The Osaka City Juso Hospital has taken advantage of a relocation and reconstruction to build a comprehensive medical information system. In addition to a new ordering system and an electronic medical chart system, the hospital is working toward centralized management and sharing of medical treatment information, creating mechanisms for providing patients with easy-to-understand medical information obtained through a LAN that encompasses the entire Hospital. The system is supported by NEC's total solutions, which incorporate a wide range of components, from the Express 5800 Series and iStorage to the "MegaOak" medical solution.

Taking advantage of relocation and reconstruction to build a comprehensive medical information system

Ryosuke Murata Director

The Osaka City Juso Hospital was established in July 1949 as the only public medical facility north of the Yodogawa River in Osaka. At the time, it started out as a clinic for internal medicine and surgery, but during the same year it added Obstetrics and Gynecology, Pediatrics, and Ophthalmology Departments, and later Dermatology, Urology, and other departments to become a full-fledged general hospital. As the number of departments increased, the hospital facilities were expanded and improved, but when the building began to deteriorate with age, relocation and reconstruction was undertaken from March 1999, and the facility was reopened as a new hospital in May 2002.

According to Director Ryosuke Murata, the philosophy of the hospital is to "earn the trust of city residents and contribute to the community; to practice medicine characterized by great humanity and warmth; and to respond to the needs of city residents now and in the future." The hospital, which has nine floors above ground and one basement floor, specifically emphasizes patient-centered functionality and amenities that provide patients with a sense of "comfort" and "warmth."

The introduction of computers into medical operations began in 1992 with the computerization of administrative procedures using a reception computer, and the implementation of computers in the Nutrition, Pharmaceutical, and Testing Departments. In each case, only independent systems were implemented.

When a medical information system is implemented in a hospital, the implementation is usually gradual, following a series of steps. The first step is the introduction of reception computers, aimed at increasing the efficiency of medical administration procedures. In the second stage, systems are developed for each individual division, for example with treatment-related systems for testing, pharmacies, examinations, and nursing support, as well as accounting systems for medical accounting, financial management, and personnel management. In the third stage, electronic ordering operations are undertaken, such as in the ordering of tests, prescriptions, in-patient care, and food, as the hospital information system begins to take on the characteristics of an integrated system. Finally, these systems are linked together, and medical information and images are converted into electronic format to promote centralized management of medical information based on electronic charts.

If we were to apply this common progression to the case of Juso Hospital, the first and second stages had already been accomplished, but with the relocation and reconstruction, the hospital made a single rapid progression to a comprehensive medical information system that enabled centralized management of everything from ordering to medical treatment information.

Aiming for improved patient services with a focus on accessibility of medical information

The goal of implementing a reception computer is to increase the efficiency of medical accounting, and among the goals of implementing an ordering system are increasing the speed and efficiency of order instructions by converting reservations and test instructions into an electronic format. In other words, the most important elements of these systems lie in providing support for medical treatments and increasing the efficiency of hospital operations. Of course these goals were also very important in the case of Juso Hospital's medical information system, but the thing that makes it very unique is that it promotes information sharing from the perspective of improving patient services, by making medical information available to patients in an easy-to-understand format.

Chief of Internal Medicine Yoichi Tatsumi, who led the system construction project, emphasizes the concept behind the hospital's system. "The philosophy of the hospital has always been to respond to medical needs from the patient's perspective. Similarly, our major goal in the construction of the medical information system was to achieve centralized management and sharing of medical information from the perspective of gaining the trust of patients by giving them access to all the information obtained through treatments, and at the same time to provide that information in a format that is easy for patients to understand."

In the past, when explaining the results of a medical exam to patients, doctors would have to have gastric camera photos or x-rays sent from the testing departments and show them in the exam rooms, and in the case of echocardiography and other complex tests, they were unable to show crucial materials without specialized equipment. By converting this test data into electronic format and storing it in a database, doctors are able to use a PC terminal to call up the actual data right in front of the patient, and show the images while offering explanations. Nurses working in the hospital can call up information anytime for in-patients whose data has been input into the system using the attending doctor's PC, enabling them to give instructions for prescriptions quickly and accurately. This type of system represents a major step forward compared to simply converting reservations, test instructions, and other types of traditional ordering into electronic format. According to Dr. Tatsumi, the hospital is aiming to create "a medical information system that truly takes systems for transmitting information to the next step?that is, sharing and applying the information that is obtained."

Building the system on a platform comprising MegaOak and the Express5800 Series

Yoichi Tatsumi Chief of Internal Medicine

The newly constructed medical information system is made up of a total of 17 servers, with a medical information database server and medical accounting server at the center; other servers have been implemented for each department or specific function, such as testing operations, radiology operations, nutrition operations, reference image processing, medical history databases, and accounting operations. As for the network, the backbone LAN operates on a gigabit base, and is accessed at connection speeds of 100 Mbytes/second from around 200 client PCs. All of these servers run on a Windows 2000 platform.
"We know that mainframes are really robust," says Dr. Tatsumi, "but we are a public medical facility, and considering the scale of the hospital, we had to choose a platform with a client/server configuration, and one that offered superior cost performance. Because this is a medical system, an absolute condition was that it operate 24 hours a day, 365 days a year, without the slightest possibility of system interruptions. For this reason, based on the premise that system failures could happen, we placed emphasis on mechanisms that would activate a backup somewhere in the event that such a failure occurred, and that would enable data to be recovered immediately."
In addition to selecting a Windows platform, which offers superior cost performance, the hospital adopted solutions for increasing availability. One of these was a cluster configuration for the medical information database servers, which represent the core of the system. The LAN connections for the client PCs feature complete redundancy, and redundancy has also been incorporated into the backbone servers and the network.

Juso Hospital's medical information system is supported by NEC's Express5800 Series, storage units, and the MegaOak group of package software products, which is NEC's original medical information solution. The 4-way Express5800/140Ra-4 has been adopted as the medical information database server, medical accounting server, and test operations server?all of which have been assembled in a cluster configuration?and as the interface server that handles links between these servers. The 2-way Express5800/120Rc-2 is used for all other servers. Storage is handled by the iStorage3100, which accommodates massive data volumes of up to three terabits (effective data volume of 1 TB, with mirroring configuration). Meanwhile, various applications packages?including MegaOak-NEMR (an electronic chart system) and MegaOak-Nursing (a nursing support system)?have been implemented on a foundation of the MegaOak-Base (common platform), which enables centralized management of patient information and treatment information. The result is a medical information system based on a total solution encompassing all components from hardware to software.