Improved Medication Adherence of an Elderly Diabetic Patient at a Dwelling Home Using a Pill Dispenser and Personal Health Records

Fookkun® is a pill dispenser in which single doses of several medications intended to be taken simultaneously are sealed in single film bags rolled onto a medication rotating drum. The system makes musical alert sounds when it is time for the patient to take the medications. If the patient misses a dose, a designated contact, such as the patient's child, is alerted. We conducted an experiment monitoring the use of a pill dispenser (Fookkun®) by an older patient. The participant was a 71-year-old woman with diabetes living in a dwelling home. The experiment lasted approximately 6 months. Fookkun® and the prototype data transmitter were installed at the patient's home. Fookkun®'s medication history data are displayed on the electronic medication record book (E-MRB) and the patient's pharmacist checks the patient's medication history on the E-MRB. The Fookkun® was effective in facilitating medication adherence. The pharmacist and the patient's daughter did not need to check the E-MRB because Fookkun® alerted them when the patient missed her medication. We believe that if the medication history data linked between a pill dispenser and an E-MRB can be shared among medical staff, this will contribute to a medical digital transformation in Japan in the future.

Standard Protocol for Exchange of Health-checkup Data Based on SGML: The Health-checkup Data Markup Language (HDML)

Objectives: To develop a health/medical data interchange model for efficient electronic exchange of data among health-checkup facilities.

Results: A Health-checkup Data Markup Language (HDML) was developed on the basis of the Standard Generalized Markup Language (SGML), and a feasibility study carried out, involving data exchange between two health checkup facilities. The structure of HDML is described.

Results: The transfer of numerical lab data, summary findings and health status assessment was successful.

Conclusions: HDML is an improvement to laboratory data exchange. Further work has to address the exchange of qualitative and textual data.

The state of telepathology in Japan

Telepathology began in Japan in the early 1990s in response to advances in computing and telecommunications equipment development and a dearth of pathologists. Telepathology in Japan is most often used for rapid intraoperative pathological diagnosis using frozen section, followed by second opinions and consultation. Intraoperatively, telepathology is used to determine malignancy, metastasis of malignant tumors, and the extent of excision. Infrastructure and equipment has evolved from analog lines to digital lines like integrated services digital network (ISDN) and asymmetric digital subscriber line (ADSL), and recently to fiber optics. The use of communications satellites is also being considered. Image quality is being improved to Hi-Vision (HDTV), and from still images to real-time video. Digital microscopy has been introduced, and is used in education and consultation.

[Trends of utilization of information technologies in clinical laboratory and pathology domain]

The life expectancy of the Japanese population is one of longest in the world. Society is aging, with fewer children, increasing the total national medical payment in Japan. This situation has forced the Government to reduce the payment and to increase the efficiency of the medical system, so information technologies are expected to contribute to these policies. Electronic patient record systems (EPR) were expected to be used widely, but only 23% of clinical training hospitals have implemented them. This is mainly due to the lack of incentives and large costs to install EPR. Standardization is a good method to reduce system construction cost and increase its quality. New global IHE activities are expected to solve these problems with methodologies of workflow analyses, standard applications, tests and demonstrations. Laboratory information systems (LIS) have a long history and tradition of standard interfaces for connecting computers with analyzers. IHE activities for LIS are providing easy and secure connections with hospital information systems (HIS). Pathology departments also have their own information systems. IHE activities for pathology were launched in 2005, and we are now developing in collaboration with the international IHE pathology working group, HL7 SIG pathology and DICOM WG-26. Pathologists and technical experts in Japanese laboratories are encouraged to join IHE activities to ensure good results.

[Development of telepathology systems between different types of terminals based on the standard for image collaboration command protocol]

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.

Standard protocol for exchange of health-checkup data based on SGML: the Health-checkup Data Markup Language (HDML)

OBJECTIVES

To develop a health/medical data interchange model for efficient electronic exchange of data among health-checkup facilities.

RESULTS

A Health-checkup Data Markup Language (HDML) was developed on the basis of the Standard Generalized Markup Language (SGML), and a feasibility study carried out, involving data exchange between two health checkup facilities. The structure of HDML is described.

RESULTS

The transfer of numerical lab data, summary findings and health status assessment was successful.

CONCLUSIONS

HDML is an improvement to laboratory data exchange. Further work has to address the exchange of qualitative and textual data.

[On standardization of optical memory cards]

An optical card optimizes recording of medical data since it has a large memory capacity, data cannot be interpolated by the addition method, and data are protected from disruption by magnetic force or static electricity. Now that international standards have been established for the card, reader/writer control, and data management, a highly-compatible optical card system for medical use can be fabricated. The optical card is expected to play an important role in the social system as a promising medium for recording or exchanging individual health data, which is anticipated to grow in the near future.

The basic diagnostic approaches used in robotic still-image telepathology

We investigated the basic diagnostic processes used in telepathology with our robotic still-image system, OLMICOS, by analysing the steps and patterns used in 20 consecutive tissue section diagnoses. Three basic approaches were recognized. One was magnifying a suspect finding in a low-powered microscopic image. This approach was used mostly for confirming or characterizing a tumour. The second approach was scanning over a low-powered image by magnifying square images to form a mesh. This was found to be useful to confirm the presence or absence of signs and was mostly used as the initial step in judging the surgical margin of malignant cases or diagnosing lesions. The third approach was a combination of these two and was used for delineating the surgical margin, confirming the absence of metastases or diagnosing difficult lesions. Recognition of these three basic diagnostic approaches is important in making a rapid and correct remote diagnosis.