Health informatics in Japan, update, 2008- 2009.

Like other countries, the economic stimulus package in Japan is including healthcare delivery support. For the health informatics domain, there are two large subsidies proposed. One is to provide “the last one mile” optic fiber network to all hospitals in Japan. We have about 9000 hospitals nationwide, and some very local hospitals only have a slower network infrastructure. The other is to support regional healthcare allies, for the regional core hospitals to help more local hospitals’ activities. Many applicants are proposing various aspects of healthcare. Some plan prenatal period information sharing, others offer image examination remote reading. Outcomes of these projects are anticipated in reports in the future. In Japan, CPOE (Physician’s Order Entry System) is very popular. More than 80% of large hospitals (with 400+ beds) have CPOE. About 25% have EMR (electronic medical record). Medical errors have come out in the open in recent years, therefore to cope with very crowded hospital/clinic situations and lack of medical staff, Japanese hospitals have used CPOE to make orders and messages promptly delivered to destination departments. University hospitals are now experiencing forth replacement/upgrade of CPOE. From accumulated experience through the years, three of four papers in this Japan issue are based on data acquired from operation, transaction, and planning of CPOE. As CPOE is popular in Japan, so is the standardized export of data prevailing also. Since 2006, through two large Ministry projects to promote standardized export of data in HL7 and DICOM format, two top HIS ven dors (Fujitsu and NEC) are shipping HL7 conformant HIS. With other conformant vendor products, around 50% of large hospitals have HL7 and DICOM export features. We are headed for the secondary use of clinical data. Pros have already been told; regional health network, provider management planning, health policy planning, clinical research , etc. However, we must have crisp guidelines for the protection of patient privacy. As high-speed, high-level searching tools become available, the guidelines we now have (like HIPAA) will soon become outdated.