Information and communications technology has attracted attention as a useful way of sharing care records in community-based care. Such information sharing systems, however, imposed the burden of inputting the same records into different information systems due to a lack of interoperability of the systems.
OBJECTIVES:
The purpose of this study was to develop a gateway that links information systems and to investigate the functionality and usability of the gateway through an empirical study.
METHODS:
We developed a gateway with healthcare and welfare professionals in Kashiwa city, Japan. The gateway system consisted of two sub-systems: a data exchange sub-system and a common sub-system. Regarding the security, we used the transport layer security 1.2 and a public key infrastructure. For document formats, we utilized the health level seven international, extensible markup language, and portable document format. In addition, we performed an empirical study with 11 scenarios of four simulated patients and a questionnaire survey to the professionals.
RESULTS:
Professionals of eight occupations participated the empirical study and verified the gateway to link information systems of six vendors. For a questionnaire survey, 32 professionals out of 40 reported that the gateway would eliminate the burden of inputting the same records into different information systems.
United Nations. World Population Aging 2015. New York: 2015.
2.
MatsudaSYamamotoM. Long-term care insurance and integrated care for the aged in Japan. International Journal of Integrated Care. 2001; 1: e28. Epub 2006/08/10. PubMed PMID: 16896410; PubMed Central PMCID: PMCPMC1484411.
3.
Ministry of Health, Labour and Welfare in Japan. Long-Term Care, Health and Welfare Services for the Elderly [cited 2017 May 23]. Available from: http://www.mhlw.go.jp/english/policy/care-welfare/care-welfare-elderly/.
4.
TsutsuiT. Implementation process and challenges for the community-based integrated care system in Japan. International Journal of Integrated Care. 2014; 14: e002. Epub 2014/01/31. PubMed PMID: 24478614; PubMed Central PMCID: PMCPMC3905786.
5.
Ministry of Health, Labour and Welfare in Japan. Overview of the Revision of the Long-term Care Insurance System – Amendment of the Long-term Care Insurance Law and Long-term Care Fee [cited 2017 May 23]. Available from: http://www.ilcjapan.org/linksE/doc/Overview_of_the_Revision_of_LTCI.pdf.
6.
MorikawaM. Towards community-based integrated care: trends and issues in Japan’s long-term care policy. International Journal of Integrated Care. 2014; 14: e005. Epub 2014/03/08. PubMed PMID: 24605073; PubMed Central PMCID: PMCPMC3943617.
7.
BragaRD. A multiprofessional information model for Brazilian primary care: Defining a consensus model towards an interoperable electronic health record. Int J Med Inform. 2016; 90: 48-57. Epub 2016/04/23. doi: 10.1016/j.ijmedinf.2016.03.004. PubMed PMID: 27103197.
8.
WatersonP. Health information technology and sociotechnical systems: a progress report on recent developments within the UK National Health Service (NHS). Appl Ergon. 2014; 45(2): 150-61. Epub 2013/07/31. doi: 10.1016/j.apergo.2013.07.004. PubMed PMID: 23895916.
9.
CifuentesMDavisMFernaldDGunnRDickinsonPCohenDJ. Electronic Health Record Challenges, Workarounds, and Solutions Observed in Practices Integrating Behavioral Health and Primary Care. J Am Board Fam Med. 2015; 28 Suppl 1: S63-72. Epub 2015/09/12. doi: 10.3122/jabfm.2015.S1.150133. PubMed PMID: 26359473.
10.
Cabinet office, Government of Japan. Japan revitalization strategy; 2013 [cited 2017 May 23]. Avairable from: http://www.kantei.go.jp/jp/singi/keizaisaisei/pdf/en_saikou_jpn_hon.pdf.
11.
Cabinet office, Government of Japan. Declaration to be the World’s Most Advanced IT Nation; 2013 [cited 2017 May 23]. Avairable from: http://japan.kantei.go.jp/policy/it/2013/0614_declaration.pdf.
12.
IijimaKYoshieSKimataMIhoriMYamamotoTGotoJ, et al. A new attempt to promote home medical care in Kashiwa city-usefulness of information and communication technology with seamless multidisciplinary cooperation. Gan To Kagaku Ryoho. 2012; 39 Suppl 1: 51-4. Epub 2012/12/28. PubMed PMID: 23268899. (in Japanese)
13.
