The Ubiquitous Information Network for The …...Information Network (UIN) for the Community Based...

The Ubiquitous Information Network for The Community The Ubiquitous Information Network for The Community based Health Services May Offer Optimal Health Care based Health Services May Offer Optimal Health Care and Welfare for Every Citizen by Tailorand Welfare for Every Citizen by Tailor--Made FormMade Form

生活者起点の医療を目指した地域医療情報ネットワークの構築生活者起点の医療を目指した地域医療情報ネットワークの構築

Copyright@2004 Yuki Kitaoka

Yuki Yuki KitaokaKitaoka, MD, PhD, MD, PhDNational Hospital Organization Kyoto Medical CenterNational Hospital Organization Kyoto Medical Center

独立行政法人国立病院機構京都医療センター独立行政法人国立病院機構京都医療センター

医療情報部長医療情報部長北岡北岡有喜有喜

The 5thThe 5th KitasatoKitasato University University -- Harvard School of Public Health SymposiumHarvard School of Public Health Symposiumon Advanced and Global Drug Development Techniqueson Advanced and Global Drug Development Techniques

医療を取り巻く環境の変化医療を取り巻く環境の変化

医療過誤･健康環境汚染･･････････安全確保が急務医療過誤･健康環境汚染･･････････安全確保が急務

患者ニーズの多様化････････････患者ニーズの多様化････････････ITITによる情報収集による情報収集

情報公開･･･････････････････････患者の「知る権利」情報公開･･･････････････････････患者の「知る権利」

個人情報保護･････････････････プライバシーの保護個人情報保護･････････････････プライバシーの保護

医療制度改革････････････････国民総医療費の高騰医療制度改革････････････････国民総医療費の高騰

少子高齢化社会における少子高齢化社会における患者本位の医療とは？患者本位の医療とは？

Our health care and welfare environment are getting worse rapidlOur health care and welfare environment are getting worse rapidly in recent years, y in recent years, such as various medical malpractice, contamination problems of bsuch as various medical malpractice, contamination problems of blood products, lood products, safety problems of meals, such as BSE and bird influenza, a penssafety problems of meals, such as BSE and bird influenza, a pension system ion system alteration and so on. alteration and so on.

Are you satisfied with the present health Are you satisfied with the present health care and welfare environment?care and welfare environment?


医療を取り巻く環境の変化医療を取り巻く環境の変化

医療過誤･健康環境汚染･･････････安全確保が急務医療過誤･健康環境汚染･･････････安全確保が急務

患者ニーズの多様化････････････患者ニーズの多様化････････････ITITによる情報収集による情報収集

情報公開･･･････････････････････患者の「知る権利」情報公開･･･････････････････････患者の「知る権利」

個人情報保護･････････････････プライバシーの保護個人情報保護･････････････････プライバシーの保護

医療制度改革････････････････国民総医療費の高騰医療制度改革････････････････国民総医療費の高騰

↓↓

誰でも、何時でも、何処でも、安心・安全で、誰でも、何時でも、何処でも、安心・安全で、良質な医療が享受できる環境整備良質な医療が享受できる環境整備

少子高齢化社会における少子高齢化社会における患者本位の医療とは？患者本位の医療とは？

Our health care and welfare environment are getting worse rapidlOur health care and welfare environment are getting worse rapidly in recent years, y in recent years, such as various medical malpractice, contamination problems of bsuch as various medical malpractice, contamination problems of blood products, lood products, safety problems of meals, such as BSE and bird influenza, a penssafety problems of meals, such as BSE and bird influenza, a pension system ion system alteration and so on. alteration and so on.

↓↓

We, citizen, wish now to be prepared the local We, citizen, wish now to be prepared the local environment where every citizen can receive the high environment where every citizen can receive the high quality health care and welfare with safe and safety in quality health care and welfare with safe and safety in anywhere at anytime by adequate costs. anywhere at anytime by adequate costs.

Are you satisfied with the present health Are you satisfied with the present health care and welfare environment?care and welfare environment?


