multiple computer-based medical resources can be run on
MS-Windows. The system is able to run simultaneously with other programs,
such as an electronic reference system [4]. The system may be obtained from the
authors upon request.

124: Medinfo. 1995;8 Pt 2:1158-61.
Education on medical informatics integrated in the campus

information network system at Shimane Medical University.
Yamamoto K, Sasagawa N, Kamae I.
Department of Medical Informatics, Shimane Medical University, Iztirno 693,

Japan.
An integrated campus information network system at Shimane Medical

University has been developed to organize medical information generated from
each section and provide information services useful for education, research, and
clinical practice. This report outlines: the education-research system in connection
with a campus information network system, the MUMPS programming self-
directed learning software, and the curriculum of education on medical
informatics.

125: Medinfo. 1995;8 Pt 1:598-601.
Hospital information systems in China.
Song Y, Luo A.
Department of Medical Informatics, Zhenjiang Medical College, Jiangsu, P.R.

China.
The hospital information system (HIS) is an important aspect of computer

application in hospitals. China is a developing country, and its HIS has been in the
process of being developed since the 80s. In this paper the process of developing
the HIS in China is reviewed. By comparing it with the developed countries, we
found some existing problems in the HIS. The key problem for us is to design and
implement a Chinese HIS. Backward models need to be discarded and new ideas
of development encouraged.
Publication Types:

126: Proc Annu Symp Comput Appl Med Care. 1995:756-60.
The role of the information architect at King Faisal Specialist

Hospital and Research Centre.
Sittig DF, Sengupta S, al-Daig H, Payne TH, Pincetl P.
King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
Successful implementation of integrated clinical information system requires

modification of the institution's long range strategic plans and its personnel's
behavior. The changes warrant a concerted effort on the part of many different
individuals; this paper describes the role of the Information Architect whose
primary functions are to steer the process to fulfill stated objectives and build
consensus where divergent forces are at work. The workings of the Architect is
presented in context of a unique Middle-Eastern institution currently undergoing
automation of clinical information.

127: J Med Syst. 1994 Jun;18(3):117-24.
The organization of statistical activities at medical research

institutions.
Akazawa K, Sakamoto M, Nishioka Y, Kinukawa N, Nose Y.
Department of Medical Informatics, Faculty of Medicine, Kyushu University,

Fukuoka, Japan.
In this paper, we discuss the organizational structure for the conduct of statistical
activities at medical Colleges and Universities. Here, we have particularly focused
on two significant statistical activities, i.e., statistical consultation and research.
The consulting service for medical researchers consists of practical statistical
analysis, instruction on computer manipulation and software, response to
reviewer's comments and statistical design of prospective studies. From our
various experiences, we describe the actual implementation of statistical
consultations for medical researchers. It has played an important role in
supporting medical research. In addition, we also outline some research, with
respect to new ways of applying statistics in medical science. This paper
concludes that it may be practical for the existing computer center or department
of medical informatics, in charge of the computing service, to conduct statistical
activities until formal organizations are established at the academic institution. To
realize the conduct of statistical activities by Department of Medical Informatics,
it needs a team of biostatisticians, data analysts and computer personnel.
Publication Types:

128: Environ Res. 1993 Nov;63(2):219-28.
Occupational influences relative to the burnout phenomenon among

Japanese nursery school teachers.
Hisashige A.
Suzuka University of Medical Science and Technology, Department of Health

Care Informatics, Mie, Japan.
To identify and evaluate recent working conditions and job content of nursery
school teachers in Japan, as well as the prevalence of the burnout phenomenon
and the occupational influences responsible for it, a questionnaire survey was
carried out. The subjects consisted of 719 nursery school teachers and 204
municipal clerical workers as the control group. Working conditions and workload
burdens were more severe among nursery school teachers than those of the
clerical workers. The burnout phenomenon among the nursery school teachers
was characterized by emotional exhaustion. Moreover, the rate ratio and
multivariate analyses indicated that a great variety of occupational factors, not
only interpersonal relationships, but also the general working conditions and
specific physical or mental workloads, influenced the burnout phenomenon as
well. Therefore, in examining measures dealing with the burnout phenomenon
among nursery school teachers, it is important to evaluate the occupational factors
systematically and comprehensively.