WatersonPEasonKTuttDDentM. Using HIT to deliver integrated care for the frail elderly in the UK: current barriers and future challenges. Work (Reading, Mass). 2012; 41 Suppl 1: 4490-3. Epub 2012/02/10. doi: 10.3233/wor-2012-0750-4490. PubMed PMID: 22317413.
14.
BusettoLLuijkxKHuizingAVrijhoefB. Implementation of integrated care for diabetes mellitus type 2 by two Dutch care groups: a case study. BMC Fam Pract. 2015; 16: 105. Epub 2015/08/22. doi: 10.1186/s12875-015-0320-z. PubMed PMID: 26292703; PubMed Central PMCID: PMCPMC4546228.
15.
Van DurmeTMacqJAnthierensSSymonsLSchmitzOPaulusD, et al. Stakeholders’ perception on the organization of chronic care: a SWOT analysis to draft avenues for health care reforms. BMC Health Serv Res. 2014; 14: 179. Epub 2014/04/20. doi: 10.1186/1472-6963-14-179. PubMed PMID: 24742204; PubMed Central PMCID: PMCPMC4022440.
16.
O’MalleyASDraperKGourevitchRCrossDAScholleSH. Electronic health records and support for primary care teamwork. J Am Med Inform Assoc. 2015; 22(2): 426-34. Epub 2015/01/30. doi: 10.1093/jamia/ocu029. PubMed PMID: 25627278; PubMed Central PMCID: PMCPMC4394968.
17.
RichardsonJEVestJRGreenCMKernLMKaushalR. A needs assessment of health information technology for improving care coordination in three leading patient-centered medical homes. J Am Med Inform Assoc. 2015; 22(4): 815-20. Epub 2015/03/23. doi: 10.1093/jamia/ocu039. PubMed PMID: 25796597.
18.
Internet Engineering Task Force (IETF). The Transport Layer Security (TLS) Protocol Version 1.2; 2008 [cited 2017 May 23]. Available from: https://tools.ietf.org/html/rfc5246.
19.
KarthikeyanBCedricFMarkulfKAlfredoPPierre-YvesS. Implementing TLS with Verified Cryptographic Security. 2013 IEEE Symposium on Security and Privacy. 2013: 445-59. doi: 10.1109/SP.2013.37.
20.
KellyGMcKenzieB. Security, privacy, and confidentiality issues on the Internet. J Med Internet Res. 2002; 4(2): E12. Epub 2003/01/30. doi: 10.2196/jmir.4.2.e12. PubMed PMID: 12554559; PubMed Central PMCID: PMCPMC1761937.
21.
ZakiaEUHananEB. A comparative study of PKI trust models. 2014 International Conference on Next Generation Networks and Services (NGNS). 2014: 255-61. Epub 261. doi: 10.1109/NGNS.2014.6990261.
22.
JewelWHuimingYXiaohongY. Case study: Using Smart Cards with PKI to implement data access control for health information systems. Proceedings of the IEEE SoutheastCon 2010 (SoutheastCon). 2010: 163-7. doi: 10.1109/SECON.2010.5453896.
23.
Institute of Gerontology, the University of Tokyo. Guidelines for the appropriate use of information systems to link home health care and long-term care. Tokyo: Institute of Gerontology; 2014 [cited 2017 May 23]. Available from: http://www.iog.u-tokyo.ac.jp/wp-content/uploads/2014/05/5435d2ad3a28ce3767b71b2bfb764856.pdf. (in Japanese)
24.
Japanese Association of Healthcare Information Systems Inductry (JAHIS). JAHIS vision [cited 2017 May 23]. Available from: https://www.jahis.jp/about_en/contents_type=46.
25.
Health Level Seven Internarional (HL7 International). Introduction to HL7 standards [cited 2017 May 23]. Available from: http://www.hl7.org/implement/standards/index.cfm?ref=common.
26.
World Wide Web Consortium (W3C). Extensible Markup Language (XML) [updated 2016 Oct 11; cited 2017 May 23]. Available from: https://www.w3.org/XML/.
27.
Adobe Systems Incorporated. Adobe PDF reference archives [cited 2017 May 23]. Available from: https://www.adobe.com/devnet/pdf/pdf_reference_archive.html.