In order to realize this optimal health In order to realize this optimal health care and welfare environment,care and welfare environment,

生活者起点の医療を実現するには･･･生活者起点の医療を実現するには･･･



(1) (1) Offer of good medicine Offer of good medicine →→ Offer of EvidenceOffer of Evidence--Based Medicine (EBM)Based Medicine (EBM)(2) Creation of evidences (2) Creation of evidences →→ Data mining of the accumulated medical informationData mining of the accumulated medical information(3) Electronic preservation of medical information (3) Electronic preservation of medical information →→ Development and introductionDevelopment and introduction

of the Electronic Health Recording system (EHRof the Electronic Health Recording system (EHR--S) to each medical institutionS) to each medical institution(4) They are a share and accumulation about the medical informat(4) They are a share and accumulation about the medical information in an area ion in an area →→ The development and introduction of the ASP type EHRThe development and introduction of the ASP type EHR--S of HL7 conformityS of HL7 conformity

(5) Also accumulate the medical information outside a medical in(5) Also accumulate the medical information outside a medical institution stitution →→ Maintenance of a public radio VPN networkMaintenance of a public radio VPN network

(6) Safe and safety public wireless VPN network (6) Safe and safety public wireless VPN network →→ Maintenance of IPv6 networkMaintenance of IPv6 network

生活者起点の医療を実現するには･･･生活者起点の医療を実現するには･･･①① 良質な医療の提供････････････････････････････････根拠に基づく医療の提供良質な医療の提供････････････････････････････････根拠に基づく医療の提供

②② 根拠の創造････････････････････････集積された医療情報のデータマイニング根拠の創造････････････････････････集積された医療情報のデータマイニング

③③ 医療情報の電子保存･････････････個々の医療機関への電子カルテの開発･導入医療情報の電子保存･････････････個々の医療機関への電子カルテの開発･導入

④④ 地域内の医療情報を共有･集積････････地域内の医療情報を共有･集積････････HL7HL7準拠の準拠のASPASP型電子カルテの開発･導入型電子カルテの開発･導入

⑤⑤ 医療機関外の医療情報も集積･････････････････････････公衆無線医療機関外の医療情報も集積･････････････････････････公衆無線VPNVPN網の整備網の整備

⑥⑥ 安心･安全な公衆無線安心･安全な公衆無線VPNVPN網･･････････････････････････････････網･･････････････････････････････････IPv6IPv6網の整備網の整備



We are now developing the mission of the Ubiquitous We are now developing the mission of the Ubiquitous Information Network (UIN) for the Community Based Information Network (UIN) for the Community Based Health Services (CBHS) within the framework of HL7 Health Services (CBHS) within the framework of HL7 (Health Level Seven) standards, in order to promote (Health Level Seven) standards, in order to promote information exchange between Community Based and information exchange between Community Based and Acute Care service domains.Acute Care service domains.

The scope of the mission of the UIN for CBHS includes but is noThe scope of the mission of the UIN for CBHS includes but is not limited to home health, hospice, longt limited to home health, hospice, long--term care, term care, mental health and other community based providers. mental health and other community based providers. And the goal of the mission is to offer optimal health care andAnd the goal of the mission is to offer optimal health care and welfare for every citizen by tailorwelfare for every citizen by tailor--made form, on the made form, on the infrastructure of theinfrastructure of the MiakoMiako.net (a public wireless VPN.net (a public wireless VPN--LAN), the ASP type Electronic Health Recording system LAN), the ASP type Electronic Health Recording system (EHR(EHR--S) and the Data Mining system on Data Ware House in order to proS) and the Data Mining system on Data Ware House in order to produce the evidences for Evidenceduce the evidences for Evidence--Based Based Medicine (EBM).Medicine (EBM).



We are now developing the mission of the Ubiquitous Information We are now developing the mission of the Ubiquitous Information Network (UIN) for the Community Based Network (UIN) for the Community Based Health Services (CBHS) within the framework of HL7 (Health LevelHealth Services (CBHS) within the framework of HL7 (Health Level Seven) standards, in order to promote Seven) standards, in order to promote information exchange between Community Based and Acute Care servinformation exchange between Community Based and Acute Care service domains. ice domains.