129: Med Inform (Lond). 1993 Jan-Mar;18(1):1-10.
The important role of international exchange in the development of

medical informatics in developing countries: a report from China.
Wang C.
Section on Medical Informatics, Suzhou Medical College, PR, China.
China is a developing country, and so is inferior to the developed countries in

many aspects of science and technology. It is similarly a new member in the
world ranking of the application of computers in biomedicine. However, since
implementing the policy of reform and opening to the outside world in 1976,
China has achieved greater success in biomedical signal and image processing,
biomedical data processing, computer-aided diagnosis, computerized hospital
management, etc. China's development shows that international exchange and
cooperation are very important for the development of medical informatics in
developing countries, and the application of computers in biomedicine has
progressively spread all over the world and is increasingly taking root in the
hearts of the people.
Publication Types:
• Review

130: Toxicol Ind Health. 1991 Sep-Nov;7(5-6):485-94.
Risk assessment/management and education for medical decision

making in Japan.
Hisashige A.
Department of Public Health, Kochi Medical School, Japan.
PMID: 1780892
e-Healthcare in India: critical success factors for sustainable health

systems.
Taneja U, Sushil .
University School of Management Studies, GGS Indraprastha University, Delhi,

India. utaneja@vsnl.com
As healthcare enterprises seek to move towards an integrated, sustainable

healthcare delivery model an IT-enabled or e-Healthcare strategy is being
increasingly adopted. In this study we identified the critical success factors
influencing the effectiveness of an e-Healthcare strategy in India. The
performance assessment criteria used to measure effectiveness were increasing
reach and reducing cost of healthcare delivery. A survey of healthcare providers
was conducted. Analytic Hierarchy Process (AHP) and Interpretive Structural
Modeling (ISM) were the analytical tools used to determine the relative
importance of the critical success factors in influencing effectiveness of e-
Healthcare and their interplay with each other. To succeed in e-Healthcare
initiatives the critical success factors that need to be in place are appropriate
government policies, literacy levels, and telecommunications and power
infrastructure in the country. The focus should not be on the IT tools and
biomedical engineering technologies as is most often the case. Instead the
nontechnology factors such as healthcare provider and consumer mindsets should
be addressed to increase acceptance of, and enhance the effectiveness of,
sustainable e-Healthcare services.

The evaluation criteria of internet health information.

Kang NM, Kim S, Hong S, Ryu S, Chang HJ, Kim J.
College of Nursing, Konkuk University, Seoul, Korea.
The Internet has great powerful forces for health information and education. This
describes the development of a web-based evaluation criteria for internet health
information. The purpose of this study was to explore the evaluation criteria (tool)
of internet health information for Korean. This utilized a cross-sectional design
with four sections: (1) CAHPS (Consumer assessment of health plans studies); (2)
Health consumer terminology and understanding review; (3) web based
interactive tool construction; (4) semantic web technology application. The
findings showed follows; (1) literature review related quality evaluation tool for
internet health information; (2) case study; (3) development of evaluation
prototype; (4) validity assessment of tool; (5) Evaluation system information
strategic planning.

Consumers' use of the internet for health information.
Yom YH, Yee JA.
Department of Nursing, Chung Ang University, Seoul, Korea.
Although health information is one of the most frequently sought subjects on the
Internet, little research has been performed in this area. This study was designed
to examine the use of the Internet for health information by the consumers. A
questionnaire was administered to a sample of 212 consumers who were using
health care. Only small percentages of the consumers accessed the Internet for
health information. This result indicates that different marketing strategies based
on geographic characteristics should be developed for consumers who wish to get
health care information.

A study of network education application on nursing staff

continuing education effectiveness and staff's satisfaction.
Lin JS, Yen-Chi L, Lee TT.