28.
Ministry of Health, Labour and Welfare in Japan. Guidelines for the safe management of medical information systems. 4.2 ed. Tokyo: Ministry of Health, Labour and Welfare; 2013. Available from: http://www.mhlw.go.jp/stf/shingi/0000026088.html. (in Japanese)
29.
Ministry of Internal Affairs and Communications in Japan. Information security guidelines for ASP and SaaS. Tokyo: Ministry of Internal Affairs and Communications; 2008. Available from: http://www.soumu.go.jp/main_content/000166465.pdf. (in Japanese)
30.
Ministry of Internal Affairs and Communications in Japan. Safety guidelines for ASP and SaaS in medical information. 1.1 ed. Tokyo: Ministry of Internal Affairs and Communications; 2010. Available from: http://www.soumu.go.jp/main_content/000166469.pdf. (in Japanese)
31.
Ministry of Economy Trade and Industry in Japan. Management guidelines of medical information (for information processing corporations). 2nd ed. Tokyo: Ministry of Economy Trade and Industry; 2012. Available from: http://www.meti.go.jp/policy/it_policy/privacy/iryouglv2.pdf. (in Japanese)
32.
FoldySGrannisSRossDSmithT. A ride in the time machine: information management capabilities health departments will need. Am J Public Health. 2014; 104(9): 1592-600. Epub 2014/07/18. doi: 10.2105/ajph.2014.301956. PubMed PMID: 25033122; PubMed Central PMCID: PMCPMC4151922.
33.
KoopmanRJKochendorferKMMooreJLMehrDRWakefieldDSYadamsurenB, et al. A diabetes dashboard and physician efficiency and accuracy in accessing data needed for high-quality diabetes care. Ann Fam Med. 2011; 9(5): 398-405. Epub 2011/09/14. doi: 10.1370/afm.1286. PubMed PMID: 21911758; PubMed Central PMCID: PMCPMC3185474.
34.
BouterSvan Weel-BaumgartenEBolhuisS. Construction and validation of the Nijmegen Evaluation of the Simulated Patient (NESP): assessing simulated patients’ ability to role-play and provide feedback to students. Acad Med. 2013; 88(2): 253-9. Epub 2012/12/28. doi: 10.1097/ACM.0b013e31827c0856. PubMed PMID: 23269298.
35.
NakayaJKimuraMOgishimaSShaboAKimIKParisotC, et al. Future Direction of IMIA Standardization. Report from the IMIA Standardization Working Group. Yearb Med Inform. 2014; 9: 105-9. Epub 2014/08/16. doi: 10.15265/iy-2014-0010. PubMed PMID: 25123729; PubMed Central PMCID: PMCPMC4287064.
36.
International Medical Informatics Association. NI-Health Informatics Standards [cited 2017 May 23]. Available from: http://imia-medinfo.org/wp/ni-health-informatics-standards/.
37.
KambourakisGMaglogiannisIRouskasA. PKI-based secure mobile access to electronic health services and data. Technol Health Care. 2005; 13(6): 511-26. Epub 2005/12/13. PubMed PMID: 16340094.
38.
ZhouYAnckerJSUpadhyeMMcGeorgeNMGuarreraTKHegdeS, et al. The impact of interoperability of electronic health records on ambulatory physician practices: a discrete-event simulation study. Inform Prim Care. 2013; 21(1): 21-9. Epub 2013/01/01. doi: 10.14236/jhi.v21i1.36. PubMed PMID: 24629653.
39.
Committee on Patient Safety and Quality Improvement, Committee on Practice Management. Committee opinion no. 621: Patient safety and health information technology. Obstet Gynecol. 2015; 125(1): 282-3. Epub 2015/01/07. doi: 10.1097/01.AOG.0000459867.14114.7a. PubMed PMID: 25560146.
40.
JohnsonKBUnertlKMChenQLorenziNMNianHBaileyJ, et al. Health information exchange usage in emergency departments and clinics: the who, what, and why. J Am Med Inform Assoc. 2011; 18(5): 690-7. Epub 2011/08/19. doi: 10.1136/amiajnl-2011-000308. PubMed PMID: 21846788; PubMed Central PMCID: PMCPMC3168326.