The scope of the mission of the UIN for CBHS includes The scope of the mission of the UIN for CBHS includes but is not limited to home health, hospice, longbut is not limited to home health, hospice, long--term care, term care, mental health and other community based providers. mental health and other community based providers.

And the goal of the mission is to offer optimal health care andAnd the goal of the mission is to offer optimal health care and welfare for every citizen by tailorwelfare for every citizen by tailor--made form, on the made form, on the infrastructure of theinfrastructure of the MiakoMiako.net (a public wireless VPN.net (a public wireless VPN--LAN), the ASP type Electronic Health Recording system LAN), the ASP type Electronic Health Recording system (EHR(EHR--S) and the Data Mining system on Data Ware House in order to proS) and the Data Mining system on Data Ware House in order to produce the evidences for Evidenceduce the evidences for Evidence--Based Based Medicine (EBM).Medicine (EBM).



We are now developing the mission of the Ubiquitous Information We are now developing the mission of the Ubiquitous Information Network (UIN) for the Community Based Network (UIN) for the Community Based Health Services (CBHS) within the framework of HL7 (Health LevelHealth Services (CBHS) within the framework of HL7 (Health Level Seven) standards, in order to promote Seven) standards, in order to promote information exchange between Community Based and Acute Care servinformation exchange between Community Based and Acute Care service domains. ice domains. The scope of the mission of the UIN for CBHS includes but is noThe scope of the mission of the UIN for CBHS includes but is not limited to home health, hospice, longt limited to home health, hospice, long--term care, term care, mental health and other community based providers. mental health and other community based providers.

And the goal of the mission is to offer optimal health And the goal of the mission is to offer optimal health care and welfare for every citizen by tailorcare and welfare for every citizen by tailor--made form, on made form, on the infrastructure of thethe infrastructure of the MiakoMiako.net (a public wireless .net (a public wireless VPNVPN--LAN), the ASP type Electronic Health Recording LAN), the ASP type Electronic Health Recording System (EHRSystem (EHR--S) and the Data Mining system on Data S) and the Data Mining system on Data Ware House in order to produce the evidences for Ware House in order to produce the evidences for EvidenceEvidence--Based Medicine (EBM).Based Medicine (EBM).


What is What is ““DokokaruDokokaru.net.net”” ??The missionThe mission’’s code name is s code name is ““DokokaruDokokaru.net.net””; ;

““DokoDoko”” is an abbreviation of a Japanese word is an abbreviation of a Japanese word ““DokodemoDokodemo”” meaning meaning ““everywhere i.e., everywhere i.e., ubiquitousubiquitous””, and , and ““karukaru”” is an abbreviation of is an abbreviation of ““KarteKarte”” meaning meaning ““Health RecordsHealth Records””. .

The The ““DokokaruDokokaru.net.net”” does not only merely offer the hardware or software of a high sdoes not only merely offer the hardware or software of a high security ecurity UIN for CBHS. UIN for CBHS. The The ““DokokaruDokokaru.net.net”” but also offer the new life style providing every citizen with but also offer the new life style providing every citizen with various various health care and welfare information via the UIN for CBHS and a hhealth care and welfare information via the UIN for CBHS and a human networks connected uman networks connected in the in the ““DokokaruDokokaru.net.net”” by tailorby tailor--made form.made form.


What is What is ““DokokaruDokokaru.net.net”” ??The missionThe mission’’s code name is s code name is ““DokokaruDokokaru.net.net””; ; ““DokoDoko”” is an abbreviation of a Japanese word is an abbreviation of a Japanese word ““DokodemoDokodemo”” meaning meaning ““everywhere i.e., everywhere i.e., ubiquitousubiquitous””, and , and ““karukaru”” is an abbreviation of is an abbreviation of ““KarteKarte”” meaning meaning ““Health RecordsHealth Records””. .

The The ““DokokaruDokokaru.net.net”” does not only merely does not only merely offer the hardware or software of a high offer the hardware or software of a high security UIN for CBHS. security UIN for CBHS. The The ““DokokaruDokokaru.net.net”” but also offer the new life but also offer the new life

style providing every citizen with various style providing every citizen with various health care and welfare information via the health care and welfare information via the UIN for CBHS and a human networks UIN for CBHS and a human networks connected in the connected in the ““DokokaruDokokaru.net.net”” by tailorby tailor--made form.made form.