Department of Nursing Shin Kong Wu Ho-Su Memorial Hospital, Taiwan, ROC.
The rapid development of computer technology pushes Internet's popularity and

makes daily services more timely and convenient. Meanwhile, it also becomes a
trend for nursing practice to implement network education model to break the
distance barriers and for nurses to obtain more knowledge. The purpose of this
study was to investigate the relationship of nursing staff's information
competency, satisfaction and outcomes of network education. After completing 4
weeks of network education, a total of 218 nurses answered the on-line
questionnaires. The results revealed that nurses who joined the computer training
course for less than 3 hours per week, without networking connection devices and
with college degree, had the lower nursing informatics competency; while nurses
who were older, at N4 position, with on-line course experience and participated
for more than 4 hours each week, had higher nursing informatics competency.
Those who participated in the network education course less than 4 hours per
week were less satisfied. There were significant differences between nursing
positions before and after having the network education. Nurses who had higher
nursing information competency also had higher satisfaction toward the network
education. Network education not only enhances learners' computer competency
but also improves their learning satisfaction. By promoting the network education
and improving nurses' hardware/software skills and knowledge, nurses can use
networks to access learning resources. Healthcare institutions should also enhance
computer infrastructure, and to establish the standards for certificate courses to
increase the learning motivation and learning outcome.

A project to improve the computerization procedure of emergency

nursing record.
Ya WP, Huang SL, Tang WL, Shu SS, Shan-Huang , Chun LY.
Emergency Department, Kaohsiung Chang Gung Memorial Hospital, Taiwan,

ROC.
This project is to implement the computerization procedure of emergency nursing

record. The nursing record must be complete and correct enough to present the
uniqueness of different specialty. We encouraged nurses to participate in
classroom lessons of informatics technology in nursing records. We then used the
standardized version of the emergency nursing records. We also set up criteria for
computerization of nursing records. As a result, the nursing records become more
complete. It was improved by 8.5% as compared to manual records. The
satisfaction of nurses was improved by 82.1%. It is much more time-saving and
convenient to check the nursing records. In conclusion, the emergency nursing
profession and quality surveillance did improve from the computerization. The
patients will receive better nursing care quality.
Publication Types:

Factors affecting the degree of satisfaction for nursing information

system.
Kim SY.
College of Nursing, Hanyang University, Seoul, Korea.
This study was performed to identify the degree of satisfaction for Nursing
Information System of clinical nurses and factors affecting the degree of
satisfaction in S hospital that introduced and managed Nursing Information
System when it opened in 2003. In result it was revealed that the degree of
satisfaction of the Nursing Information System varies according to the selected
subjects' demographical characteristics, such as age, marital status, department,
position, and computer using capability for online searches. Also, the subjects'
level of experience and perception and satisfaction toward the Nursing
Information System had significant correlations.

Theory development in health care informatics: Information and

communication technology acceptance model (ICTAM) improves the
explanatory and predictive power of technology acceptance models.
An JY.
College of Nursing, New York University, New York, NY 10003, USA.

jiyoung.an@nyu.edu
The purpose of this web-based study was to explain and predict consumers'
acceptance and usage behavior of Internet health information and services.
Toward this goal, the Information and Communication Technology Acceptance
Model (ICTAM) was developed and tested. Individuals who received a flyer
through the LISTSERV of HealthGuide were eligible to participate. The study
population was eighteen years old and older who had used Internet health
information and services for a minimum of 6 months. For the analyses, SPSS
(version 13.0) and AMOS (version 5.0) were employed. More than half of the
respondents were women (n = 110, 55%). The average age of the respondents was
35.16 years (S.D. = 10.07). A majority reported at least some college education (n
= 126, 63%). All of the observed factors accounted for 75.53% of the total
variance explained. The fit indices of the structural model were within an
acceptable range: chi2/df = 2.38 (chi2 = 1786.31, df = 752); GFI = .71; RMSEA =
.08; CFI = .86; NFI = .78. The results of this study provide empirical support for
the continued development of ICTAM in the area of health consumers'
information and communication technology acceptance.
Publication Types:

138: Int J Med Inform. 2007 Nov-Dec;76(11-12):790-800. Epub 2006 Oct 17.
Key functional characteristics in designing and operating health

information websites for user satisfaction: an application of the
extended technology acceptance model.
Kim D, Chang H.
College of Business Administration, Kyung Hee University, Hoegi-dong #1,

Dongdaemoon-gu, Seoul 130-701, Republic of Korea. dyohaan@khu.ac.kr
OBJECTIVE: With growing demand for health information and rapid

development of information technology, health information websites are emerging
as the most effective media to meet the public's needs for health information. This
article is intended to offer a technical view on the design and operations of health
information websites. Along this line, employed here is the Technology
Acceptance Model (TAM), which has been widely used to predict user acceptance
based on Perceived Ease-of-Use (PEOU) and Perceived Usefulness (PU).
METHODS: We extend the original TAM by including some exogenous variables
since it is necessary to understand the role of the antecedents of acceptance
constructs when designing an effective health information website for improving
user satisfaction. This study focuses on identifying the core functional factors in
designing and operating health information websites. Conducted are some
multivariate statistical analyses based on data from an extensive survey.
RESULTS: The results from the structural equation analysis suggest that
functional characteristics should be categorized into three groups: one affecting
PU and PEOU, another affecting only PEOU, and the other having no direct effect
on either PU or PEOU. In particular, 'usage support' and 'customization' are two
key functional characteristics in the extended TAM framework for health
information websites. CONCLUSION: Contrary to expectations, however, the
direct effect of PEOU on usage support is hardly observed, which differentiates
health information websites from other commercial websites like online shopping
malls. As a result, understanding the antecedents of PU takes on more
significance.

139: Telemed J E Health. 2006 Oct;12(5):535-41.
Eye contact in medical examinations using videophones.
Suzuki T, Murase S, Kitano A, Nagase H, Momoi S, Nakamaki M.
Division of Medical Informatics, Shinshu University Hospital, Matsumoto, Japan.
In Japan, approximately 12,000,000 cellular phones with a videophone function

have been distributed and are becoming an important part of the telemedicine
infrastructure. By eye movement analysis, we investigated the effectiveness of
eye contact using cellular videophones during medical interviews. Three male
volunteers acted as first-time patients and were filmed using a high-resolution
camera. The video of each of these volunteers was converted into pictures of three
different sizes-70 cm x 40 cm (large picture), 26 cm x 20 cm (medium picture),
and 14 cm x 12 cm (small picture)-and viewed on a 32-inch video monitor. The
large, medium, and small pictures were considered to represent an actual medical
interview, an interview via a television conference system, and an interview via a
cellular videophone, respectively. Nine doctors watched these pictures, and their
eye movements were recorded with a gaze-point recorder. After watching the
videos, the doctors evaluated quality of three size pictures. Standard deviation
values of the gaze point coordinates decreased with the picture size. However, a
very low decrease was observed in the time ratio, during which the gaze point was
on the face (eye contact rate); the rate was 92.2% (large picture), 91.8% (medium
picture), and 85.1% (small picture). No statistical difference was observed
between the values of the medium and small pictures. Subjective evaluations
yielded low scores in the small pictures. The relatively high rate of eye contact
rate in the small pictures suggests that a cellular videophone will be a good tool
for telemedicine, although the usage by which the subjective evaluations can be
improved should be determined by doctors.