""Safe and Safety" society realized via Safe and Safety" society realized via DokokaruDokokaru.net.netどこカルどこカル..ネットで実現する「安心･安全」な社会ネットで実現する「安心･安全」な社会

Case 1: Case 1: ケース１ケース１

It discovered that the old woman It discovered that the old woman had broken down from the passage had broken down from the passage one day! An ambulance was called.one day! An ambulance was called.ある日、道路でおばあさんが倒れているのを発見！ある日、道路でおばあさんが倒れているのを発見！

救急車を呼ぶ。救急車を呼ぶ。






She was unconscious and her She was unconscious and her identity was not understood, either.identity was not understood, either.By a finger vein authorization By a finger vein authorization system, authentication started a system, authentication started a clinical recording automatically.clinical recording automatically.意識もなく、身元もわからない。意識もなく、身元もわからない。指静脈認証システムで、認証すると、自動的にカル指静脈認証システムで、認証すると、自動的にカルテが起動。テが起動。







Finger vein authenticationFinger vein authentication指静脈認証「静紋」指静脈認証「静紋」






She was proved that it was diabetes She was proved that it was diabetes mellitus. In this case, the most mellitus. In this case, the most fearful one was the hypoglycemia. fearful one was the hypoglycemia. By supply of quick glucose, it was By supply of quick glucose, it was consciousness recovery.consciousness recovery.おばあさんは、糖尿病と判明。この場合、おばあさんは、糖尿病と判明。この場合、一番怖いのが低血糖。一番怖いのが低血糖。すばやいブドウ糖の補給で、意識回復。すばやいブドウ糖の補給で、意識回復。








She was proved that it was diabetes She was proved that it was diabetes mellitus. In this case, the most mellitus. In this case, the most fearful one was the hypoglycemia. fearful one was the hypoglycemia. By supply of quick glucose, it was By supply of quick glucose, it was consciousness recovery.consciousness recovery.おばあさんは、糖尿病と判明。この場合、おばあさんは、糖尿病と判明。この場合、一番怖いのが低血糖。一番怖いのが低血糖。すばやいブドウ糖の補給で、意識回復。すばやいブドウ糖の補給で、意識回復。



Supply of glucoseSupply of glucoseブドウ糖の補給ブドウ糖の補給



Case 2Case 2：：ケース２ケース２

Seemingly he had forgotten the medicine Seemingly he had forgotten the medicine at the time of aat the time of a pectoralgiapectoralgia attack, and attack, and consciousness was lost immediately!consciousness was lost immediately!ある日、駅でうずくまる初老の紳士を発見！ある日、駅でうずくまる初老の紳士を発見！胸痛発作時の薬を忘れたらしく、すぐに意識がな胸痛発作時の薬を忘れたらしく、すぐに意識がなくなる！くなる！





Ambulance officer arrival Ambulance officer arrival It logged in with a common patient's It logged in with a common patient's registration card. EHRregistration card. EHR--S started.S started.救急隊員到着救急隊員到着共通診察券でログイン。電子カル共通診察券でログイン。電子カルテが起動。テが起動。






In a site and a hospital, an ambulance In a site and a hospital, an ambulance officer transmitted an electrocardiogram officer transmitted an electrocardiogram on that occasion to a center medical on that occasion to a center medical practitioner on real time, looking at the practitioner on real time, looking at the normalnormal electocardiogramelectocardiogram of three days of three days ago simultaneously.ago simultaneously.現場と病院では同時に３日前の正常心電図を見現場と病院では同時に３日前の正常心電図を見ながら、救急隊員はその場の心電図をセンターながら、救急隊員はその場の心電図をセンター医師へリアルタイムに伝送。医師へリアルタイムに伝送。





It was proved that it was aIt was proved that it was a tachycardiatachycardiaseizure. Iced water is given with seizure. Iced water is given with directions of a medical practitioner. directions of a medical practitioner. Consciousness returned by the stimulus.Consciousness returned by the stimulus.頻脈発作と判明。医師の指示で氷水を飲ませる。頻脈発作と判明。医師の指示で氷水を飲ませる。その刺激で意識が戻る。その刺激で意識が戻る。

In a site and a hospital, an ambulance In a site and a hospital, an ambulance officer transmitted an electrocardiogram officer transmitted an electrocardiogram on that occasion to a center medical on that occasion to a center medical practitioner on real time, looking at the practitioner on real time, looking at the normalnormal electocardiogramelectocardiogram of three days of three days ago simultaneously.ago simultaneously.現場と病院では同時に３日前の正常心電図を見現場と病院では同時に３日前の正常心電図を見ながら、救急隊員はその場の心電図をセンターながら、救急隊員はその場の心電図をセンター医師へリアルタイムに伝送。医師へリアルタイムに伝送。




Case 3Case 3：：ケースケース33

The report "the multiplex accident The report "the multiplex accident occurred on the highway under traffic occurred on the highway under traffic congestion" entered.congestion" entered.「「渋滞中の高速道路で多重事故が発生した。」と渋滞中の高速道路で多重事故が発生した。」との通報が入った。の通報が入った。





Large traffic congestion which cannot Large traffic congestion which cannot pass along an ambulance. A helicopter pass along an ambulance. A helicopter did not immediately come, either!did not immediately come, either!救急車も通れない大渋滞。救急車も通れない大渋滞。ヘリもすぐには来られない！ヘリもすぐには来られない！






One person of a back car reported One person of a back car reported information to an emergency center information to an emergency center for the for the CentrinoCentrino Mobile Technology Mobile Technology loading note PC.loading note PC.後方の車の後方の車の11人がセントリーノ搭載ノート人がセントリーノ搭載ノートPCPCで、救で、救急センターへ情報を報告。急センターへ情報を報告。






One person of a back car reported One person of a back car reported information to an emergency center information to an emergency center for the for the CentrinoCentrino Mobile Technology Mobile Technology loading note PC.loading note PC.後方の車の後方の車の11人がセントリーノ搭載ノート人がセントリーノ搭載ノートPCPCで、救で、救急センターへ情報を報告。急センターへ情報を報告。

A center medical practitioner advised A center medical practitioner advised on the procedure of an emergency on the procedure of an emergency allowance! The scale of damage was allowance! The scale of damage was able to be kept to the minimum.able to be kept to the minimum.センター医師が救急手当の方法をアドバイス！センター医師が救急手当の方法をアドバイス！被害の規模を最小限に食い止めることができた。被害の規模を最小限に食い止めることができた。


IT revolution in medicineIT revolution in medicineStatus of Development of the DataStatus of Development of the Data--Mining Tool used as the Base of EBMMining Tool used as the Base of EBM

医療における医療におけるITIT革命革命EBMEBMのベースとなるデータマイニングツールの開発状況のベースとなるデータマイニングツールの開発状況


Knowledge Gap

Data Amount of Information

Analysis Amount of Information

1960 1970 1980 1990 2000

Analysis is not carried out although there is Data.

Fom Data toIn Information and Knowledge !

Source: U.S. Gartner Group

Increase of a Knowledge GapIncrease of a Knowledge Gap-- Expectation for the New Analysis Procedure Expectation for the New Analysis Procedure --


Copyright@2002 Yuki KitaokaCopyright@2004 Yuki Kitaoka

Knowledge discovery Knowledge discovery typetype

The important knowledge The important knowledge which lurks in it is unearthed which lurks in it is unearthed from raw data.from raw data.

Data collection typeData collection type

Raw data is collected, Raw data is collected, searched and analyzed on searched and analyzed on real time.real time.

Hypothesis testing Hypothesis testing typetype

It verifies to the It verifies to the hypothesis built up hypothesis built up beforehand using raw data.beforehand using raw data.