140: Rinsho Shinkeigaku. 2003 Nov;43(11):840-2.
[Clinical practice guidelines in Japan: toward their appropriate use
and diffusion]
Nakayama T.
Department of Health Informatics, Kyoto University School of Public Health.
In Japan, the governmental report on health technology assessment in 1999

referred to the need to develop evidence-based clinical practice guidelines. The
Ministry of Health and Welfare established priorities for the development of
clinical practice guidelines, and started several projects. About 20 clinical practice
guidelines are to be developed by 2004. However, what "guideline" means and
how "guidelines" work are unclear because the word "guideline" is ambiguous in
Japan. Although it is generally accepted that "directives are stronger than
recommendations, which are stronger than guidelines" in the western countries,
Japanese people do not usually recognize these distinctions and tend to regard
guidelines as mandatory directives even in individual cases. Patients, consumers
and legal professionals may overestimate the authority of clinical practice
guidelines when they see them. What clinical practice guidelines are, or are not
should be clarified appropriately. Autumn 2003, the Japan Council for Quality
Health Care will open the information service that provides practice guidelines
and related literature. This will be accessible to both healthcare professionals and
the general public. Much remains to be done to bring other stakeholders to the
table. All of Japanese society can, and needs to, participate in the process of
developing a consensus on clinical practice guidelines.
Publication Types:
• Review

141: Int J Med Inform. 2004 Mar 31;73(3):217-27.
The Malaysian Telehealth Flagship Application: a national approach

to health data protection and utilisation and consumer rights.
Mohan J, Razali Raja Yaacob R.
Malaysian Health Informatics Association, Apt 2A, 8 Jalan Perumahan Gurney,

54100 Kuala Lumpur, Malaysia. jmohan@pc.jaring.my
Telehealth refers to the integration of information, telecommunication, human-

machine interface technologies and health technologies to deliver health care, to
promote the heath status of the people and to create health. The Malaysian
Telehealth Application will, on completion, provide every resident of the country
an electronic Lifetime Health Record (LHR) and Lifetime Health Plan (LHP). He
or she will also hold a smart card that will contain a subset of the data in the
Lifetime Health Record. These will be the means by which Malaysians will
receive "seamless continuous quality care" across a range of health facilities and
health care providers, and by which Malaysia's health goal of a nation of "healthy
individuals, families and communities" is achieved. The challenges to security
and privacy in providing access to an electronic Lifetime Health Record at private
and government health facilities and to the electronic Lifetime Health Plan at
homes of consumers require not only technical mechanisms but also national
policies and practices addressing threats while facilitating access to health data
during health encounters in different care settings. Organisational policies
establish the goals that technical mechanisms serve. They should outline
appropriate uses and access to information, create mechanisms for preventing and
detecting violations, and set sanctions for violations. Some interesting innovations
have been used to address these issues against the background of the launching of
the multimedia supercorridor (MSC) in Malaysia.

142: Kokuritsu Iyakuhin Shokuhin Eisei Kenkyusho Hokoku. 2003;(121):1-11.
[Safety information project on drug, food and chemicals. Division of

Safety Information on Drug, Food and Chemicals. National Institute
of Health Sciences]
Morikawa K, Yamamoto M, Nakano T, Kasuga F, Yamamoto M.
morikawa@nihs.go.jp
Recent issues on BSE(Bovine Spongiform Encephalopathy) and health hazards

caused by adverse reactions of medical drugs, have strongly emphasized the
necessity for safety measures to secure public health. These issues have been
attributed to the delay to obtain overseas information on safety and regulation,
and the lack of an adequate system for acquirement and assessment of such
information. In order to develop a system where domestic and international safety
information is collected, analyzed, assessed and presented both scientifically and
systematically, the Division of Chem-Bio Informatics of the National Institute of
Health Sciences was reorganized to the Division of Safety Information on Drug,
Food and Chemicals in April, 2003. Collection and evaluation of safety
information on medical drugs, food and chemical substances is now centralized at
the Division, which consists of 5 sections, the first, second and third sections
being newly established. The first section assesses information on medical drugs,
the second section deals with food microorganisms, and the third section focuses
on chemicals in food. The fourth and fifth sections retain their previous functions,
namely, chemical safety information research and information network
infrastructure support within the institute, respectively. The purpose of this paper
is to describe how we will manage safety information on drug, food and
chemicals, focusing on the role of the three new sections.
Publication Types:
• Review