The Classification of The Classification of the Data Analysis Procedurethe Data Analysis Procedure

データ解析手法の分類データ解析手法の分類


The process which was not known before The process which was not known before and which is effective, extracts utilizable and which is effective, extracts utilizable information from a large scale database, and information from a large scale database, and makes a decision on important business using makes a decision on important business using the information.the information.

以前には知られていなかった、有効で、活用できる情報を以前には知られていなかった、有効で、活用できる情報を大規模データベースから抽出し、その情報を用いて重要な大規模データベースから抽出し、その情報を用いて重要なビジネス上の決定を行うプロセスビジネス上の決定を行うプロセス

Data MiningData Mining


The process which was not known before and The process which was not known before and which is effective, extracts utilizable which is effective, extracts utilizable evidences from a national common EHRevidences from a national common EHR--S S database, and performs discovery and database, and performs discovery and development of a new prevention and development of a new prevention and diagnostic treatment method using the diagnostic treatment method using the informationinformation

以前には知られていなかった、有効で、活用できる以前には知られていなかった、有効で、活用できるevidencesevidencesを全国共通電子カルテデータベースから抽出し、を全国共通電子カルテデータベースから抽出し、その情報を用いて新たな予防・診断・治療法の発見・開発その情報を用いて新たな予防・診断・治療法の発見・開発を行うプロセスを行うプロセス



If the following two conditions are not fulfilled, it If the following two conditions are not fulfilled, it cannot be said to be true data mining.cannot be said to be true data mining.

Condition 1: The Condition 1: The highhigh--speedspeed analysisanalysis of the huge of the huge data can be carried out data can be carried out comprehensivelycomprehensively..Condition 2: Target knowledge can be Condition 2: Target knowledge can be discovered discovered automaticallyautomatically..

次の２条件が満たされなければ、真のデータマイニングとは言えない。次の２条件が満たされなければ、真のデータマイニングとは言えない。

条件１］巨大データを条件１］巨大データを網羅的に高速処理網羅的に高速処理できる。できる。条件２］目標とする知識を条件２］目標とする知識を自動的に発見自動的に発見できる。できる。



The Fundamental Mining ProcedureThe Fundamental Mining Procedureデータベースを元に、数値予測モデルを自動生成し、その予測モデルを用いて、新しいレコードの数値を予測する。また、そのレコードにおける各種項目と予測対象項目との間の因果関係を発見する。

データベースのレコードについて、その特性ごとにいくつかのクラスター(層)に分け、かつレコード間の類似関係も抽出できる。また、こうして分けられた各クラスターは、別途の各種分析に使用される。

データベースを元に、クラス判別モデルを自動生成し、その判別モデルを用いて、新しいレコードのクラスを予測する。また、その際の判別ルールも抽出できる。

予め、仮説を設定することなく、トランザクションの中から、特定のアイテム同士の関連性を見つけ出す。例えば、併売分析では、｢ビールを購入する客の多くは、コーラも購入する傾向があり、その確信度は幾らである｣といった法則を発見する。

特定の顧客が時系列の中で、どのような購買パターンを取るかといった、時系列的な購買分析を行う。

一定期間内における、複数のデータ系列の中から、類似した変動を見せるデータ系列を発見する。例えば、類似した変動パターンを取る株式銘柄や類似した売上パターンを示す商品など、該当の全セットを発見できる。

prospect予測

Similar time series analysis類似時系列分析

Time series pattern analysis時系列

パターン分析

Correlation analysis相関関係分析

Class distinctionクラス判別

Cluster analysisクラスター分析

大脳＝３

ベッセル数＝０

以前のピーク＜3.55

年齢＜57.5

血圧＜109

血圧＜106.5


血圧＜158

呼吸数＝1

コレステロール＜309

痛みのタイプ＝4

性別＝0

血圧＜134



コレステロール＜318.5

傾斜＝2

ベッセル数＝０

呼吸数＝1



血圧＜143

年齢＜40.5

コレステロール＜174.5

心拍数＜130

痛みのタイプ＝１＆２



血圧＜109


年齢＜61.5

ＥＣＧ＝2

血圧＜119

年齢＜65

ＩｎｔｅｌｌｉｇｅｎｔＭｉｎｅｒクラス判別：決定木法（全体図）


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