143: J Med Internet Res. 2001 Jan-Mar;3(1):E12.
Internet medical usage in Japan: current situation and issues.
Tatsumi H, Mitani H, Haruki Y, Ogushi Y.
Department of Anatomy, Sapporo Medical University, Sapporo, 060-8556, Japan.

tatsumi@sapmed.ac.jp
Internet use by physicians and patients has become very popular in Japan. Fifty
percent of physicians use the Internet to search for medical and other information.
Over the past year, 22% of patients used the Internet to obtain medical
information. Because there are no restrictions within Japan on using Web sites to
advertise medical treatment, information can be freely sent out, and over the past
two or three years this practice has increased dramatically. Internet medical
information provides information about illnesses and medications, and it helps
improve the quality of life of patients and families. Yet, depending on the content
of the information provided and the way this information is used, there is a
potential negative side as well. On principle, users are responsible for the way
information is used, but there is a need for information providers to consider users
safety and to make the information effective for use. Because there is no absolute
standard for evaluating the value of medical information, it is necessary to
establish a system that opens a dialogue with society and that continuously
accumulates high-quality information through the collection of various
evaluations, rather than rely on an established authority. For industries and
organizations related to commercial pursuits, in particular, it is most effective to
establish their own codes for ethical conduct, rather than rely on governmental
regulations. At the same time, it is important to have a confirmation function to
evaluate how goals set by the outside are being implemented. Aiming at
establishing a framework for the Internet medical usage, the Japan Internet
Medical Association (JIMA) was founded in 1998 by medical professionals,
lawyers, researchers, consumer representatives, patients and their families. We
propose a system that would combine feedback from users, who would take on
the role of evaluators of the implementation of an ethical code, with a displayed
mark that verifies the identity of the Web site. Objective evaluation of information
is needed to ensure that users have the power to make choices. Medical experts or
patient and family groups would assist in this task. The development of medical
care will be promoted through patients and physicians working together in the
accumulation of shared resources for good medical care information.
Publication Types:
PMCID: PMC1761890
144: Stud Health Technol Inform. 1997;43 Pt B:884-8.

Primary care informatics: Bhorugram, India: revisited.
Singh AK, Kohli M, Trell E, Kohli S, Wigertz O.
Dept of Primary Health Care & General Practice, Health Faculty, Linköping
University, Sweden.
A Primary Health Care Informatics project was initiated in 1990 at Bhorugram,

Rajasthan, India. It was reported in MIE91 with initial, encouraging results. The
evaluation of the information system has been successful in all operational terms,
and the Fully Immunised Child (FIC) could be used as a local cardinal index to
monitor and evaluate the quality of care, cost-effectiveness and community
participation. Health Systems and Health Economy Research alike have long
searched for apt quality and performance markers that in themselves could
embrace and express a number of aspects and factors. The FIC index is shown to
well meet the criteria of such a cardinal measure in the MCHC services. We, also,
demonstrate an implementation strategy for establishing Information Systems in
Primary Health Care Centres in Developing countries.

145: Medinfo. 1995;8 Pt 2:1535-7.
Regional medical information network using optical memory cards

and integrated services for digital network.
Ogushi Y, Misawa T, Hayashi Y, Ohta Y, Suzuki S, Horie M, Sakashita Y.
Department of Medical Informatics, Tokai University School of Medicine, Japan.
Since 1986, we have been developing a regional health and welfare system using
optical memory cards. We have expanded the system and performed model
experiments and evaluations this time. There are approximately 3000 card-holders
and 23 card-reader terminals in use. They cover 50 percent of the medical
facilities in the city of Isehara. Two medical clinics within neighboring cities have
joined our project. Standard Deviation Index (SDI) has been introduced to
standardize the numeric results of examinations. The terminals are connected with
Integrated Services for Digital Network (ISDN) allowing remote access to the
optical memory cards. This enhanced connectivity has allowed greater
cooperation in delivering quality medical services.
PMID: 8591493

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